Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient’s interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown that physicians (...) have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation. (shrink)

Background: Freezing of gait is a common symptom in Parkinson’s disease and can be difficult to treat with dopaminergic medications or with deep brain stimulation. Novel stimulation paradigms have been proposed to address suboptimal responses to conventional DBS programming methods. Burst-cycling deep brain stimulation delivers current in various frequencies of bursts, while maintaining an intra-burst frequency identical to conventional DBS.Objective: To evaluate the safety and tolerability of BCDBS in PD patients with FOG.Methods: Ten PD subjects with STN or GPi DBS (...) and complaints of FOG were recruited for this single center, single blinded within-subject crossover study. For each subject, we compared 4, 10, and 15 Hz BCDBS to conventional DBS during the PD medication-OFF state.Results: There were no serious adverse events with BCDBS. It was feasible and straightforward to program BCDBS in the clinic setting. The benefit was comparable to conventional DBS in measures of FOG, functional mobility and in PD motor symptoms. BCDBS had lower battery consumption when compared to conventional DBS.Conclusions: BCDBS was feasible, safe and well tolerated and it has potential to be a viable future DBS programming strategy. (shrink)

Good Science is an account of psychological research emphasizing the moral foundations of inquiry. This volume brings together existing disciplinary critiques of scientism, objectivism, and instrumentalism, and then discusses how these contribute to institutionalized privilege and to less morally responsive research practices. The author draws on historical, critical, feminist, and science studies traditions to provide an alternative account of psychological science and to highlight the irreducibly moral foundations of everyday scientific practice. This work outlines a theoretical framework for thinking about (...) and practicing psychology in ways that center moral responsibility, collective commitment, and justice. The book then applies this framework, describing psychological research practices in terms of the their moral dilemmas. Also included are materials meant to aid in methods instruction and mentoring. (shrink)

"I'll furnish the war" : the making of a media myth -- Fright beyond measure? : the myth of the war of the worlds -- Murrow vs. McCarthy : timing makes the myth -- TV viewers, radio listeners, and the myth of the first Kennedy-Nixon debate -- The Bay of Pigs-New York Times suppression myth -- Debunking the "Cronkite moment" -- The nuanced myth : bra burning at Atlantic City -- Picture power? : confronting the myths of the "napalm girl" (...) photograph -- It's all about the media : Watergate's heroic-journalist myth -- The "fantasy panic" : the news media and the "crack-baby" myth -- "She was fighting to the death" : mythmaking in Iraq -- Hurricane Katrina and the myth of superlative reporting -- Counterfeit quotations : swelling with a digital tide. (shrink)

Much more than just an anthology, this survey of humanity's search for the meaning of life includes the latest contributions to the debate, a judicious selection of key canonical essays, and insightful commentary by internationally respected philosophers. Cutting-edge viewpoint features the most recent contributions to the debate Extensive general introduction offers unprecedented context Leading contemporary philosophers provide insightful introductions to each section.

Even if the question, “What is the meaning of life?” is coherent, the fact remains that it is vague. Its vagueness largely centers on the use of the term “meaning.” The most prevalent strategy for addressing this vagueness is to discard the word “meaning” and reformulate the question entirely into questions such as, “What is the purpose of life?” or “What makes life valuable?” among others. This approach has philosophical merit but does not account for the intuitions and sub-questions driving (...) the original question as plausibly as does an interpretation that I call the narrative interpretation. I will argue that the question, “What is the meaning of life?” should be understood as the request for a narrative that narrates across those elements and accompanying questions of life of greatest existential import to human beings. (shrink)

In this entry, we survey key discussions on the role of narrative in theology and philosophy of religion. We begin with epistemological questions about whether and how narrative offers genuine understanding of reality. We explore how narrative intersects with the problems of evil and divine hiddenness. We discuss narrative's role in theological reflection and practice in general, and in black and feminist theologies specifically. We close by briefly exploring the role of narrative in theorization about life's meaning.

It is a common pessimistic worry among both philosophers and non-philosophers that our lives, viewed sub specie aeternitatis, are meaningless given that they make neither a noticeable nor lasting impact from this vast, cosmic perspective. The preferred solution for escaping this kind of pessimism is to adopt a different measure by which to evaluate life’s meaningfulness. One of two primary routes is often taken here. First, one can retreat back to the sub specie humanitatis perspective, and argue that life is (...) meaningful only when viewed within the local context of human values, cares, and concerns. Or, second, one can distinguish between perspectives and standards for meaningfulness, arguing that the latter are independent of the former and are the most appropriate means by which evaluations of life’s meaningfulness are made. Importantly, none of these issues can be sufficiently addressed without first answering a prior question, and one that is surprisingly under-addressed in the literature: What is the sub specie aeternitatis perspective? Unfortunately, many philosophers who employ this perspective do so without carefully defining or clarifying it, or, if they do clarify what it means, they only note its time and spatial components. I will argue that, in addition to these components, this perspective includes something like a modal component (following Thomas Nagel), and an ontological Normative component. I will then apply this more nuanced understanding of the sub specie aeternitatis perspective to the question of whether perspectives can be distinguished from standards for meaningfulness. (shrink)

Over the past decade, there has been a growing interest among analytic philosophers in life's meaning, but this surge of work is nearly all by naturalists theorizing from non-theistic starting points. To answer the need for a theistic philosophical perspective, God and Meaning features leading thinkers in analytic philosophy of religion and theology exploring important issues in metaphysics, epistemology, ethics, and biblical theology that intersect with life's meaning.

Reviews the book, Relational being: Beyond self and community by Kenneth J. Gergen . The primary plea of the book is that psychology consider a relational rather than individual conception of its phenomena. Gergen encourages us to "treat what we take to be the individual units as derivative of relational process" . This notion of a fundamentally relational subject is one that the reader is invited to explore and to test against other, more traditional, ways of constructing being. It is (...) a proposition entertained and evaluated in terms of its implications but it is not presented as the real, true, or most factual account of human experience. Throughout the text, Gergen attempts to replace the individual or monological expositional style with a more dialogical, plural kind of textual negotiation. The book is constantly questioning and coming to terms with itself, its critics, and its limitations. The book is, as Bakhtin might have it, multivocal. Gergen invokes his own authorial voice, but also his voice as an embedded, historical being. Each chapter is peppered with anecdotes and personal reflections woven into the overall narrative as concrete counterpoint to the abstractions of theoretical argument. In the process, Gergen is surprisingly intimate, personal, and generous with his private life and history. The book also becomes something more human, narrative, and funny than is usual in theoretical exegesis. This style is quite inviting, partly because it is rooted in everyday life but also because it explicitly invites, and even voices, the critic, the question, and the doubt. Ultimately, what is compelling in the pages of Relational Being is what is fundamentally compelling about relationalism itself—namely, the way that it displaces abstract system as the core of meaning and replaces it with embodied relation. This displacement has the potential to redress some of the essential distortions at the heart of Enlightenment reason—particularly that venerable tradition of riding one’s chosen theoretical hobby horse into the face of concrete, lived experience . Relational practice moves us away from the distortions that inevitably come when we make everything we encounter instrumental to some idea that we cherish . Relational practice asks us, instead, to continually return to the lived relation and so continually rupture and remake the narratives by which we understand it. 2012 APA, all rights reserved). (shrink)

In the past two decades, reinforcement learning has become a popular framework for understanding brain function. A key component of RL models, prediction error, has been associated with neural signals throughout the brain, including subcortical nuclei, primary sensory cortices, and prefrontal cortex. Depending on the location in which activity is observed, the functional interpretation of prediction error may change: Prediction errors may reflect a discrepancy in the anticipated and actual value of reward, a signal indicating the salience or novelty of (...) a stimulus, and many other interpretations. Anterior cingulate cortex has long been recognized as a region involved in processing behavioral error, and recent computational models of the region have expanded this interpretation to include a more general role for the region in predicting likely events, broadly construed, and signaling deviations between expected and observed events. Ongoing modeling work investigating the interaction between ACC and additional regions involved in cognitive control suggests an even broader role for cingulate in computing a hierarchically structured surprise signal critical for learning models of the environment. The result is a predictive coding model of the frontal lobes, suggesting that predictive coding may be a unifying computational principle across the neocortex. (shrink)

This study employed the Duquesne method of phenomenology to explore eight participants' experiences of not belonging. These experiences began with a discomforting sense of difference that then developed into self-conscious, wary behavior. This experience was followed by attempts at interpersonal transformation whose success led to an episodic view of not belonging and whose failure led to a more dramatic, personalized, isolating, and permanent view of not belonging. Such a view was also accompanied by a profound transformation in how the participants (...) experienced themselves, others, and their social environments. Among the most interesting findings in this research were the descriptions of isolated belonging—a pattern of relating involving many interpersonally distant relationships—and consistent, generalized not belonging—an experience where not belonging is the primary mode of interpersonal relation. (shrink)

"I'll furnish the war": the making of a media myth -- Fright beyond measure? the myth of the war of the worlds -- Murrow vs. McCarthy: timing makes the myth -- The Bay of Pigs/New York Times suppression myth -- Debunking the "Cronkite moment" -- The nuanced myth: bra burning at Atlantic City -- It's all about the media: Watergate's heroic-journalist myth -- The "fantasy panic": the news media and the crack-baby myth -- "She was fighting to the death": mythmaking (...) in Iraq -- Hurricane Katrina and the myth of superlative reporting -- Conclusion. (shrink)

Medical missions to provide cardiac surgical procedures in developing and technologically less advanced countries is a great challenge. It is also immensely gratifying, personally and professionally. Such missions typically present significant ethical dilemmas, especially making difficult choices, given limited time and resources, and the inability to help all children in need of cardiac surgery. We describe some of these issues from our perspective as visiting cardiologists.

This essay examines a dialogue between Kierkegaard and the Aristotelian tradition on the topic of love and friendship. At stake in the dispute is whetherphilia or agape is the highest form of love and how we should understand the relation between the two loves. The essay contributes to the conversation by analyzing two kinds of deceptive love identified in Kierkegaard’s Works of Love, viewing each through the lens of a Shakespearian persona. Against the Aristotelian tradition, Kierkegaard defends the idiosyncratic view (...) that Hamlet’s Ophelia is a villain and King Lear’s Cordelia is happy. Central to Kierkegaard’s argument is the contention that agape requires an epistemic attitude of charitable presumption towards one’s neighbor despite the possibility of error, an attitude found in Cordelia but not in Ophelia. The essay contrasts this Thomistic attitude with its Cartesian counterpart as well as their consequences for moral and religious life. (shrink)

In this paper, I pursue a dialogue between John Dryzek and Robert E. Goodin’s positions on deliberative democracy’s ‘problem of economy’ with an eye toward a synthesis that could lead us toward a conception of deliberation that counters the threat to legitimacy posed by this problem. By sketching a view that makes the two accounts more consonant by casting discourses as intersubjectively constituted, with deliberation as the contestation of intersubjectively constituted discourses in the public sphere, we ought to be able (...) to describe democratic legitimacy as being linked to the epistemic quality of deliberation while not succumbing to the problem of economy. This would thereby maintain deliberative democracy’s critical edge and feasibility and legitimize the deliberative democratic model as a standpoint to critically evaluate social relations and collective decisions, such that our politics can be rendered more just. (shrink)

In this paper, I pursue a dialogue between John Dryzek and Robert E. Goodin’s positions on deliberative democracy’s ‘problem of economy’ with an eye toward a synthesis that could lead us toward a conception of deliberation that counters the threat to legitimacy posed by this problem. By sketching a view that makes the two accounts more consonant by casting discourses as intersubjectively constituted, with deliberation as the contestation of intersubjectively constituted discourses in the public sphere, we ought to be able (...) to describe democratic legitimacy as being linked to the epistemic quality of deliberation while not succumbing to the problem of economy. This would thereby maintain deliberative democracy’s critical edge and feasibility and legitimize the deliberative democratic model as a standpoint to critically evaluate social relations and collective decisions, such that our politics can be rendered more just. (shrink)

The medial prefrontal cortex (mPFC) has been the subject of intense interest as a locus of cognitive control. Several computational models have been proposed to account for a range of effects, including error detection, conflict monitoring, error likelihood prediction, and numerous other effects observed with single-unit neurophysiology, fMRI, and lesion studies. Here, we review the state of computational models of cognitive control and offer a new theoretical synthesis of the mPFC as signaling response–outcome predictions. This new synthesis has two interacting (...) components. The first component learns to predict the various possible outcomes of a planned action, and the second component detects discrepancies between the actual and intended responses; the detected discrepancies in turn update the outcome predictions. This single construct is consistent with a wide array of performance monitoring effects in mPFC and suggests a unifying account of the cognitive role of medial PFC in performance monitoring. (shrink)

Background: In prevalence studies of sexually transmitted infections (STIs), investigators often provide syndromic management for symptomatic participants, but may not provide specific treatment for asymptomatic individuals with positive laboratory test results due to the delays between sample collection and availability of results as well as logistical constraints in recontacting study participants. Methods: To characterize the extent of this issue, 80 prevalence studies from the World Health Organization’s Report on global sexually transmitted infection surveillance, 2018, were reviewed. Studies were classified as (...) to whether clinically relevant positive results were returned or if this was not specified. Results: More than half (56%) of the cited studies did not specify if participants were notified of clinically relevant positive STI test results. The percentages were similar for low- and middle-income country populations (57%) and high-income country populations (53%). Conclusions: The absence of documentation of the provision of test results raises the possibility that in some instances, results may not have been communicated, with potential negative effects for participants, their sexual partners, and newborns. From an ethical perspective, clinically relevant results should be returned to study participants and treating clinicians in a timely fashion to ensure appropriate management of identified infections. Study authors should document if they returned test results to study participants and report on numbers lost to follow-up. (shrink)