Background: Pulsed dye laser is the gold standard for treatment of port-wine stain birthmarks but multiple treatments are required and complete resolution is often not achieved. Posttreatment vessel recurrence is thought to be a factor that limits efficacy of PDL treatment of PWS. Imiquimod 5% cream is an immunomodulator with antiangiogenic effects. Objective: We sought to determine if application of imiquimod 5% cream after PDL improves treatment outcome. Methods: Healthy individuals with PWS were treated with PDL and then randomized to (...) apply posttreatment placebo or imiquimod 5% cream for 8 weeks. Chromameter measurements for 57 PWS sites were taken at baseline and compared with measurements taken 8 weeks posttreatment. The Δa and ΔE were measured to quantify treatment outcome. Results: Two patients developed minor skin irritation. Other adverse effects were not noted. Average a was 0.43 for PDL + placebo sites and 1.27 for PDL + imiquimod sites indicating a greater reduction in erythema with imiquimod. Average E was 2.59 for PDL + placebo and 4.08 for PDL + imiquimod, again indicating a greater color improvement with imiquimod. Limitations: Effects were evaluated after a single treatment and duration of effect is unknown. Conclusion: Combined selective photothermolysis and antiangiogenic therapy may enhance PWS treatment efficacy. © 2011 by the American Academy of Dermatology, Inc. (shrink)

ABSTRACT:Despite widespread attention to corruption and organizational change in the literature, to our knowledge, no research has attempted to understand the linkages between these two powerful organizational phenomena. Accordingly, we draw on major theories in ethics, sociology, and management to develop a theoretical framework for understanding how organizational change can sometimes generate corruption. We extend anomie theory and ethical climate theory to articulate the deinstitutionalization of the normative control system and argue that, through this deinstitutionalization, organizations have the potential to (...) become incubators for corruption. We qualify this process by proposing conditions more ripe for anomie and under which this deinstitutionalization is more likely to occur, propounding moderating relationships that influence organizational reconfiguration. Examples of turbulence in the contemporary business environment that can trigger change highlight our discussion. We conclude with managerial implications, offering means by which the deleterious effects of corruption may be arrested or controlled. (shrink)

When ethics committees are consulted about patients who have or need court-appointed guardians, they lack empirical evidence about several common issues, including the relationship between guardianship and prolonged, potentially medically unnecessary hospitalizations for patients. To provide information about this issue, we conducted quantitative and qualitative analyses using a retrospective cohort from Veterans Healthcare Administration. To examine the relationship between guardianship appointment and hospital length of stay, we first compared 116 persons hospitalized prior to guardianship appointment to a comparison group (n (...) = 348) 3:1 matched for age, diagnosis, date of admission, and comorbidity. We then compared 91 persons hospitalized in the year following guardianship appointment to a second matched comparison group (n = 273). Mean length of stay was 30.75 days (SD = 46.70) amongst those admitted prior to guardianship, which was higher than the comparison group (M = 7.74, SD = 9.71, F = 20.75, p. (shrink)

Cancer and its treatment pose challenges that affect not only patients but also their significant others, including intimate partners. Accumulating evidence suggests that couples’ ability to communicate effectively plays a major role in the psychological adjustment of both individuals and the quality of their relationship. Two key conceptual models have been proposed to account for how couple communication impacts psychological and relationship adjustment: the social-cognitive processing (SCP) model and the relationship intimacy (RI) model. These models posit different mechanisms and outcomes, (...) and thus have different implications for intervention. The purpose of this project is to test and compare the utility of these models using comprehensive and methodologically rigorous methods. Aims are: (1) to examine the overall fit of the SCP and RI models in explaining patient and partner psychological and relationship adjustment as they occur on a day-to-day basis and over the course of 1 year; (2) to examine the fit of the models for different subgroups (males vs. females, and patients vs. partners); and (3) to examine the utility of various methods of assessing communication by examining the degree to which baseline indices from different measurement strategies predict self-reported adjustment at 1-year follow up. The study employs a longitudinal, multi-method approach to examining communication processes including: standard self-report questionnaires assessing process and outcome variables collected quarterly over the course of 1 year; smartphone-based ecological momentary assessments to sample participant reports in real time; and laboratory-based couple conversations from which we derive observational measures of communicative behavior and affective expression, as well as vocal indices of emotional arousal. Participants are patients with stage II-IV breast, colon, rectal, or lung cancer and their spouses/partners, recruited from two NCI-designated comprehensive cancer centers. Results will be published in scientific journals, presented at scientific conferences, and conveyed to a larger audience through infographics and social media outlets. Findings will inform theory, measurement, and the design and implementation of efficacious interventions aimed at optimizing both patient and partner well-being. (shrink)

Ethical guidance for genomic research is increasingly sought and perceived to be necessary. Although there are pressing ethical issues in genomic research – concerning for example the recruitment of patients/participants; the process of taking consent; data sharing; and returning results to patients/participants – there is still limited useful guidance available for researchers/clinicians or for the research ethics committees who review such projects. This report outlines the ethical principles and guidance for genomic research co-produced with stakeholders during two workshops which took (...) place in the UK between November 2016 and May 2017. The stakeholders involved in these workshops included: healthcare professionals, genomic research teams, academics, patients, biobank managers, and representatives from the Health Research Authority, NHS Research Ethics Committees, patient support groups, pharmaceutical industry, and health policy think tanks. The co-produced principles and guidance are specifical... (shrink)

Background: Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. (...) Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges. (shrink)

Background Pediatric critical care physician attitudes about withdrawal of ventricular assist devices and extracorporeal membrane oxygenation in cases of medical futility are poorly defined. Our aim was to define current attitudes regarding the withdrawal of these devices. Methods IRB-approved, cross-sectional observational survey conducted among pediatric critical care attending physicians and fellow physicians in the United States between 2016 and 2017. Data was collected anonymously and statistically analyzed. Results A total of 158 physicians responded with 67% being attending physicians. Compared to (...) a VAD, a higher percentage had taken care of a patient on ECMO where the device was turned off because care was believed to be futile, including currently. Nearly all reported that it can be ethically permissible to withdraw support from a patient with a VAD and on ECMO, but varied opinions existed as to who should ultimately make this decision if the patient/their family disagrees. More respondents agreed that a patient/their family should agree to withdrawal of VAD or ECMO support prior to initiation if futility is later determined and that protocols should be created for VAD and ECMO withdrawal. Conclusion Most pediatric critical care physicians felt that it can be ethically permissible to withdraw VAD and ECMO support. Our study indicates that pediatric VAD and ECMO withdrawal protocols are desired, but further investigation is needed to determine how to best design protocols that would incorporate multiple stakeholders. (shrink)

The people and the value of their experience, by N. T. Pratt.--From kingship to democracy, by J. P. Harland.--Democracy at Athens, by G. M. Harper.--Athens and the Delian League, by B. D. Meritt.--Socialism at Sparta, by P. R. Coleman-Norton.--Tyranny, by M. Mac Laren.--Federal unions, by C. A. Robinson.--Alexander and the world state, by O. W. Reinmuth.--The Antigonids, by J. V. A. Fine.--Ptolemaic Egypt: a planned economy, by S. L. Wallace.--The Seleucids: the theory of monarchy, by G. Downey.--The political status of (...) the independent cities of Asia Minor in the Hellenistic period, by D. Magie.--The ideal states of Plato and Aristotle, by W. J. Oates.--Epilogue, by A. C. Johnson.--Bibliography (p. 225-233).--Index, by H. V. M. Dennis, III. (shrink)

Philosophy and the scientific revolution / Daniel Garber -- Old history and introductory teaching in early modern philosophy : a response to Daniel Garber / Lisa Downing -- Meaning and metaphysics / Susan Neiman -- Evil and wonder in early modern philosophy : a response to Susan Neiman / Mark Larrimore -- The forgetting of gender / Nancy Tuana -- The forgetting of gender and the new histories of philosophy : a response to Nancy Tuana / Eileen O’Neill -- The (...) idea of early modern philosophy / Knud Haakonssen -- Response to Knud Haakonssen / Jeffrey Edwards -- Arguments over obligation : teaching time and place in moral philosophy / Ian Hunter -- Response to Ian Hunter / T.J. Hochstrasser -- Teaching the history of moral philosophy / J.B. Schneewind -- Historicism, moral judgment, and the good life : a response to J.B. Schneewind / Jennifer A. Herdt -- Integrating history of philosophy with history of science after Kant / Michael Friedman -- Response to Michael Friedman / Juliet Floyd -- Thought versus history : reflections on a French problem / Denis Kambouchner -- Response to Denis Kambouchner / Bé́atrice Longuenesse -- Teaching the history of philosophy in 19th-century Germany / Ulrich Johannes Schneider -- Response to Ulrich Johannes Schneider / Karl Ameriks -- Comment : philosophy in practice / Lorraine Daston -- A note from inside the teapot / Anthony Grafton -- Philosophy, history of philosophy, and L’histoire de l’esprit humain : a historiographical question and problem for philosophers / Jonathan Israel -- History and/or philosophy / Donald R. Kelly -- Historians look at the new histories of philosophy : roundtable discussion. (shrink)

In his philosophy of ethics and time, Emmanuel Levinas highlighted the tension that exists between the "ontological adventure" of immediate experience and the "ethical adventure" of redemptive relationships-associations in which absolute responsibility engenders a transcendence of being and self. In an original commingling of philosophy and cinema study, Sam B. Girgus applies Levinas's ethics to a variety of international films. His efforts point to a transnational pattern he terms the "cinema of redemption" that portrays the struggle to connect to others (...) in redeeming ways. Girgus not only reveals the power of these films to articulate the crisis between ontological identity and ethical subjectivity. He also locates time and ethics within the structure and content of film itself. Drawing on the work of Luce Irigaray, Tina Chanter, Kelly Oliver, and Ewa Ziarek, Girgus reconsiders Levinas and his relationship to film, engaging with a feminist focus on the sexualized female body. Girgus offers fresh readings of films from several decades and cultures, including Frank Capra's _Mr. Smith Goes to Washington_ (1939), Federico Fellini's _La dolce vita_ (1959), Michelangelo Antonioni's _L'avventura_ (1960), John Huston's _The Misfits_ (1961), and Philip Kaufman's _The Unbearable Lightness of Being_ (1988). (shrink)

ABSTRACT:Anomie is a condition in which normative guidelines for governing conduct are absent. Using survey data from a sample of U.S. manufacturing firms, we explore the impact of internal (cultural) and external (environmental) determinants of organizational anomie. We suggest that four internal organizational factors can generate or suppress organizational anomie, including strategic aggressiveness, long-term orientation, competitor orientation, and strategic flexibility. Similarly, we argue that external contextual factors, including competitive intensity and technological turbulence, can influence organizational anomie. We extend anomie and (...) ethics research by considering the impact of these firm cultural and environmental factors according to whether firms are publicly-traded or privately-held. Findings demonstrate that a number of firm cultural and environmental factors can generate or reduce anomie in firms. Moreover, strategic aggressiveness, long-term orientation, and strategic flexibility influence organizational anomie differently depending on whether the firm is publicly-traded or privately-held. Theoretical and practical implications of our findings are discussed. (shrink)

The Society of Jesus sprang from the devout faith of a sidelined soldier who traded in his weapons to form a militant order of Catholic Reformers sworn to serve the Papacy as missionary soldiers of Christ. Specialization in education led Jesuits to roles as theologians of the 16th Century, including as members of the School of Salamanca, whose Jesuit members mostly took pro-market positions on free enterprise. One learned Jesuit in particular deviated from his order’s default position of papal dirigisme (...) to become an enemy of the state. (shrink)

The papers in the 2010 “Clinical Ethics” number of the Journal of Medicine and Philosophy explore issues along La Frontera, the borders and boundaries of clinical ethics. The first three papers in this “Clinical Ethics” number of the Journal explore borders and boundaries drawn within clinical ethics, concerning the moral standing of complementary and alternative medicine, palliative sedation, and induced abortion and feticide. The fourth and fifth papers explore the borders and boundaries between research ethics and clinical ethics.

The present research examines whether the perceived uniqueness of one’s thoughts and salience of uniqueness motivations can influence attitude strength and resistance. Participants who rated their thoughts as relatively unique formed attitudes that showed greater correspondence with behavioral intentions to act on the attitude (Study 1). In Study 2, participants who recalled a previous purchase motivated by the desire to be unique (versus to fit in) after generating message counterarguments were less persuaded (more resistant) and reported greater willingness to act (...) on their (negative) attitude. Moreover, attitudes mediated the effect of the purchase manipulation on intentions to act on the attitude. (shrink)

We offer a critique of one prominent understanding of the principle of respect for autonomy and of analyses of medical paternalism based on that understanding. Our main critique is that understanding respect for autonomy as respect for freedom from interference is mistaken because it is overly influenced by four-alarm cases, because it fails to appreciate the full dimensions of legal self-determination (one of its main sources), because it conflates the research and therapeutic settings, and because it fails to appreciate themes (...) of authority and power that have historically shaped the principle of respect for freedom from interference. We argue that respect for autonomy involves more than just freedom from interference and, on this basis, offer a critique of prevailing accounts of medical paternalism. (shrink)

S'il est un point que les réflexions contemporaines sur le temps ont mis en relief et inscrit profondément dans notre conscience, c'est que l'avenir qu'on espère dépend directement du présent qu'on réalise. Telle est notre attitude en face du présent, telle elle sera inéluctablement en face de l'avenir; et donc l'avenir lui-même, puisque ce dernier n'est rien sinon un présent caché encore, au cœur d'un présent déjà actuel, et explicite. Il est en effet de l'essence même de notre condition humaine (...) d'avoir un présent structuré et comme stratifié. Certes on peut imaginer le présent comme un point sans épaisseur, comme la limite évanescente entre un segment de ligne qui marque le passé à jamais révolu, et l'avenir qui se meut vers nous pour basculer inexorablement vers le non-être en franchissant ce présent. Mais cette image, utile pour bien des tâches, ne correspond d'aucune manière à la réalité vivante de la conscience humaine et des activités qui lui sont propres. Nous sommes dans le présent ce que nous sommes et ce que, en un sens, nous croyons pouvoir dire que nous avons été. Une grande partie de ce que nous appelons le passé, notre passé personnel et sans doute notre passé spécifique, est présent, non seulement à titre de souvenir, pouvant être, ou non, évoqué, mais à titre de schéma dynamique modifiant notre être-au-monde, notre présente réaction au réel le plus réel, à la situation où nous avons à déployer notre activité. (shrink)

In recent years, W. H. Walsh and William Dray have introduced to methodological studies of history the term “colligation.” An historian who colligates explains, roughly, what an event ‘really’ was, or what it ‘amounts to’, by relating particular events into a single entity, by synthesizing parts into a whole. He thus explains many of the events of fifteenth-century Italy as a renaissance or those of eighteenth-century France as a revolution. The explanatory power of colligation is said to lie in the (...) newness of the interpretation of a collection of events which historians have previously ascertained to have occurred. (shrink)

Since the role of the Asian countries is increasing in the modern world, their philosophical traditions attract more and more attention. Due to this trend, a more complete panoramic view of the development of world philosophy as a whole is accessible, and it has become possible to understand that any constructions of the human mind that have arisen in a particular cultural field of experience cannot be regarded as exemplary and absolute. The researchers of Asian philosophies concentrate mostly on studying (...) the texts of individual thinkers. As a rule, they do not set themselves the task of examining these texts from the point of view of intercultural interactions and transformations of significant ideas and concepts in various cultural and historical contexts, defining the direction and mechanisms of cultural borrowing, as well as revealing new approaches and growth points. To achieve these goals, the research should focus at the problem of the self-determination and development of philosophy as a separate science in non-Western cultures, which are based on intellectual traditions with different origin than Greek and Judeo-Christian traditions. This article deals with the consideration of some topics that elucidate the features of the development of philosophical science in Japan, including the emergence of the concept of “philosophy” in this country, the definition of its subject, the formation of philosophical terminology, and various interpretations of what the term “Japanese philosophy” means. The author pays special attention to the characteristic of the main periods of progress of Japanese philosophical thought. In the conclusion, the author argues that the most important characteristic feature of the Japanese philosophy is its involvement in intercultural dialogue throughout its history. (shrink)

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The paper illustrates how organic chemists dramatically altered their practices in the middle part of the twentieth century through the adoption of analytical instrumentation - such as ultraviolet and infrared absorption spectroscopy and nuclear magnetic resonance spectroscopy - through which the difficult process of structure determination for small molecules became routine. Changes in practice were manifested in two ways: in the use of these instruments in the development of 'rule-based' theories; and in an increased focus on synthesis, at the expense (...) of chemical analysis. These rule-based theories took the form of generalizations relating structure to chemical and physical properties, as measured by instrumentation. This 'Instrumental Revolution' in organic chemistry was two-fold: encompassing an embrace of new tools that provided unprecedented access to structures, and a new way of thinking about molecules and their reactivity in terms of shape and structure. These practices suggest the possibility of a change in the ontological status of chemical structures, brought about by the regular use of instruments. The career of Robert Burns Woodward (1917-1979) provides the central historical examples for the paper. Woodward was an organic chemist at Harvard from 1937 until the time of his death. In 1965, he won the Nobel Prize in Chemistry. (shrink)