ObjectiveEfforts to understand why some marriages thrive while others falter are not well integrated conceptually and rely heavily on data collected from White middle-class samples. The Vulnerability-Stress-Adaptation Model is used here to integrate prior efforts and is tested using data collected from couples living with low incomes.BackgroundThe VSA Model assumes that enduring vulnerabilities, stress, and couple communication account for unique variance in relationship satisfaction, that communication mediates the effects of vulnerabilities and stress on satisfaction, and that the predictors of satisfaction (...) generalize across socioeconomic levels. To date, these assumptions remain untested.Materials and methodsWith 388 couples from diverse backgrounds, we used latent variable structural equation models to examine enduring vulnerabilities, chronic stress, and observed communication as predictors of 4-wave, 27-month satisfaction trajectories, first as main effects and then interacting with a validated 10-item index of sociodemographic risk.Results The three variable sets independently predict satisfaction trajectories; couple communication does not mediate the effects of enduring vulnerabilities or stress on satisfaction; and in 19% of tests, effects were stronger among couples with higher sociodemographic risk.ConclusionEffects of established predictor domains on satisfaction replicate in a diverse sample of newlywed couples, and most findings generalize across levels of sociodemographic risk. The failure of couple communication to mediate effects of enduring personal vulnerabilities and stress raises new questions about how these two domains undermine committed partnerships. (shrink)

Cultural competence, a clinical skill to recognise patients' cultural and religious beliefs, is an integral element in patient‐centred medical practice. In the area of death and dying, physicians' understanding of patients' and families' values is essential for the delivery of culturally appropriate care. Dementia is a neurodegenerative condition marked by the decline of cognitive functions. When the condition progresses and deteriorates, patients with advanced dementia often have eating and swallowing problems and are at high risk of developing malnutrition. Enteral tube (...) feeding is a conventional means of providing artificial nutrition and hydration to meet nutritional needs, but its benefits to the frail population are limitedly shown in the clinical evidence. Forgoing tube feeding is ethically challenging when patients are mentally incompetent and in the absence of an advance directive. Unlike some developed countries, like the United States of America, death and dying is a sensitive issue or even a taboo in some cultures in developing countries that forgoing enteral tube feeding is clinically and ethically challenging, such as China and Malaysia. This article in three parts 1) discusses the clinical and ethical issues related to forgoing tube feeding among patients with advanced dementia, 2) describes how Hong Kong Chinese, North American, and Malaysian Islamic cultures respond differently in the decision‐making patterns of forgoing tube feeding for patients with advanced dementia, and 3) reiterates the clinical implications of cultural competence in end‐of‐life care. (shrink)

Although tissue plasminogen activator (tPA) is the only medication approved by the United States Food and Drug Administration (FDA) for acute ischemic stroke, there is no consensus about the need for informed consent for its use. As a result, hospitals throughout the U.S. have varying requirements regarding obtaining informed consent from patients for the use of tPA, ranging from no requirement for informed consent to a requirement for verbal or written informed consent. We conducted a study to (1) determine current (...) beliefs about obtaining patients’ informed consent for tPA among a large group of stroke clinicians and (2) identify the ethical, clinical, and organizational factors that influence tPA consent practices. Semi-structured interviews were conducted by trained and experienced investigators and research staff to identify key barriers to implementing acute stroke services. Part of the interview explored current beliefs and practices around informed consent for tPA.This was a multicenter study that included 38 Veterans Health Administration (VHA) hospital locations. Participants were 68 stroke team clinicians, serving primarily on the neurology (35 percent) or emergency medicine (41 percent) service. We conducted thematic analysis based on principles of grounded theory to identify codes about consent for tPA. We used interpretive convergence to ensure consistency among the individual investigators’ codes and to ensure that all of the investigators agreed on coding and themes.We found that 38 percent of the stroke clinicians did not believe any form of consent was necessary for tPA, 47 percent thought that some form of consent was necessary, and 15 percent were unsure. Clinicians who believed tPA required informed consent were divided on whether consent should be written (40 percent) or verbal (60 percent). We identified three factors describing clinicians’ attitudes about consent: (1) legal and policy factors, (2) ethical factors, and (3) medical factors.The lack of consensus regarding consent for tPA creates the potential for delays in treatment, uneasiness among clinicians, and legal liability. The identified factors provide a potential framework to guide discussions about developing a standard of care for acquiring the informed consent of patients for the administration of tPA. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Ao mesmo tempo que a disciplinaridade continua e se reforça, assiste-se crescentemente a um movimento que, para simplificar, designamos de interdisciplinaridade. As interdisciplinaridades com os seus objectos científicos próprios e os anseios de uma ciência da totalidade assumem crescente importância. Uma relevância que frequentemente é mais simbólica do que epistemológica, mais discursiva do que metodológica, mais emblemática do que construtora. 'Interdisciplinaridade - Antologia' reúne um conjunto de textos de importantes autores contemporâneos que fizeram do tema da interdisciplinaridade objecto de estudo (...) privilegiado. A sua publicação tem como principal propósito contribuir para o esclarecimento teórico do conceito de interdisciplinaridade e conceitos afins visando o aprofundamento do seu significado, a compreensão do seu valor e limites e um mais profundo entendimento das dificuldades em presença. (shrink)

Ethical issues related the responsible conduct of research involve questions concerning the rights and obligations of investigators to propose, design, implement, and publish research. When a principal investigator transfers institutions during a grant cycle, financial and recognition issues need to be addressed to preserve all parties’ obligations and best interests in a mutually beneficial way. Although grants often transfer with the PI, sometimes they do not. Maintaining a grant at an institution after the PI leaves does not negate the grantee (...) institution’s obligation to recognize the PI’s original ideas, contributions, and potential rights to some forms of expression and compensation. Issues include maintaining a role for the PI in determining how to take credit for, share and publish results that involve his or her original ideas. Ascribing proper credit can become a thorny issue. This paper provides a framework for addressing situations and disagreements that may occur when a new PI continues the work after the original PI transfers. Included are suggestions for proactively developing institutional mechanisms that address such issues. Considerations include how to develop solutions that comply with the responsible conduct of research, equitably resolve claims regarding reporting of results, and avoid the possibility of plagiarism. (shrink)

Civility is often treated as an essential virtue in liberal democracies that promise to protect diversity as well as active disagreement in the public sphere. Yet the fear that our tolerant society faces a crisis of incivility is gaining ground. Politicians and public intellectuals call for "more civility" as the solution--but is civility really a virtue? Or is it something more sinister--a covert demand for conformity that silences dissent? Mere Civility sheds light on this tension in contemporary political theory and (...) practice by examining similar appeals to civility in early modern debates about religious toleration. In seventeenth-century England, figures as different as Roger Williams, Thomas Hobbes, and John Locke could agree that some restraint on the wars of words and "persecution of the tongue" between sectarians would be required; and yet, they recognized that the prosecution of incivility was often difficult to distinguish from persecution.--. (shrink)

The classical liberal doctrine of free expression asserts the priority of speech as an extension of the freedom of thought. Yet its critics argue that freedom of expression, itself, demands the suppression of the so-called “silencing speech” of racists, sexists, and so on, as a threat to the equal expressive rights of others. This essay argues that the claim to free expression must be distinguished from claims to equal speech. The former asserts an equal right to express one’s thoughts without (...) interference; the latter the right to address others, and to receive a hearing and consideration from them, in turn. I explore the theory of equal speech in light of the ancient Athenian practice of isegoria and argue that the equality demanded is not distributive but relational: an equal speaker’s voice should be counted as “on a par” with others. This ideal better captures critics’ concerns about silencing speech than do their appeals to free expression. Insofar as epistemic and status-harms provide grounds for the suppression and exclusion of some speech and speakers, the ideal of equal speech is more closely connected with the freedom of association than of thought. Noticing this draws attention to the continuing—and potentially problematic—importance of exclusion in constituting effective sites of equal speech today. (shrink)

Ever since Mary Astell was introduced as the “First English Feminist” in 1986, scholars have been perplexed by her dual commitments to natural equality and social, political, and ecclesiastical hierarchy. But any supposed “paradox” in her thought is the product of a modernist conceit that treats equality and hierarchy as antonyms, assuming the former must be prior, normative, and hostile to the latter. Seeing this, two other crucial features of Astell’s thought emerge: her ethics of ascent and her psychology of (...) superiority. These, in turn, illuminate her lifelong fascination with ambition as a feminine virtue, as well as her curious embrace of Machiavelli. Astell’s politics and ethics are thus doubly worthy of recovery, both as the product of a singularly brilliant early modern mind and as a fascinating but forgotten vision of “equality before egalitarianism” that sheds light on the persistent complexities of equality and hierarchy to this day. (shrink)

Ethical extensionism generally involves drawing one or more lines of moral standing. I argue for all living organisms, there is a non- zero probability of sentience and consciousness, and we cannot justify excluding beings from consideration on the basis of uncertainty of their sentience, etc., and rather we should incorporate this uncertainty into the strength of our moral responsibilities. This use of probabilities differs critically from multi-criteria theories of moral standing and those that assign benefit of the doubt, which involve (...) unjustified exclusions and dilutions of duties. From uncertainty rises certainty : we have duties to non-human organisms, although they may often be minor. This modification of extensionist ethics provides foundation for an environmental ethic that parallels interpersonal and animal welfare ethics, and it suggests that we owe much greater concern to 'lower' organisms than they are typically given. (shrink)

The purpose of this article has been to show what social sciences can contribute to advance in the knowledge and understanding of personal and social problems derived from suffering from rare vision diseases. It concludes that the incorporation of data in the National Patient Registries is an opportunity to encourage research into the problems existing in our social and cultural context, in the search for solutions that will lead to improvements in treatment, health care, psycho-social care, education, employment, etc. and (...) in the evaluation of results. In short, in the conditions and quality of life of patients and their families. (shrink)

In this article, I examine the meaning of the concept of ‘civility’ for Roger Williams and the role it played in his arguments for religious toleration. I place his concern with civility in the broader context of his life and works and show how it differed from the missionary and civilizing efforts of his fellow New English among the American Indians. For Williams, civility represented a standard of inclusion in the civil community that was ‘essentially distinct’ from Christianity, which properly (...) governed membership in the spiritual community of the church. In contrast to recent scholarship that finds in Williams a robust vision of mutual respect and recognition between co-citizens, I argue that civility constituted rather a very low bar of respectful behavior towards others entirely compatible with a lack of respect, disapproval, and even disgust for them and their beliefs. I show further that civility for Williams was consistent with—and partially secured by—a continued commitment on the part of godly citizens to the potential conversion of their neighbors. Williams endorsed this ‘mere’ civility as a necessary and sufficient condition for toleration while also delineating a potentially expansive role for the magistrate in regulating incivility. Contemporary readers of William who conflate civility with other good things, such as mutual respect, recognition, and civic friendship, slide into a position much like that he was trying to refute. (shrink)

The idea of treating robots as free agents seems only to have existed in the realm of science fiction. In our current world, however, children are interacting with robotic technologies that look, talk, and act like agents. Are children willing to treat such technologies as agents with thoughts, feelings, experiences, and even free will? In this paper, we explore whether children’s developing concepts of agency and free will apply to robots. We first review the literature on children’s agency and free-will (...) beliefs, particularly looking at their beliefs about volition, responding to constraints, and deliberation about different options for action. We then review an emerging body of research that investigates children’s beliefs about agency and free will in robots. We end by discussing the implications for developing beliefs about agency and free will in an increasingly technological world. (shrink)

The construction industry consistently ranks amongst the highest contributors to global gross domestic product, as well as, amongst the most corrupt. Corruption therefore inflicts significant risk on construction activities, and overall economic development. These facts are widely known, but the various sources and nature of corruption risks endemic to the Iranian construction industry, along with the degree to which such risks manifest, and the strength of their impact, remain undescribed. To address the gap, a mixed methods approach is used; with (...) a questionnaire, 103 responses were received, and these were followed up with semi-structured interviews. Results were processed using social network analysis. Four major corruption risks were identified: procedural violations in awarding contracts, misuse of contractual arrangements, neglect of project management principles, and, irrational decision making. While corruption risks in Iran align with those found in other countries, with funds being misappropriated for financial gain, Iran also shows a strong inclination to champion projects that serve the government’s political agenda. Root cause identification of corruption risks, namely, the noticeable impact of authoritarianism on project selection in Iran, over criterion of economic benefit or social good, is a significant outcome of this study. (shrink)

ABSTRACT This article argues that Thomas Hobbes' analysis of insult or ‘contumely’ prefigures recent developments in moral and political philosophy in striking ways. Specifically, Hobbes's concerns about the dignitary harms in hate speech went well beyond ‘fighting words’ to the essential role played by expressions of hatred and contempt in making and unmaking social hierarchies. Hobbes’s sensitivity to contumely’s subtle power to constitute social in/equalities recalls recent work in feminist and critical race theory. Yet his expansive solutions – both negative (...) and positive, legal and ethical – also shed light on the difficulties faced by aspirationally egalitarian societies in their efforts to eradicate contempt today. (shrink)

Bringing allegory into the light from the neglect into which it fell means focusing on the wondrous heights of the human spirit in its significance for culture. Contemporary philosophies and literary theories, which give pre-eminence to primary linguistics forms (symbol and metaphor), seem to favor just that which makes intelligible communication possible. But they fall short in accounting for the deepest subliminal founts that prompt the mind to exalt in beauty, virtue, transcending aspiration. The present, rich collection shows how allegory, (...) incorporating the soaring of the spirit, offers highlights for culture, with its fluctuations and transformation. This collective effort, rich in ideas and intuitions and covering a vast range of cultural manifestations, is a pioneering work, retrieving the vision of the exalted human spirit, bringing together literature, theatre, music and painting in a variety of revealing perspectives. The authors include: M. Kronegger, Ch. Raffini, J. Smith, J.B. Williamson, H. Ross, M.F. Wagner, F. Divorne, L. Oppenheim, D.K. Heckerl, N. Campi de Castro, P. Saurez Pascual, M. Alfaro Amieiro, H. Fletcher Thompson, R.J. Wilson III, and A. Stensaas. For specialists, students and workers in philosophy, comparative literature, aesthetic phenomenologists and historians of art. (shrink)

In her Introduction, Tymieniecka states the core theme of the present book sharply: Is culture an excess of nature's prodigious expansiveness - an excess which might turn out to be dangerous for nature itself if it goes too far - or is culture a 'natural', congenial prolongation of nature-life? If the latter, then culture is assimilated into nature and thus would lose its claim to autonomy: its criteria would be superseded by those of nature alone. Of course, nature and culture (...) may both still be seen as being absorbed by the inner powers of specifically human inwardness, on which view, human being, caught in its own transcendence, becomes separated radically in kind from the rest of existence and may not touch even the shadow of reality except through its own prism. Excess, therefore, or prolongation? And on what terms? The relationship between culture and nature in its technical phase demands a new elucidation. Here this is pursued by excavating the root significance of the 'multiple rationalities' of life. In contrast to Husserl, who differentiated living types according to their degree of participation in the world, the phenomenology of life disentangles living types from within the ontopoietic web of life itself. The human creative act reveals itself as the Great Divide of the Logos of Life - a divide that does not separate but harmonizes, thus dispelling both naturalistic and spiritualistic reductionism. (shrink)

El texto que presentamos recoge las principales conclusiones que han derivado de los estudios sobre la Colección de documentos árabes del Archivo Histórico Provincial de Granada. Compuesta principalmente por documentos de carácter jurídico, el análisis del contenido de cada uno de ellos en relación con la materialidad del soporte y las tintas así como la coincidencia en el diseño y planificación de la página revelan el uso de idénticos protocolos de ejecución. Esta investigación nos está permitiendo, además, establecer coincidencias relevantes (...) relacionadas con los procesos de elaboración del papel entre los últimos años de permanencia de los árabes en la Península Ibérica y los primeros tras la incorporación del territorio a la Corona de Castilla y, sobre todo, con el modo de ejecutar el documento de archivo en sus formas externa e interna. (shrink)

This article argues that Thomas Hobbes' analysis of insult or ‘contumely’ prefigures recent developments in moral and political philosophy in striking ways. Specifically, Hobbes's concerns about the dignitary harms in hate speech went well beyond ‘fighting words’ to the essential role played by expressions of hatred and contempt in making and unmaking social hierarchies. Hobbes’s sensitivity to contumely’s subtle power to constitute social in/equalities recalls recent work in feminist and critical race theory. Yet his expansive solutions – both negative and (...) positive, legal and ethical – also shed light on the difficulties faced by aspirationally egalitarian societies in their efforts to eradicate contempt today. (shrink)

When I was a little girl, I received the classic 1967 collection D’Aulaires’ Book of Greek Myths as a gift. The stories and illustrations remain etched in my me.

En Guedi, un oasis en la orilla occidental del Mar Muerto, es uno de los más importantes yacimientos del desierto de Judea. En el periodo romano—bizantino En Guedi fue famosa par sus excelentes dátiles y por sus plantaciones de bálsamo. En la última fase de su sinagoga hay una extraña inscripción, cuya interpretación ha ocupado el interés de muchos estudiosos. El presente artículo es un intento de aproximación al correcto significado de la inscripción de En Guedi con inclusión de los (...) últimos datos conocidos. (shrink)