Social and structural inequities shape health and illness; they are an everyday presence within the doctor-patient encounter yet, there is limited ethical guidance on what individual physicians should do. This paper draws on a study that explored how doctors and their professional associations ought to respond to the issue of social health inequities.

BackgroundAwareness of aging brings to light one’s own perceived behavioral, physical, and cognitive changes associated with getting older. Personality and physical illness are each related to two components of awareness of aging: attitudes toward own aging, and awareness of age-related changes. Here, we move beyond main effects to examine how personality and arthritis interact with respect to awareness of aging.Materials and Methods296 participants completed online self-report questionnaires of personality, arthritis, ATOA, and AARC gains and losses.ResultsWe ran three hierarchical multiple regression (...) models to test how personality traits and arthritis interacted to predict ATOA, AARC gains, and AARC losses, respectively. Higher extraversion was related to positive ATOA, and higher openness was related to positive ATOA and more AARC gains. Higher neuroticism was related to negative ATOA, more AARC losses, and less AARC gains. We found a main effect for arthritis, where those with arthritis reported more AARC losses. Lastly, we found a significant interaction between arthritis and agreeableness when predicting AARC gains. Among those with low agreeableness, people with arthritis reported significantly more AARC gains compared to those without arthritis.ConclusionPersonality and arthritis are each important for awareness of aging. Overall, our study suggests that for those with arthritis, it is especially important to consider behavioral and cognitive factors related to agreeableness, as they may be important means of promoting positive views on aging. (shrink)

This thought-provoking book initiates a dialogue among scholars in rhetoric and hermeneutics in many areas of the humanities. Twenty leading thinkers explore the ways these two powerful disciplines inform each other and influence a wide variety of intellectual fields. Walter Jost and Michael J. Hyde organize pivotal topics in rhetoric and hermeneutics with originality and coherence, dividing their book into four sections: Locating the Disciplines; Inventions and Applications; Arguments and Narratives; and Civic Discourse and Critical Theory. Contributors to this volume (...) include Hans-Georg Gadamer, Paul Ricoeur, Gerald L. Bruns, Charles Altieri, Richard E. Palmer, Calvin O. Schrag,.Victoria Kahn, Eugene Garver, Michael Leff, Nancy S. Streuver, Wendy Olmsted, David Tracy, Donald G. Marshall, Allen Scult, Rita Copeland, William Rehg, and Steven Mailloux. For readers across the humanities, the book demonstrates the usefulness of rhetorical and hermeneutic approaches in literary, philosophical, legal, religious, and political thinking. With its stimulating new perspectives on the revival and interrelation of both rhetoric and hermeneutics, this collection is sure to serve as a benchmark for years to come. (shrink)

In their article, “The Rise of Citizen Science in Health and Biomedical Research,” Wiggins and Wilbanks (2019) discuss the rising role of a variety of traditional and newer citizen science models i...

Meaningful relationships are centrally important for human functioning. It remains unclear, however, which aspects of meaningful relationships impact wellbeing the most and whether these differ between psychiatric patients and members of the community. Information about relationship attributes and functions were collected in community members and psychiatric patients. Relationship attributes and functions were examined for differences between groups, their impact on wellbeing and symptoms, and the size of network. Community members reported fewer relationships, higher frequency of contact and less desire for (...) change when compared to the psychiatric patients. Nevertheless, both groups reported relatively high levels of fulfilled functions. Quality of the relationship and investment into the relationship was associated with both wellbeing and symptoms for both the community and the patient group. Almost all functions were associated with wellbeing and symptoms for the community group. However, for the patient group, only few functions were associated with wellbeing and no functions were associated with symptoms. Contrary to our hypotheses, the results show that psychiatric patients do not have a deficit in fulfilling relationships. Most people report a well-functioning network of meaningful, high-quality relationships. Patients benefit from meaningful, function-fulfilling relationships just as much as community members. Results are discussed with respect to how targeting relationships can be used clinically. (shrink)

The highly homologous Rac1 and Rac2 GTPases are co‐expressed in cells of haematopoietic origin and are likely to show some functional redundancy. While disruption of the Rac2 gene in mice has provided insight into some of its functions, Rac1 null mice are embryonic lethal and only recently has conditional gene disruption been possible. Consequently, two articles1,2 have recently elucidated some overlapping and unique key roles of Rac1 and Rac2 in haematopoietic processes including specialized roles in innate and humoral immunity. BioEssays (...) 26:221–224, 2004. © 2004 Wiley Periodicals, Inc. (shrink)

Gleason-type theorems derive the density operator and the Born rule formalism of quantum theory from the measurement postulate, by considering additive functions which assign probabilities to measurement outcomes. Additivity is also the defining property of solutions to Cauchy’s functional equation. This observation suggests an alternative proof of the strongest known Gleason-type theorem, based on techniques used to solve functional equations.

Two eleven-year-old boys face a bulletin board, arranging silver thumbtacks into shapes of fighter planes. They have arrived early for an after-school puppet workshop. Both boys are under five feet tall: the thin one sports a green terrycloth wristband and a big fro. “The girls like the poof,” he says. The other boy has a fuller body, a haircut similar to the Fab Four in the late sixties, and wears wide-leg jeans and a red t-shirt that brushes his kneecaps. The (...) boys talk while puncturing the corkboard with tacks. I like this game. It’s Star Miner. There’s this thing. It’s a ship that looks like this. The other ships are too detailed. You try and blow up a jet thingy, it spirals and can catch on .. (shrink)

The authors would like to make the corrections to the original article described below.

POHLMAN S, CIBULKA NJ, PALMER JL, LORENZ RA and SMITHBATTLE L. Nursing Inquiry 2013; 20: 71–81 The placebo puzzle: examining the discordant space between biomedical science and illness/healingThe placebo response presents an enigma to biomedical science: how can ‘inert’ or ‘sham’ procedures reduce symptoms and produce physiological changes that are comparable to prescribed treatments? In this study, we examine this puzzle by explicating the discordant space between the prevailing biomedical paradigm, which focuses on a technical understanding of diagnosis and (...) treatment, and a broader understanding of illness and healing as relational and embodied. Although biomedical achievements are impressive, the knowledge resulting from this paradigm is limited by its ontological and epistemological assumptions. When the body and world are objectified, illness meanings, therapeutic relationships, and healing practices are dismissed or distorted. In spite of a robust critique of the tenets of biomedicine for guiding practice, the biomedical paradigm retains a tenacious hold on evidence-based medicine and nursing, downplaying our clinical understanding of the sentient body, patients’ life-worlds, and illness and healing. In reality, skilled nurses rely on multiple forms of knowledge in providing high-quality care to particular patients. Clinically wise nurses integrate their experience and knowledge of patients’ priorities, fears, and illness trajectories along with biomedical findings to make astute judgments and promote health and healing. (shrink)

Over the last decade, empirical research on compassion has burgeoned in the biomedical, clinical, translational, and foundational sciences. Increasingly sophisticated understandings and measures of compassion continue to emerge from the abundance of multi- and cross-disciplinary studies. Naturally, the diversity of research methods and theoretical frameworks employed presents a significant challenge to consensus and synthesis of this knowledge. To bring the empirical findings of separate and sometimes siloed disciplines into conversation with one another requires an examination of their disparate assumptions about (...) what compassion is and how it can be known. Here, we present an integrated theoretical review of methodologies used in the empirical study of compassion. Our goal is to highlight the distinguishing features of each of these ways of knowing compassion, as well as the strengths and limitations of applying them to specific research questions. We hope this will provide useful tools for selecting methods that are tailored to explicit objectives (methods matching), taking advantage of methodological complementarity across disciplines (methods-mixing), and incorporating the empirical study of compassion into fields in which it may be missing. (shrink)

Public and government outrage over recent tax fraud and tax shelter cases led to significant changes in the preparer penalty laws under the Small Business Work Opportunity Act of 2007. This study experimentally examines the effectiveness of the revised preparer penalty provisions at reducing tax preparer aggressiveness. Specifically, we examine the impact of two significant components of the changes to the preparer penalty provisions - the increase in penalty amount and the increase in the likelihood of sustaining the tax position (...) required to avoid penalty imposition (required likelihood threshold) - on tax preparers’ willingness to (1) recommend an uncertain position and (2) sign a tax return containing an aggressive position. The results suggest that both the increase in penalty amount and the increase in required likelihood threshold reduce tax preparers’ willingness to recommend an uncertain position and/or sign a tax return containing an aggressive position. Of the two components, the results indicate that the increase in required likelihood threshold is more effective at reducing tax preparer aggressiveness than the increase in penalty amount. Congress may want to rethink its recent decision to reduce the required likelihood threshold for many of the decisions that tax preparers make with their clients. (shrink)

Over the last decade, numerous interventions and techniques that aim to engender, strengthen, and expand compassion have been created, proliferating an evidence base for the benefits of compassion meditation training. However, to date, little research has been conducted to examine individual variation in the learning, beliefs, practices, and subjective experiences of compassion meditation. This mixed-method study examines changes in novice meditators’ knowledge and contemplative experiences before, during, and after taking an intensive course in CBCT®, a contemplative intervention that is increasingly (...) used for both inter- and intrapersonal flourishing. The participants in this study were Christian healthcare chaplains completing a 1-year residency in Clinical Pastoral Education who learned CBCT as part of their professional chaplaincy training curriculum. Prior to and upon completion of training, we surveyed participants to assess their beliefs about the malleability of compassion, types of engagement in compassion meditation, and perceptions of the impact of taking CBCT. We also conducted in-depth interviews with a subset of participants to gain a qualitative understanding of their subjective experiences of learning and practicing compassion meditation, a key component of CBCT. We found that participants reported increases in the extent to which they believed compassion to be malleable after studying CBCT. We also found high levels of variability of individual ways of practicing and considered the implications of this for the study of contemplative learning processes. This multi-methodological approach yielded novel insights into how compassion practice and compassion-related outcomes interrelate, insights that can inform the basic scientific understanding of the experience of learning and enacting compassion meditation as a means of strengthening compassion itself. (shrink)

Medical decision making when a patient cannot participate is complicated by the question of whose voice should be heard. The most common answer to this question is that “autonomy” is paramount, and therefore it is the voice of the unwell person that should be given priority. Advance care planning processes and practices seek to capture this sentiment and to allow treatment preferences to be documented and decision makers to be nominated. Despite good intentions, advance care planning is often deficient because (...) it is unable to facilitate a relational approach to decision making in cases when the patient’s competence is reduced. In this article we present findings from a study of the ways in which older people and their significant others understand decision making in such circumstances. Critical to the participants’ understanding was the emergent concept of “relational knowing,” a concept that is poorly articulated in the advance care planning literature. Our findings suggest that the dominant understanding of decision making in conditions of impaired competence is incomplete and obscures much of what matters to people. We conclude that, having recognized a broader set of ethical concerns, it is necessary to develop a relational and narrative based approach that applies in appropriate settings. (shrink)

This collection gathers classic, influential, and important papers in environmental philosophy ranging from the late 1960s and early 1970s to the present. The volumes explore environmental ethics, epistemological, metaphysical, and comparative worldview questions raised by environmental concerns. The set also represents a genuinely global and international focus, and includes a full index and new introductions by the editors.

The class forcing theorem, which asserts that every class forcing notion ${\mathbb {P}}$ admits a forcing relation $\Vdash _{\mathbb {P}}$, that is, a relation satisfying the forcing relation recursion—it follows that statements true in the corresponding forcing extensions are forced and forced statements are true—is equivalent over Gödel–Bernays set theory $\text {GBC}$ to the principle of elementary transfinite recursion $\text {ETR}_{\text {Ord}}$ for class recursions of length $\text {Ord}$. It is also equivalent to the existence of truth predicates for the (...) infinitary languages $\mathcal {L}_{\text {Ord},\omega }$, allowing any class parameter A; to the existence of truth predicates for the language $\mathcal {L}_{\text {Ord},\text {Ord}}$ ; to the existence of $\text {Ord}$ -iterated truth predicates for first-order set theory $\mathcal {L}_{\omega,\omega }$ ; to the assertion that every separative class partial order ${\mathbb {P}}$ has a set-complete class Boolean completion; to a class-join separation principle; and to the principle of determinacy for clopen class games of rank at most $\text {Ord}+1$. Unlike set forcing, if every class forcing notion ${\mathbb {P}}$ has a forcing relation merely for atomic formulas, then every such ${\mathbb {P}}$ has a uniform forcing relation applicable simultaneously to all formulas. Our results situate the class forcing theorem in the rich hierarchy of theories between $\text {GBC}$ and Kelley–Morse set theory $\text {KM}$. (shrink)

The language of “participant-driven research,” “crowdsourcing” and “citizen science” is increasingly being used to encourage the public to become involved in research ventures as both subjects and scientists. Originally, these labels were invoked by volunteer research efforts propelled by amateurs outside of traditional research institutions and aimed at appealing to those looking for more “democratic,” “patient-centric,” or “lay” alternatives to the professional science establishment. As mainstream translational biomedical research requires increasingly larger participant pools, however, corporate, academic and governmental research programs (...) are embracing this populist rhetoric to encourage wider public participation. We examine the ethical and social implications of this recruitment strategy. We begin by surveying examples of “citizen science” outside of biomedicine, as paradigmatic of the aspirations this democratizing rhetoric was originally meant to embody. Next, we discuss the ways these aspirations become articulated in the biomedical context, with a view to drawing out the multiple and potentially conflicting meanings of “public engagement” when citizens are also the subjects of the science. We then illustrate two uses of public engagement rhetoric to gain public support for national biomedical research efforts: its post-hoc use in the “care.data” project of the National Health Service in England, and its proactive uses in the “Precision Medicine Initiative” of the United States White House. These examples will serve as the basis for a normative analysis, discussing the potential ethical and social ramifications of this rhetoric. We pay particular attention to the implications of government strategies that cultivate the idea that members of the public have a civic duty to participate in government-sponsored research initiatives. We argue that such initiatives should draw from policy frameworks that support normative analysis of the role of citizenry. And, we conclude it is imperative to make visible and clear the full spectrum of meanings of “citizen science,” the contexts in which it is used, and its demands with respect to participation, engagement, and governance. (shrink)

Healthcare priority-setting institutions have good reason to want to demonstrate that their decisions are morally justified—and those who contribute to and use the health service have good reason to hope for the same. However, finding a moral basis on which to evaluate healthcare priority-setting is difficult. Substantive approaches are vulnerable to reasonable disagreement about the appropriate grounds for allocating resources, while procedural approaches may be indeterminate and insufficient to ensure a just distribution. In this paper, we set out a complementary, (...) coherence-based approach to the evaluation of healthcare priority-setting. Drawing on Rawls, we argue that an institutional priority-setter’s claim to moral justification can be assessed, in part, based on the extent to which its many normative commitments are mutually supportive and free from dissonance; that is, on the ability to establish narrow reflective equilibrium across the normative content of a priority-setter’s policy and practice. While we do not suggest that the establishment of such equilibrium is sufficient for moral justification, we argue that failure to do so might—like the proverbial canary in the coalmine—act as a generalised warning that something is awry. We offer a theoretical argument in support of this view and briefly outline a practical method for systematically examining coherence across priority-setting policy and practice. (shrink)

The devotion of a full article in the Paris Agreement to loss and damage was a major breakthrough for the world’s most vulnerable nations seeing to gain support for climate impacts beyond what can be adapted to. But how will loss and damage be paid for, and who will pay it? Will ethics be part of this decision? Here we ask what are the possible means of raising predictable and adequate levels of funding to address loss and damage? Utilizing a (...) framework developed by Marco Grasso, we argue that making the ethical connections between addressing climate impacts and finance mechanisms could significantly enhance their likelihood of being adopted. We briefly review insurance mechanisms and catastrophe bonds, and then move on to six “innovative finance” approaches to funding loss and damage. We utilize six criteria in assessing them: adequacy, predictability, technical feasibility, fairness, and indirect effects, and whether each has a clear link to loss and damage. Several mechanisms for gathering funds emerged as most promising. Three of the six financial mechanisms we reviewed to raise funding involved airline transport: clearly, there is a huge opportunity to tax this sector in one form or another, in recognition of airline emissions’ role in creating losses and damages in vulnerable nations from sea level rise, droughts, floods or hurricanes. Funding loss and damage response is a contentious issue that will get only more unwieldy if Parties’ conceptions of loss and damage are at odds: a common definition of loss and damage needs to be agreed upon under the UNFCCC. Most immediately, to meet any equity criteria, wealthy countries should do more to support the premiums of those who cannot afford insurance. (shrink)

Salespeople have long been considered unique employees. They tend to work apart from each other and experience little daily contact with supervisors and other organizational employees. Additionally, salespeople interact with customers in an increasingly complex and multifunctional environment. This provides numerous opportunities for unethical behavior which has been chronicled in the popular press as well as academic research. Much of the research in sales ethics has relied on conceptual foundations which focus on individual and organizational influencers on ethical decision making. (...) While significant, contributors to this research suggest that alternative theoretical perspectives and methods of investigation should be utilized and call for more research on the status of professional selling as a whole. We answer this call by exploring an alternative and complementary perspective based on the theory of occupational choice, social learning, and work groups to gain insight on how the sales profession evolves as its own subculture that extends beyond individual and organizational boundaries. First, we discuss the characteristics of the sales profession and empirically examine the relationship between typical individual and organizational factors and sales professionals’ perceptions of ethical behavior. Second, we offer a theoretical explanation that our findings may be due to how salespeople choose and are socialized into the subculture of the sales profession. Third, we examine this theoretical perspective via qualitative in-depth interviews with experienced sales professionals. Results and implications are discussed in terms of a sales profession code of ethics and future research directions. (shrink)

The structure of Au layers deposited by sputtering on oxidized p-type Si substrates is investigated by a combination of scanning electron microscopy and scanning probe microscopy. The effect of the temperature on the grain structure of the layers has been determined, revealing that an annealing temperature of 300° C results in a larger grain size and smoother surfaces but generates some cracks in the film surface. At an annealing temperature of 500° C, further grain growth is observed, but a high (...) density of cracks and voids also results while there is little enhancement regarding the smoothness of the grain surfaces. (shrink)

As in other countries, the traditional doctor-patient relationship in the Japanese healthcare system has often been characterised as being of a paternalistic nature. However, in recent years there has been a gradual shift towards a more participatory-patient model in Japan. With advances in technology, the possibility to use digital technologies to improve patient interactions is growing and is in line with changing attitudes in the medical profession and society within Japan and elsewhere. The implementation of an online patient engagement platform (...) is being considered by the Myotonic Dystrophy Registry of Japan. The aim of this exploratory study was to understand patients’ views and attitudes to using digital tools in patient registries and engagement with medical research in Japan, prior to implementation of the digital platform. We conducted an exploratory, cross-sectional, self-completed questionnaire with a sample of myotonic dystrophy patients attending an Open Day at Osaka University, Japan. Patients were eligible for inclusion if they were 18 years or older, and were diagnosed with MD. A total of 68 patients and family members attended the Open Day and were invited to participate in the survey. Of those, 59 % submitted a completed questionnaire. The survey showed that the majority of patients felt that they were not receiving the information they wanted from their clinicians, which included recent medical research findings and opportunities to participate in clinical trials, and 88 % of patients indicated they would be willing to engage with digital technologies to receive relevant medical information. Patients also expressed an interest in having control over when and how they received this information, as well as being informed of how their data is used and shared with other researchers. Overall, the findings from this study suggest that there is scope to develop a digital platform to engage with patients so that they can receive information about medical care and research opportunities. While this study group is a small, self-selecting population, who suffer from a particular condition, the results suggest that there are interested populations within Japan that would appreciate enhanced communication and interaction with healthcare teams. (shrink)

The language of “participant-driven research,” “crowdsourcing” and “citizen science” is increasingly being used to encourage the public to become involved in research ventures as both subjects and scientists....

The objective of this paper is to explore the problem of human sacrifice in Euripides’ tragedy Iphigenia among the Taurians. Although the archaeological surveys indicate that this type of sacrifices was not practiced in archaic and classical Greece, we find them repeatedly in Greek literature, in general, and more especially in the tragic genre, of which this work is a finished example. In this sense, we will focus our study on the role of allusions and references to human sacrifice in (...) the tragedy, especially within the prologue, since we understand that it constitutes a central issue to the plot, as not only it relates to Iphigenia's past but also conforms a constant threat to the other characters. (shrink)

Advance care directives for health care have been promoted as a way to improve end-of-life decision making. These documents allow a patient to state, in advance of incapacity, the types of medical treatments they would like to receive, to name a surrogate to make those decisions, or to do both. Although studies have shown that both physicians and patients generally have positive attitudes about the use of these documents, relatively few individuals have actually completed one.What underlies this discrepancy between attitudes (...) and behavior with regard to advance care directives? One obvious explanation is lack of access. Emanuel et al. estimated that approximately 90 percent of the population desire an advance care directive, and they pointed to access as the major barrier. Yet interventions that increase accessibility have typically failed to yield more than a 20 percent completion rate. Thus, it appears that access is not the sole determinant of advance care directive completion. (shrink)

Investigation of neural and cognitive processes underlying individual variation in moral preferences is underway, with notable similarities emerging between moral- and risk-based decision-making. Here we specifically assessed moral distributive justice preferences and non-moral financial gambling preferences in the same individuals, and report an association between these seemingly disparate forms of decision-making. Moreover, we find this association between distributive justice and risky decision-making exists primarily when the latter is assessed with the Iowa Gambling Task. These findings are consistent with neuroimaging studies (...) of brain function during moral and risky decision-making. This research also constitutes the first replication of a novel experimental measure of distributive justice decision-making, for which individual variation in performance was found. Further examination of decision-making processes across different contexts may lead to an improved understanding of the factors affecting moral behaviour. (shrink)

A call to advance integrative teaching and learning in higher education. From Parker Palmer, best-selling author of The Courage to Teach, and Arthur Zajonc, professor of physics at Amherst College and director of the academic program of the Center for Contemplative Mind in Society, comes this call to revisit the roots and reclaim the vision of higher education. The Heart of Higher Education proposes an approach to teaching and learning that honors the whole human being--mind, heart, and spirit--an essential (...) integration if we hope to address the complex issues of our time. The book offers a rich interplay of analysis, theory, and proposals for action from two educators and writers who have contributed to developing the field of integrative education over the past few decades. Presents Parker Palmer's powerful response to critics of holistic learning and Arthur Zajonc's elucidation of the relationship between science, the humanities, and the contemplative traditions. Explores ways to take steps toward making colleges and universities places that awaken the deepest potential in students, faculty, and staff. Offers a practical approach to fostering renewal in higher education through collegiality and conversation. The Heart of Higher Education is for all who are new to the field of holistic education, all who want to deepen their understanding of its challenges, and all who want to practice and promote this vital approach to teaching and learning on their campuses. (shrink)