We hypothesize that black women experience accelerated biological aging in response to repeated or prolonged adaptation to subjective and objective stressors. Drawing on stress physiology and ethnographic, social science, and public health literature, we lay out the rationale for this hypothesis. We also perform a first population-based test of its plausibility, focusing on telomere length, a biomeasure of aging that may be shortened by stressors. Analyzing data from the Study of Women’s Health Across the Nation (SWAN), we estimate that at (...) ages 49–55, black women are 7.5 years biologically “older” than white women. Indicators of perceived stress and poverty account for 27% of this difference. Data limitations preclude assessing objective stressors and also result in imprecise estimates, limiting our ability to draw firm inferences. Further investigation of black-white differences in telomere length using large-population-based samples of broad age range and with detailed measures of environmental stressors is merited. (shrink)

We are printing in its entirety the discussion document which sets out a code of professional conduct for nurses published by the Royal College of Nursing in November 1976 together with commentaries by the Assistant Secretary of the British Medical Association, a professor of nursing studies, student nurses and a lawyer. The image of the nurse is still that of one of Florence Nightingale's young ladies or of a member of a religious order who is wholly dedicated to caring for (...) the sick. Today, as this document and the comments upon it show, 'dedication' is still part of the motive which leads a man or woman to become a nurse but in addition, and this is where the public may be ignorant or choose to be ignorant, nursing offers a career where intellectual achievement and the satisfaction of a demanding job bring their proper financial reward and place in the professional community. We are grateful to the Royal College of Nursing for permission to publish this document. (shrink)

BackgroundThe COVID-19 pandemic has had a significant impact on the health system worldwide. The organ and tissue donation and transplantation (OTDT) system is no exception and has had to face ethical challenges related to the pandemic, such as risks of infection and resource allocation. In this setting, many Canadian transplant programs halted their activities during the first wave of the pandemic.MethodTo inform future ethical guidelines related to the COVID-19 pandemic or other public health emergencies of international concern, we conducted a (...) literature review to summarize the ethical issues.ResultsThis literature review identified three categories of ethical challenges. The first one describes the general ethical issues and challenges reported by OTDT organizations and transplantation programs, such as risks of COVID-19 transmission and infection to transplant recipients and healthcare professionals during the transplant process, risk of patient waitlist mortality or further resource strain where transplant procedures have been delayed or halted, and resource allocation. The second category describes ethical challenges related to informed consent in the context of uncertainty and virtual consent. Finally, the third category describes ethical issues related to organ allocation, such as social considerations in selecting transplant candidates.ConclusionThis literature review highlights the salient ethical issues related to OTDT during the current COVID-19 pandemic. As medical and scientific knowledge about COVID-19 increases, the uncertainties related to this disease will decrease and the associated ethical issues will continue to evolve. (shrink)

Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)

Hilary Putnam's Twin Earth thought experiment has come to have an enormous impact on contemporary philosophical thought. But while most of the discussion has taken place within the context of the philosophy of mind and language, Terence Horgan and Mark Timmons (H8cT) have defended the intriguing suggestion that a variation on the original thought experiment has important consequences for ethics.' In a series of papers, they' ve developed the idea of a Moral Twin Earth and have argued that its significance (...) is that it has the resources to undermine naturalistic versions of moral realism.' H8t T don't hold back in their assessment. "Moral Twin.. (shrink)

It has been proposed that the urgency of having a vaccine as a response to SARS-CoV-2 is so great, given the potential health, economic and social benefits that we should override the established s...

Machine generated contents note: PART ONE: TOWARD A SOCIOLOGY OF HISTORY -- SECTION I: THE SOCIOLOGICAL -- FOUNDATIONS OF HISTORY -- I. The Sources of Culture Change -- 2. Sociology as a Science -- 3. Sociology and the Theory of Progress -- 4. Civilization and Morals -- 5. Progress and Decay in Ancient and Modern Civilization -- 6. Art and Society -- 7. Vitality or Standardization in Culture -- 8. Cultural Polarity and Religious Schism -- 9. Prevision in Religion -- (...) Io. T. S. Eliot on the Meaning of Culture -- SECTION II: THE MOVEMENT OF WORLD HISTORY -- I. Religion and the Life of Civilization -- 2. The Warrior Peoples and the Decline -- of the Archaic Civilization -- 3. The Origins of Classical Civilization -- 4. The Patriarchal Family in History -- 5. Stages in Mankind's Religious Experience -- SECTION III: URBANISM AND THE ORGANIC -- NATURE OF CULTURE -- I. The Evolution of the Modern City -- 2. Catholicism and the Bourgeois Mind -- 3. The World Crisis and the English Tradition -- 4. Bolshevism and the Bourgeoisie -- PART TWO: CONCEPTIONS OF WORLD HISTORY -- SECTION IV: CHRISTIANITY AND THE -- MEANING OF HISTORY -- I. The Christian View of History -- 2. History and the Christian Revelation -- 3. Christianity and Contradiction in History -- 4. The Kingdom of God and History -- SECTION II: THE VISION OF THE HISTORIAN -- I. The Problem of Metahistory -- 2. St. Augustine and the City of God -- 3. Edward Gibbon and the Fall of Rome -- 4. Karl Marx and the Dialectic of History -- 5. H. G. Wells and the Outline of History -- 6. Oswald Spengler and the Life of Civilizations -- 7. Arnold Toynbee and the Study of History -- 8. Europe in Eclipse -- Afterword by John J. Mulloy: Continuity and Development -- in Christopher Dawson's Thought -- Sources -- Notes -- Index. (shrink)

We agree that autistics’ unusual overt behaviors don't necessarily mean reduced social motivation. But Jaswal & Akhtar maintain that, while autistics may appear socially uninterested, their social interest is in fact typical and indeed must be to avoid multiple poor outcomes. This problematic idealization of social typicality deflects attention from important differences in autistic cognition and interests, which should be valued.

New mechanisms to ensure that counter ter ror ism ac t ivit ies do not contravene international law or ethical values and principles will require careful design. Apart from the ethical and legal grounds, there are good practical rea-sons to design more effective counterter-rorism measures. Preventable harms to population health contribute to mistrust and instability and undermine the stated objectives of the intelligence services.

From ancient times to the present, the discovery and presentation of new proofs of previously established theorems has been a salient feature of mathematical practice. Why? What purposes are served by such endeavors? And how do mathematicians judge whether two proofs of the same theorem are essentially different? Consideration of such questions illuminates the roles that proofs play in the validation and communication of mathematical knowledge and raises issues that have yet to be resolved by mathematical logicians. The Appendix, in (...) which several proofs of the Fundamental Theorem of Arithmetic are compared, provides a miniature case study. (shrink)

The thesis of this article is that engagement and suffering are essential aspects of responsible caregiving. The sense of medical responsibility engendered by engaged caregiving is referred to herein as clinical phronesis, i.e. practical wisdom in health care, or, simply, practical health care wisdom. The idea of clinical phronesis calls to mind a relational or communicative sense of medical responsibility which can best be understood as a kind of virtue ethics, yet one that is informed by the exigencies of moral (...) discourse and dialogue, as well as by the technical rigors of formal reasoning. The ideal of clinical phronesis is not (necessarily) contrary to the more common understandings of medical responsibility as either beneficence or patient autonomy — except, of course, when these notions are taken in their disengaged form (reflecting the malaise of modern medicine). Clinical phronesis, which gives rise to a deeper, broader, and richer, yet also to a more complex, sense than these other notions connote, holds the promise both of expanding, correcting, and perhaps completing what it currently means to be a fully responsible health care provider. In engaged caregiving, providers appropriately suffer with the patient, that is, they suffer the exigencies of the patient's affliction (though not his or her actual loss) by consenting to its inescapability. In disengaged caregiving — that ruse Katz has described as the silent world of doctor and patient — provides may deny or refuse any given connection with the patient, especially the inevitability of the patient's affliction and suffering (and, by parody of reasoning, the inevitability of their own. When, however, responsibility is construed qualitatively as an evaluative feature of medical rationality, rather than quantitatively as a form of calculative reasoning only, responsibility can be viewed more broadly as not only a matter of science and will, but of language and communication as well — in particular, as the task of responsibly narrating and interpreting the patient's story of illness. In summary, the question is not whether phronesis can save the life of medical ethics — only responsible humans can do that! Instead, the question should be whether phronesis, as an ethical requirement of health care delivery, can prevent the death of medical ethics. (shrink)

The general question to which this paper is addressed is whether knowledge and rationality carry within themselves the seeds of their own destruction. Some of those who set out in search of knowledge come to believe as a result of their inquiries that the object of their quest is not what they had taken it to be; seeking to discover the way the world actually is, they are led to conclude that all they can hope to find is a reflection (...) of their own needs and interests; the grail is but a beaker. Similarly, some of those whose aim is to formulate the principles of rational thought are led by reason to deny that any beliefs can be rationally justified; reasons are never reasons for believing but mere epiphenomena, produced by but not producing events whose only begetter is the passions; the quest is just another power struggle. The particular question I wish to ask is whether this picture is an accurate representation of social inquiry. (shrink)

Raanan Gillon is a noted defender of the four principles approach to healthcare ethics. His general position has always been that these principles are to be considered to be both universal and prima facie in nature. In recent work, however, he has made two claims that seem to present difficulties for this view. His first claim is that one of these four principles, respect for autonomy, has a special position in relation to the others: he holds that it is first (...) among equals. We argue that this claim makes little sense if the principles are to retain their prima facie nature. His second claim is that cultural variation can play an independent normative role in the construction of our moral judgments. This, he argues, enables us to occupy a middle ground between what he sees as the twin pitfalls of moral relativism and moral imperialism. We argue that there is no such middle ground, and while Gillon ultimately seems committed to relativism, it is some form of moral imperialism that will provide the only satisfactory construal of the four principles as prima facie universal moral principles. (shrink)

El artículo, tras validar la importancia de las organizaciones de derechos humanos y las de familiares de las víctimas en Chile, y del realce de este tema en los gobiernos de la Concertación, se centra en analizar el rol de las universidades frente a este tema, argumentando la necesidad de que estas desempeñen la noble tarea de formar profesionales ciudadanos, es decir personas con una formación basada en los derechos humanos. Para ello se focaliza en los objetivos y contenidos transversales (...) y postula un nuevo método pedagógico. (shrink)

We question the role given to depiction in Clark and Fischer's account of interaction with social robots. Specifically, we argue that positing a unique cognitive process for handling depiction is evolutionarily implausible and empirically redundant because the phenomena it is intended to explain are not limited to depictive contexts and are better explained by reference to more general cognitive processes.

This article provides an English translation of a historic discussion on the foundations of mathematics, during which Kurt GÖdel first announced his incompleteness theorem to the mathematical world. The text of the discussion is preceded by brief background remarks and commentary.

ABSTRACT This essay is an attempt to examine the idea that a professional code of practice can entail ethical conduct. It is focused around two differing perspectives on ethics. It will be argued that the professions have, perhaps too hastily, adopted one theory without considering the merits, or the objections offered by the alternative account. This alternative, a ‘cognitivist’ theory, is sketched, and the possible advantages of such an approach are discussed. Such a perspective means adopting a radically different approach (...) to the nature of ethics and what it is to be a moral agent, and could have interesting consequences for professional practice. Even if a cognitivist account is ultimately unconvincing, it does provide a number of worrying arguments for those professionals who believe that ethical conduct is generated by following a code of practice, and these arguments need to be addressed. (shrink)

One new tradition that has emerged from early research on autonomous robots is embodied cognitive science. This paper describes the relationship between embodied cognitive science and a related tradition, synthetic psychology. It is argued that while both are synthetic, embodied cognitive science is antirepresentational while synthetic psychology still appeals to representations. It is further argued that modern connectionism offers a medium for conducting synthetic psychology, provided that researchers analyze the internal representations that their networks develop. The paper then provides a (...) detailed example of the synthetic approach by showing how the construction of a connectionist network can be used to contribute to a theory of how humans solve Piaget's classic balance scale task. (shrink)

Recent policy in relation to clinical research proposals in the UK has distinguished between two types of review: scientific and ethical. This distinction has been formally enshrined in the recent changes to research ethics committee structure and operating procedures, introduced as the UK response to the EU Directive on clinical trials. Recent reviews and recommendations have confirmed the place of the distinction and the separate review processes. However, serious reservations can be mounted about the science/ethics distinction and the policy of (...) separate review that has been built upon it. We argue here that, first, the science/ethics distinction is incoherent, and, second, that RECs should not only be permitted to consider a study’s science, but that they have anobligation do so. (shrink)

A number of ethical frameworks have been proposed to support decision-making in public health and the evaluation of public health policy and practice. This is encouraging, since ethical considerations are of paramount importance in health policy. However, these frameworks have various deficiencies, in part because they incorporate substantial ethical positions. In this article, we discuss and criticise a framework developed by James Childress and Ruth Bernheim, which we consider to be the state of the art in the field. Their framework (...) distinguishes aims, such as the promotion of public health, from constraints on the pursuit of those aims, such as the requirement to avoid limitations to liberty, or the requirement to be impartial. We show how this structure creates both theoretical and practical problems. We then go on to present and defend a more practical framework, one that is neutral in avoiding precommitment to particular values and how they ought to be weighted. We believe ethics is at the very heart of such weightings and our framework is developed to reflect this belief. It is therefore both pluralist and value-based. We compare our new framework to Childress and Bernheim’s and outline its advantages. It is justified by its impetus to consider a wide range of alternatives and its tendency to direct decisions towards the best alternatives, as well as by the information provided by the ranking of alternatives and transparent explication of the judgements that motivate this ranking. The new framework presented should be useful to decision-makers in public health, as well as being a means to stimulate further reflection on the role of ethics in public health. (shrink)

As initially envisioned, Gödel's Collected Works were to include transcriptions of material from his mathematical workbooks. In the end that material, as well as some other manuscript items from Gödel's Nachlass, had to be left out. This note describes some of the unpublished items in the Nachlass that are likely to attract the notice of scholars and surveys the extent of shorthand transcription efforts undertaken hitherto. Some examples of sources outside Gödel's Nachlass that may be of interest to Gödel scholars (...) are also indicated. (shrink)

This is a reproduction of a book published before 1923. This book may have occasional imperfections such as missing or blurred pages, poor pictures, errant marks, etc. that were either part of the original artifact, or were introduced by the scanning process. We believe this work is culturally important, and despite the imperfections, have elected to bring it back into print as part of our continuing commitment to the preservation of printed works worldwide. We appreciate your understanding of the imperfections (...) in the preservation process, and hope you enjoy this valuable book. (shrink)

Though regarded today as one of the most important results in logic, the compactness theorem was largely ignored until nearly two decades after its discovery. This paper describes the vicissitudes of its evolution and transformation during the period 1930-1970, with special attention to the roles of Kurt Gödel, A. I. Maltsev, Leon Henkin, Abraham Robinson, and Alfred Tarski.

The pipeline framework for identifying ethical issues in machine learning healthcare applications outlined by Char et al. is a very useful starting point for the systematic consideration...

The obligations of organisations associated with policy formation and implementation of international mass public health programmes are explored. Lines of responsibility are considered to become unclear because of the large number of agencies associated with such programmes. A separation of the relevant obligations among the bodies responsible for the formulation and those responsible for the implementation of the policies is suggested. The continuing oral polio vaccine campaign against poliomyelitis in India is used to illustrate the general argument. Although the aim (...) of the programme is legitimate and laudable, unnecessary harm is currently being caused to some children as a result of elements of the policy and this should be rectified immediately. Such mass programmes should take care to ensure that people are not unnecessarily sacrificed in the drive to attain the desirable ends of the policy. (shrink)

This study evaluated the biological dimension of meditation and self-transcendent states. A convenience sample of 513 participants was drawn from attendees at a 4-day guided meditation workshop. Half were randomly assigned to an active placebo control intervention. All were assessed on a variety of measures, both psychological [anxiety, pain, posttraumatic stress disorder, positive emotions, and transcendent states], and physiological. Additional biological assessments including salivary immunoglobulin-A, cortisol, and Quantitative Electroencephalography were obtained from subset of the Experimental group. No significant difference in (...) psychological symptoms or positive emotions was observed between Experimental and placebo groups at baseline. At post-test, significant improvements were noted in the Experimental group, including a 49.5% median increase in SIgA, though cortisol remained unchanged. qEEG z-score analysis identified sustained stress reduction, including delta frequency band amplitude increases, high beta decreases, and faster acquisition of sustained alpha states. Psychological symptoms also improved on all measures. At 6-month follow-up, PTSD and somatic symptoms significantly improved from baseline, and post-test versus 6-month follow-up results indicated significant increases in happiness and spiritual and physical oneness, along with decreases in depressive symptoms. These findings suggest that autonomic self-regulation and transcendent states may be measured in both biological and psychological dimensions and are associated with pervasive health benefits. (shrink)

In September of 2002, without fanfare, Ivor Grattan-Guinness retired from the faculty of Middlesex University. His scholarly activity, however, has continued unabated, his time now no longer fetter...