Do terminally ill patients who have exhausted all other available, government-approved treatment options have a constitutional right to experimental treatment that may prolong their lives? On May 2, 2006, a divided panel of the U.S. Court of Appeals for the District of Columbia, in a startling opinion, Abigail Alliance for Better Access to Developmental Drugs v. Von Eschenbach, held “Yes.” The plaintiffs, Abigail Alliance for Better Access to Developmental Drugs and Washington Legal Foundation, sought to enjoin the Food and Drug (...) Administration from refusing to allow the sale of investigational new drugs that had not yet received FDA approval. The terminally ill plaintiffs contended that they quite literally could not wait that long for the drugs. With no other treatment options available, the plaintiffs urged the court to recognize a fundamental, constitutional right to take potentially life-saving or life-prolonging drugs, even though the treatment had not been fully tested through human trials for safety and effectiveness and could not be legally marketed to the public. (shrink)

On May 2, 2006, a divided panel of the U.S. Court of Appeals for the District of Columbia, in a startling opinion, Abigail Alliance for Better Access to Developmental Drugs v. Eschenbach, held that terminally ill patients who have exhausted all other available options have a constitutional right to experimental treatment that FDA has not yet approved. Although ultimately overturned by the full court, Abigail Alliance generated considerable interest from various constituencies. Meanwhile, FDA proposed similar regulatory amendments, as have lawmakers (...) on both sides of the aisle in Congress. But proponents of expanded access fail to consider public health and consumer safety concerns. In particular, allowing patients to try unproven treatments, outside of controlled clinical trials risks both the study's outcome and the health of patients who might benefit from the deliberate, careful process of new drug approval as it currently operates under FDA's auspices. (shrink)

The Patient Protection and Affordable Care Act represents the most significant reform of the United States health care system in decades. ACA also substantially amplifies the federal role in health care regulation. Among other provisions, ACA expands government health care programs, imposes detailed federal standards for commercial health insurance policies, creates national requirements on employers and individuals, and enlists state administrative capacity to implement various federal reforms. In response, a persistent voice in the protracted, contentious debate surrounding ACA was, and (...) continues to be, resistance from states. The rhetoric of federalism — states’ rights, reserved powers, state sovereignty, limited government, and local diversity — resonates deeply even around provisions of ACA that do not specifically implicate state interests. For example, the loudest and most persistent state objections target the new mandate that individuals maintain health insurance, a requirement imposed by ACA and enforced through federal tax penalties. (shrink)

The Patient Protection and Affordable Care Act represents the most significant reform of the United States health care system in decades. ACA also substantially amplifies the federal role in health care regulation. Among other provisions, ACA expands government health care programs, imposes detailed federal standards for commercial health insurance policies, creates national requirements on employers and individuals, and enlists state administrative capacity to implement various federal reforms. In response, a persistent voice in the protracted, contentious debate surrounding ACA was, and (...) continues to be, resistance from states. The rhetoric of federalism — states’ rights, reserved powers, state sovereignty, limited government, and local diversity — resonates deeply even around provisions of ACA that do not specifically implicate state interests. For example, the loudest and most persistent state objections target the new mandate that individuals maintain health insurance, a requirement imposed by ACA and enforced through federal tax penalties. (shrink)

In long Midwestern winters, two things are certain: snow and basketball. But two things that you cannot count on are snow day school closures and a home-team collegiate basketball championship. In Kansas last winter, we had both. Winter precipitation was much above average, resulting in a rare invocation of the University's inclement weather policy to cancel classes in early February. And the Kansas Jayhawks basketball team brought home the National Collegiate Athletic Association championship trophy for the first time in two (...) decades. The Chancellor commemorated the achievement with a campuswide celebration, including all-day class cancellation. This is all well and good. I am all for respecting Mother Nature's forces and celebrating remarkable athletic accomplishments.But the combination of events does leave law professors nearing the end of the semester in a bit of a quandary. How to make up the cancelled classes to ensure compliance with American Bar Association accreditation instructional hours requirements? How to cover the missed course content? How to find mutually agreeable make-up class times and locations with a group of busy, upper-level law students? (shrink)

In long Midwestern winters, two things are certain: snow and basketball. But two things that you cannot count on are snow day school closures and a home-team collegiate basketball championship. In Kansas last winter, we had both. Winter precipitation was much above average, resulting in a rare invocation of the University's inclement weather policy to cancel classes in early February. And the Kansas Jayhawks basketball team brought home the National Collegiate Athletic Association championship trophy for the first time in two (...) decades. The Chancellor commemorated the achievement with a campuswide celebration, including all-day class cancellation. This is all well and good. I am all for respecting Mother Nature's forces and celebrating remarkable athletic accomplishments.But the combination of events does leave law professors nearing the end of the semester in a bit of a quandary. How to make up the cancelled classes to ensure compliance with American Bar Association accreditation instructional hours requirements? How to cover the missed course content? How to find mutually agreeable make-up class times and locations with a group of busy, upper-level law students? (shrink)

Evidence-based medicine (EBM), by its ability to decrease irrational variations in health care, was expected to improve healthcare quality and outcomes. The utility of EBM principles evolved from individual clinical decision-making to wider foundational clinical practice guideline applications, cost containment measures, and clinical quality performance measures. At this evolutionary juncture one can ask the following questions. Given the time-limited exigencies of daily clinical practice, is it tenable for clinicians to follow guidelines? Whose or what interests are served by applying performance (...) assessments? Does such application improve medical care quality? What happens when the best interests of vested parties conflict? Mindful of the constellation of socially and clinically relevant variables influencing health outcomes, is it fair to apply evidence-based performance assessment tools to judge the merits of clinical decision-making? Finally, is it fair and just to incentivize clinicians in ways that might sway clinical judgment? To address these questions, we consider various clinical applications of performance assessment strategies, examining what performance measures purport to measure, how they are measured and whether such applications demonstrably improve quality. With attention to the merits and frailties associated with such applications, we devise and defend criteria that distinguish between justice-sustaining and justice-threatening performance-based clinical protocols. (shrink)

This article provides a broad survey of issues facing rural communities and suggests that medicalization of poverty concepts and interventions need to be tailored to those populations. Rural poverty may be both broader and deeper than in urban areas. Those challenges seem to produce a constellation of health conditions, as rural residents struggle with unemployment and lack of opportunities. Relatedly, rural communities struggle to maintain financially viable hospitals and specialty providers. The article closes by offering a snapshot of rural-specific strategies (...) to address these issues. (shrink)

Stigma can lead to poor health outcomes. At the same time, people who are perceived as unhealthy may experience stigma as the result of that perception. As part of a larger project examining discrimination on the basis of health status or “healthism,” we explore the role of stigma in producing disadvantage based on health status. Specifically, we look to the principles of health equality and health justice. An intervention violates health equality when it is driven by animus, which can be (...) the result of stigma. Additionally, laws and policies offend health justice when they worsen health outcomes or they create or deepen health disparities. An intervention that produces stigma — whether intentionally or unintentionally — may offend health justice by making people worse off, in absolute or in comparative terms. Stigma-related health laws and policies can therefore be healthist in at least two ways. We therefore conclude that stigma should neither be the basis, nor the product, of efforts to improve health. (shrink)

Disparities exist in the health, livelihood, and opportunities for the 46-60 million people living in America’s rural communities. Rural communities across the United States need a new energy and focus concentrated around health and health care that allows for the designing capturing, and spreading of existing and new innovations. This paper aims to provide a framework for policy solutions to build a healthier rural America describing both the current state of rural health policy and the policies and practices in states (...) that could be used as a national model for positive change. (shrink)

When Cool finally realized that false memories had been planted, she sued the psychiatrist for malpractice. In March 1997, after five weeks of trial, her case was settled out of court for $2.4 million. Nadean Cool is not the only patient to develop false memories as a result of questionable therapy. In Missouri in 1992 a church counselor helped Beth Rutherford to remember during therapy that her father, a clergyman, had regularly raped her between the ages of seven and (...) 14 and that her mother sometimes helped him by holding her down. Under her therapist's guidance, Rutherford developed memories of her father twice impregnating her and forcing her to abort the fetus herself with a coat hanger.The father had to resign from his post as a clergyman when the allegations were made public. Later medical examination of the daughter revealed, however, that she was still a virgin at age 22 and had never been pregnant. The daughter sued the therapist and received a $1-million settlement in 1996. (shrink)

In 2017, a Philadelphia research team revealed the closest thing to an artificial womb the world had ever seen. The ‘biobag’, if as successful as early animal testing suggests, will change the face of neonatal intensive care. At present, premature neonates born earlier than 22 weeks have no hope of survival. For some time, there have been no significant improvements in mortality rates or incidences of long-term complications for preterms at the viability threshold. Artificial womb technology, that might change (...) these odds, is eagerly anticipated for clinical application. We need to understand whether AWT is an extension of current intensive care or something entirely new. This question is central to determining when and how the biobag should be used on human subjects. This paper examines the science behind AWT and advances two principal claims. First, AWT is conceptually different from conventional intensive care. Identifying why AWT should be understood as distinct demonstrates how it raises different ethico-legal questions. Second, these questions should be formulated without the ‘human being growing in the AW’ being described with inherently value laden terminology. The ‘human being in an AW’ is neither a fetus nor a baby, and the ethical tethers associated with these terms could perpetuate misunderstanding and confusion. Thus, the term ‘gestateling’ should be adopted to refer to this new product of human reproduction: a developing human being gestating ex utero. While this paper does not attempt to solve all the ethical problems associated with AWT, it makes important clarifications that will enable better formulation of relevant ethical questions for future exploration. (shrink)

We use “I’ll be glad I did it” reasoning all the time. For example, last night I was trying to decide whether to work on this paper or go out to a movie. I realized that if I worked on the paper, then today I would be glad I did it. Whereas, if I went out to the movie, today I would regret it. This enabled me to see that I should work on the paper rather than going out to (...) a movie. This looks like excellent reasoning: Paper argument: 1. If I work on my paper, I’ll be glad I did it. 2. Therefore, I should work on my paper. When we’re having trouble making a big life decision, we often try to picture what will happen each way we might choose, and imagine how we’ll feel in that outcome. When choosing between two jobs, we might use this reasoning. Suppose you are choosing between two jobs and you know quite a lot about what the two jobs will be like. In one, you will make a lot of money but have to work eighty-hour weeks and see little of your family. In the other, you will make considerably less money—though enough to support yourself and your family. You’ll have much more time for your family. The money is attractive. But overall, you realize you’ll be glad to have the time with your family if you take the second job—you’ll be glad you made that choice. It seems this is a good way of realizing that you should take the second job. (shrink)

Smoking consequences are seen disproportionately among low-SES smokers. We examine the self-regulatory strategy of mental contrasting with implementation intentions as a smoking reduction tool and whether its effectiveness depends on subjective-SES. This pre-registered online experiment comprised a pre-screening, baseline survey, and follow-up. Participants reported past-week smoking, subjective-SES, perceived stress, and were randomized to an active control or MCII condition. Data were collected via MTurk, during the U.S.’ initial wave of COVID-19. Participants were moderate-to-heavy smokers open to reducing or quitting. The (...) primary outcome was self-reported smoking reduction, computed as the difference between recent smoking at baseline and follow-up. The secondary outcome was cessation, operationalized as self-reported 7-day point-prevalence abstinence at follow-up. Among those low—but not high—in subjective-SES, MCII improved smoking reduction by an average of 1.09 fewer cigarettes smoked per day, though this effect was not conclusive. Similarly, quitting was descriptively more likely for those in the MCII than control condition, but the effect was non-significant. Per an exploratory analysis, we observed that stress significantly moderated the condition effect, such that MCII facilitated reduction among those experiencing high, but not low stress. Consistent with prior findings that MCII works best in vulnerable populations, MCII may be more effective for smoking reduction among high-stress than low-stress individuals. These findings contribute to growing research on income-related health disparities and smoking behavior change tools. (shrink)

On September 27, 2016 people across the world looked down at their buzzing phones to see the AP Alert: “Baby born with DNA from 3 people, first from new technique.” It was an announcement met with confusion by many, but one that polarized the scientific community almost instantly. Some celebrated the birth as an advancement that could help women with a family history of mitochondrial diseases prevent the transmission of the disease to future generations; others held it unethical, citing medical (...) tourism and consequences for the future of the therapy. The child in question was actually born a few months earlier on April 6, 2016, but the research was published a few months later in the October edition of Fertility and Sterility. The mother carries DNA that could have given the baby Leigh Syndrome, a severe neurological disorder characterized by psychomotor regression that typically results in death between ages two and three.[1] Also known as subacute necrotizing encephalomyelopathy, Leigh Syndrome is caused by genetic mutations in mitochondrial DNA, which causes defective oxidative phosphorylation. Because people with this condition cannot re-form ATP, “demyleniation, gliosis, necrosis, spongiosis, or capillary proliferation”[2] can occur, thereby producing bilateral lesions across the central nervous system. The 36-year-old mother previously had four miscarriages and successfully birthed two children, both of whom survived less than six years due to the syndrome. For religious reasons, the mother opted for Spindle Nuclear Transfer instead of Pronuclear Transfer,[3] which many religious organizations oppose because it entails the destruction of fertilized eggs.[4] In Pronuclear Transfer, both the parent and donor egg are fertilized. The parent’s nuclear material is then removed from the egg containing mutated mitochondria and inserted into the fertilized donor egg—from which the original nuclear material has been removed and destroyed. Spindle Nuclear Transfer, on the other hand, removes the mother’s nuclear material from the egg with unhealthy mitochondria, then implants it into a donor’s egg. The newly created egg is then fertilized with the father’s sperm. This Spindle Nuclear Transfer was performed in Mexico by a team of doctors led by Dr. John Zhang, the founder of the New Hope Fertility Center in New York City. In their report, the doctors outline that five oocytes were successfully reconstituted, four of which developed into blastocysts. Only one was euploid: containing 46 XY chromosomes. Researchers then biopsied that blastocyst and found that the transmission rate of maternal mtDNA was, “5.10 ± 1.11% and the heteroplasmy level for 8993T>G was 5.73%.”[5] This indicates that at the blastocyst stage, around five percent of the mitochondria are from the original maternal egg with the mutation for Leigh Syndrome. After birth, they biopsied different tissues and found that they had an average of less than 1.60 ± 0.92% of transmitted mtDNA from the original maternal egg. The baby is reportedly doing well and the team of doctors concluded that “[h]uman oocytes reconstituted by SNT are capable of producing a healthy live birth. SNT may provide a novel treatment option in minimizing pathogenic mtDNA transmission from mothers to their babies."[6] Even when considered theoretically, Spindle Nuclear Transfer is controversial. Many doctors believe that the risks at this stage of research are too great. Dr. Trevor Stammers, a bioethicist at St. Mary’s University in London, points out: “We do not yet have a clear picture of the interaction between nuclear DNA and mitochondria.”[7] Others hold that faulty mitochondrial DNA can still be transferred during the procedure. Still more argue this technology could create problems because of germline modification.[8] Dr. Paul Knoepfler, a cell biologist at the UC Davis School of Medicine, explains: “Since this is uncharted territory and the children born from this technology would have heritable genetic changes, there are also significant unknown risks to future generations.”[9] However, proponents counter these arguments. They say the benefits outweigh the risks, as “mitochondrial replacement techniques [like Spindle Nuclear Transfer] would eliminate maternal transmission of mitochondrial disease… allowing a woman with a family history of mitochondrial diseases to ensure her children would not be affected.”[10] Additionally, experts say that no symptoms will occur if less than 20% of the transferred mitochondrial DNA is faulty.[11] And while opponents see potential germline modification as a problem, advocates answer that this could stop a family history of mitochondrial disease, which they deem a more serious concern. In this case specifically, however, there are more issues at hand. While the team of doctors did eliminate the possibility of germline modification by selecting a male embryo, there are other ethical concerns. Some argue that this case could be described as “medical tourism.” While New Hope Medical Clinic does maintain a branch in Mexico, Dr. Zhang stated that Mexico has “no rules.”[12] It is a country with underdeveloped regulations, making it difficult to confirm that doctors adhere to widely-held medical and ethical standards. Furthermore, while it is highly unlikely that the child will develop Leigh’s Syndrome, Dr. Dietrich Egli of the New York Stem Cell Foundation says the 5% mitochondrial transfer rate indicates that the technique “was not carried out well.”[13] He points to studies of embryos where the rate of mtDNA transfer was almost ten times lower. Spindle Nuclear Transfer is currently legal in the UK,[14] and many are hoping to see it legalized in the US, although Congress currently prohibits the FDA from considering applications that would entail trials in people.[15] While Dr. Zhang’s work is arguably revolutionary, many wonder if the manner in which this study was performed—in Mexico and with a high mitochondrial transfer rate—will impact the technology’s future in the US. Last week, Dr. Zhang presented the report to scientists gathered in Salt Lake City, saying that while science isn’t a race, it is “in a sense, a race for the family to find a cure, to find hope.”[16] Only time will tell if this study set back other families racing and hoping for a cure. References 1. "Leigh Syndrome." Genetics Home Reference, US National Library of Medicine, 25 Oct. 2016. Accessed 26 Oct. 2016. 2. McKusick, Victor A., and Ada Hamosh. "LEIGH SYNDROME; LS." Online Mendelian Inheritance in Man, Johns Hopkins University, 20 Jan. 2016. Accessed 30 Oct. 2016. 3. Zhang, J, H Liu, S Luo, A Chavez-Badiola, and Z Liu. "First live birth using human oocytes reconstituted by spindle nuclear transfer for mitochondrial DNA mutation causing Leigh syndrome." Fertility and Sterility, vol. 106, no. 3, 2016, pp. e375-76. Accessed 30 Oct. 2016. 4. Sample, Ian. "‘Three-parent’ babies explained: what are the concerns and are they justified?" The Guardian, 2 Feb. 2015. Accessed 30 Oct. 2016. 5. Zhang, et al. 6. Ibid. 7. Knapton, Sarah. "Three-parent babies: the arguments for and against." The Telegraph, 3 Feb. 2015. 8. Ibid. 9. Ibid. 10. "Mitochondrial Replacement Therapy FAQs." New York Stem Cell Foundation Research Institute, New York Stem Cell Foundation. Accessed 30 Oct. 2016. 11. Reardon, Sara. "‘Three-parent baby’ claim raises hopes — and ethical concerns." Nature, 28 Sept. 2016. Accessed 30 Oct. 2016. 12. Hamzelou, Jessica. "Exclusive: World’s first baby born with new “3 parent” technique." New Scientist, 27 Sept. 2016. Accessed 30 Oct. 2016. 13. Reardon, Sara. "‘Three-parent baby’ claim raises hopes — and ethical concerns." Nature, 28 Sept. 2016. Accessed 30 Oct. 2016. 14. "3-Person IVF: A Resource Page." Center for Genetics and Society, 24 Oct. 2016. Accessed 30 Oct. 2016. 15. Ritter, Malcolm. "Baby born with DNA from 3 people, first from new technique." Associated Press, 27 Sept. 2016. Accessed 30 Oct. 2016. 16. Chen, Daphne. "Controversy swirls around first three-parent baby." Deseret News, 19 Oct. 2016. Accessed 30 Oct. 2016. Works consulted Swetlitz, Ike. "FDA urged to approve ‘three-parent embryos,’ a new frontier in reproduction." STAT, 3 Feb. 2016. Accessed 30 Oct. 2016. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Editors' Introduction to the Special Issue on the Translational Work of BioethicsElizabeth Lanphier and Larry R. ChurchillRecent essays in Perspectives and Biology and Medicine, including "Can Clinical Ethics Survive Climate Change" by Andrew Jameton and Jessica Pierce and "Ethical Maxims for a Marginally Inhabitable Planet" by David Schenck and Larry R. Churchill, both appearing in the Autumn 2021 issue, inspired conversations between us, among our colleagues, and with various (...) contributors to this symposium. We asked of ourselves and each other: where can, should, or must bioethics as a field go to make what bioethicists know and publish about in the academic literature relevant to public policy decisions, health and technological innovation, and a general public? In other words, where do we, practically speaking, go with our bioethical insights and discoveries to make a tangible impact on issues like climate change—though that is only one of the various topics that the authors in this symposium tackle.This translational work of connecting scholarly innovation back to overt practical innovation is often peripheral to academic bioethics. It is not the work the academy typically recognizes in its credit system. Yet this translational work is becoming a critical, central duty of bioethics for the 21st century, while the kinds of work the academy most valorizes may be the least important at this time. In particular, the need for translational initiatives is increasingly evident as pandemics linger into a new normal, the long history and ongoing impacts of racism become even more evident at institutional levels, and the devastating health implications of global warming emerge. [End Page 515]Bioethicists function in privileged proximity to the deleterious effects of failed health and social policy, as well the interplay between seemingly personal health choices, such as those related to diet or lifestyle, and inequitable conditions that impact the options available to individuals and groups. We are increasingly distressed by what we see from this privileged window into health. The COVID-19 pandemic has made preexisting social and policy inequities impacting health impossible to ignore. At the same time, the patterns of carbon pollution portend health crises of unprecedent severity and magnitude in the near future—and will likely deepen inequities and disparities already occurring between those most contributing to, and those most harmed by, climate change.As a field, bioethics has, since its start, been at the intersection of theory and practice. But it is not sufficient for the field to reside passively at this crossroads. The field must be constantly innovating new byways and highways, new offshoots from existing pathways and connector roads between them, that build out both the theory and practice of bioethics in a mutually innovative relationship to each other. Bioethics does not make sense without attention to the real-world practices and the lived realities of health and care. The practical engagement is what deepens and enriches theory, in ways that are more responsive to the real world in which bioethicists toil. But it also is not enough to merely contribute to the body of bioethics scholarship. The translational bioethics we envision is also about using novel theories and concepts to actively shape practices and realities; it is a bioethics in which theory and practices mutually influence each other, each reaching out to generate and change the other.This collection of essays, drawn from a diverse number of scholars, offers several promising paths forward. The essays were written in the spring of 2022, two years into the COVID-19 pandemic, two years after the murder of George Floyd and international attention to the movement for Black lives, and for the most part in the weeks just prior to a set of US Supreme Court decisions with enormous impacts on health, including the June 24 Dobbs v. Jackson Women's Health Organization and the June 30 West Virginia v. EPA decisions.The authors are diverse in age, spheres of work, discipline, sex, race, and ethnicity. They expand our vision for what bioethics can and should be. While we have grouped the essays by subject matter, most of the pieces speak to the field as a whole and invite cross-fertilization. We hope readers will find new ideas, old ideas... (shrink)

Thirty-six 1-year-old middle-class children with fathers who spent differential time with them at home were observed in two experimental contexts separated by 2 weeks. In the first, each infant was shown six to eight repetitions of three different nonsocial events followed by a change in..

In lieu of an abstract, here is a brief excerpt of the content:A Liberating BreathElizabeth DotsenkoFunding. Elizabeth Dotsenko, MD, is supported by the Loyola University Chicago–Ukrainian Catholic University Bioethics Fellowship Program, funded by the National Institutes of Health Fogarty International Center (D43TW011506).The war in Ukraine started not in 2022, but in 2014. Some of my relatives have been living under occupation for the past nine years. After a year of occupation, parts of Ukrainian society stopped paying attention.But on February (...) 24th 2022, that changed. The whole country was awakened by missile attacks in almost every region. Kyiv, the capital, was heavily shelled by air strikes, and from the North, South, and Eastern borders, Russian troops entered our territory with long convoys of military vehicles. In one moment, we all woke up in a country at war.I have experience working in conflict zones. In 2017, I worked in Iraq in Internally Displaced Persons (IDP) camps for one year. On the 25th of February, 2022, my colleagues and founders of STEP-IN, the NGO with whom I used to work in Iraq, initiated a Zoom call. We decided immediately to start work in Ukraine—without any funding. Although my only previous work experience was being a doctor, I ended up taking on managerial responsibilities and established a Ukrainian branch of STEP-IN. I was also mother of a 1.5-year-old girl in a country of war. To say it was challenging is an understatement.In the first week of the full-scale invasion, STEP-IN opened a crisis intervention point on the Ukrainian-Slovak border crossing, where people could get psychological help and warm meals. We provided shelter and a place to sleep for those waiting in overcrowded border points.As soon as we received our first grant, we started a mobile medical team in the Western part of Ukraine, where thousands of IDPs were relocated. They were living in schools, huge sports halls without any privacy, kindergartens, churches, and at the end, any building that could provide shelter from winter weather.My colleague and I assessed the region and settled on ten permanent, consistent locations for biweekly visits. Aside from my role as coordinator, I also worked as a doctor for the first few weeks because we struggled to recruit any Ukrainian doctors. However, within a month, we had a full team with a psychotherapist and medical doctor. The team traveled through the Trascarpathian region in Western Ukraine and provided free consultations with physicians and psychotherapists as well as medicines, hygiene kits, and social services.After the de-occupation of northern Ukraine, the tension and hopelessness seem to have decreased. People started smiling on the streets. I feel like I can finally breathe and live. At the beginning of the war, my husband and I, with our young daughter, fled from Kyiv and were not sure we would ever be able to return. After the de-occupation, life started to feel more stable. During one of STEP-IN’s assessment trips, my husband and I visited our home. In such a situation, very small things unexpectedly become [End Page E1] very valuable to me. I was so happy to see pictures on the wall, a ceramic bowl I brought from Iraq and our child’s favorite toys.The project in the Transcarpathian region had been ongoing for a few months, and in October 2022, I went to work there for a week as a physician to cover for someone else. We were searching for a new candidate and didn’t want our beneficiaries to remain without medical help, especially in the peak flu season.There is a day that I remember vividly in all its details. I remember the smell in the room and how the light from the window lay on my patient’s face. It was Tuesday, and each Tuesday, we went to the Protestant church guesthouse, where around sixty IDPs were hosted. The church was one of my favorite places to work because the administration was very supportive and caring toward IDPs. Unfortunately, that was not the case everywhere. From the moment I arrived at a location, it was apparent how the IDPs were treated. Their eyes were the best... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:ContingenciesElizabeth RottenbergAnalysis does precious little, but the little it does is precious.—Therese BenedekI’d like to begin with an anecdote of a slightly confessional nature. If I mention this anecdote, it’s because it came to me by chance as an association to what French analyst and philosopher Monique David-Ménard, in her introduction to Éloge des hasards dans la vie sexuelle, calls “positive contingency” or the “positive aspect of chance” (David-Ménard (...) 2011, 19–20), what in colloquial English we call a “happy accident.”So here’s the association. For reasons I cannot fully explain, the therapist I was seeing in graduate school encouraged me to take the Minnesota Multiphasic Personality Inventory test (the MMPI, as it’s called), a widely used and researched psychometric test of adult personality and psychopathology. The test involved hundreds of simple, inoffensive questions, questions such as, “Do you read all the editorials in the newspaper every day?”1 and it took me hours to complete. A week or so after taking the test, I met with my therapist and we went over the results together. According to the test (which, interestingly, takes into account the performative aspects of test taking), I had answered all the questions in such a way as to appear neither excessively good nor excessively bad, that is, I had answered all the questions honestly and consistently. And as far as psychopathology was concerned, my answers showed few signs of hypochondriasis, hysteria, psychopathy, schizophrenia, or hypomania. On the other hand, when it came to depression, paranoia, psychasthenia, and social introversion, my scores were a little higher, and a shockingly high percentage of my answers [End Page 128] reflected “stereotypical masculine interests/behaviors.” None of this seemed to worry my therapist in the least. The only thing she pointed to were my “odd answers” (the MMPI also has a special category for odd answers—presumably the answers of academics). She wondered about my answer to this question in particular: “Do you see people or animals or things that other people don’t see?” “You answered ‘true’ to that question,” she said. “I don’t understand. Why would you answer ‘true’? You’re not psychotic.” I explained that I had read the “or”—do you see people OR animals OR things that other people don’t see—as a disjunctive rather than a conjunctive OR. “So, yes, it’s true, when I read texts, sometimes I see things that other people don’t see.” At the time, of course, I wasn’t thinking of Deleuze’s “contingent reason” or of Monique’s discussion of the inventive power of disjunctive synthesis in her Deleuze et la psychanalyse (2005). And I certainly wasn’t thinking that my figurative reading of seeing, my misreading of seeing, was indicative of the essential and indeterminable contingencies of reading. No, I was only giving what I took to be a perfectly accurate description of the déformation professionnelle that is ours and that belongs to anyone who is a stickler for grammar... a positive déformation, I might add.But this association immediately leads me to another (contingent) association, this time one that is intimately related to Monique’s discussion of Torricelli’s law and to Claude Bernard’s discovery of the exocrine function of the pancreas. My association is to Freud and to Freud’s astonishment before the transformative power of Jean-Martin Charcot’s dazzling, clinical insight. In Freud’s description of his teacher, Charcot is someone who sees things that other people don’t see:[Charcot]... had the nature of an artist—he was, as he himself said, a “visuel,” a seer. Here is what he himself told us about his method of working. He used to look again and again at the things he did not understand, to deepen his impression of them day by day, till suddenly [plötzlich] an understanding of them dawned on him.... He might be heard to say that the greatest satisfaction a [person] could have was to see something new—that is, to recognize it as new; and he remarked again and again on the difficulty and value of this kind of... (shrink)

THE TITLE OF THIS ESSAY, "READING MORE THAN LOLITA IN TEHRAN," IS meant to invoke Azar Nafisi's Reading Lolita in Tehran, a memoir documenting how Western literary classics have the ability to change and improve the lives of people living under theocratic rule. In 1995, after resigning from her job as a professor at a university in Tehran, Nafisi invited seven of her best women students to attend a weekly study of Vladimir Nabokov, F. Scott Fitzgerald, Jane Austen, and other (...) authors she believed would provide the women with examples of how to successfully assert their autonomy despite great odds. (shrink)

In this sweeping revision of avant-garde history, John Cage takes his rightful place as Wordsworth's great and final heir. George Leonard traces a direct line back from Cage, Pop, and Conceptual Art through the Futurists to Whitman, Emerson, Ruskin, Carlyle, and Wordsworth, showing how the art of everyday objects, often thought an exclusively contemporary phenomenon, actually began as far back as 1800. In recovering the links between such seemingly disparate figures, Leonard transforms our understanding of modern culture. Selected (...) by the American Library Association's journal, _Choice_, as "one of the Outstanding Academic Books of the Year" "Leonard's book is a fine example of interdisciplinary studies. He shifts focus persuasively from art theory to literature to religious thought and biography, making his method seem the natural mode of inquiry into culture."—Kenneth Baker, _San Francisco Chronicle Book Review_ "Provocative and illuminating."—_Library Journal_ "Highly stimulating, impassioned."—_Publisher's Weekly_ "A rich and rewarding study written in a clear and accessible style with excellent references and a very useful index. Highly recommended."—_Choice_. (shrink)

Scholars explore from many fresh angles the interweavings of two of the richest strands of human culture-music and esotericism-with examples from the medieval period to the modern age. Music and esotericism are two responses to the intuition that the world holds hidden order, beauty, and power. Those who compose, perform, and listen to music have often noted that music can be a bridge between sensory and transcendent realms. Such renowned writers as Boethius expanded the definition of music to encompass not (...) only sounded music but also the harmonic fabric of human and cosmic life. Those who engage in pursuits called "esoteric," from ancient astrology, magic, and alchemy to recent and more novel forms of spirituality, have also remarked on the relevance of music to their quests. Esotericists have composed music in order to convey esoteric meaning, performed music to create esoteric influences, and listened to music to raise their esoteric awareness. The academic study of esotericism is a young field, and few researchers have probed the rich interface between the musical and esoteric domains. In Explorations in Music and Esotericism, scholars from numerous fields introduce the history of esotericism and current debates about its definition and extent. The book's sixteen chapters present rich instances of connections between music and esotericism, organized with reference to four aspects of esotericism: as a form of thought; as the keeping and revealing of secrets; as an identity; and as a signifier. Edited by Marjorie Roth and Leonard George. Contributors: Elizabeth Abbate, Malachai Komanoff Bandy, Adam Bregman, Charles E. Brewer, Benjamin Dobbs, Anna Gawboy, Pasquale Giaquinto, Adam Knight Gilbert, Joscelyn Godwin, Virginia Christy Lamothe, Andrew Owen, Christopher Scheer, Codee Ann Spinner, Woodrow Steinken, and Daphne Tan. (shrink)

Cortisone, initially known as ‘compound E’ was the medical sensation of the late 1940s and early 1950s. As early as April 1949, only a week after Philip Hench and colleagues first described the potential of ‘compound E’ at a Mayo Clinic seminar, the New York Times reported the drug’s promise as a ‘modern miracle’ in the treatment of rheumatoid arthritis. Given its high profile, it is unsurprising that historians of medicine have been attracted to study the innovation of cortisone. It (...) arrived at the end of a decade of ‘therapeutic revolutions’, kicked off by penicillin transforming the treatment of bacterial infections and ending with hopes of a revolution in the treatment of non-infectious, chronic inflammatory diseases. Despite these studies of cortisone’s introduction, few historians have taken the story forward and considered how cortisone was adopted and adapted into clinical practice. This article tells the longer of how the drug and its derivatives were taken from research laboratories and integrated into clinical practice; what has in recent decades become known as translational medicine. In exploring cortisone’s first decade in Britain, we focus specifically on its role in the treatment of RA. Our approach is always to consider cortisone’s use in the context of other treatments available to clinicians, and at local and national institutional settings. We do not discuss the many other therapeutic uses of cortisone, which ranged for topical applications for skin diseases to the management of cancers, especially childhood leukaemia, nor do we discuss its close analogue ACTH—AdenoCorticoTropic Hormone. We think there are lessons in our study for TM policies today. (shrink)

Cortisone, initially known as ‘compound E’ was the medical sensation of the late 1940s and early 1950s. As early as April 1949, only a week after Philip Hench and colleagues first described the potential of ‘compound E’ at a Mayo Clinic seminar, the New York Times reported the drug’s promise as a ‘modern miracle’ in the treatment of rheumatoid arthritis. Given its high profile, it is unsurprising that historians of medicine have been attracted to study the innovation of cortisone. It (...) arrived at the end of a decade of ‘therapeutic revolutions’, kicked off by penicillin transforming the treatment of bacterial infections and ending with hopes of a revolution in the treatment of non-infectious, chronic inflammatory diseases. Despite these studies of cortisone’s introduction, few historians have taken the story forward and considered how cortisone was adopted and adapted into clinical practice. This article tells the longer of how the drug and its derivatives were taken from research laboratories and integrated into clinical practice; what has in recent decades become known as translational medicine. In exploring cortisone’s first decade in Britain, we focus specifically on its role in the treatment of RA. Our approach is always to consider cortisone’s use in the context of other treatments available to clinicians, and at local and national institutional settings. We do not discuss the many other therapeutic uses of cortisone, which ranged for topical applications for skin diseases to the management of cancers, especially childhood leukaemia, nor do we discuss its close analogue ACTH—AdenoCorticoTropic Hormone. We think there are lessons in our study for TM policies today. (shrink)

Cortisone, initially known as ‘compound E’ was the medical sensation of the late 1940s and early 1950s. As early as April 1949, only a week after Philip Hench and colleagues first described the potential of ‘compound E’ at a Mayo Clinic seminar, the New York Times reported the drug’s promise as a ‘modern miracle’ in the treatment of rheumatoid arthritis. Given its high profile, it is unsurprising that historians of medicine have been attracted to study the innovation of cortisone. It (...) arrived at the end of a decade of ‘therapeutic revolutions’, kicked off by penicillin transforming the treatment of bacterial infections and ending with hopes of a revolution in the treatment of non-infectious, chronic inflammatory diseases. Despite these studies of cortisone’s introduction, few historians have taken the story forward and considered how cortisone was adopted and adapted into clinical practice. This article tells the longer of how the drug and its derivatives were taken from research laboratories and integrated into clinical practice; what has in recent decades become known as translational medicine. In exploring cortisone’s first decade in Britain, we focus specifically on its role in the treatment of RA. Our approach is always to consider cortisone’s use in the context of other treatments available to clinicians, and at local and national institutional settings. We do not discuss the many other therapeutic uses of cortisone, which ranged for topical applications for skin diseases to the management of cancers, especially childhood leukaemia, nor do we discuss its close analogue ACTH—AdenoCorticoTropic Hormone. We think there are lessons in our study for TM policies today. (shrink)

Providing high-quality education for students with emergent proficiency in the language of instruction (referred to here as multilingual students) presents a challenge to inclusion for educational systems the world over. In Austria, a new German language support model was implemented in the school year 2018/19 which provides language support in separate classrooms up to 20 h a week. Since its implementation, the model has been strongly criticized for excluding multilingual students from the mainstream classroom, which is argued to reinforce the (...) educational disadvantages that they face. The study presented here provides unprecedented qualitative insight into how schooling for students within the so-called German language support classes (GLSC) was organized during the COVID-19 pandemic. It builds on results of a previous large-scale quantitative study (n= 3,400 teachers), which was conducted during the first lockdown (spring 2020) and indicated a high risk of exclusion for marginalized students, especially for multilingual students in GLSC. To gain deeper insights into the situation of these students during school closures, 37 teachers who work in these classes at both primary and lower-secondary schools in Vienna were interviewed, of which 18 interviews were considered for analysis. The interviews focus on the situation during the first and second school closures in the city of Vienna. A thematic analysis of the interview data reveals teachers’ perceptions of aspects which harmed or promoted inclusion for students in GLSC during these periods of school closure. Teachers’ perceptions of the most harming factors for students included strong language barriers between teachers and students, restricted access to technical equipment and supportive learning spaces, and low parental engagement. A development that promoted inclusion of these students was the option to allow them to come to school during the second school closure. Since existing studies on the schooling of students during school closures have hardly addressed the situation of students in GLSC, this study contributes to closing this research gap. (shrink)

The core dimensions of cognitive fitness, such as attention and cognitive control, are emerging through a transdisciplinary expert consensus on what has been termed the Cognitive Fitness Framework. These dimensions represent key drivers of cognitive performance under pressure across many occupations, from first responders to sport, performing arts and the military. The constructs forming the building blocks of CF2 come from the RDoC framework, an initiative of the US National Institute of Mental Health aimed at identifying the cognitive processes underlying (...) normal and abnormal behavior. Similar to physical conditioning, cognitive fitness can be improved with deliberate practice. This paper reports the development of a prototype cognitive fitness training program for competitive athletes and the protocol for its evaluation. The program is focused on primary cognitive capacities and subtending skills for adjusting training rhythms and enhancing readiness for competition. The project is driven by the Australian Psychological Society’s College of Sport & Exercise Psychology and includes the development of a Cognitive Gym program for a smartphone app-enhanced implementation. Its key building blocks are training protocols connected by a periodized training plan. A website with background supporting resources has also been developed as part of the project. National-level training squads will participate in a three-week pilot evaluation protocol, assessing the program’s efficacy and usability through gamified cognitive assessment of participants’ training gains and coaching staff evaluations, respectively. Both near and far transfer of training effects will be examined. (shrink)

In response to the COVID-19 pandemic, millions of students in China followed an emergency policy called “Suspending Classes without Stopping Learning” to continue their study online as schools across the country were closed. The present study examines how students adapted to learning online in these unprecedented circumstances. We aimed to explore the relationship between adaptability, academic emotion, and student engagement during COVID-19. 1,119 university students from 20 provinces participated in this longitudinal study (2 time points with a 2-week interval). The (...) results showed that adaptability (the ability to respond to changes) and student engagement are significantly positively correlated with positive academic emotion and negatively correlated with negative academic emotion. Furthermore, adaptability not only directly predicts student engagement, but also affects student engagement through the chain mediation of positive academic emotion and negative academic emotion. The results contribute to the gap in knowledge regarding changes in students’ learning in response to the outbreak. This study further explains the internal mechanisms mediating the relationship between adaptability and student engagement. It may provide references for educational researchers and universities in dampening the negative effects of COVID-19 on students’ learning by improving their adaptability and developing positive academic emotions. (shrink)

This intervention study examined the effects of a career crafting training on physicians' perceptions of their job crafting behaviors, career self-management, and employability. A total of 154 physicians working in two hospitals in a large Dutch city were randomly assigned to a waitlist control group or an intervention group. Physicians in the intervention group received an accredited training on career crafting, including a mix of theory, self-reflection, and exercises. Participants developed four career crafting goals during the training, to work on (...) in the subsequent weeks, after which a coaching conversation took place over the phone. Physicians in the control group received no intervention. A pre- and post-test 8 weeks later measured changes in job crafting and career self-management and employability of 103 physicians that completed the pre- and post-test. RM ANOVAs showed that the intervention enhanced perceptions of career self-management and job crafting behavior to decrease hindering job demands. No support was found for the effect of the intervention on other types of job crafting and employability. This study offers novel insights into how career crafting can be enhanced through training, as this is the first empirical study to examine a career crafting intervention. HR managers can use the outcomes to develop tailored career policies and career development practices. (shrink)

Previous research with adults suggests that a catalog of minimally counterintuitive concepts, which underlies supernatural or religious concepts, may constitute a cognitive optimum and is therefore cognitively encoded and culturally transmitted more successfully than either entirely intuitive concepts or maximally counterintuitive concepts. This study examines whether children's concept recall similarly is sensitive to the degree of conceptual counterintuitiveness (operationalized as a concept's number of ontological domain violations) for items presented in the context of a fictional narrative. Seven- to nine-year-old children (...) who listened to a story including both intuitive and counterintuitive concepts recalled the counterintuitive concepts containing one (Experiment 1) or two (Experiment 2), but not three (Experiment 3), violations of intuitive ontological expectations significantly more and in greater detail than the intuitive concepts, both immediately after hearing the story and 1 week later. We conclude that one or two violations of expectation may be a cognitive optimum for children: They are more inferentially rich and therefore more memorable, whereas three or more violations diminish memorability for target concepts. These results suggest that the cognitive bias for minimally counterintuitive ideas is present and active early in human development, near the start of formal religious instruction. This finding supports a growing literature suggesting that diverse, early-emerging, evolved psychological biases predispose humans to hold and perform religious beliefs and practices whose primary form and content is not derived from arbitrary custom or the social environment alone. (shrink)

BackgroundThe increased risk of developing attention-deficit hyperactivity disorder (ADHD) in extremely preterm infants is well-documented. Better understanding of perinatal risk factors, particularly those that are modifiable, can inform prevention efforts.MethodsWe examined data from the Extremely Low Gestational Age Newborns (ELGAN) Study. Participants were screened for ADHD at age 10 with the Child Symptom Inventory-4 (N = 734) and assessed at age 15 with a structured diagnostic interview (MINI-KID) to evaluate for the diagnosis of ADHD (N = 575). We studied associations (...) of pre-pregnancy maternal body mass index (BMI), pregestational and/or gestational diabetes, maternal smoking during pregnancy (MSDP), and hypertensive disorders of pregnancy (HDP) with 10-year and 15-year ADHD outcomes. Relative risks were calculated using Poisson regression models with robust error variance, adjusted for maternal age, maternal educational status, use of food stamps, public insurance status, marital status at birth, and family history of ADHD. We defined ADHD as a positive screen on the CSI-4 at age 10 and/or meeting DSM-5 criteria at age 15 on the MINI-KID. We evaluated the robustness of the associations to broadening or restricting the definition of ADHD. We limited the analysis to individuals with IQ ≥ 70 to decrease confounding by cognitive functioning. We evaluated interactions between maternal BMI and diabetes status. We assessed for mediation of risk increase by alterations in inflammatory or neurotrophic protein levels in the first week of life.ResultsElevated maternal BMI and maternal diabetes were each associated with a 55–65% increase in risk of ADHD, with evidence of both additive and multiplicative interactions between the two exposures. MSDP and HDP were not associated with the risk of ADHD outcomes. There was some evidence for association of ADHD outcomes with high levels of inflammatory proteins or moderate levels of neurotrophic proteins, but there was no evidence that these mediated the risk associated with maternal BMI or diabetes.ConclusionContrary to previous population-based studies, MSDP and HDP did not predict ADHD outcomes in this extremely preterm cohort, but elevated maternal pre-pregnancy BMI, maternal diabetes, and perinatal inflammatory markers were associated with increased risk of ADHD at age 10 and/or 15, with positive interaction between pre-pregnancy BMI and maternal diabetes. (shrink)

BackgroundDepression and anxiety create a large health burden and increase the risk of premature mortality. Mental health screening is vital, but more sophisticated screening and monitoring methods are needed. The Ellipsis Health App addresses this need by using semantic information from recorded speech to screen for depression and anxiety.ObjectivesThe primary aim of this study is to determine the feasibility of collecting weekly voice samples for mental health screening. Additionally, we aim to demonstrate portability and improved performance of Ellipsis’ machine learning (...) models for patients of various ages.MethodsStudy participants were current patients at Desert Oasis Healthcare, mean age 63 years. Two non-randomized cohorts participated: one with a documented history of depression within 24 months prior to the study, and the other without depression. Participants recorded 5-min voice samples weekly for 6 weeks via the Ellipsis Health App. They also completed PHQ-8 and GAD-7 questionnaires to assess for depression and anxiety, respectively.ResultsProtocol completion rate was 61% for both groups. Use beyond protocol was 27% for Group Positive and 9% for Group Negative. The Ellipsis Health App showed an AUC of 0.82 for the combined groups when compared to the PHQ-8 and GAD-7 with a threshold score of 10. Performance was high for senior participants as well as younger age ranges. Additionally, many participants spoke longer than the required 5 min.ConclusionThe Ellipsis Health App demonstrated feasibility in using voice recordings to screen for depression and anxiety among various age groups and the machine learning models using Transformer methodology maintain performance and improve over LSTM methodology when applied to the study population. (shrink)

Limited research has been done among pregnant people participating in investigational drug trials. To enhance the ethical understanding of pregnant people’s perspectives on research participation, we sought to describe motives and risk perceptions of participants in a phase 1 trial of ledipasvir/sofosbuvir treatment for chronic Hepatitis C virus during pregnancy. Pregnant people with chronic HCV infection enrolled in an open-label, phase 1 study of LDV/SOF participated in semi-structured, in-depth interviews to explore their reasons for participation and experiences within the study. (...) Pregnant people took 12 weeks of LDV/SOF and were interviewed at enrollment and at the end of study. We recorded the interviews, transcribed them verbatim, coded them using NVivo software, and performed inductive thematic analysis. Nine women completed the study yielding 18 interview transcripts. We identified two themes regarding motives and one regarding risk perception. Motives— Women conceptualized study participation as part of the caregiving role they associate with motherhood; participating was viewed as an act of caregiving for their infants, their families, themselves, and other pregnant women with chronic HCV. Women also noted that they faced multiple barriers to treatment prior to pregnancy that created a desire to receive therapy through trial participation. Risk perception— Women acknowledged personal and fetal risk associated with participation. Acceptance of risk was influenced by women’s concepts of motherhood, preexisting knowledge of HCV and medical research, family members, intimate partners, or by the study design. Women enrolled in a phase 1 trial for chronic HCV therapy during pregnancy acknowledged risks of participation and were motivated by hopes for fetal and personal benefit and by lack of prenatal access to treatment. Ethical inclusion of pregnant people in research should acknowledge structural factors that contribute to vulnerability and data deficiencies for treatment in pregnancy. (shrink)

Research Ethics, Volume 18, Issue 2, Page 132-150, April 2022. Limited research has been done among pregnant people participating in investigational drug trials. To enhance the ethical understanding of pregnant people’s perspectives on research participation, we sought to describe motives and risk perceptions of participants in a phase 1 trial of ledipasvir/sofosbuvir treatment for chronic Hepatitis C virus during pregnancy. Pregnant people with chronic HCV infection enrolled in an open-label, phase 1 study of LDV/SOF participated in semi-structured, in-depth interviews to (...) explore their reasons for participation and experiences within the study. Pregnant people took 12 weeks of LDV/SOF and were interviewed at enrollment and at the end of study. We recorded the interviews, transcribed them verbatim, coded them using NVivo software, and performed inductive thematic analysis. Nine women completed the study yielding 18 interview transcripts. We identified two themes regarding motives and one regarding risk perception. Motives— Women conceptualized study participation as part of the caregiving role they associate with motherhood; participating was viewed as an act of caregiving for their infants, their families, themselves, and other pregnant women with chronic HCV. Women also noted that they faced multiple barriers to treatment prior to pregnancy that created a desire to receive therapy through trial participation. Risk perception— Women acknowledged personal and fetal risk associated with participation. Acceptance of risk was influenced by women’s concepts of motherhood, preexisting knowledge of HCV and medical research, family members, intimate partners, or by the study design. Women enrolled in a phase 1 trial for chronic HCV therapy during pregnancy acknowledged risks of participation and were motivated by hopes for fetal and personal benefit and by lack of prenatal access to treatment. Ethical inclusion of pregnant people in research should acknowledge structural factors that contribute to vulnerability and data deficiencies for treatment in pregnancy. (shrink)

ObjectiveParenting sensitivity and mutual parent-child attunement are key features of environments that support children’s learning and development. To-date, observational measures of these constructs have focused on children aged 2–6 years and are less relevant to the more sophisticated developmental skills of children aged 7–8 years, despite parenting being equally important at these ages. We undertook a rigorous process to adapt an existing observational measure for 7–8-year-old children and their parents. This paper aimed to: describe a protocol for adapting an existing (...) framework for rating parent-child interactions, determine variations in parents’ sensitive responding and parent-child mutual attunement by family demographics, and evaluate the psychometric properties of the newly developed measure.MethodParent-child dyads completed one home visit, including a free-play observation and parent questionnaire. Dyads were provided with three toy sets: LEGO® Classic Box, Classic Jenga®, and animal cards. The Coding of Attachment-Related Parenting was adapted for use with 7–8-year-old children, and rating procedures were streamlined for reliable use by non-clinician/student raters, producing the SCARP:7–8 Years. Trained staff rated video-recorded observations on 11 behaviors across two domains.ResultsData were available for 596 dyads. Consistently strong inter-rater agreement on the 11 observed behaviors was achieved across the 10-week rating period. Average ICCs were 0.77 for sensitive responding and 0.84 for positive mutuality. These domains were found to be related but distinct constructs. For both domains, average ratings were strongly associated with the main toy used during the observation. Adjusted multivariate linear regression models revealed that less sensitive responding was associated with younger parent, male parent, non-English speaking background, and greater neighborhood disadvantage. Construct validity was demonstrated using six parent-reported psychosocial and parenting measures.ConclusionThe SCARP: 7–8 Years shows promise as a reliable and valid measure of parent-child interaction in the early school years. Toy selection for direct observation should be considered carefully in research and practice settings. (shrink)

If the world itself is metaphysically indeterminate in a specified respect, what follows? In this paper, we develop a theory of metaphysical indeterminacy answering this question.

Classic analysis of the subject and the development of personal probability; one of the greatest controversies in modern statistcal thought.

Since Mueller’s 1958 article calling Hegelian dialectics a “legend,” it has been fashionable to deny that Hegel used thesis-antithesis-synthesis dialectics. But in truth, Hegel’s Phenomenology of Spirit has 28 dialectics hidden on four outline levels, and The Philosophy of History has 10 more on three outline levels. In Phenomenology’s macrodialectic, Hegel’s nonsupernatural Spirit–all reality, everything in the universe, including man and artificial objects–advances from unconscious + union (thesis) to conscious + separation (antithesis) to a synthesis of conscious (from the antithesis) (...) + union (from the thesis). Previous interpretations of Phenomenology have missed this dialectic: they have assumed that Spirit’s journey begins with consciousness, whereas the journey actually begins in the primordial state of nature, before man arrives and provides Spirit with its Mind (the collective mind of man). Mind then misperceives itself as a multitude of separate alien “objects”–things other than itself. The macrodialectic and all other dialectics are based on Christianity’s Johannine separation-and-return mythology; all Hegelian dialectics separate from a concept in the thesis, going to that something’s opposite (antithesis), and then return to the thesis concept. Thus, in Hegel’s master-and-slave dialectic (God = master, man = slave), man advances from potential + freedom to actual + bondage (religiosity) to actual + freedom (atheism). Only Marx and Tillich understood Hegelian dialectics. Marx’s basic dialectic (one of four) saw history separating from and returning to Communism, going from communal ownership + poverty (primitive communism, or gens) to private ownership + wealth (slavery, feudalism, capitalism) to communal ownership + wealth (final communism). Tillich’s basic dialectic (one of many) separates from and returns to God, advancing from Yes to God + Yes to supernaturalism (theism) to No to God + No to supernaturalism (atheism) to Yes to God + No to supernaturalism (humanism: humanity is the nonsupernatural “God above the God of theism”). (shrink)

This chapter is an investigation of the morality of medical deportation, the practice of returning undocumented migrants, despite their ill health and/or injuries, to their countries of origin. In Sect. 16.1, I look more closely at the nature of medical deportation. In Sect. 16.2, I argue that understanding the morality of medical deportation requires nonideal theory. In Sect. 16.3, I outline contractualism as a nonideal theory. In Sect. 16.4, I apply contractualism to medical deportation and make the case that, first, (...) there are in principle some cases in which medical deportation is morally permissible but, second, the standards that must be met in cases of morally permissible medical deportation are very high. In Sect. 16.5, I consider stakeholders other than the patient and the medical care facility and examine the ways in which effects on them might render medical deportation morally impermissible. I conclude that real-world cases of morally permissible medical deportation are rare at best, and there is little prospect of this situation changing. (shrink)