Background: This article describes the types of community‐wide benefits provided by investigators conducting public health research in South Asia as well as their self‐reported reasons for providing such benefits.Methods: We conducted 52 in‐depth interviews to explore how public health investigators in low‐resource settings make decisions about the delivery of ancillary care to research subjects. In 39 of the interviews respondents described providing benefits to members of the community in which they conducted their study. We returned to our narrative dataset to (...) find answers to two questions: What types of community‐wide benefits do researchers provide when conducting public health intervention studies in the community setting, and what reasons do researchers give when asked why they provided community‐wide benefits?Findings: The types of community‐wide benefits delivered were directed to the health and well‐being of the population. The most common types of benefits delivered were the facilitation of access to health care for individuals in acute medical need and emergency response to natural disasters. Respondents' self‐reported reasons when asked why they provided such benefits fell into 2 general categories: intrinsic importance and instrumental importance. (shrink)

Researchers conducting large community-based studies among underserved populations may collect data on health conditions that are little-acknowledged in the local setting, and for which there are few if any services for referral of participants who need follow-up diagnosis and care. In the design and planning of studies for such settings, investigators and research ethics committees may struggle to determine what constitutes effective referral and whether it is reasonably available. We offer a guiding framework for referral planning, informed by our experiences (...) of research in the field and of service on research ethics committees, to support evaluation of local referral resources and consideration of the benefits, burdens and risks of referral in the local setting. The framework addresses both the impact of referral on the well-being of the people who would be referred and the impact that referral of study participants would have on local people outside the study. We use a sustained discussion of three field-based case examples to illustrate the ethical concerns at issue and to demonstrate the use of the referral planning framework. (shrink)

We sought to assess formally the extent to which different control and elimination strategies for human African trypanosomiasis Trypanosoma brucei gambiense would exacerbate or alleviate experiences of societal disadvantage that traditional economic evaluation does not take into account. Justice-enhanced cost-effectiveness analysis is a normative approach under development to address social justice considerations in public health decision-making alongside other types of analyses. It aims to assess how public health interventions under analysis in comparative evaluation would be expected to influence the clustering (...) of disadvantage across three core dimensions of well-being: agency, association and respect. As a case study to test the approach, we applied it to five strategies for Gambiense HAT control and elimination, in combination with two different other evaluations: a cost-effectiveness analysis and a probability of elimination analysis. We have demonstrated how JE-CEA highlights the ethical importance of adverse social justice impacts of otherwise attractive options and how it indicates specific modifications to policy options to mitigate such impacts. JE-CEA holds promise as an approach to help decision makers and other stakeholders consider social justice more fully, explicitly and systematically in evaluating public health programs. (shrink)

This article proposes an action guide to making decisions regarding the ethical allocation of resources that affect access to healthcare services offered by community-based healthcare organizations. Using the filter of empirical data from a study of decision making in two community-based healthcare organizations, we identify potentially relevant conceptual guidance from a review of frameworks and action guides in the public health, health policy, and organizational ethics literature. We describe the development of this action guide. We used data from a prior (...) empirical study of the values that influence decision making about the allocation of resources in particular types of community-based healthcare organizations. We evaluated, organized, and specified the conceptual guidance we found in 14 frameworks for ethical decision making. The result is an action guide that includes four domains that are relevant to the context of the decision to be made, eight domains that are relevant to the process of the decision to be made, and 15 domains that are relevant to the criteria of the decision to be made. We demonstrate the potential use of this action guide by walking through an illustrative resource allocation decision. The action guide provides community-based healthcare organizations with a conceptually grounded, empirically informed framework for ethical decision making. (shrink)

Health researchers working in low-resource settings routinely encounter serious unmet health needs for which research participants have, at best, limited treatment options through the local health system (Taylor, Merritt, and Mullany 2011). A recent case discussion features a study conducted in Bamako, Mali (Dickert and Wendler 2009). The study objective was to see whether children with severe malaria develop pulmonary hypertension in order to improve the general understanding of morbidity and mortality associated with malaria. In the study team's interactions (...) with participating children, they encountered not only malaria but also "eye infections, upper respiratory tract illnesses, rashes, pericardial effusions," .. (shrink)

Ethics guidance increasingly recognises that researchers and sponsors have obligations to consider provisions for post-trial access to interventions that are found to be beneficial in research. Yet, there is little information regarding whether and how such plans can actually be implemented. Understanding practical experiences of developing and implementing these plans is critical to both optimising their implementation and informing conceptual work related to PTA. This viewpoint is informed by experiences with developing and implementing PTA plans for six large-scale multicentre HIV (...) prevention trials supported by the HIV Prevention Trials Network. These experiences suggest that planning and implementing PTA often involve challenges of planning under uncertainty and confronting practical barriers to accessing healthcare systems. Even in relatively favourable circumstances where a tested intervention medication is approved and available in the local healthcare system, system-level barriers can threaten the viability of PTA plans. The aggregate experience across these HIV prevention trials suggests that simply referring participants to local healthcare systems for PTA will not necessarily result in continued access to beneficial interventions for trial participants. Serious commitments to PTA will require additional efforts to learn from future approaches, measuring the success of PTA plans with dedicated follow-up and further developing normative guidance to help research stakeholders navigate the complex practical challenges of realising PTA. (shrink)

Background: This article describes the types of community-wide benefits provided by investigators conducting public health research in South Asia as well as their self-reported reasons for providing such benefits. Methods: We conducted 52 in-depth interviews to explore how public health investigators in low-resource settings make decisions about the delivery of ancillary care to research subjects. In 39 of the interviews respondents described providing benefits to members of the community in which they conducted their study. We returned to our narrative dataset (...) to find answers to two questions: What types of community-wide benefits do researchers provide when conducting public health intervention studies in the community setting, and what reasons do researchers give when asked why they provided community-wide benefits? Findings: The types of community-wide benefits delivered were directed to the health and well-being of the population. The most common types of benefits delivered were the facilitation of access to health care for individuals in acute medical need and emergency response to natural disasters. Respondents' self-reported reasons when asked why they provided such benefits fell into 2 general categories: intrinsic importance and instrumental importance. (shrink)

Biomedical research is increasingly globalized with ever more research conducted in low and middle-income countries. This trend raises a host of ethical concerns and critiques. While community engagement has been proposed as an ethically important practice for global biomedical research, there is no agreement about what these practices contribute to the ethics of research, or when they are needed.

This paper travels into what De Sardan calls the unexplored "social mechanisms of corruption" . One of the great contemporary assignments for ethics, sociology and ethnography scholarships is accounting for the enormous distance between judicial, political and donor condemnation of African "corruption" on one hand and their frequency, banalisation and outright cultural legitimacy by ordinary people on the other. To do this the paper is set within the unremitting colonialism that is the African tragedy. It depicts the current interventions by (...) the West into African "corruption" as the third wave of colonialism, and anticipates two further waves. Using the outlooks of a post-colonial ethnography I explore the western takeover of the management of African corruption and consider the motives that drive this new colonialism. (shrink)

The Moral Psychology Handbook is a contribution to a relatively new genre of philosophical writing, the “handbook.” In the first section, I comment on an expectation about handbooks, namely that handbooks contain works representative of a field, and raise concerns about The Moral Psychology Handbook in this regard. In the rest of the article I comment in detail on two Handbook articles, “Moral Motivation” by Timothy Schroeder, Adina Roskies, and Shaun Nichols, and “Character” by Maria W. Merritt, John (...) M. Doris, and Gilbert Harman. Both articles illustrate the perils as well as the promise of reliance on empirical studies for philosophers who work in moral psychology. (shrink)

In this paper I examine and reply to a deflationary challenge brought against virtue ethics. The challenge comes from critics who are impressed by recent psychological evidence suggesting that much of what we take to be virtuous conduct is in fact elicited by narrowly specific social settings, as opposed to being the manifestation of robust individual character. In answer to the challenge, I suggest a conception of virtue that openly acknowledges the likelihood of its deep, ongoing dependence upon particular social (...) relationships and settings. I argue that holding this conception will indeed cause problems for some important strands of thought in virtue ethics, most notably in the tradition of Aristotle's Nicomachean Ethics. But an approach to virtue ethics modeled on David Hume's treatment of virtue and character in A Treatise of Human Nature promises to escape these problems. (shrink)

I examine the Aristotelean conception of virtuous character as firm and unchangeable, a normative ideal endorsed in the currently influential, broadly Aristotelean school of thought known as 'virtue ethics'. Drawing on central concepts of Aristotle's Nicomachean Ethics, I offer an account of how this ideal is supposed to be realized psychologically. I then consider present-day empirical findings about relevant psychological processes, with special attention to interpersonal processes. The empirical evidence suggests that over time, the same interpersonal processes that sometimes help (...) to sustain character may also disrupt it, even among agents who have the right values in principle. Fortunately, the evidence also suggests some remedial measures. An important philosophical measure, I conclude, is for advocates of virtue ethics to address agents' psychological need for a systematic decision procedure that will focus attention primarily on substantive ethical considerations, rather than characterological assessment. (shrink)

Max Weber's fragmentary writings on social status suggest that differentiation on this basis should disappear as capitalism develops. However, many of Weber's examples of status refer to the United States, which Weber held to be the epitome of capitalist development. Weber hints at a second form of status, one generated by capitalism, which might reconcile this contradiction, and later theorists emphasize the continuing importance of status hierarchies. This article argues that such theories have missed one of the most important forms (...) of contemporary status: celebrity. Celebrity is an omnipresent feature of contemporary society, blazing lasting impressions in the memories of all who cross its path. In keeping with Weber's conception of status, celebrity has come to dominate status “honor,” generate enormous economic benefits, and lay claim to certain legal privileges. Compared with other types of status, however, celebrity is status on speed. It confers honor in days, not generations; it decays over time, rather than accumulating; and it demands a constant supply of new recruits, rather than erecting barriers to entry. (shrink)

This authoritative new book details the most recent advances in clinical neuroscience, from neurogenetics to the study of consciousness.

Directional deep brain stimulation contacts provide greater spatial flexibility for therapy than traditional ring-shaped electrodes, but little is known about longitudinal changes of impedance and orientation. We measured monopolar and bipolar impedance of DBS contacts in 31 patients who underwent unilateral subthalamic nucleus deep brain stimulation as part of a randomized study. At different follow-up visits, patients were assigned new stimulation configurations and impedance was measured. Additionally, we measured the orientation of the directional lead during surgery, immediately after surgery, and (...) 1 year later. Here we contrast impedances in directional versus ring contacts with respect to local anatomy, active stimulation contact, and over time. Directional contacts display larger impedances than ring contacts. Impedances generally increase slightly over the first year of therapy, save for a transient decrease immediately post-surgery under general anesthesia during pulse generator placement. Local impedances decrease at active stimulation sites, and contacts in closest proximity to internal capsule display higher impedances than other anatomic sites. DBS leads rotate slightly in the immediate postoperative period but otherwise remain stable over the following year. These data provide useful information for setting clinical stimulation parameters over time. (shrink)

The volume brings together ancient-philosophy specialists and Kant scholars to advance our understanding of the significance of Stoicism for Immanuel Kant's ethical thought. Kant and Stoic Ethics -/- Contents: -/- Introduction -/- 1 Ethical Formulae in Ancient Stoicism — Brad Inwood -/- 2 Duties and Permissible Actions in the Early Stoics and Kant — Iakovos Vasiliou -/- 3 The Stoics and Kant on the Motive of Duty — Jacob Klein -/- 4 Kant on the Unity and Plurality of the Virtues (...) — Katja Maria Vogt -/- 5 Perfection and Morality — Stephen Engstrom -/- 6 The Stoical Sublime — I.S. Blecher 7 Kant’s Rejection of Stoic Eudaimonism — Michael Vazquez -/- 8 Life as a Game of Skill? Kant and the Stoics about the Results of Human Agency — Jens Timmermann -/- 9 Living in accordance with Nature: Kant and Stoicism — Paul Guyer -/- 10 On the Relationship between Orientation and Agency: From the Stoics’ Oikeiōsis to Kant’s Orientierung — Alix Cohen -/- 11 “Everyone has a price at which he sells himself”: Epictetus and Kant on Self-respect — Melissa Merritt -/- 12 Anger Reinstated: Stoics and Kant on Anger — Nancy Sherman 13 Kant’s Philosophy of History as Stoic Consolation — Rachel Zuckert -/- Bibliography Index . (shrink)

Discussions about nineteenth-century African American ethnology tend to focus only on black male thinkers. In the nineteenth century, ethnology was the study of difference among humans and often used racist science to justify discrimination against blacks. Black woman thinker Maria W. Stewart made important contributions to ethnology but remains understudied. I argue that Stewart is a black feminist ethnologist because she aligns herself with her black male interlocutors on the core points of ethnology. Yet Stewart adds a distinctly black (...) feminist position to the conversation. By focusing on Stewart's speech “An Address Delivered to the African Masonic Hall”, I show that she concurs with her contemporaries that black people are inherently great because of their genealogical connection to Africa. Stewart also agrees that the inherent greatness of blacks establishes their claim to sociopolitical rights. I argue that Stewart's call for racial unity makes her a proto-black feminist and is a unique feature of her contribution to African American ethnology. Stewart's call demands that white people be held responsible for the harm that they have caused to blacks, which can be remedied by the races coming together on equal footing. (shrink)

The current assessment of behaviors in the inventories to diagnose autism spectrum disorders (ASD) focus on observation and discrete categorizations. Behaviors require movements, yet measurements of physical movements are seldom included. Their inclusion however, could provide an objective characterization of behavior to help unveil interactions between the peripheral and the central nervous systems. Such interactions are critical for the development and maintenance of spontaneous autonomy, self-regulation and voluntary control. At present, current approaches cannot deal with the heterogeneous, dynamic and stochastic (...) nature of development. Accordingly, they leave no avenues for real-time or longitudinal assessments of change in a coping system continuously adapting and developing compensatory mechanisms. We offer a new unifying statistical framework to reveal re-afferent kinesthetic features of the individual with ASD. The new methodology is based on the non-stationary stochastic patterns of minute fluctuations (micro-movements) inherent to our natural actions. Such patterns of behavioral variability provide re-entrant sensory feedback contributing to the autonomous regulation and coordination of the motor output. From an early age, this feedback supports centrally driven volitional control and fluid, flexible transitions between intentional and spontaneous behaviors. We show that in ASD there is a disruption in the maturation of this form of proprioception. Despite this disturbance, each individual has unique adaptive compensatory capabilities that we can unveil and exploit to evoke faster and more accurate decisions. Measuring the kinesthetic re-afference in tandem with stimuli variations we can detect changes in their micro-movements indicative of a more predictive and reliable kinesthetic percept. Our methods address the heterogeneity of ASD with a personalized approach grounded in the inherent sensory-motor abilities that the individual has already developed. (shrink)

Corruption involves greed, money, and risky decision-making. We explore the love of money, pay satisfaction, probability of risk, and dishonesty across cultures. Avaricious monetary aspiration breeds unethicality. Prospect theory frames decisions in the gains-losses domain and high-low probability. Pay dissatisfaction (in the losses domain) incites dishonesty in the name of justice at the individual level. The Corruption Perceptions Index, CPI, signals a high-low probability of getting caught for dishonesty at the country level. We theorize that decision-makers adopt avaricious love-of-money aspiration (...) as a lens and frame dishonesty in the gains-losses domain (pay satisfaction-dissatisfaction, Level 1) and high-low probability (CPI, Level 2) to maximize expected utility and ultimate serenity. We challenge the myth: Pay satisfaction mitigates dishonesty across nations consistently. Based on 6500 managers in 32 countries, our cross-level three-dimensional visualization offers the following discoveries. Under high aspiration conditions, pay dissatisfaction excites the highest- (third-highest) avaricious justice-seeking dishonesty in high (medium) CPI nations, supporting the certainty effect. However, pay satisfaction provokes the second-highest avaricious opportunity-seizing dishonesty in low CPI entities, sustaining the possibility effect—maximizing expected utility. Under low aspiration conditions, high pay satisfaction consistently leads to low dishonesty, demonstrating risk aversion—achieving ultimate serenity. We expand prospect theory from a micro and individual-level theory to a cross-level theory of monetary wisdom across 32 nations. We enhance the S-shaped Curve to three 3-D corruption surfaces across three levels of the global economic pyramid, providing novel insights into behavioral economics, business ethics, the environment, and responsibility. (shrink)

Beyond the observation that both speakers and listeners rapidly inspect the visual targets of referring expressions, it has been argued that such gaze may constitute part of the communicative signal. In this study, we investigate whether a speaker may, in principle, exploit listener gaze to improve communicative success. In the context of a virtual environment where listeners follow computer-generated instructions, we provide two kinds of support for this claim. First, we show that listener gaze provides a reliable real-time index of (...) understanding even in dynamic and complex environments, and on a per-utterance basis. Second, we show that a language generation system that uses listener gaze to provide rapid feedback improves overall task performance in comparison with two systems that do not use gaze. Aside from demonstrating the utility of listener gaze in situated communication, our findings open the door to new methods for developing and evaluating multi-modal models of situated interaction. (shrink)

This book seeks to resolve an issue that has divided psychoanalysts and other scholars of aggression for decades, namely the nature of aggression. The work expands and unifies the Freudian drive-based explanation of aggression into contemporary psychoanalytic theory and practice and brings Freudian theory into the 21st Century.

This book seeks to resolve an issue that has divided psychoanalysts and other scholars of aggression for decades, namely the nature of aggression. The work expands and unifies the Freudian drive-based explanation of aggression into contemporary psychoanalytic theory and practice and brings Freudian theory into the 21st Century.

Given its non-invasive nature, there is increasing interest in the use of transcutaneous vagus nerve stimulation across basic, translational and clinical research. Contemporaneously, tVNS can be achieved by stimulating either the auricular branch or the cervical bundle of the vagus nerve, referred to as transcutaneous auricular vagus nerve stimulation and transcutaneous cervical VNS, respectively. In order to advance the field in a systematic manner, studies using these technologies need to adequately report sufficient methodological detail to enable comparison of results between (...) studies, replication of studies, as well as enhancing study participant safety. We systematically reviewed the existing tVNS literature to evaluate current reporting practices. Based on this review, and consensus among participating authors, we propose a set of minimal reporting items to guide future tVNS studies. The suggested items address specific technical aspects of the device and stimulation parameters. We also cover general recommendations including inclusion and exclusion criteria for participants, outcome parameters and the detailed reporting of side effects. Furthermore, we review strategies used to identify the optimal stimulation parameters for a given research setting and summarize ongoing developments in animal research with potential implications for the application of tVNS in humans. Finally, we discuss the potential of tVNS in future research as well as the associated challenges across several disciplines in research and clinical practice. (shrink)

This book offers both the theoretical background behind the minority effect, teachers' personal experiences as they experienced being a minority, and their analyses and insights for teaching diverse learners. This book uses real-life experiences of diverse people to illustrate that, if not understood and addressed, situational minorities at school or work are unlikely to perform at their highest potentials.