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)

Analyses of between-sex differences have provided a powerful starting point for evolutionarily informed work on human sexuality. This early work set the stage for an evolutionary analysis of within-sex differences in human sexuality. A comprehensive theory of human sexual strategies must address both between-sex differences and within-sex differences in evolved psychology and manifest behavior.

In the late seventies at the Centre for Computers and Law research was started to find means for supporting lawyers' work with the aid of a computer. The research project was called JURICAS. In 1982 a prototype of a JURICAS system was produced and since 1986 seven advisory packages have been brought out on the market in the Netherlands. These packages consist of two main parts, an author's shell and an advisory program. The user cannot make changes to either the (...) shell or the program.In 1988 the JURICAS author's shell became commercially available. A buyer has to make his own advisory program and fill it with his expertise to produce an advisory package. To facilitate the designing, the typing in and the testing of a package a number of utility programs are included in the author's system. (shrink)

Female coital orgasm may be an adaptation for preferentially retaining the sperm of males with “good genes.” One indicator of good genes may be physical attractiveness. Accordingly, R. Thornhill, S. W. Gangestad, and R. Comer (1995) found that women mated to more attractive men reported an orgasm during a greater proportion of copulations than did women mated to less attractive men. The current research replicates this finding, with several design variations. We collected self-report data from 388 women residing in the (...) United States or in Germany. Results support the hypothesis that women mated to more attractive men are more likely to report an orgasm at the most recent copulation than are women mated to less attractive men, after statistically controlling for several key variables. Discussion addresses (a) the inability of the present research to specify the causal link between female orgasm and male attractiveness and (b) the proactive nature of female sexuality documented in recent research guided by an evolutionary perspective. (shrink)

Young men are more distressed by a partner’s sexual infidelity, whereas young women are more distressed by a partner’s emotional infidelity. The present research investigated (a) whether the sex difference in jealousy replicates in an older sample, and (b) whether younger people differ from older people in their selection of the more distressing infidelity scenario. We presented forced-choice dilemmas to 202 older people (mean age = 67 years) and to 234 younger people (mean age = 20 years). The sex difference (...) replicated in the older sample. In addition, older women were less likely than younger women to select a partner’s emotional infidelity as more distressing than a partner’s sexual infidelity. Discussion offers directions for future work on sex differences and age differences in jealousy. (shrink)

Patient safety has only recently been subjected to wide-spread systematic study. Healthcare differs from other high risk industries in being more diverse and multi-contextual, and less certain and regulated. Also many patient safety problems are low-frequency events associated with many, varied contributing factors. The subject of this paper is the epistemology of patient safety (the science of the method of finding out about patient safety). Patient safety research is considered here on the background of a risk management framework which requires (...) researchers to: • Understand the context - as a subset of healthcare quality, services and systems research, with technical and human behavioural (cultural) components and a range of external and internal organisational influences, a wide range of research disciplines is necessary • Identify the risks - identify the things that go wrong and the frequency and nature of different types of incidents from sources such as medical record review, observational studies, audit, incident and medico-legal reports • Analyse the risks - deconstruct the things that go wrong, identifying contributing factors and trying to detect trends and patterns in contributing factors, detection, mitigation factors, ameliorating factors and actions taken to reduce risk • Evaluate the risks - decide on priorities, identifying preventive and corrective strategies and judging the risk- and cost-benefit of potential corrective strategies such as standardisation or simplification of a process or device • Manage the risk - evaluate and scope preventive and/or corrective strategies and then implement these, or place the problem on a risk register pending solution, or accept that what is needed is unaffordable • Communicate and consult - use interactive sessions, audit, on-going feedback, reminders and patient mediated prompts • Monitor and review the state of the problem - get baseline trends and patterns so that changes can be tracked and properly attributed to an intervention A hierarchy of levels of evidence has been proposed for clinical research and we argue that insufficient weighting has been given to lower ranked levels of research and to qualitative research, although critical interpretive synthesis is now gaining acceptance in mainstream thinking (e.g. by the Cochrane Collaboration). Fundamental challenges remain including how to grasp the elusive concept of patient safety, how to quantify, characterise and cost the problems, how to judge the extent to which harm can be attributed to errors, violations or system failures, how to identify contributing factors and the extent to which they can be implicated, how to judge whether incidents or their precursors are preventable, how to generate strong evidence to make healthcare safer and how to translate research into practice. Future directions include addressing the mundane as well as rare, dramatic events, and developing further research in non-hospital settings and in developing countries. In summary, a mixture of qualitative and quantitative methods, using information from all available data sources and combining retrospective, real time and prospective study designs, is necessary to address some of the more difficult patient safety problems. (shrink)

SETTING: Previous health policies in South Africa neglected the teaching of ethics and human rights to health professionals. In April 1995, a pilot course was run at the University of Cape Town in which the ethical dimensions of human rights issues in South Africa were explored. OBJECTIVES: To compare knowledge and attitudes of participating students with a group of control students. DESIGN: Retrospective cohort study. SUBJECTS: Seventeen fourth-year medical students who participated in the course and 13 control students from the (...) same class, matched for gender. INTERVENTIONS: Students participated in a one-week module on ethics and human rights. Five months after the course had been run, students completed a semi-structured questionnaire exploring their knowledge and attitudes with regards to ethics and human rights issues. MAIN OUTCOME MEASURES: Knowledge scores, attitude scores and various individual indicators of attitude. RESULTS: Clear benefits for overall knowledge score, for four out of five individual knowledge questions and for one of the attitude questions, were demonstrated. Participating students also appeared to be more convinced of the need for teaching on the ethical dimensions of human rights at postgraduate level and that such teaching should also be integrated in the curriculum. The low response rate amongst controls may have selected students who were more socially conscious, thereby leading to an underestimate of the true impact of the course. CONCLUSION: The evaluation indicates clear benefits of the course for undergraduate students, and supports arguments for the inclusion of such courses in the training of health professionals. This is particularly important given the challenges posed by the Truth and Reconciliation Commission to the health professions to address past complicity in human rights abuses through reorientation of medical training in South Africa. (shrink)

BackgroundResearchers are working to identify dynamic factors involved in the shift from behavioral initiation to maintenance—factors which may depend on behavioral complexity. We test hypotheses regarding changes in factors involved in behavioral initiation and maintenance and their relationships to behavioral frequency over time, for a simple vs. complex behavior.MethodsData are secondary analyses from a larger RCT, in which young adult women, new to both behaviors, were randomly assigned to take daily calcium or to go for a daily, brisk walk, for (...) 4-weeks. Factors were measured weekly. Multi-level modeling evaluated their change over time. Bivariate correlations and multiple regression determined the relationships between factors and the subsequent-week behavioral frequency.FindingResults were partly in-line with expectations, in that individuals’ intentions and self-efficacy predicted initial behavioral engagement for both behaviors, and habit strength increased for both behaviors, becoming a significant predictor of behavioral frequency in later weeks of the study in some analyses. However, results depended on whether the outcome was self-reported or objectively measured and whether analyses were bivariate or multivariate.DiscussionThe factors theorized to play a role in behavioral maintenance started to develop, but only habit strength predicted behavioral frequency by study-end, for both behaviors. Differences in initiation and maintenance between behaviors of differing complexity may not be as stark as theorized, but longer follow-up times are required to evaluate maintenance factors. (shrink)

Here, we report on a quasi-experimental study to explore the applicability and perceived benefits of the CRAFT program, which is based on mindfulness, yoga, positive psychology, and emotional intelligence, to improve higher education student musicians’ health and well-being during the lockdown. A subset of student musicians at a Higher Conservatory of Music in Spain followed the CRAFT program during the academic year 2019/2020, 1 h per week as part of their curriculum. Students enrolled in CRAFT-based elective subjects formed the CRAFT (...) program group, while other students represented the control group. The onset of the national lockdown elicited by the COVID-19 pandemic occurred halfway through the program, which was subsequently delivered in an online format. We administered an online survey to explore the effect that the exposure to the CRAFT program had in terms of how participants dealt with various health and well-being concerns arising from the COVID-19 lockdown. There was a significantly higher proportion of proactive participants in the CRAFT program group, 92%, than in the control group, 58%, in terms of implementing practices to improve their health and well-being during the lockdown. Additionally, significantly more participants acknowledged perceived benefits from their practices in the CRAFT program group, 78%, than in the control group, 52%. Among proactive participants, yoga/meditation was the most implemented in the CRAFT program group, followed by exercise, and other yoga/meditation practices, whereas in the control group, exercise and Alexander technique-based practices were the most applied. In the CRAFT program group, the highest rate of perceived benefits was from yoga/meditation CRAFT-based practices, 51%, followed by exercise, 32%, and other yoga/meditation practices, 27%, whereas in the control group, benefits were reported by 29% of exercising participants and 16% for those having practiced the Alexander technique. A similar pattern was observed when excluding participants with previous yoga/meditation experience. This study revealed how participants can independently apply learned skills from the CRAFT program in response to a naturally occurring life event of unprecedented global impact, suggesting that previous exposure to mindfulness and yoga is likely to have a beneficial effect on how young adults react towards exceptionally stressful conditions. (shrink)

On reviewing the literature regarding acceptance and trust in human-robot interaction (HRI), there are a number of open questions that needed to be addressed in order to establish effective collaborations between humans and robots in real-world applications. In particular, we identified four principal open areas that should be investigated to create guidelines for the successful deployment of robots in the wild. These areas are focused on: (1) the robot’s abilities and limitations; in particular when it makes errors with different severity (...) of consequences, (2) individual differences, (3) the dynamics of human-robot trust, and (4) the interaction between humans and robots over time. In this paper, we present two very similar studies, one with a virtual robot with human-like abilities, and one with a Care-O-bot 4 robot. In the first study, we create an immersive narrative using an interactive storyboard to collect responses of 154 participants. In the second study, 6 participants had repeated interactions over three weeks with a physical robot. We summarise and discuss the findings of our investigations of the effects of robots’ errors on people’s trust in robots for designing mechanisms that allow robots to recover from a breach of trust. In particular, we observed that robots’ errors had greater impact on people’s trust in the robot when the errors were made at the beginning of the interaction and had severe consequences. Our results also provided insights on how these errors vary according to the individuals’ personalities, expectations and previous experiences. (shrink)

Preterm birth is defined as delivery occurring before 37 weeks gestation.1 Infants born prematurely have increased risks of morbidity and mortality throughout life, especially during the first year. These risks increase as the gestational age at birth decreases.2 Additionally, there are significant racial and ethnic differences in preterm birth rates. In 2022, the rate of preterm birth among non-Hispanic black women was approximately 50% higher than that observed in non-Hispanic white women.1 The outcomes for these infants are also disparate–preterm (...) birth and low birth weight are the second-leading causes of infant mortality (deaths before 1 year of age). Notably, among preterm neonates, infants born to non-Hispanic black women have a mortality rate more than double that of infants born to non-Hispanic white mothers.3 Importantly, there is a small but significant group of neonates that can be classified as severely premature (those born <28 weeks). Infants born before 28 weeks have varied and uncertain outcomes. While this group accounts for only 0.4% of preterm births, it also accounts for 40% of deaths among preterm neonates.4 As noted by Romanis and Adkins, the advent of artificial amnion and placenta technology (AAPT) holds promise for its potential to address the physiologic complications and mortality risks of extreme prematurity by introducing amniotic substitutes that mimic in vivo placental oxygenation and substrate delivery. In contrast …. (shrink)

This year, a new subject, Ethics, will be introduced for fifth- and sixth-graders. It is a cultural course of a secular nature, it lacks religious education. Children of ten to twelve years will be introduced to moral norms and universal values, will try to help determine their own life position. The authors of the program and textbooks expect that school ethics lessons written once a week will teach children to be friendly, polite, attentive and responsive to other people, make our (...) children more tolerant and compassionate, and teach morality and immorality. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“Please Help Me”Rebecca L. VolpeTwo–year–old Jay was born prematurely at 26 weeks gestation, addicted to opiates. After several months in the Neonatal ICU, he was sent home, ventilator–dependent but with a high likelihood of survival and a low chance of severe, lasting disability. When Jay was 1½, he had a cardiopulmonary arrest at home. The parents of children who are on ventilators at home receive extensive education and (...) training about how to respond to something like an arrest. They are taught that a quick response is often critical to their child’s long–term prognosis. And yet, Jay’s parents took such a long time to respond to his code that Jay now has severe hypoxic ischemic encephalopathy: his brain was deprived of oxygen for so long that he has no higher cortical function, and will never think, speak, walk, or play.Currently, Jay is ventilator–dependent and has a very poor prognosis. Jay goes back and forth between a nursing home and the hospital. During one of his many hospitalizations, the ICU team decided to call an ethics consultation, because they felt that continued aggressive intervention was no longer in Jay’s best interests. I was the person on the other end of the line when the medical team called. After having a brief conversation with the attending physician, I left my office and walked to the Pediatric ICU to visit Jay. I arrived at the bedside—really just a large crib—and saw a baby with dark hair lying flat on his back. His tongue was swollen and protruding from his mouth, his eyes were puffy and closed, and his limbs were limp. On his belly was a piece of paper with the words, “BECKY PLEASE HELP ME” typed in huge, bold font. I looked up, into the eyes of the attending physician and said, “Did you type that?” The physician nodded yes. Much could be said about this physician’s behavior. But the bottom line—from a clinical perspective, at least—is that this ICU team was desperate, and that they had significant expectations that I would be able to help them.I began the work of the consultation. I reviewed the medical record, spoke with members of the treating team, and set up a time to talk to the family. During the family meeting, I learned that Jay’s parents wanted to continue to treat aggressively, and that they believed it was not their place to decide when it was their son’s time to die. That was [End Page 122] God’s decision. They could not fathom removing interventions that were maintaining their son’s life. They acknowledged that his quality of life was not high, but, still, it was life.The preferences of the treating team were in stark contrast to the parents’ preferences. The neurologists believed Jay did not have the capacity to experience physical pain, but the ICU team believed that continuing to treat Jay was cruel. Although the ICU team acknowledged that Jay was probably not suffering, they noted that we could not know for sure, and that sometimes Jay grimaced and withdrew—signs that are often interpreted as suffering. The ICU team also argued that given all the sick children in the world, and the scarcity of healthcare resources, it didn’t make sense to invest hundreds of thousands of dollars into prolonging Jay’s life. Additionally, they discovered that Jay had osteopenia (weak, brittle bones)—which was causing multiple bone fractures. The ICU team anguished over the thought of Jay’s small, soft bones continuing to break despite their best efforts.The bioethicist in me knows that, as long as the patient isn’t suffering and the parents aren’t demanding futile interventions (they weren’t), our role as providers was not to judge the parents’ value system. I told the ICU team over and over that different people place different value on Jay’s type of life, and that it wasn’t for us to tell them that their value structure was wrong. I talked with other members of the clinical ethics consultation service. Then I brought the case to the entire institutional... (shrink)

The present study investigated the effect of Parkinson’s disease (PD) on prospective memory (PM) tasks by varying the emotional content of the PM actions. Twenty-one older adults with PD and 25 healthy older adults took part in the present study. Participants performed three virtual days in the Virtual Week task. On each virtual day, participants performed actions with positive, negative or neutral content. Immediately following each virtual day, participants completed a recognition task to assess their retrospective memory for the various (...) prospective memory tasks. PD patients were less accurate than the control group at both PM accuracy and recognition task accuracy. The effect of emotional valence was also evident, indicating that all participants were more accurate on positive PM tasks than both negative and neutral. This study confirmed PM impairment in PD patients and extended previous research showing how positive emotional stimuli can influence PM performance. (shrink)

The relationship between emotional arousal and long-term memory is addressed in two experiments in which subjects viewed either a relatively emotionally neutral short story or a closely matched but more emotionally arousing story and were tested for retention of the story 2 weeks later. Experiment 1 provides essential replication of the results of Heuer and Reisberg and illustrates the common interpretive problem posed by the use of different stimuli in the neutral versus emotional stories. In Experiment 2, identical slides (...) were used in both the neutral and arousal stores. Two different stories were created by varying the narration that accompanied each slide. In both experiments, subjects who viewed the arousal story both experienced a greater emotional reaction to the story than did the subjects who viewed the neutral story, and subsequently exhibited enhanced memory for the story. Subjects in Experiment 2 who viewed the arousal story also recalled more slides than did the subjects who viewed the neutral story. This effect was greatest for story phase 2, the phase in which the emotional slide narration occurred. Because this enhanced retention of the story slides cannot be explained by any differences in the slides themselves, the results provide new evidence to support the contention that emotional arousal influences long-term memory in normal human subjects. (shrink)

The purpose of the present mixed method study was to investigate personal benefits, perceptions, and the effect of a 15-week sport psychological skills training program adapted for musicians. The program was individually tailored for six music performance students with the objective of facilitating the participants' instrumental practice and performance. The participants learnt techniques such as goal setting, attentional focus, arousal regulation, imagery, and acceptance training / self-talk. Zimmerman's ( 1989 ) cyclical model of self-regulated learning was applied as a theoretical (...) frame for the intervention. The present study's mixed-method approach (i.e., quan+ QUAL) included effect size, semi-structured interviews, a research log, and practice diaries of the participants (Creswell, 2009 ). Thematic analysis revealed that participants had little or no experience concerning planning and goal setting in regard to instrumental practice. Concentration, volition, and physical pain were additional issues that the participants struggled with at the time of pre-intervention. The study found that psychological skills training (with special emphasis on planning and goal setting) facilitated cyclical self-regulated learning patterns in the participants. In essence, the intervention was found to facilitate the participants' concentration, self-observation, self-efficacy, and coping in the face of failure. The appliance of practice journals facilitated the participants‘ self-observation, self-evaluation, and awareness of instrumental practice. Finally, the psychological skills intervention reduced participants' worry and anxiety in performance situations. An 8-month follow up interview revealed that the participants were still actively applying psychological skills. (shrink)

The ability to learn cause–effect relations from experience is critical for humans to behave adaptively — to choose causes that bring about desired effects. However, traditional experiments on experience-based learning involve events that are artificially compressed in time so that all learning occurs over the course of minutes. These paradigms therefore exclusively rely upon working memory. In contrast, in real-world situations we need to be able to learn cause–effect relations over days and weeks, which necessitates long-term memory. 413 participants (...) completed a smartphone study, which compared learning a cause–effect relation one trial per day for 24 days versus the traditional paradigm of 24 trials back- to- back. Surprisingly, we found few differences between the short versus long timeframes. Subjects were able to accurately detect generative and preventive causal relations, and they exhibited illusory correlations in both the short and long timeframe tasks. These results provide initial evidence that experience-based learning over long timeframes exhibits similar strengths and weaknesses as in short timeframes. However, learning over long timeframes may become more impaired with more complex tasks. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Breathing TogetherRebecca L. Walkowitz (bio)For the first seven years of my career, I taught a very large lecture course once, and sometimes twice, a year in a graded auditorium filled seat-to-seat with as many as 350 undergraduates. The course focused on a cluster of themes that linked art and violence–how art resists violence, how art animates violence, how art expresses violence, how violence spurs art– and traced those themes (...) through the history of British fiction from Joyce, Woolf, and Forster through Barker, Burgess, Ishiguro, and Rushdie. I loved teaching that class. I loved and was sometimes terrified and almost always invigorated by being in that room with those students. Needless to say, no one wore masks. Far from it.I remember the feel of the crowded, anonymous, yet intimate room. Intimate, because a group of 20 or 30 very avid students occupied the first few rows, and I came to value and recognize their attentive faces. I could hear their little sounds as they scratched out notes, adjusted their laptops, whispered to each other, and rustled papers. Intimate, because I was standing at my full, not very substantial height on a stage, and they were looking up at my body and listening to my voice for 50 minutes twice a week. And intimate, in another sense, because they would sometimes forget that we were there together live and behave in ways that I have never experienced in a smaller classroom. One day, two students in the last row, which in the slanted auditorium was directly level with my elevated gaze, spent most of the lecture kissing ardently. I was impressed by their enthusiasm and by the duration of their embrace. At the end of the lecture, I quick-stepped up the aisle to remind them: this is not TV; we are here together. I smiled while I said it, and they apologized for distracting me. I smile as I think about it now.During the COVID lockdown, I missed the embodied experience of large gatherings, including large lectures. The Zoom classroom, for all its affordances, can't replicate the accidental encounters, the risk and energy of embodied presentation, the warmth of individual eye contact, and the shoulder experiences of the class period: what happens in the time just before and the time just after the actual class takes place. The shoulder experiences are truly precious, as any seasoned teacher knows, because [End Page 258] they allow us to shift the scale of encounter up and down, and they allow us to interact in spontaneous and less formal ways than we do when the entire class is gathered as one. Close up and informally, we are more likely to use our faces and our hands: smiling, nodding, tilting, waving, and pressing our palms together to say thank you.There is a kind of social intimacy and a kind of social violence that can only be illustrated in a very large group, and I appreciated my lecture for allowing me to experience that. The most terrifying day of my class each semester was the day I spoke about– and performed!–the shock of involuntary, inchoate expression in E. M. Forster's A Room with a View. Like other Bloomsbury artists, Forster was committed to ushering out traditional ideas of self-restraint and maturity and ushering in greater communication between men and women, between social classes, and between ages about sexuality, desire, and the experiences of the body. The word of the day was "play": life needed more play, more honesty, more curiosity, and less seriousness, less decorum, and less lying to ourselves and others.What does this look like in the classroom? On the day in question, we would talk about the scenes in the novel in which characters are criticized for disruptive actions they cannot or do not control, such as fainting, laughing, bleeding, getting carried away, or expressing sounds in addition to words. I would explain that there are two problems with these actions: they are accidental or unintentional, and they involve an unexpected, unregulated expression of the body in public. Even worse, the actions take place in what our grandparents used to call "mixed... (shrink)

Background:Nurses exposed to community health nursing commonly encounter situations that can be morally distressing. However, most research on moral distress has focused on acute care settings and very little research has explored moral distress in a community health nursing setting especially among nursing students.Aim:To explore the moral distress experiences encountered by undergraduate baccalaureate nursing students in community health nursing.Research design:A descriptive qualitative design was employed to explore the community health nursing experiences of the nursing students that led them to have (...) moral distress.Participants and research context:The study included 14 senior nursing students who had their course in Community Health Nursing in their sophomore year and stayed in the partner communities in their junior year for 6 and 3 weeks during their senior year.Ethical considerations:Institutional review board approval was sought prior to the conduct of the study. Self-determination was assured and anonymity and confidentiality were guaranteed to all participants.Findings:Nursing students are vulnerable and likely to experience moral distress when faced with ethical dilemmas. They encounter numerous situations which make them question their own values and ideals and those of that around them. Findings of the study surfaced three central themes which included moral distress emanating from the unprofessional behavior of some healthcare workers, the resulting sense of powerlessness, and the differing values and mindsets of the people they serve in the community.Conclusion:This study provides educators a glimpse of the morally distressing situations that often occurs in the community setting. It suggests the importance of raising awareness and understanding of these situations to assist nursing students to prepare themselves to the “real world,” where the ideals they have will be constantly challenged and tested. (shrink)