In many research studies, tumor biopsies are an unavoidable requirement for achieving key scientific aims. Yet some commentators view mandatory research biopsies as coercive and suggest they should be optional, or at least optional until further data are obtained regarding their scientific usefulness. Further complicating the ethical picture is the fact that some research biopsies offer a potential for clinical benefit to trial participants. We interviewed and surveyed a convenience sample of participants in phase I clinical trials at a single (...) institution. Our primary aim was to describe phase I participants’ understanding of whether a research biopsy offered them the prospect of medical benefit. We also endeavored to describe participants’ views about biopsies—specifically, the benefits of biopsies, if any, and whether biopsies were acceptable, risky, or discouraged trial participation. Finally, we collected data on demographics and attitudes to see if any strong correlations with misunderstanding, acceptability, or riskiness existed. Overall, the respondents tended to view research biopsies as acceptable, though they did not succeed in identifying the lack of benefit of a research biopsy. These findings call for renewed efforts in consent conversations and documents to carefully describe the benefits, or lack thereof, of research biopsies. (shrink)

Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino and (...) Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend to disadvantage individuals with barriers in access to care (3). There is mounting evidence of racial, ethnic, and socioeconomic disparities in access to medications for COVID-19 (4, 5). -/- One potential method to promote equitable allocation is to use a weighted lottery, which is an allocation strategy that gives all eligible patients a chance to receive the scarce treatment while also allowing the assignment of higher or lower chances according to other ethical considerations (6). We sought to assess the feasibility of implementing a weighted lottery to allocate scarce COVID-19 medications in a large U.S. health system and to determine whether the weighted lottery promotes equitable allocation. (shrink)

This book provides practical and research-based chapters that offer greater clarity about the particular kinds of teacher reflection that matter and avoids talking about teacher reflection generically, which implies that all kinds of reflection are of equal value.

ObjectivesThe purpose of the current study was to examine whether a self-report measure identifies prenatal substance use and predicts resulting adverse birth outcomes in a large cohort using electronic medical records.MethodsPregnant patients who were admitted between 2014 and 2015 at Christiana Care Health System and delivered singleton birth were included in the analyses. Participant demographic information, pregnancy comorbidities, self-reported substance use, and birth outcomes were retrieved from electronic medical records. Detailed descriptive analyses of prenatal substance use were conducted, and logistic (...) models were evaluated for the associations between substance use and each birth outcome.ResultsThe average maternal age was 30 years, 37% receiving Medicaid. Over 58% were White, 26% were Black, and 13% were Hispanic. Cigarette smoking only showed the highest prevalence among substance u... (shrink)

Previous research has found that funding disparities are driven by applications’ final impact scores and that only a portion of the black/white funding gap can be explained by bibliometrics and topic choice. Using National Institutes of Health R01 applications for council years 2014–2016, we examine assigned reviewers’ preliminary overall impact and criterion scores to evaluate whether racial disparities in impact scores can be explained by application and applicant characteristics. We hypothesize that differences in commensuration—the process of combining criterion scores (...) into overall impact scores—disadvantage black applicants. Using multilevel models and matching on key variables including career stage, gender, and area of science, we find little evidence for racial disparities emerging in the process of combining preliminary criterion scores into preliminary overall impact scores. Instead, preliminary criterion scores fully account for racial disparities—yet do not explain all of the variability—in preliminary overall impact scores. (shrink)

The authors use the term “principlism” to refer to the practice of using “principles” to replace both moral theory and particular moral rules and ideals in dealing with the moral problems that arise in medical practice. The authors argue that these “principles” do not function as claimed, and that their use is misleading both practically and theoretically. The “principles” are in fact not guides to action, but rather they are merely names for a collection of sometimes superficially related matters for (...) consideration when dealing with a moral problem. The “principles” lack any systematic relationship to each other, and they often conflict with each other. These conflicts are unresolvable, since there is no unified moral theory from which they are all derived. For comparison the authors sketch the advantages of using a unified moral theory. (shrink)

Transpersonal psychology: Dean, S. R. The ultraconscious mind. Arasteh, A. R. Final integration in the adult personality.--The nature of madness: First, E. Visions, voyages, and new interpretations of madness. Van Dusen, W. Hallucinations as the world of spirits.--Biofeedback: White, J. The yogi in the lab. Kiefer, D. EEG alpha feedback and subjective states of consciousness.--Meditation research: Griffith, F. F. Meditation research: its personal and social implications. Kiefer, D. Intermeditation notes: reports from inner space.--Psychic research: Honorton, C. Tracing ESP through (...) altered states of consciousness. Johnson, C. W. Unexplored areas of parapsychology.--Paraphysics: White, J. Plants, polygraphs, and paraphysics. Reiser, O. L. Messages to and from the galaxy.--Biotechnology: Beal, J. B. The new biotechnology. Tiller, W. A. Energy fields and the human body.--The neurosciences: Conway, H. Life, death, and antimatter. Floyd, K. Of time and mind: from paradox to paradigm.--Ecological consciousness: Smith, R. A. Our passport to evolutionary awareness. Esser, A. H. Synergy and social pollution in the communal imagery of mankind.--Space travel and extraterrestrial life: Mitchell, E. D. Global consciousness and the view from space. White, J. Exobiology--where science fiction meets science fact.--Death as an altered state of consciousness: Tietze, T. R. Some perspectives on survival. Noyes, R. Dying and mystical consciousness. (shrink)

This slim volume is another addition to the ever growing family of anthologies—in this case Oxford Readings in Philosophy—recognizable as such not only because of its eye-catching external appearance but also, and mainly, on account of its close similarity in technical features to the previously born siblings. The composite body of the various contributions bears the unmistakable mark of ‘analysis’ as an identifying label. This observation, needless to say, is not intended to be condemnatory—for there is a great deal to (...) be said in favour of dissecting propensities—it is merely an indication of what one should expect to find in this compilation. The nonet playing ‘Action’ consists of the following performers: J L Austin, A C Danto, H A Prichard, A I Melden, D Davidson, J Feinberg, P J Fitzgerald, G E M Anscombe, J O Urmson. As can be seen, the group represents a pretty homogeneous bunch—with the possible exception of the veteran ethical intuitionist Prichard, whose participation ceases to be a mystery only after Melden’s essay has been digested. I must confess that I find the arrangement of the articles rather puzzling. There seems to be no clear criterion involved. It cannot be in order of importance ; neither can it be taken to signify logical affinity ; it certainly is not chronological; and—in the presence of an eminent editor—one hesitates to see it as an ad hoc, haphazard motley. It might be maintained that A White’s excellent introduction—a rare combination of lucidity, economy and relevant information—with its appropriate headings throws some light on the collocation of players in the ensemble. If it was intended to do this then I fail to see the logic behind the plan. This, however, is a minor matter when compared with the meritorious execution of a difficult task which the introduction represents. It gives us a comprehensive bird’s-eye view of the territory disputed and pin-points neatly the various claimants to the, often more than obscure, land-titles. Considering the nature of the landscape and the diversity of figures swarming over and about it Professor White has done a splendid job and deserves unqualified praise. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Surprised by DisabilityEmily K. MichaelToday I am meeting Diana, one of my young blind students, for coffee. Soon she will enroll in our summer program that teaches blind teenagers independent living skills and self–advocacy. Her teachers explain that she has prepared questions for me.“So,” Diana begins, as we follow the uneven sidewalk toward the restaurant. “What would you do if you wanted to go outside without your sunglasses?”I can (...) guess why she poses this question, but I conceal my theory for now. Instead, I smile and adjust the large, dark sunglasses that fit over my regular glasses. “Why would I want to do that?”“I don’t know... Just say, you wanted to,” she finishes diffidently. She walks slightly in front of me, the familiar sound of her white cane scraping and tapping against the bricks laid in the sidewalk. I rarely travel with other blind people, so the sound of her cane comforts me.“I’m so sensitive to light that I’d be miserable without my shades,” I explain. I’m careful with my tone here. Like me, Diana is unable to read facial expressions—she listens attentively to vocal cues. She is a smart 13–year–old, and she will notice if I start to sound preachy. [End Page 207]“Okay, so what if you wanted to go out without your cane?”I’m ready for this one: “Diana, my cane keeps me safe. I’m happy to have it with me.” The cane alerts me to vital environmental changes, like the textural difference between sidewalks and streets. Unexpected curbs, sudden stairs, perilous sign-posts, and wayward children become apparent to me through the white cane. It is as if the cane helps sketch the boundaries around me; its contact with objects creates a vivid spatial awareness.I sense that my responses fill Diana with a mixture of defeat and frustration. I have not validated her reticence to use the shades or cane. Nor have I handed her a rhetorical placebo, a catchy phrase she can pull out whenever she feels uncomfortable with her disability. Resisting her white cane and dark glasses, she loathes the idea of looking different. Though neither of us can see others staring, we feel the judgment and pity—and the occasional sense of wonder from those for whom we’re still a novelty, the ones who want to point and exclaim, “Look Ma, a real blind girl!”Both Diana and I carry emblems of blindness that are easily recognized from a distance—visible signs of disability. Other disabled people can “pass” as nondisabled. If they don’t use wheelchairs, crutches, canes, dogs, or braces, no one will know that they have disabilities. Hence, the disabilities that don’t require visible accessories are called “invisible disabilities”—a term that strengthens the connection between disability and appearance.Diana doesn’t want to “look” blind. She wants me to give her an out, to divulge the strategies I’ve devised for leaving the house without my cane and shades. Underneath her casual questions lies the prevailing obsession, “What’s the secret to looking normal?” As a successful blind woman, I must have it figured out. The secret, Diana, is easy to articulate and difficult to enforce. I can write it more readily than I can live it.The secret begins with a very broad spectrum of acceptance. First, I must accept myself as a blind woman who needs a cane and dark glasses to travel in safety and confidence. Then I must accept that these mobility aids are uncommon and highly visible—which means that, almost every time I go out, people will approach me. And lastly, I must accept that the attitudes of others do not determine who I am, that their idea of blindness does not define my experience of it.The white cane was not always easy for me to carry. Though I have been legally blind from birth, I did not use the white cane in my daily life until high school. Before my freshman year, I could pass as nondisabled. At high school, I found myself on a large, crowded campus with only six minutes... (shrink)

SummaryAs part of a prospective controlled study of the psychosomatic effects of elective tubal sterilization, 138 women were questioned about their menstrual functioning before sterilization, and again 6 months and 12 months post-operatively, using standardized interviewing procedures. Adverse changes, including increased menstrual loss, shorter menstrual cycles and greater use of pads or tampons were reported by sterilized subjects at both of the post-operative interviews. Control subjects reported several comparable effects, although adverse changes overall were reported more commonly by sterilized women (...) than by control subjects. However, many of the reported changes appeared to be related to pre-operative contraceptive methods, although consistent increases in use of pads or tampons were found in women who had pre-operatively used neither the pill nor the IUD. (shrink)