Dr. M is a fifty-nine-year-old internist with a successful practice in a major Eastern United States city. He has lived in this city his whole life and is a highly esteemed citizen. Because of his broader social concerns and energetic support of activities to improve access to health care and quality of care for the underserved, Dr. M became involved in a number of local and regional medical organizations and quickly rose to prominence as as a director of a board (...) of a major national organization. In this position, he was an effective, articulate spokesperson, highly respected for his integrity and thoughtfulness.Before one of the meetings of thithis s board, Dr. M personally contacted the organization's other directors, including me, to warn us that we might be hearing some scandalous news about him. He wanted us first to hear it from him personally. This was the scandalous news.Dr. M had assumed the care of a patient of a recently retired colleague. The patient was an older woman with multiple musculoskeletal complaints related to lumbar stenosis and advanced degenerative arthritis of the spine, which left her in immense pain. (shrink)

Dr. M is a fifty-nine-year-old internist with a successful practice in a major Eastern United States city. He has lived in this city his whole life and is a highly esteemed citizen. Because of his broader social concerns and energetic support of activities to improve access to health care and quality of care for the underserved, Dr. M became involved in a number of local and regional medical organizations and quickly rose to prominence as as a director of a board (...) of a major national organization. In this position, he was an effective, articulate spokesperson, highly respected for his integrity and thoughtfulness.Before one of the meetings of thithis s board, Dr. M personally contacted the organization's other directors, including me, to warn us that we might be hearing some scandalous news about him. He wanted us first to hear it from him personally. This was the scandalous news.Dr. M had assumed the care of a patient of a recently retired colleague. The patient was an older woman with multiple musculoskeletal complaints related to lumbar stenosis and advanced degenerative arthritis of the spine, which left her in immense pain. (shrink)

Rape myth acceptance, perceived barriers, and self-efficacy were examined as predictors of likelihood to report different types of rape to law enforcement among 409 undergraduates. Participants had lower likelihood to report incapacitated compared to physically forced rape. Men had lower reporting likelihood than women for rape perpetrated by the same and opposite sex and were more likely to perceive several barriers. RMA and perceived barriers predicted a lower likelihood to report several types of rape. Among men, higher self-efficacy predicted increased (...) reporting likelihood. Targeting RMA and decreasing perceived barriers is imperative to increase college students’ likelihood to report rape to local and campus law enforcement. (shrink)

Volume 20, Issue 10, October 2020, Page 63-65.

Examining the subtle forms of aggression, violence, and harassment that occur in our society and manifest in institutions and places of work, the expert contributors collected here describe the experience of social marginalization and expose how vulnerable individuals work to navigate exclusionary climates. This volume explores how bodies disrupt the status quo in multiple contexts and locations; provides insights into how institutions are structured and how practices that may cause harm are maintained; and, finally, considers progressive and proactive alternatives. This (...) book will be a key resource for academics and professionals in education, sociology, nursing, law, business and political science, as well as organizations and policymakers grappling with aggression in the workplace. (shrink)

We examined the course of caregiver motherese and the course of the infant’s response based on home movies from two single cases: a boy with typical development and a boy with autistic development. We first blindly assessed infant CG interaction using the Observer computer-based coding procedure, then analyzed speech CG production using a computerized algorithm. Finally we fused the two procedures and filtered for co-occurrence. In this exploratory study we found that the course of CG parentese differed based on gender (...) and child status. The course of an infant’s response to CG vocalization differed according to the type of speech and child status. Mothers spent more time interacting with infants, and fathers appeared to interact with their child preferentially between 12 and 18 months in the TD boy, but not in the AD boy. The TD boy responded equally well to motherese compared to other speech after 1 year of age. For the AD boy, the responses to both types of speech were lower than in the boy with TD and decreased from the second to the third semester. Keywords: Autism; motherese; early interaction; computational methods. (shrink)

Over the past decades, anti-cancer treatments have evolved rapidly from cytotoxic chemotherapies to targeted therapies including oral targeted medications and injectable immunooncology and cell therapies. New anti-cancer medications come to markets at increasingly high prices, and health insurance coverage is crucial for patient access to these therapies. State laws are intended to facilitate insurance coverage of anti-cancer therapies.Using Massachusetts as a case study, we identified five current cancer coverage state laws and interviewed experts on their perceptions of the relevance of (...) the laws and how well they meet the current needs of cancer care given rapid changes in therapies. Interviewees emphasized that cancer therapies, as compared to many other therapeutic areas, are unique because insurance legislation targets their coverage. They identified the oral chemotherapy parity law as contributing to increasing treatment costs in commercial insurance. For commercial insurers, coverage mandates combined with the realities of new cancer medications — including high prices and often limited evidence of efficacy at approval — compound a difficult situation. Respondents recommended policy approaches to address this challenging coverage environment, including the implementation of closed formularies, the use of cost-effectiveness studies to guide coverage decisions, and the application of value-based pricing concepts. Given the evolution of cancer therapeutics, it may be time to evaluate the benefits and challenges of cancer coverage mandates. (shrink)

Background: Ethical issues related to comparative effectiveness research, or research that compares existing standards of care, have recently received considerable attention. In this paper we focus on how Ethics Review Committees should evaluate the risks of comparative effectiveness research. Main text: We discuss what has been a prominent focus in the debate about comparative effectiveness research, namely that it is justified when “nothing is known” about the comparative effectiveness of the available alternatives. We argue that this focus may be misleading. (...) Rather, we should focus on the fact that some experts believe that the evidence points in favor of one intervention, whereas other experts believe that the evidence favors the alternative. We will then introduce a case that illustrates this point, and based on that, discuss how ERCs should deal with such cases of expert disagreement. Conclusion: We argue that ERCs have a duty to assess the range of expert opinions and based on that assessment arrive at a risk judgment about the study under consideration. We also argue that assessment of expert disagreement is important for the assignment of risk level to a clinical trial: what is the basis for expert opinions, how strong is the evidence appealed to by various experts, and how can clinical trial monitoring affect the possible increased risk of clinical trial participation. (shrink)

What is the primary function of consciousness in the nervous system? The answer to this question remains enigmatic, not so much because of a lack of relevant data, but because of the lack of a conceptual framework with which to interpret the data. To this end, we have developed Passive Frame Theory, an internally coherent framework that, from an action-based perspective, synthesizes empirically supported hypotheses from diverse fields of investigation. The theory proposes that the primary function of consciousness is well-circumscribed, (...) serving the 'somatic nervous system[. For this system, consciousness serves as a frame that constrains and directs skeletal muscle output, thereby yielding adaptive behavior. The mechanism by which consciousness achieves this is more counterintuitive, passive, and “low level” than the kinds of functions that theorists have previously attributed to consciousness. Passive frame theory begins to illuminate (a) what consciousness contributes to nervous function, (b) how consciousness achieves this function, and (c) the neuroanatomical substrates of conscious processes. Our untraditional, action-based perspective focuses on olfaction instead of on vision and is 'descriptive' (describing the products of nature as they evolved to be) rather than 'normative' (construing processes in terms of how they should function). Passive frame theory begins to isolate the neuroanatomical, cognitive-mechanistic, and representational (e.g., conscious contents) processes associated with consciousness. (shrink)

IN CRITICALLY ANALYZING THE DEADLY VIPER CONTROVERSY AND MARY Queen of Vietnam Catholic Church's social activism in the aftermath of Hurricane Katrina, we consider questions concerning the ability of Asian Americans to participate in public discourse in meaningful ways that spur social change while fostering solidarity with other marginalized ethnic groups in the United States. Drawing on Christian theo-ethical reflection on the racial or social identity of Jesus as a hybridized concept, we argue for a robust public discourse that recognizes (...) Asian Americans as a social group without succumbing to the ghettoization of Asian American identity or a withdrawal from engagement with other justice-seeking social groups. In doing so, we look toward constructive modes of public discourse carried out by multiple counterpublics that both give voice to the Asian American community and open the space for collaboration across ethnic, racial, class, religious, and national boundaries. (shrink)

A fundamental fact about human minds is that they are never truly alone: all minds are steeped in situated interaction. That social interaction matters is recognized by any experimentalist who seeks to exclude its influence by studying individuals in isolation. On this view, interaction complicates cognition. Here, we explore the more radical stance that interaction co-constitutes cognition: that we benefit from looking beyond single minds toward cognition as a process involving interacting minds. All around the cognitive sciences, there are approaches (...) that put interaction center stage. Their diverse and pluralistic origins may obscure the fact that collectively, they harbor insights and methods that can respecify foundational assumptions and fuel novel interdisciplinary work. What might the cognitive sciences gain from stronger interactional foundations? This represents, we believe, one of the key questions for the future. Writing as a transdisciplinary collective assembled from across the classic cognitive science hexagon and beyond, we highlight the opportunity for a figure-ground reversal that puts interaction at the heart of cognition. The interactive stance is a way of seeing that deserves to be a key part of the conceptual toolkit of cognitive scientists. (shrink)

Ethical issues related to comparative effectiveness research, or research that compares existing standards of care, have recently received considerable attention. In this paper we focus on how Ethics Review Committees should evaluate the risks of comparative effectiveness research. We discuss what has been a prominent focus in the debate about comparative effectiveness research, namely that it is justified when “nothing is known” about the comparative effectiveness of the available alternatives. We argue that this focus may be misleading. Rather, we should (...) focus on the fact that some experts believe that the evidence points in favor of one intervention, whereas other experts believe that the evidence favors the alternative. We will then introduce a case that illustrates this point, and based on that, discuss how ERCs should deal with such cases of expert disagreement. We argue that ERCs have a duty to assess the range of expert opinions and based on that assessment arrive at a risk judgment about the study under consideration. We also argue that assessment of expert disagreement is important for the assignment of risk level to a clinical trial: what is the basis for expert opinions, how strong is the evidence appealed to by various experts, and how can clinical trial monitoring affect the possible increased risk of clinical trial participation. (shrink)

The past two decades of psychoanalytic discourse have witnessed a marked transformation in the way we think about women and gender. The assignment of gender carries with it a host of assumptions, yet without it we can feel lost in a void, unmoored from the world of rationality, stability and meaning. The feminist analytic thinkers whose work is collected here confront the meaning established by the assignment of gender and the uncertainty created by its absence. The contributions brought together in (...) _Psychoanalytic Reflections on a Gender-free Case_ address a cross-section of significant issues that have both chronicled and facilitated the changes in feminist psychoanalysis since the mid 1980s. Difficult issues which have previously been ignored are considered first. The book goes on to address family perspectives as they interact and shape the child’s experience of growing up male or female. Other topics covered are the authority of personal agency as influenced by the language and theory of patriarchy, male-centred concepts that consistently define women as inferior, and the concept of gender as being co-constructed within a relationship. The gender-free case presented here will fascinate all psychoanalysts interested in exploring ways of grappling with the elusive nature of gender, as well as those studying gender studies. (shrink)

X chromosome inactivation is the mammalian answer to the dilemma of dosage compensation between males and females. The study of this fascinating form of chromosome-wide gene regulation has yielded surprising insights into early development and cellular memory. In the past few months, three papers1-3 reported unexpected findings about the paternal X chromosome (Xp). All three studies agree that the Xp is imprinted to become inactive earlier than ever suspected during embryonic development. Although apparently incomplete, this early form of inactivation insures (...) dosage compensation throughout development. Silencing of the Xp persists in cells of extraembryonic tissues, but it is erased and followed by random X inactivation in cells of the embryo proper. These findings challenge several aspects of the current view of X inactivation during early development and may have profound impact on studies of pluripotency and epigenetics. BioEssays 26:821–824, 2004. © 2004 Wiley Periodicals, Inc. (shrink)

Although the presence or absence of a pitch accent clearly can play an important role in signaling the discourse and information structure of an utterance, whether the form of an accent determines the type of information it conveys is more controversial. We used an eye‐tracking paradigm to investigate whether H*, which has been argued to signal new information, evokes different eye fixations than L+H*, which has been argued to signal the presence of contrast. Our results demonstrate that although listeners interpret (...) these accents differently, their interpretive domains overlap. L+H* creates a strong bias toward contrast referents whereas H* is compatible with both new and contrast referents. (shrink)

The recent Common Rule revision process took almost a decade and the resulting changes are fairly modest, particularly when compared to the ambitious ideas proposed in the advance notice of proposed rulemaking and notice of proposed rulemaking. Furthermore, the revision process did not even attempt to tackle any of the Common Rule subparts pertaining to vulnerable populations where commentators think the rules unduly restrict important research. We believe that this was a missed opportunity to make desirable changes, and that given (...) the usual process the next opportunity to revisit the Common Rule is unacceptably remote. In this article, we argue that the Common Rule should be regularly reassessed, with a mechanism for making substantive changes. Drawing on lessons learned from the recent revision process, we make recommendations about ways to structure future attempts to maximize the ability to make timely and necessary changes. (shrink)

Adaptation to changing and new environmental conditions is of fundamental importance to sustainability and requires concerted efforts amongst science, policy, and practice to produce solution-oriented knowledge. Joint knowledge production or co- production of knowledge has become increasingly popular terms to describe the process of scientists, policy makers and actors from the civil society coming together to cooperate in the production, dissemination, and application of knowledge to solve wicked problems such as climate change. Networks are particularly suited to produce knowledge in (...) a joint fashion. However, the process of joint knowledge production (JKP) in networks has rarely been examined. In this paper, we present a sketch of the adaptation network landscape and assess how joint knowledge production supports the development of solution-oriented knowledge in climate change adaptation networks. We conclude that the processes of JKP are diverse, complex, and highly dependent on the interests and roles of actors within the network. To keep such processes alive, signposts in form of analysis and intermediary products along the network lifetime should be positioned as means of stocktaking and monitoring for the future. (shrink)

IntroductionCognitive impairment is a highly prevalent non-motor feature of Parkinson’s disease. A better understanding of the underlying pathophysiology may help in identifying therapeutic targets to prevent or treat dementia. This study sought to identify metabolic alterations in the prefrontal cortex, a key region for cognitive functioning that has been implicated in cognitive dysfunction in PD.MethodsProton Magnetic Resonance Spectroscopy was used to investigate metabolic changes in the PFC of a cohort of cognitively normal individuals without PD, as well as PD participants (...) with either normal cognition, mild cognitive impairment, or dementia. Ratios to Creatine resonance were obtained for glutamate, glutamine and glutamate combined, N-acetylaspartate, myoinositol, and total choline, and correlated with cognitive scores across multiple domains administered to the PD participants only.ResultsWhen individuals retain cognitive capabilities, the presence of Parkinson’s disease does not create metabolic disturbances in the PFC. However, when cognitive symptoms are present, PFC Glu/Cre ratios decrease with significant differences between the PD-NC and PPD groups. In addition, Glu/Cre ratios and memory scores were marginally associated, but not after Bonferroni correction.ConclusionThese preliminary findings indicate that fluctuations in prefrontal glutamate may constitute a biomarker for the progression of cognitive impairments in PD. We caution for larger MRS investigations of carefully defined PD groups. (shrink)

This article examines the concept of the “education of desire,” which undergirds literary utopian studies’ response to postmodernism’s challenge to the modern utopian impulse. The analysis returns to two classic utopian texts—the work of Miguel Abensour, who coined the term “education of desire,” and Ursula K. Le Guin’s novel about ecological sustainability, “The Dispossessed”—to argue that the education of desire involves a more intimate relationship between desire and domination than literary utopian studies has allowed. This article not only transforms our (...) understanding of a mainstay of utopian studies; it relates this discussion to utopian strains in environmental thought, tracing the tension between the desire for ecological sustainability and the social, political, and economic prescriptions this would entail. (shrink)