During a prostate exam, Mr. Watson, age 65, learns that his prostate appears to be abnormal. The family physician conducting the exam, Dr. Kleinman, informs Mr. Watson that he may have prostate cancer. Mr. Watson agrees to a variety of tests, including blood tests, bone scans, ultrasound scanning, and a biopsy. After learning about this possible diagnosis and these tests, Mr. Watson surfs the Web for information about prostate cancer and gathers data from many different sources, including the National Cancer (...) Society, the National Institutes of Health, Johns Hopkins University, the Mayo Clinic, and medicine sites. He also searches for information from medical journals using MEDLINE, visits several chat rooms on prostate cancer, and joins some e-mail lists. He arrives in Dr. Kleinman's office for a follow-up appointment with a stack of material and many questions. Dr. Kleinman is surprised, irritated, and offended. He recommends that Mr. Watson have a prostatectomy followed by radiation, but Mr. Watson does not want this operation. He would rather receive a form of radiation therapy recently approved by the FDA that he learned about through his own research. Dr. Kleinman admits that he does not know much about this new treatment, but he says that he would read up on it and consult an oncologist. (shrink)

Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA (...) PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions. (shrink)

Emergency departments are challenging research settings, where truly informed consent can be difficult to obtain. A deeper understanding of emergency medical patients’ opinions about research is needed. We conducted a systematic review and meta-summary of quantitative and qualitative studies on which values, attitudes, or beliefs of emergent medical research participants influence research participation. We included studies of adults that investigated opinions toward emergency medicine research participation. We excluded studies focused on the association between demographics or consent document features and participation (...) and those focused on non-emergency research. In August 2011, we searched the following databases: MEDLINE, EMBASE, Google Scholar, Scirus, PsycINFO, AgeLine and Global Health. Titles, abstracts and then full manuscripts were independently evaluated by two reviewers. Disagreements were resolved by consensus and adjudicated by a third author. Studies were evaluated for bias using standardised scores. We report themes associated with participation or refusal. Our initial search produced over 1800 articles. A total of 44 articles were extracted for full-manuscript analysis, and 14 were retained based on our eligibility criteria. Among factors favouring participation, altruism and personal health benefit had the highest frequency. Mistrust of researchers, feeling like a ‘guinea pig’ and risk were leading factors favouring refusal. Many studies noted limitations of informed consent processes in emergent conditions. We conclude that highlighting the benefits to the participant and society, mitigating risk and increasing public trust may increase research participation in emergency medical research. New methods for conducting informed consent in such studies are needed. (shrink)

BackgroundAccurate reporting on sex and gender in health research is integral to ensuring that health interventions are safe and effective. In Canada and internationally, governments, research organizations, journal editors, and health agencies have called for more inclusive research, provision of sex-disaggregated data, and the integration of sex and gender analysis throughout the research process. Sex and gender analysis is generally defined as an approach for considering how and why different subpopulations (e.g., of diverse genders, ages, and social locations) may experience (...) health conditions and interventions in different or similar ways.The objective of this study was to assess the extent and nature of reporting about sex and/or gender, including whether sex and gender analysis (SGA) was carried out in a sample of Canadian randomized controlled trials (RCTs) with human participants.MethodsWe searched MEDLINE from 01 January 2013 to 23 July 2014 using a validated filter for identification of RCTs, combined with terms related to Canada. Two reviewers screened the search results to identify the first 100 RCTs that were either identified in the trial publication as funded by a Canadian organization or which had a first or last author based in Canada. Data were independently extracted by two people from 10% of the RCTs during an initial training period; once agreement was reached on this sample, the remainder of the data extraction was completed by one person and verified by a second.ResultsThe search yielded 1433 records. We screened 256 records to identify 100 RCTs which met our eligibility criteria. The median sample size of the RCTs was 107 participants (range 12–6085). While 98% of studies described the demographic composition of their participants by sex, only 6% conducted a subgroup analysis across sex and 4% reported sex-disaggregated data. No article defined “sex” and/or “gender.” No publication carried out a comprehensive sex and gender analysis.ConclusionsFindings highlight poor uptake of sex and gender considerations in the Canadian RCT context and underscore the need for better articulated guidance on sex and gender analysis to improve reporting of evidence, inform policy development, and guide future research. (shrink)

As concern over the use of questionable research practices in academic science has increased over the last couple of decades, some reforms have been implemented and many others have been debated and recommended. While many of these proposals have merit, efforts to improve scientific practices are more likely to succeed when they are responsive to the prevailing views and concerns of scientists themselves. To date, there have been few efforts to solicit wide-ranging input from researchers on the topic of needed (...) reforms. This article is a qualitative report of responses from federally funded scientists to the question of what should be done to address the problem of QRPs in their disciplines. Overall, participants were concerned about how institutional and career-oriented incentives encourage the use of QRPs. Compared to previous recommendations, participants had surprisingly little confidence in the ability of ethics training to improve research integrity. (shrink)

Essay on mysticism in poetry, the Australian bush, and a photo essay on the Coorong by Brian Medlin, with an introduction by his wife, Christine Vick.

This chapter first surveys general issues in the epistemic internalism / externalism debate: what is the distinction, what motivates it, and what arguments can be given on both sides. -/- The second part of the chapter will examine the internalism / externalism debate as regards to the specific case of the epistemology of memory belief.

The acquisition of a new skill usually proceeds through five stages, from novice to expert, with a sixth stage of mastery available for highly motivated performers. In this chapter, we re-state the six stages of the Dreyfus Skill Model, paying new attention to the transitions and interrelations between them. While discussing the fifth stage, expertise, we unpack the claim that, “when things are proceeding normally, experts don’t solve problems and don’t make decisions; they do what normally works” (Dreyfus & Dreyfus, (...) 1988, pp. 30 – 31). This leads us to offer an account of the “perspectival deliberation” that arises for experts and masters and that is distinct from the calculative deliberation characteristic of the lower stages of skillfulness. (shrink)

'The problem of the twentieth-century is the problem of the color-line.' Originally published in 1903, The Souls of Black Folk is a classic study of race, culture, and education at the turn of the twentieth century. With its singular combination of essays, memoir, and fiction, this book vaulted W. E. B. Du Bois to the forefront of American political commentary and civil rights activism. The Souls of Black Folk is an impassioned, at times searing account of the situation of African (...) Americans in the United States. Du Bois makes a forceful case for the access of African Americans to higher education, memorably extols the achievements of black culture (above all the spirituals or 'sorrow songs'), and advances the provocative and influential argument that due to the inequalities and pressures of the 'race problem', African American identity is characterized by 'double consciousness'. This edition includes a valuable appendix of other writing by Du Bois, which sheds light on his attitudes and intentions. ABOUT THE SERIES: For over 100 years Oxford World's Classics has made available the widest range of literature from around the globe. Each affordable volume reflects Oxford's commitment to scholarship, providing the most accurate text plus a wealth of other valuable features, including expert introductions by leading authorities, helpful notes to clarify the text, up-to-date bibliographies for further study, and much more. (shrink)

Bridging the gap between the world of science and the realm of the spiritual, B. Alan Wallace introduces a natural theory of human consciousness that has its roots in contemporary physics and Buddhism. Wallace's "special theory of ontological relativity" suggests that mental phenomena are _conditioned_ by the brain, but do not _emerge_ from it. Rather, the entire natural world of mind and matter, subjects and objects, arises from a unitary dimension of reality that is more fundamental than these dualities, as (...) proposed by Wolfgang Pauli and Carl Jung. To test his hypothesis, Wallace employs the Buddhist meditative practice of _samatha_, refining one's attention and metacognition, to create a kind of telescope to examine the space of the mind. Drawing on the work of the physicist John Wheeler, he then proposes a more general theory in which the participatory nature of reality is envisioned as a self-excited circuit. In comparing these ideas to the Buddhist theory known as the Middle Way philosophy, Wallace explores further aspects of his "general theory of ontological relativity," which can be investigated by means of _vipasyana_, or insight, meditation. Wallace then focuses on the theme of symmetry in reference to quantum cosmology and the "problem of frozen time," relating these issues to the theory and practices of the Great Perfection school of Tibetan Buddhism. He concludes with a discussion of the general theme of complementarity as it relates to science and religion. The theories of relativity and quantum mechanics were major achievements in the physical sciences, and the theory of evolution has had an equally deep impact on the life sciences. However, rigorous scientific methods do not yet exist to observe mental phenomena, and naturalism has its limits for shedding light on the workings of the mind. A pioneer of modern consciousness research, Wallace offers a practical and revolutionary method for exploring the mind that combines the keenest insights of contemporary physicists and philosophers with the time-honored meditative traditions of Buddhism. (shrink)

We presuppose a position of scientific realism to the effect (i) that the world exists and (ii) that through the working out of ever more sophisticated theories our scientific picture of reality will approximate ever more closely to the world as it really is. Against this background consider, now, the following question: 1. Do the empirical theories with the help of which we seek to approximate a good or true picture of reality rest on any non-empirical presuppositions? One can answer (...) this question with either a 'yes' or a 'no'. 'No' is the preferred answer of most contemporary methodologists -- Murray Rothbard is one distinguished counterexample to this trend -- who maintain that empirical theories are completely free of non-empirical ('a priori') admixtures and who see science as a matter of the gathering of pure 'data' obtained through simple observation. From such data scientific propositions are then supposed to be somehow capable of being established. (shrink)

What are the most fundamental features of the world? Do minds stand outside the natural order? Is a unified picture of mental and physical reality possible? The Mind in Nature provides a staunchly realist account of the world as a unified system incorporating both the mental and the physical. C. B. Martin, an original and influential exponent of 'ontologically serious' metaphysics, echoes Locke's dictum that 'all things that exist are only particulars', and argues that properties are powerful qualities. He also (...) spells out the implications of this view for philosophical conceptions of causation, intentionality, consciousness, and the mind-body problem. Martin emphasizes the importance of non-conscious 'vegetative' systems, which provide clear examples of intentionality in the form of representational use. The slide from representational use to consciousness involves a change in the material of use, but not the form of representation. A concluding chapter provides an argument for the view that an ontology of particular substances and properties leads ineluctably to monism: the bus we board with Locke takes us directly to the world of Spinoza and Einstein. Along the way, we are led to understand the nature of minds and conscious states of mind in a way that avoids both reductionism and dualism. (shrink)

In this concise yet powerful book, one of the twentieth century's most respected political philosophers presents a controversial reassessment of the political ideas and intellectual legacy of Edmund Burke. A practicing politician and powerful writer, full of ideas, Burke was intent on getting those ideas translated into government policies. But he was too much the impatient practitioner to set out his principles in a single book in the manner of Locke or Hume, leaving both admirers and opponents ample scope to (...) reinterpret his work in different ways. Macpherson, however, finds Burke's views on political economy to be the one consistent factor in his thinking. Today Burke is often viewed as one of modern conservatism's founding lights, and in an era of global capitalism unfettered by national borders, Macpherson's reassessment of Burke's ideas is perhaps more timely than ever. (shrink)

First published in 1986, Knowledge, Belief, and Witchcraft remains the only analysis of indigenous discourse about an African belief system undertaken from within the framework of Anglo-American analytical philosophy. Taking as its point of departure W. V. O. Quine's thesis about the indeterminacy of translation, the book investigates questions of Yoruba epistemology and of how knowledge is conceived in an oral culture.