BackgroundHospitalized older adults frequently have impaired cognition and must rely on surrogates to make major medical decisions. Ethical standards for surrogate decision making are well delineated, but little is known about what factors surrogates actually consider when making decisions.ObjectivesTo determine factors surrogate decision makers consider when making major medical decisions for hospitalized older adults, and whether or not they adhere to established ethical standards.DesignSemi-structured interview study of the experience and process of decision making.SettingA public safety-net hospital and a tertiary referral (...) hospital in a large city in the Midwest United States.ParticipantsThe study included 35 surrogates with a recent decision-making experience for an inpatient aged 65 or older.MeasurementsThe key factors that surrogates considered when making decisions. Interview transcripts were coded and analyzed using the grounded theory method of qualitative analysis.ResultsSurrogates considered patient-centered factors and surrogate-centered factors. Patient-centered factors included: respecting the patient’s input, using past knowledge of the patient to infer the patient’s wishes, and consider ing what is in the patient’s best interests. Some surrogates expressed a desire for more information about the patient’s prior wishes. Surrogate-centered factors included: surrogate’s wishes as a guide, surrogate’s religious beliefs and/or spirituality, surrogate’s interests, and family consensus.ConclusionOur study indicates that surrogate decision making is more complex than the standard ethical models, which are limited to considerations of the patient’s autonomy and beneficence. Because surrogates also imagine what they would want under the circumstances and consider their own needs and preferences, models of surrogate decision making must account for these additional considerations. Surrogates’ desire for more information about patients’ preferences suggests a need for greater advance care planning. (shrink)

Although national surveys consistently show that an overwhelming majority of adults in the United States would like to see some sort of moral education in the schools, it is not clear how much real agreement this indicates. "Whose morality are we talking about?" one might ask. The significance of this question is apparent when we consider the moral diversity among those who ask it. This is not merely a diversity among moral beliefs. This is bound to be present to (...) some degree in any large group of reflective people. Many societies are multicultural. As Amy Gutmann puts it, these societies contain within their borders "many cultures that interact in some significant way with each other." Thus, a multicultural society will, in part, be characterized by different traditions and practices, some of which may reflect fundamental moral and religious differences. (shrink)

The complexity of biobank research raises concerns about individuals’ understanding of the information conveyed in the consent process for such research.. We report the results of a qualitative, cognitive interview study with an ethnically, linguistically, and educationally diverse sample of 43 respondents to assess the clarity and utility of a multimedia tool developed for a biobank. Using weighted randomization, respondents were assigned to either view the multimedia tool or read a written consent document . The study illustrates the utility of (...) cognitive interviews for gaining insights from prospective research participants about the clarity of informed consent tools. Findings suggest that a multimedia tool is useful for communicating key messages but should be combined with a written consent document and personal interaction with the study staff. We recommend that the potential value of multimedia tools should be more rigorously tested in a randomized controlled trial. (shrink)

In 1983, we were declared a nation at risk. Now, over a decade later the declaration seems to ring even more true, but for different reasons. Our communities have become killing fields, and the assassins that stalk our streets are our children. We sit frozen in horror as the daily news bombards us with the images of children murdering other children and adults for the thrill of it, as a rite of initiation, as an act of racial hatred, for profit, (...) and in anger and retaliation. (shrink)

Introduction Understanding the views of the public is essential if generally acceptable policies are to be devised that balance research access to general practice patient records with protection of patients' privacy. However, few large studies have been conducted about public attitudes to research access to personal health information. Methods A mixed methods study was performed. Informed by focus groups and literature review, a questionnaire was designed which assessed attitudes to research access to personal health information and factors that influence these. (...) A postal survey was conducted of an electoral roll-based sample of the adult population of Ireland. Results Completed questionnaires were returned by 1575 (40.6%). Among the respondents, 67.5% were unwilling to allow GPs to decide when researchers could access identifiable personal health information. However, 89.5% said they would agree to ongoing consent arrangements, allowing the sharing by GPs of anonymous personal health information with researchers without the need for consent on a study-by-study basis. Increasing age (by each 10-year increment), being retired and primary level education only were significantly associated with an increased likelihood of agreeing that any personal health information could be shared on an ongoing basis: OR 1.39 (95% CI 1.18 to 1.63), 2.00 (95% CI 1.22 to 3.29) and 3.91 (95% CI 1.95 to 7.85), respectively. Conclusions Although survey data can be prone to response biases, this study suggests that prior consent agreements allowing the supply by GPs of anonymous personal health information to researchers may be widely supported, and that populations willing to opt in to such arrangements may be sufficiently representative to facilitate valid and robust consent-dependent observational research. (shrink)

Lexical alignment, a communication phenomenon where conversational partners adapt their word choices to become more similar, plays an important role in the development of language and social communication skills. While this has been studied extensively in the conversations of preschool‐aged children and their parents in Western, Educated, Industrialized, Rich, and Democratic (WEIRD) communities, research in other pediatric populations is sparse. This study makes significant expansions on the existing literature by focusing on alignment in naturalistic conversations of school‐aged children from a (...) non‐WEIRD population across multiple conversational tasks and with different types of adult partners. Typically developing children aged 5 to 8 years (n = 45) engaged in four semi‐structured conversations that differed by task (problem‐solving vs. play‐based) and by partner (parent vs. university student), resulting in a corpus of 180 conversations. Lexical alignment scores were calculated and compared to sham conversations, representing alignment occurring at the level of chance. Both children and adults coordinated their conversational utterances by re‐using or aligning each other's word choices. This alignment behavior persisted across conversational tasks and partners, although the degree of alignment was moderated by the conversational context. These findings suggest that lexical alignment is a robust phenomenon in conversations between school‐age children and adults. Furthermore, this study extends lexical alignment findings to a non‐WEIRD culture, suggesting that alignment may be a coordination strategy employed by adults and children across diverse linguistic and cultural backgrounds. (shrink)

Obesity is widely recognized as a preventable cause of death and disease. Reducing obesity among adults and children has become a national health goal in the United States. As one approach to the obesity epidemic, public health practitioners and others have asserted the need to provide consumers with information about the foods they eat. Some state and local governments across the United States have introduced menu labeling bills and regulations that require restaurants to post information, such as calorie content, for (...) foods offered on their menus or menu boards. A major dilemma is whether state and local menu labeling laws are preempted by the federal Nutrition Labeling and Education Act . While few courts have addressed this issue, ongoing litigation in New York City provides an early glimpse of judicial interpretation in this area. This article explores these preemption issues, arguing that appropriately written and implemented menu labeling laws should not be preempted by the NLEA. We offer guidance for states and localities that wish to develop and implement menu labeling laws. (shrink)

Researchers are increasingly applying neuroscience technologies that probe or manipulate the brain to improve educational outcomes. However, their use remains fraught with ethical controversies. Here, we investigate the acceptability of neuroscience applications to educational practice in two groups of young adults: those studying bioscience who will be driving future basic neuroscience research and technology transfer, and those studying education who will be choosing among neuroscience-derived applications for their students. Respondents rated the acceptability of six scenarios describing neuroscience applications to (...) education spanning multiple methodologies, from neuroimaging to neuroactive drugs to brain stimulation. They did so from two perspectives (student, teacher) and for three recipient populations (low-achieving, high-achieving students, students with learning disabilities). Overall, the biosciences students were more favorable to all neuroscience applications than the education students. Scenarios that measured brain activity (i.e., EEG or fMRI) to assess or predict intellectual abilities were deemed more acceptable than manipulations of mental activity by drug use or stimulation techniques, which may violate body integrity. Enhancement up to the norm for low-achieving students and especially students with learning disabilities was more favorably viewed than enhancement beyond the norm for high-achieving students. Finally, respondents rated neuroscientific applications to be less acceptable when adopting the perspective of a teacher than that of a student. Future studies should go beyond the acceptability ratings collected here to delineate the role that concepts of access, equity, authenticity, agency and personal choice play in guiding respondents’ reasoning. (shrink)

Worldwide, obesity has become a major cause of preventable death, disease, and disability. While the epidemic of obesity is a significant public health issue in many developed nations, the United States has the highest prevalence of obesity among adults and children internationally. The National Health and Nutrition Examination Survey estimates that over 60 percent of U.S. adults are overweight or obese. According to the Centers for Disease Control and Prevention, “overweight” refers to adults whose body mass index, a number calculated (...) using weight and height measurements, is between 25 and 29.9. “Obese” refers to adults whose BMI is 30 or higher. Among American children and adolescents, approximately 17 percent are overweight. (shrink)

IntroductionThe present study aimed to evaluate the effects of the Active Communication Education program on the social/emotional impacts of hearing loss in a group of older adults with a cochlear implant.DesignProspective cohort study design, with a “within-subject” control procedure.Study SampleTwenty adults over-65 post-lingually deafened CI users. All subjects were required to be native Italian speakers, to have normal cognitive level, have no significant psychiatric conditions and/or diagnosed incident dementia, and used CI for at least 9 months.Materials and MethodsTwenty participants (...) were assessed using the Hearing Handicap Inventory for the Elderly, the Geriatric Depression Scale, and the Speech, Spatial, and Qualities of Hearing Scale before, during, and after ACE program, with a one and 6-month follow up. The cognitive and audiological evaluation was carried out before commencing the ACE program.ResultsThe ACE program had a positive impact by reducing HL’s social/emotional effects. Participants benefited from a rehabilitative approach by improving multilevel skills: comprehension of audiological and hearing dimensions, acquisition of communicative, pragmatic and problem-solving strategies, and interaction and sharing of experiences with peers.ConclusionAlthough targeting the older adults with moderate HL, the ACE program also seemed to benefit older adult CI users. An improvement in social and emotional adaptation to hearing difficulties can, in turn, significantly promote optimal use of CI in the older adults, thereby possibly reducing the risk of losing motivation and engagement in device use and in rehabilitation protocols. (shrink)

Objective We sought to understand ethics and education needs of emergency nurses and physicians in paediatric and adult emergency departments in order to build ethics capacity and provide a foundation for the development of an ethics education programme. Methods This was a prospective cross-sectional survey of all staff nurses and physicians in three tertiary care EDs. The survey tool, called Clinical Ethics Needs Assessment Survey, was pilot tested on a similar target audience for question content and clarity. Results (...) Of the 123 participants surveyed, 72% and 84% of nurses and physicians fully/somewhat agreed with an overall positive ethical climate, respectively. 69% of participants reported encountering daily or weekly ethical challenges. Participants expressed the greatest need for additional support to address moral distress, conflict management with patients or families and resource issues. Of the 23 reported occurrences of moral distress, 61% were associated with paediatric mental health cases. When asked how the ethics consultation service could be used in the ED, providing education to teams was the most desired method. Conclusions Nurses report a greater need for ethics education and resources compared with their physician colleagues. Ethical challenges in paediatric EDs are more prevalent than adult EDs and nurses voice specific moral distress that are different than adult EDs. These results highlight the need for a suitable educational strategy, which can be developed in collaboration with the leadership of each ED and team of hospital ethicists. (shrink)

Medical confidentiality is a core concept of professionalism and should be an integral part of pregraduate and postgraduate medical education. The aim of our study was to define the factors influencing attitudes towards patient confidentiality in everyday situations in order to define the need for offering further education to various subgroups of physicians. All internists and general practitioners who were registered members of the association of physicians in Geneva or who were working in the department of internal medicine (...) or in the medical polyclinic of the University Hospital of Geneva in 2004 received a standardised questionnaire. Physicians were asked to indicate for seven vignettes whether a violation of confidentiality had occurred and whether the violation was not important, important or serious (scores 1–3; no violation = 0). 508 completed questionnaires were returned (participation rate 55%). Physicians who had worked in the hospital for more than 20 years identified violations of confidentiality more often than physicians with less hospital experience. Binary logistic regression showed that ethics education, total years of professional experience, being an internist, having a private practice, the length of working in private practice and gender were factors associated with correct identification of violations and their severity. However, each factor played a specific role only for single cases or a small number of situations (Cronbach α <0.6). Postgraduate education programs on confidentiality should be offered to a wide range of physicians and should address specific hypothetical situations in which there is a risk of avoidable breaches of confidentiality. (shrink)

The development of neuropsychological assessment methods using virtual reality (VR) is a valid and promising option for the detection of cognitive impairment in the older people, focusing on activities composed of tasks of multiple demands. This study verified the association of age, schooling, and general cognitive status on the performance of neurologically healthy older adults in ECO-VR, a virtual reality task of multiple demands for neuropsychological assessment. A total of 111 older adults answered a sociodemographic questionnaire, the Mini Mental State (...) Examination, the Vocabulary subtest of the Wechsler Intelligence Scale for Adults (third edition), and the ECO-VR. Correlation analyses, multiple linear regression, and comparisons between groups (effects by age and schooling groups) were used to evaluate the results. The ECO-VR total score was significantly associated with age, years of education, MMSE, and Vocabulary subtest. The linear regression models identified that age was the main predictor for total score and rule breaking of ECO-VR. According to the univariate analysis, it was identified the main effect of age group and schooling group in the total ECO-VR score, but there was no interaction effect. The results are discussed in order to understand the role of sociodemographic characteristics in the performance of older adults in a virtual reality task of multiple demands. It was also verified the possibility use of virtual reality for neuropsychological assessment of older adults. (shrink)

The human-centred debate in Britain focuses on the idea of human-machine symbiosis, and the “Dialogue” debate in Scandinavia focuses on the deep understanding of human communication, through a process of inner reflection. Both of these debates provide a framework for the participatory design of AI systems.The emergence of “social Europe” creates the desirability for a sharing of social and cultural knowledge and resources among the citizens of Europe. This raises the possibility of exploiting the potential of new technology for the (...) distribution and transfer of knowledge and skill among the citizens of Europe whilst retaining the diversity of their cultures and languages. These issues of transfer have been the focus of many AI researchers who have been concerned with the design of AI systems for the education, training and welfare of disadvantaged citizens. It is suggested that central to such a transfer is the design of participatory learning systems which focus on the mediation and distribution of knowledge in diverse socio-cultural contexts.In this paper, the SEAKE Centre's projects, especially “Brighton Parosi”, and “Adult Literacy” are discussed to provide an insight into the concepts and practice of designing such participatory systems. The philosophy of these projects was rooted in the sharing of social and cultural experiences, through participatory learning. The development of the projects involved a process of exchange of language and culture in both formal and informal learning environments. For the Parosi Project social interaction was the central core for the exchange of cultural experiences and the language acquisition process. The Adult Literacy project built on the exchange process, and used the idea of the mediation of knowledge for the design of a knowledge based system. The design process developed by the above two projects could be described as a participatory design approach which builds upon and extends the human-machine symbiosis and dialogue approaches. (shrink)

In this article we aim to open a new line of debate about religion in public schools by focusing on religious ideals. We begin with an elucidation of the concept ‘religious ideals’ and an explanation of the notion of reasonable pluralism, in order to be able to explore the dangers and positive contributions of religious ideals and their pursuit on a liberal democratic society. We draw our examples of religious ideals from Christianity and Islam, because these religions have most adherents (...) in Western liberal democracies that are the focus of this article. The fifth and most important section ‘‘Reasonable pluralism and the inclusion of religious ideals in public secondary schools’’ provides three arguments for our claim that public schools should include religious ideals, namely that they are important to religious people, that they are conducive for the development of pupils into citizens of a liberal democracy, and that the flourishing of pupils as adults is advanced by encountering religious ideals. We also offer a more practical reason: religious ideals can more easily be included within public education than religious dogmas and rules. (shrink)

Most of what we know about teaching comes from research among people living in large, politically and economically stratified societies with formal education systems and highly specialized roles with a global market economy. In this paper, we review and synthesize research on teaching among contemporary hunter-gatherer societies. The hunter-gatherer lifeway is the oldest humanity has known and is more representative of the circumstances under which teaching evolved and was utilized most often throughout human history. Research among contemporary hunter-gatherers also (...) illustrates a complex pattern of teaching that is both consistent with and distinct from teaching in other small- and large-scale societies with different subsistence practices and cultural forms. In particular, we find that the cultural emphasis on individual autonomy and socio-political egalitarianism among hunter-gatherers differently shapes how teaching occurs. For example, teaching clearly exists among hunter-gatherers and appears in many forms, including institutionalized instruction in valued cultural and technical skills. However, teaching tends to be less common in hunter-gatherer societies because people live in small, intimate egalitarian, groups that support each other’s learning in a variety of ways without teaching. Furthermore, foundational cultural schemas of autonomy and egalitarianism impact the nature of teaching. For example, adults and older children limit their interventions, permitting autonomous learning, and, when they occur, teaching episodes are generally brief, subtle, indirect, and situated in a present activity. We discuss the implications of this research in terms of discussions of the evolution of human cognition and the co-evolution of teaching and culture through the process of cultural niche construction. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Parenting Adults with ASD: Lessons for Researchers and CliniciansCassandra R. Newsom, Amy S. Weitlauf, Cora M. Taylor, and Zachary E. WarrenRecent reviews of treatments for individuals with autism spectrum disorders (ASD) reveal how little we still know about how to help adolescents with ASD and their families successfully transition into adulthood (Shattuck et al., 2012b; Taylor et al., 2012a). Shattuck and colleagues found that services in the United States (...) for adults with ASD were marked by high unemployment rates, a reliance on families to provide care across the lifespan, high turnover rates in front-line service providers, insufficient transition planning for high school students, and generally insufficient services to meet current needs. In a recent Agency for Healthcare Research and Quality (AHRQ) Comparative Effectiveness Review, the authors similarly found that there is very little evidence available to pinpoint specific intervention approaches for adolescents and young adults with ASD due to a lack of good quality studies. This was especially true for evidence-based approaches to support the transition of youth with ASD to adulthood (Taylor et al., 2012a).For the last decade, with dramatic increases in both ASD awareness and estimates of ASD prevalence, our field has understandably focused intensely on improving early detection and treatment of ASD. Our diagnostic tools and understanding of ASD presentation in very young children has improved tremendously. Different from many of the young adults in these stories, who were often diagnosed in their early teens, we now aim to identify children well before their third birthdays. Research has consistently shown that early and intense ASD-specific intervention can dramatically enhance outcomes for children with ASD. As such, there has been heavy investment in attempting to take full advantage of this early window of neuro-plasticity. However, as these stories illustrate, these children grow up. Their needs change, and our systems are often poorly equipped to help them live fulfilling lives, capitalize on their talents, and obtain independence and equal access, while still providing a safe, supportive environment. Without readily accessible and understandable coordinated systems of care, parents are forced to adopt the multiple roles of case manager, teacher, therapist, community educator, advocate, job coach, housing specialist, financial planner, and often, lifelong caregiver. These stories eloquently illustrate those struggles and successes.Grief and Joy: Opposite Sides of the Same Parenting CoinThe idea of grieving a diagnosis is controversial. Many of the writers seemed to feel conflicted about their grief responses and the validity of their feelings. Research shows that many families view the diagnostic process as extremely stressful (Siklos & [End Page 199] Kerns, 2005; Heiman, 2002). Feelings of sadness, anxiety, and depression are common at the point of diagnosis and may reemerge as milestones pass unmet. Families must modify the futures they imagined for their children and begin to envision new goals and dreams. Anonymous Three described this process when she wrote:Most children grow up, go to school, get jobs, move out of their parents’ home, etc. My husband and I have had to seriously consider how much of these are even possible for a young man with autism, even one who has a good number of functional life skills.Tasks of adolescence and adulthood such as starting high school, driving a car, and moving out of the house may be delayed and hard won if met. Raising a child with ASD appears to have particular challenges. Throughout this process, families begin to redefine what “success” means. Rather than ascribing to societal standards, they find joy in personal milestones. McDonald described the triumph of teaching his nephew to shake women’s hands instead of touching their hair, an important safety goal that took three months to accomplish. Each family thereby creates its own path.People outside of the family often do not understand the complicated interplay of love and obligation as well as the frustration and fulfillment that families experience. Just like any family, the parents of children with ASD describe many joys in addition to their struggles. They see their children’s strengths in a world that too often focuses on their weaknesses. Gifted with the everyday experience of their child’s development, they see past the necessity of a... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Rhetorical Definition:A French InitiativeNancy S. StrueverRhetoric as TheoryIl y a quelque chose de démesuré et de prématuré à entreprendre une histoire de la rhétorique dans I'Europe moderne(Fumaroli 1999).When in his preface to the Histoire de la rhétorique Marc Fumaroli states that the project itself is overambitious and premature, he proceeds to justify his judgment by listing the complications of rhetorical definition: rhetoric is Protean in nature, and in this (...) it simply matches the fluidity of the phenomena of speech, parole ; it is oxymoronic as the science of the uncertain, trying to ally incertitude of topic with intelligibility of explanation; it intricates theoria and ergon, the concept of parole with an engagement with parole in act. Long a part of early education, it generates grace in adult expression, finesse. It is as well a primary source for reflection on communication phenomena. It is manifest in works of genius, yet, it is democratic in its accessibility; it is perdurable, remarkably persistent through change; and, it recognizes that the sharing and abusing of parole are intimately bound together. Finally rhetoric stimulates, for it may illumine the contemporary "exile" of literature and the arts, an exile that poses for us the issue of, perhaps intractable, cultural decline (Fumaroli 1999, 2–3). [End Page 401]These disparate elements of rhetoric, I would argue, by their very complexity justify rhetoric as mode of inquiry, and prompt our continuing consideration of the investigative protocols of rhetoric as hermeneutic. Roman rhetoric, subdivided into three communicative tasks—docere, delectare, movere —sponsors three investigative tasks: instructing requires command of the strategies of argument; delighting sponsors an ecology of desire, and moving requires a socio-pathology of community assent and dissent. The rhetorical interest in discursive effect, then, sponsors a second-order inquiry, the task of reviewing the basic assumptions of the communicative community: the beliefs, doxa, the shared opinions, endoxa, habits, dispositions. Rhetoric collects assumptions; thus Aristotle's Rhetoric has been characterised as a compendium of the collective wisdom of the polis. Rhetorical topoi, commonplaces, are the rubrics that organize common sense, sensus communis. Rhetoric has the task of understanding the means of asserting, rejecting, altering beliefs, the transfer of theory into practice, dealing with the transformations of idea into ideology.Rhetorical interests, in the Habermasian sense of motives that color knowledge initiatives, can correct careers of inquiry; a shift to a rhetorical investigative focus is pragmatic, to a most distinctive engagement with practice. And thus Martin Heidegger's aphorism: "Rhetoric functions inside politics." Rhetoric is framed, compromised by politics defined in the generous sense of discursive negotiations within the communal domain of beliefs, shared opinions, habits of action, dispositions. Rhetorical inquiry has to identify the beliefs and habits of action of a community in its efforts to preserve and extend its identity, and rhetoric must analyze the discursive negotiations for affirmation and alteration of beliefs vital to the continued existence of the polity.The work of Marc Fumaroli is of intrinsic interest to the historian of rhetoric as an instantiation of rhetorical interests driving an entire career, a practice shaped by rhetorical tasks and habits of action in inquiry; the effect is that of a kind of alchemy, of the transformation, at every turn, of the history of culture into the history of cultural politics. "Cultural politics" does not denote, of course, an exclusive focus on state policy, dirigisme in culture. Rather, we have a combination of a compendious notion of culture as all our inventions, artifices—political, theological, affective, aesthetic—with a generous sense of politics as all our discursive negotiations of differences of public import, a combination that sets a topic that Fumaroli prefers to call a "politics of the spirit" (Fumaroli 1992a, 80–81).1 If we distinguish rhetoric as discipline, oratory as product, eloquence as value, we [End Page 402] see Fumaroli's career is exemplary of a modern initiative that links rhetoric as disciplined inquiry to the politics of value. Thus, he will give us a rhetorical definition of the Académie Française's communal, historical duty to French "eloquence," to a pursuit of a national excellence (Fumaroli 1996a, 304, 1992b, 78). And... (shrink)

Increased knowledge of the gene–disease associations contributing to common cancer development raises the prospect of population stratification by genotype and other risk factors. Individual risk assessments could be used to target interventions such as screening, treatment and health education. Genotyping neonates, infants or young children as part of a systematic programme would improve coverage and uptake, and facilitate a screening package that maximises potential benefits and minimises harms including overdiagnosis. This paper explores the potential justifications and risks of genotyping (...) children for genetic variants associated with common cancer development within a personalised screening programme. It identifies the ethical and legal principles that might guide population genotyping where the predictive value of the testing is modest and associated risks might arise in the future, and considers the standards required by population screening programme validity measures . These are distinguished from the normative principles underpinning predictive genetic testing of children for adult-onset diseases—namely, to make best-interests judgements and to preserve autonomy. While the case for population-based genotyping of neonates or young children has not yet been made, the justifications for this approach are likely to become increasingly compelling. A modified evaluative and normative framework should be developed, capturing elements from individualistic and population-based approaches. This should emphasise proper communication and genuine parental consent or informed choice, while recognising the challenges associated with making unsolicited approaches to an asymptomatic group. Such a framework would be strengthened by complementary empirical research. (shrink)

SummaryThe variability of three behavioural risk factors for heart disease—heavy alcohol and tobacco consumption and physical inactivity—was assessed in an Australian Aboriginal community, where heart disease death rates were high. Prevalence levels were assessed by comparison with those experienced by all adult Australians and by evaluating whether Aboriginal rates were influenced by underlying sociodemographic conditions. Relative risk ratios, odds ratios and logistic regression analysis were used.A total of 159 males and 114 females participated. Compared to all Australians, Aborigines are significantly (...) more likely to drink five or more drinks on a drinking day, to be current smokers, and not to participate in vigorous exercise. In the Aboriginal community, univariate analysis indicates that: the odds of being a heavy drinker are significantly higher for those in unsatisfactory health; odds of being a current smoker are significantly higher for those in unsatisfactory health or unemployed; odds of not participating in vigorous exercise are significantly higher for those in unsatisfactory health, unemployed or without secondary education. Multivariate analysis shows that risk of being a heavy drinker is independently associated with sex, age, and health status; risk of being a current smoker is associated with health and employment status. The risk of not participating in vigorous exercise is significantly related to all sociodemographic variables examined. Reasons for these associations are discussed. (shrink)

Some Thoughts concerning Education, originally published in 1693, is one of John Locke's major works, a classic text in the philosophy of education; this is the definitive scholarly edition. The work mainly concerns moral education and its role in creating a responsible adult, and the importance of virtue as a transmitter of culture; but Locke ranges also over a wide range of practical topics.

I Venture to take as the subject for our consideration the philosophical study of politics. However imperfect the treatment of such a subject, it seems to me opportune that attention should at this point of time be directed to the question. The study of politics is of increasing importance in the curricula of our universities and in general adult education. There is also the plain fact that we live in times when a deep unrest of spirit and a great (...) variety of experiment challenge ideas and institutions which have received wide acceptance. There has been, in short, a return to politics. It is well that we should consider afresh the value of the study and the methods by which it is studied. (shrink)

OBJECTIVES: To study whether linguistic analysis and changes in information leaflets can improve readability and understanding. DESIGN: Randomised, controlled study. Two information leaflets concerned with trials of drugs for conditions/diseases which are commonly known were modified, and the original was tested against the revised version. SETTING: Denmark. PARTICIPANTS: 235 persons in the relevant age groups. MAIN MEASURES: Readability and understanding of contents. RESULTS: Both readability and understanding of contents was improved: readability with regard to both information leaflets and understanding with (...) regard to one of the leaflets. CONCLUSION: The results show that both readability and understanding can be improved by increased attention to the linguistic features of the information. (shrink)

Emerging adult newlywed couples often experience many demands on their time, and three common problems may surface as couples try to balance these demands—problems related to finances, sleep, and sex. We used two waves of dyadic data from 1,001 emerging adult newlywed couples to identify four dyadic latent profiles from husbands’ and wives’ financial management behaviors, sexual satisfaction, and sleep quality: Flounderers, Financially Challenged Lovers, Drowsy Budgeters, and Flourishers. We then examined how husbands’ and wives’ marital satisfaction, in relation to (...) profile membership, varied at a later wave. We found that Financially Challenged Lovers and Flourishers had significantly higher marital satisfaction than Drowsy Budgeters and Flounderers. Whereas, Financially Challenged Lovers and Flourishers did not differ in terms of marital satisfaction, Drowsy Budgeters seemed to have slightly higher marital satisfaction than Flounderers for wives only. However, we did not find evidence that these connections meaningfully differed by sex. Implications for the efforts of clinicians and educators are discussed. (shrink)

BackgroundThe use of electronic nicotine delivery systems, also known as vaping, is becoming popular among young adults. Few studies have explored the psychological factors that predict ENDS use and susceptibility in young adults, in addition to known demographic predictors.MethodIn a cross-sectional survey design, 521 young adults, ages 18–25 from the United States, were recruited via Amazon’s Mechanical Turk in 2019, to answer an online survey measuring demographic characteristics and psychological characteristics related to mental health and the Big Five personality traits. (...) The survey also included measures of ENDS ever-use, current use, and susceptibility, which we predicted from the demographic and psychological measures using independent and multiple binary logistic regression analyses.ResultsOf those surveyed, 282 were ENDS ever-users, 93 were current ENDS users, and 61 were ENDS susceptible; 62 were current smokers. Demographically, young adults lower in adulthood socioeconomic-status, not pursuing education further than high school, and current smokers were more likely to be ENDS users. Psychologically, young adults higher in anxiety and lower in conscientiousness more likely to have ever-used ENDS. Lower conscientiousness further predicted current ENDS use and ENDS susceptibility.ConclusionIn this sample of MTurk workers, young adults with experience in vaping were more demographically and psychologically vulnerable than young adults with no experience in vaping. Young adults interested in vaping, but without prior experience, were less conscientious than their non-interested peers. Interventions to target vaping use should focus on economically disadvantaged young adults and those lower in conscientiousness. (shrink)

Bioethical decision‐making in pediatrics diverges from similar decisions in other medical domains because the young child is not an autonomous decision‐maker, while the teen is developing—and should be encouraged to develop—autonomy and decisional capacity. Thus the balance between autonomy and beneficence is fundamentally different in pediatrics than in adult medicine. While ethical dilemmas that reflect these fundamental issues are common, many pediatric physician and nursing training programs do not delve into the issues or offer specific training about how to deal (...) with borderline cases.To meet this need, the Children's Mercy Bioethics Center in Kansas City, Missouri, created a program specifically dedicated to serving practicing, experienced pediatric health professionals. Our students come from various professional disciplines: they are doctors, nurses, social workers, chaplains, lawyers, psychologists, counselors, and hospital administrators practicing in pediatrics. (shrink)

Kids in the Middle: The Micro-Politics of Special Education takes the reader on a fascinating journey through special education in the past, present, and future. On this journey, the micro-politics of special education are seen through the eyes and experiences of children with disabilities, their parents and advocates, adult educators, and school administrators. Supplementing these perspectives to develop an understanding of special education that goes beyond its administrative and political aspects, such as the Individuals with Disabilities (...) Education Act , are scholars with expertise in special education law, administration, severe and profound disabilities, ethics, finance, teaching, and disability rights. Together, these voices explain the micro-political issues that affect how children with disabilities are educated. Kids in the Middle promotes a new model of special education to help transform special education. Instead of perpetuating a system grounded in the concepts of promises, privilege, and power, this book considers how to build a system based on caring, compassion, and the common good, a system that will elevate the status of special education children who are lost in the middle. (shrink)

It is predicted that the rapid acquisition of new genetic knowledge and related applications during the next decade will have significant implications for virtually all members of society. Currently, most people get exposed to information about genes and genetics only through stories publicized in the media. We sought to understand how individuals in the general population used and understood the concepts of ???genetics??? and ???genes.??? During in-depth one-on-one telephone interviews with adults in the United States, we asked questions exploring their (...) basic understanding of these terms, as well as their belief as to the location of genes in the human body. A wide range of responses was received. Despite conversational familiarity with genetic terminology, many noted frustration or were hesitant when trying to answer these questions. In addition, some responses reflected a lack of understanding about basic genetic science that may have significant implications for broader public education measures in genetic literacy, genetic counseling, public health practices, and even routine health care. (shrink)

Learning disabilities are highly prevalent on college campuses, yet students with learning disabilities graduate at lower rates than those without disabilities. Academic and psychosocial supports are essential for overcoming challenges and for improving postsecondary educational opportunities for students with learning disabilities. A holistic, multi-level model of campus-based supports was established to facilitate culture and practice changes at the institutional level, while concurrently bolstering mentors’ abilities to provide learning disability-knowledgeable support, and simultaneously creating opportunities for students’ personal and interpersonal development. Mixed (...) methods were used to investigate implementation of coordinated personal, interpersonal, and institutional level supports for undergraduate science, technology, engineering, and math (STEM) students with learning disabilities. A one-group pre-test post-test strategy was used to examine undergraduate outcomes. Participants included 52 STEM undergraduates with learning disabilities, 57 STEM graduate student mentors, 34 STEM faculty mentors, and 34 university administrators and personnel as members of a university-wide council. Enrolled for two years, undergraduates were engaged in group meetings involving psychoeducation and reflective discussions, development of self-advocacy projects, and individual mentorship. Undergraduates reported improved self efficacy (p =.001), campus connection (p <.001), professional development (p ≤.002), and self advocacy (p <.001) after two academic years. Graduate student mentors increased their understanding about learning disabilities and used their understanding to support both their mentees and other students they worked with. Council members identified and created opportunities for delivering learning disability-related trainings to faculty, mentors and advisors on campus, and for enhancing coordination of student services related to learning and related disorders. Disability-focused activities became integrated in broader campus activities regarding diversity. This research explicates a role that college campuses can play in fostering the wellbeing and the academic and career development of its students with developmental learning and related disorders. It offers an empirically tested campus-based model that is multilevel, holistic, and strengths-based for supporting positive outcomes of young people with learning disabilities in STEM. Moreover, findings advance the knowledge of supports and skills that are important for self-regulating and navigating complex and multi-faceted disability-related challenges within both the post-secondary educational environment and the young adults’ sociocultural context. (shrink)

This study investigated relationships between state anxiety and leisure-domain physical activity levels during Covid-19 pandemic. We used frequency, duration, and intensity as key variables of physical activity. Trait anxiety, state anxiety before pandemic, age, gender, and education level were also included in the analysis. Our general hypothesis was that participants who declared doing more physical activity levels would exhibit lower levels of anxiety during the Covid-19 pandemic. A convenient sample of 571 volunteer adults was drawn mainly from São Paulo (...) State, the epicenter of Covid-19 pandemic in Brazil. To obtain the participants’ levels of anxiety we used a validated short-version of the State and Trait Anxiety Inventory. Levels of physical activity were measured via questions from VIGITEL, a validated questionnaire about the individual’s habits on risk factors. Answers were given regarding the first week of March 2020 and at the very moment the participant was filling in the electronic form. Data analyses were conducted through descriptive and inferential techniques, with the use of non-parametric tests and linear regression models. Overall, participants’ responses indicate that anxiety levels were higher during the pandemic compared to the period that preceded the pandemic, and that frequent and long physical activity in the leisure-domain reduced anxiety, regardless its intensity. The regression models revealed an inverse relationship between physical activity and anxiety and independent of gender, age, education level, trait anxiety, and physical activity before pandemic. (shrink)

The purpose of this study is to investigate the influence of the dimensions of the theory of planned behavior, gender and course majors on unethical behavior intentions among Generation Y undergraduates. The sample of this study comprises 245 undergraduates from a private higher education institution (PHEI) in Malaysia. The instrument of this study is developed based on concepts developed from extant literature. Reliability and validity is accessed using Cronbach’s Alpha and Exploratory Factor Analysis respectively. Social desirability bias was monitored (...) utilizing concepts adapted from Phillips and Clancy (American Journal of Sociology, 77(5), 921–940, 1972 ). Multiple Linear Regression and Independent sample T-tests were used for hypotheses testing. As a whole, results indicate that egoism, utilitarianism and magnitude of consequences exerted significant influence on unethical behavior intentions. Peer influence was not significant. In terms of gender, unethical intentions among males were influenced by egoism and peer influenced while females by utilitarianism and magnitude of consequences. Business majors did not consider magnitude of consequences significant in unethical behavior intentions. Ethical values form the fundamentals of ethical culture within organizations and a business environment which is increasingly based on self-regulation. Ethics is an essential part of the holistic personal development of future business leaders. As such, by understanding ethical attitudes and perceptions, we can draw implications for the further enhancements of teaching and learning of Business Ethics in academia as well as the development of ethical culture in the Malaysian context. Educators, parents and society also need to realise their role in the ethical development of these future Malaysian leaders. The framework of this study could be extended to actual behaviors, adult samples and also account for religiosity and age. This study utilizes the established dimensions and framework of the Theory of Planned Behavior in bridging the gap of research in unethical behavior within the context of a PHEI in Malaysia. (shrink)

In the education context, The Motivational Strategies for Learning Questionnaire is extensively used in assessing self-regulated learning strategies. However, more research is needed to address whether it is applicable for distance education. The exploratory and confirmatory factor analysis were used to test the Chinese version of the Motivated Strategies for Learning Questionnaire part-B for distance learning using two samples totalling 385 participants. This paper substantiates MSLQ-B-DL's criterion-related, convergent, and factorial validity, as well as its internal consistency, in China. (...) Specifically, the concurrent validity of the MSLQ-B-DL was shown from three aspects: the negative correlation of MSLQ-B-DL with trait procrastination; the positive correlation of MSLQ-B-DL with self-control; and the positive correlation of MSLQ-B-DL with instrumental help-seeking and the former's negative correlation with help-seeking avoidance and executive help-seeking. Finally, this study highlights the MSLQ-B-DL's validity and reliability in evaluating the learning strategies in adult distance education in China. (shrink)

Cette recherche propose d’étudier succinctement, à la suite de travaux de Foucault, deux textes de Platon dans deux contextes différents : au moment de l’apogée de la démocratie athénienne, celui sur Alcibiade, et au moment de la décadence des cités et démocraties grecques, sa Lettre VII. Dans les deux cas, il s’agit de l’éducation d’adultes, le premier, Alcibiade, prétendant à la gestion de la cité, le second, Denis II, nouvellement en exercice. Il est question ici d’identifier dans les deux cas, (...) les présupposés et les obstacles pour que les idées d’éducation et de formation participent à l’accroissement d’une conscience éthique et à la réalisation du politique. Le but étant de montrer, comment cette approche proposée par le jeune et le dernier Platon, peut encore revitaliser l’idée de la formation de l’adulte dans le contexte qui, comme le nôtre, a extirpé sous l’influence du modèle des sciences modernes, du champ de l’éducation et de la formation toutes questions métaphysiques comme celles qui donnent pourtant sens à nos actions, à notre existence et à celle du monde. (shrink)

The author reviews the literature in professional education that cites Ernest Becker’s work from the 1960s-70s. Some of Becker’s main ideas from his own writing on education are also reviewed. The purpose here is to establish a sketch, not a full-study, of the importance of Becker’s educational legacy and begin some critique of the biases of professional educators in regard to utilizing Becker’s work. This critical reflectivity is an appropriate model of Becker’s own integrative approach to knowledge and (...) learning. The aim is to ensure that future applications may be cautious to certain reductive tendencies and offer more diverse perspectives that are truer to Becker’s oeuvre and core ideas about human behavior and societies in general, and education specifically. The author concludes that the future of Education, formal and informal, would do well to take a long serious look at Becker’s work, especially as the world’s children, youths and adults are is becoming more and more vulnerable to frightening conditions, with cascading collapse of systems, including extinctions of all kinds already well underway in an era of global threats nearing extremes. Becker’s oeuvre is both realistic and idealistic, offering Education a way to radically improve to help make for a better world. (shrink)

Previous scientific contributions show that interactive learning environments have contributed to promoting learners' learning and development, as interaction and dialogue are key components of learning. When it comes to students with special needs, increasing evidence has demonstrated learning improvements through interaction and dialogue. However, most research focuses on children's education, and there is less evidence of how these learning environments can promote inclusion in adult learners with SEN. This article is addressed to analyse a case study of an interactive (...) learning environment shared by adults with and without special needs. This case shows several improvements identified by adult learners with special needs participating in this study. Based on a documental analysis and a qualitative study, this study analyses a context of participatory and dialogic adult education. From the analysis undertaken, the main results highlight some improvements identified in the lives of these adult women and men with SEN, covering educational improvements, increased feeling of social inclusion, and enhanced well-being. (shrink)

Today, the persistence of infantile attitudes into adulthood seems to have become a way of life associated with enjoyment and the renunciation of social obligations. Contemporary society, crossed by the emotional culture of Social Media, favors the example of parents who are friends with their children, of teachers who are enemies of their parents and of young people who are far from authority and traditional morality. Distances between parents and children and between teachers and pupils are eliminated. Today's adolescent is (...) represented with the image of Narcissus because within the affective family he grows up with the idea that success is the goal for achieving happiness and personal satisfaction. What future prospects can you imagine for young people? How to tackle adult frailty? The pedagogical debate could reflect on new educational systems that concern the affective and relational dimension of young people and the orientation skills of adults. By accepting the new needs of young people, adults could carry out that progressive process of affectivity, the acceptance of new educational, affective and relational functions. (shrink)