As clinical trials end, little is understood about how participants exiting from clinical trials approach decisions related to the removal or post-trial use of investigational brain implants, such as deep brain stimulation (DBS) devices. This empirical bioethics study examines how research participants experience the process of exit from research at the end of clinical trials of implanted neural devices. Using a modified grounded theory study design, we conducted semi-structured, in-depth interviews with 16 former research participants from clinical trials of DBS (...) and responsive neurostimulation (RNS). Open-ended questions elicited motivations for joining the trial, understanding of study procedures at the time of initial informed consent, the process of exiting from research, and decisions about device removal or post-trial device use. Thematic analysis identified categories related to: limited preparedness for the end of research participation, straightforwardness of decisions to explant or keep the device, reconciling with the end of research participation, reconciling post-trial expectations, and achieving a sense of closure after exit from research. A preliminary theoretical model describes contextual factors influencing the process and experience of exit from research. Experiences of clinical trial participants should guide research practices to enhance the ethical design and conduct of clinical trials in DBS and other brain devices. (shrink)

The new National Institutes of Health (NIH) Policy on the Use of a Single Institutional Review Board (sIRB) for Multi-Site Research was adopted primarily to simplify and speed the review of complex multisite clinical trials. However, speeding review requires overcoming a number of obstacles. Perhaps the most substantial obstacle is the time and effort needed to develop reliance agreements among the participating sites. We conducted 102 semistructured interviews with sIRB personnel, including directors, chairs, reviewers, and staff, from 20 IRBs that (...) acted as sIRBs for multisite research, including 6 commercial/independent sIRBs, and 10 university-based academic and 4 federal sIRBs. Almost without exception, the interviewees agreed that reliance agreements were complex, difficult to develop, and time-consuming. A major problem for relying sites was that different agreements specified different responsibilities for the relying sites. Attitudes differed about whether these problems will be resolved as IRB staff and managers become more experienced with sIRBs. However it is clear that the process of developing reliance agreements must be simplified. Federal assistance in standardizing at least some sections of reliance agreements might reduce the difficulties involved. (shrink)

PurposePrevious studies examining the relationship between health-related quality of life and speech perception ability in cochlear implant users have yielded variable results, due to a range of factors, such as a variety of different HRQoL questionnaires and CI speech testing materials in addition to CI configuration. In order to decrease inherent variability and better understand the relationship between these measures in CI users, we administered a commonly used clinical CI speech testing battery as well as two popular HRQoL questionnaires in (...) bimodal and bilateral CI users.MethodsThe Glasgow Benefit Inventory, a modified five-factor version of the GBI, and the Nijmegen Cochlear Implant Questionnaire were administered to 25 CI users. Speech perception abilities were measured with the AzBio sentence test in several conditions.ResultsHigher performance scores on the GBI general subscore were related to greater binaural speech perception ability in noise. There were no other relationships between the GBI or NCIQ and speech perception ability under any condition. Scores on many of the GBI-5F factors were substantially skewed and asymmetrical; therefore, correlational analyses could not be applied. Across all participants, binaural speech perception scores were greater than first-ear CI only scores.ConclusionThe GBI general subscore was related to binaural speech perception, which is considered the everyday listening condition of bimodal and bilateral CI users, in noise; while the more CI-specific NCIQ did not relate to speech perception ability in any listening condition. Future research exploring the relationships between the GBI, GBI-5F, and NCIQ considering bimodal and bilateral CI configurations separately is warranted. (shrink)

Aim Facebook is an increasingly popular online social networking site. The purpose of this study was to describe the Facebook activity of residents and fellows and their opinions regarding the impact of Facebook on the doctor–patient relationship. Methods An anonymous questionnaire was emailed to 405 residents and fellows at the Rouen University Hospital, France, in October 2009. Results Of the 202 participants who returned the questionnaire (50%), 147 (73%) had a Facebook profile. Among responders, 138 (99%) displayed their real name (...) on their profile, 136 (97%) their birthdates, 128 (91%) a personal photograph, 83 (59%) their current university and 76 (55%) their current position. Default privacy settings were changed by 61% of users, more frequently if they were registered for >1 year (p=0.02). If a patient requested them as a ‘friend’, 152 (85%) participants would automatically decline the request, 26 (15%) would decide on an individual basis and none would automatically accept the request. Eighty-eight participants (48%) believed that the doctor–patient relationship would be altered if patients discovered that their doctor had a Facebook account, but 139 (76%) considered that it would change only if the patient had open access to their doctor's profile, independent of its content. Conclusions Residents and fellows frequently use Facebook and display personal information on their profiles. Insufficient privacy protection might have an impact the doctor–patient relationship. (shrink)

L’épreuve projective intitulée « spatiographie projective familiale » a pour objectif de comprendre l’image inconsciente du corps familial à travers l’analyse du dessin groupal de la « maison de rêve ». Par cette méthodologie, les auteurs peuvent établir un diagnostic de la structure des liens inconscients de la famille et en faire un objet médiateur pour la prise en charge psychothérapique et une épreuve projective groupale familiale pour le diagnostic. Le dessin de la « maison de rêve » est un (...) outil original qui investigue les dimensions diachronique et synchronique permettant une approche complète de la structuration de l’image du corps familial. (shrink)

Recent arguments claim that behavioral science has focused – to its detriment – on the individual over the system when construing behavioral interventions. In this commentary, we argue that tackling economic inequality using both framings in tandem is invaluable. By studying individuals who have overcome inequality, “positive deviants,” and the system limitations they navigate, we offer potentially greater policy solutions.

Over the last decades, changes within higher education have created increased pressure and uncertainty for academics, increasing their risk for cognitive, behavioral, physical, as well as psychological issues due to high job demands. Specifically, for new academics in teaching roles, their lack of knowledge and skills can contribute to a negative effect of these job demands on their well-being. This study therefore explored how teaching-related professional development programs can enhance new university teachers’ well-being, through semi-structured interviews with 10 university teachers (...) participating in such a program at a mid-sized Dutch university. We pay special attention to the relationship between specific learning activities integrated in the program and various dimensions of the psychological model of well-being by Ryff and Keyes. Using co-occurrence analysis and content analysis, we found that different learning activities had distinct relationships with different well-being facets. For example, formal workshops were mainly related to environmental mastery, a purpose in life and personal growth, while reflecting seemed to be especially connected to teachers’ self-acceptance, and participating in a learning community was mainly related to positive relations with others and personal growth. Our findings have implications for research on teacher well-being as well as for the design of professional development programs for higher education teaching staff. (shrink)

Cet article propose la première publication complète d’un monument consacré par les Thespiens aux Muses dans leur sanctuaire au pied de l’Hélicon, dont les éléments constitutifs sont connus depuis le xixe s., et notamment depuis les fouilles de P. Jamot au Val des Muses. Les statues en bronze de petite taille des neuf Muses se dressaient sur une base en arc de cercle d’une ampleur de ca 10 m, placée dans un écrin architectural largement ouvert sur l’extérieur. Un nouveau lustre (...) est donné à ce groupe statuaire hellénistique exceptionnel à l’époque d’Auguste par la gravure, sous chacune des figures, d’une épigramme descriptive et érudite signée par le poète corinthien Honestos. Est ainsi conservé l’un des rares exemples archéologiques de recueil de poèmes décrivant des œuvres d’art figuré. L’analyse des épigrammes et l’observation détaillée des mortaises de fixation visibles à la face supérieure des blocs de la base permettent d’émettre des hypothèses sur les types utilisés pour la représentation des Muses, mais aussi d’assurer, au‑delà de tout doute, que les statues prenaient place au milieu d’ornements végétaux en bronze qui évoquaient le paysage du Val des Muses. La représentation de la nature comme élément non plus secondaire, mais essentiel d’un groupe sculpté correspond aux recherches nouvelles de la basse époque hellénistique. Faute de fouilles exhaustives du sanctuaire des Muses, l’emplacement du monument ne peut être déterminé avec certitude. Des lettres de remontage nous apprennent en revanche qu’il a été déplacé, peut‑être à l’époque où furent gravés les poèmes d’Honestos. (shrink)

This study examined the extent to which concussion management plans at National Collegiate Athletic Association member schools were in line with NCAA Concussion Policy and best practice recommendations in absence of any process to ensure compliance. Most schools' concussion management plans were in compliance with 3 or 4 of the NCAA's 4 required components. Annual athlete education and acknowledgement was the requirement least often included, representing an area for improvement. Further, schools tended to more often include best practices that were (...) more medically-oriented, compared to best practices that were less medical in nature. (shrink)

Tissue plasminogen activator (tPA) is administered to patients with suspected ischemic stroke to improve blood flow to the brain In rare cases, patients present with complaints of stroke symptoms that appear to be non-organic due to malingering, factitious disorder, or conversion disorder (psychogenic stroke mimics). Deciding whether or not to administer tPA to these patients can be challenging. The risk of hemorrhage after administration of tPA is low, but not zero. The ethical principles of beneficence and nonmaleficence need to be (...) weighed carefully in these situations. We present two cases of patients with suspected psychogenic stroke mimics to illustrate the ethical challenges faced in identifying and managing psychogenic stroke mimics. Further research is needed to demonstrate effective treatment strategies for patients with acute stroke symptoms of psychogenic etiology. (shrink)

Aristotle's endeavor, at least insofar as we can judge from the way it has been transmitted to us and from the titles of the lost works, is often presented as the first work of an encyclopedic nature, as it seems to embrace and order all of the elements of knowledge. Does Aristotle not advance a classification of sciences, in Metaphysics, E, 1, as well as a systematic outline of the “sciences of nature” in his Meteorologica, I, 1? And again, although (...) logic is often presented as not belonging to the system of sciences since it is not counted as a science in Metaphysics, E, 1, is Aristotle not generally considered the inventor of this discipline? The impression is all the stronger in that Andronicus of Rhodes, in the first century b.c., edited Aristotle's works by roughly adopting the threefold division of philosophy into Logic-Physics-Ethics, a division that had become common during the Hellenistic period though more particularly proper to the Stoic system. Since then, all the editions of Aristotle, in every language, have been made to serve the order in which Aristotle's treatises were thus edited. (shrink)

Background The first COVID-19 wave started in February 2020 in France. The influx of patients requiring emergency care and high-level technicity led healthcare professionals to fear saturation of available care. In that context, the multidisciplinary Ethics- Support Cell (EST) was created to help medical teams consider the decisions that could potentially be sources of ethical dilemmas. Objectives The primary objective was to prospectively collect information on requests for EST assistance from 23 March to 9 May 2020. The secondary aim was (...) to describe the Cell’s functions during that period. Research design This observational, real-time study of requests for Cell consultations concerned ethical dilemmas arising during a public health crisis. The EST created a grid to collect relevant information (clinical, patient’s/designated representative’s preferences and ethical principles strained by the situation), thereby assuring that each EST asked the same questions, in the same order. Participants and research context Only our university hospital’s clinicians could request EST intervention. Ethical considerations The hospital Research Ethics Committee approved this study (no. CER-2020-107). The patient, his/her family, or designated representative was informed of this ethics consultation and most met with EST members, which enabled them to express their preferences and/or opposition. Findings/results 33 requests (patients’ mean age: 80.8 years; 29 had COVID-19: 24 with dyspnea, 30 with comorbidities). 17 Emergency Department solicitations concerned ICU admission, without reference to resource constraints; others addressed therapeutic proportionality dilemmas. Discussion Intervention-request motives concerned limited resources and treatment intensity. Management revolved around three axes: the treatment option most appropriate for the patient, the feasibility of implementation, and dignified care for the patient. Conclusions COVID-19 crisis forced hospitals to envisage prioritization of ICU access. Established decision-making criteria and protocols do not enable healthcare professionals to escape ethical dilemmas. That acknowledgement highlights ethical risks, enhances the added-value of nursing and encourages all players to be vigilant to pursue collective deliberations to achieve clear and transparent decisions. (shrink)

Previous research shows that females use more exclamation marks than males, often to establish rapport. The purpose of the present studies was to test whether people associate texters’ use of exclamation marks with friendliness and femaleness. If this association is due to normative expectations, we hypothesized that females would appear less friendly if they did not use an exclamation mark in texting. In Study 1, participants rated a texter using an exclamation mark to be highly female and highly friendly. The (...) gender results disappeared when friendliness was controlled for. In Study 2, we tested whether friendliness ratings decreased if texters violated gender-associated punctuation. Participants rated a texter with a gendered name on friendliness. Regardless of gender, participants inferred greater friendliness to texters using an exclamation mark. That is, there was no evidence of a cost for violating this gender expectation. We conclude that people predict that a texter using an exclamation mark is likely to be female, but do not penalize females for not using an exclamation mark. (shrink)

Max Bense gilt als Vorreiter der Computerkunst und der Technikphilosophie und war ein engagierter Förderer von Kunst und Literatur, Promotor interdisziplinären Denkens und politischer Provokateur. Häufig ist es bei der Auseinandersetzung mit Bense jedoch bei diesen Etikettierungen geblieben. Der Sammelband nimmt daher eine konzertierte Neuaufnahme der Diskussion von Max Benses Arbeiten aus literaturwissenschaftlicher, philosophie- und wissenschaftshistorischer sowie aus medien- und ästhetiktheoretischer Perspektive vor. Er versammelt Beiträge zu Themenkomplexen wie der Semiotik, Technikphilosophie, experimentellen Poesie und Ästhetiktheorie, zu Benses lokalen und internationalen (...) Kontakten und Netzwerken sowie zu seinem publizistischen Verhalten im Nationalsozialismus und in der Nachkriegszeit. (shrink)

La composición polifónica musical nos permite hablar de la emergencia, en el sur y desde el sur que somos, de Voces de la Tierra, que han susurrado, cantado, llorado o gritado el dolor producido por las maneras de habitar humanas construidas en la modernidad cosificadora de la tierra y del mundo de la vida, modernidad mercantil, industrial y global cuya ética se ha reducido a valores absolutamente euro-antropo-racional-centristas, permeados por el valor supremo del capital. En este artículo, emergente de pensadores (...) ambientales latinoamericanos y pensadores-otros que han sospechado radicalmente del edificio de la ética ambiental emergente de la conferencia del Club de Roma o del Informe Burndtland, intentamos desplegar lo ético, como ethos con e larga, que en griego significa casa, y desde este lugar de enunciación, intentamos salirnos del sujeto y del objeto en la variación ética ambiental eurocentrista, y proponer con las voces de la tierra sur, abya yala, diseños del ethos, ligado óntica-relacionalmente con el cuerpo-tierra. Diseñamos, inspirados en Husserl, Heidegger, Deleuze, Guattari, Ángel-Maya, Enrique Leff, Noguera, Echeverri, pensadores-otros y voces de montañas, animales, ríos, y plantas, la vida, territorios de libertad entendida ésta como expansión de los cuerpos en la naturaleza y de paz integral y completa, entendiendo que no puede haber paz, si no amamos ni respetamos la tierra que somos. Esto exige el giro óntico-etico- estético-político de la ética en clave de un Pensamiento Ambiental Sur. (shrink)

Résumé À travers le cas clinique d’une adolescente obèse, l’article postule que le corps « obèse » peut être l’espace d’expression de la conflictualité inter et transgénérationnelle. Le symptôme de l’obésité viendrait alors préserver l’homéostasie familiale. Cet écrit met le projecteur sur la dimension contenante de ce corps « encombrant », signifiant formel d’une enveloppe psychique porteuse de traces douloureuses appartenant au mémorial familial. Il expose ainsi une explication au phénomène de résistance à l’amaigrissement rencontré parfois dans la clinique de (...) l’obésité. (shrink)

We argue that planning and control may not be separable entities, either at the behavioural level or at the neurophysiological level. We review studies that show the involvement of superior and inferior parietal cortex in both planning and control. We propose an alternative view to the localization theory put forth by Glover.

Culminada la Guerra Fría, la sociedad global consideró superadas la colisión ideológica y la polarización de teorías. Sin embargo, al finalizar el siglo xx y descollando el siglo xxi surgieron indicios que apuntaban en dirección contraria. Los primeros con el resurgimiento del marxismo que a partir de la tesis humanista de la filosofía de la praxis revive desde Latinoamérica el legado de Mariátegui, el Che Guevara y Camilo Torres R. El artículo se pregunta si el paradigma del marxismo humanista arroga (...) los fundamentos del buen vivir o vivir bien para enfrentar al capitalismo neoliberal y su proyecto desarrollista. La aproximación al tema se hace de manera cualitativa y descriptiva. A través del método de análisis del discurso político expuesto en la teoría crítica al desarrollismo se aborda la caracterización del capitalismo neoliberal y el modelo de desarrollo, continuando con las tesis que desde el marxismo humanista y la estrategia de revolución cultural se estructura para la emancipación en Latinoamérica. Finalmente, se exponen los planteamientos del buen vivir a partir de la apropiación que hacen los neomarxistas para dar la batalla contra el capitalismo neoliberal. (shrink)

The article argues that there are different ways of justifying suspension of judgement. We suspend judgement not only privatively, that is, because we lack evidence, but also positively, that is, because there is evidence that provides reasons for suspending judgement: suspension is more than the rational fallback position in cases of insufficient evidence. The article applies the distinction to recent discussions about the role of suspension for inquiry, Turri's puzzle about withholding, and formal representations of suspension.

The aim of this paper is to propose a systematic classification of emotions which can also characterize their nature. The first challenge we address is the submission of clear criteria for a theory of emotions that determine which mental phenomena are emotions and which are not. We suggest that emotions as a subclass of mental states are determined by their functional roles. The second and main challenge is the presentation of a classification and theory of emotions that can account for (...) all existing varieties. We argue that we must classify emotions according to four developmental stages: 1. pre-emotions as unfocussed expressive emotion states, 2. basic emotions, 3. primary cognitive emotions, and 4. secondary cognitive emotions. We suggest four types of basic emotions (fear, anger, joy and sadness) which are systematically differentiated into a diversity of more complex emotions during emotional development. The classification distinguishes between basic and non-basic emotions and our multi-factorial account considers cognitive, experiential, physiological and behavioral parameters as relevant for constituting an emotion. However, each emotion type is constituted by a typical pattern according to which some features may be more significant than others. Emotions differ strongly where these patterns of features are concerned, while their essential functional roles are the same. We argue that emotions form a unified ontological category that is coherent and can be well defined by their characteristic functional roles. Our account of emotions is supported by data from developmental psychology, neurobiology, evolutionary biology and sociology. (shrink)

For females without a functioning womb, the only way to become a biological parent is via assisted gestation—either surrogacy or uterus transplantation (UTx). This paper examines the comparative impact of these options on two types of putative ‘womb‐givers’: people who provide gestational surrogacy and those who donate their uterus for live donation. The surrogate ‘leases’ their womb for the gestational period, while the UTx donor donates their womb permanently via hysterectomy. Both enterprises involve a significant degree of self‐sacrifice and medical (...) risk in order to enable another person(s) to become a parent by either providing gestational labour or enabling the other person to undertake gestation themselves. In this paper, we explore the burdens and the benefits from the perspective of the womb‐giver in order to inform ethical debate about assisted gestation. This is a perspective that is often neglected in the bioethical discourse. With both surrogacy and UTx, when success follows the womb‐giver’s sacrifice, the key benefit is delivered to the intending parent(s), but as this article examines, the womb‐giver may also enjoy some unique (relational) benefits as a result of their sacrifice. Ultimately, the choice of how a womb‐giver lends assistance in gestation will impact on their bodily autonomy; some will prefer to carry a pregnancy and others to donate their uterus. We argue that the perspective of the womb‐giver is crucial and thus far has not been afforded sufficient consideration in ethical discussion. (shrink)

Recent empirical studies have established that disgust plays a role in moral judgment. The normative significance of this discovery remains an object of philosophical contention, however; ‘disgust skeptics’ such as Martha Nussbaum have argued that disgust is a distorting influence on moral judgment and has no legitimate role to play in assessments of moral wrongness. I argue, pace Nussbaum, that disgust’s role in the moral domain parallels its role in the physical domain. Just as physical disgust tracks physical contamination and (...) pollution, so moral disgust tracks social contamination. I begin by examining the arguments for skepticism about disgust and show that these arguments threaten to overgeneralize and lead to a widespread skepticism about the justifiability of our moral judgments. I then look at the positive arguments for according disgust a role in moral judgment, and suggest that disgust tracks invisible social contagions in much the same way as it tracks invisible physical contagions, thereby serving as a defense against the threat of socio-moral contamination. (shrink)

Empirical studies indicate that business compliance with the UK Modern Slavery Act is disappointing, but they struggle to make sense of this phenomenon. This article offers a novel framework to understand how business organizations construct the meaning of compliance with the UK Modern Slavery Act. Our analysis builds on the endogeneity of law theory developed by Edelman. Empirically, our study is based on the analysis of the modern slavery statements of 10 FTSE 100 (Financial Times Stock Exchange 100 Index) companies (...) in the food and tobacco sector, backed by interviews with business, civil society, and public officers. We offer a dynamic model that draws attention to the role of compliance professionals in framing ambiguous rules and devising a variety of organizational responses to modern slavery law. Contrary to extant research that tends to praise organizations for going “beyond compliance”, our study underlines the risks of managerialization of modern slavery law, whereby merely symbolic structures come to be associated with legal compliance, even when they are ineffective at tackling modern slavery. (shrink)

Previous research suggested a role of gaze in preference formation, not merely as an expression of preference, but also as a causal influence. According to the gaze cascade hypothesis, the longer subjects look at an item, the more likely they are to develop a preference for it. However, to date the connection between viewing and liking has been investigated predominately with self-paced viewing conditions in which the subjects were required to select certain items from simultaneously presented stimuli on the basis (...) of perceived visual attractiveness. Such conditions might promote a default, but non-mandatory connection between viewing and liking. To explore whether the connection is separable, we examined the evaluative processing of single naturalistic food images in a 2 x 2 design, conducted completely within subjects, in which we varied both the type of exposure (self-paced versus time-controlled) and the type of evaluation (non-exclusive versus exclusive). In the self-paced exclusive evaluation, longer viewing was associated with a higher likelihood of a positive evaluation. However, in the self-paced non-exclusive evaluation, the trend reversed such that longer viewing durations were associated with lesser ratings. Furthermore, in the time-controlled tasks, both with non-exclusive and exclusive evaluation, there was no significant relationship between the viewing duration and the evaluation. The overall pattern of results was consistent for viewing times measured in terms of exposure duration (i.e., the duration of stimulus presentation on the screen) and in terms of actual gaze duration (i.e., the amount of time the subject effectively gazed at the stimulus on the screen). The data indicated that viewing does not intrinsically lead to a higher evaluation when evaluating single food images; instead, the relationship between viewing duration and evaluation depends on the type of task. We suggest that self-determination of exposure duration may be a prerequisite for any influence from viewing time on evaluative processing, regardless of whether the influence is facilitative. Moreover, the purported facilitative link between viewing and liking appears to be limited to exclusive evaluation, when only a restricted number of items can be included in a chosen set. (shrink)

ObjectiveOur research aim is to enrich the conceptualization of high conflict post-divorce co-parenting by understanding the dynamic process involved.BackgroundThe studied phenomena were explored by linking previous scientific knowledge to practice.MethodWe cross-referenced the previous study results with the experiences reported by eight professionals and tried to answer the following research question: how professionals’ experience and previous scientific knowledge contribute to a better understanding of HC post-divorce co-parenting? Individual face to face interviews were conducted and analyzed regarding the qualitative theoretical reasoning of (...) thematic analysis.ResultsAnalysis allowed us to highlight how four main axes are related to HC post-divorce co-parenting: Parents for life, Acting in the child’s best interests, Managing disagreements, and Healing the separation.ConclusionOur findings capture high conflict post-divorce co-parenting as a multidimensional dynamic process. As such, dealing with co-parenting disagreements must be understood as a moment in a process that is influenced by, and influences, other dimensions.ImplicationsInterventions must consider the four dimensions and their reciprocal interactions. The essential elements underlying parents’ difficulties may reside at a multiplicity of levels: inter-relational, contextual, and intrapsychic. Each level contains key potential factors in understanding these families, and in formulating intervention guidelines. (shrink)

The aim of this paper is to examine a special subgroup of emotion: self-referential emo- tions such as shame, pride and guilt. Self-referential emotions are usually conceptualized as (i) essentially involving the subject herself and as (ii) having complex conditions such as the capacity to represent others’ thoughts. I will show that rather than depending on a fully fledged ‘theory of mind’ and an explicit language-based self-representation, (i) pre-forms of self-referential emotions appear at early developmental stages already exhib- iting their (...) characteristic structure of the intentional object of the emotion being identical with or intricately related to the subject experiencing the emotional state and that (ii) they precede and substantially contribute to the development of more complex representations and to the development of a self-concept, to social interaction and to ways of understand- ing of other minds. (shrink)