Recently, bioethicists and the UNCRPD have advocated for supported medical decision-making on behalf of patients with intellectual disabilities. But what does supported decision-making really entail? One compelling framework is Anita Silvers and Leslie Francis’ mental prosthesis account, which envisions supported decision-making as a process in which trustees act as mere appendages for the patient’s will; the trustee provides the cognitive tools the patient requires to realize her conception of her own good. We argue that supported decision-making would be better understood (...) as a collaborative process, giving patients with intellectual disabilities the opportunity to make decisions in a respectful relationship with trusted others. We offer an alternative account of supported decision-making where the primary constraint is to protect the patient from domination by the trustee. This is advantageous in its preservation of the prospects for genuine collaboration, for the mental prosthesis approach ultimately reinforces a problematic ideal of isolated patient self-determination. (shrink)

ABSTRACTThe attentional blink is the impaired ability to detect a second target when it follows shortly after the first among distractors in a rapid serial visual presentation...

There is convincing evidence of the transmission of anxiety and depression from parents to children; however, mechanisms by which this vulnerability is passed on are unclear. Cognitive models and a small body of cross-sectional research suggest that parental attention biases may be one mechanism involved in transmission. Longitudinal associations of maternal and offspring ABs with offspring symptoms have been scarcely studied. Forty-three mothers–child dyads were included. All children were diagnosis-free while 24 mothers had a lifetime emotional disorder and 19 mothers (...) had no psychiatric diagnoses. This study examined cross-sectional and longitudinal associations of maternal and child AB and child anxiety symptomology at initial and 12-month assessments. ABs were assessed using a visual-probe task with emotional faces. There was a significant cross-sectional but not longitudinal association of increased child anxiety symptoms with increased maternal threat AB for HR but not LR dyads. At the cross-sectional level, increases in HR but not LR offspring anxiety symptomology were associated with maternal threat AB. Larger longitudinal studies are required that examine the interplay between parent–child variables and include multiple time-points of assessment and measures of AB. (shrink)

The ability to rapidly detect facial expressions of anger and threat over other salient expressions has adaptive value across the lifespan. Although studies have demonstrated this threat superiority effect in adults, surprisingly little research has examined the development of this process over the childhood period. In this study, we examined the efficiency of children's facial processing in visual search tasks. In Experiment 1, children (N=49) aged 8 to 11 years were faster and more accurate in detecting angry target faces embedded (...) in neutral backgrounds than vice versa, and they were slower in detecting the absence of a discrepant face among angry than among neutral faces. This search pattern was unaffected by an increase in matrix size. Faster detection of angry than neutral deviants may reflect that angry faces stand out more among neutral faces than vice versa, or that detection of neutral faces is slowed by the presence of surrounding angry distracters. When keeping the background constant in Experiment 2, children (N=35) aged 8 to 11 years were faster and more accurate in detecting angry than sad or happy target faces among neutral background faces. Moreover, children with higher levels of anxiety were quicker to find both angry and sad faces whereas low anxious children showed an advantage for angry faces only. Results suggest a threat superiority effect in processing facial expressions in young children as in adults and that increased sensitivity for negative faces may be characteristic of children with anxiety problems. (shrink)

Applying the framework proposed by Jeffery et al. to nonhuman primates moving in multilayer arboreal and terrestrial environments, we see that these animals must generate a mosaic of many bicoded spaces in order to move efficiently and safely through their habitat. Terrestrial light detection and ranging (LiDAR) technology and three-dimensional modelling of canopy movement may permit testing of Jeffery et al.'s framework in natural environments.

The subject of this thesis is Friedrich Nietzsche’s methodology, the genealogical mode of inquiry, which came to fruition in On the Genealogy of Morals. The precise nature of the genealogy, as a mode of inquiry, is a site of contest amongst scholars, with the central debates pivoting around four questions which arise upon considering the methodology: what is the critical import of Nietzsche’s genealogical mode of inquiry? What form of critique does it take? To whom does Nietzsche address his reflections? (...) And what role, if any, does history play in Nietzsche’s genealogical narratives? Accordingly, this thesis seeks to offer and to defend answers to the central questions that are generated by the consideration of Nietzsche’s methodology. In order to get a foothold into these debates and to provide the boundary within which these disagreements occur the first chapter has as its object of inquiry an examination and evaluation of Nietzsche scholars’ responses to these issues. In chapter two I defend my interpretation against these rival views, and contend that the genealogy takes the form of an immanent critique, and that it is intended, at least, to reach all of Nietzsche’s contemporaries. The adage “genealogy is history correctly practiced” is treated in the remaining three chapters, in which I attempt to morph what appears to be at present an uninformative formulation into an informative one by arguing that for Nietzsche historiography is best seen as a form of artistry. And, this I submit, serves to shed light upon the genealogical mode of inquiry, and to shape the boundary by which the equation of genealogy as methodology with history becomes instructive. (shrink)

This article examines the rise of the anti-vaccination movement, the proliferation of laws allowing parental exemptions to mandatory school vaccines, and the impact of the movement on immunization rates for all vaccines. It uses the ongoing debate about the Human Papillomavirus vaccine as an example to highlight the ripple effect and consequences of the anti-vaccine movement despite robust evidence of the vaccine's safety and efficacy. The article scrutinizes how state legislatures ironically promote vaccination while simultaneously deferring to the opposition by (...) promulgating broad opt-outs from mandatory vaccine laws. This article concludes by offering an alternative legislative approach to specifically combat the anti-vaccine movement's impact on HPV vaccination rates. Lowering the age of consent has not been widely attempted or proposed and provides an alternative statutory mechanism to push back against vaccine resistance. (shrink)

This paper has both theoretical and practical ambitions. The theoretical ambitions are to explore what would constitute both effective and ethical treatment of Autism Spectrum Disorder.1 However, the practical ambition is perhaps more important: we argue that a dominant form of Applied Behavior Analysis, which is widely taken to be far-and-away the best “treatment”2 for ASD, manifests systematic violations of the fundamental tenets of bioethics. Moreover, the supposed benefits of the treatment not only fail to mitigate these violations, but they (...) often exacerbate them. Warnings of the perils of ABA are not original to us—autism advocates have been ringing this... (shrink)

In humans over 15% of X‐linked genes have been shown to ‘escape’ from X‐chromosome inactivation (XCI): they continue to be expressed to some extent from the inactive X chromosome. Mono‐allelic expression is anticipated within a cell for genes subject to XCI, but random XCI usually results in expression of both alleles in a cell population. Using a study of allelic expression from cultured lymphoblasts and fibroblasts, many of which showed substantial skewing of XCI, we recently reported that the expression of (...) genes lies on a contiunuum between those that are subject to inactivation, and those that escape. We now review allelic expression studies from mouse, and discuss the variability in escape seen in both humans and mice in genic expression levels, between X chromosomes and between tissues. We also discuss current knowledge of the heterochromatic features, DNA elements and three‐dimensional topology of the inactive X that contribute to the balance of expression from the otherwise inactive X chromosome. (shrink)

Success in online and blended courses requires engaging in self-regulated learning, especially for challenging STEM disciplines, such as physics. This involves students planning how they will navigate course assignments and activities, setting goals for completion, monitoring their progress and content understanding, and reflecting on how they completed each assignment. Based on Winne & Hadwin’s COPES model, SRL is a series of events that temporally unfold during learning, impacted by changing internal and external factors, such as goal orientation and content difficulty. (...) Thus, as goal orientation and content difficulty change throughout a course, so might students’ use of SRL processes. This paper studies how students’ SRL behavior and achievement goal orientation change over time in a large college introductory level physics course taught online. Students’ achievement goal orientation was measured by repeated administration of the achievement goals questionnaire-revised. Students’ SRL behavior was measured by analyzing their clickstream event traces interacting with online learning modules via a combination of trace clustering and process mining. Event traces were first divided into groups similar in nature using agglomerative clustering, with similarity between traces determined based on a set of derived characteristics most reflective of students’ SRL processes. We then generated causal nets for each cluster of traces via process mining and interpreted the underlying behavior and strategy of each causal net according to the COPES SRL framework. We then measured the frequency at which students adopted each causal net and assessed whether the adoption of different causal nets was associated with responses to the AGQ-R. By repeating the analysis for three sets of online learning modules assigned at the beginning, middle, and end of the semester, we examined how the frequency of each causal net changed over time, and how the change correlated with changes to the AGQ-R responses. Results have implications for measuring the temporal nature of SRL during online learning, as well as the factors impacting the use of SRL processes in an online physics course. Results also provide guidance for developing online instructional materials that foster effective SRL for students with different motivational profiles. (shrink)

BackgroundNarrative medicine is a well-recognized and respected approach to care. It is now found in medical school curricula and widely implemented in practice. However, there has been no analysis of the perception and usage of narrative medicine across different medical specialties and whether there may be unique recommendations for implementation based upon specialty. The aims of this study were to explore these gaps in research.MethodsFifteen senior physicians who specialize in internal medicine, pediatrics, or surgery (5 physicians from each specialty) were (...) interviewed in a semi-structured format about the utilization, benefits, drawbacks (i.e., negative consequences), and roles pertaining to narrative medicine. Qualitative content analysis of each interview was then performed.ResultsThree themes emerged from our analysis: roles, practice, and outcomes. Through these themes we examined the importance, utilization, barriers, benefits, and drawbacks of narrative medicine. There was consensus that narrative medicine is an important tool in primary care. Primary care physicians (general internists and general pediatricians) also believed that narrative medicine is not as important for non-primary care providers. However, non-primary care providers (surgeons) generally believed narrative medicine is valuable in their practice as well. Within specialties, providers’ choice of language varied when trying to obtain patients’ narratives, but choice in when to practice narrative medicine did not differ greatly. Among specialties, there was more variability regarding when to practice narrative medicine and what barriers were present. Primary care physicians primarily described barriers to eliciting a patient’s narrative to involve trust and emotional readiness, while surgeons primarily described factors involving logistics and patient data as barriers to obtaining patients’ narratives. There was broad agreement among specialties regarding the benefits and drawbacks of narrative medicine.ConclusionsThis study sheds light on the shared and unique beliefs in different specialties about narrative medicine. It prompts important discussion around topics such as the stereotypes physicians may hold about their peers and concerns about time management. These data provide some possible ideas for crafting narrative medicine education specific to specialties as well as future directions of study. (shrink)

\noindent\textbf{Introduction} Online interventions hold great potential for Therapeutic Change Process Research (TCPR), a field that aims to relate in-therapeutic change processes to the outcomes of interventions. Online a client is treated essentially through the language their counsellor uses, therefore the verbal interaction contains many important ingredients that bring about change. TCPR faces two challenges: how to derive meaningful change processes from texts, and secondly, how to assess these complex, varied and multi-layered processes? We advocate the use text mining and multi-level (...) models (MLMs): the former offers tools and methods to discovers patterns in texts; the latter can analyse these change processes as outcomes that vary at multiple levels. \noindent\textbf{Method} We (re-)used the data from \cite{Lamers2015} because it includes outcomes and the complete online intervention for clients with mild depressive symptoms. We used text mining to obtain basic text-variables from e-mails, that we analysed through MLMs. \noindent\textbf{Results} We found that we could relate outcomes of interventions to variables containing text-information. We conclude that we can indeed bridge text mining and MLMs for TCPR as it was possible to relate text-information (obtained through text mining) to multi-levelled TCPR outcomes (using a MLM). \noindent\textbf{Discussion} Text mining can be helpful to obtain change processes, which is also the main challenge for TCPR. We showed how MLMs and text mining can be combined, but our proposition leaves open how to obtain the most relevant textual operationalization of TCPR concepts. That requires interdisciplinary collaboration and discussion. The future does look bright: based on our proof-of-concept study we conclude that MLMs and text mining can indeed advance TCPR. (shrink)

In spring 2020, COVID-19 and the ensuing social distancing and stay-at-home orders instigated abrupt changes to employment and educational infrastructure, leading to uncertainty, concern, and stress among United States college students. The media consumption patterns of this and other social groups across the globe were affected, with early evidence suggesting viewers were seeking both pandemic-themed media and reassuring, familiar content. A general increase in media consumption, and increased consumption of specific types of content, may have been due to media use (...) for coping strategies. This paper examines the relationship between the stress and anxiety of university students and their strategic use of media for coping during initial social distancing periods in March-April 2020 using data from a cross-sectional survey. We examine links between specific types of media use with psychological well-being concepts, and examine the moderating roles of traits as buffers against negative relationships between stress and anxiety and psychological well-being. Our findings indicate that stress was linked to more hedonic and less eudaimonic media use, as well as more avoidant and escapist media-based coping. Anxiety, on the other hand, was linked to more media use in general, specifically more eudaimonic media use and a full range of media-based coping strategies. In turn, escapist media was linked to negative affect, while reframing media and eudaimonic media were linked to positive affect. Avoidant coping was tied to poorer mental health, and humor coping was tied to better mental health. Hedonic and need-satisfying media use were linked to more flourishing. Hope, optimism, and resilience were all predictive of media use, with the latter two traits moderating responses to stress and anxiety. The findings give a nuanced portrait of college students’ media use during a pandemic-induced shutdown, showing that media use is closely intertwined with well-being in both adaptive and maladaptive patterns. (shrink)

This article offers a critique of the recently revised BMA guidance on routine neonatal male circumcision and seeks to challenge the assumptions underpinning the guidance which construe this procedure as a matter of parental choice. Our aim is to problematise continued professional willingness to tolerate the non-therapeutic, non-consensual excision of healthy tissue, arguing that in this context both professional guidance and law are uncharacteristically tolerant of risks inflicted on young children, given the absence of clear medical benefits. By interrogating historical (...) medical explanations for this practice, which continue to surface in contemporary justifications of non-consensual male circumcision, we demonstrate how circumcision has long existed as a procedure in need of a justification. We conclude that it is ethically inappropriate to subject children—male or female—to the acknowledged risks of circumcision and contend that there is no compelling legal authority for the common view that male circumcision is lawful. (shrink)

Across languages, children map words to meaning with great efficiency, despite a seemingly unconstrained space of potential mappings. The literature on how children do this is primarily limited to spoken language. This leaves a gap in our understanding of sign language acquisition, because several of the hypothesized mechanisms that children use are visual (e.g., visual attention to the referent), and sign languages are perceived in the visual modality. Here, we used the Human Simulation Paradigm in American Sign Language (ASL) to (...) determine potential cues to word learning. Sign‐naïve adult participants viewed video clips of parent–child interactions in ASL, and at a designated point, had to guess what ASL sign the parent produced. Across two studies, we demonstrate that referential clarity in ASL interactions is characterized by access to information about word class and referent presence (for verbs), similarly to spoken language. Unlike spoken language, iconicity is a cue to word meaning in ASL, although this is not always a fruitful cue. We also present evidence that verbs are highlighted well in the input, relative to spoken English. The results shed light on both similarities and differences in the information that learners may have access to in acquiring signed versus spoken languages. (shrink)

This is a critical introduction to modern French philosophy, commissioned from one of the liveliest contemporary practitioners and intended for an English-speaking readership. The dominant 'Anglo-Saxon' reaction to philosophical development in France has for some decades been one of suspicion, occasionally tempered by curiosity but more often hardening into dismissive rejection. But there are signs now of a more sympathetic interest and an increasing readiness to admit and explore shared concerns, even if these are still expressed in a very different (...) idiom and intellectual context. Vincent Descombes offers here a personal guide to the main movements and figures of the last forty-five years. He traces over this period the evolution of thought from a generation preoccupied with the 'three H's' - Hegel, Husserl and Heidegger, to a generation influenced since about 1960 by the 'three masters of suspicion' - Marx, Nietzsche and Freud. In this framework he deals in turn with the thought of Sartre, Merleau-Ponty, the early structuralists, Foucault, Althusser, Serres, Derrida, and finally Deleuze and Lyotard. The 'internal' intellectual history of the period is related to its institutional setting and the wider cultural and political context which has given French philosophy so much of its distinctive character. (shrink)

Do the conditions under which promises are made determine whether they ought to be kept? Philosophers have placed a number of conditions on promising which, they hold, must be met in order to make promise‐keeping obligatory. In so doing, they have distinguished valid promises from invalid promises and justified promises from promises that are not justified. Considering such conditions, one by one, we argue that they are mistaken. In the first place, the conditions they lay down are not necessary for (...) either valid or justified promise‐making. In the second place, promises need not meet such conditions in order to create moral obligations. In general, such analyses of promising fail because they suffer from a confusion between promise‐making and promise‐keeping. Philosophers have wrongly supposed that obligations to keep promises are dependent upon, or derivable from, the quality of the promises themselves, at the time they are made, instead of focusing on conditions that must be satisfied at the time when promises are supposed to be kept. It is not the quality of a promise that determines an obligation to keep it but the rightness or wrongness of performing the promised act. (shrink)

Here is a question as intriguing as it is brief: what are we? The animalist’s answer is equal in brevity: we are animals. This stark formulation of the animalist slogan distances it from nearby claims—that we are essentially animals, for example, or that we have purely biological criteria of identity over time. Is the animalist slogan—unburdened by modal or criterial commitments—still interesting, though? Or has it lost its bite? In this article we address such questions by presenting a positive case (...) for the importance of animalism and applying that case to recent critiques. (shrink)

For good or for ill, we have animal bodies. Through them, we move around, eat and drink, and do many other things besides. We owe much – perhaps our very lives – to these ever-present animals. But how exactly do we relate to our animals? Are we parts of them, or they of us? Do we and these living animals co-inhere or constitute or coincide? Or what? Animalism answers that we are identical to them. There are many objections to animalism, (...) and a dizzying array of rival views. In this article, we do not propose to evaluate those objections and rivals. We will instead present a new argument for that view. The argument begins with the fact that we have emotions. (shrink)