Introduction While quizzing during informed consent for research to ensure understanding has become commonplace, it is unclear whether the quizzing itself is problematic for potential participants. In this study, we address this issue in a multinational HIV prevention research trial enrolling injection drug users in China and Thailand. Methods Enrolment procedures included an informed consent comprehension quiz. An informed consent survey followed. Results 525 participants completed the informed consent survey (Heng County, China=255, Xinjiang, China=229, Chiang Mai, Thailand=41). Mean age was (...) 33 and mean educational level was 8 yrs. While quizzing was felt to be a good way to determine if a person understands the nature of clinical trial participation (97%) and participants did not generally find the quiz to be problematic, minorities of respondents felt pressured (6%); anxious (5%); bored (5%); minded (5%); and did not find the questions easy (13%). In multivariate analysis, lower educational level was associated with not minding the quizzing (6–10 yrs vs 0–5 yrs: OR=0.27, p=0.03; more than 11 yrs vs 0–5 yrs: OR=0.18, p=0.03). There were also site differences (Heng County vs Xinjiang) in feeling anxious (OR=0.07; p=<0.01), not minding (OR=0.26; p=0.03), being bored (OR=0.25; p=0.01) and not finding the questions easy (OR=0.10; p=<0.01). Conclusions Quizzing during the informed consent process can be problematic for a minority of participants. These problems may be associated with the setting in which research takes place and educational level. Further research is needed to develop, test and implement alternative methods of ensuring comprehension of informed consent. Trial Registration clinicaltrials.gov number NCT00270257. (shrink)

Highlights: -/- • Breastfeeding and breastfeeding support can contribute to mitigating climate change. • Achieving global nutrition targets will save more emissions than fuel-switching. • Breastfeeding support programmes support a just transition. • This work can support the expansion of mitigation options in energy system models. -/- Abstract: -/- Renewable gas has been proposed as a solution to decarbonise industrial processes, specifically heat demand. As part of this effort, the breast-milk substitutes industry is proposing to use renewable gas as a (...) substitute for fossil natural gas. However, decarbonising the industrial processing of breast-milk substitutes can increase social license for these products, potentially undermining breastfeeding. World Health Organisation nutrition targets aim to increase exclusive breastfeeding to at least 50% globally by 2025 to improve maternal, infant, and young child health and nutrition. This target will have implications for the energy transition. A weakness of existing energy models is that demands for end-use products such as breast-milk substitutes are typically not considered explicitly. This paper develops an analytical framework for explicitly representing infant feeding methods in energy systems models. We compare the emissions saved in Ireland from decarbonising the industrial processing of breast-milk substitutes with renewable gas with the emissions saved by an increase in exclusive breastfeeding to 50% in both Ireland and a key export market, China. We demonstrate that the emissions saved from achieving the minimum global breastfeeding target are greater than when renewable gas is used to displace natural gas in the production of breast-milk substitutes in Ireland. We discuss the decarbonisation of breast-milk substitutes in relation to the principle of justice as non-maleficence, a principle based on the commitment to avoid harm, a novel application of a principle of justice. We conclude that breastfeeding support can be considered a demand-side measure for mitigating climate change by reducing the demand for energy services to produce breast-milk substitutes. A key recommendation is to position breastfeeding support as both a public health and a climate justice issue that is relevant for a just transition. The framework developed for this paper could be applied to support the inclusion of a wider range of mitigation options with social justice outcomes in energy system models. [Open access]. (shrink)

Biodiversity is a valuable resource that supports sustainability within agricultural systems, yet in contradiction to this agriculture is recognised as a contributor to biodiversity loss. Agricultural advisory services are institutions that support sustainable agricultural development, employing a variety of approaches including farmer discussion groups in doing so. This study evaluates the impact of a farmland biodiversity management (FBM) communication strategy piloted within Irish farmer discussion groups. A sensemaking lens was applied in this objective to gain an understanding of how this (...) strategy could create an actionable space for FBM promotion amongst farmers. The strategy was piloted with six Irish dairy farmer discussion groups, after which focus groups were conducted with members of these groups. Additionally, baseline and endline surveys were completed by the members to determine their knowledge, attitude and on-farm practices relating to FBM. Analysis of the focus group data identified that the communication strategy supported the affordance of sensemaking with respect to FBM. Analysis of the data from the baseline and endline surveys relating to knowledge, attitudes and practices found that engaging with the communication strategy promoted farmers to improve their attitude in relation to FBM. Results from this study provide important lessons for agricultural advisory services to support farmers in incorporating FBM into the overall management of their farms and, in turn, to promote the improvement of farmland biodiversity and contribute to a sustainable future. (shrink)

What is the future of Philosophy of education? Or as many of scholars and thinkers in this final ‘future-focused’ collective piece from the philosophy of education in a new key Series put it, what are the futures—plural and multiple—of the intersections of ‘philosophy’ and ‘education?’ What is ‘Philosophy’; and what is ‘Education’, and what role may ‘enquiry’ play? Is the future of education and philosophy embracing—or at least taking seriously—and thinking with Indigenous ethicoontoepistemologies? And, perhaps most importantly, what is that (...) ‘Future’? These debates have been located in the work of diverse scholars: from the West, from Global South, from indigenous thinkers. In this collective piece, we purposefully juxtapose diverse takes on the future of these intersections. We have given up the urge to organise, place together, separate with subheadings or connect the paragraphs that follow. Instead, we let these philosophers of education and thinkers who use philosophical texts and ideas to sit together in one long read as potentially ‘strange and unusual bedfellows’. This text urges us to understand how these scholars and thinkers perceive our educational philosophical futures, and how the work and thinking they have done on thinking about what the future of that new key in philosophy of education may look like is embedded in a much deeper and richer literature, and personal experience. (shrink)

The ability of managers to identify and interpret challenges in the external environment is one of the micro-foundations of dynamic capabilities. The underlying literature on strategic issue interpretation suggests that interpreting environmental challenges as opportunities rather than threats is more likely to lead to proactive and innovative responses, but there are also potentially positive effects of threat interpretation, for instance high levels of commitment and risk-seeking behaviour. In this paper, I use the context of climate change to explore the link (...) between threat interpretation and innovation in more detail. I use exploratory cluster analysis and illustrative case studies to develop a set of propositions to explain when threat interpretation can in fact encourage innovation. I identify two ethical mechanisms that positively mediate the relationship between threat interpretation and innovation: enlarged concept of responsibility to society and moral legitimacy. The paper contributes to the literature by identifying the importance of ethics in linking managerial interpretation to innovation, particularly in the context of global environmental and social challenges. (shrink)

Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons. We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.

The freedom to choose for oneself is a part of what it means to be a human being.Jackson J In England and Wales, the Mental Capacity Act 20...

In this powerful and wonderfully accessible meditation on psychoanalysis, hermeneutics, and social constructivism, Donnel Stern explores the relationship between two fundamental kinds of experience: explicit verbal reflection and "unformulated experience," or experience we have not yet reflected on and put into words. Stern is especially concerned with the process by which we come to formulate the unformulated. It is not an instrumental task, he holds, but one that requires openness and curiosity; the result of the process is not accuracy alone, (...) but experience that is deeply felt and fully imagined. Stern's sense of explicit verbal experience as continuously constructed and emergent leads to a central dialectic at the heart of his work: that between curiosity and imagination, on one hand, and dissociation and unthinking acceptance of the familiar on the other. The goal of psychoanalytic work, he holds, is the freedom to be curious, whereas defense signifies the denial of this freedom. We defend against our fear of what we would think, that is, if we allowed ourselves the freedom to think it. Stern also shows how the unconscious itself can be reconceptualized hermeneutically, and he goes on to explore the implications of this viewpoint on interpretation and countertransference. He is especially persuasive in showing how the interpersonal field, which is continuously in flux, limits the experience that it is possible for participants to reflect on. Thus it is that analyst and patient are together "caught in the grip of the field," often unable to see the kind of relatedness in which they are mutually involved. A brilliant demonstration of the clinical consequentiality of hermeneutic thinking, _Unformulated Experience_ bears out Stern's belief that psychoanalysis is as much about the revelation of the new in experience as it is about the discovery of the old. (shrink)

Research using explicit measures has linked decreased positive future thinking, but not increased negative future thinking, with clinical depression. However, individuals may be unable or unwilling to express thoughts about the future, and can be unaware of implicit beliefs that can influence their behavior. Implicit measures of cognition may shed light on the role of future thinking in depression. To our knowledge, the current study presents the first implicit measure of positive and negative future thinking. A sample of 71 volunteers (...) completed both implicit and explicit measures of positive and negative future thinking. The findings indicate differences in the evaluation of both positive and negative future events between the two groups. However, group differences were more pronounced on the implicit measure. These findings point to the potential utility of an implicit measure of future thinking in mental health research and clinical practice. (shrink)

Building on the innovative work of _Unformulated Experience,_ Donnel B. Stern continues his exploration of the creation of meaning in clinical psychoanalysis with _Partners in Thought_. The chapters in this fascinating book are undergirded by the concept that the meanings which arise from unformulated experience are catalyzed by the states of relatedness in which the meanings emerge. In hermeneutic terms, what takes place in the consulting room is a particular kind of conversation, one in which patient and analyst serve as (...) one another’s partner in thought, an emotionally responsive witness to the other’s experience. Enactment, which Stern theorizes as the interpersonalization of dissociation, interrupts this crucial kind of exchange, and the eventual breach of enactments frees analyst and patient to resume it. Later chapters compare his views to the ideas of others, considering mentalization theory and the work of the Boston Change Process Study Group. Approaching the link between dissociation and enactment via hermeneutics, metaphor, and narrative, among other perspectives, Stern weaves an experience-near theory of psychoanalytic relatedness that illuminates dilemmas clinicians find themselves in every day. Full of clinical illustrations showing how Stern works with dissociation and enactment, _Partners in Thought_ is destined to take its place beside Unformulated Experience as a major contribution to the psychoanalytic literature. (shrink)

Hayek argued that the central question of economics is the coordination problem: How does the spontaneous interaction of many purposeful individuals, each having dispersed bits of subjective knowledge, generate an order in which the actors' subjective data are coordinated in a way that enables them to dovetail their plans and activities successfully? In attempting to solve this problem, Hayek outlined an approach to economic theorizing that takes seriously the limited, subjective nature of human knowledge. Despite purporting to have appropriated Hayek's (...) thought by acknowledging the information-transmitting role of prices, mainstream economists have missed Hayek's point. The predominant tool of formal economics—equilibrium analysis—begins by assuming the data held by actors to have been pre-reconciled, and so evades the problem to be solved. Even the more advanced tools for modeling knowledge in economic analysis, such as the economics of information, assume away either the subjectivism of knowledge and expectations (rendering the coordination of beliefs and plans a trivial matter) or the frictions and “imperfections” of reality (rendering the coordination problem indeterminate). (shrink)

Contemporary developments in American epistemology, by R. M. Chisholm.--Contemporary metaphysics in the United States, by D. F. Gustafson.--Philosophy of physics, by H. Putnam--The influence of continental philosophy on the contemporary American scene: a summons to autonomy, by G. A. Scharader, Jr.--The influence of the later Wittgenstein on American philosophy, by J. O. Nelson.--Philosophy of mind, by F. H. Donnell, Jr.--Some remarks on the philosophy of language, by J. A. Fodor.--Ethics in the United States today, by D. Kading.--Social philosophy; philosophy (...) of social science, by P. Diesing. (shrink)

This volume brings together 14 classic papers by interpersonal pioneers. Collectively, these papers not only demonstrate the coherence and explanatory richness of interpersonal psychoanalysis; they anticipate the emphasis on relational patterns and analyst-analysand interaction that typifies much recent theorizing. Each paper receives a substantial introduction from a leading contemporary interpersonalist. The pioneers of interpersonal psychoanalysis are: H. Sullivan, F. Fromm-Reichmann, J. Rioch, C. Thompson, R. Crowley, E. Schachtel, E. Tauber, E. Fromm, H. Bone, E. Singer, D. Schecter, J. Barnett, S. (...) Arieti, and J.Schimel. (shrink)

The authors interrogate genital examinations as events in which both client and practitioner are `produced' as relational subjects in quite specific ways. This article explores the way one female sex health worker talks about her work as a form of cultural exchange, noting what she requires of her clients and seeks to give of herself. Of particular importance is the way the practitioner produces the client as a social subject amenable to intimate examination, while resisting some traditional means for doing (...) so. The authors use a Foucauldian conceptual framework to signal their departure from feminist analyses which explain such practices in terms of a patriarchal medical system. (shrink)

BackgroundEverybody has the right to decide whether to receive specific medical treatment or not and to provide their free, prior and informed consent to do so. As dementia progresses, people with Alzheimer’s dementia (PwAD) can lose their capacity to provide informed consent to complex medical treatment. When the capacity to consent is lost, the autonomy of the affected person can only be guaranteed when an interpretable and valid advance directive exists. Advance directives are not yet common in Germany, and their (...) validity is often questionable. Once the dementia diagnosis has been made, it is assumed to be too late to write an advance directive. One approach used to support the completion of advance directives is ‘Respecting Choices’®—an internationally recognised, evidence-based model of Advance Care Planning (ACP), which, until now, has not been evaluated for the target group of PwAD. This study’s aims include (a) to investigate the proportion of valid advance directives in a memory clinic population of persons with suspected AD, (b) to determine the predictors of valid advance directives, and (c) to examine whether the offer of ACP can increase the proportion of valid advance directives in PwAD.MethodWe intend to recruit at leastN = 250 participants from two memory clinics in 50 consecutive weeks. Of these, the first 25 weeks constitute the baseline phase (no offer of ACP), the following 25 weeks constitute the intervention phase (offer of ACP). The existence and validity of an advance directive will be assessed twice (before and after the memory clinic appointment). Moreover, potential predictors of valid advance directives are assessed.DiscussionThe results of this study will enhance the development of consent procedures for advance directives of PwAD based on the ACP/Respecting Choices (R) approach. Therefore, this project contributes towards increasing the autonomy and inclusion of PwAD and the widespread acceptance of valid advance directives in PwAD.Trial RegistrationDRKS, DRKS00026691, registered 15th of October 2021,https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00026691. (shrink)

Despite a recent wave in global recognition of the rights of transgender and gender-diverse populations, referred to in this text by the umbrella label of trans*, international law continues to presume a cisgender binary definition of gender — dismissing the lived realities of trans* individuals throughout the world. This gap in international legal recognition and protection has fundamental implications for health, where trans* persons have been and continue to be subjected to widespread discrimination in health care, longstanding neglect of health (...) needs, and significant violations of bodily autonomy. (shrink)

The Republic of Ireland has some of the most restrictive abortion legislation in the world which grants to the ‘unborn’ an equal right to life to that of the pregnant woman. This article outlines recent developments in the public discourse on abortion in Ireland and explains the particular cultural and religious context that informs the ethical case for access to abortion services. Our perspective rests on respect for two very familiar moral principles – autonomy and justice – which are at (...) the centre of social and democratic societies around the world. This article explains the context for the deployment of these concepts in order to support the claim that the current legislation and its operationalisation in clinical practice poses serious risks to the health, lives and well-being of pregnant women, tramples on their autonomy rights and requires of them a self-sacrifice that is unreasonable and unjust. (shrink)

O'Donnell, J. R. Anton Charles Pegis on the occasion of his retirement.--Conlan, W. J. The definition of faith according to a question of MS. Assisi 138: study and edition of text.--Spade, P. V. Five logical tracts by Richard Lavenham.--Maurer, A. Henry of Harclay's disputed question on the plurality of forms.--Brown, V. Giovanni Argiropulo on the agent intellect: an edition of Ms. Magliabecchi V 42.--Synan, E. A. The Exortacio against Peter Abelard's Dialogus inter philosophum, Iudaeum et Christianum.--Fitzgerald, W. Nugae Hyginianae.--Sheehan, (...) M. M. Marriage and family in English conciliar and synodal legislation.--Shook, L. K. Riddles relating to the Anglo-Saxon scriptorium.--Boyle, L. E. The De regno and the two powers.--Colledge, E. A Middle English Christological poem.--Gough, M. R. E. Three forgotten martyrs of Anazarbus in Cilicia.--Häring, N. Chartres and Paris revisited.--Hayes, W. Greek recentiores, (Ps.) Basil, Adversus eunomium, IV-V.--Owens, J. The physical world of Parmenides. (shrink)

Constitutionalism offers a governance order a set of normative values including, amongst others, the rule of law, divisions of power and democratic legitimacy. These normative values regulate the relationship between constituent and constituted power holders. Such normative constitutional legal orders are commonplace in domestic systems but the global constitutionalisation debate seeks to identify a constitutional narrative beyond the state. This book considers the manner in which the global constitutionalisation debate has neglected constitutionalism within its proposals. It examines the role normative (...) constitutionalism plays within a constitutionalisation process, and considers the use of community at both the domestic and global governance levels to identify the holders of constituent and constituted power within a constitutional order. In doing so this analysis offers an alternative narrative for global constitutionalisation based within normative constitutionalism. (shrink)

The project of this paper is to deliver a semantics for a broad subset of bare plural generics about racial kinds, a class which I will dub 'Type C generics.' Examples include 'Blacks are criminal' and 'Muslims are terrorists.' Type C generics have two interesting features. First, they link racial kinds with ​ socially perspectival predicates ​ (SPPs). SPPs lead interpreters to treat the relationship between kinds and predicates in generic constructions as nomic or non-accidental. Moreover, in computing their content, (...) interpreters must make implicit reference to socially privileged​ ​ perspectives which are treated as authoritative about whether a given object fits into the extension of the predicate. Such deference grants these authorities influence over both the conventional meaning of these terms and over the nature of the ​ objects ​ in the social ontology that these terms purport to describe, much the way a baseball umpire is authoritative over the meaning and metaphysics of 'strike'/​ strike ​. Second, terms like 'criminal' and 'terrorist' receive default ​ racialized ​ interpretations in which these terms conventionally token racial or ethnic identities. I show that neither of these features can be explained by Sarah-Jane Leslie's influential 'weak semantics' for generics, and show how my own 'socially perspectival semantics' fares better on both counts. Finally, I give an analysis of 'Blacks are criminal' which explores the semantic mechanisms that underlie default racialized interpretations. (shrink)

We use formal semantic analysis based on new constructions to study abstract realizability, introduced by Läuchli in 1970, and expose its algebraic content. We claim realizability so conceived generates semantics-based intuitive confidence that the Heyting Calculus is an appropriate system of deduction for constructive reasoning.Well-known semantic formalisms have been defined by Kripke and Beth, but these have no formal concepts corresponding to constructions, and shed little intuitive light on the meanings of formulae. In particular, the completeness proofs for these semantics (...) do not generate confidence in the sufficiency of the Heyting Calculus, since we have no reason to believe that every intuitively constructive truth is valid in the formal semantics.Läuchli has proved completeness for a realizability semantics with formal concepts analogous to constructions. We argue in some detail that, in spite of a certain inherent inexactness of the analogy, every intuitively constructive truth is valid in Läuchli semantics, and therefore the Heyting Calculus is powerful enough to prove all constructive truths. Our argument is based on the postulate that a uniformly constructible object must be communicable in spite of imprecision in our language, and that the permutations in Läuchli's semantics represent conceivable imprecision in a language, while allowing a certain amount of freedom in choosing the particular structure of the language.We give a detailed generalization of Läuchli's proof of completeness for the propositional part of the Heyting Calculus, in order to make explicit constructive and algebraic content.In our treatment, we establish several new results about Läuchli models. We show how to extend the sconing and gluing constructions familiar from Kripke and Frame semantics and Topos theory, to Läuchli models, and use them to give an algebraic approach to countermodel construction. In particular, the Läuchli arguments are given without the restriction to the integers, Z, as a group of permutations, which makes much of the coding scheme used in Läuchli's original paper transparent.We also make use of a new propositions-as-types syntax for the Heyting calculus, with limited nondeterminism, in which validity of formulae can be decided without loop-detection. (shrink)

Since classical antiquity debates about tyranny, tyrannicide and preventing tyranny's re-emergence have permeated governance discourse. Yet within the literature on the global legal order, tyranny is missing. This book creates a taxonomy of tyranny and poses the question: could the global legal order be tyrannical? This taxonomy examines the benefits attached to tyrannical governance for the tyrant, considers how illegitimacy and fear establish tyranny, asks how rule by law, silence and beneficence aid in governing a tyranny. It outlines the modalities (...) of tyranny: scale, imperialism, gender, and bureaucracy. Where it is determined that a tyranny exists, the book examines the extent of the right and duty to effect tyrannicide. As the global legal order gathers ever more power to itself, it becomes imperative to ask whether tyranny lurks at the global scale. (shrink)

ABSTRACT In this article the Irish harp tradition is re-configured as a space consisting of visual and sonic dimensions. The visual dimension of the Irish harp space incorporates the employment of the instrument in contemporary iconography; the sonic dimension includes the employment of the instrument as a metaphor in contemporary literature and songs. By employing Bloch’s concept of surplus and tracing the path of the Irish harp from its earliest employment in Christian iconography, its prominence as an icon of colonial (...) and Ascendancy rule, and finally its utilisation as an utopian tool to inspire members of the Volunteer and United Irish movements in the late eighteenth century, I identify how the accumulation of centuries of utopian surplus resulted in the creation of an utopian icon that had the capacity to inspire a generation of Irish men and women to critique the prevailing social and political order in the eighteenth century. (shrink)

The eukaryotic helicase is an 11-subunit machine containing an Mcm2-7 motor ring that encircles DNA, Cdc45 and the GINS tetramer, referred to as CMG. CMG is “built” on DNA at origins in two steps. First, two Mcm2-7 rings are assembled around duplex DNA at origins in G1 phase, forming the Mcm2-7 “double hexamer.” In a second step, in S phase Cdc45 and GINS are assembled onto each Mcm2-7 ring, hence producing two CMGs that ultimately form two replication forks that travel (...) in opposite directions. Here, we review recent findings about CMG structure and function. The CMG unwinds the parental duplex and is also the organizing center of the replisome: it binds DNA polymerases and other factors. EM studies reveal a 20-subunit core replisome with the leading Pol ϵ and lagging Pol α-primase on opposite faces of CMG, forming a fundamentally asymmetric architecture. Structural studies of CMG at a replication fork reveal unexpected details of how CMG engages the DNA fork. The structures of CMG and the Mcm2-7 double hexamer on DNA suggest a completely unanticipated process for formation of bidirectional replication forks at origins. Here, we review the structure and function of CMG, the 11 subunit helicase for eukaryotic DNA replication. Two CMGs are assembled at origins starting from two Mcm2-7 hexamers oriented N-to-N. The orientation of CMG at a forked DNA implies that the two CMGs at an origin pass one another. (shrink)

Over the last decade, there has been a considerable expansion of mindfulness programmes into a number of different domains of contemporary life, such as corporations, schools, hospitals and even the military. Understanding the reasons for this phenomenon involves, I argue, reflecting upon the nature of contemporary capitalism and mapping the complexity of navigating new digital technologies that make multiple and accelerated solicitations upon attention and our affective lives. Whilst acknowledging the benefits of mindfulness practice, this article argues that it is (...) equally important to attend to the ethical framework that gives orientation to these practices and the outer conditions that shape lived daily experience, such as school or work environments. I suggest that the well-meaning efforts to secularise mindfulness, provide scientific evidence for its effectiveness, and introduce it to wider publics may have served to impoverish the rich contribution that practices of mindfulness, situated within a broader ethical framework, can make to human lives, and arguably contribute to the educational endeavour. For example, the emphasis on transforming inner conditions of students’ lives can lead to the neglect of outer conditions, such as structural inequality, or unhealthy and exploitative work practices. This can result in practices that privilege individual wellbeing over compassion and concern for the happiness of others, providing a buffer against loving attention to the world and others. Instead, I ask how mindfulness in educational settings could come to be viewed in a different light if we reflect upon the ways in which school environments and curricula can promote mindfulness, awareness, sensitive inquiry, and contemplative practices through the day, rather than offering it as a discrete intervention focused on the self and wellbeing. (shrink)