Each contributor to this book has used personal experience as the basis from which to frame his individual sociological perspectives. Because they have personalized their work, their accounts are real, and recognizable as having come from 'real' persons, about 'real' experiences. There are no objectively-distanced disembodied third person entities in these accounts. These writers are actual people whose stories will make you laugh, cry, think, and want to know more.

Prenatal screening and testing are preference‐based health care options. They are offered so that pregnant women and their partners can learn genetic information about the developing fetus. In this literature review, I summarize studies of women’s and their partners’ psychological responses to prenatal testing and screening. These studies investigate the experiences of pregnant women, largely in the United States, who have access to health care services. Although the results indicate that these women are receptive to prenatal testing and screening and (...) seem to have limited negative psychological consequences, pregnant women without access to these services are not represented and may have different experiences. With that caveat in mind, based on the evidence, women generally do well psychologically as they manage the options that arise for them in the prenatal context. (shrink)

Suffering is a universal human phenomenon. In a time when religious differences are evident and often fuel conflict, shared narratives may provide common ground in which true understanding may take root. This paper will consider the problem of suffering and address how adherents of the three great monotheistic traditions seek understanding, comfort, and the believer’s appropriate response from the same story found within their respective sacred texts: the story of Job, the servant of Yahweh in the Tanakh/Old Testament of Judaism (...) and Christianity— known as Ayyub, prophet of Allah, in the Qur’an. The story of Job addresses more than the distribution of evil problem. At stake in the story is Job’s very relationship to his God. This paper will consider a few of the many Jewish, Christian, and Islamic insights from the ancient story, hopefully leading to mutual understanding and empathy. Keywords: suffering, Tanakh, Qur’an, Job, Ayyub. (shrink)

Integral Science's most distinctive effect is to shift the context of human interactions from competition against one another to seeking what is good for both one's self and the larger whole. The partnership environment it suggests creates a foundation of relationship that powerfully increases organizational intelligence. This simple switch creates the potential for both more humanistic and more effective organizations that are better able to meet the needs of the populations they serve.

Surgery is an important part of health care worldwide. Without access to surgical treatments, morbidity and mortality increase. Access to surgical treatment is a significant problem in global public health because surgical services are not equally distributed in the world. There is a disproportionate scarcity of surgical access in low-income countries. There are many charitable organizations around the world that sponsor surgical missions to under served nations. One such organization is Operation Smile International, a group with which both authors have (...) volunteered. This paper will describe the purpose and processes involved in Operation Smile and identify some of the key ethical issues that arise in short term medical volunteer work highlighting the importance of sustainability. (shrink)

The purpose of the current study was to examine the reliability and validity of the RESTQ-Sport-36 for use in the collegiate student-athlete population. A total of 494 collegiate student-athletes competing in National Collegiate Athletic Association Division I, II, or III sanctioned sport completed the RESTQ-Sport-36 and Brief Profile of Mood States. Structural equation modeling procedures were used to compare first order to hierarchical model structures. Results of a confirmatory factor analysis and exploratory structural equation modeling analysis indicated that the first (...) order 12-factor structure demonstrated the best fit of all models tested. Support was not observed for the fit of any hierarchical model. Moderate to strong correlations were observed between stress and recovery subscales and mood states, thus supporting the construct validity of the abbreviated RESTQ measurement model. The current findings provide support for the measure’s use in this population and give pause as it relates to the scoring and interpretation of hierarchical factors such as Total Stress and Total Recovery. Overall, the current results indicate that the RESTQ-Sport-36 may be a useful tool for collegiate student-athlete training load and competition monitoring. (shrink)

During the past two decades, several reports have documented substantial support from clinicians, policy-makers, and the general public for the use of advance directives, yet studies continue to find that only a minority of individuals have completed these legal documents. Advance directives are written instructions, such as living wills or durable powers of attorney for health care, which describe an individual's medical treatment wishes in the event that individual becomes incapacitated in the future. The completion and use of advance directives (...) is one of several components of the broader activity of advance care planning, that is, the overall planning and communication of personal wishes concerning future medical care.In December 1991, the federal Patient Self-Determination Act became effective. Promoted as a federal initiative to enhance an individual's control over medical treatment decision making and, therefore, patient autonomy and self-determination, PSDA placed several new requirements on health care organizations receiving Medicare or Medicaid payments. (shrink)

During the past two decades, several reports have documented substantial support from clinicians, policy-makers, and the general public for the use of advance directives, yet studies continue to find that only a minority of individuals have completed these legal documents. Advance directives are written instructions, such as living wills or durable powers of attorney for health care, which describe an individual's medical treatment wishes in the event that individual becomes incapacitated in the future. The completion and use of advance directives (...) is one of several components of the broader activity of advance care planning, that is, the overall planning and communication of personal wishes concerning future medical care.In December 1991, the federal Patient Self-Determination Act became effective. Promoted as a federal initiative to enhance an individual's control over medical treatment decision making and, therefore, patient autonomy and self-determination, PSDA placed several new requirements on health care organizations receiving Medicare or Medicaid payments. (shrink)

There is limited knowledge about cancer patients' experiences of uncertainty while waiting for genome sequencing results, and whether prolonged uncertainty contributes to psychological factors in this context. To investigate uncertainty in patients with a cancer of likely hereditary origin while waiting for genome sequencing results, we collected questionnaire and interview data at baseline, and at three and 12 months follow up. Participants had negative attitudes towards uncertainty at baseline, and low levels of uncertainty at three and 12 months. Uncertainty about (...) genome sequencing did not change significantly over time [t = 0.660, p = 0.510]. Greater perceived susceptibility for cancer [r = 0.14, p < 0.01], fear of cancer recurrence [r = 0.19, p < 0.01], perceived importance of genome sequencing [r = 0.24, p < 0.01], intention to change behavior if a gene variant indicating risk is found [r = 0.29, p < 0.01], perceived ability to cope with results [r = 0.36, p < 0.01], and satisfaction with decision to have genome sequencing [r = 0.52, p < 0.01] were significantly correlated with negative attitudes towards uncertainty at baseline. Multiple primary cancer diagnoses [B = −2.364 [−4.238, −0.491], p = 0.014], lower perceived ability to cope with results [B = −0.1.881 [−3.403, −0.359], p = 0.016] at baseline, greater anxiety about genome sequencing [B = 0.347 [0.148, 0.546], p = 0.0012] at 3 months, and greater perceived uncertainty about genome sequencing [B = 0.494 [0.267, 0.721] p = 0.000] at 3 months significantly predicted greater perceived uncertainty about genome sequencing at 12 months. Greater perceived uncertainty about genome sequencing at 3 months significantly predicted greater anxiety about genome sequencing at 12 months [B = 0.291 [0.072, 0.509], p = 0.009]. Semi-structured interviews revealed that while participants were motivated to pursue genome sequencing as a strategy to reduce their illness and risk uncertainty, genome sequencing generated additional practical, scientific and personal uncertainties. Some uncertainties were consistently discussed over the 12 months, while others emerged over time. Similarly, some uncertainty coping strategies were consistent over time, while others emerged while patients waited for their genome sequencing results. This study demonstrates the complexity of uncertainty generated by genome sequencing for cancer patients and provides further support for the inter-relationship between uncertainty and anxiety. Helping patients manage their uncertainty may ameliorate psychological morbidity. (shrink)

James questions the validity of the very tentative statement made in the final sentence of our paper. Our claim concerned the proportion of twins in Britain in the 1990s that might have arisen through subfertility treatment and was linked to the suggestion that the natural twinning rate might still be in decline. If this were true, we, like James, would regard that prospect with concern.

The National Longitudinal Study of Adolescent Health data were used to test predictions from life history theory. We hypothesized that (1) in young adulthood an emerging life history strategy would exist as a common factor underlying many life history traits (e.g., health, relationship stability, economic success), (2) both environmental harshness and unpredictability would account for unique variance in expression of adolescent and young adult life history strategies, and (3) adolescent life history traits would predict young adult life history strategy. These (...) predictions were supported. The current findings suggest that the environmental parameters of harshness and unpredictability have concurrent effects on life history development in adolescence, as well as longitudinal effects into young adulthood. In addition, life history traits appear to be stable across developmental time from adolescence into young adulthood. (shrink)

Microphysical laws are time reversible, but macrophysics, chemistry and biology are not. This paper explores how this asymmetry arises due to the cosmological context, where a non-local Direction of Time is imposed by the expansion of the universe. This situation is best represented by an Evolving Block Universe, where local arrows of time emerge in concordance with the Direction of Time because a global Past Condition results in the Second Law of Thermodynamics pointing to the future. At the quantum level, (...) the indefinite future changes to the definite past due to quantum wave function collapse events. (shrink)

Digital computers carry out algorithms coded in high level programs. These abstract entities determine what happens at the physical level: they control whether electrons flow through specific transistors at specific times or not, entailing downward causation in both the logical and implementation hierarchies. This paper explores how this is possible in the light of the alleged causal completeness of physics at the bottom level, and highlights the mechanism that enables strong emergence to occur. Although synchronic emergence of higher levels from (...) lower levels is manifestly true, diachronic emergence is generically not the case; indeed we give specific examples where it cannot occur because of the causal effectiveness of higher level variables. (shrink)

The current paper synthesizes theory and data from the field of life history (LH) evolution to advance a new developmental theory of variation in human LH strategies. The theory posits that clusters of correlated LH traits (e.g., timing of puberty, age at sexual debut and first birth, parental investment strategies) lie on a slow-to-fast continuum; that harshness (externally caused levels of morbidity-mortality) and unpredictability (spatial-temporal variation in harshness) are the most fundamental environmental influences on the evolution and development of LH (...) strategies; and that these influences depend on population densities and related levels of intraspecific competition and resource scarcity, on age schedules of mortality, on the sensitivity of morbidity-mortality to the organism’s resource-allocation decisions, and on the extent to which environmental fluctuations affect individuals versus populations over short versus long timescales. These interrelated factors operate at evolutionary and developmental levels and should be distinguished because they exert distinctive effects on LH traits and are hierarchically operative in terms of primacy of influence. Although converging lines of evidence support core assumptions of the theory, many questions remain unanswered. This review demonstrates the value of applying a multilevel evolutionary-developmental approach to the analysis of a central feature of human phenotypic variation: LH strategy. (shrink)

Initial responses to questionnaires used to assess participants' understanding of informed consent for malaria vaccine trials conducted in the United States and Mali were tallied. Total scores were analyzed by age, sex, literacy (if known), and location. Ninety-two percent (92%) of answers by United States participants and 85% of answers by Malian participants were correct. Questions more likely to be answered incorrectly in Mali related to risk, and to the type of vaccine. For adult participants, independent predictors of higher scores (...) were younger age and female sex in the United States, and male sex in Mali. Scores in the United States were higher than in Mali (P = 0.005). Despite this difference participants at both sites were well informed overall. Although interpretation must be qualified because questionnaires were not intended as research tools and were not standardized among sites, these results do not support concerns about systematic low understanding among research participants in developing versus developed countries. (shrink)

To understand public discourse in the United States on genetic causation of behavioral disorders, we analyzed media representations of genetic research on addiction published between 1990 and 2010. We conclude first that the media simplistically represent biological bases of addiction and willpower as being mutually exclusive: behaviors are either genetically determined, or they are a choice. Second, most articles provide only cursory or no treatment of the environmental contribution. A media focus on genetics directs attention away from environmental factors. Rhetorically, (...) media neglect the complexity underlying the etiology the addiction and direct focus back toward individual causation and responsibility. (shrink)

I. EXECUTIVE SUMMARY The MRCT Center Post-trial Responsibilities: Continued Access to an Investigational Medicine Framework outlines a case-based, principled, stakeholder approach to evaluate and guide ethical responsibilities to provide continued access to an investigational medicine at the conclusion of a patient’s participation in a clinical trial. The Post-trial Responsibilities (PTR) Framework includes this Guidance Document as well as the accompanying Toolkit. A 41-member international multi-stakeholder Workgroup convened by the Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard University (...) (MRCT Center) developed this Guidance and Toolkit. Project Motivation A number of international organizations have discussed the responsibilities stakeholders have to provide continued access to investigational medicines. The World Medical Association, for example, addressed post-trial access to medicines in Paragraph 34 of the Declaration of Helsinki (WMA, 2013): “In advance of a clinical trial, sponsors, researchers and host country governments should make provisions for post-trial access for all participants who still need an intervention identified as beneficial in the trial. This information must also be disclosed to participants during the informed consent process.” This paragraph and other international guidance documents converge on several consensus points: • Post-trial access (hereafter referred to as “continued access” in this Framework [for terminology clarification – see definitions]) is the responsibility of sponsors, researchers, and host country governments; • The plan for continued access should be determined before the trial begins, and before any individual gives their informed consent; • The protocol should delineate continued access plans; and • The plan should be transparent to potential participants and explained during the informed consent process. -/- However, there is no guidance on how to fulfill these responsibilities (i.e., linking specific responsibilities with specific stakeholders, conditions, and duration). To fill this gap, the MRCT Center convened a working group in September of 2014 to develop a framework to guide stakeholders with identified responsibilities. This resultant Framework sets forth applicable principles, approaches, recommendations and ethical rationales for PTR regarding continued access to investigational medicines for research participants. (shrink)

How does evolution grow bigger brains? It has been widely assumed that growth of individual structures and functional systems in response to niche-specific cognitive challenges is the most plausible mechanism for brain expansion in mammals. Comparison of multiple regressions on allometric data for 131 mammalian species, however, suggests that for 9 of 11 brain structures taxonomic and body size factors are less important than covariance of these major structures with each other. Which structure grows biggest is largely predicted by a (...) conserved order of neurogenesis that can be derived from the basic axial structure of the developing brain. This conserved order of neurogenesis predicts the relative scaling not only of gross brain regions like the isocortex or mesencephalon, but also the level of detail of individual thalamic nuclei. Special selection of particular areas for specific functions does occur, but it is a minor factor compared to the large-scale covariance of the whole brain. The idea that enlarged isocortex could be a a by-product of structural constraints later adapted for various behaviors, contrasts with approaches to selection of particular brain regions for cognitively advanced uses, as is commonly assumed in the case of hominid brain evolution. (shrink)

This searching examination of the life and philosophy of the twentieth-century Indian intellectual Jarava Lal Mehta details, among other things, his engagement with the oeuvres of Martin Heidegger, Hans-Georg Gadamer, and Jacques Derrida. It shows how Mehta’s sense of cross-cultural philosophy and religious thought were affected by these engagements, and maps the two key contributions Mehta made to the sum of human ideas. First, Mehta outlined what the author dubs a ‘postcolonial hermeneutics’ that uses the ‘ethnotrope’ of the pilgrim to (...) challenge the philosophical hermeneutic emphasis on supplementation and augmentation. For Mehta, the hermeneutic encounter ruptures, rather than supplements, the self. Secondly, Mehta extended this concept of hermeneutics to interrogate the Hindu tradition, arriving at the concept of the ‘negative messianic’. In contrast to Derrida's emphasis on the 'one to come', Mehta shows how the Hindu bhakti model represents the very opposite, that is, the 'withdrawn other,' identifying thereby the ethical pitfalls of deconstructivism's emphasis on the messianic tradition. This is the only full-length study in English of this high-profile Hindu philosopher. (shrink)

Until recently, it was assumed that co-representation of others’ actions, an essential part in joint action, is biologically tuned. However, research demonstrated that we also simulate actions of non-biological interaction partners under certain conditions. In the present study, we investigated whether perceived intentionality or perspective taking is the underlying mechanisms of this phenomenon. Participants saw a short video fragment of a non-biological agent as main character. The movements of this agent were either described as intentional or as unintentional. Furthermore, participants (...) were instructed to either take the perspective of this non-biological agent or not. Results show that perspective taking and perceived intentionality both lead to action co-representation of non-biological actions. Possible explanations for these findings are discussed. (shrink)

Until recently, it was assumed that co-representation of others’ actions, an essential part in joint action, is biologically tuned. However, research demonstrated that we also simulate actions of non-biological interaction partners under certain conditions. In the present study, we investigated whether perceived intentionality or perspective taking is the underlying mechanisms of this phenomenon. Participants saw a short video fragment of a non-biological agent as main character. The movements of this agent were either described as intentional or as unintentional. Furthermore, participants (...) were instructed to either take the perspective of this non-biological agent or not. Results show that perspective taking and perceived intentionality both lead to action co-representation of non-biological actions. Possible explanations for these findings are discussed. (shrink)

Book reviewed in this article: Abortion and the Private Practice of Medicine. By Jonathan B. Imber.