Questions about when to limit unhelpful treatments are often raised in general medicine but are less commonly considered in psychiatry. Here we describe a survey of U.S. psychiatrists intended to characterize their attitudes about the management of suicidal ideation in patients with severely treatment-refractory illness. Respondents (n = 212) received one of two cases describing a patient with suicidal ideation due to either borderline personality disorder or major depressive disorder. Both patients were described as receiving all guideline-based and plausible emerging (...) treatments. Respondents rated the expected helpfulness and likelihood of recommending each of four types of intervention: hospitalization, additional medication changes, additional neurostimulation, and additional psychotherapy. Across both cases, most respondents said they were likely to provide each intervention, except for additional neurostimulation in borderline personality disorder, while fewer thought each intervention would be helpful. Substantial minorities of respondents indicated that they would provide an intervention they did not think was likely to be helpful. Our results suggest that while most psychiatrists recognize the possibility that some patients are unlikely to be helped by available treatments, many would continue to offer such treatments. (shrink)

Rationale: Deep brain stimulation (DBS) of the hippocampus is proposed for enhancement of memory impaired by injury or disease. Many pre-clinical DBS paradigms can be addressed in epilepsy patients undergoing intracranial monitoring for seizure localization, since they already have electrodes implanted in brain areas of interest. Even though epilepsy is usually not a memory disorder targeted by DBS, the studies can nevertheless model other memory-impacting disorders, such as Traumatic Brain Injury (TBI). Methods: Human patients undergoing Phase II invasive monitoring for (...) intractable epilepsy were implanted with depth electrodes capable of recording neurophysiological signals. Subjects performed a delayed-match-to-sample (DMS) memory task while hippocampal ensembles from CA1 and CA3 cell layers were recorded to estimate a multi-input, multi-output (MIMO) model of CA3-to-CA1 neural encoding and a memory decoding model (MDM) to decode memory information from CA3 and CA1 neuronal signals. After model estimation, subjects again performed the DMS task while either MIMO-based or MDM-based patterned stimulation was delivered to CA1 electrode sites during the encoding phase of the DMS trials. Each subject was sorted (post hoc) by prior experience of repeated and/or mild-to-moderate brain injury (RMBI), TBI, or no history (control) and scored for percentage successful delayed recognition (DR) recall on stimulated vs. non-stimulated DMS trials. The subject’s medical history was unknown to the experimenters until after individual subject memory retention results were scored. Results: When examined compared to control subjects, both TBI and RMBI subjects showed increased memory retention in response to both MIMO and MDM-based hippocampal stimulation. Furthermore, effects of stimulation were also greater in subjects who were evaluated as having pre-existing mild-to-moderate memory impairment. Conclusion: These results show that hippocampal stimulation for memory facilitation was more beneficial for subjects who had previously suffered a brain injury (other than epilepsy), compared to control (epilepsy) subjects who had not suffered a brain injury. This study demonstrates that the epilepsy/intracranial recording model can be extended to test the ability of DBS to restore memory function in subjects who previously suffered a brain injury other than epilepsy, and support further investigation into the beneficial effect of DBS in TBI patients. (shrink)

Peoples’ perceptions of healthy eating are influenced by the cultural context in which they occur. Despite this general acceptance by health practitioners and social scientists, studies suggest that there remains a relative homogeneity around peoples’ perceptions that informs a hegemonic discourse around healthy eating. People often describe healthy eating in terms of learned information from sources that reflect societies’ norms and values, such as the Canada Food Guide and the ubiquitous phrase “fruits and vegetables”. Past research has examined how built (...) environments shape people’s access to healthy living options, such as distribution of grocers versus convenience stores and fast food restaurants. Often overlooked is an in-depth understanding of how social contexts interact with built environments, molding peoples’ perceptions of healthy eating. This paper reports on perceptions of healthy eating in four communities across Alberta, Canada. A photovoice methodology was employed to elicit perceptions of healthy eating with 35 participants. This study illustrates how participants’ photographs and their stories convey multiple meanings about healthy eating within their own lives and communities. Findings suggest that a ‘local’ context is an important part of the discourse centered around the promotion of healthy eating practices in these and potential other communities. (shrink)

Wilhelm Bousset, a leading member of the religionsgeschichtliche school and author of a seminal work on early Christology, Kyrios Christos, is typically regarded by reviewers of his work as a classic nineteenth-century liberal who sought a secure foundation for faith in the historical Jesus. However, this view of Bousset fails to appreciate the significant development of his theological perspective on the relationship between faith and history, a perspective that underwent a profound shift due to the influence of the English historian (...) Thomas Carlyle and the Kantian philosopher Jakob Friedrich Fries. It is the influence of these two figures that enables Bousset to justify a full-scale flight from history and to seek faith's foundation elsewhere, in the poetic symbol of Jesus Christ. The resulting solution to the problem of faith and history represents a unique and compelling alternative to the solutions of the leading theologians and New Testament scholars of the early twentieth century. (shrink)

Doubly robust (DR) estimators are an important class of statistics derived from a theory of semiparametric efficiency. They have become a popular tool in causal inference, including applications to dynamic treatment regimes. The doubly robust estimators for the mean response to a dynamic treatment regime may be conceived through the augmented inverse probability weighted (AIPW) estimating function, defined as the sum of the inverse probability weighted (IPW) estimating function and an augmentation term. The IPW estimating function of the causal estimand (...) via marginal structural model is defined as the complete-case score function for those subjects whose treatment sequence is consistent with the dynamic regime in question divided by the probability of observing the treatment sequence given the subject's treatment and covariate histories. The augmentation term is derived by projecting the IPW estimating function onto the nuisance tangent space and has mean-zero under the truth. The IPW estimator of the causal estimand is consistent if (i) the treatment assignment mechanism is correctly modeled and the AIPW estimator is consistent if either (i) is true or (ii) nested functions of intermediate and final outcomes are correctly modeled.Hence, the AIPW estimator is doubly robust and, moreover, the AIPW is semiparametric efficient if both (i) and (ii) are true simultaneously. Unfortunately, DR estimators can be inferior when either (i) or (ii) is true and the other false. In this case, the misspecified parts of the model can have a detrimental effect on the variance of the DR estimator. We propose an improved DR estimator of causal estimand in dynamic treatment regimes through a technique originally developed by [4] which aims to mitigate the ill-effects of model misspecification through a constrained optimization.In addition to solving a doubly robust system of equations, the improved DR estimator simultaneously minimizes the asymptotic variance of the estimator under a correctly specified treatment assignment mechanism but misspecification of intermediate and final outcome models. We illustrate the desirable operating characteristics of the estimator through Monte Carlo studies and apply the methods to data from a randomized study of integrilin therapy for patients undergoing coronary stent implantation. The methods proposed here are new and may be used to further improve personalized medicine, in general. (shrink)

By combining and augmenting recent arguments that have appeared in the literature, I show how a modified Rawlsian theory of justice generates a strong environmental and animal rights ethic. These modifications include significant changes in the conditions of the contract situation vis-a-vis A Theory of Justice, but I argue that these modifications are in fact more consistent with Rawls’ basic assumptions about the functions of a veil of ignorance and a thin theory of the good.

In this paper I present the basic outlines of a nonstandard interpretation of Sein und Zeit. The merit of this interpretation is that it brings out and develops some of the radical possibilities contained in this rich text, possibilities which, I believe, have yet to be given their due. On the basis of this interpretation it is clear not only how Heidegger’s ontology departs from its Cartesian and Kantian predecessors, but also how his ontology puts the traditional mind/body problem, and (...) the problem of the external world, onto radically new grounds. However, unlike standard interpretations of Sein und Zeit, I argue that these new grounds neither resolve, nor dissolve, these problems, and that Heidegger’s discussion of the so-called “scandal of philosophy” is misleading at best. (shrink)

In this paper I present the basic outlines of a nonstandard interpretation of Sein und Zeit. The merit of this interpretation is that it brings out and develops some of the radical possibilities contained in this rich text, possibilities which, I believe, have yet to be given their due. On the basis of this interpretation it is clear not only how Heidegger’s ontology departs from its Cartesian and Kantian predecessors, but also how his ontology puts the traditional mind/body problem, and (...) the problem of the external world, onto radically new grounds. However, unlike standard interpretations of Sein und Zeit, I argue that these new grounds neither resolve, nor dissolve, these problems, and that Heidegger’s discussion of the so-called “scandal of philosophy” is misleading at best. (shrink)

This article compares the ethical attitudes of Ukrainian business professionals with those of United States business professionals. A widely used survey instrument consisting of 16 hypothetical situations involving ethical dilemmas was employed to gather information on ethical attitudes in the two countries. On 13 of 16 vignettes, Ukrainian respondents demonstrated less stringent ethical attitudes than did their United States counterparts. Possible reasons for these differences are discussed, with primary emphasis on the transition from one economic system to another that is (...) underway in Ukraine. Comments from Ukrainian respondents are presented so as to give an indication of the thought processes behind the questionnaire responses. (shrink)

Physiological concentrations of retinoic acid can induce acute alterations in the expression of the enzyme tissue transglutaminase in cultured macrophages. The induction of this enzyme offers a probe to study the mechanism of retinoid action in both normal and leukemic cells.

This article reports the findings of a survey examining if there are gender and career stage differences between male and female practitioners regarding ethical judgment. The results show that, on average, females adopted a more strict ethical stance than their male counterparts on 7 out of 19 vignettes. Males on the other hand, demonstrated a more ethical stance than their female counterparts on 2 out of 19 vignettes. The results furthermore indicate there is a significant difference in ethical judgment across (...) career stages. Overall, it appears that practitioners in later career stages display higher ethical judgment than practitoners in lower career stages. Implications are provided for both practitioners and academicians. (shrink)

Our studies of naturally occurring human dialogue have led to the recognition of a class of regularities which characterize impoltant aspects of communication. People appear to interact according to established patterns which span several turns in a dialogue and which recur frequently. These patterns appear to be organized around the goals which the dialogue serves for each participant. Many things which are said later in a dialogue can only be interpreted as pursuit of these goals, established by earlier dialogue.These patterns (...) have been represented b) a set of knowledge structures called Dialogue‐Games, capturing shared, conventional knowledge that people have about communication and how it can be used to achieve goals. A Dialogue‐Game has Parameters, which represent those elements that vary across instances of a particular pattern‐the particular dialogue participants and the content topic. The states of the world which must be in effect for a particular Dialogue‐Game to be employed successfully are represented by Specifications of these Parameters. Finally, the expected sequence of intermediate states that occur during instances of a particular conventional pattern are represented by the Components of the corresponding Dialogue‐Game.Representations for several Dialogue‐Games are presented here, based on our analyses of different kinds of naturally occurring dialogue. A process model is discussed, showing Dialogue‐Game identification, pursuit, and termination as part of the comprehension of dialogue utterances. This Dialogue‐Game model captures some of the important functional aspects of language, especially indirect uses to achieve implicit communication. (shrink)

For decades, aged care facility residents at risk of pressure ulcers have been repositioned at two-hour intervals, twenty-four-hours-a-day, seven-days-a-week. Yet, PUs still develop. We used a cross-sectional survey of eighty randomly selected medical records of residents aged ≥ 65 years from eight Australian Residential Aged Care Facilities to determine the number of residents at risk of PUs, the use of two-hourly repositioning, and the presence of PUs in the last week of life. Despite 91 per cent of residents identified as (...) being at risk of PUs and repositioned two-hourly 24/7, 34 per cent died with one or more PUs. Behaviours of concern were noted in 72 per cent of residents of whom 38 per cent were restrained. Dementia was diagnosed in 70 per cent of residents. The prevalence of behaviours of concern displayed by residents with dementia was significantly greater than by residents without dementia. The rate of restraining residents with dementia was similar to the rate in residents without dementia. Two-hourly repositioning failed to prevent PUs in a third of at-risk residents and may breach the rights of all residents who were repositioned two-hourly. Repositioning and restraining may be unlawful. Rather than only repositioning residents two-hourly, we recommend every resident be provided with an alternating pressure air mattress. (shrink)

This unique edited collection illuminates Paul Ricoeur's engagement with Scripture. The contributors include one of the primary translators, several who studied at the University of Chicago, and some of this generation's noted Ricoeur scholars. The essays discuss Hebrew and Christian Scripture, hermeneutics, and biblical scholarship.

First published in 2002. Routledge is an imprint of Taylor & Francis, an informa company.

This article analyzes the attitudes of United States business professionals toward the issue of international bribery, and in particular, whether or not having a written code of ethics has an effect on these attitudes. A vignette relating to international bribery from a widely used survey instrument was employed in a nationwide survey of business professionals to gather information on ethical attitudes of respondents. Data were also collected on gender of respondents, whether or not respondents were self-employed, whether or not the (...) respondents' firms had a written code of ethics, and to what extent the respondents' firms generated revenues from international operations. Attitudes concerning whether or not international bribery is ever acceptable exhibited wide dispersion. Respondents from firms that have a written code of ethics were significantly less likely to find international bribery acceptable. Firms that generate revenues from international operations were significantly more likely to have a written code of ethics than were firms which did not generate revenues from international operations. Implications of the findings for business policy are discussed. (shrink)

Compassion is a prosocial motivation that is critical to the development and survival of the human species. Cultivating compassion involves developing deep wisdom, insight, and understanding into the nature and causes of human suffering; and wisdom and commitment to take positive action to alleviate suffering. This perspective piece discusses how compassion relates to the context of modern technology, which has developed at a rapid pace in recent decades. While advances in digital technology build on humankind’s vast capacity to develop practical (...) tools that promise to enrich our lives and improve our social connections, in reality the effects are often far from benign. The motives underlying the development of many contemporary digital platforms seem rooted in competitiveness and capitalism; while modern social media and online platforms are having a profound and pervasive impact on the mental health and wellbeing of humans around the globe. Nonetheless, digital technology holds considerable potential to promote compassionate insight, wisdom, and prosocial behavior. We reflect on the current state of technology within human society and examine the notion of compassionate technologies; discuss how contemporary paradigm shifts such as the inclusive design movement may be harnessed to build tools and platforms that promote collective good and increase prosocial behavior; and highlight examples of initiatives that are harnessing modern technology to advance democracy, collective knowledge, and personal freedoms and agency. (shrink)

Research on the relationship between religious commitment and business ethics has produced widely varying results and made the impact of such commitment unclear. This study presents an empirical investigation based on a questionnaire survey of business managers and professionals in the United States yielding a database of 1234 respondents. Respondents evaluated the ethical acceptability of 16 business decisions. Findings varied with the way in which the religion variable was measured. Little relationship between religious commitment and ethical judgment was found when (...) responses were compared on the basis of broad faith categories – Catholic, Protestant, Jewish, other religions, and no religion. However, respondents who indicated that religious interests were of high or moderate importance to them demonstrated a higher level of ethical judgment (less accepting of unethical decisions) than others in their evaluations. Evangelical Christians also showed a higher level of ethical judgment. (shrink)

Cultural difference has been largely ignored within bioethics, particularly within the end-of-life discourses and practices that have developed over the past two decades in the U.S. healthcare system. Yet how should culturebe taken into account?

This paper reports on the results from two studies that were conducted eight years apart with different respondents. The studies examined the role of the Mere Exposure Effect on ethical tolerance or acceptability of particular business decisions. The results from Study 1 show there is a significant difference in ethical judgment for 12 out of 16 vignettes between those who have been exposed to such situations compared to those who have not been exposed to them. In those 12 situations, those (...) who have been exposed to such situations adopted a more tolerant stance toward the ethically questionable behavior. The results from Study 2 show there is a significant difference in ethical judgment for 9 out of 16 vignettes between those who have been exposed to such situations compared to those who have not been exposed to them. Again, in those nine situations, those who have been exposed to such situations adopted a more tolerant stance toward the ethically questionable behavior. Interestingly, the 9 situations in Study 2 were 9 of the 12 situations found to be significant in Study 1, and in the same direction, suggesting that we have found consistency in our findings and support for the Mere Exposure Effect. Implications are provided for both higher education and practitioners. (shrink)

A questionnaire on business ethics was administered to business professionals and to upper-class business ethics students. On eight of the seventeen situations involving ethical dilemmas in business, students were significantly more willing to engage in questionable behavior than were their professional counterparts. Apparently, many students were willing to do whatever was necessary to further their own interests, with little or no regard for fundamental moral principles. Many students and professionals functioned within Lawrence Kohlberg's stage four of moral reasoning, the law (...) and order stage. Individualism and egoism remain strong patterns in the moral reasoning of many professionals, but they influence moral reasoning patterns among students to a much greater degree. (shrink)