Health‐care and public sector institutions are high‐risk settings for workplace bullying. Despite growing acknowledgement of the scale and consequence of this pervasive problem, there has been little critical examination of the institutional power dynamics that enable bullying. In the aftermath of large‐scale failures in care standards in public sector healthcare institutions, which were characterised by managerial bullying, attention to the nexus between bullying, power and institutional failures is warranted. In this study, employing Foucault's framework of power, we illuminate bullying as (...) a feature of structures of power and knowledge in public sector institutions. Our analysis draws upon the experiences of a large sample (n = 3345) of workers in Australian public sector agencies – the type with which most nurses in the public setting will be familiar. In foregrounding these power dynamics, we provide further insight into how cultures that are antithetical to institutional missions can arise and seek to broaden the debate on the dynamics of care failures within public sector institutions. Understanding the practices of power in public sector institutions, particularly in the context of ongoing reform, has important implications for nursing. (shrink)

This book brings together contributions from academics and practitioners to explore the implications of legal pluralism for legal development.

We report on an unpublished and previously unknown manuscript of John von Neumann and contextualize it within the development of the theory of shock waves and detonations during the nineteenth and twentieth centuries. Von Neumann studies bombs comprising a primary explosive charge along with explosive booster material. His goal is to calculate the minimal amount of booster needed to create a sustainable detonation, presumably because booster material is often more expensive and more volatile. In service of this goal, he formulates (...) and analyzes a partial differential equation-based model describing a moving shock wave at the interface of detonated and undetonated material. We provide a complete transcription of von Neumann’s work and give our own accompanying explanations and analyses, including the correction of two small errors in his calculations. Today, detonations are typically modeled using a combination of experimental results and numerical simulations particular to the shape and materials of the explosive, as the complex three dimensional dynamics of detonations are analytically intractable. Although von Neumann’s manuscript will not revolutionize our modern understanding of detonations, the document is a valuable historical record of the state of hydrodynamics research during and after World War II. (shrink)

Individuals of many animal species are said to have a personality. It has been shown that some individuals are bolder than other individuals of the same species, or more sociable or more aggressive. In this paper, we analyse what it means to say that an animal has a personality. We clarify what an animal personality is, that is, its ontology, and how different personality concepts relate to each other, and we examine how personality traits are identified in biological practice. Our (...) analysis shows that biologists often study specific personality traits, such as boldness, sociability or aggressiveness, rather than personalities in general. We claim that personality traits are best understood as dispositions and that they are operationally defined in terms of certain sets of behaviours, which are studied in specific experimental set-ups. Furthermore, we develop an integrative philosophical account that specifies and formalises three criteria for identifying personality traits, which are used in biological practice. For an individual animal to have a personality trait it must, first, behave differently than others. Second, these behavioural differences must be stable over a certain time, and third, they must be consistent in different contexts. (shrink)

Soil balancing is widely used in organic farming, but little is known about the practice because technical knowledge and goals for the practice are produced and negotiated within an alternative community of practice (CoP). We used a review of the private soil balancing literature and semi-structured interviews with farmers and consultants to document the knowledge, shared meanings, and goals of key actors within the soil balancing CoP. Our findings suggest this CoP is dominated by discourse between private consultants and farmers, (...) with few contributions to or from scientists or the peer reviewed literature. The idea of soil balancing is centered around improving soil quality through adjustments in Base Cation Saturation Ratios (BCSR), and practitioners report a wide range of positive agronomic outcomes. For most soil balancers, however, BCSR is only one part of a broader approach to soil health management that also utilizes traditional soil fertility recommendations and soil health-building cultural management practices. Meanwhile, a survey of land grant university soil fertility specialists and the peer-reviewed literature documented a high degree of skepticism and a lack of scientific evidence that BCSR can boost crop yields. We conclude that this scientific discourse reflects a disconnect from the practices and meanings used in the soil balancing CoP. While tensions between the dominant and niche agricultural knowledge systems are not unique, we believe a better appreciation for the nuanced meanings and goals within the soil balancing CoP present an opening for expanded collaborations with scientists doing research on soil health. (shrink)

MARY CAROLINE RICHARDS - "M.C." to her friends - attended Reed College (A.B.) and the University of California (M.A., Ph.D.).

The historian Caroline Walker Bynum, who solicited and organized this set of five case studies, explains in her introduction to them that their intent is to bypass the currently popular and unsupported claim that the humanities have practical relevance and, instead, to offer ruminative descriptions of what happens when teachers and students meet to discuss texts and objects. She explains that the essays report in detail on five individual classes in five very different academic settings, in the hope of (...) helping to turn the international anglophone conversation about humanistic education away from utilitarian, presentist, all-inclusive claims and toward a demonstration of what the humanities do in practice. (shrink)

In vertebrates, single cell analyses of replication timing patterns brought to light a very well controlled program suggesting a tight regulation on initiation sites. Mapping of replication origins with different methods has revealed discrete preferential sites, enriched in promoters and potential G‐quadruplex motifs, which can aggregate into initiation zones spanning several tens of kilobases (kb). Another characteristic of replication origins is a nucleosome‐free region (NFR). A modified yeast strain containing a humanized origin recognition complex (ORC) fires new origins at NFRs (...) revealing their regulatory role. In cooperation with NFRs, the histone variant H2A.Z facilitates ORC loading through di‐methylation of lysine 20 of histone H4. Recent studies using genome editing methods show that efficient initiation sites associated with transcriptional activity can synergize over several tens of kb by establishing physical contacts and lead to the formation of early domains of DNA replication demonstrating a co‐regulation between replication initiation and transcription. (shrink)

Artificial Intelligence (AI) is increasingly being used in disaster risk management applications to predict the effect of upcoming disasters, plan for mitigation strategies, and determine who needs how much aid after a disaster strikes. The media is filled with unintended ethical concerns of AI algorithms, such as image recognition algorithms not recognizing persons of color or racist algorithmic predictions of whether offenders will recidivate. We know such unintended ethical consequences must play a role in DRM as well, yet there is (...) surprisingly little research on exactly what the unintended consequences are and what we can do to mitigate them. The aim of this perspective is to call researchers working on fairness, accountability, and transparency to work with DRM and local experts—so we can ensure that disaster mitigation and relief is accountable, considers local values, and is not unintentionally biased. (shrink)

Michael A PetersBeijing Normal UniversityChatGPT is an AI chatbot released by OpenAI on November 30, 2022 and a ‘stable release’ on February 13, 2023. It belongs to OpenAI’s GPT-3 family (generativ...

BackgroundWith the emergence of Brain Computer Interfaces, clinicians have been facing a new group of patients with severe acquired brain injury who are unable to show any behavioral sign of consciousness but respond to active neuroimaging or electrophysiological paradigms. However, even though well documented, there is still no consensus regarding the nomenclature for this clinical entity.ObjectivesThis systematic review aims to 1) identify the terms used to indicate the presence of this entity through the years, and 2) promote an informed discussion (...) regarding the rationale for these names and the best candidates to name this fascinating disorder.MethodsThe Disorders of Consciousness Special Interest Group of the International Brain Injury Association launched a search on Pubmed and Google scholar following PRISMA guidelines to collect peer-reviewed articles and reviews on human adults published in English between 2006 and 2021.ResultsThe search launched in January 2021 identified 4,089 potentially relevant titles. After screening, 1,126 abstracts were found relevant. Finally, 161 manuscripts were included in our analyses. Only 58% of the manuscripts used a specific name to discuss this clinical entity, among which 32% used several names interchangeably throughout the text. We found 25 different names given to this entity. The five following names were the ones the most frequently used: covert awareness, cognitive motor dissociation, functional locked-in, non-behavioral MCS and higher-order cortex motor dissociation.ConclusionSince 2006, there has been no agreement regarding the taxonomy to use for unresponsive patients who are able to respond to active neuroimaging or electrophysiological paradigms. Developing a standard taxonomy is an important goal for future research studies and clinical translation. We recommend a Delphi study in order to build such a consensus. (shrink)

Whether or not conscious recollection in autobiographical memory is affected in schizophrenia is unknown. The aim of this study was to address this issue using an experiential approach. An autobiographical memory enquiry was used in combination with the Remember/Know procedure. Twenty-two patients with schizophrenia and 22 normal subjects were asked to recall specific autobiographical memories from four lifetime periods and to indicate the subjective states of awareness associated with the recall of what happened, when and where. They gave Remember, Know (...) or Guess responses according to whether they recalled these aspects of the event on the basis of conscious recollection, simply knowing, or guessing. Results showed that the frequency and consistency of Remember responses was significantly lower in patients than in comparison subjects. In contrast, the frequency of Know responses was not significantly different, whereas the frequency of patients’ Guess responses was significantly enhanced. It is concluded that the frequency and consistency of conscious recollection in autobiographical memory is reduced in patients with schizophrenia. (shrink)

Pandemics first and foremost hit those who are most vulnerable, and the COVID-19 pandemic is not different. Although the infection rate in the nation’s poorest neighborhoods is twice as it is in th...

Using the Remember/Know procedure, we compared the impact of a reflective repetition by refreshing and a perceptual repetition on subjective experience during recognition memory. Participants read aloud words as they appeared on a screen. Critical words were presented once , immediately repeated , or followed by a dot signalling the participants to think of and say the just-previous word . In Experiments 1 and 2, Remember responses benefited from refreshing a word . In Experiment 2, this benefit disappeared when participants (...) had to refresh one of three active items. Perceptual repetition increased Remember responses in Experiment 1, but not in Experiment 2 regardless of whether participants had just previously seen 1- or 3-items. These findings indicate that under some circumstances, reflective and perceptual repetition may have different consequences for later subjective experience during remembering, suggesting differences in their underlying functional mechanisms. (shrink)

The SALOMON project is a contribution to the automatic processing of legal texts. Its aim is to automatically summarise Belgian criminal cases in order to improve access to the large number of existing and future cases. Therefore, techniques are developed for identifying and extracting relevant information from the cases. A broader application of these techniques could considerably simplify the work of the legal profession.A double methodology was used when developing SALOMON: the cases are processed by employing additional knowledge to interpret (...) structural patterns and features on the one hand and by way of occurrence statistics of index terms on the other. As a result, SALOMON performs an initial categorisation and structuring of the cases and subsequently extracts the most relevant text units of the alleged offences and of the opinion of the court. The SALOMON techniques do not themselves solve any legal questions, but they do guide the user effectively towards relevant texts. (shrink)

Workplace bullying is a significant issue confronting the nursing profession. Bullying in nursing is frequently described in terms of ‘oppressed group’ behaviour or ‘horizontal violence’. It is proposed that the use of ‘oppressed group’ behaviour theory has fostered only a partial understanding of the phenomenon in nursing. It is suggested that the continued use of ‘oppressed group’ behaviour as the major means for understanding bullying in nursing places a flawed emphasis on bullying as a phenomenon that exists only among nurses, (...) rather than considering it within the broader organisational context. The work of Foucault and the ‘circuits of power’ model proposed by Clegg are used to provide an alternative understanding of the operation of power within organisations and therefore another way to conceive bullying in the nursing workforce. (shrink)

Background In this qualitative analysis we aimed to explore addiction physicians’ perspectives on safer injection education for people who inject drugs, especially: (1) on possible means of introducing safer injection education in the medical environment, (2) on the compatibility of safer injection education with each physician’s core values and goals, and (3) on possible reasons for the ethical dilemma in safer injection education. Methods We conducted semi-structured interviews with eleven physicians practicing addiction medicine in France in clinical and harm reduction (...) settings. Results All participants were in favor of educational interventions for people who inject drugs. Nonetheless, these interventions varied from simple advice to injection supervision and they were seen as less acceptable when they concerned the practical and material aspects of injection. Some participants found that physicians practicing in clinical settings, where patients consult mostly to stop their drug use, should not practice safer injection education. On the contrary, other participants claimed that safer injection education was essential in all settings and was not a choice but rather a duty for addiction physicians. The ethical dilemma of such intervention when delivered by medical staff was viewed as a complex phenomenon, related to the representations of intravenous drug use and to societal expectations from physicians. Conclusion Physicians’ views on safer injection education for people who inject drugs reveal an emotionally charged subject related to the structural organization of addiction management in France. Such education is marked by an arduous history of harm reduction policies in France. IRB registration: #00011928. (shrink)

ABSTRACTRecent research suggests that impaired emotion regulation may play an important role in the development of youth psychopathology. However, little research has explored the effects of ER strategies on affect in early adolescents. In Study 1, we examined if early adolescents are able to use distraction and whether the effects of this strategy are similar to talking to one’s mother. In Study 2, we compared the effects of distraction, cognitive reappraisal, acceptance, and rumination. In both studies, participants received instructions on (...) how to regulate their emotions after a standardised negative mood induction. In general, the results indicated that distraction, but also cognitive reappraisal and acceptance, had promising short-term effects on positive and negative affect in early adolescents. These findings suggest that targeting adaptive ER skills, such as distraction, acceptance, and cognitive reappraisal, may be an important strategy to prevent or treat psychological pro... (shrink)

Following the recent condemnation of the National Health Service charging regulations by medical colleges and the UK Faculty of Public Health, we demonstrate that through enactment of this policy, the medical profession is betraying its core ethical principles. Through dissection of the policy using Beauchamp and Childress’ framework, a disrespect for autonomy becomes evident in the operationalisation of the charging regulations, just as a disregard for confidentiality was apparent in the data sharing Memorandum of Understanding. Negative consequences of the regulations (...) are documented to highlight their importance for clinical decision makers under the principles of beneficence and non-maleficence. Exploration of the principle of justice illuminates the core differentiation between the border-bound duties of the State and borderless duties of the clinician, exposing a fundamental tension. (shrink)

Aim Genetic research representative of the population is crucial to understanding the underlying causes of many diseases. In a prospective evaluation of informed consent we assessed the willingness of individuals of different ethnicities, gender and drug dependence history to participate in genetic studies in which their genetic sample could be shared with a repository at the National Institutes of Health. Methods Potential subjects were recruited from the general population through the use of flyers and referrals from previous participants and clinicians (...) with knowledge of our study. They could consent to 11 separate choices so that they could specify how and with whom their genetic sample could be shared. Rates of affirmative consent were then analysed by gender, ethnicity and drug dependence history. Results Of 1416 volunteers enrolled, 99.7% gave affirmative informed consent for studies of addiction conducted in our laboratory. No significant difference was found for participation in genetic studies conducted in our laboratory by gender, ethnicity or drug dependence history. Over all 11 questions, individuals with a history of drug use were more likely to agree to consent to participate in our study than were healthy volunteers. Conclusion A high percentage of each category of gender, ethnicity and drug history, gave affirmative consent at all levels. The level of detail in and the amount of time spent reviewing the informed consent, and a relationship of trust with the clinical investigator may contribute to this outcome. (shrink)

Digital communication between a patient and their clinician offers the potential for improved patient care, particularly for young people with long term conditions who are at risk of service disengagement. However, its use raises a number of ethical questions which have not been explored in empirical studies. The objective of this study was to examine, from the patient and clinician perspective, the ethical implications of the use of digital clinical communication in the context of young people living with long-term conditions. (...) A total of 129 semi-structured interviews, 59 with young people and 70 with healthcare professionals, from 20 United Kingdom -based specialist clinics were conducted as part of the LYNC study. Transcripts from five sites were read by a core team to identify explicit and implicit ethical issues and develop descriptive ethical codes. Our subsequent thematic analysis was developed iteratively with reference to professional and ethical norms. Clinician participants saw digital clinical communication as potentially increasing patient empowerment and autonomy; improving trust between patient and healthcare professional; and reducing harm because of rapid access to clinical advice. However, they also described ethical challenges, including: difficulty with defining and maintaining boundaries of confidentiality; uncertainty regarding the level of consent required; and blurring of the limits of a clinician’s duty of care when unlimited access is possible. Paradoxically, the use of digital clinical communication can create dependence rather than promote autonomy in some patients. Patient participants varied in their understanding of, and concern about, confidentiality in the context of digital communication. An overarching theme emerging from the data was a shifting of the boundaries of the patient-clinician relationship and the professional duty of care in the context of use of clinical digital communication. The ethical implications of clinical digital communication are complex and go beyond concerns about confidentiality and consent. Any development of this form of communication should consider its impact on the patient-clinician-relationship, and include appropriate safeguards to ensure that professional ethical obligations are adhered to. (shrink)

In this article, we clarify and describe the nature of nursing expertise and provide a framework to guide its identification and further development. To have utility and rigour, concept‐driven research and theories of practice require underlying concepts that are robust, valid and reliable. Advancing understanding of a concept requires careful attention to explicating its knowledge, metaphors and conceptual meaning. Examining the concepts and metaphors of nursing expertise, and how they have been interpreted into the nursing discourse, we aimed to synthesise (...) definitions and similarities between concepts and elicit the defining characteristics and properties of nursing expertise. In clarifying the concept, we sought to move beyond the ambiguity that currently surrounds expertise in nursing and unravel it to make explicit the characteristics of nursing expertise from published peer‐reviewed studies and structured literature synthesis. Findings indicate a lack of clarity surrounding the use of the term expertise. Traditional reliance upon intuition as a way of explaining expert performance is slowly evolving. Emerging from the analysis is a picture of expertise as the relationship between networks of contextual reasoning, understanding and practice. Striking absences in the discourse include limited explication of ethical reasoning and theorising a broader interpretation of expertise reflective of contemporary forms of nursing. (shrink)

L'ouvrage publié réunit les actes d'une journée d'étude consacrée à L'imprévu et le droit, souhaitée par les doctorants et organisée par l'Ecole doctorale de droit comparé de l'Université Paris 1 Panthéon-Sorbonne. Le sujet est immédiatement apparu très riche. Si le terme d'imprévu n'est pas essentiellement juridique, il fait écho à des critères du droit tels que la prévisibilité d'une situation ou d'un texte, ou l'imprévisibilité d'un événement comme cause exonératoire de responsabilité. Il renvoie plus généralement à l'exigence de sécurité juridique (...) qui s'opposerait à l'imprévu juridique. En outre le contexte était des plus propices, quelle que soit la discipline concernée, droit public, droit privé et/ou droit pénal. L'imprévu est entendu comme tout ce qui n'a pas été prévu, tout ce qui arrive lorsqu'on ne s'y attend pas. Prévoir, c'est admettre comme probable. La question de l'imprévu confronté au droit est intéressante car les deux concepts semblent antinomiques. Le droit apparaît en effet comme quelque chose de figé, permettant de régler par anticipation les comportements humains. Il doit permettre à chacun de régler sa conduite puisque nul n'est censé ignorer la loi. Le droit doit donc être à la fois connu et prévisible dans ses effets même s'il n'en est pas toujours ainsi. La notion d'imprévu semble rencontrer le droit de deux manières. D'une part, il existe la norme imprévue : la norme nouvelle, la coutume en formation ou l'interprétation surprenante. Se posent alors les questions de la prévisibilité du droit, et corrélativement celle de la sécurité juridique. D'autre part, il y a le fait imprévu. La norme doit se saisir de comportements humains ou de situations de fait qui n'avaient pas été anticipés. L'appréhension du risque et de la survenance d'événements inattendus par des règles de droit préexistantes devient alors un enjeu essentiel. (shrink)

In our target article (Sabatello et al. 2021), we proposed the use of community engagement and the establishment of a Truth and Reconciliation Commission (TRC) as pathways for promoting social just...

The articles collected in this critical edition represent a variety of interpretations both of the kind of feminism Mill represents and of the specific arguments he offers in The Subjection of Women including their lexical ordering and relative merit. Each selection is preceded by a brief and useful summary of the author's position intended to assist introductory students.

Digital Earth applications provide a common ground for visualizing, simulating, and modeling real-world situations. The potential of Digital Earth applications has increased significantly with the evolution of artificial intelligence systems and the capacity to collect and process complex amounts of geospatial data. Yet, the widespread techno-optimism at the root of Digital Earth must now confront concerns over high-risk artificial intelligence systems and power asymmetries of a datafied society. In this commentary, we claim that not only can current debates about data (...) governance and ethical artificial intelligence inform development in the field of Digital Earth, but that the specificities of geospatial data, together with the expectations surrounding Digital Earth applications, offer a fruitful lens through which to examine current debates on data governance and artificial intelligence ethics. In particular, we argue that for the implementation of ethical artificial intelligence and inclusive approaches to data governance, Digital Earth initiatives need to involve stakeholders and communities at the local level and be sensitive to social, legal, cultural, and institutional contexts, including conflicts that might arise within those contexts. (shrink)

Si en droit public comme en droit privé, l’ordre public limite la liberté contractuelle et fonde des atteintes à la stabilité des relations contractuelles, sa force impérative apparaît aujourd’hui tempérée par la sécurité juridique et par les exigences du service public. Mais il s’agit en réalité de la confrontation de plusieurs éléments de l’ordre public, en raison de la place croissante accordée dans l’ordre social à des valeurs liées à l’institutionnalisation de la paix sociale.

This article explores some of the challenges and benefits of doing a dissertation with participants from a population to which I belong and on a topic some consider controversial, that of gay and lesbian educators. I describe the homophobia I experienced and how that homophobia affected my choice of topic, the research process, and my job prospects. Each step of this research journey presented me with a variety of delicate decisions. I discuss my thought processes in resolving these dilemmas and (...) some of the practical solutions I used to address a variety of difficulties. Although written specifically about doing research with gay and lesbian teachers, many of the lessons I learned throughout this process can be applied to a range of research situations. For example, many researchers share cultural backgrounds with their participants. This presents both the opportunity to establish rapport with participants quickly but also the danger of the researcher reading his or her own experiences into the data. I describe some of the ways I addressed this issue as well as others commonly faced by those doing dissertations. I conclude that doing a dissertation on a topic I feel passionately about sustained me throughout the dissertation process. (shrink)

Michael A. Petersa and Fazal Rizvib aBeijing Normal University, Beijing, PR China; bMelbourne University, Melbourne, Australia Our minds are still racing back and forth, longing for a return to ‘no...

Moral or ethical questions are vital because they affect our daily lives: what is the best choice we can make, the best action to take in a given situation, and ultimately, the best way to live our lives? Health ethics has contributed to moving ethics toward a more experience-based and user-oriented theoretical and methodological stance but remains in our practice an incomplete lever for human development and flourishing. This context led us to envision and develop the stance of a “living (...) ethics”, described in this inaugural collective and programmatic paper as an effort to consolidate creative collaboration between a wide array of stakeholders. We engaged in a participatory discussion and collective writing process known as instrumentalist concept analysis. This process included initial local consultations, an exploratory literature review, the constitution of a working group of 21 co-authors, and 8 workshops supporting a collaborative thinking and writing process. First, a living ethics designates a stance attentive to human experience and the role played by morality in human existence. Second, a living ethics represents an ongoing effort to interrogate and scrutinize our moral experiences to facilitate adaptation of people and contexts. It promotes the active and inclusive engagement of both individuals and communities in envisioning and enacting scenarios which correspond to their flourishing as authentic ethical agents. Living ethics encourages meaningful participation of stakeholders because moral questions touch deeply upon who we are and who we want to be. We explain various aspects of a living ethics stance, including its theoretical, methodological, and practical implications as well as some barriers to its enactment based on the reflections resulting from the collaborative thinking and writing process. (shrink)

The ethical conduct of research rests largely on researchers, and as such, an understanding of how they perceive and enact their role in research is paramount. However, the literature around ethics and research mostly focuses on researchers’ perception of Research Ethics Boards roles and functions. To fill that gap, we analyzed the perceptions of researchers, REB members, and influential parties about researchers’ role in the ethical conduct of research through discourse analysis. Three discourses emerged: researchers as reflective practitioners, protectors of (...) participants, and technicians. Understanding the commonalities and differences among the discourses may foster a shared and compelling institutional research culture. (shrink)

Incidental findings in research with human participants may have implications for a person’s present health or future health outcomes. Current guidelines focus on methods for handling and reporting incidental findings from biological test data but incidental findings might also arise from non-biological tests. This article presents three examples in which the results from non-biological test data can be predictive of future disease and should be disclosed to research participants. It is intended to increase awareness and facilitate further discussion about the (...) reporting of incidental findings from non-biological data. (shrink)

This study examines the conditions under which apologies help to elicit forgiveness and restore trust following trust violations between leaders and followers. The intentionality and severity of violations are examined in a critical incident study and a laboratory study. The results support a model in which forgiveness mediates the relation of apology quality and trust. More importantly, the moderation–mediation model shows that apology quality influenced forgiveness and subsequent trust following violations that were moderate in severity–intentionality combination. The effect of apologizing (...) affects trust directly without forgiveness when the severity–intentionality combination held minor or extreme intensity. The results suggest a range in which apologies are effective and enrich understanding of the conditions under which trust can be recovered through an apology–forgiveness process in leader–follower relationships. The contribution of the study lies in elucidating that the combination of severity and intentionality of leaders’ trust violations has greater importance than either one separately. (shrink)

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

Conscious awareness comprises two distinct states, autonoetic and noetic awareness. Schizophrenia impairs autonoetic, but not noetic, awareness. We investigated the strategic regulation of relevant and irrelevant contents of conscious awareness in schizophrenia using a directed forgetting paradigm. Twenty-one patients with schizophrenia and 21 normal controls were presented with words and told to learn some of them and forget others. In a subsequent test, they were asked to recognize all the words they had seen previously and give remember, know or guess (...) responses according to whether they recognized words on the basis of autonoetic awareness, noetic awareness, or guessing. Overall, patients showed the same degree of a directed forgetting effect as normal subjects. However, whereas the effect was observed both for remember and know responses in normal subjects, it was observed for know, but not for remember, responses in patients. These results indicate that patients with schizophrenia exhibit an impaired strategic regulation of contents of autonetic awareness for relevant and irrelevant information. (shrink)