In this ground-breaking work, Deborah Cowen makes the first book-length critical intervention into the field of business logistics. Tracing the social, spatial and political transformations wrought by the ‘logistics revolution’, Cowen argues that logistical systems have blurred the boundaries between production and circulation, civilian and military life, and geopolitics and geo-economics, constructing an architecture of the supply chain animated by both the art of war and the science of business. This review considers the political stakes of Cowen’s argument that logistics (...) has reconfigured capitalist social relations of production, especially in relation to the securitisation of spatial mobility and the restructuring of the labour process. In particular, Cowen’s wager that logistical supply-chains are characterised by their vulnerability – and that attendant possibilities for building solidarity emerge out of movements that disrupt such flows – is interrogated in order to question whether such interruptions effectively produce challenges to value-in-motion, or actually become integral to processes of value production. (shrink)

Background:Nurses exposed to community health nursing commonly encounter situations that can be morally distressing. However, most research on moral distress has focused on acute care settings and very little research has explored moral distress in a community health nursing setting especially among nursing students.Aim:To explore the moral distress experiences encountered by undergraduate baccalaureate nursing students in community health nursing.Research design:A descriptive qualitative design was employed to explore the community health nursing experiences of the nursing students that led them to have (...) moral distress.Participants and research context:The study included 14 senior nursing students who had their course in Community Health Nursing in their sophomore year and stayed in the partner communities in their junior year for 6 and 3 weeks during their senior year.Ethical considerations:Institutional review board approval was sought prior to the conduct of the study. Self-determination was assured and anonymity and confidentiality were guaranteed to all participants.Findings:Nursing students are vulnerable and likely to experience moral distress when faced with ethical dilemmas. They encounter numerous situations which make them question their own values and ideals and those of that around them. Findings of the study surfaced three central themes which included moral distress emanating from the unprofessional behavior of some healthcare workers, the resulting sense of powerlessness, and the differing values and mindsets of the people they serve in the community.Conclusion:This study provides educators a glimpse of the morally distressing situations that often occurs in the community setting. It suggests the importance of raising awareness and understanding of these situations to assist nursing students to prepare themselves to the “real world,” where the ideals they have will be constantly challenged and tested. (shrink)

Conventional wisdom holds that the von Neumann entropy corresponds to thermodynamic entropy, but Hemmo and Shenker (2006) have recently argued against this view by attacking von Neumann's (1955) argument. I argue that Hemmo and Shenker's arguments fail due to several misunderstandings: about statistical-mechanical and thermodynamic domains of applicability, about the nature of mixed states, and about the role of approximations in physics. As a result, their arguments fail in all cases: in the single-particle case, the finite particles case, and the (...) infinite particles case. (shrink)

In Everettian quantum mechanics, justifications for the Born rule appeal to self-locating uncertainty or decision theory. Such justifications have focused exclusively on a pure-state Everettian multiverse, represented by a wave function. Recent works in quantum foundations suggest that it is viable to consider a mixed-state Everettian multiverse, represented by a (mixed-state) density matrix. Here, we develop the conceptual foundations for decoherence and branching in a mixed-state multiverse, and extend the standard Everettian justifications for the Born rule to this setting. This (...) extended framework provides a unification of 'classical' and 'quantum' probabilities, and additional theoretical benefits, for the Everettian picture. (shrink)

Programs in quantum gravity often claim that time emerges from fundamentally timeless physics. In the semiclassical time program time arises only after approximations are taken. Here we ask what justifies taking these approximations and show that time seems to sneak in when answering this question. This raises the worry that the approach is either unjustified or circular in deriving time from no–time.

[Accepted for publication in Lakatos's Undone Work: The Practical Turn and the Division of Philosophy of Mathematics and Philosophy of Science, special issue of Kriterion: Journal of Philosophy. Edited by S. Nagler, H. Pilin, and D. Sarikaya.] Lakatos’s analysis of progress and degeneration in the Methodology of Scientific Research Programmes is well-known. Less known, however, are his thoughts on degeneration in Proofs and Refutations. I propose and motivate two new criteria for degeneration based on the discussion in Proofs and Refutations (...) – superfluity and authoritarianism. I show how these criteria augment the account in Methodology of Scientific Research Programmes, providing a generalized Lakatosian account of progress and degeneration. I then apply this generalized account to a key transition point in the history of entropy – the transition to an information-theoretic interpretation of entropy – by assessing Jaynes’s 1957 paper on information theory and statistical mechanics. (shrink)

This article describes challenges of conducting an HIV prevention program involving 40 male and female participants ages 12–18 in Hammanskraal, South Africa, aimed at increasing awareness and knowledge of laws protecting children’s sexual health rights and access to services through a culturally based “study circle” format. Challenges highlighted by the project included Institutional Review Board approval of youth consent procedures, cooperation and coordination with local policymakers, the need to modify presentation materials to youths’ comprehension levels, availability of youth-based sexual health (...) service providers, and cultural ambiguity over parental involvement in youth health care decisions and laws pertaining to sexual relationships among minors. (shrink)

Strong non-maximalism holds that some truths require no ontological ground of any sort. Strong non-maximalism allows one to accept that some propositions are true without being forced to endorse any corresponding ontological commitments. We show that there is a version of truthmaker theory available—anti-aboutness truthmaking—that enjoys the dialectical benefits of the strong non-maximalist’s position. According to anti-aboutness truthmaking, all truths require grounds, but a proposition need not be grounded in the very thing(s) that the proposition is about. We argue that (...) if strong non-maximalism can be defended, then so can anti-aboutness truthmaking on the very same basis; one can enjoy the benefits of strong non-maximalism without giving up on the idea that truth is always grounded in being. (shrink)

Xunzi's philosophy provides a rich resource for understanding how ethical relationships between humans and nature can be articulated in terms of harmony. In this paper, I build on his ideas to develop the concept of reciprocal harmony, which requires us to reciprocate those who make our lives liveable. In the context of the environment, I argue that reciprocal harmony generates moral obligations towards nature, in return for the existential debt that humanity owes towards heaven and earth. This can be used (...) as a normative basis for an environmental ethic that enables humanity and nature to flourish together. (shrink)

Clinical ethics consultation service remains undeveloped in developing countries. It is recognised that its introduction poses challenges. Malaysia, a multicultural society with diverse religions, values and perceptions further complicate the introduction of formal clinical ethics consultation service. Clinicians attending a national congress workshop completed a Strengths–Weaknesses–Opportunities–Threats analysis. The aim was to gain insight into clinician’s expectations and promote initiatives leading to the introduction of clinical ethics consultation service. Clinicians agree that clinical ethics consultation service can improve quality of care, reduce (...) healthcare costs and advocate for patients and providers. The analysis highlighted constraints in sufficient critical mass of relevant expertise and restricted opportunities for training. The opportunities lie in education, curriculum development and availability of dedicated proponents. Cultural barriers, limited resources, lack of awareness, differenc... (shrink)

In this article we critically evaluate an argument against state‐sanctioned euthanasia made by David Velleman in his 1992 paper ‘Against the right to die’. In that article, Velleman argues that legalizing euthanasia is morally problematic as it will deprive eligible patients of the opportunity of staying ‘alive by default’. That is to say, those patients who are rendered eligible for euthanasia as a result of legislative reform will face the burden of having to justify their continued existence to their epistemic (...) peers if they are to be perceived as ‘reasonable’. We discuss potential criticisms that could be made of the argument, and consider how a defender of the view might respond. Velleman’s argument is particularly interesting as it is a consequentialist argument against state‐sanctioned euthanasia, challenging the many consequentialist arguments that have been made in favour of legalizing the procedure. We conclude by suggesting that further research on the question of unfair burdens is important to adequately evaluating the potential harms of legalizing euthanasia for patients at the end of life. (shrink)

BackgroundResearch and academic institutions use various delivery channels to deliver Research Integrity education in their communities. Yet there is no consensus on the best delivery method and the effectiveness of these channels in inculcating a positive RI culture varies across institutions. Hence, this study aimed to understand the preferences of the research community in Nanyang Technological University, Singapore.MethodsAn online survey was conducted on NTU research community to understand their experience with, and preference for each RI education mode offered in NTU. (...) The RI education modes surveyed in the general ranking question are Data Management Plan workshops, Epigeum e-Learning, Compass e-newsletter, and NTU policy on Research Integrity and Responsible Conduct of Research. There were 242 responses, comprising 50% research students, 32.2% research staff and 17.8% faculty members. Non-parametric statistical techniques were used to analyse preferences across different RI education modes and within sub-groups.ResultsMore than 92% of respondents subscribed to the importance of RI education, but with different preferences for education modes. With respect to RI education in NTU, Compass e-newsletters were ranked the lowest. Most felt that they were too wordy and unengaging, making it difficult to absorb information. Similarly, Epigeum e-Learning and ‘policy’ were found to be too lengthy in presentation. The compulsory NTU RI education modes enjoyed higher participation rates of 70–80% compared with 32–37% for the self-regulated modes. This suggests that regulatory mechanisms are still necessary to promote participation in RI education, and thus, core RI education content should be made compulsory in research/academic institutions. Although Epigeum is a compulsory course, some may not have participated in the programme due to technical issues or they might have forgotten to participate in the programme within the permissible timeframe. For all four RI education modes in NTU, the lack of awareness was among the top cited reasons for not participating.ConclusionsMost NTU researchers perceived RI education positively although they may have reservations for some approaches. Conversely, e-Learning is favored over all the other modes except for the mode of Policy. Findings from this study are useful for improving the design of RI education strategies to be more appealing to the research community by enhancing user experience in terms of user-friendliness, relevance to specialisation, providing concise information and better presentation of materials For institutions with similar modes of RI education as NTU, these results may be relevant in improving participation rates and presentation of RI education modes, such as the use of infographics and more concise information. (shrink)

L S Penrose’s Limit Theorem – which is implicit in Penrose [7, p. 72] and for which he gave no rigorous proof – says that, in simple weighted voting games, if the number of voters increases indefinitely and the relative quota is pegged, then – under certain conditions – the ratio between the voting powers of any two voters converges to the ratio between their weights. Lindner and Machover [4] prove some special cases of Penrose’s Limit Theorem. They give a (...) simple counter-example showing that the theorem does not hold in general even under the conditions assumed by Penrose; but they conjecture, in effect, that under rather general conditions it holds ‘almost always’ – that is with probability 1 – for large classes of weighted voting games, for various values of the quota, and with respect to several measures of voting power. We use simulation to test this conjecture. It is corroborated with respect to the Penrose–Banzhaf index for a quota of 50% but not for other values; with respect to the Shapley–Shubik index the conjecture is corroborated for all values of the quota. (shrink)

BiDil, a heart failure drug for African Americans, emerged five years ago as the first FDA approved drug targeted at a specific racial group. While critical scholarship and the popular media have meticulously detailed the history of BiDil from its inauspicious beginnings as a generic combination drug for the general population to its dramatic resuscitation as a racial medicine, the enthusiastic support shown by some African American interest groups has been too little understood, as has their argument that BiDil was (...) an important response to race-based health disparities. In this essay, we show how the drugmaker, NitroMed, used the support it had solicited from black advocacy groups and community members to market BiDil as a unique “grassroots” pharmaceutical to the African American community. We go on to situate BiDil, which relied on a domestic, U.S.-centered conception of race, within the context of the global nature of both race and health disparities. Ironically, the grassroots angle of the BiDil case ultimately obscured the global crisis in health disparities. Furthermore, we argue that the grassroots model initiated by NitroMed should be taken note of, as it marks a potential avenue for the marketing of other drugs in the future. (shrink)

Since the first phase of the formal effort to sequence the human genome, geneticists, social scientists and other scholars of race and ethnicity have warned that new genetic technologies and knowledge could have negative social effects, from biologizing racial and ethnic categories to the emergence of dangerous forms of genetic discrimination. Early on in the Human Genome Project, population geneticists like Luigi Luca Cavalli-Sforza enthusiastically advocated for the collection of DNA samples from global indigenous populations in order to track the (...) history of human ancestry, migration, and languages, while social scientists like Troy Duster insisted that the new genetics was in danger of ushering in insidious practices of eugenics. The Human Genome Diversity Project's 1991 proposal to archive human genetic variation around the world quickly came under intense scrutiny by indigenous peoples and advocacy groups who worried that such measures could exploit indigenous groups as research populations and even resurrect racist taxonomies from the nineteenth century. (shrink)

Several bioethicists have recently discussed the complexity of defining human death, and considered in particular how our definition of death affects our understanding of the ethics of vital organ procurement. In this brief paper, we challenge the mainstream medical definition of human death—namely, that death is equivalent to total brain failure—and argue with Nair-Collins and Miller that integrated biological functions can continue even after total brain failure has occurred. We discuss the implications of Nair-Collins and Miller’s argument and suggest that (...) it may be necessary to look for alternative biological markers that reliably indicate the death of a human being. We reject the suggestion that we should abandon the dead-donor criteria for organ donation. Rather than weaken the ethical standards for vital organ procurement, it may be necessary to make them more demanding. The aim of this paper is not to justify the dead donor rule. Rather, we aim to explore the perspective of those who agree with critiques of the whole brain and cardiopulmonary definitions of death but yet disagree with the proposal that we should abandon the dead-donor rule. We will consider what those who want to retain the dead-donor rule must argue in light of Nair-Collins and Miller’s critique. (shrink)

Life history theory is a fruitful source of testable hypotheses about human individual differences. However, this field of study is beset by unresolved debates about basic concepts and methods. One of these controversies concerns the usefulness of instruments that purport to tap a unidimensional life history factor based on a set of self-reported personality, social, and attitudinal variables. Here, we take a novel approach to analyzing the psychometrics of two variants of the Arizona Life History Battery: the Mini-K and the (...) K-SF-42. Psychological network analysis generates models in which psychological variables comprise the nodes of a network, while partial correlation coefficients between these variables comprise the edges of the network. Centrality indices operationalize each node’s importance based on the pattern of the connections in which that node plays a role. Because childhood environments are hypothesized to influence adult LH, we tested the hypothesis that among the Mini-K items, and the K-SF-42 scales, those that tap relationships with parents are central to the networks constructed from these instruments. In an MTurk sample and an undergraduate sample that completed the Mini-K, and an MTurk sample that completed the K-SF-42, this hypothesis was falsified. Indeed, the “relationships with parents” items were among the most peripheral in all three networks. We propose that network analysis, as an alternative to latent variable modeling, offers considerable potential to test hypotheses about the input-output mappings of specific evolved psychological mechanisms. (shrink)

Good communication between healthcare providers and patients is vital to effective healthcare. In order to understand patients’ complaints, make accurate diagnoses, obtain informed consent and explain treatment regimens, clinicians must communicate well with their patients. This can be challenging when treating patients from unfamiliar cultural backgrounds, such as the Deaf. Not only are they a linguistic and cultural minority, they are also members of the world’s largest and oft-forgotten minority group: the disability community. Under Article 25 of the United Nations (...) Convention on the Rights of Persons with Disabilities, persons with disabilities have rights to the same range, quality and standard of free or affordable healthcare and programmes as provided to other people. Yet communication barriers and healthcare providers’ lack of familiarity with Deaf culture can impair the quality and accessibility of healthcare for the Deaf. This essay analyses the scope of this issue in Singapore: a state party to the CRPD which has a vibrant Deaf community, and yet no legislative or constitutional guarantees of the rights of persons with disabilities. In addition to exploring the communication barriers faced by Deaf patients in Singapore, this essay highlights ways in which healthcare providers and the state can support community-based initiatives to overcome these barriers. (shrink)

Abstractabstract:This article presents previous attempts to map Utopia, a fictional island in the book Utopia by Thomas More, and proposes another possibility, based on the assumption that Utopia is an enclosed garden on an artificial island that is not flat, but has piedmont slopes of 2.5:1. Our mapping experiment is founded on the Renaissance analogy between the domestication of wild nature, and the civilization of the human beings in More’s enclosed garden; and on the anecdotal similarities between the Inca Empire (...) and Utopia. This approach is not only consistent with the island’s dimensional specifications, which have hampered previous mapping attempts due to their mathematical incompatibility, but it also addresses the educative capacity of utopian life not considered by previous mapping efforts. Utopia, as a result, is to be understood as a series of performative spatial arrangements where the physical and geographical specifications would inform the vernacular life of its inhabitants in the direction of self-enhancement. (shrink)

The laws of classical logic are taken to be logical truths, which in turn are taken to hold objectively. However, we might question our faith in these truths: why are they true? One general approach, proposed by Putnam [8] and more recently Dickson [3] or Maddy [5], is to adopt empiricism about logic. On this view, logical truths are true because they are true of the world alone – this gives logical truths an air of objectivity. Putnam and Dickson both (...) take logical truths to be true in virtue of the world’s structure, given by our best empirical theory, quantum mechanics. This assumes a determinate logical structure of the world given by quantum mechanics. Here, I argue that this assumption is false, and that the world’s logical structure, and hence the related ‘true’ logic, is underdetermined. This leads to what I call empirical conventionalism. (shrink)

Name der Zeitschrift: Semiotica Jahrgang: 2016 Heft: 209 Seiten: 249-275.

Religious identity has, in recent times, become an important point of inquiry because of the growing awareness of religious diversity. On the one hand, this reality of diversity has served as an impetus to return to the roots of one’s religion. On the other hand, others have called for a more pluralist stance, out of the need to open up to other traditions. In light of this polarity, I argue that one can commit to one’s religion while opening up to (...) the religious other in a way that does not threaten one’s own tradition. This is done through a hermeneutic analysis of the religious identity, taking off from Paul Ricoeur’s phenomenological hermeneutics – how this identity is formed and informed by the different significations of meaning within the tradition, and how the believer interacts with this tradition to construct his or her own narrative identity, through his or her imagination, mapping out the constellations of possible human action that root themselves in the necessity in encountering and working with the religious other, for this necessity is constitutive of one’s commitment to the tradition, embodied in the biblical narratives that call for this encounter. In sum, it is possible to be committed to one’s faith conviction while being hospitable to the religious other because it is constitutive of religion itself to encounter its other, and it is in this encounter that faith is truly understood as conviction. (shrink)

[To be presented at PSA 2018] -/- The gauge/gravity duality and its relation to the possible emergence of gravity from quantum physics has been much discussed. Recently, however, Sebastian De Haro has argued that the very notion of a duality precludes emergence, given what he calls the internal view of dualities, on which the dual theories are physically equivalent. However, I argue that De Haro's argument for the internal view is not convincing, and we do not have good reasons to (...) adopt it. In turn, I propose we adopt the external view, on which dual theories are not physically equivalent, instead. (shrink)

I discuss Eckhart’s and Aquinas’ conception of human-divine union with reference to what I call the problem of intrinsic goods, a problem concerning how to reconcile the pursuit of actions which are prima facie sought for their own sake (e.g. pursuing justice for the marginalized, listening to a work of music) with the pursuit of God as the ultimate end of every action. I introduce the problem with the help of Germain Grisez’s critique of Aquinas’ account of union with God, (...) and I suggest that Eckhart’s alternative conception of union may be understood as an attempt to resolve (or dissolve) the problem. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical CommentaryChua Hong Choon, Adjunct Associate ProfessorThe case for commentary describes a difficult, and yet not uncommon, clinical situation faced by clinicians at the Institute of Mental Health (IMH) in the course of their work. Based on the information provided on the case, the patient is likely to be suffering from the paranoid subtype of schizophrenia, and his illness is characterised by hostile and aggressive behaviour during episodes of (...) relapse.Although aggressive behaviour is known to be associated with young, male patients with paranoid delusions, auditory hallucinations and lack of insight,1 it is still necessary to exclude other causes of aggressive behaviour in this young man. Two causes of aggressive behaviour that are sometimes misattributed to schizophrenia are antisocial personality disorder and substance abuse. However, Mr. T did not have a history of conduct or behavioural problems prior to the onset of his psychotic illness, and he was also not reported to be violent or disruptive during the periods when he was on regular medication. There was also no history of illicit drug use.The initial onset of Mr. T’s illness while he was serving his National Service is a fairly common presentation of the first episode of schizophrenia in Singaporean males. While traits apparent prior to National Service such as his academic difficulties and inability to make friends are associated with the development of schizophrenia,2 the stress of regimented life and military drills might be more closely associated with his initial full-blown psychotic episode with prominent paranoid (and persecutory) delusions.The systematised nature of Mr. T’s delusions and the prominent threatening auditory hallucinations significantly increase his risk of [End Page 217] dangerousness,3 and when his wife became “incorporated” into his delusional beliefs, he began to threaten her physically during episodes of relapse. Despite being only 28 years old, Mr. T has already been hospitalised numerous times for inpatient treatment, due to frequent relapses of his illness. While relapses in schizophrenia may be attributed to various factors, including lack of social support, substance abuse, poor (or partial) response to medication and psychosocial stressors, Mr. T’s multiple relapses were primarily due to the stopping of his medication and his refusal to continue with any form of psychiatric treatment.The key problem to be addressed in this case is therefore the patient’s severe lack of insight which leads to recurrent episodes of treatment non-adherence and subsequent relapses.Mr. T’s wife has come to the clinic to ask for medication to secretly put into his food. Although the patient is apparently in remission of his condition (having just been treated and discharged from hospital), he has again stopped his medication, and she is justifiably afraid that he will become unwell again. Recognising that the patient’s lack of insight is the main (and possibly only) reason for his refusal to take medication, it would be prudent to first consider if all possible actions had been taken to create an awareness and to help the patient gain insight into his illness and the need to take medication. This may yet be possible in the window of opportunity that exists when the patient is in remission of his illness (and is therefore not disturbed by the symptoms of his psychotic disorder).Recent studies have demonstrated that psycho-education is able to reduce self-stigmatisation in individuals with schizophrenia, and also significantly improve insight 4 (as measured by the Birchwood’s Psychosis Insight Scale). A 2011 Cochrane Review 5 also concluded psycho-education does seem to reduce relapse, readmission and encourage medication compliance, as well as reduce the length of hospital stays in patients with schizophrenia. In this case, psycho-education could be given to Mr. T even after he has been discharged from hospital; he might not want to continue with medication, but he might consider seeing a trained clinician (case manager, nurse or medical social worker) to make sense of his life experiences. Engaging Mr. T through psycho-education may result in sufficient insight for him to consider resuming medication voluntarily, at least in the short term.Although there is a paucity of studies examining specific psycho-therapies (including cognitive behavioural therapy... (shrink)

This paper defends a normative basis for entrepreneurial ventures, and draws the conclusion that any enterprise, insofar as it is reasonable, has in final analysis to be a (free) gift to promote good. Building on Herbert Simon's idea of "satisficing" and developing it in line with axiological insights of the new classical natural law theory, this paper makes the argument that a choice to proceed reasonably in any entrepreneurial venture will be guided by rationality that is bounded. Bounded rationality entails (...) that the various end-values or goals of the venture will be incommensurable, and this implies that (1) the enterprise need not be locked in on promoting merely one value, such as profits, and (2) a choice to aim at one or more goals will be a personal (free) gift, which is ethically valuable. This paper has appeared in Spanish translation as El don personal en las empresas sanas: racionalidad limitada, valores incommensurables y agencia economica in Revista Empresa y Humanismo, Vol. XI no. 1 (2008), pp. 67-88, published by the Institute for Business and Humanism, University of Navarra, Spain. Permission granted to reproduce/publish the original English version here and elsewhere. (shrink)

Visual feedback regulation during movement is not fully captured in Plamondon's kinematic theory. However, numerous studies indicate that visual response-produced feedback is a powerful determinant of performance and kinematic characteristics of target-directed movement.

Research suggests that the reaching hand automatically deviates toward a target that changes location during the reach. In the current study, we investigated whether movement intention can influence the target jump’s impact on the hand. We compared the degree of trajectory deviation to a jumped target under three instruction conditions: GO, in which participants were told to go to the target if it jumped, STOP, in which participants were told to immediately stop their movement if the target jumped, and IGNORE, (...) in which participants were told to ignore the target if it jumped and to continue to its initial location. We observed a reduced response to the jump in the IGNORE condition relative to the other conditions, suggesting that the response to the jump is contingent on the jump being a task-relevant event. (shrink)

As a subject for philosophizing about education, there are few topics as rich and significant as the role of public schools in fostering respect for sexual and religious diversity. The liberal state, it is said, has a clear mission to teach students to respect the rights of others to lead fundamentally different ways of life, and to provide students with the tools needed to make similarly fundamental choices about their own lives. The liberal state must do this, however, without undue (...) or excessive infringement on the rights of children and parents who believe that some common ways of life are, writ large, morally objectionable. This symposium paper features three arguments, each formulated by a different student in education or a related field. The first argues that LGBTQ role models must be provided in schools (through school resources or in person). The second argues that teachers are being placed in a very difficult position when such provision causes controversy with the surrounding community. The third argues that parents must not be given unchecked power over their children’s exposure to LGBTQ role modeling. (shrink)

BackgroundThe COVID-19 pandemic has changed the healthcare landscape drastically. Stricken by sharp surges in morbidity and mortality with resource and manpower shortages confounding their efforts, the medical community has witnessed high rates of burnout and post-traumatic stress amongst themselves. Whilst the prevailing literature has offered glimpses into their professional war, no review thus far has collated the deeply personal reflections of physicians and ascertained how their self-concept, self-esteem and perceived self-worth has altered during this crisis. Without adequate intervention, this may (...) have profound effects on their mental and physical health, personal relationships and professional efficacy.MethodsWith mentions of the coronavirus pervading social media by the millions, this paper set out to collate and thematically analyse social media posts containing first-person physician reflections on how COVID-19 affected their lives and their coping mechanisms. A consistent search strategy was employed and a PRISMA flowchart was used to map out the inclusion/exclusion criteria.ResultsA total of 590 social media posts were screened, 511 evaluated, and 108 included for analysis. Salient themes identified include Disruptions to Personal Psycho-Emotional State, Disruptions to Professional Care Delivery, Concern for Family, Response from Institution, Response from Society and Coping Mechanisms.ConclusionIt is evident that the distress experienced by physicians during this time has been manifold, multi-faceted and dominantly negative. Self-concepts were distorted with weakened self-esteem and perceived self-worth observed. The Ring Theory of Personhood (RToP) was adopted to explain COVID-19’s impact on physician personhood as it considers existential, individual, relational and social concepts of the self. These entwined self-concepts serve as ‘compensatory’ to one another, with coping mechanisms buffering and fortifying the physician’s overall personhood. With healthcare institutions playing a vital role in providing timely and targeted support, it was further proposed that a comprehensive assessment tool based on the RToP could be developed to detect at-risk physicians and evaluate the presence and effectiveness of established support structures. (shrink)

Sickle cell disease is a debilitating illness that affects quality of life and life expectancy for patients. In Cameroon, it is now possible to opt for termination of an affected pregnancy where the fetus is found to be affected by SCD. Our earlier studies found that, contrary to the views of Cameroonian physicians, a majority of parents with their children suffering from SCD would choose to abort if the fetuses were found to be affected. What have not yet been investigated (...) are the views of people suffering from/living with SCD. We used a quantitative sociological method, with administered structured questionnaires, to study the attitudes of adult patients suffering from SCD on prenatal genetic diagnosis and possible TAP. The majority of the 89 participants were urban dwellers , women , Christian and single , with a secondary/tertiary education . The majority would consider PND for SCD; almost half would reject TAP while 40.9% would consider it. Respondents who rejected TAP claimed mostly ethical reasons while those who found TAP acceptable cited fear of having an affected child and the poor quality of the affected child's health . Cameroonian patients with SCD are generally supportive of PND and a remarkably high number of patients living with SCD reported that they would consider terminating a pregnancy based on their assessment of the future well-being of the child. Research is required to investigate the burden of SCD on families and their quality of life. (shrink)

The coming of bioethics to Singapore / W. Calvin Ho and Sylvia S.N. Lim -- The impact of the bioethics advisory committee on the research community in Singapore / Charmaine K.M. Chan and Edison T. Liu -- Engaging the public : the role of the media / Chang Ai-Lien and Judith Tan -- Confucian trust and the biomedical regulatory framework in Singapore / Anh Tuan Nuyen -- The clinician-researcher : a servant of two masters? / Alastair V. Campbell, Jacqueline (...) Chin, and Teck Chuan Voo -- The US model for oversight of human stem cell research / Lindsay Parham and Bernard Lo -- Genetics and stem cell research : models of international policy-making / Bartha Maria Knoppers, Emily Kirby and Rosario Isasi -- Public engagement and bioethics commissions / Thomas H. Murray and Ross S. White -- Norm-making on human-animal chimeras and hybrids in Singapore, the United Kingdom and the international domain / W. Calvin Ho and Martin Bobrow -- How will future bioethical issues engage Singapore? / John Elliott. (shrink)

Engaging communities in community-based health research is increasingly being adopted in low- and middle-income countries. The use of community advisory boards is one method of practicing community involvement in health research. To date, few studies provide in-depth accounts of the strategies that CAB members use to practice community engagement. We assessed the perspectives, experiences and practices of the first local CAB in Eswatini, which was implemented as part of the MaxART Early Access to ART for All study. Trained Swazi research (...) assistants conducted two focus group discussions and 13 semi-structured interviews with CAB members who had been part of the MaxART study for at least 2.5 years. Interviews explored CAB composition and recruitment, the activities of CAB members, the mechanisms used to engage with communities and the challenges they faced in their role. The MaxART CAB played an active role in the implementation of the Early Access to Art for All study, and activities mainly focused on: promoting ethical conduct, in particular privacy, consent and confidentiality; communication and education, communicating about the study and educating the community on the benefits of HIV testing and early access to HIV treatment; and liaising between the community and the research team. Strategies for interacting with communities were varied and included attending general community meetings, visiting health facilities and visiting public places such as cattle dipping tanks, buses, bars and churches. Differences in the approach to community engagement between CAB members living in the study areas and those residing outside were identified. The experiences of the first CAB in Eswatini demonstrate that community engagement using CABs is a valuable mechanism for engaging communities in implementation studies. Considerations that could impact CAB functioning include clearly defining the scope of the CAB, addressing issues of CAB independence, the CAB budget, providing emotional support for CAB members, and providing continuous training and capacity building. These issues should be addressed during the early stages of CAB formation in order to optimize functioning. (shrink)

Engaging communities in community-based health research is increasingly being adopted in low- and middle-income countries. The use of community advisory boards is one method of practicing community involvement in health research. To date, few studies provide in-depth accounts of the strategies that CAB members use to practice community engagement. We assessed the perspectives, experiences and practices of the first local CAB in Eswatini, which was implemented as part of the MaxART Early Access to ART for All study. Trained Swazi research (...) assistants conducted two focus group discussions and 13 semi-structured interviews with CAB members who had been part of the MaxART study for at least 2.5 years. Interviews explored CAB composition and recruitment, the activities of CAB members, the mechanisms used to engage with communities and the challenges they faced in their role. The MaxART CAB played an active role in the implementation of the Early Access to Art for All study, and activities mainly focused on: promoting ethical conduct, in particular privacy, consent and confidentiality; communication and education, communicating about the study and educating the community on the benefits of HIV testing and early access to HIV treatment; and liaising between the community and the research team. Strategies for interacting with communities were varied and included attending general community meetings, visiting health facilities and visiting public places such as cattle dipping tanks, buses, bars and churches. Differences in the approach to community engagement between CAB members living in the study areas and those residing outside were identified. The experiences of the first CAB in Eswatini demonstrate that community engagement using CABs is a valuable mechanism for engaging communities in implementation studies. Considerations that could impact CAB functioning include clearly defining the scope of the CAB, addressing issues of CAB independence, the CAB budget, providing emotional support for CAB members, and providing continuous training and capacity building. These issues should be addressed during the early stages of CAB formation in order to optimize functioning. (shrink)

Background:Moral distress, moral sensitivity, and moral courage among healthcare professionals have been explored considerably in recent years. However, there is a paucity of studies exploring these topics among baccalaureate nursing students.Aim/objective:The purpose of this study was to explore the relationship between and among moral distress, moral sensitivity, and moral courage of undergraduate baccalaureate nursing students.Research design:The research employed a descriptive-correlational design to explore the relationships between and among moral distress, moral sensitivity, and moral courage of undergraduate nursing students.Participants and research (...) context:A total of 293 baccalaureate Filipino nursing students who have been exposed to various clinical areas participated in the study.Ethical considerations:Institutional review board approval was sought prior to the conduct of the study. Self-determination was assured and anonymity and confidentiality were guaranteed to all participants.Findings:Results indicate that a majority of the nursing students in the clinical areas encounter morally distressing situations that compromise quality patient care. However, despite the fact that they want to do what is in the best interest of their patients, their perception of being the inexperienced among the healthcare team drives the majority of them to ignore morally distressing situations to avoid conflict and confrontation. Another interesting finding is that 79.20% of the respondents hardly consider quitting the nursing profession even if they frequently encounter morally distressing situations. Analysis also shows associations between moral distress intensity and frequency ( r = 0.13, p < 0.05) and moral distress intensity and moral sensitivity ( r = 0.25, p < 0.05). The dimensions of moral courage are also related to both moral distress and moral sensitivity.Conclusion:Results of the study imply that moral distress is a reality among all healthcare professionals including nursing students and requires more consideration by nurse educators. (shrink)