Purpose: to characterize ethics course content, structure, resources, pedagogic methods, and opinions among academic administrators and course directors at U.S. medical schools. Method: An online questionnaire addressed to academic deans and ethics course directors identified by medical school websites was emailed to 157 Association of American Medical Colleges member medical schools in two successive waves in early 2022. Descriptive statistics were utilized to summarize responses. Results: Representatives from 61 (39%) schools responded. Thirty-two (52%) respondents were course directors; 26 (43%) were (...) deans of academic affairs, medical education, or curriculum; and 3 with other roles also completed the survey (5%). All 61 schools reported some form of formal ethics education during the first year of medical school, with most (n = 54, 89%) reporting a formal mandatory introductory course during preclinical education. Schools primarily utilized lecture and small-group teaching methods. Knowledge-based examinations, attendance, and participation were most commonly used for assessment. A large majority regarded ethics as equally or more important than other foundational courses, but fewer (n = 37, 60%) provided faculty training for teaching ethics. Conclusions: Despite a response rate of 39 percent, the authors conclude that medical schools include ethics in their curricula in small-group and lecture formats with heterogeneity regarding content taught. Preclinical curricular redesigns must innovate and implement best practices for ensuring sound delivery of ethics content in future curricula. Additional large-scale research is necessary to determine said best practices. (shrink)

Since the 1970s, historical sociology in the United States has been constituted by a configuration of substantive questions, a theoretical vocabulary anchored in concepts of economic interest and rationalization, and a methodological commitment to comparison. More recently, this configuration has been destabilized along each dimension: the increasing autonomy of comparative-historical methods from specific historical puzzles, the shift from the analysis of covariation to theories of historical process, and new substantive questions through which new kinds of arguments have been elaborated. Although (...) the dominant responses have centered on methodological elaboration and epistemological debate, greater attention to historical process also informs new strategies for defining cases and framing puzzles, thereby highlighting different categories of empirical questions: social caging, group formation, and multiple orders. The most striking shift is from the imagery of systems-and-crises, which highlighted revolution and state-building, to multidimensional understandings of emergence and destabilization. (shrink)

Organizational citizenship behaviors (OCBs) are essential for effective organizational functioning. Decisions by employees to engage in these important discretionary behaviors are based on how they make sense of the organizational context. Using fairness heuristic theory, we tested two important OCB predictors: manager trustworthiness and interactional justice. In the process, we control for the effects of dispositional factors (propensity to trust) and for system-based organizational fairness (procedural and distributive justice). Results, based on surveys collected from 120 employee–supervisor dyads, indicate that manager (...) trustworthiness explains variance in OCBs over and above the variance accounted for by interactional fairness. Implications for theory and practice are discussed. (shrink)

Although cities were given no role in the constitutional order of the United States, the new nation posed the same potential threats to the accumulation of capital and wealth as European monarchs posed to long-powerful urban centers. In mobilizing for self-protection and advancement, American business developed new practices and discourses of citizenship that sustained a central role for the community as the locus of social provision. The strategy combined opportunity-hoarding through restricted membership in civic groups and obligation-hoarding through the alignment (...) of diverse networks of voluntarism with this civic core. The linkage of business interests to this hybrid charitable-civic configuration constituted a source of resistance to nationalizing tendencies driven by demands for social protection. This alternative model of social provision and civic organization sustained a distinctive pattern of political membership and state development. By fiercely defending the capacity of privately governed civic networks to provide substantial social support, this history of business influence through community organizations lives on in the partial and fragmented character of the American welfare state. (shrink)

ABSTRACTEmotion differentiation, the ability to describe and label our own emotions in a differentiated and specific manner, has been repeatedly associated with well-being. However, it is unclear exactly what type of differentiation is most strongly related to well-being: the ability to make fine-grained distinctions between emotions that are relatively closely related, the ability to make larger distinctions between very distinct emotions, or the combination of both. To determine which type of differentiation is most predictive of well-being, we performed a comprehensive (...) meta-analysis across six datasets. We examined the correlations between these three types of differentiation and several indicators of well-being. Results showed that individuals differentiated most between very distinct emotions and least between more related emotions, and that an index computed across emotions from both the same and di... (shrink)

Limited Aggregation is the view that when there are competing moral claims that demand our attention, we should sometimes satisfy the largest aggregate of claims, depending on the strength of the claims in question. In recent years, philosophers such as Patrick Tomlin and Alastair Norcross have argued that Limited Aggregation violates a number of rational choice principles such as Transitivity, Separability, and Contraction Consistency. Current versions of Limited Aggregation are what may be called Comparative Approaches because they involve assessing the (...) relative strengths of various claims. In this paper, we offer a non-comparative version of Limited Aggregation, what we call the Threshold Approach. It states that there is a non-relative threshold that separates various claims. We demonstrate that the Threshold Approach does not violate rational choice principles such as Transitivity, Separability, and Contraction Consistency, and we show that potential concerns regarding such a view are surmountable. (shrink)

Transfers of critically ill neonates are frequent phenomena. Even though parents’ participation is regarded as crucial in neonatal care, a transfer often means that parents and neonates are separated. A systematic review of the parents’ experiences of neonatal transfer is lacking. This paper describes a meta‐study addressing qualitative research about parents’ experiences of neonatal transfer. Through deconstruction and reflections of theories, methods, and empirical data, the aim was to achieve a deeper understanding of theoretical, empirical, contextual, historical, and methodological issues (...) of qualitative studies concerning parents’ experiences of neonatal transfer over the course of this meta‐study (2000–2017). Meta‐theory and meta‐method analyses showed that caring, transition, and family‐centered care were main theoretical frames applied and that interviewing with a small number of participants was the preferred data collection method. The meta‐data‐analysis showed that transfer was a scary, unfamiliar, and threatening experience for the parents; they were losing familiar context, were separated from their neonate, and could feel their parenthood disrupted. We identified ‘wavering and wandering’ as a metaphoric representation of the parents’ experiences. The findings add knowledge about meta‐study as an approach for comprehensive qualitative research and point at the value of meta‐theory and meta‐method analyses. (shrink)

Ibn Wasil (d. 1298), perhaps better known today as a historian and an emissary to the court of King Manfred in southern Italy, was also an eminent logician. The present work is a critical edition of his main work in the field, a commentary on his teacher Khunaji's (d. 1248) handbook al-Jumal. The work helped consolidate the logic of the "later scholars" (such as Khunaji). It also shows that commentators did much more than merely explain the original work and instead (...) regularly discussed and assessed received views. Ibn Wasil's work was an influential contribution to a particularly dynamic chapter in the history of Arabic logic. (shrink)

Ibn Wasil (d. 1298), perhaps better known today as a historian and an emissary to the court of King Manfred in southern Italy, was also an eminent logician. The present work is a critical edition of his main work in the field, a commentary on his teacher Khunaji's (d. 1248) handbook al-Jumal. The work helped consolidate the logic of the "later scholars" (such as Khunaji). It also shows that commentators did much more than merely explain the original work and instead (...) regularly discussed and assessed received views. Ibn Wasil's work was an influential contribution to a particularly dynamic chapter in the history of Arabic logic. (shrink)

The aim of this report is to present an example of a multidisciplinary Indian-Swedish co-operation on ethics in health care. It is based on a conference held in Asia Plateau, Panchgani, Maharasthra, India in 1998. The emphasis is on ethical values that are important for consumers of health care and professionals, and also for different cultures in developed and developing countries. The importance of human dignity is stressed. Sixteen recommendations are given in an appendix.

In an oft-quoted paper entitled “To What Extent Was the Austrian School Marginalist?”, Streissler challenged earlier interpretations of Menger’s work that had accorded equal billing to Menger alongside Jevons and Walras as co-discoverer of the marginalist principle. In Streissler’s words, Menger was exceptionally great because he created marginalism at the same time that he surpassed it: the essence of Menger’s contribution to economic science was to be located in his subjectivist vision of the economy rather than in marginalism per se. (...) Streissler’s interpretation presaged Professor Kirzner’s subsequent rendering of Menger’s work, namely, that Menger’s subjectivist vision of the system as whole forms the very core of his contribution. This paper argues that, while these modern subjectivist reinterpretations are more faithful to Menger’s work than the earlier restrictive marginalist interpretations, they have nonetheless failed to identify Menger’s ‘vision.’ It is submitted here that this vision is to be located in Menger’s intention of constructing a theory of complex economic phenomena. Building upon Alfred Whitehead’s “process philosophy”, this paper provides a philosophically realist reconstruction of Menger’s theory of complex phenomena before investigating its pervasiveness and significance in the economic sphere.Dans un article célèbre intitulé “To What Extent Was the Austrian School Marginalist?”, Streissler remit en cause les interprétations antérieures de l’oeuvre de Menger qui faisaient de ce dernier un des co-inventeurs du principe marginaliste au même titre que Jevons et Walras. Pour Streissler, Menger était exceptionnellement grand parce qu’il créa le marginalisme en même temps qu’il le surpassa : l’essence de la contribution de Menger à la science économique se trouvait dans sa vision subjectiviste de l’économie plus que dans le marginalisme en soi. L’article de Streissler annonçait l’interprétation que devait donner le Professeur Kirzner de la contribution de Menger, à savoir que sa vision subjectiviste du système dans son ensemble constituait le coeur même de sa contribution. Ces réinterprétations subjectivistes modernes de l’oeuvre de Menger sont certes plus fidèles à celle-ci que les interprétations étroites antérieures données sous l’angle marginaliste. Ces réinterprétations modernes n’ont pas pour autant identifié la vision qu’avait Menger de la sphère économique. L’article suggère que cette vision se situe dans la théorie des phénomènes complexes de l’économie que Menger se propose d’élaborer. En se fondant sur “ la pensée du procès ” d’Alfred Whitehead, l’article propose une reconstruction philosophico-réaliste de la théorie des phénomènes complexes de Menger avant d’illustrer sa pertinence et son importance dans la sphère économique. (shrink)

I take up three puzzles about our emotional and evaluative responses to fiction. First, how can we even have emotional responses to characters and events that we know not to exist, if emotions are as intimately connected to belief and action as they seem to be? One solution to this puzzle claims that we merely imagine having such emotional responses. But this raises the puzzle of why we would ever refuse to follow an author’s instructions to imagine such responses, since (...) we happily imagine many other implausible things. A natural response to this second puzzle is that our responses to fiction are real, and so can’t just be conjured up in response to an author’s demands. However, this simple response is inadequate, because we often respond differently to people and events in fiction than we would if we encountered them in real life. Solving these three puzzles in a consistent way requires the notion of a “perspective” on a fictional world. I sketch an account of this intuitive but frustratingly amorphous notion: perspectives are tools for organizing our thinking, which can in turn alter our emotional and evaluative responses. Cultivating a perspective can be illuminating, entertaining, or corrupting — or all three at once. (shrink)

Traditional theories of sarcasm treat it as a case of a speaker's meaning the opposite of what she says. Recently, 'expressivists' have argued that sarcasm is not a type of speaker meaning at all, but merely the expression of a dissociative attitude toward an evoked thought or perspective. I argue that we should analyze sarcasm in terms of meaning inversion, as the traditional theory does; but that we need to construe 'meaning' more broadly, to include illocutionary force and evaluative attitudes (...) as well as propositional content. I distinguish four subclasses of sarcasm, individuated in terms of the target of inversion. Three of these classes raise serious challenges for a standard implicature analysis. (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)

While pharmaceutical industry involvement in producing, interpreting, and regulating medical knowledge and practice is widely accepted and believed to promote medical innovation, industry-favouring biases may result in prioritizing corporate profit above public health. Using diabetes as our example, we review successive changes over forty years in screening, diagnosis, and treatment guidelines for type 2 diabetes and prediabetes, which have dramatically expanded the population prescribed diabetes drugs, generating a billion-dollar market. We argue that these guideline recommendations have emerged under pervasive industry (...) influence and persisted, despite weak evidence for their health benefits and indications of serious adverse effects associated with many of the drugs they recommend. We consider pharmaceutical industry conflicts of interest in some of the research and publications supporting these revisions, and in related standard-setting committees and oversight panels. We raise concern over the long-term impact of these multifaceted involvements. Rather than accept industry conflicts of interest as normal, needing only to be monitored and managed, we suggest challenging that normalcy, and ask: what are the real costs of tolerating such industry participation? We urge the development of a broader focus to fully understand and curtail the systemic nature of industry’s influence over medical knowledge and practice. (shrink)

In recent months, pharmaceutical manufacturers have brought legal challenges to a provision of the 2022 Inflation Reduction Act (IRA) empowering the federal government to negotiate the prices Medicare pays for certain prescription medications. One key argument made in these filings is that price negotiation is a “taking” of property and violates the Takings Clause of the US Constitution. Through original case law and health policy analysis, we show that government price negotiation and even price regulation of goods and services, including (...) patented goods, are constitutional under the Takings Clause. Finding that the IRA violates the Takings Clause would radically upend settled constitutional law and jeopardize the US’s most important state and federal health care programs. (shrink)

Mental timing studies may be influenced by powerful cognitive illusions that can produce an asymmetry in their rate of progress relative to neuronal timing studies. Both types of timing research are also governed by a temporal asymmetry, expressed by the fact that the direction of causation must follow time's arrow. Here we refresh our earlier suggestion that the temporal asymmetry offers promise as a means of timing mental activities. We update our earlier analysis of Libet's data within this framework. Then (...) we consider the surprises which often occur on those rare occasions when neural timing experiments parallel mental timing work exactly. Together, these surprises and asymmetries prescribe a relentlessly meticulous and fully transparent exposition of timing methods, terms, and concepts which shuns plausible narratives, even when buttressed by rigorous formal models, unless guided by apposite empirical evidence. (shrink)

Stress in health care is affected by moral factors. When people are prevented from doing ‘good’ they may feel that they have not done what they ought to or that they have erred, thus giving rise to a troubled conscience. Empirical studies show that health care personnel sometimes refer to conscience when talking about being in ethically difficult everyday care situations. This study aimed to construct and validate the Stress of Conscience Questionnaire (SCQ), a nine-item instrument for assessing stressful situations (...) and the degree to which they trouble the conscience. The items were based on situations previously documented as causing negative stress for health care workers. Content and face validity were established by expert panels and pilot studies that selected relevant items and modified or excluded ambiguous ones. A convenience sample of 444 health care personnel indicated that the SCQ had acceptable validity and internal consistency (Cronbach’s alpha exceeded 0.83 for the overall scale). Explorative factor analysis identified and labelled two factors: ‘internal demands’ and ‘external demands and restrictions’. The findings suggest that the SCQ is a concise and practical instrument for use in various health care contexts. (shrink)

continent. 1.4 (2011): 310—311. Writing Death . Jeremy Fernando, foreword by Avital Ronell. Den Haag: Uitgeverij. 2011 ISBN: 978-90-817091-0-1 Rite and ceremony as well as legend bound the living and the dead in a common partnership. They were esthetic but they were more than esthetic. The rites of mourning expressed more than grief; the war and harvest dance were more than a gathering of energy for tasks to be performed; magic was more than a way of commanding forces of nature (...) to do the bidding of man; feasts were more than a satisfaction of hunger. Each of these communal modes of activity united the practical, the social, and the educative in an integrated whole having esthetic form.(1) Jeremy Fernando’s Writing Death is a sensitive attempt at exploring the depths and heights to which the processes of mourning can take us. Death, as an absence, renders all gestures (for what is mourning but a gesture with many faces) surrounding it at once as a possibility and an impossibility. Fernando poses questions that often elude the mourner and the mourned—the same, and different—by raising the specter of subject and object; by compelling the examination of what it actually means to mourn; and most crucially, by considering the very status of possibility itself that the act of mourning foregrounds. Mourning, he reminds us, is premised upon memory (remembrance, recollection), the shadow of forgetting upon which is perpetually cast—the inextricability between memory and forgetting haunts the living more than it does the dead. And if grief has anything to do with it, mourning can quite easily be mistaken for an attempt to remember in order to forget; an attempt, in other words, to deny death, deny the one thing that confirms mortality. As if living has anything to do with it. What, then, of writing death? It becomes an unceasing process of locating—and addressing—possibility itself: the passing as possibility; loss as possibility; impossibility as, and of, naming this possibility. In confronting the passing on, it is possible, nay inevitable, to move on, move away from the site of loss, of grief. All the while, we forget, Fernando reminds us, that mourning has little to do with the dead, and a whole lot to do with the living, the mourning self. Here, he echoes Dewey’s consolidation of rituals and ceremonies, of the dead and of the living, all as parts of a larger unity, of a social, public gesture meant to sate a private need: In trying to “get over it,” are we trying to get over ourselves? Or more than that: are we trying to get over the fact that we can never quite get over ourselves? (Fernando, 77) As if guilt has anything to do with it. And “it” continues to be the point that he is driving at, driving towards. “It” is the possibility and impossibility, death and life, memory and forgetting, lost and cherished. “It” is what eludes mourning, eludes attempts to overcome grief. Nonetheless, move on, he must. And Fernando does this in fewer moves than a 12-step program—hardly therapeutic, but intellectually satisfying. Writing Death attends to some of the pertinent aspects of the act of mourning—both as gesture and as meditation: eulogy, distress (call), tears, and the question of how (beyond ritual, beyond sentimentality) to mourn. And what’s love got to do with it? Everything and nothing. Mourning, after all, is an articulation of love, but it is also one that forces the mourner to be selective, as with myth-making, in the recollection: Remembering only ever occurs in exception to memory—quite possibly in betrayal of a memory. In this way, each remembrance is a naming of that memory, a naming of something as memory, bringing with it an act of violence. (40) Mourning is thus not only an act of fictionalizing, it is also an act of reading, to continually be compelled to respond to another, all the while keeping vigil against a reconceptualization of the dead, without, therefore, misreading the dead. This can only be done, Fernando argues, by all the while “maintaining the otherness of the other. After all, one must try not to forget that one cannot be too close—space is needed—to touch.” (82) There is also tacit acknowledgement that doing so foregrounds the fact that the selectivity of memory becomes exclusive, and concretizes into a singularity, thus negating the multi-dimensionality of a life lived – and thus killing the already dead. Writing Death is framed by two eulogies—or the approximations of eulogies; approximation because both foreground and call into question the eulogy as a genre. The first is Avital Ronell’s foreword to the book, remembering Philippe Lacoue-Labarthe; the second is Fernando’s own response to the passing of a mentor, Jean Baudrillard. Both are not merely attempts to philosophize their way out of the act of mourning. Both are in fact deeply moving pieces that remind us of the emotional possibilities that may reside within any intellectual undertaking, that the latter need not be cold and devoid of feelings. And whereas Writing Death does not attempt to make any philosophical claim for humanism, the underlying wistfulness of both pieces does suggest that there is a proper place for deep-seated human response to death. We can (and the book does) intellectualize and problematize the acts of mourning and grieving, but these do not diminish the fact that we mourn and grieve. And, framing Writing Death as the two eulogies do, Jeremy Fernando perhaps finally, and inadvertently, names “It”—it is, above everything else, Human. August, 2011 Singapore NOTES (1) Dewey, John. Art as Experience . New York: Perigee, 1934. (shrink)

Faith (Islam); liberty; religious aspects; Islam.

Metaphors are powerful communicative tools because they produce ”framing effects’. These effects are especially palpable when the metaphor is an insult that denigrates the hearer or someone he cares about. In such cases, just comprehending the metaphor produces a kind of ”complicity’ that cannot easily be undone by denying the speaker’s claim. Several theorists have taken this to show that metaphors are engaged in a different line of work from ordinary communication. Against this, I argue that metaphorical insults are rhetorically (...) powerful because they combine perspectives, presupposition, and pragmatics in the service of speech acts with assertoric force. (shrink)

Background The Liverpool Care Pathway is an interdisciplinary protocol, aiming to ensure that dying patients receive dignified and individualized treatment and care at the end-of-life. LCP was originally developed in 1997 in the United Kingdom from a model of cancer care successfully established in hospices. It has since been introduced in many countries, including Norway. The method was withdrawn in the UK in 2013. This review investigates whether LCP has been adapted and validated for use in nursing homes and for (...) dying people with dementia. Methods This systematic review is based on a systematic literature search of MEDLINE, CINAHL, EMBASE, and Web of Science. Results The search identified 12 studies, but none describing an evidence-based adaption of LCP to nursing home patients and people with dementia. No studies described the LCP implementation procedure, including strategies for discontinuation of medications, procedures for nutrition and hydration, or the testing of such procedures in nursing homes. No effect studies addressing the assessment and treatment of pain and symptoms that include dying nursing home patients and people with dementia are available. Conclusion LCP has not been adapted to nursing home patients and people with dementia. Current evidence, i.e. studies investigating the validity and reliability in clinically relevant settings, is too limited for the LCP procedure to be recommended for the population at hand. There is a need to develop good practice in palliative medicine, Advance Care Planning, and disease-specific recommendations for people with dementia. (shrink)

BackgroundThe Liverpool Care Pathway is an interdisciplinary protocol, aiming to ensure that dying patients receive dignified and individualized treatment and care at the end-of-life. LCP was originally developed in 1997 in the United Kingdom from a model of cancer care successfully established in hospices. It has since been introduced in many countries, including Norway. The method was withdrawn in the UK in 2013. This review investigates whether LCP has been adapted and validated for use in nursing homes and for dying (...) people with dementia.MethodsThis systematic review is based on a systematic literature search of MEDLINE, CINAHL, EMBASE, and Web of Science.ResultsThe search identified 12 studies, but none describing an evidence-based adaption of LCP to nursing home patients and people with dementia. No studies described the LCP implementation procedure, including strategies for discontinuation of medications, procedures for nutrition and hydration, or the testing of such procedures in nursing homes. No effect studies addressing the assessment and treatment of pain and symptoms that include dying nursing home patients and people with dementia are available.ConclusionLCP has not been adapted to nursing home patients and people with dementia. Current evidence, i.e. studies investigating the validity and reliability in clinically relevant settings, is too limited for the LCP procedure to be recommended for the population at hand. There is a need to develop good practice in palliative medicine, Advance Care Planning, and disease-specific recommendations for people with dementia. (shrink)