American Academy of Pediatrics (AAP) and American College of Medical Genetics (ACMG) recently provided two recommendations about predictive genetic testing of children. The Clinical Sequencing Exploratory Research Consortium's Pediatrics Working Group compared these recommendations, focusing on operational and ethical issues specific to decision making for children. Content analysis of the statements addresses two issues: (1) how these recommendations characterize and analyze locus of decision making, as well as the risks and benefits of testing, and (2) whether the guidelines conflict or (...) come to different but compatible conclusions because they consider different testing scenarios. These statements differ in ethically significant ways. AAP/ACMG analyzes risks and benefits using best interests of the child and recommends that, absent ameliorative interventions available during childhood, clinicians should generally decline to order testing. Parents authorize focused tests. ACMG analyzes risks and benefits using the interests of the child and other family members and recommends that sequencing results be examined for additional variants that can lead to ameliorative interventions, regardless of age, which laboratories should report to clinicians who should contextualize the results. Parents must accept additional analysis. The ethical arguments in these statements appear to be in tension with each other. (shrink)

In contemporary discussions of the university’s public role, intellectual complexity often takes center stage. This account, however, rests on a particular understanding of civic engagement, one that views such engagement primarily in terms of constitutional rights, democratic processes, and deliberative discourse. Other understandings of public life apply a different calculus. Drawing on both traditional and liberatory models of intellectual development, the chapter suggests that teaching for civic engagement requires reflection on at least four basic capacities: intellectual complexity; recognition of social (...) location and diverse frames of reference; empathetic accountability; and motivated action. These four guiding objectives represent cumulative, mutually reinforcing capacities. Though it may be unreasonable to expect that any individual assignment could aim for all of these objectives, instructors do well to reflect on them as different aspects of a single, integrated approach to student development, attentive to the multifaceted reality of civic participation itself. (shrink)

Wisdom is a multi-component trait that is important for mental health and well-being. In this study, we sought to understand gender differences in relative strengths in wisdom. A total of 659 individuals aged 27–103 years completed surveys including the 3-Dimensional Wisdom Scale and the San Diego Wisdom Scale. Analyses assessed gender differences in wisdom and gender’s moderating effect on the relationship between wisdom and associated constructs including depression, loneliness, well-being, optimism, and resilience. Women scored higher on average on the 3D-WS (...) but not on the SD-WISE. Women scored higher on compassion-related domains and on SD-WISE Self-Reflection. Men scored higher on cognitive-related domains and on SD-WISE Emotion Regulation. There was no impact of gender on the relationships between wisdom and associated constructs. Women and men have different relative strengths in wisdom, likely driven by sociocultural and biological factors. Tailoring wisdom interventions to individuals based on their profiles is an important next step. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethos in Steig’s and Sendak’s Picture Books: The Connected and the Lonely ChildEllen Handler SpitzThere was the child, listening to everything...—Yasunari Kawabata1IntroductionPicture-book characters spring to life in both verbal and visual registers. Moving about the page before our eyes as well as speaking and acting in their respective stories, they often make a long-lasting impact on children. Pictures and words, moreover, may overlap but are never commensurate; like the (...) words and notes of a song, they mean and evoke differently even while being experienced together. This brief essay considers a small selection of works by two distinguished twentieth-century American authors-artists: William Steig (1907–2003) and Maurice Sendak (b. 1928). It argues that, with their artful words and pictures, Steig and Sendak construct very different—even contrasting—visions of childhood. By “ethos” in this context I mean to suggest a vision of what a child is, a sense of what it means both to be a child and to address one. Such visions differ not only through the ages and from one culture and locale to another but also from one author-artist of the same period and locale to another. Invited to speak on Sendak’s and Steig’s respective works at meetings scheduled just a week apart in New York City during the winter of 2007, I found in these paired invitations a fortuitous opportunity to juxtapose several of their works and thereby discover some arresting contrasts and formulate the following readings.2First, a word on the topic of methodology. Nearly one hundred years have elapsed since Freud published his celebrated-cum-notorious foray into psychobiography with Leonardo da Vinci and a Memory of His Childhood,3 wherein shards of circumstantial biographical evidence were laid out in seductive mosaic patterns secured with a grout of ingenious speculation. Despite subsequent decades of critical reflection, Freud’s method soldiers on nonetheless as a modus operandi in the psychological interpretation of art and literature.4 By bracketing a small selection of Steig’s and Sendak’s works here and limiting myself to extracting a tentative underlying ethos from them, I am [End Page 64] taking the position that to write psychologically one need not mention or exploit a creator’s personal life. This essay points gently toward psychological approaches that ask what we can see when we look carefully at the pages of works. What can we find when we share children’s books with children? Why, for example, has Sendak’s Where the Wild Things Are sold over seventeen million copies (and its Amazon rank last time I checked was around 145, which means that only 144 other books in the United States were selling more copies at that particular moment), whereas his later work Outside Over There—a book that apparently figures prominently in his personal life—comes nowhere close?5 While market figures do not correlate flawlessly with children’s actual preferences (adults, not children, are the buyers), I would aver that, in this case, they do reflect the success and beloved status of Where the Wild Things Are, since the figures tally with additional facts: the book continues to appeal in its fifth decade post publication; it is known and has been translated worldwide, dramatized, and set to music6; and its characters have been fashioned into ubiquitous stuffed toys. On the other hand, in my (limited) experience, young children seem to find Outside Over There unsettling, unintelligible, even “creepy” and often have trouble sitting still through a full rendition. Some adults, on the other hand, praise that book as poetic and admire its more complex art. Such discrepancies in reception deserve our attention; they hint at fallow fertile fields lying over the rainbow, far beyond the much-plowed tracts of authorial psychobiography. This essay gestures casually toward those fields.The Connected Child“My dear Deborah,” said Doctor De Soto, “you must have been reading my mind.7Let’s begin with William Steig, who is best known for his New Yorker cartoons. His work for children extends back to 1968,8 however, when he was already a man in his sixties. Setting aside the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethos in Steig’s and Sendak’s Picture Books: The Connected and the Lonely ChildEllen Handler SpitzThere was the child, listening to everything...—Yasunari Kawabata1IntroductionPicture-book characters spring to life in both verbal and visual registers. Moving about the page before our eyes as well as speaking and acting in their respective stories, they often make a long-lasting impact on children. Pictures and words, moreover, may overlap but are never commensurate; like the (...) words and notes of a song, they mean and evoke differently even while being experienced together. This brief essay considers a small selection of works by two distinguished twentieth-century American authors-artists: William Steig (1907–2003) and Maurice Sendak (b. 1928). It argues that, with their artful words and pictures, Steig and Sendak construct very different—even contrasting—visions of childhood. By “ethos” in this context I mean to suggest a vision of what a child is, a sense of what it means both to be a child and to address one. Such visions differ not only through the ages and from one culture and locale to another but also from one author-artist of the same period and locale to another. Invited to speak on Sendak’s and Steig’s respective works at meetings scheduled just a week apart in New York City during the winter of 2007, I found in these paired invitations a fortuitous opportunity to juxtapose several of their works and thereby discover some arresting contrasts and formulate the following readings.2First, a word on the topic of methodology. Nearly one hundred years have elapsed since Freud published his celebrated-cum-notorious foray into psychobiography with Leonardo da Vinci and a Memory of His Childhood,3 wherein shards of circumstantial biographical evidence were laid out in seductive mosaic patterns secured with a grout of ingenious speculation. Despite subsequent decades of critical reflection, Freud’s method soldiers on nonetheless as a modus operandi in the psychological interpretation of art and literature.4 By bracketing a small selection of Steig’s and Sendak’s works here and limiting myself to extracting a tentative underlying ethos from them, I am [End Page 64] taking the position that to write psychologically one need not mention or exploit a creator’s personal life. This essay points gently toward psychological approaches that ask what we can see when we look carefully at the pages of works. What can we find when we share children’s books with children? Why, for example, has Sendak’s Where the Wild Things Are sold over seventeen million copies (and its Amazon rank last time I checked was around 145, which means that only 144 other books in the United States were selling more copies at that particular moment), whereas his later work Outside Over There—a book that apparently figures prominently in his personal life—comes nowhere close?5 While market figures do not correlate flawlessly with children’s actual preferences (adults, not children, are the buyers), I would aver that, in this case, they do reflect the success and beloved status of Where the Wild Things Are, since the figures tally with additional facts: the book continues to appeal in its fifth decade post publication; it is known and has been translated worldwide, dramatized, and set to music6; and its characters have been fashioned into ubiquitous stuffed toys. On the other hand, in my (limited) experience, young children seem to find Outside Over There unsettling, unintelligible, even “creepy” and often have trouble sitting still through a full rendition. Some adults, on the other hand, praise that book as poetic and admire its more complex art. Such discrepancies in reception deserve our attention; they hint at fallow fertile fields lying over the rainbow, far beyond the much-plowed tracts of authorial psychobiography. This essay gestures casually toward those fields.The Connected Child“My dear Deborah,” said Doctor De Soto, “you must have been reading my mind.7Let’s begin with William Steig, who is best known for his New Yorker cartoons. His work for children extends back to 1968,8 however, when he was already a man in his sixties. Setting aside the... (shrink)

Excerpt from The Fundamental Principle of Fichte's Philosophy The purpose of this monograph is to make a careful study of Fichte's conception of the ultimate principle. In his various writings the principle appears under many different names. 'The Ego, ' 'the Idea of the Ego, ' 'the moral world-order, ' 'God, ' 'the Absolute, ' 'Being, ' 'the Light, ' are some of the phrases by which it is most commonly designated. It is not the main purpose of this study (...) to examine tile much discussed question of the relation between the two periods of Fichte's philosophy. But the question is so intimately connected with the problem which I have undertaken that some discussion of it is inevitable. I have tried, however, to keep well within the limits of my theme, and instead of considering the relation between the two periods in all its aspects, have sought merely to determine how far the conception of the fundamental principle which we find in Fichte's later writings differs from that which appears in the earlier ones. The references to Fichte's writings are to the Sammtliche Werke (Berlin, 1845-1846, 8 vols.) and to the Nachgelassene Werke (Bonn, 1834-1835, 3 vols.). References to the Sammtliche Werke are indicated by the letters S. W.; to the Nachgelassene Werke, by the letters N. W. References to the Kritik der remen Vernunft arc indicated by the letters A (for the First Edition) and B (for the Second). All other references to Kant's writings are made to Hartenstein's second edition of the Sammtliche Werke (Leipzig, 1867-1868, 8 vols.) and are indicated by the letter H. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works.". (shrink)

Ethical dilemmas are often not discussed in the dissemination of educational research. While the ethical guidelines for research seem clear at first glance, a closer look at the intimate nature of qualitative research reveals that there are many ambiguities or ‘grey’ areas where researchers must rely on their personal value systems. This article discusses the challenges faced by an experienced educator, although novice researcher, in considering the ethical parameters of her own research with adolescents with hearing loss. In particular, the (...) grey ethical areas identified by the researcher include: (a) vulnerable population; (b) researcher role confusion; (c) consent; (d) privacy, confidentiality, and anonymity; as well as (e) the nature of risk. Based on the author’s own reflections on beginning the research process, the article presents possible pitfalls and ways of overcoming the possibility of becoming immobilized by the ethical enigmas of research. (shrink)

IntroductionYounger age at diagnosis is a risk factor for poor health-related quality of life in long-term breast cancer survivors. However, few studies have specifically addressed HRQOL in young adults with breast cancer, nor have early changes in HRQOL been fully characterized.MethodsEligible female patients with breast cancer were identified through our local cancer center. To establish HRQOL, patients completed the Functional Assessment of Cancer Therapy-Breast around diagnosis and 12 months later. Sociodemographic factors, genetic susceptibility to cancer, tumor- and treatment-related factors, and (...) comorbidities were abstracted from medical records and the local oncology registry. Mixed-effects models were used to identify changes in FACT-B scores during the first year of treatment and to determine whether any demographic/treatment-related factors modulated changes in scores.ResultsHealth-related quality of life in young patients with breast cancer was within normal limits at baseline, with a FACT-B overall well-being score of 108.5. Participants reported slight improvements over a 12-month period: FACT-B overall well-being scores increased 6.6 points, functional well-being improved 3.0 points, emotional well-being improved 1.9 points, and physical well-being improved 1.5 points, on average. Participants with anxiety/depression at baseline reported greater improvements in FACT-B overall well-being and functional well-being than participants who did not have anxiety/depression at baseline. Marital status, reconstructive surgery, and baseline clinical staging were also significantly associated with changes in aspects of HRQOL, although their impact on change was relatively minimal.ConclusionYoung women with breast cancer do not report HRQOL concerns during the first year of treatment. Improvements in HRQOL during the first year of treatment may be attributable to a sense of relief that the cancer is being treated, which, in the short run, may outweigh the negative late effects of treatment. (shrink)

Extensive research has documented the harmful effects associated with working for a narcissistic supervisor. However, little effort has been made to investigate ways for victims to alleviate the burdens associated with exposure to such aversive persons. Building on the tenets of conservation of resources theory and the documented efficacy of functional assets to combat job-related stress, we hypothesized that subordinates’ resource management ability would buffer the detrimental impact of narcissistic supervisors on affective, cognitive, and behavioral work outcomes for subordinates. We (...) found support for our hypotheses across three independent samples of US workers. Specifically, higher levels of subordinate resource management ability attenuated the harmful effects of supervisor narcissism on employee-reported emotional exhaustion, job tension, depressed mood, task performance, and citizenship behavior. Conversely, these relationships further deteriorated for subordinates with lower levels of resource management ability. Overall, our research contributes to the literature that, although extensively documenting the harmful ramifications of narcissism in organizations, has neglected to investigate potentially mitigating factors. (shrink)

Thirty-five current therapy clients, 47 former clients, and 42 college students with no therapy experience rated 27 items in terms of importance for inclusion in informed consent discussions. The current and former client samples rated information about inappropriate therapeutic techniques, confidentiality, and the risks of alternative treatments as most important, and information about the personal characteristics of the therapist and the therapist's degree as least important. The results of this study provide evidence for differential informed consent disclosure practices.

Extensive research has documented the harmful effects associated with working for a narcissistic supervisor. However, little effort has been made to investigate ways for victims to alleviate the burdens associated with exposure to such aversive persons. Building on the tenets of conservation of resources theory and the documented efficacy of functional assets to combat job-related stress, we hypothesized that subordinates’ resource management ability would buffer the detrimental impact of narcissistic supervisors on affective, cognitive, and behavioral work outcomes for subordinates. We (...) found support for our hypotheses across three independent samples of US workers (N = 187; 199; 136). Specifically, higher levels of subordinate resource management ability attenuated the harmful effects of supervisor narcissism on employee-reported emotional exhaustion, job tension, depressed mood, task performance, and citizenship behavior. Conversely, these relationships further deteriorated for subordinates with lower levels of resource management ability. Overall, our research contributes to the literature that, although extensively documenting the harmful ramifications of narcissism in organizations, has neglected to investigate potentially mitigating factors. (shrink)

(2008). A Review of: “Schools or Markets? Commercialism, Privatization, and School-Business Partnerships”. Educational Studies: Vol. 43, No. 2, pp. 158-162.

Historically, patients have deferred to physicians′ judgments about appropriate medical care, thereby limiting patient participation in treatment decisions. In this model of medical decision making, physicians typically decided upon the treatment plan. Communication with patients focused on securing their cooperation in accepting a treatment decision that essentially had already been made.

Arguably, there is no better place to acquire the civic capacities described in the previous chapter than in the theology or religious studies classroom. As individual religion courses emphasize different aspects of civic engagement, they serve a liberal arts education historically committed to producing good citizens; as these different approaches are themselves brought into shared conversation, religion provides a distinctive site for cultivating capacities of intellectual complexity, social framing, empathetic accountability, and motivated action, and thus for the broader civic project. (...) This chapter illustrates how some of the aspects of teaching and learning in religion can advance the objectives described in chapter 1, attentive both to the function of these pedagogical methods to the study of religion and their potential to enhance education for civic engagement across the curriculum. The final section addresses the difficult question of assessment. (shrink)

O presente artigo objetiva apresentar uma compreensão crítica do tempo presente, que se pode chamar de contemporaneidade. Nessa direção, as reflexões sobre esse momento histórico priorizaram os questionamentos filosóficos de Heidegger. Para interpretação mais ampla do pensamento heideggeriano, foi abordada, rapidamente, as concepções existenciais de homem e de mundo trazidas em sua obra “Ser e tempo”. Após essas considerações, a “Era da Técnica”, marcada pelo esquecimento do ser, foi tomada enquanto foco de discussão. Por fim, ressalta-se a inquietação não com (...) relação ao crescimento da técnica planetária, mas sim acerca do fato de o homem não compreender a dimensão e o sentido das transformações empreendidas por esta destinação; rejeitando, com isso, aquilo que tem de mais próprio, a condição de ser o único ser que reflete. (shrink)

The idea that gauge theory has `surplus' structure poses a puzzle: in one much discussed sense, this structure is redundant; but on the other hand, it is also widely held to play an essential role in the theory. In this paper, we employ category-theoretic tools to illuminate an aspect of this puzzle. We precisify what is meant by `surplus' structure by means of functorial comparisons with equivalence classes of gauge fields, and then show that such structure is essential for any (...) theory that represents a rich collection of physically relevant fields which are `local' in nature. (shrink)

In this interview, professor Davis discusses the evolution of his career and research interests as a philosopher-economist and gives his perspective on a number of important issues in the field. He argues that historians and methodologists of economics should be engaged in the practice of economics, and that historians should be more open to philosophical analysis of the content of economic ideas. He suggests that the history of recent economics is a particularly fruitful and important area for research exactly because (...) it is an open-ended story that is very relevant to understanding the underlying concerns and concepts of contemporary economics. He discusses his engagement with heterodox economics schools, and their engagement with a rapidly changing mainstream economics. He argues that the theory of the individual is “the central philosophical issue in economics” and discusses his extensive contributions to the issue. (shrink)

This article provides practical guidance for researchers who wish to enroll and collect data from pediatric research participants through online and mobile platforms, with a focus on the involvement of both children and their parents in the decision to participate.

The promises of precision medicine are often heralded in the medical and lay literature, but routine integration of genomics in clinical practice is still limited. While the “last mile” infrastructure to bring genomics to the bedside has been demonstrated in some healthcare settings, a number of challenges remain — both in the receptivity of today's health system and in its technical and educational readiness to respond to this evolution in care. To improve the impact of genomics on health and disease (...) management, we will need to integrate both new knowledge and new care processes into existing workflows. This change will be onerous and time-consuming, but hopefully valuable to the provision of high quality, economically feasible care worldwide. (shrink)

The authors surveyed hospitals across the country on their policies regarding overlapping surgery, and found large variation between hospitals in how this practice is regulated. Specifically, institutions chose to define “critical portions” in a variety of ways, ultimately affecting not only surgical efficiency but also the autonomy of surgical trainees and patient experiences at these different hospitals.

In 2015, the major critical care societies issued guidelines outlining a procedural approach to resolving intractable conflict between healthcare professionals and surrogates over life-sustaining treatments (LST). We report our experience with a resolving conflict procedure. This was a retrospective, single-centre cohort study of ethics consultations involving intractable conflict over LST. The resolving conflict process was initiated eleven times for ten patients over 2,015 ethics consultations from 2000 to 2020. In all cases, the ethics committee recommended withdrawal of the contested LST. (...) In seven cases, the patient died or was transferred or a legal injunction was obtained before completion of the process. In the four cases in which LST was withdrawn, the time from ethics consultation to withdrawal of LST was 24.8 ± 12.2 days. Healthcare provider and surrogate were often distressed during the process, sometimes resulting in escalation of conflict and legal action. In some cases, however, surrogates appeared relieved that they did not have to make the final decision regarding LST. Challenges regarding implementation included the time needed for process completion and limited usefulness in emergent situations. Although it is feasible to implement a due process approach to conflict over LST, there are factors that limit the procedure’s usefulness. (shrink)

One of the hallmarks of virtue is reliably acting well. Such reliable success presupposes that an agent is able to recognize the morally salient features of a situation, and the appropriate response to those features and is motivated to act on this knowledge without internal conflict. Furthermore, it is often claimed that the virtuous person can do this in a spontaneous or intuitive manner. While these claims represent an ideal of what it is to have a virtue, it is less (...) clear how to make good on them. That is, how is it actually possible to spontaneously and reliably act well? In this paper, we will lay out a framework for understanding how it is that one could reliably act well in an intuitive manner. We will do this by developing the concept of an action schema, which draws on the philosophical and psychological literature on skill acquisition and self-regulation. In short, we will give an account of how self-regulation, grounded in skillful structures, can allow for the accurate intuitions and flexible expertise required for virtue. While our primary goal in this paper is to provide a positive theory of how virtuous intuitions might be accounted for, we also take ourselves to be raising the bar for what counts as an explanation of reliable and intuitive action in general. (shrink)

Girard and Reynolds independently invented System F to handle problems in logic and computer programming language design, respectively. Viewing F in the Curry style, which associates types with untyped lambda terms, raises the questions of typability and type checking. Typability asks for a term whether there exists some type it can be given. Type checking asks, for a particular term and type, whether the term can be given that type. The decidability of these problems has been settled for restrictions and (...) extensions of F and related systems and complexity lower-bounds have been determined for typability in F, but this report is the first to resolve whether these problems are decidable for System F. This report proves that type checking in F is undecidable, by a reduction from semi-unification, and that typability in F is undecidable, by a reduction from type checking. Because there is an easy reduction from typability to type checking, the two problems are equivalent. The reduction from type checking to typability uses a novel method of constructing lambda terms that simulate arbitrarily chosen type environments. All of the results also hold for the λI-calculus. (shrink)

In this issue of American Journal of Bioethics, Childress et al. address one of the most challenging modern clinical ethical dilemmas: the awake, competent patient dependent on extracorporeal membr...

Reflects the many facets of Jean Piaget's work.

The Patient Self Determination Act of 1991 brought much needed attention to the importance of advance care planning and surrogate decision-making. The purpose of this law is to ensure that a patient’s preferences for medical care are recognized and promoted, even if the patient loses decision-making capacity. In general, patients are presumed to have DMC. A patient’s DMC may come under question when distortions in thinking and understanding due to illness, delirium, depression or other psychiatric symptoms are identified or suspected. (...) Physicians and other healthcare professionals working in hospital settings where medical illness is frequently comorbid with depression, adjustment disorders, demoralization and suicidal ideation, can expect to encounter ethical tension when medically sick patients who are also depressed or suicidal request do not resuscitate orders. (shrink)

Human development is meant to be transformational in that it aims to improve people's lives by enhancing their capabilities. But who does it target: people as they are or the people they will become? This paper argues that the human development approach relies on an understanding of personal identity as dynamic rather than as static collections of preferences, and that this distinguishes human development from conventional approaches to development. Nevertheless, this dynamic understanding of personal identity is presently poorly conceptualized and (...) this has implications for development practice. We identify a danger of paternalism and propose institutionalizing two procedural principles as side constraints on development policies and projects: the principle of free prior informed consent and the principle of democratic development. -/- . (shrink)

Journal Name: Semiotica Issue: Ahead of print.