SignificanceElectrical burns can cause severe damage to the nervous system, resulting in autonomic dysfunction with reduced cerebral perfusion. However, few studies have investigated these consequences.AimTo elucidate changes in prefrontal cerebral hemodynamics using functional near-infrared spectroscopy (fNIRS) during the head-up tilt table test (HUT) for patients with electrical burns.ApproachWe recruited 17 patients with acute electrical burns within 1 week after their accidents and 10 healthy volunteers. The NIRS parameters acquired using an fNIRS device attached to the forehead were analyzed in five (...) distinct HUT phases.ResultsBased on their HUT response patterns, patients with electrical burns were classified into the group with abnormal HUT results (APG, n = 4) or normal HUT results (NPG, n = 13) and compared with the healthy control (HC, n = 10) participants. We found trends in hemodynamic changes during the HUT that distinguished HC, NPG, and APG. Reduced cerebral perfusion and decreased blood oxygenation during the HUT were found in both the NPG and APG groups. Patients with electrical burns had autonomic dysfunction compared to the HC participants.ConclusionsUsing fNIRS, we observed that acute-stage electrical burn injuries could affect cerebral perfusion. (shrink)

Direction of fit theories usually claim that beliefs are such that they “aim at truth” or “ought to fit” the world and desires are such that they “aim at realization” or the world “ought to fit” them. This essay argues that no theory of direction of fit is correct. The two directions of fit are supposed to be determinations of one and the same determinable two-place relation, differing only in the ordering of favored terms. But there is no such determinable (...) because of ineliminable asymmetries between the way that beliefs “aim at truth” and the way that desires “aim at realization.” This essay traces the ills of direction of fit theory to a misunderstanding of Anscombe and proposes a cure that distinguishes theoretical and practical thought by appeal to a distinction between thought in the form of a state and thought in the form of an event. (shrink)

Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

Some people of colour feel shame in response to racist incidents. This phenomenon seems puzzling since, plausibly, they have nothing to feel shame about. This puzzle arises because we assume that targets of racism feel shame about their race. However, I propose that when an individual is racialised as non-White in a racist incident, shame is sometimes prompted, not by a negative self-assessment of her race, but by her inability to choose when her stigmatised race is made salient. I argue (...) that this can make sense of some shame responses to racism. My account also helps to highlight some of the emotional and cognitive costs of racism that have their root in shame as well as a new form of hermeneutical injustice and distinctive communicative harms, contributing to a fuller picture of what is objectionable about racism. (shrink)

Is Anscombean practical knowledge independent of what the agent actually does on an occasion? Failure to understand Anscombe’s answer to this question is a major obstacle to appreciating the subtlety and plausibility of her view. I argue that Anscombe’s answer is negative, and turns on the nature of mistakes in performance, and reveals a distinctive implicit metaphysics of mind and knowledge, structured by related capacities and exercises of capacities. If my interpretation is correct, then practical knowledge shares features with knowledge-how (...) and knowledge-that, but deserves its own epistemic category. (shrink)

In men and women sexual arousal culminates in orgasm, with female orgasm solely from sexual intercourse often regarded as a unique feature of human sexuality. However, orgasm from sexual intercourse occurs more reliably in men than in women, likely reflecting the different types of physical stimulation men and women require for orgasm. In men, orgasms are under strong selective pressure as orgasms are coupled with ejaculation and thus contribute to male reproductive success. By contrast, women's orgasms in intercourse are highly (...) variable and are under little selective pressure as they are not a reproductive necessity. The proximal mechanisms producing variability in women's orgasms are little understood. In 1924 Marie Bonaparte proposed that a shorter distance between a woman's clitoris and her urethral meatus (CUMD) increased her likelihood of experiencing orgasm in intercourse. She based this on her published data that were never statistically analyzed. In 1940 Landis and colleagues published similar data suggesting the same relationship, but these data too were never fully analyzed. We analyzed raw data from these two studies and found that both demonstrate a strong inverse relationship between CUMD and orgasm during intercourse. Unresolved is whether this increased likelihood of orgasm with shorter CUMD reflects increased penile–clitoral contact during sexual intercourse or increased penile stimulation of internal aspects of the clitoris. CUMD likely reflects prenatal androgen exposure, with higher androgen levels producing larger distances. Thus these results suggest that women exposed to lower levels of prenatal androgens are more likely to experience orgasm during sexual intercourse. . (shrink)

The aim of the present study was to investigate the association between work-related moral stress, moral climate and moral sensitivity in mental health nursing. By means of the three scales Hospital Ethical Climate Survey, Moral Sensitivity Questionnaire and Work-Related Moral Stress, 49 participants’ experiences were assessed. The results of linear regression analysis indicated that moral stress was determined to a degree by the work place’s moral climate as well as by two aspects of the mental health staff’s moral sensitivity. The (...) nurses’ experience of ‘moral burden’ or ‘moral support’ increased or decreased their experience of moral stress. Their work-related moral stress was determined by the job-associated moral climate and two aspects of moral sensitivity. Our findings showed an association between three concepts: moral sensitivity, moral climate and moral stress. Despite being a small study, the findings seem relevant for future research leading to theory development and conceptual clarity. We suggest that more attention be given to methodological issues and developing designs that allow for comparative research in other disciplines, as well as in-depth knowledge of moral agency. Copyright © 2011 by SAGE Publications. (shrink)

Responsible leadership is rare. It is not that most leaders are irresponsible, but responsibility in leadership is frequently defined so that an important connotation of responsible leadership is ignored. This article equates responsible leadership with virtuousness. Using this connotation implies that responsible leadership is based on three assumptions—eudaemonism, inherent value, and amplification. Secondarily, this connotation produces two important outcomes—a fixed point for coping with change, and benefits for constituencies who may never be affected otherwise. The meaning and advantages of responsible (...) leadership as virtuous leadership are discussed. (shrink)

The aim of this Swedish study was to develop the concept of moral sensitivity in health care practice. This process began with an overview of relevant theories and perspectives on ethics with a focus on moral sensitivity and related concepts, in order to generate a theoretical framework. The second step was to construct a questionnaire based on this framework by generating a list of items from the theoretical framework. Nine items were finally selected as most appropriate and consistent with the (...) research team’s understanding of the concept of moral sensitivity. The items were worded as assumptions related to patient care. The questionnaire was distributed to two groups of health care personnel on two separate occasions and a total of 278 completed questionnaires were returned. A factor analysis identified three factors: sense of moral burden, moral strength and moral responsibility. These seem to be conceptually interrelated yet indicate that moral sensitivity may involve more dimensions than simply a cognitive capacity, particularly, feelings, sentiments, moral knowledge and skills. (shrink)

(From the Press's Website) -/- Winner of the 2004 Lakatos Prize, Thought in a Hostile World is an exploration of the evolution of cognition, especially human cognition, by one of today's foremost philosophers of biology and of mind. Features an exploration of the evolution of human cognition. Written by one of today’s foremost philosophers of mind and language. Presents a set of analytic tools for thinking about cognition and its evolution. Offers a critique of nativist, modular versions of evolutionary psychology, (...) rejecting the example of language as a model for thinking about human cognitive capacities. Applies to the areas of cognitive science, philosophy of mind, and evolutionary psychology. -/- . (shrink)

Depression experienced by older adults is proving an increasing global health burden, with rates generally 7% and as high as 27% in the USA. This is likely to significantly increase in coming years as the number and proportion of older adults in the population rises all around the world. Therefore, it is imperative that the effectiveness of approaches to the prevention and treatment of depression are understood. Creative arts interventions, including art, dance movement, drama and music modalities, are utilised internationally (...) to target depression and depressive symptoms in older adults. This includes interventions led by trained arts therapists as well as other health and arts professionals. However, to date there has not been a systematic review that reports effects and examines the processes (why) and mechanisms (how) of creative arts interventions are used to address depression in this older age group. This systematic review of studies on creative arts interventions for older adults experiencing depression examined: outcomes of four creative arts modalities (art, dance movement, drama, and music); with particular attention paid to processes documented as contributing to change in each modality; and mechanisms considered to result from these processes. Our analysis of 75 articles (17 art, 13 dance, 4 drama and 41 music) indicates mostly significant quantitative or positive qualitative findings, particularly for interventions led by creative arts therapists. Mechanisms of change gleaned from the studies that were common across modalities include physical (e.g. increased muscle strength; neurochemical effects, such as endorphin release), intra-personal (e.g. enhanced self-concept, strengthened agency and mastery; processing and communication of emotions), cultural (e.g. creative expression, aesthetic pleasure), cognitive (e.g. stimulation of memory) and social (e.g. increased social skills and connection), that were all considered to contribute to reduced depression and symptoms. Recommendations for future research include a stronger focus on testing of processes and mechanisms. (shrink)

Alvarez and Steward think the power of agency is a two-way power; Lowe thinks the will is. There is a problem for two-way powers. Either there is a unified description of the manifestation-type of the power, or not. If so, two-way powers are really one-way powers. If not, two-way powers are really combinations of one-way powers. Either way, two-way powers cannot help distinguish free agents from everything else. I argue the problem is best avoided by an Aristotelian view, which posits (...) a distinctive unity of explanation proper to two-way powers, grounded in a distinctive form of reasoning. (shrink)

The aim of this article is to describe the synthesis of the concept of moral stress and to attempt to identify its preconditions. Qualitative data from two independent studies on professional issues in nursing were analysed from a hypothetical-deductive approach. The findings indicate that moral stress is independent of context-given specific preconditions: (1) nurses are morally sensitive to the patient’s vulnerability; (2) nurses experience external factors preventing them from doing what is best for the patient; and (3) nurses feel that (...) they have no control over the specific situation. The findings from this analysis are supported by recent research on stress in the workplace but differ in that the imperatives directing work are moral in nature. Stress researchers have found that persons who experience that they have no control over their work situation and at the same time experience high demands may be prone to cardiovascular diseases. An important question raised by this study is whether moral stress should be recognized as a health risk in nursing. Further research is required in order to generate intervention models to prevent or deal with moral stress. (shrink)

We provide new findings that add to the growing body of empirical evidence that important epistemic intuitions converge across cultures. Specifically, we selected three recent studies conducted in the US that reported surprising effects of knowledge attribution among English speakers. We translated the vignettes used in those studies into Mandarin Chinese and Korean and then ran the studies with participants in Mainland China, Taiwan, and South Korea. We found that, strikingly, all three of the effects first obtained in the US (...) also emerged in the East Asian cultures we studied. Our findings not only cohere with but also provide—at least moderate—support for the existence of extensive convergences of important epistemic intuitions across cultures. (shrink)

Evidence‐based practice (EBP) first appeared on the healthcare horizon just over a decade ago. In 2003 its presence has intensified and extended beyond its initial relation to medicine embracing as it does now, nursing and the allied health disciplines. In this paper, I contend that its appearance and subsequent growth and development are the effects of potent ‘regimes of truth’, four of which bear the names: positivism, empiricism, pragmatism and economic rationalism. My aim is to show how EBP generates the (...) controversy it does because its nature and methods are inextricably interwoven with the way it has become politicised and professionalised. This exegesis is an attempt to outline how the combined effects of the four forms of rationality mentioned above allow for both the methods and objectives of EBP to be constructed as they are, while at the same moment producing the particular effects of knowledge and power in terms of who sells and who buys the idea of EBP in the culture of contemporary healthcare. (shrink)

We report the results of an investigation of nurses’ and physicians’ sensitivity to ethical dimensions of clinical practice. The sample consisted of 113 physicians working in general medical settings, 665 psychiatrists, 150 nurses working in general medical settings, and 145 nurses working in psychiatry. The instrument used was the Moral Sensitivity Questionnaire (MSQ), a self-reporting Likert-type questionnaire consisting of 30 assumptions related to moral sensitivity in health care practice. Each of these assumptions was categorized into a theoretical dimension of moral (...) sensitivity: relational orientation, structuring moral meaning, expressing benevolence, modifying autonomy, experiencing moral conflict, and following the rules. Significant differences in responses were found between health care professionals from general medical settings and those working in psychiatry. The former agreed to a greater extent with the assumptions in the categories ‘meaning’ and ‘autonomy’ and to a lesser degree with the categories ‘benevolence’ and ‘conflict’. Moreover, those from the psychiatric sector agreed to a greater extent to the use of coercion if necessary. Significant differences were also found for some of the MSQ categories, between physicians and nurses, and between males and females. (shrink)

Does the seller of a house have to tell the buyer that the water is turned off twelve hours a day? Does the buyer of a great quantity of tobacco have to inform the seller that the military blockade of the local port, which had depressed tobacco sales and lowered prices, is about to end? Courts say yes in the first case, no in the second. How can we understand the difference in judgments? And what does it say about whether (...) the psychiatrist should disclose to his patient's girlfriend that the patient wants to kill her? Kim Lane Scheppele answers the question, Which secrets are legal secrets and what makes them so? She challenges the economic theory of law, which argues that judges decide cases in ways that maximize efficiency, and she shows that judges use equality as an important principle in their decisions. In the course of thinking about secrets, Scheppele also explores broader questions about judicial reasoning--how judges find meaning in legal texts and how they infuse every fact summary with the values of their legal culture. Finally, the specific insights about secrecy are shown to be consistent with a general moral theory of law that indicates what the content of law should be if the law is to be legitimate, a theory that sees legal justification as the opportunity to attract consent. This is more than a book about secrets. It is also a book about the limits of an economic view of law. Ultimately, it is a work in constructive legal theory, one that draws on moral philosophy, sociology, economics, and political theory to develop a new view of legal interpretation and legal morality. (shrink)

"No human now gathers for himself or herself the essential resources for life: food, shelter, clothing, and the like. Humans are obligate co-operator, and this has been true for tens of thousands of years; probably much longer. In this regard, humans are very unusual. Cooperation outside the family is rare: though it can be very profitable, it is also very risky, as cooperation makes an agent vulnerable to incompetence and cheating. This book presents a new picture of the emergence of (...) cooperation in our lineage, developing through four fairly distinct phases from a baseline that was probably fairly similar to living great apes, who cooperate, but in fairly minimal ways. As adults, they rarely depend on others when the outcome really matters. This book suggests that cooperation began to be more important for humans through an initial phase of cooperative foraging generating immediate returns from collective action in small mobile bands. This established in our lineage about 1.8 million years ago, perhaps earlier. Over the rest of the Pleistocene, cooperation became more extended in its social scale, with forms of cooperation between bands gradually establishing, and in spatial and temporal scale too, with various forms of reciprocation becoming important. The final phase was the emergence of cooperation in large scale, hierarchical societies in the Holocene, beginning about 12,000 years ago. This picture is nested in a reading of the archaeological and ethnographic record, and twinned to an account of the gradual elaboration of cultural learning in our lineage, making cooperation both more profitable and more stable"--. (shrink)

This paper discusses two perspectives, each of which recognises the importance of environmental resources in enhancing and amplifying our cognitive capacity. One is the Clark–Chalmers model, extended further by Clark and others. The other derives from niche construction models of evolution, models which emphasise the role of active agency in enhancing the adaptive fit between agent and world. In the human case, much niche construction is epistemic: making cognitive tools and assembling other informational resources that support and scaffold intelligent action. (...) I shall argue that extended mind cases are limiting cases of environmental scaffolding, and while the extended mind picture is not false, the niche construction model is a more helpful framework for understanding human action. (shrink)

This study reports the results of a study of Swedish psychiatrists’ responses to moral statements related to decision making in the psychiatric context. Use was made of the Moral Sensitivity Questionnaire, a modified instrument previously constructed from a theory of moral sensitivity. This Likert-type scale contains 30 items constructed from the following categories: interpersonal orientation, structuring moral meaning, benevolence, modifying autonomy, experiencing moral conflict, and trust in medical knowledge and principles of care. The purpose was to identify possible differences in (...) responses rather than to evaluate right or wrong responses. The analysis is based on 754 completed questionnaires. The results of the study showed some significant differences in the item and category levels; for example, male psychiatrists experienced more conflicts than female psychiatrists and agreed to a greater extent that medical knowledge was most important in deciding what was best for the patient. The results also showed that more female than male psychiatrists thought that the relationship with the patient was most important in psychiatric practice. (shrink)

This book is not a conventional introduction to the philosophy of mind, nor is it a contribution to the physicalist/ dualist debate. Instead The Representational Theory of Mind demonstrates that we can construct physicalist theories of important aspects of our mental life. Its aim is to explain and defend a physicalist theory of intelligence in two parts: the first six chapters consist of an exposition, elaboration and defence of human sentience (the functionalist theory of mind), and the second part considers (...) rivals and objections to this theory. Kim Sterelny aims to introduce people to this area of philosophy by exemplifying it, to show that philosophical and empirical investigations can be synthesized to the benefit of both. --From publisher's description. (shrink)

Change is inevitable, and increasingly rapid and continuous in healthcare as organizations strive to adapt, improve and innovate. Organizational change challenges healthcare providers because it restructures how and when patient care delivery is provided, changing ways in which nurses must carry out their work. The aim of this doctoral study was to explore frontline nurses’ experiences of living with rapid and continuous organizational change. A critical hermeneutic approach was utilized. Participants described feeling voiceless, powerless and apolitical amidst rapid and continuous (...) organizational changes which fuelled apathy, cynicism and disengagement from the organization. However, critical analysis of the data showed that nurses actively engaged with power, voice and politics through resistant and transgressive behaviours in micro‐ethical moments of practice. There is a need to reconceptualize the concepts of voice, power and politics in nursing as there is dissonance between nurses’ beliefs about these concepts and what they are enacting in practice. Recognizing their enactment of power, voice and political agency at the micro‐level may empower nurses. Empowerment would mitigate the high levels of reports of powerlessness experienced in practice during organizational changes. (shrink)