In May 1973 a new collaboration between NASA, the Indian Health Service, and the Lockheed Missiles and Space Company promised to transform the way members of the Papago (now Tohono O’odham) Tribe of southern Arizona accessed modern medicine. Through a system of state-of-the-art microwave relays, slow-scan television links, and Mobile Health Units, the residents of the third-largest American Indian reservation began to access physicians remotely via telemedical encounters instead of traveling to distant hospitals. Examining the history of the STARPAHC (Space (...) Technology Applied to Rural Papago Advanced Health Care) project from the perspective of NASA and its contractors, from the perspective of the Indian Health Service, and from the perspective of O’odham engineers and health professionals offers a new focus, emphasizing the American Indian reservation as a site of medical research and technological development in the late twentieth century, with specific attention to the promise of information technology to address health disparities and the role of American Indians as actors in the late twentieth-century history of science, technology, and medicine. (shrink)

They use high-tech equipment, chemical analyses, sampling strategies, and other modern means to gain a better understanding of why and how cultures change. Using the study of the Maya as a test case, Jeremy Sabloff shows how the exciting transformation of archaeology is shedding new light on past civilizations.

This article examines the question of how can museum professionals and the interested public resolve the competing claims of traditional ownership and continuing scientific research in relation to museum collections.

A national survey on researchers’ experiences with their institutional review boards (IRBs) is presented, focused exclusively on social and behavioral researchers. A wide range of experiences is apparent in the data, especially in terms of turnaround time for submitted protocols, incidence of data collection without prior IRB approval, and stated reasons for "going solo." Sixty-two percent felt that the turnaround time they typically experience is "reasonable," and 44% said they had not experienced long delays in obtaining approval. However, 48% of (...) respondents reported either conducting a project without IRB approval or modifying an existing project without IRB approval, with anticipated time for approval being the dominant reason offered for doing so. This adds a new dimension to the widely discussed "national IRB crisis" (e.g., Illinois White Paper, 2005). The article concludes with 2 preliminary recommendations for IRB reform. (shrink)

In November of 1959, William Bean published in the Archives of Internal Medicine a scathing review of Félix Martí-Ibañez’s Centaur: Essays on the History of Medical Ideas. Martí-Ibañez and Bean were two of the leading exponents of the importance of medical humanism during a formative period from the 1950s through the 1970s. But the two physicians differed fundamentally in their views of the ideal relationships among the pharmaceutical industry, the medical profession, and the medical humanities. We situate Bean’s review within (...) its historical context, shedding light on the history and diverging uses of the medical humanities. (shrink)

There is evidence that problem-based learning (PBL) is an effective approach to teach team and problem-solving skills, but also to acquire content knowledge. However, there is hardly any literature about using PBL in philosophy classes. One problem is that PBL is resource intensive because a facilitator is needed for each group of students to support learning efforts and monitor group dynamics. In order to establish more PBL classes, the question is whether PBL can be provided without the need for facilitators. (...) We present a combination of five strategies—among them the collaborative argument visualization software AGORA-net—to replace facilitators. Additionally, we present evidence that these strategies are sufficient to provide a PBL experience that achieves intended learning goals in an ethics class and is satisfying for students without facilitators. (shrink)

Volume 19, Issue 7, July 2019, Page 51-53.

Early life stress precedes alterations to neuro-immune activation, which may mediate an increased risk for stress-related psychiatric disorders, potentially through alterations of central kynurenine pathway metabolites, the latter being relatively unexplored. We hypothesized that ELS in a non-human primate model would lead to a reduction of neuroprotective and increases of neurotoxic KP metabolites. Twelve adult female bonnet macaques reared under conditions of maternal variable foraging demand were compared to 27 age- and weight-matched non-VFD-exposed female controls. Baseline behavioral observations of social (...) affiliation were taken over a 12-week period followed by the first cerebrospinal fluid sample. Subjects were then either exposed to a 12-week repeated separation paradigm or assigned to a “no-RSP” condition followed by a second CSF. We used high-performance liquid chromatography for kynurenine, tryptophan, 5-hydroxyindoleacetic acid, kynurenic acid, and anthranilic acid as a proxy for quinolinic acid determination. At baseline, social affiliation scores were reduced in VFD-reared versus control subjects. CSF log KYNA and log KYNA/KYN ratio were lower in VFD-reared versus control subjects. CSF log KYNA/KYN was positively correlated with CSF log ANTH in VFD only. Controlling for log KYNA/KYN, log ANTH was elevated in VFD-reared subjects versus controls. CSF log KYNA/KYN obtained post-RSP was positively correlated with mean social affiliation scores during RSP, specifically in VFD. ELS is associated with a reduced neuroprotective and increased neurotoxic pathway products. That the two contrasting processes are paradoxically correlated following ELS suggests a cross-talk between two opposing KP enzymatic systems. (shrink)

The current two-sample investigation explores the role of enactment as a boundary condition in the relationship between experienced incivility and workplace outcomes. We integrate the tenets of the transactional model of stress and sensemaking theory to explain why enactment is a psychological sensemaking capability that can neutralize the adverse effects of experienced incivility on workplace outcomes. The results across two samples of data supported the study hypotheses by demonstrating that experienced incivility had stronger adverse effects on employees’ job satisfaction, OCBs, (...) and turnover intent for employees who reported lower levels of enactment than employees who reported higher levels of enactment. This study’s results make three important contributions to theory and research. First, we make an empirical contribution by examining enactment as a psychological sensemaking capability that can neutralize the adverse effects of experienced incivility on workplace outcomes. Second, we make a theoretical contribution by integrating the tenets of the transactional model of stress and sensemaking theory in a novel way that explains why enactment is a psychological sensemaking capability that can neutralize the adverse effects of stress on strain. Third, we demonstrate that enactment is the boundary condition that explains why incivility does not have universally adverse effects on employees’ outcomes. (shrink)

A challenge of performing research in the paediatric emergency and acute care setting is obtaining valid prospective informed consent from parents. The ethical issues are complex, and it is important to consider the perspective of participants, health care workers and researchers on research without prospective informed consent while planning this type of research. We performed a systematic review according to PRISMA guidelines, of empirical evidence relating to the process, experiences and acceptability of alternatives to prospective informed consent, in the paediatric (...) emergency or acute care setting. Major medical databases and grey sources were searched and results were screened and assessed against eligibility criteria by 2 authors, and full text articles of relevant studies obtained. Data were extracted onto data collection forms and imported into data management software for analysis. Thirteen studies were included in the review consisting of nine full text articles and four abstracts. Given the heterogeneity of the methods, results could not be quantitatively combined for meta-analysis, and qualitative results are presented in narrative form, according to themes identified from the data. Major themes include capacity of parents to provide informed consent, feasibility of informed consent, support for alternatives to informed consent, process issues, modified consent process, child death, and community consultation. Our review demonstrated that children, their families, and health care staff recognise the requirement for research without prior consent, and are generally supportive of enrolling children in such research with the provisions of limiting risk, and informing parents as soon as possible. Australian data and perspectives of children are lacking and represent important knowledge gaps. (shrink)

A Humean Critique of David Hume's Theory of Knowledge provides the first full-length Aristotilian-Thomistic critique of Hume's most mature and familiar work. While giving Hume proper respect and appreciation for his achievement, Jeremy White engages in a thoughtful critique through an approach based in Hume's own method.

As idealized descriptions of mathematical language, there is a sense in which formal systems specify too little, and there is a sense in which they specify too much. On the one hand, formal languages fail to account for a number of features of informal mathematical language that are essential to the communicative and inferential goals of the subject. On the other hand, many of these features are independent of the choice of a formal foundation, so grounding their analysis on a (...) particular choice of a formal system introduces unnecessary specificity. This chapter begins to map out the design features of mathematical language without descending to the level of formal implementation, drawing on examples from the mathematical literature and insights from the design of computational proof assistants and their libraries. (shrink)

The Patient Self-Determination Act (PSDA) requires hospitals to ask patients upon admission whether they have an advance directive. Although the PSDA has received extensive criticism, little attention has been paid to the cost of the law, either during its legislative course or following its implementation. Nonetheless, several tangible and intangible costs are associated with the PSDA. Such costs may be incurred by different parties. This paper examines the costs and benefits of the PSDA and illustrates the extent of some of (...) its tangible costs. The incremental start-up cost for one institution's response to the PSDA is estimated to be $49,304 ($1.31 per admission) and the total implementation cost of the program to be $114,528. In addition, the national incremental start-up cost for hospitals to implement the PSDA is estimated to be between $43,625,114 and $101,569,922. Finally, the potential implications of the PSDA for future governmental health care ethics regulation are discussed. (shrink)

Medical tourism is the practice of traveling across international borders with the intention of accessing medical care, paid for out-of-pocket. This practice has implications for preferential access to medical care for Canadians both through inbound and outbound medical tourism. In this paper, we identify four patterns of medical tourism with implications for preferential access to care by Canadians: Inbound medical tourism to Canada’s public hospitals; Inbound medical tourism to a First Nations reserve; Canadian patients opting to go abroad for medical (...) tourism; and Canadian patients traveling abroad with a Canadian surgeon. These patterns of medical tourism affect preferential access to health care by Canadians by circumventing domestic regulation of care, creating jurisdictional tensions over the provision of health care, and undermining solidarity with the Canadian health system. (shrink)

BackgroundCritical public health measures implemented to mitigate the spread of the novel coronavirus disease (COVID-19) pandemic have disrupted health research worldwide, including HIV prevention research. While general guidance has been issued for the responsible conduct of research in these challenging circumstances, the contours of the dueling COVID-19 and HIV/aids pandemics raise some critical ethical issues for HIV prevention research. In this paper, we use the recently updated HIV Prevention Trials Network (HPTN) Ethics Guidance Document (EGD) to situate and analyze key (...) ethical challenges related to the conduct of HIV prevention research during the COVID-19 pandemic as well as identify potential areas for refinement of the guidance document based on this unprecedented state of affairs.Main bodyNecessary actions taken for HIV prevention research studies due to the COVID-19 pandemic involve an array of ethical issues including those related to: (1) risk mitigation; (2) behavior change; (3) compounding vulnerability; (4) community engagement; (5) trial reopening; and 6) shifting research priorities.ConclusionsIn the context of the dueling HIV and COVID-19 global pandemics, research teams and sponsors must be nimble in responding to the rapidly changing environment by being sensitive to the associated ethical issues. The HTPN EGD provides a rich set of tools to help identify, analyze and address many of these issues. At the same time, future refinements of the HPTN EGD and other research ethics guidance could be strengthened by providing explicit advice regarding the ethical issues associated with disrupted research and the reopening of studies. In addition, additional consideration should be given to appropriately balancing domains of risk (e.g., physical versus social), addressing the vulnerability of research staff and community partners, and responding to un-anticipatable ancillary care needs of participants and communities. Appropriately addressing these issues will necessitate conceptual work, which would benefit from the careful documentation of the actual ethical issues encountered in research, the strategies implemented to overcome them, and their success in doing so. Throughout all of these efforts, it is critical to remember that the HIV pandemic not be forgotten in the rush to deal with the COVID-19 pandemic. (shrink)

Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will (...) be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)

Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will (...) be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)

This article builds on my previous article on Dirk H. Th. Vollenhoven (Ive 2015) and provides an overview of the development of the systematic philosophy of Herman Dooyeweerd. This article seeks to provide an overview of the key developments in the thinking of Dooyeweerd, both in the convergences arising from the conversation of the two brothers-in-law and long-term colleagues and in their divergences. Dooyeweerd and Vollenhoven worked within the tradition of Abraham Kuyper, the father of Reformational philosophy. The development of (...) their respective philosophical systematics has tended to be addressed separately. However, I argue that the close cooperation between the two philosophers was critical in the formulation of the philosophy of the cosmonomic Idea. The philosophical conversation between the two persisted, despite critical divergences, largely aired privately. Their respective insights remained a source of mutual stimulus and complementarity foundational for Reformational philosophy. (shrink)

This book studies the diverse societies, cities, nations, economies, and regions of the Americas as they emerged in the Western hemisphere in the nineteenth and twentieth centuries. Drawing on the paradigms of social imaginaries and civilizational analysis, it explores regions of Central America, the Caribbean, the United States, and Latin America.

The international migration of health workers, including long-term care workers for aging populations, contributes to a shortage of these workers in many parts of the world. In the Anglophone Caribbean, LCW shortages and the migration of nurses to take on LCW positions abroad threaten the health of local populations and widen global inequities in health. Many responses have been proposed to address the international migration of health workers generally, including making it more difficult for these workers to emigrate and increasing (...) and improving local employment opportunities. In this article, we suggest an additional means of ethically reducing health worker migration, targeting the Anglophone Caribbean specifically. Countries in this region can take advantage of their warmer climate and well-trained work force to encourage aging populations in the global north to emigrate temporarily or permanently through international retirement migration. As a result, countries in the Anglophone Caribbean can not only decrease the international migration of trained health workers through the provision of well-paying, local jobs, but potentially reverse this flow by drawing on the international diaspora of their workers. International retirement migration, if carefully managed, can reduce global inequities in health while treating both retirees and LCWs ethically. (shrink)

When people use online platforms to solicit funds from others for health-related needs, they are engaging in medical crowdfunding. This form of crowdfunding is growing in popularity, and its visibility is increasing as campaigns are commonly shared via social networking. A number of ethical issues have been raised about medical crowdfunding, one of which is that it introduces a number of privacy concerns. While campaigners are encouraged to share very personal details to encourage donations, the sharing of such details may (...) result in privacy losses for the beneficiary. Here, we explore the ways in which privacy can be threatened through the practice of medical crowdfunding by exploring campaigns for children with defined health needs scraped from the GoFundMe platform. We found specific privacy concerns related to the disclosure of private details about the beneficiary, the inclusion of images and the nature of the relationship between campaigner, funding recipient and beneficiary. For example, it was found that identifying personal and medical details about the beneficiary, including symptoms and treatment history, were often mentioned by campaigners. While the privacy concerns identified are problematic, they are also difficult to remedy given the strong financial incentive to crowdfund. However, crowdfunding platforms can enhance privacy protections by, for example, requiring those campaigning on behalf of child beneficiaries to ensure consent has been obtained from their guardians and providing additional guidelines for the inclusion of personal information in campaigns made on behalf of those not able to give their consent to the campaign. (shrink)

International travel for medical care, or medical tourism, creates ethical and safety concerns for patients. Guidelines could be developed and distributed to help address these concerns, but they may at the same time appear to endorse this practice.

Medical tourists, persons that travel across international borders with the intention to access non-emergency medical care, may not be adequately informed of safety and ethical concerns related to the practice of medical tourism. Researchers indicate that the sources of information frequently used by medical tourists during their decision-making process may be biased and/or lack comprehensive information regarding individual safety and treatment outcomes, as well as potential impacts of the medical tourism industry on third parties. This paper explores the feedback from (...) former Canadian medical tourists regarding the use of an information sheet to address this knowledge gap and raise awareness of the safety and ethical concerns related to medical tourism. (shrink)

ABSTRACT:This article reviews a conversation between business ethicists and feminist scholars begun in the early 1990s and traces the development of that conversation in relation to feminist theory. A bibliographic analysis of the business ethics and corporate social responsibility literatures over a twenty-five-year period elucidates the degree to which gender has been a salient concern, the methodologies adopted, and the ways in which gender has been analyzed. Identifying significant limitations to the incorporation of feminist theory in these literatures, we discuss (...) how feminist scholarship relating to behavior, organizations, and economics could be integrated. We suggest that a better integration of feminist theory would strengthen BE/CSR research, and point to new research directions and agendas arising from our approach. (shrink)