Recent research in moral psychology highlights the role of emotion and intuition in moral judgment. In the wake of these findings, the role and significance of moral reasoning remain uncertain. In this article, we distinguish among different kinds of moral reasoning and review evidence suggesting that at least some kinds of moral reasoning play significant roles in moral judgment, including roles in abandoning moral intuitions in the absence of justifying reasons, applying both deontological and utilitarian moral principles, and counteracting automatic (...) tendencies toward bias that would otherwise dominate behavior. We argue that little is known about the psychology of moral reasoning and that it may yet prove to be a potent social force. (shrink)

BackgroundThe U.S. Food and Drug Administration traditionally has kept confidential significant amounts of information relevant to the approval or non-approval of specific drugs, devices, and biologics and about the regulatory status of such medical products in FDA’s pipeline.ObjectiveTo develop practical recommendations for FDA to improve its transparency to the public that FDA could implement by rulemaking or other regulatory processes without further congressional authorization. These recommendations would build on the work of FDA’s Transparency Task Force in 2010.MethodsIn 2016-2017, we convened (...) a team of academic faculty from Harvard Medical School, Brigham and Women’s Hospital, Yale Medical School, Yale Law School, and Johns Hopkins Bloomberg School of Public Health to develop recommendations through an iterative process of reviewing FDA’s practices, considering the legal and policy constraints on FDA in expanding transparency, and obtaining insights from independent observers of FDA.ResultsThe team developed 18 specific recommendations for improving FDA’s transparency to the public. FDA could adopt all these recommendations without further congressional action.FundingThe development of the Blueprint for Transparency at the U.S. Food and Drug Administration was funded by the Laura and John Arnold Foundation. (shrink)

BackgroundAlthough the peer review process is believed to ensure scientific rigor, enhance research quality, and improve manuscript clarity, many investigators are concerned that the process is too slow, too expensive, too unreliable, and too static. In this feasibility study, we sought to survey corresponding authors of recently published clinical research studies on the speed and efficiency of the publication process.MethodsWeb-based survey of corresponding authors of a 20% random sample of clinical research studies in MEDLINE-indexed journals with Ovid MEDLINE entry dates (...) between December 1 and 15, 2016. Survey addressed perceived manuscript importance before first submission, approximate first submission and final acceptance dates, and total number of journal submissions, external peer reviews, external peer reviewers, and revisions requested, as well as whether authors would have considered publicly sharing their manuscript on an online platform instead of submitting to a peer-reviewed journal.ResultsOf 1780 surveys distributed, 27 corresponding authors opted out or requested that we stop emailing them and 149 emails failed (e.g., emails that bounced n = 64, returned with an away from office message n = 70, or were changed/incorrect n = 15), leaving 1604 respondents, of which 337 completed the survey (21.0%). Respondents and non-respondents were similar with respect to study type and publication journals’ impact factor, although non-respondent authors had more publications (p = 0.03). Among respondents, the median impact factor of the publications’ journal was 2.7 (interquartile range (IQR), 2.0–3.6) and corresponding authors’ median h-index and number of publications was 9 (IQR, 3–20) and 27 (IQR, 10–77), respectively. The median time from first submission to journal acceptance and publication was 5 months (IQR, 3–8) and 7 months (IQR, 5–12), respectively. Most respondents (62.0%, n = 209) rated the importance of their research as a 4 or 5 (5-point scale) prior to submission. Median number of journal submissions was 1 (IQR, 1–2), external peer reviews was 1 (IQR, 1–2), external peer reviewers was 3 (IQR, 2–4), and revisions requested was 1 (IQR, 1–1). Sharing manuscripts to a public online platform, instead of submitting to a peer-reviewed journal, would have been considered by 55.2% (n = 186) of respondents.ConclusionCorresponding authors have high perceptions of their research and reported requiring few manuscript submissions prior to journal acceptance, most commonly by lower impact factor journals. (shrink)

BackgroundThe Freedom of Information Act (FOIA) provides access to unreleased government records that can be used to enhance the transparency and integrity of biomedical research. We characterized FOIA requests to Department of Health and Human Services (HHS) agencies, including request outcomes, processing times, backlogs, and costs.MethodsUsing HHS FOIA annual reports, we extracted data on the number of FOIA requests received and processed by HHS agencies between 2008 and 2017, as well as request outcomes. Processing times were reported in three time (...) increments, < 1–20, 21–60, or 61+ days, and trends in backlog status were also described. Information about costs and fees collected were aggregated.ResultsBetween 2008 and 2017, 69.6% of 530,094 HHS FOIA requests were received by the Centers for Medicare and Medicaid Services (CMS), 18.9% by the Food and Drug Administration (FDA), and 11.6% by all other HHS agencies. During this period, CMS processed 374,728 requests, FDA 114,938, and other HHS agencies 61,890. CMS and FDA reduced backlogged requests by 9396 (89.7%) and 4289 (65.3%), respectively, leaving backlogs of 1081 and 2279 requests at the end of 2017. CMS fully or partially granted 60.3% of requests whereas FDA fully or partially granted 72.4%. Of all requests to CMS, 82.0% were considered simple and 18.0% complex; 82.2% of simple requests and 54.9% of complex requests were processed in 20 days, and 5.6% and 29.9% were processed in 61+ days. In contrast, 60.2% of requests to FDA were considered simple and 39.8% complex; 28.8% of simple requests and 9.0% of complex requests were processed in 20 days, and 58.3% and 81.5% were processed in 61+ days. The costs to HHS associated with FOIA requests totaled $446.4 million ($809 per processed request), increasing from $28.1 million ($423 per request) in 2008 to $53.3 million ($1544 per request) in 2017. In total, HHS collected $8.5 million in fees (1.9% of total costs).ConclusionsFOIA is frequently used to obtain information about HHS and its agencies. With growing costs, minimal fees collected, and lengthy processing times, HHS agencies’ FOIA programs might be made more efficient through greater proactive record disclosure. (shrink)

The present study investigates the importance of emotional disclosure and vulnerability in the production of hegemonic masculinities. Of particular interest is the role that silence and invisibility play in how men talk about recent stressful life events. One-on-one interviews with men who experienced a stressful life event in the past year illustrate how men often talk about these events in simultaneously visible and invisible ways. We use the term “cloudy visibility” to describe this engagement, identified both in terms of what (...) men articulate in relation to their past stressful experiences and how they articulate these experiences within the present moment of the interview. The conversational consequences of these linguistic devices are analyzed to illustrate how men obscure their inner emotional lives, thus reproducing hegemonic masculine ideals of staying strong and stoic in the face of adversity, while they also seek to make aspects of their inner lives seen and heard to an interviewer. (shrink)

Background: Freezing of gait is a common symptom in Parkinson’s disease and can be difficult to treat with dopaminergic medications or with deep brain stimulation. Novel stimulation paradigms have been proposed to address suboptimal responses to conventional DBS programming methods. Burst-cycling deep brain stimulation delivers current in various frequencies of bursts, while maintaining an intra-burst frequency identical to conventional DBS.Objective: To evaluate the safety and tolerability of BCDBS in PD patients with FOG.Methods: Ten PD subjects with STN or GPi DBS (...) and complaints of FOG were recruited for this single center, single blinded within-subject crossover study. For each subject, we compared 4, 10, and 15 Hz BCDBS to conventional DBS during the PD medication-OFF state.Results: There were no serious adverse events with BCDBS. It was feasible and straightforward to program BCDBS in the clinic setting. The benefit was comparable to conventional DBS in measures of FOG, functional mobility and in PD motor symptoms. BCDBS had lower battery consumption when compared to conventional DBS.Conclusions: BCDBS was feasible, safe and well tolerated and it has potential to be a viable future DBS programming strategy. (shrink)

A new edition of the classic anthology of Christian, Muslin, and Jewish political philosophy in the Middle Ages.

In this volume, Simona Goi and Frederick M. Dolan gather stimulating arguments for the indispensability of fiction_including poetry, drama, and film_as irreplaceable sites for wrestling with nature, meaning, shortcomings, and the future of modern politics.

Background: In prevalence studies of sexually transmitted infections (STIs), investigators often provide syndromic management for symptomatic participants, but may not provide specific treatment for asymptomatic individuals with positive laboratory test results due to the delays between sample collection and availability of results as well as logistical constraints in recontacting study participants. Methods: To characterize the extent of this issue, 80 prevalence studies from the World Health Organization’s Report on global sexually transmitted infection surveillance, 2018, were reviewed. Studies were classified as (...) to whether clinically relevant positive results were returned or if this was not specified. Results: More than half (56%) of the cited studies did not specify if participants were notified of clinically relevant positive STI test results. The percentages were similar for low- and middle-income country populations (57%) and high-income country populations (53%). Conclusions: The absence of documentation of the provision of test results raises the possibility that in some instances, results may not have been communicated, with potential negative effects for participants, their sexual partners, and newborns. From an ethical perspective, clinically relevant results should be returned to study participants and treating clinicians in a timely fashion to ensure appropriate management of identified infections. Study authors should document if they returned test results to study participants and report on numbers lost to follow-up. (shrink)

Background: Flow states are considered a positive, subjective experience during an optimal balance between skills and task demands. Previously, experimentally induced flow experiences have relied solely on adaptive tasks. Objective: To investigate whether cathodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (DLPFC) area and anodal tDCS over the right parietal cortex area during video game play will promote an increased experience of flow states. Methods: Two studies had participants play Tetris or first-person shooter (FPS) video games (...) while receiving either real tDCS or sham stimulation. Tetris recruited nineteen untrained players who infrequently played video games while the ten FPS participants played FPS frequently. Flow experience was assessed before and after stimulation. Results: Compared to sham stimulation, real stimulation increased flow experience for both untrained Tetris and trained FPS players. No ceiling effects were noticed between trained and untrained groups. Conclusion: Cathodal and anodal tDCS over the left DLPFC and right parietal areas respectively may encourage flow experiences in complex real-life motor tasks that occur during sports, games and everyday life. (shrink)

In two studies, we tested how the expression of civic hope in narratives and the perceived authenticity of civic/political actions relate to civic/political engagement. In a cross-sectional study of undergraduates (N = 230), the expression of civic hope predicted the perceived authenticity of civic actions (e.g., voting), which in turn predicted the motivation to engage in them. In a longitudinal on-line study that began 8 weeks prior to the 2020 U.S. Presidential election (N = 308 MTurk workers), overall expressions of (...) civic hope positively predicted the perceived authenticity of voting and the motivation to vote. In addition, expressions of civic hope positively predicted the perceived authenticity of voting, which in turn positively predicted the likelihood of reporting that one did vote. These findings indicate that a sense of civic hope and the experience of authenticity in political contexts may be important for democratic engagement. (shrink)

This volume contains essays dealing with complex relationships between Judaism and Christianity, taking a bold step, assuming that no historical period can be excluded from the interactive process between Judaism and Christianity, conscious or unconscious, as either rejection or appropriation.

Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient’s interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown that physicians (...) have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation. (shrink)

This paper investigates the effect of the countervailing forces within organizations of formal systems that direct employees toward ethical acts and informal systems that direct employees toward fraudulent behavior. We study the effect of these forces on deception, a key component of fraud. The results provide support for an interactive effect of these formal and informal systems. The effectiveness of formal systems is greater when there is a strong informal “push” to do wrong; conversely, in the absence of a strong (...) push to do wrong, the strength of formal systems has little impact on fraudulent behavior. These results help to explain why the implementation of formal systems within organizations has been met with mixed results and identifies when formal systems designed to promote ethical behavior will be most efficacious. (shrink)

Organizational ethics programs often are created to address tensions in organizational values that have been identified through repeated clinical ethics consultation requests. Clinical ethicists possess some core competencies that are suitable for the leadership of high-quality organizational ethics programs, but they may need to develop new skills to build these programs, such as familiarity with healthcare delivery science, healthcare financing, and quality improvement methodology. To this end, we suggest that clinical ethicists build organizational ethics programs incrementally and via quality improvement (...) projects undertaken in collaboration with senior clinical leaders. Organizational ethics programs often differ from clinical ethics programs in their membership and processes, and likely will require ethicists to forge new partnerships with a wide array of organizational leaders. With attention to the ways that organizational ethics programs differ from clinical ethics programs, and investment in quality improvement methodology and formal institutional needs assessments, clinical ethics leaders can position an organizational ethics program to advocate effectively for visible and compelling alignment of leadership decision making with the values of the organization. (shrink)

Text Is In English, Hebrew And Arabic. American Academy For Jewish Research, Proceedings, V8, 1937-1938.

This article revises received wisdom about the Durkheimian school of sociology and its relationship to Marxism by analyzing the work of Célestin Bouglé, one of the most influential and least examined sociologists of the Durkheimian tradition. Like other better-known Durkheimians of his generation such as Marcel Mauss and Maurice Halbwachs, Bouglé engaged Durkheimian sociology with Marxian and other German traditions of social thought. In the process he also paid an important debt to the French socialists that Marx and so many (...) French Marxists have denigrated as ‘utopian’, especially Saint-Simon, Pierre-Joseph Proudhon and Charles Fourier. In fact, the concerns of Bouglé’s political sociology and Durkheimian sociology more generally are indissociable from the politics of Third Republic France. (shrink)

Scholars have hitherto found little to no place for natural philosophy in the intellectual makeup of the Enlightened historian William Robertson, overlooking his significant contacts with that province and its central relevance to the controversy surrounding David Hume and Lord Kames in the 1750s. Here I reexamine Robertson's Situation of the World at the Time of Christ's Appearance (1755) in light of these contexts. I argue that his foundational sermon drew upon the scientific theism of such thinkers as Joseph (...) Butler, Edmund Law, and Colin Maclaurin to counter the autonomous figurations of the universe associated with Hume and Kames, and to develop a historical account of progress based around Christian progressivism rather than the stadial theory of Adam Smith. Robertson conceived of history neither in secular terms nor in those of traditional religion, but sought instead to update the language of providentialism by naturalizing the sacred within a framework of general laws. (shrink)

Derek Parfit, Joseph Raz, and T. M. S canlon, among others, all hold that reasons for action are provided by facts about those actions. They also hold that the fact that an action would promote or achieve the object of an agent's desire is not one of the relevant facts, and does not provide a reason. Rather, the facts that provide reasons are typically facts about valuable states of affairs that the action is likely to bring about, or valuable (...) properties that the action itself will instantiate. For this reason it is appropriate to call Parfit, Raz, and Scanlon "value-based" theorists about reasons for action. In contrast to value-based theorists, there is a strong current of contemporary theorizing, starting with Bernard Williams, that can be called "desire-based." Desire-based theorists argue that practical reasons should be understood in terms of the desires of the agents who are said to have those reasons. (shrink)