Background Respect is essential to providing high quality healthcare, particularly for groups that are historically marginalized and stigmatized. While ethical principles taught to health professionals focus on patient autonomy as the object of respect for persons, limited studies explore patients’ views of respect. The purpose of this study was to explore the perspectives of a multiculturally diverse group of low-income women living with HIV (WLH) regarding their experience of respect from their medical physicians. Methods We analyzed 57 semi-structured interviews conducted (...) at HIV case management sites in South Florida as part of a larger qualitative study that explored practices facilitating retention and adherence in care. Women were eligible to participate if they identified as African American (n = 28), Hispanic/Latina (n = 22), or Haitian (n = 7). They were asked to describe instances when they were treated with respect by their medical physicians. Interviews were conducted by a fluent research interviewer in either English, Spanish, or Haitian Creole, depending on participant’s language preference. Transcripts were translated, back-translated and reviewed in entirety for any statements or comments about “respect.” After independent coding by 3 investigators, we used a consensual thematic analysis approach to determine themes. Results Results from this study grouped into two overarching classifications: respect manifested in physicians’ orientation towards the patient (i.e., interpersonal behaviors in interactions) and respect in medical professionalism (i.e., clinic procedures and practices). Four main themes emerged regarding respect in provider’s orientation towards the patient: being treated as a person, treated as an equal, treated without blame or prejudice, and treated with concern/emotional support. Two main themes emerged regarding respect as evidenced in medical professionalism: physician availability and considerations of privacy. Conclusions Findings suggest a more robust conception of what ‘respect for persons’ entails in medical ethics for a diverse group of low-income women living with HIV. Findings have implications for broadening areas of focus of future bioethics education, training, and research to include components of interpersonal relationship development, communication, and clinic procedures. We suggest these areas of training may increase respectful medical care experiences and potentially serve to influence persistent and known social and structural determinants of health through provider interactions and health care delivery. (shrink)

The Declaration of Helsinki and the Council of the International Organization of Medical Sciences provide guidance on standards of care and prevention in clinical trials. In the current and increasingly challenging research environment, the ethical status of a trial design depends not only on protection of participants, but also on social value, feasibility, and scientific validity. Using the example of a study assessing efficacy of a vaccine to prevent human papilloma virus in HIV-1 infected adolescent girls in low resource countries (...) without access to the vaccine, we compare several trial designs which rank lower on some criteria and higher on others, giving rise to difficult trade-offs. This case demonstrates the need for developing more nuanced guidance documents to help researchers balance these often conflicting criteria. (shrink)

Theories of sentence production that involve a convergence of activation from conceptual‐semantic and syntactic‐sequential units inspired a connectionist model that was trained to produce simple sentences. The model used a learning algorithm that resulted in a sharing of responsibility (or “division of labor”) between syntactic and semantic inputs for lexical activation according to their predictive power. Semantically rich, or “heavy”, verbs in the model came to rely on semantic cues more than on syntactic cues, whereas semantically impoverished, or “light”, verbs (...) relied more on syntactic cues. When the syntactic and semantic inputs were lesioned, the model exhibited patterns of production characteristic of agrammatic and anomic aphasic patients, respectively. Anomic models tended to lose the ability to retrieve heavy verbs, whereas agrammatic models were more impaired in retrieving light verbs. These results obtained in both sentence production and single‐word naming simulations. Moreover, simulated agrammatic lexical retrieval was more impaired overall in sentences than in single‐word tasks, in agreement with the literature. The results provide a demonstration of the division‐of‐labor principle, as well as general support for the claim that connectionist learning principles can contribute to the understanding of non‐transparent neuropsychological dissociations. (shrink)

Social reintegration of self-demobilised child combatants can be seriously imperilled by the lack of accountability for human rights violations allegedly carried out during their soldiering life and the failure to pursue reconciliation with their respective communities. This paper examines the circumstances leading young soldiers to voluntarily exit armed groups and militias and the extent to which resettling in the community can be facilitated by restorative justice mechanisms. The findings suggest a large support by war-affected communities for restorative justice peacemaking circles (...) as potential accountability and reconciliation measures to help reintegrate self-demobilised soldiers into society. These results were obtained from interviews, focus group discussions and descriptive statistics in which 1447 respondents participated. These included young ex-soldiers, students, educators, government official, members on NGOs, traditional leaders and councils, Security Services, and the Police. The inquiry was conducted between 3 May and 17 December 2014 in North Kivu Province, Democratic Republic of Congo. (shrink)

The present study investigated children’s understanding development of multiple graphics, here paired conventions commonly used in primary school textbooks. Paired graphics depicting everyday objects familiar to the children were used as the basis for an analogy task that tested their comprehension of five graphics conventions. This task required participants to compare pictures in a base pair in order to complete a target pair by choosing the correct picture from five alternative possibilities. Four groups of children aged 5, 6, 8 and (...) 10 years old respectively (total N = 105), completed 45 analogy task items built around nine conceptual domains. Results showed mainly an overall increase of comprehension performance with age for all the tested conventions. There were also differences between the five conventions and an interaction between age and convention type. Further, children's explanation of the conventions (justification of the choices in the analogy task) were also analyzed. This investigation showed the analogy task answers were a more reliable measure of the "actual" level of understanding of the conventions than the justification themselves. The findings show that younger students tried to actively compare the pictures of the pairs and to search for a relevant meaning of the pairs, however, the youngest children have a limited capacity to interpret paired graphic conventions and our results suggests that this aspect of graphic conventions develops slowly but effectively over the course of children’s schooling. Because "graphicacy" knowledge and skills are not typically taught in primary school classrooms (in contrast with literacy and numeracy), its development is likely acquired incidentally with increasing exposure to varied paired graphics during primary school education. Given the high reliance of today’s educational resources on graphics-based explanations, the results from this study may signal a need for (i) for more attention to learning graphics conventions (and more generally to graphics explanations) from teachers in primary school and (ii) for a better design of the graphics with their contextual accompanying texts and captions, from designers. (shrink)

Amidst expanding interest in local food and agriculture, food banks and allied organizations across the United States have increasingly engaged in diverse gleaning, gardening, and farming activities. Some of these programs reinforce food banks’ traditional role in distributing surplus commodities, and most extend food banks’ reliance on middle class volunteers and charitable donations. But some gleaning and especially gardening and farming programs seek to build poor people’s and communities’ capacity to meet more of their own food needs, signaling new roles (...) for some food banks in promoting community food security and food justice. This article reports the results of a national survey and in-depth case studies of the ways in which food banks are engaging in and with local agriculture and how this influences food banks’ roles in community and regional food systems. The patterns it reveals reflect broader tensions in debates about hunger relief and food security. (shrink)

We hypothesize that effective collaboration is facilitated when individuals and environmental components form a synergy where they work together and regulate one another to produce stable patterns of behavior, or regularity, as well as adaptively reorganize to form new behaviors, or irregularity. We tested this hypothesis in a study with 32 triads who collaboratively solved a challenging visual computer programming task for 20 min following an introductory warm‐up phase. Multidimensional recurrence quantification analysis was used to examine fine‐grained (i.e., every 10 (...) s) collective patterns of regularity across team members' speech rate, body movement, and team interaction with the shared user interface. We found that teams exhibited significant patterns of regularity as compared to shuffled baselines, but there were no systematic trends in regularity across time. We also found that periods of regularity were associated with a reduction in overall behavior. Notably, the production of irregular behavior predicted expert‐coded metrics of collaborative activity, such as teams' ability to construct shared knowledge and effectively negotiate and coordinate execution of solutions, net of overall behavioral production and behavioral self‐similarity. Our findings support the theory that groups can interact to form interpersonal synergies and indicate that information about system‐level dynamics is a viable way to understand and predict effective collaborative processes. (shrink)

BackgroundRadiotherapy is an essential component of cancer treatment, yet many countries do not have adequate capacity to serve all patients who would benefit from it. Allocation systems are needed to guide patient prioritization for radiotherapy in resource-limited contexts. These systems should be informed by allocation principles deemed relevant to stakeholders. This study explores the ethical dilemmas and views of decision-makers engaged in real-world prioritization of scarce radiotherapy resources at a cancer center in Rwanda in order to identify relevant principles.MethodsSemi-structured interviews (...) were conducted with a purposive sample of 22 oncology clinicians, program leaders, and clinical advisors. Interviews explored the factors considered by decision-makers when prioritizing patients for radiotherapy. The framework method of thematic analysis was used to characterize these factors. Bioethical analysis was then applied to determine their underlying normative principles.ResultsParticipants considered both clinical and non-clinical factors relevant to patient prioritization for radiotherapy. They widely agreed that disease curability should be the primary overarching driver of prioritization, with the goal of saving the most lives. However, they described tension between curability and competing factors including age, palliative benefit, and waiting time. They were divided about the role that non-clinical factors such as social value should play, and agreed that poverty should not be a barrier.ConclusionsMultiple competing principles create tension with the agreed upon overarching goal of maximizing lives saved, including another utilitarian approach of maximizing life-years saved as well as non-utilitarian principles, such as egalitarianism, prioritarianism, and deontology. Clinical guidelines for patient prioritization for radiotherapy can combine multiple principles into a single allocation system to a significant extent. However, conflicting views about the role that social factors should play, and the dynamic nature of resource availability, highlight the need for ongoing work to evaluate and refine priority setting systems based on stakeholder views. (shrink)

Despite governmental and private antismoking initiatives, tobacco smoking remains a significant public health and economic challenge. The Centers for Disease Control and Prevention estimates that for each year between 1997 and 2001, cigarette smoking and exposure to secondhand smoke caused approximately 438,000 U.S. residents to die prematurely, resulting in 5.5 million years of potential life lost, and in $92 billion dollars of lost productivity. Also, despite convincing scientific data that laws against indoor smoking protect people from the negative health effects (...) of cigarette smoke, not all states have afforded their residents this protection. As of July 2007, 16 states neither restricted nor banned indoor smoking in restaurants, private worksites, or government worksites, and many state statutes only required separate rooms for smokers rather than eliminating all smoking inside buildings. In several states, local governments have attempted to fill this gap by adopting their own antismoking measures. (shrink)

This chapter contains sections titled: A Brave New (Sexual) World The Original Study “Let's get this party started”: How Friends with Benefits Relationships Were Established “Is this a good idea?” Motivations and Barriers to Friends with Benefits Relationships “How does it feel?” Emotions Associated with Friends with Benefits Relationships “Can we make this work?” Rules for Maintaining Friends with Benefits Relationships “Was it good for you?” Outcomes of Friends with Benefits Relationships “So, what do you think?” Friends' Reactions to Friends (...) with Benefits Relationships Friends with Benefits Relationships: The Good, the Bad, and the Ugly. (shrink)

Elimination of state laws that preempt local antismoking ordinances is a national health objective. However, the tobacco industry and its supporters have continued to pursue statelevel preemption of local tobacco control ordinances as part of an apparent strategy to avoid the difusion of grassroots antismoking initiatives. And, an increasing number of challenges to local ordinances by the tobacco industry and persons supported by the tobacco industry are being decided in state supreme courts and courts of appeals. The outcomes of seemingly (...) similar cases about the validity of local smoke-free air ordinances vary signifcantly by state. This paper examines the common and unique aspects of the decisions and the potential implications of court rulings on preemption for future state tobacco control eforts and achievement of national health objectives around the elimination of preemption. Using a search strategy developed for the Centers for Disease Control and Prevention's State Tobacco Activities Tracking and Evaluation System, cases where a state or federal appellate level court made a fnding on the validity of a local smoke-free air ordinance or regulation were identifed in 19 states. In contrast to previous studies, we found that cases in approximately half of states were decided for local governments. We also found that across the states, courts were considering similar factors in their decisions including the extent to which: the local government possessed the authority to pass the ordinance, the ordinance conficted with the state constitution, and state statutes preempt the ordinance. (shrink)

In this book, internationally recognized scholars in philosophical hermeneutics discuss various aspects of language and linguisticality. The translations of Hans-Georg Gadamer's two recent essays provoke a preliminary discussion on the philosopher's polemic claim in Truth and Method—"Being that can be understood is language." Topics addressed by the contributors include the relationship of rituals to tradition and the immemorial; the unity of the word; conversation; translation and conceptuality; and the interrelationship between the art of writing and linguisticality. This work is of (...) critical importance to anyone interested in Gadamer's claims regarding the boundaries of language, the transition from the prelinguistic to linguistic realms, and the role of rituals in this transition. (shrink)

The worldwide COVID-19 pandemic has shed more light on the difficulty of making health care decisions integrating scientific knowledge and values associated to life and death issues, human suffering, quality of life, economic losses, liberty of movement, etc. But the difficulties related to health care decisions and the use of innovative drugs or technologies are not new, and many countries have created agencies that have the mandate to evaluate new technologies in health care. Health Technological Assessment (HTA) reports’ aim is (...) to guide the decision makers in these difficult matters. There are two ethical components in HTA. The first is the report’s presentation of an ethical evaluation of the technology. The second is the value-ladenness of the HTA decision-making process itself. When implicit value judgments are not elicited, the justification of the final decision cannot be transparent. The present paper aims to identify and elicit the implicit value-judgments related to each step of the HTA process. This research is grounded on an applied ethics decision-making paradigm based on the role of value judgments in the decision-making process. The first part discusses two different approaches to values and value judgments in HTA. In the second part, citations mentioning value judgments extracted from a systematic review on the integration of ethics into HTA were categorized to elicit the value judgments and their criteria for each different HTA decision-making steps. The results show that there are 18 decision-making steps in the HTA process where 23 implicit value-judgments can be recognized. The range of these value judgments encompasses the whole HTA process: from the initial request, the presenting of the principal issues, to the final report’s dissemination. Since stakeholders need to understand which value judgments the conclusion of a report relies on, eliciting the implicit value judgments in the HTA decision-making process should yield more transparency. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Narrative Symposium:Conflicting Interests in MedicineLaura Jean Bierut, Sal Cruz-Flores, Laura E. Hodges, Anthony A. Mikulec, Govind K. Nagaldinne, Erine L. Bakanas, John F. Peppin, Joel S. Perlmutter, William H. Seitz Jr., Edward Diao, Andre N. Sofair, and David M. Zientek• To Recruit or Not to Recruit for a Clinical Trial• An Unexpected Lesson• Am I on call for the entire Midwest?• Why is Medicare Wasting Away?• The Downside (...) of the Informed Consent Juggernaut• Expert Testimony at the Food and Drug Administration: Who Wants the Truth?• Crossroads: The Intersection of Personal, Professional Society, and Industry Relationships• A Change of Heart• The Evolution of Conflicts of Interest in a New Subspecialty: A Case Study of the Development of Interventional CardiologyCopyright © 2011 The Johns Hopkins University Press... (shrink)

The purpose of this paper is to address the question of whethercomputer source code is speech protected by the First Amendmentto the United States Constitution or whether it is merelyfunctional, a ``machine'', designed to fulfill a set task andtherefore bereft of protection. The answer to this question is acomplex one. Unlike all other forms of ``speech'' computer sourcecode holds a unique place in the law: it can be copyrighted, likea book and it can be patented like a machine or process.Case (...) law, intellectual property law and encryption exportregulations all reflect this contradictory dichotomy. (shrink)

Exceptionally preserved fossils are the product of complex interplays of biological and geological processes including burial, autolysis and microbial decay, authigenic mineralization, diagenesis, metamorphism, and finally weathering and exhumation. Determining which tissues are preserved and how biases affect their preservation pathways is important for interpreting fossils in phylogenetic, ecological, and evolutionary frameworks. Although laboratory decay experiments reveal important aspects of fossilization, applying the results directly to the interpretation of exceptionally preserved fossils may overlook the impact of other key processes that (...) remove or preserve morphological information. Investigations of fossils preserving non-biomineralized tissues suggest that certain structures that are decay resistant are rarely preserved, and decay-prone structures can fossilize, albeit rarely. As we review here, decay resistance is an imperfect indicator of fossilization potential, and a suite of biological and geological processes account for the features preserved in exceptional fossils. Organisms decayed experimentally in seawater have been used as direct analogs for soft-bodied fossil taxa, with fossils representing a snapshot of a particular stage of decay. We argue that numerous geological and biological processes account for fossilization and that all of these should be considered when reconstructing extinct organisms. (shrink)

Exceptionally preserved fossils are the product of complex interplays of biological and geological processes including burial, autolysis and microbial decay, authigenic mineralization, diagenesis, metamorphism, and finally weathering and exhumation. Determining which tissues are preserved and how biases affect their preservation pathways is important for interpreting fossils in phylogenetic, ecological, and evolutionary frameworks. Although laboratory decay experiments reveal important aspects of fossilization, applying the results directly to the interpretation of exceptionally preserved fossils may overlook the impact of other key processes that (...) remove or preserve morphological information. Investigations of fossils preserving non-biomineralized tissues suggest that certain structures that are decay resistant are rarely preserved, and decay-prone structures can fossilize, albeit rarely. As we review here, decay resistance is an imperfect indicator of fossilization potential, and a suite of biological and geological processes account for the features preserved in exceptional fossils. Organisms decayed experimentally in seawater have been used as direct analogs for soft-bodied fossil taxa, with fossils representing a snapshot of a particular stage of decay. We argue that numerous geological and biological processes account for fossilization and that all of these should be considered when reconstructing extinct organisms. (shrink)

We estimate that 208,000 deep brain stimulation (DBS) devices have been implanted to address neurological and neuropsychiatric disorders worldwide. DBS Think Tank presenters pooled data and determined that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. The DBS Think Tank was founded in 2012 providing a space where clinicians, engineers, researchers from industry and academia discuss current and emerging DBS technologies and logistical and ethical issues facing the field. (...) The emphasis is on cutting edge research and collaboration aimed to advance the DBS field. The Eighth Annual DBS Think Tank was held virtually on September 1 and 2, 2020 (Zoom Video Communications) due to restrictions related to the COVID-19 pandemic. The meeting focused on advances in: (1) optogenetics as a tool for comprehending neurobiology of diseases and on optogenetically-inspired DBS, (2) cutting edge of emerging DBS technologies, (3) ethical issues affecting DBS research and access to care, (4) neuromodulatory approaches for depression, (5) advancing novel hardware, software and imaging methodologies, (6) use of neurophysiological signals in adaptive neurostimulation, and (7) use of more advanced technologies to improve DBS clinical outcomes. There were 178 attendees who participated in a DBS Think Tank survey, which revealed the expansion of DBS into several indications such as obesity, post-traumatic stress disorder, addiction and Alzheimer’s disease. This proceedings summarizes the advances discussed at the Eighth Annual DBS Think Tank. (shrink)

1 Evidence-based policy requires researchers to provide the answers to ecological questions that are of interest to policy makers. To find out what those questions are in the UK, representatives from 28 organizations involved in policy, together with scientists from 10 academic institutions, were asked to generate a list of questions from their organizations. 2 During a 2-day workshop the initial list of 1003 questions generated from consulting at least 654 policy makers and academics was used as a basis for (...) generating a short list of 100 questions of significant policy relevance. Short-listing was decided on the basis of the preferences of the representatives from the policy-led organizations. 3 The areas covered included most major issues of environmental concern in the UK, including agriculture, marine fisheries, climate change, ecosystem function and land management. 4 The most striking outcome was the preference for general questions rather than narrow ones. The reason is that policy is driven by broad issues rather than specific ones. In contrast, scientists are frequently best equipped to answer specific questions. This means that it may be necessary to extract the underpinning specific question before researchers can proceed. 5 Synthesis and applications. Greater communication between policy makers and scientists is required in order to ensure that applied ecologists are dealing with issues in a way that can feed into policy. It is particularly important that applied ecologists emphasize the generic value of their work wherever possible. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

With the potential to process the world's agricultural and food waste, provide sustainable fodder for livestock, aquaculture, and pet animals, as well as act as a source of novel biomolecules, the black soldier fly, Hermetia illucens, has been launched into the leading position within the insects as feed industry. Fulfilment of these goals, however, requires mass‐rearing facilities to have a steady supply of neonate larvae, which in‐turn requires an efficient mating process to yield fertile eggs; yet, little is known about (...) adult reproductive behavior, nor what physiological factors lead to its emergence. Moreover, fertile egg production tends to be highly variable in colony. Therefore, this review brings together what is currently known of the organismal biology of H. illucens, compiling information on adult morphology, physiology, biogeography, genomics, and behavioral ecology. As a holistic synthesis, it highlights several directions of interest for research to follow. (shrink)