Are clinical practice guidelines a means for improving the quality of health care? For saving money in the health care system? For solving the malpractice problem? For making the health care system work better for all? Or, are they a recipe for disaster? This overview sets out conceptual, definitional, and practical aspects of clinical practice guidelines as a broad framework for reflecting on the issue of what guidelines are and why they count. It draws mainly on work done since 1990 (...) at the Institute of Medicine and focuses on five questions. First, what are guidelines, and who develops them? Second, what criteria or principles should be used to create good guidelines? Third, what problems or pitfalls exist in developing and disseminating guidelines? Fourth, in what ways can guidelines help improve medical care, and in what ways will they not be as practical or useful, particularly with respect to quality of care? Finally, what ethical context might guide deliberations on this topic? (shrink)

Are clinical practice guidelines a means for improving the quality of health care? For saving money in the health care system? For solving the malpractice problem? For making the health care system work better for all? Or, are they a recipe for disaster? This overview sets out conceptual, definitional, and practical aspects of clinical practice guidelines as a broad framework for reflecting on the issue of what guidelines are and why they count. It draws mainly on work done since 1990 (...) at the Institute of Medicine and focuses on five questions. First, what are guidelines, and who develops them? Second, what criteria or principles should be used to create good guidelines? Third, what problems or pitfalls exist in developing and disseminating guidelines? Fourth, in what ways can guidelines help improve medical care, and in what ways will they not be as practical or useful, particularly with respect to quality of care? Finally, what ethical context might guide deliberations on this topic? (shrink)

Whether they realize it or not, most stakeholders in the debate about using animals for research agree on the common goal of seeking an end to research that causes animals harm. The central issues in the controversy are about how much effort should be devoted to that goal and when we might reasonably expect to achieve it. Some progress has already been made: The number of animals used for research is about half what it was in the 1970s, and biomedical (...) research has reached the point where we can reasonably begin to envision a time when it could advance without causing harm to animals. With some effort and aggressive development of new biomedical research technologies, full replacement of animals in harmful research is within our grasp. The goal will not be reached all at once, however, and phasing out invasive research on all nonhuman primates should be the priority. (shrink)

This article investigates the online information practices of persons grieving and mourning via Facebook. It examines how, or whether, these practices and Facebook’s terms of use policies have implications for the bereaved and/or the memory of the deceased. To explore these questions, we compared traditional publicly recorded asynchronous modes of grieving (i.e., obituaries) with Facebook’s asynchronous features (i.e., pages, photos, messages, profiles, comments). Additionally, by applying observational techniques to Facebook memorial pages and Facebook profiles, conducting a survey, and interviewing respondents (...) as a follow-up to the survey, we examined the benefits of and issues surrounding online information sharing via Facebook when coping with the loss of another. We found that the immediacy of publishing comments, messages, wall posts, and photos provides Facebook mourners with a quick outlet for their emotions and a means of timely group support; however, these actions directly affect the online curation of the deceased’s self and memory and also create an environment of competition among mourners. The aforementioned benefits and complications of using Facebook during bereavement are shaped by the policies outlined by the social media platform. (shrink)

Testosterone fluctuates in response to competitive social interactions, with the direction of change typically depending on factors such as contest outcome. Watching a competition may be sufficient to activate T among fans and others who are invested in the outcome. This study explores the change in T associated with vicarious experiences of competition among combat sport athletes viewing a teammate win or lose and assesses how individual differences in social identification with one’s team relates to these patterns of T reactivity. (...) Twenty-six male combat athletes completed a social identity questionnaire on a neutral day. Later, salivary samples were obtained before and after athletes viewed a video of a teammate engaged in a formal contest. T reactivity to viewing a teammate compete varied among participants in both the magnitude and direction of change, independent of contest outcome. Individual differences in cognitive centrality, a core feature of social identification, showed a strong positive relationship with T reactivity, particularly if their teammate won. Initial findings suggest that dominance-linked androgen responses associated with watching a teammate win a competition might depend on the belief that team membership is central to one’s own identity. These exploratory results in a small sample of combat athletes should be interpreted with caution. Uncovering the role of social group dynamics in influencing T responses to competition is particularly important in light of the evolutionary history of coalitional combat in humans. (shrink)

Home care is one of the fastest‐growing industries in the United States, providing valuable opportunities for millions of older adults and people with disabilities to live at home rather than in institutional settings. Home care workers assist clients with essential activities of daily living, but their wages and working conditions generally fail to reflect the importance of their work. Drawing on the work of Eva Feder Kittay and other care ethicists, we argue that good care involves attending to the needs (...) of another out of a concern for their well‐being. Such care should be standard in the home care system. Yet, because of the pervasive racial, gender, and economic inequalities that the home care industry perpetuates, home care workers and their clients cannot reasonably be expected to care about each other. We endorse reforms aimed at enabling home care workers and their clients to form and maintain professional relationships that cultivate care.. (shrink)

The objectives of this study were to develop a high-density chromosome bin map of homoeologous group 7 in hexaploid wheat, to identify gene distribution in these chromosomes, and to perform comparative studies of wheat with rice and barley. We mapped 2148 loci from 919 EST clones onto group 7 chromosomes of wheat. In the majority of cases the numbers of loci were significantly lower in the centromeric regions and tended to increase in the distal regions. The level of duplicated loci (...) in this group was 24% with most of these loci being localized toward the distal regions. One hundred nineteen EST probes that hybridized to three fragments and mapped to the three group 7 chromosomes were designated landmark probes and were used to construct a consensus homoeologous group 7 map. An additional 49 probes that mapped to 7AS, 7DS, and the ancestral translocated segment involving 7BS also were designated landmarks. Landmark probe orders and comparative maps of wheat, rice, and barley were produced on the basis of corresponding rice BAC/PAC and genetic markers that mapped on chromosomes 6 and 8 of rice. Identification of landmark ESTs and development of consensus maps may provide a framework of conserved coding regions predating the evolution of wheat genomes. (shrink)

This qualitative study describes the lived experience of physicians who work in communities that have experienced a public mass shooting. Semi-structured interviews were conducted with seventeen physicians involved in eight separate mass casualty shooting incidents in the United States. Four major themes emerged from constant comparative analysis: The psychological toll on physicians: “I wonder if I'm broken”; the importance of and need for mass casualty shooting preparedness: “[We need to] recognize this as a public health concern and train physicians to (...) manage it”; massive media attention: “The media onslaught was unbelievable”; and commitment to advocacy for a public health approach to firearm violence: “I want to do whatever I can to prevent some of these terrible events.”. (shrink)

Physiologically accurate mouse models of cancer are critical in the pre‐clinical development of novel cancer therapies. However, current standardized animal‐housing temperatures elicit chronic cold‐associated stress in mice, which is further increased in the presence of tumor. This cold‐stress significantly impacts experimental outcomes. Data from our lab and others suggest standard housing fundamentally alters murine physiology, and this can produce altered immune baselines in tumor and other disease models. Researchers may thus underestimate the efficacy of therapies that are benefitted by immune (...) responses. A potential mediator, norepinephrine, also underlies stress pathways common in mice and humans. Therefore, research into mechanisms connecting cold‐stress and norepinephrine signaling with immune depression in mice could highlight new combination therapies for humans to simultaneously target stress while stimulating anti‐tumor immunity. (shrink)

A total of 1918 loci, detected by the hybridization of 938 expressed sequence tag unigenes from 26 Triticeae cDNA libraries, were mapped to wheat homoeologous group 4 chromosomes using a set of deletion, ditelosomic, and nulli-tetrasomic lines. The 1918 EST loci were not distributed uniformly among the three group 4 chromosomes; 41, 28, and 31% mapped to chromosomes 4A, 4B, and 4D, respectively. This pattern is in contrast to the cumulative results of EST mapping in all homoeologous groups, as reported (...) elsewhere, that found the highest proportion of loci mapped to the B genome. Sixty-five percent of these 1918 loci mapped to the long arms of homoeologous group 4 chromosomes, while 35% mapped to the short arms. The distal regions of chromosome arms showed higher numbers of loci than the proximal regions, with the exception of 4DL. This study confirmed the complex structure of chromosome 4A that contains two reciprocal translocations and two inversions, previously identified. An additional inversion in the centromeric region of 4A was revealed. A consensus map for homoeologous group 4 was developed from 119 ESTs unique to group 4. Forty-nine percent of these ESTs were found to be homoologous to sequences on rice chromosome 3, 12% had matches with sequences on other rice chromosomes, and 39% had no matches with rice sequences at all. Limited homology was found between wheat ESTs on homoeologous group 4 and the Arabidopsis genome. Forty-two percent of the homoeologous group 4 ESTs could be classified into functional categories on the basis of blastX searches against all protein databases. (shrink)

The complex hexaploid wheat genome offers many challenges for genomics research. Expressed sequence tags facilitate the analysis of gene-coding regions and provide a rich source of molecular markers for mapping and comparison with model organisms. The objectives of this study were to construct a high-density EST chromosome bin map of wheat homoeologous group 2 chromosomes to determine the distribution of ESTs, construct a consensus map of group 2 ESTs, investigate synteny, examine patterns of duplication, and assess the colinearity with rice (...) of ESTs assigned to the group 2 consensus bin map. A total of 2600 loci generated from 1110 ESTs were mapped to group 2 chromosomes by Southern hybridization onto wheat aneuploid chromosome and deletion stocks. A consensus map was constructed of 552 ESTs mapping to more than one group 2 chromosome. Regions of high gene density in distal bins and low gene density in proximal bins were found. Two interstitial gene-rich islands flanked by relatively gene-poor regions on both the short and long arms and having good synteny with rice were discovered. The map locations of two ESTs indicated the possible presence of a small pericentric inversion on chromosome 2B. Wheat chromosome group 2 was shown to share syntenous blocks with rice chromosomes 4 and 7. (shrink)

© 2015, Springer-Verlag Berlin Heidelberg.Genetic studies have identified single nucleotide polymorphisms associated with the risk of prostate cancer. It remains unclear whether such genetic variants are associated with disease aggressiveness. The NCI-SPORE Genetics Working Group retrospectively collected clinicopathologic information and genotype data for 36 SNPs which at the time had been validated to be associated with PC risk from 25,674 cases with PC. Cases were grouped according to race, Gleason score and aggressiveness. Statistical analyses were used to compare the frequency (...) of the SNPs between different disease cohorts. After adjusting for multiple testing, only PC-risk SNP rs2735839 was significantly and inversely associated with aggressive and high-grade disease in European men. Similar associations with aggressive and high-grade disease were documented in African-American subjects. The G allele of rs2735839 was associated with disease aggressiveness even at low PSA levels in both European and African-American men. Our results provide further support that a PC-risk SNP rs2735839 near the KLK3 gene on chromosome 19q13 may be associated with aggressive and high-grade PC. Future prospectively designed, case-case GWAS are needed to identify additional SNPs associated with PC aggressiveness. (shrink)

RÉSUMÉKant affirme que nous exigeons l'accord des autres quand nous rendons des jugements de goût. Je soutiens que cette affirmation fait partie d'une explication de la façon dont la phénoménologie des jugements esthétiques familiers appuie son affirmation selon laquelle les jugements de goût sont universels. La théorie esthétique de Kant n'est plausible que si nous rejetons l'affirmation répandue selon laquelle cette exigence est normative. Je propose une lecture non normative des jugements de goût kantiens basée sur une étude des textes, (...) puis je conteste les trois interprétations normatives importantes, qui nous obligent à attribuer à Kant une position qu'il n'acceptait pas. (shrink)

A study was done with incoming freshmen, sophomore, senior, and graduate business students (n = 185) to assess the effects of moral development, gender, education level, and context on the moral choices in a simulated business situation, a potential hostile takeover of a fictional company. The results indicated that level of moral development did affect the decisions of students; however, main effects for gender, the level of education, and context were not significant. Theresults did find significant interaction effects between context (...) and moral development and gender and moral development. Students with lower levels of moral development were less likely to consider the contextual situation when making their decisions. The effect of moral development was more pronounced for female business students than for male business students. The implications of these results for ethics education in business schools are discussed. (shrink)

A study was done with incoming freshmen, sophomore, senior, and graduate business students (n = 185) to assess the effects of moral development, gender, education level, and context on the moral choices in a simulated business situation, a potential hostile takeover of a fictional company. The results indicated that level of moral development did affect the decisions of students; however, main effects for gender, the level of education, and context were not significant. Theresults did find significant interaction effects between context (...) and moral development and gender and moral development. Students with lower levels of moral development were less likely to consider the contextual situation when making their decisions. The effect of moral development was more pronounced for female business students than for male business students. The implications of these results for ethics education in business schools are discussed. (shrink)

La conviction que la modernité occidentale soit un monde sécularisé, athée, dans lequel la religion ne domine plus la sphère publique, n’est qu’une présomption. Autrement dit : une transformation, à partir d’un monde où le sens réside en dehors de lui, vers un monde où le sens se situe en lui-même. Si nous suivons la pensée du philosophe français Jean-Luc Nancy, présentée dans ses livres Le Sens du Monde et La déclosion, nous devons penser le monde non pas comme ayant (...) un sens en soi, mais comme étant le sens lui-même. Vivre dans un monde laïque signifie vivre dans un monde qui est sens, un monde devenu responsable pour soi-même mais qui ne s’enferme pas sur soi-même. Nancy, s’inspirant de Martin Heidegger, affirme que, dans un monde laïque, il n’est plus question de savoir si le monde a un sens, mais si le monde est sens. Pour être athée aujourd’hui, conclut Nancy, nous n’avons plus à faire à la question « pourquoi est-il quelque chose en général ? », mais à la réponse « il y a quelque chose, et cela en soi fait sens ». (shrink)

Understanding cognitive effort expended during assessments is essential to improving efficiency, accuracy, and accessibility within these assessments. Pupil dilation is commonly used as a psychophysiological measure of cognitive effort, yet research on its relationship with effort expended specifically during language processing is limited. The present study adds to and expands on this literature by investigating the relationships among pupil dilation, trial difficulty, and accuracy during a vocabulary test. Participants (n = 63, Mage = 19.25) completed a subset of trials from (...) the Peabody Picture Vocabulary Test while seated at an eye‐tracker monitor. During each trial, four colored images were presented on the monitor while a word was presented via audio recording. Participants verbally indicated which image they thought represented the target word. Words were categorized into Easy, Medium, and Hard difficulty. Pupil dilation during the Medium and Hard trials was significantly greater than during the Easy trials, though the Medium and Hard trials did not significantly differ from each other. Pupil dilation in comparison to trial accuracy presented a more complex pattern, with comparisons between accurate and inaccurate trials differing depending on the timing of the stimulus presentation. These results present further evidence that pupil dilation increases with cognitive effort associated with vocabulary tests, providing insights that could help refine vocabulary assessments and other related tests of language processing. (shrink)

Importance Informed consent is essential to ethical, rigorous research and is important to recruitment and retention in cancer trials.Objective To examine cancer clinical trial (CCT) participants’ perceptions of informed consent processes and variations in perceptions by cancer type.Design and Setting and Participants Cross-sectional survey from mixed-methods study at National Cancer Institute–designated Northeast comprehensive cancer center. Open-ended and forced-choice items addressed: (1) enrollment and informed consent experiences and (2) decision-making processes, including risk-benefit assessment. Eligibility: CCT participant with gastro-intestinal or genitourinary, hematologic-lymphatic (...) malignancies, lung cancer, and breast or gynecological cancer (N = 334).Main Outcome Measures Percentages satisfied with consent process and information provided; and assessing participation’s perceptions of risks/benefits. Multivariable logistic or ordinal regression examined differences by cancer type.Results Most patient-participants felt well informed by the consent process (more than 90% overall and by cancer type) and. most (87.4%) reported that the consent form provided all the information they wanted, although nearly half (44.8%) reported that they read the form somewhat carefully or less. More than half (57.9%) said that talking to research staff (i.e., the consent process) had a greater impact on participation decisions than reading the consent form (2.1%). A third (31.1%) were very sure of joining in research studies before the informed consent process (almost half of lung cancer patients did—47.1%). Most patients personally assessed the risks and benefits before consenting. However, trust in physicians played an important role in the decision to enroll in CCT.Conclusions and Relevance Cancer patients rely less on written features of the informed consent process than on information obtained from the research staff and their own physicians. Research should focus on information and communication strategies that support informed consent from referring physicians, researchers, and others to improve patient risk-benefit assessment and decision-making. (shrink)

PurposeAdolescents develop their decision-making ability as they transition from childhood to adulthood. Participation in their medical care should be encouraged through obtaining assent, as recommended by the American Academy of Pediatrics (AAP). In this research, we aim to define the current knowledge of AAP recommendations and surgeon practices regarding assent for elective reconstructive procedures.MethodsAn anonymous electronic survey was distributed to North American paediatric surgeons and fellows through the American Pediatric Surgical Association (n=1353).ResultsIn total, 220 surgeons and trainees responded (16.3%). Fifty (...) per cent of the surgeons who are familiar with the concept of assent had received formal training; 12% of the respondents had not heard of assent before the survey. Forty-seven per cent were aware of the 2016 AAP policy statement regarding assent in paediatric patients. Eighty-nine per cent always include adolescents as part of the consent discussion. Seventy-seven per cent solicit an expression of willingness to accept the proposed care from the patient. The majority (74%) of the surgeons perceived patient cooperation/understanding as the biggest barrier to obtaining assent. Over half of the respondents would consider proceeding with elective surgery despite the adolescent patient’s refusal. Reasons cited for proceeding with elective surgery include surgeons’ perception of medical necessity, perceptions of disease urgency, and lack of patient maturity.ConclusionPaediatric surgeons largely acknowledge the importance of assent, but variably practice the principles of obtaining assent from adolescent patients undergoing elective reconstructive procedures. Fewer surgeons are explicitly aware of formal policy statements or received formal training. Additional surgeon education and institutional policies are warranted to maximise inclusion of adolescents in their medical care. (shrink)

We investigate whether standard counterfactual analyses of causation imply that the outcomes of space-like separated measurements on entangled particles are causally related. Although it has sometimes been claimed that standard CACs imply such a causal relation, we argue that a careful examination of David Lewis’s influential counterfactual semantics casts doubt on this. We discuss ways in which Lewis’s semantics and standard CACs might be extended to the case of space-like correlations.

A presentation of the speculative and exegetical content of one of the most important medieval Jewish texts dealing with Biblical metaphors and literary theory.

Bayesian models of legal arguments generally aim to produce a single integrated model, combining each of the legal arguments under consideration. This combined approach implicitly assumes that variables and their relationships can be represented without any contradiction or misalignment, and in a way that makes sense with respect to the competing argument narratives. This paper describes a novel approach to compare and ‘average’ Bayesian models of legal arguments that have been built independently and with no attempt to make them consistent (...) in terms of variables, causal assumptions or parameterization. The approach involves assessing whether competing models of legal arguments are explained or predict facts uncovered before or during the trial process. Those models that are more heavily disconfirmed by the facts are given lower weight, as model plausibility measures, in the Bayesian model comparison and averaging framework adopted. In this way a plurality of arguments is allowed yet a single judgement based on all arguments is possible and rational. (shrink)

Scientists depend on complex computational systems that are often ineliminably opaque, to the detriment of our ability to give scientific explanations and detect artifacts. Some philosophers have s...

This chapter defends a theory of objectification, conceiving of it as a species of what aestheticians have called ‘seeing‐as’, and more specifically, a kind of seeing‐as which to some degree is insensitive to the mind or mental aspects. An advantage of this view is that it covers both sexual and racial objectification, and can also explain how photographic images can objectify their subjects: namely, by encouraging the viewer to view in a way insensitive to the mind or mental aspects of (...) the subject. It also explains in what context objectification to can be harmless. This view is discussed in relation to several others. (shrink)

A successful writer and committed feminist's search for spiritual wholeness after a career crisis, the sudden death of her brother, and the birth of her son moves her to seek out a range of remarkable women who are consciously tryng to live in balance.

The author addresses speech restrictions on campuses, the axiom “A is A” as it applies to men and women, Roe v. Wade and its effect on examining the definition of personhood, and how this examination may have contributed to the anti-conceptual mentality that was already under way on campuses and elsewhere.

In an era of fake news, alternative truths and leaked secrets making constant headlines, we are telling stories about ourselves all the time, and we are telling them in so many different ways. From vlogs and blogs to tweets and posts, from photos and gifs to live streams. From instant updates that disappear to rash words that last for ever and data trails that chart every step we take. While people around her shake their heads and mutter bad things about (...) the new levels of day-to-day deceit, Kathleen Wyatt is busy marvelling at how society manages it. How do we do this extraordinary thing - often under the most ordinary of circumstances? How do we convince each other to suspend disbelief? And why do we do it? In this brilliant, wide-ranging study of lies and lying, Wyatt introduces us to a cast of professionals and professional liars - from scientists to investigators, from double agents to journalists, from toddler specialists to a fallen titan of industry - all to help her prove a remarkable thesis: lies hold us together as much as they push us apart and may be vital in a healthy society"--Publisher's description. (shrink)