_The education system of Pakistan has always remained a cause of concern mainly for the educators, stakeholders, ruling political parties, students and parents’ community. A lot of effort has been put to upgrade the education system, increase the literacy rate and maintain the interest and motivation of the learner. One of the main reasons lies in the manner, in which the students are assessed, as assessments are considered to be the means of betterment and improvement. The main aim of the (...) study was to identify the views of university students of Karachi, towards the enhancement of motivation, through assessments. It was a quantitative research, in-person survey was conducted to investigate the role assessment plays in enhancing motivation of students. A 5-point Likert scale questionnaire was constructed, to collect the data from two hundred and fifteen, randomly selected university students of Karachi. Data were analyzed using SPSS version 22. The Psychometric Scale exhibited a positive perception of the construct amongst the respondents. The reliability=.76, with the highest M=4.44, regarding teachers’ attitudes and M=4.44 revealing teachers’ remarks have a deep effect on students’ motivation. Conflicts in the family play a vital role in university students' academic motivation with M=4.34._. (shrink)

Moving forward rapidly in the clinical research phase, uterus transplantation may be a future treatment option for women with uterine factor infertility, which accounts for three per cent of all infertility in women. This new method of treatment would allow women, who currently rely on gestational surrogacy or adoption, to gestate and birth their own genetic offspring. Since uterus transplantation carries significant risk when compared with surrogacy and adoption as well as when compared with other organ transplants, it requires greater (...) justification because its goals are quality of life, not life-saving, in their scope. It is important to address questions regarding the physical, psychosocial and ethical risks and benefits of uterus transplantation for all three parties involved—the patient, the donor and the potential child—as well as discuss the regulatory implications as research on uterus transplantations moves forward. (shrink)

This article considers the issue of racial difference in the Goddess movement, using the mythological figure of Arachne, a skilful weaver whom the goddess Athena transformed into a spider, to explore the unequal relational dynamics between white Goddess feminists and women of colour. Bringing Goddess spirituality and thealogical metaphors of webs and weaving into dialogue with postcolonial and black feminist perspectives on the politics of voice, marginality and representation, the article points to some of the ways in which colonial narratives (...) weave through Goddess feminism, including practices of silencing and the romanticization of racial difference. Ultimately, I argue that feminist spirituality must recognize and address structural inequality between white women and women of colour, or in other words, listen to Arachne’s voice. (shrink)

The paper highlights entrepreneurial skills of Indian farmers, informal channels of communications in the socio-cultural setting of the village, tacit knowledge and factors responsible for the adoption of floriculture in open field conditions. It illustrates that the diffusion of new technology in a farming community is dependent on culture-based communication and the tacit knowledge-driven entrepreneurial spirit of a few.

In this paper we investigate the effect of level of understanding revealed by feedback in the form of clarification requests from a route follower on a route giver’s spatial perspective choice in their response in route instruction dialogues. In an experiment varying the level of understanding displayed by route follower clarification requests (the independent variable), route giver perspective switching in response to this feedback is investigated. Three levels of understanding displayed by feedback are investigated: (1) low-level clarification requests indicating that (...) the instruction was not processed, (2) semantic-level clarification requests indicating that the spatial direction given in the instruction could not be resolved as the speaker of the clarification request could not interpret which perspective was intended, and (3) high-level feedback which indicates that the route giver’s instruction was understood but which note an obstacle to following the instruction. Results show that perspective choice, which is a conceptual feature of language use, is sensitive to perceived level of addressee understanding. We found that route givers consistently switch perspectives in responding to semantic-level clarification requests but not in response to low-level ones, and also that switching occurs more for high-level feedback than for low-level feedback. We address how dialogue systems can take advantage of these findings by modelling our results in an Information State model of dialogue, presenting update rules for response generation which account for our findings and also update rules which enable generation of the feedback themselves. (shrink)

In this paper we investigate the effect of level of understanding revealed by feedback in the form of clarification requests from a route follower on a route giver’s spatial perspective choice in their response in route instruction dialogues. In an experiment varying the level of understanding displayed by route follower clarification requests, route giver perspective switching in response to this feedback is investigated. Three levels of understanding displayed by feedback are investigated: low-level clarification requests indicating that the instruction was not (...) processed, semantic-level clarification requests indicating that the spatial direction given in the instruction could not be resolved as the speaker of the clarification request could not interpret which perspective was intended, and high-level feedback which indicates that the route giver’s instruction was understood but which note an obstacle to following the instruction. Results show that perspective choice, which is a conceptual feature of language use, is sensitive to perceived level of addressee understanding. We found that route givers consistently switch perspectives in responding to semantic-level clarification requests but not in response to low-level ones, and also that switching occurs more for high-level feedback than for low-level feedback. We address how dialogue systems can take advantage of these findings by modelling our results in an Information State model of dialogue, presenting update rules for response generation which account for our findings and also update rules which enable generation of the feedback themselves. (shrink)

Mind-body interactions have been the subject of debate for many generations. However, it is only in recent years that these interactions have become the subject of rigorous scientific enquiry. In recent years there have been major advances in our understanding of the stress process, the endocrine and immune systems, and the methodologies used to investigate these phenomena. As a result, we have witnessed an explosion of research activity in the field known as psychoneuroimmunology - the study of psychological processes and (...) their interaction with the nervous and immune systems. This book presents an up to date account of the human evidence in this field. The first three chapters introduce the reader to the biological systems at the heart of mind/body interactions and the methods used to investigate them. Thereafter, each chapter deals with a separate clinical entity; examining the theoretical basis for mind/body interactions; the associated empirical evidence and directions for future research. With each chapter written by international experts in the field, it provides the reader with an up to date account of the research evidence in the rapidly evolving field of psychoneuroimmunology. (shrink)

Study of Yatīndramatadīpikā, treatise on Viśiṣṭādvaita metaphysics and epistemology by Śrīnivāsācārya, Son of Govindācārya, active 17th century.

Discrimination and violence against women in India often tend to be discussed, framed and explained in cultural terms alone. It is a commonplace assumption that Indian cultural norms are responsible for women's oppression in India and that India's moves to open up the economy to globalisation will usher in modernity and empower women. Another similar assumption is that gendered violence and patriarchal oppression are produced and located primarily in the (Indian traditional) family and community, and that women's entry into the (...) globalised workforce will empower and help them confront and overcome such violence and oppression. This paper attempts to challenge this false binary between ‘family/community/tradition/culture’ and ‘modern political economy’. It looks at the methods used across various sites—household/family, college/university and factory—to subject women's labour and sexuality to a regime of surveillance and gendered discipline. It also looks at the ways in which this regime is disrupted and challenged repeatedly by women's protests. (shrink)

A philosopher whose name has become almost synonymous with religious pluralism is John Hick. He justifies his position by borrowing insights and concepts from Immanuel Kant and Ludwig Wittgenstein. We argue that Kantian and Wittgensteinian frameworks are inadequate to explain and defend religious pluralism of the kind he advocates. We critically analyze the concepts of religious experience and religious language and then proceed to discuss Yoga school of Indian philosophy as a limiting case against his enterprise.

Women with opioid use disorder (OUD) face unique challenges meeting their reproductive goals. Because the rate of unintended pregnancy in this population is almost 80 percent, there has been a push to increase the use of contraceptives among reproductive-aged women with OUD.1 The patient-level ethical issues of such initiatives, however, are often overlooked. This review discusses the ethical issues in two realms: obtaining contraception when it is desired and avoiding contraceptive coercion when contraception is not desired. It is important that (...) access to reproductive education and care be improved to ensure autonomous decision making by women with OUD. It is also necessary to be mindful of the history of oppressive and coercive contraception and sterilization policies in the United States. These policies have left a legacy of mistrust and continue to be manifested in the form of more subtly oppressive policies in contemporary medical practice. Such policies point to the ongoing stigmatization of, and implicit biases held against, women with OUD. Based on these ethical issues, solutions are suggested at the clinical, systemic, and societal levels. (shrink)

This paper argues that the type of conscience claims made in last decade’s spate of cases involving pharmacists’ objections to filling birth control prescriptions and cases such as Ms. Means and Mercy Health Partners of Michigan, and even the Affordable Care Act and the Little Sisters of the Poor, as different as they appear to be from each other, share a common element that ties them together and makes them fundamentally different in kind from traditional claims of conscience about which (...) a practical consensus emerged in the 1980s and 1990s. This difference in kind is profoundly significant; so much so, we contend, that it puts them at odds with the normative basis for protecting conscience claims in United States health care settings in the first place, making them illegitimate. Finally, we argue that, given the illegitimacy of these contemporary claims of conscience, physicians and other health professionals must honor their well-established standing obligations to provide informed consent and refer or transfer care even if the service requested or needed is at odds with their own core moral beliefs—a requirement that is in line with the aforementioned practical consensus on traditional claims of conscience. (shrink)

Research teams have made considerable progress in treating absolute uterine factor infertility through uterus transplantation, though studies have differed on the choice of either deceased or living donors. While researchers continue to analyze the medical feasibility of both approaches, little attention has been paid to the ethics of using deceased versus living donors as well as the protections that must be in place for each. Both types of uterus donation also pose unique regulatory challenges, including how to allocate donated organs; (...) whether the donor / donor's family has any rights to the uterus and resulting child; how to manage contact between the donor / donor's family, recipient, and resulting child; and how to track outcomes moving forward. (shrink)

Opponents of male circumcision have increasingly used human rights positions to articulate their viewpoint. We characterize the meaning of the term “human rights.” We discuss these human rights arguments with special attention to the claims of rights to an open future and to bodily integrity. We offer a three-part test under which a parental decision might be considered an unacceptable violation of a child's right. The test considers the impact of the practice on society, the impact of the practice on (...) the individual, and the likelihood of adverse impact. Infant circumcision is permissible under this test. We conclude that infant circumcision may be proscribed as violating local norms, even though it does not violate human rights. (shrink)

Study of the works of Śrīrāma Śarmā Ācārya, 1911-1990, Hindu philosopher.

Healthcare in the United States is most often described and experienced as an immense, convoluted industry with a sum greater than its parts. However, it is important to remember that these parts are distinct, autonomous individuals and entities with their own beliefs, customs, and viewpoints. Moral issues surface abundantly in healthcare due to its interconnectedness with human life with enhanced proximity during life’s beginning and end. Therefore, these individual beliefs are prone to clashing as seen in three key relationships: between (...) patient and provider, between providers, and between industry and providers. While this is both to be expected and respected, it is important to remember that all individuals and entities involved in healthcare do have one major duty in common – the welfare of the patient. Unfortunately, legislature at both the state and federal levels and organizational policies have been too willing to endanger the welfare of patients for the sake of balancing the individual consciences involved. (shrink)

The American Journal of Bioethics, Volume 12, Issue 7, Page 58-59, July 2012.

Infertile women in the developing world face an additional layer of vulnerability compared to their counterparts in the developed world due to social, cultural, political, and socioeconomic factors that truly render their infertility a disability. After exploring how infertility in the developing world fits the World Health Organization’s biopsychosocial model of disability, we will argue that feminists and disability rights proponents should jointly articulate and advocate for change.

Congenitally infertile woman such as those with Turner syndrome or Mayer Rokitansky-Kuster-Hauser syndrome have available the technologies of oocyte harvestation, cryropreservation, in-vitro fertilization, and gestational surrogacy in order to have genetically related offspring. Since congenital infertility results in a variety of experiences that impacts on nearly every aspect of a person’s life, in the future it is possible that these women might desire a congenitally infertile child through the use of preimplantation genetic diagnosis so as to share this common bond. (...) While infertility results in a relatively normal quality of life, it is morally wrong to necessitate the future use of infertility services with its variable success rate on a child. Also, whereas the woman has fundamental reproductive autonomy, she lacks the substantive autonomy regarding the specific characteristics of her child. Finally, the infertile community does exhibit a strong presence, but it lacks characteristics that define it as a culture. (shrink)

Female genital alteration is any cutting, removal or destruction of any part of the external female genitalia. Various FGA practices are common throughout the world. While most frequent in Africa and Asia, transglobal migration has brought ritual FGA to Western nations. All forms of FGA are generally considered undesirable for medical and ethical reasons when performed on minors. One ritual FGA procedure is the vulvar nick. This is a small laceration to the vulva that does not cause morphological changes. Besides (...) being performed as a primary ritual procedure it has been proposed as a substitute for more extensive forms of FGA. Measures advocated or taken to reduce the burden of FGA can be punitive or non-punitive. Even if it is unethical to perform VN, we argue that it also is unethical to attempt to suppress it through punishment. First, punishment of VN is likely to cause more harm than good overall, even to those ostensibly being protected. Second, punishment is likely to exceed legitimate retributive ends. We do not argue in favor of performing VN. Rather, we argue that non-punitive strategies such as education and harm reduction should be employed. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:From Impatience to EmpathyStephanie Pierce and Kavita Shah AroraWe gave J.H. a label the first time we met her, as many often do—“Uncooperative.” She was a patient with autism and intellectual delay who had presented to the emergency department (ED) with vaginal bleeding. After receiving the gynecology consult request from the emergency medicine physicians, we were already mentally formulating our recommendations based on the information they told us (...) over the phone. “Does not cooperate with exam,” “no acute surgical intervention is currently warranted,” and “recommend outpatient follow–up.”When we arrived in her room, she was sitting in the hospital bed surrounded by a protective shield of caregivers from her group home. We introduced ourselves as the gynecology team but it was obvious that J.H. could not communicate verbally. Upon speaking with her caregivers we learned that she had Cowden syndrome, a genetic disease that confers significantly increased risks for several types of cancer including endometrial, thyroid, and breast cancers. J.H. had also been having heavy vaginal bleeding, which was difficult for her caregivers to manage, and this was the reason she was brought into the emergency department. After attempting to gain as much information as we could from the caregivers, we started to perform an abdominal exam, which made J.H. extremely agitated. We quickly stopped the exam and the caregivers helped to calm J.H. We remember our mixture of emotions—bewilderment at the agitation and commotion in the exam room full of people, frustration at not being able to complete our exam fully, and annoyance that this “difficult patient” was taking up our limited time between surgical cases. Thankfully, these knee–jerk reactions were quickly replaced by feelings of concern for the patient and the realization of how frightening an experience this must be for her—being in a strange place with white walls and unfamiliar people, unable to communicate her thoughts.J.H.’s mother, her surrogate decision–maker, was not at the hospital that day but the caregivers told us that she had expressed a strong desire for her daughter to have a prophylactic hysterectomy due to her lifetime risk for developing uterine cancer as well as a permanent solution to the bleeding concerns. What had initially started as a simple ED consult was now turning into a complex question. The ethical and legal dilemma was obvious—whether to perform a major surgery that would irreversibly sterilize a patient who could not consent on her own behalf in order to minimize the potential risk of cancer later in life. While medical management could improve the bleeding and potentially reduce the risk of cancer, frequent exams would be necessary [End Page 19] to ensure that the medication was working and that premalignant changes were not occurring in J.H.’s uterus. However, based on our experience in the emergency department, J.H. would need anesthesia for such exams and it was doubtful the medications would completely normalize her elevated risk of uterine malignancy. We knew that in order to address this question, we would need to see J.H. again along with her mother to have a frank discussion about the risks and benefits of such a decision, and so we made plans to see her in our outpatient clinic.Several days later, J.H., her mother, and the group home caregivers arrived in the office. Anticipating a complex discussion, we had requested a representative from the hospital ethics committee to join us at the visit. We didn’t know what to expect meeting J.H.’s mother for the first time but as we sat in the room talking, it was obvious that she was truly trying to act in her daughter’s best interest. Similarly, it was touching to watch the faces of the caregivers from the group home as they nodded in solidarity with J.H.’s mother, also clearly wanting what was best for her and supporting her mother in this difficult decision. J.H., meanwhile, seemed content to sit silently with us during the discussion, surrounded as she was by people who cared deeply for her well–being.After extensive partnership with the ethics consultants... (shrink)

The fields of HIV care in pregnancy and reproductive genetics have always been ‘exceptional’ in that patients are highly concerned about the potential for stigma and the corresponding need for privacy and confidentiality. However, the two fields have diverged in how they have addressed these concerns. The systematic review analyzed 61 manuscripts for similarities and differences between the fields of HIV care in pregnancy and reproductive genetics in the United States, with respect to privacy, confidentiality, disclosure, and stigma. The systematic (...) review revealed that the field of HIV care in pregnancy has insufficiently addressed patient concerns about privacy, confidentiality, and stigma compared to the field of reproductive genetics. Failure to adequately protect confidentiality of HIV-positive patients, and failure to reduce stigma associated with HIV testing and treatment are deficiencies in the delivery of care to HIV-positive pregnant woman and barriers to reducing vertical transmission of HIV. Im.. (shrink)

Due to a history of coerced sterilization, a federal Medicaid sterilization policy mandates that a specific consent form be signed by a patient at least thirty days prior to when the patient undergoes sterilization. However, in contemporary obstetrical practice, the Medicaid sterilization policy serves as a policy‐level barrier to autonomously desired care. We review the clinical and ethical implications of the current Medicaid sterilization policy. After discussing the utility and impact of waiting periods for other surgical procedures, we explore the (...) psychology of time required for decision‐making and consider scientific understanding of regret. We argue that the current Medicaid sterilization waiting period is clinically and ethically unjustifiable and that the policy ought to be revised in light of the goals, preferences, and concerns of the people most affected by it. While the need for continued protection against coercion remains, the current mandated waiting period does little to enforce the high‐quality shared decision‐making that is desired for sterilization counseling. (shrink)

Writing about the history and politics of epidemics and pandemics requires stepping into a historiography that is expansive, transnational, and slotted into specific historical periods. This essay considers the main debates in this expansive historiography and highlights the strengths and limitations of dominant historiographical approaches to the study of epidemics and pandemics. This essay also interrogates the framing of three thematic periods, or categories, commonly identified by historians and social scientists in analyses of epidemics and pandemics: categories of “colonial health,” (...) “international health,” and “global health.” As this essay underscores, scholarship often analyzes epidemics and pandemics through overlapping and complex historical temporalities involving colonization, decolonization, and globalization. However, this approach is often constrained by the limitations of existing archives and the overwhelming focus of published scholarship on dominant institutions, scientific and political figures, and specific disease outbreaks that are commonly associated with categories of “colonial health,” “international health,” and “global health” from the late nineteenth to the present. As a result, scholarship may include linear narratives that flatten or generalize the legacies of epidemics and pandemics. The links between pathogens and pathologies are not linear, however, and colonial structures of power, disease tropes, and surveillance doctrines often persist across time and space. This essay ultimately seeks to challenge and complicate these dominant framings and categories from within. This approach highlights the connectedness—and complex continuities and discontinuities—in the political, economic, social, and scientific perceptions of and approaches to epidemic and pandemic risks. (shrink)

Using medical advances to enhance human athletic, aesthetic, and cognitive performance, rather than to treat disease, has been controversial. Little is known about physicians? experiences, views, and attitudes in this regard. We surveyed a national sample of physicians to determine how often they prescribe enhancements, their views on using medicine for enhancement, and whether they would be willing to prescribe a series of potential interventions that might be considered enhancements. We find that many physicians occasionally prescribe enhancements, but doctors hold (...) nuanced and ambiguous views of these issues. Most express concerns about the potential effects of enhancements on social equity, yet many also believe specific enhancements that are safe and effective should be available but not covered by insurance. These apparently contradictory views might reflect inherent tensions between the values of equity and liberty, which could make crafting coherent social policies on medical enhancements challenging. [Supplementary materials are available for this article. Go to the publisher's online edition of American Journal of Bioethics for the following free supplemental resource(s): An additional table (Table 5) referred to on p. 5]. (shrink)

ObjectiveThere have been increased efforts to implement medical ethics curricula at the student and resident levels; however, practising physicians are often left unconsidered. Therefore, we sought to pilot an ethics and professionalism curriculum for faculty in obstetrics and gynaecology to remedy gaps in the formal, informal and hidden curriculum in medical education.MethodsAn ethics curriculum was developed for faculty within the Department of Obstetrics and Gynaecology at a tertiary care, academic hospital. During the one-time, 4-hour, mandatory in-person session, the participants voluntarily (...) completed the Oldenburg Burnout Inventory, Handoff Clinical Evaluation Exercise, University of Missouri-Kansas City School of Medicine and overall course evaluation. Patient satisfaction survey scores in both the hospital and ambulatory settings were compared before and after the curriculum.ResultsTwenty-eight faculty members attended the curriculum. Overall, respondents reported less burnout and performed at the same level or better in terms of patient handoff than the original studies validating the instruments. Faculty rated the professionalism behaviours as well as teaching of professionalism much lower at our institution than the validation study. There was no change in patient satisfaction after the curriculum. However, overall, the course was well received as meeting its objectives, being beneficial and providing new tools to assess professionalism.ConclusionThis pilot study suggests that an ethics curriculum can be developed for practising physicians that is mindful of pragmatic concerns while still meeting its objectives. Further study is needed regarding long term and objective improvements in ethics knowledge, impact on the education of trainees and improvement in the care of patients as a result of a formal curriculum for faculty. (shrink)

Since USA constitutional precedent established in 1976, adolescents have increasingly been afforded the right to access contraception without first obtaining parental consent or authorisation. There is general agreement this ethically permissible. However, long-acting reversible contraception methods have only recently been prescribed to the adolescent population. They are currently the most effective forms of contraception available and have high compliance and satisfaction rates. Yet unlike other contraceptives, LARCs are associated with special procedural risks because they must be inserted and removed by (...) trained healthcare providers. It is unclear whether the unique invasive nature of LARC changes the traditional ethical calculus of permitting adolescent decision-making in the realm of contraception. To answer this question, we review the risk–benefit profile of adolescent LARC use. Traditional justifications for permitting adolescent contraception decision-making authority are then considered in the context of LARCs. Finally, analogous reasoning is used to evaluate potential differences between permitting adolescents to consent for LARC procedures versus for emergency and pregnancy termination procedures. Ultimately, we argue that the invasive nature of LARCs does not override adolescents’ unique and compelling need for safe and effective forms of contraception. In fact, LARCs may oftentimes be in the best interest of adolescent patients who wish to prevent unintended pregnancy. We advocate for the specific enumeration of adolescents’ ability to consent to both LARC insertion and removal procedures within state policies. Given the provider-dependent nature of LARCs and the stigma regarding adolescent sexuality, special political and procedural safeguards to protect adolescent autonomy are warranted. (shrink)

Healthcare policies developed during the COVID-19 pandemic to safeguard community health have the potential to disadvantage women in three areas. First, protocols for deferral of elective surgery may assign a lower priority to important reproductive outcomes. Second, policies regarding the prevention and treatment of COVID-19 may not capture the complexity of the considerations related to pregnancy. Third, policies formulated to reduce infectious exposure inadvertently may increase disparities in maternal health outcomes and rates of violence towards women. In this commentary, we (...) outline these challenges unique to women’s healthcare in a pandemic, provide preliminary recommendations and identify areas for further exploration and refinement of policy. (shrink)