Given that university faculty members and supervisors practicing in the community have been involved in at least one research supervisor-graduate student relationship, it is surprising that so little attention has been paid to the ethical issues involved in such relationships. Indeed, as a student and her or his graduate research supervisor may be involved in a close working relationship for many years, it is understandable that several opportunities can arise that could be considered dual or multiple relationships. Examples of such (...) relationship issues discussed in this article include authorship matters, favoritism or inequitable treatment of students, and sexual relationships. Depending on the nature of the relationship, the impact on students can be quite severe; although, the effects on students have not been adequately studied. Existing ethical guidelines do not provide enough guidance in this area where students are in a position of diminished power with respect to the supervisor. Following the discussion of relationship issues, we suggest extensions of current guidelines to deal with these issues. (shrink)

The Test of Basic Auditory Capabilities is a battery of auditory-discrimination tasks and speech-identification tasks that has been normed on several hundred young normal-hearing adults. Previous research with the TBAC suggested that cognitive function may impact the performance of older adults. Here, we examined differences in performance on several TBAC tasks between a group of 34 young adults with a mean age of 22.5 years and a group of 115 older adults with a mean age of 69.2 years recruited from (...) the local community. Performance of the young adults was consistent with prior norms for this age group. Not surprisingly, the two groups differed significantly in hearing loss and working memory with the older adults having more hearing loss and poorer working memory than the young adults. The two age groups also differed significantly in performance on six of the nine measures extracted from the TBAC with the older adults consistently performing worse than the young adults. However, when these age-group comparisons were repeated with working memory and hearing loss as covariates, the groups differed in performance on only one of the nine auditory measures from the TBAC. For eight of the nine TBAC measures, working memory was a significant covariate and hearing loss never emerged as a significant factor. Thus, the age-group deficits observed initially on the TBAC most often appeared to be mediated by age-related differences in working memory rather than deficits in auditory processing. The results of these analyses of age-group differences were supported further by linear-regression analyses with each of the 9 TBAC scores serving as the dependent measure and age, hearing loss, and working memory as the predictors. Regression analyses were conducted for the full set of 149 adults and for just the 115 older adults. Working memory again emerged as the predominant factor impacting TBAC performance. It is concluded that working memory should be considered when comparing the performance of young and older adults on auditory tasks, including the TBAC. (shrink)

Preface -- The mood elevator -- What drives the mood elevator? -- Up the mood elevator : the big payoffs -- Escaping unhealthy normal -- Braking your mood elevator : the power of curiosity -- Interrupting your pattern -- Feeding the thoughts you favor -- Living in mild preference -- Shifting your set point : the wellness equation -- Quieting your mind -- Cultivating gratitude -- Honoring our separate realities -- Nurturing faith and optimism -- Dealing with your down days (...) -- Relationships and the mood elevator -- Pointers for riding the mood elevator -- Notes -- How this book came to be -- Bibliography -- Acknowledgments -- Index -- About the author. (shrink)

David Benatar argues that coming into existence is always a harm, and that – for all of us unfortunate enough to have come into existence – it would be better had we never come to be. We contend that if one accepts Benatar’s arguments for the asymmetry between the presence and absence of pleasure and pain, and the poor quality of life, one must also accept that suicide is preferable to continued existence, and that his view therefore implies both anti-natalism (...) and pro-mortalism . This conclusion has been argued for before by Elizabeth Harman – she takes it that because Benatar claims that our lives are ‘awful’, it follows that ‘we would be better off to kill ourselves’ (Harman 2009: 784). Though we agree with Harman’s conclusion, we think that her argument is too quick, and that Benatar’s arguments for non-pro-mortalism deserve more serious consideration than she gives them. We make our case using a tripartite structure. We start by examining the prima facie case for the claim that pro-mortalism follows from Benatar’s position, presenting his response to the contrary, and furthering the dialectic by showing that Benatar’s position is not just that coming into existence is a harm, but that existence itself is a harm. We then look to Benatar’s treatment of the Epicurean line, which is important for him as it undermines his anti-death argument for non-pro-mortalism. We demonstrate that he fails to address the concern that the Epicurean line raises, and that he cannot therefore use the harm of death as an argument for non-pro-mortalism. Finally, we turn to Benatar’s pro-life argument for non-pro-mortalism, built upon his notion of interests, and argue that while the interest in continued existence may indeed have moral relevance, it is almost always irrational. Given that neither Benatar’s anti-death nor pro-life arguments for non-pro-mortalism work, we conclude that pro-mortalism follows from his anti-natalism, As such, if it is better never to have been, then it is better no longer to be. -/- . (shrink)

In this volume we will focus on how educators in high schools (grades 9-12) can incorporate the teaching of ethics effectively across all disciplines.

Preceded by Comprehensive textbook of psychotherapy: theory, and practice / edited by Bruce Bongar, Larry E. Beutler. 1995.

Background: Omalizumab, an anti-immunoglobulin E antibody, reduces exacerbations and symptoms in uncontrolled allergic asthma. The study objective was to estimate the costs and consequences of omalizumab compared to usual care from a US payer perspective. Methods: We estimated payer costs, quality-adjusted survival (QALYs), and the incremental cost-effectiveness ratio (ICER) of omalizumab compared to usual care using a state-transition simulation model that included sensitivity analyses. Every 2 weeks, patients could transition between chronic asthma and exacerbation health states. The best available evidence (...) informed the clinical and cost input estimates. Five years of omalizumab treatment followed by usual care was assumed to estimate a lifetime horizon. Omalizumab responders (60.5% of treated) were modeled as a separate scenario where nonresponders reverted back to usual care after 16 weeks of active treatment. Results: The mean lifetime discounted costs and QALYs were $83 400 and 13.87 for usual care and $174 500 and 14.19 for omalizumab plus usual care resulting in $287 200/QALY (95% interval: $219 300, $557 900). The ICER was $172 300/QALY when comparing omalizumab to usual care in the responder scenario. One-way sensitivity analyses indicated that the results were sensitive to the difference in treatment-specific utilities for the chronic state, exacerbation-associated mortality, omalizumab price, exacerbation rates, and response definition. Conclusions: The results suggest that adding omalizumab to usual care improves QALYs at an increase in direct medical costs. The cost-effectiveness of omalizumab is similar to other chronic disease biologics. The value increases when omalizumab response is used to guide long-term treatment. (shrink)

The aim of this systematic review was to summarize and assess the quality of asthma intervention health economic studies from 2002 to 2007, compare the study findings with clinical management guidelines, and suggest avenues for future improvement of asthma health economic studies. Forty of the 177 studies met our inclusion criteria. We assessed the quality of studies using The Quality of Health Economic Studies validated instrument (total score range: 0-100). Six studies (15%) had quality category 2, 26 studies (65%) achieved (...) quality category 3, and the remaining eight (20%) studies were scored as the highest quality level, category 4. Overall, the findings from this review are in line with the Global Initiative for Asthma clinical guidelines. Many asthma health economic studies lacked appropriate long term time horizons to match the chronic nature of the disease and suffered from using effectiveness measures that did not capture all disease related risks and benefits. We recommend that new asthma simulation models: be flexible to allow for long term time horizons, focus on using levels of asthma control in their structure, and estimate both long term asthma specific outcomes like well-controlled time as well as generic outcomes such as quality adjusted survival. (shrink)

The recent Common Rule revision process took almost a decade and the resulting changes are fairly modest, particularly when compared to the ambitious ideas proposed in the advance notice of proposed rulemaking and notice of proposed rulemaking. Furthermore, the revision process did not even attempt to tackle any of the Common Rule subparts pertaining to vulnerable populations where commentators think the rules unduly restrict important research. We believe that this was a missed opportunity to make desirable changes, and that given (...) the usual process the next opportunity to revisit the Common Rule is unacceptably remote. In this article, we argue that the Common Rule should be regularly reassessed, with a mechanism for making substantive changes. Drawing on lessons learned from the recent revision process, we make recommendations about ways to structure future attempts to maximize the ability to make timely and necessary changes. (shrink)

The Covid‐19 pandemic has concentrated bioethics attention on the “lifeboat ethics” of rationing and fair allocation of scarce medical resources, such as testing, intensive care unit beds, and ventilators. This focus drives ethics resources away from persistent and systemic problems—in particular, the structural injustices that give rise to health disparities affecting disadvantaged communities of color. Bioethics, long allied with academic medicine and highly attentive to individual decision‐making, has largely neglected its responsibility to address these difficult “upstream” issues. It is time (...) to broaden our teaching, research, and practice to match the breadth of the field in order to help address these significant societal inequities and unmet health needs. (shrink)

This user-friendly companion to the comprehensive Guidelines for the Systematic Treatment of the Depressed Patient outlines psycho-behavioral interventions to help practicing clinicians select the appropriate therapeutic procedure for various patients. This brief reference book for professional psychotherapists is intended to help practicing clinicians select the appropriate therapeutic procedure for various patients.

We argue that the trend toward providing users with feasible and actionable explanations of AI decisions—known as recourse explanations—comes with ethical downsides. Specifically, we argue that recourse explanations face several conceptual pitfalls and can lead to problematic explanation hacking, which undermines their ethical status. As an alternative, we advocate that explanations of AI decisions should aim at understanding.

Much new global genetic research employs whole genome sequencing, which provides researchers with large amounts of data. The quantity of data has led to the generation and discovery of more incidental or secondary findings and to vigorous theoretical discussions about the ethical obligations that follow from these incidental findings. After a decade of debate in the genetic research community, there is a growing consensus that researchers should, at the very least, offer to return incidental findings that provide high‐impact, medically relevant (...) information, when it is not unduly burdensome to the research enterprise to do so. Much as genetic research has been limited to U.S. and European settings, the incidental findings debate has primarily focused on research conducted in high‐income countries. In a 2015 paper, Alberto Ortiz‐Osorno, Linda Ehler, and Judith Brooks note salient differences between the circumstances of research participants in low‐ and high‐resource settings that alter the analysis of when and why incidental findings should be offered to research participants. In this article, we expand on their analysis and present a framework for thinking about how investigators’ obligations to return genomic data might change in low‐resource settings, particularly in settings where participants do not have access to the medical care needed to treat, assess, or monitor incidental findings that are actionable in settings with plentiful resources. (shrink)

Efforts by governments, firms, and patients to deliver pioneering drugs for critical health needs face a challenge of diminishing efficiency in developing those medicines. While multi-sectoral collaborations involving firms, researchers, patients, and policymakers are widely recognized as crucial for countering this decline, existing incentives to engage in drug development predominantly target drug manufacturers and thereby do little to stimulate collaborative innovation. In this mini review, we consider the unexplored potential within pharmaceutical regulations to create novel incentives to encourage a diverse (...) set of actors from the public and private spheres to engage in the kind of collaborative knowledge exchange requisite for fostering enhanced innovation in early drug development. (shrink)

In this paper several problems are raised concerning Ian Barbour's four ways of interrelating science and religion—Conflict, Independence, Dialogue, and Integration—as put forward in such publications as his highly influential Religion in an Age of Science (1990) and widely adopted by other writers in this field. The authors argue that this taxonomy is not very useful or analytically helpful, especially to historians seeking to understand past engagements between science and religion.

Given that university faculty members and supervisors practicing in the community have been involved in at least one research supervisor-graduate student relationship, it is surprising that so little attention has been paid to the ethical issues involved in such relationships. Indeed, as a student and her or his graduate research supervisor may be involved in a close working relationship for many years, it is understandable that several opportunities can arise that could be considered dual or multiple relationships. Examples of such (...) relationship issues discussed in this article include authorship matters, favoritism or inequitable treatment of students, and sexual relationships. Depending on the nature of the relationship, the impact on students can be quite severe; although, the effects on students have not been adequately studied. Existing ethical guidelines do not provide enough guidance in this area where students are in a position of diminished power with respect to the supervisor. Following the discussion of relationship issues, we suggest extensions of current guidelines to deal with these issues. (shrink)

Across a wide range of legal contexts, E. Thomas Sullivan and Richard S. Frase identify three basic ways that government measures and private remedies have been ...

This path-breaking book reconceptualizes our understanding of political tolerance as well as of its foundations.

This article focusses upon defining those factors which may contribute to the pathogenesis of cancer. The molecular basis of tumour etiology is discussed with reference to cancer predisposing syndromes, and in particular to the human inherited disease, Bloom's sysdrome. In Bloom's syndrome, patients are predisposed to a wide variety of malignant disease. We propose a model in which overexpression of the ubiquitous c‐myc proto‐oncogene contributes to this process.