Since early 2014, i have studied what life is like for staff in a mental health sanatorium at a Ghanaian prayer camp. I have traveled to the camp on six occasions to observe its rhythms and routines and interview staff about their work. What follows is an informal reflection on the role of prayer camps as a source of mental health care in Ghana. The text is based on my experience conducting the research at the camp, rather than a formal (...) reporting of results. As such, I make minimal references to theoretical frameworks and previous literature and instead have relied on my own field notes and recreated conversations I had with one staff member in particular.Despite longstanding records of human rights abuses, many... (shrink)

According to grounded cognition, words whose semantics contain sensory-motor features activate sensory-motor simulations, which, in turn, interact with spatial responses to produce grounded congruency effects. Growing evidence shows these congruency effects do not always occur, suggesting instead that the grounded features in a word's meaning do not become active automatically across contexts. Researchers sometimes use this as evidence that concepts are not grounded, further concluding that grounded information is peripheral to the amodal cores of concepts. We first review broad evidence (...) that words do not have conceptual cores, and that even the most salient features in a word's meaning are not activated automatically. Then, in three experiments, we provide further evidence that grounded congruency effects rely dynamically on context, with the central grounded features in a concept becoming active only when the current context makes them salient. Even when grounded features are central to a word's meaning, their activation depends on task conditions. (shrink)

Many health care organizations made public commitments to become antiracist in the wake of George Floyd's murder. These actions raise questions about the appropriateness of health care's engagement in racial justice and social justice movements generally. We argue that health care organizations can be usefully thought of as having two roles: a functional role to care for the sick and a meta‐role as an organizational citizen. Fulfilling the role of citizen may require participating in the pursuit of social justice, including (...) efforts to achieve racial equity. The demands of these two roles will need to be balanced, but the role of organizational citizen has been largely ignored and merits serious attention. (shrink)

The health policy community has a growing interest in the impact of nonmedical determinants of health, such as housing, nutrition, and social supports, on both health outcomes and costs. This interest has been spurred by the Affordable Care Act’s emphasis on prevention, Robert Wood Johnson’s grant‐making focus on a Culture of Health, and an uptick of research demonstrating the potential returns to health care from investments in social services. Much of this policy‐making, grant making, and research has focused on older (...) Americans.The direct policy implications of this strategy can be elusive. It has become clear that more than medicine will be necessary to improve older Americans’ health status. Real improvement likely requires the development of additional social service offerings, including housing that is accessible to people with disabilities, Meals on Wheels‐type nutrition supports, and transportation. But who should bear the costs and control the finances associated with these programs? In this essay, I explore the question of how policy‐makers should consider financing nonmedical investments in older Americans’ health. As the reader will recognize, I stop short of arguing for what will work. Rather, I identify the strands of an emerging strategy—namely, for health care dollars to be diverted into social service programming—and offer several cautions. It may be that policy‐makers still wish to continue down this path, but my hope is that this essay will allow them to so with greater attention to the risks and unintended consequences of that strategy. (shrink)

This essay summarizes key insights across the essays in the Hastings Center Report's special report “Time to Rebuild: Essays on Trust in Health Care and Science.” These insights concern trust and trustworthiness as distinct concepts, competence as a necessary but not sufficient input to trust, trust as a reciprocal good, trust as an interpersonal as well as structural phenomena, the ethical impermissibility of seeking to win trust without being trustworthy, building and borrowing trust as distinct strategies, and challenges to trustworthiness (...) posed by the contingent nature of science. Together, these insights stand to advance an area of research that we believe has been historically stymied by conceptual confusion and a long‐standing insistence on treating trust as a purely instrumental good. (shrink)

For global health academics and practitioners, it can feel as though we are living in a tyranny of partnerships. The primary trappings of professional success in global health—funding and publications—increasingly rely on the presence or absence of institutional partnerships. Funders often require letters of support from collaborators, and the literature routinely lauds partnerships as the "secret sauce" necessary to solve intractable problems. Commonly, the term describes relationships between entities in the Global North and the Global South, serving as a euphemism (...) for relationships that, at their core, are premised on a transfer of resources from the former to the latter. Many partnerships... (shrink)

As the cesarean rate rises in the United States, it is sometimes hailed as a move toward increased safety or increased autonomy. But the industrialization of birth may have consequences which actually decrease women’s autonomy and strip choices away.

During natural speech perception, listeners rely on a wide range of cues to support comprehension, from semantic context to prosodic information. There is a general consensus that prosody plays a role in syntactic parsing, but most studies focusing on ambiguous relative clauses (RC) show that prosodic cues, alone, are insufficient to reverse the preferred interpretation of sentence. These findings suggest that universally preferred structures (e.g., Late Closure principle) matter far more than prosodic cues in such cases. This study explores an (...) alternative hypothesis: that the weak effect of prosody might be due to the influence of various syntactic, lexical-semantic, and acoustic confounding factors, and investigate the consequences of prosodic breaks while controlling these variables. We used Spanish RC sentences in three experimental conditions where the presence and position (following the first or second noun phrase) of prosodic breaks was manipulated. The results showed that the placement of a prosodic break determined sentence interpretation by changing the preferred attachment of the RC. Listeners’ natural preference for low attachment (in the absence of break) was reinforced when a prosodic break was placed after the first noun. In contrast, a prosodic break placed after the second noun reversed the preferred interpretation of the sentence, toward high attachment. We argue that, in addition to other factors, listeners indeed use prosodic breaks as robust cues to syntactic parsing during speech processing, as these cues may direct listeners toward one interpretation or another. (shrink)

In response to Casasanto, Brookshire, and Ivry, we address four points: First, we engaged in conceptual replications of Brookshire, Casasanto, and Ivry, not direct replications. Second, we did not question the validity of Brookshire et al.'s results, nor the similar findings of other researchers, but instead explained divergent findings within an integrated theoretical framework. Third, challenges to the construct of automaticity, including ours, were widespread, long before Brookshire et al.'s article. Fourth, the planned comparisons that we reported tested our theoretical (...) claims and offered strong evidence for them. (shrink)

We investigate whether the disclosure of a firm’s decision to organize as a benefit corporation (BC) rather than a traditional C corporation (CC) influences investors. We survey 136 investors and 57 MBA students and find that they expect BCs to attain higher future corporate social responsibility (CSR) than CCs even when both have equal CSR ratings. Approximately one third of our sample prefers to invest in BCs when CCs have greater financial returns, indicating a willingness by some investors to sacrifice (...) personal financial gain for social good. Our results suggest that investors weight the information contained in BC disclosures as reliable and value-relevant in their investment decisions. We extend the CSR disclosure literature by indicating how investors weight this new type of CSR information, which may affect how BCs fare as publicly traded companies. (shrink)

The present volume contains 14 contributions presented at a colloquium on "Structure and Approximation in Physical Theories" held at Osnabruck in June 1980. The articles are presented in the revised form written after the colloquium and hence also take account of the results of the discussion at the colloquium. It is a striking feature that the problem of approximation in physical theories has only recently found some attention in the philosophy of science, although the working physicist is con stantly confronted (...) with those questions. No interesting theory of exact science exactly fits its experimental data; almost every relation between different theories is an approximate one. There fore an adequate reconstruction of physical theories must take into account and conceptualize the moment of approximation. The majority of the articles in this book is centered around this subject. There are at least two elaborate, 'structuralistic' approaches to the formalization of physical theories in which the aspect of approximation has been incorporated: the approach due to P. Suppes, J. Sneed, W. Stegmuller ("S-approach") and the approach of G. Lud wig and his co-workers ("L-approach"). The articles in this book correspondingly fall into three classes: presentation, elaboration and critique of the L-approach [Hartkamper/Schmidt, Ludwig, Neumann, Werner, Schmidt, Mayr, Kamiah, Majer, Grafe] or of the S-approach [Moulines, Balzer, Cooke], and articles referring to both approaches or concerned with related matters [Scheibe, Pfarr, Castrigiano]. Of course, this is only a rough classification and each article must be appraised in its own right. (shrink)

DeStefano, Oey, Brockbank, and Vul explore interdisciplinary collaboration using data‐driven measures of research topics and co‐authorship, constructed from a rich dataset of over 11,000 Cogsci conference papers. Findings suggest the cognitive science research community has become increasingly integrated in the last 19 years.

A substantial portion of the developed world's population is increasingly dependent on machines to make their way in the everyday world. For certain privileged groups, computers, cell phones, PDAs, Blackberries, and IPODs, all permitting the faster processing of information, are commonplace. In these populations, even exercise can be automated as persons try to achieve good physical fitness by riding stationary bikes, running on treadmills, and working out on cross-trainers that send information about performance and heart rate.

Objective:Prior research examining sexual and intimacy concerns among metastatic breast cancer patients and their intimate partners is limited. In this qualitative study, we explored MBC patients’ and partners’ experiences of sexual and intimacy-related changes and concerns, coping efforts, and information needs and intervention preferences, with a focus on identifying how the context of MBC shapes these experiences.Methods:We conducted 3 focus groups with partnered patients with MBC [N = 12; M age = 50.2; 92% White; 8% Black] and 6 interviews with (...) intimate partners [M age = 47.3; 83% White; 17% Black]. Participants were recruited through the Fox Chase Cancer Center Tumor Registry and the Cancer Support Community. Qualitative data were analyzed using the Framework Method and Dedoose software.Results:Qualitative analyses revealed several key themes reflecting ways in which MBC shapes experiences of sex/intimacy: the heavy disease/treatment burden leads to significant, long-term sexual concerns and consequent heightened emotional distress for both patients and partners ; viewing the relationship as having “an expiration date” influences patients’ and partners’ concerns related to sex/intimacy and complicates coping efforts; and information needs extend beyond managing sexual side effects to include emotional aspects of intimacy and the added strain of the life-limiting nature of the disease on the relationship. The heightened severity of sexual concerns faced by patients with MBC, compounded by the terminal nature of the disease, may place patients and partners at risk for significant adverse emotional and interpersonal consequences.Conclusion:Findings suggest unique ways in which sex and intimate relationships change after a diagnosis of metastatic breast cancer from both patients’ and partners’ perspectives. Consideration of the substantial physical and emotional burden of MBC and the broader context of the relationship and intimacy overall is important when developing a sexuality-focused intervention in this population. Addressing sexual concerns is a critical part of cancer care with important implications for patients’ health and quality of life. (shrink)

David Dranove and Lawton Burn’s new collaboration Big Med: Megaproviders and the High Cost of Health Care in America provides readers with a comprehensive tutorial on consolidation in United States healthcare markets over the past 40 years. Although the book is most explicitly aimed at those who look around and wonder how we arrived at a healthcare landscape dominated by giants, anyone with a serious interest in the prices of U.S. healthcare will want to have this rigorous and timely treatment (...) on their bookshelf. (shrink)

This article is an attempt to develop a measure of ethical sensitivity to racial and gender intolerance that occurs in schools. Acts of intolerance that indicate ethically insensitive behaviors in American schools were identified and tied to existing professional ethical codes developed by school-based professional organizations. The Racial Ethical Sensitivity Test consists of 5 scenarios that portray acts of racial intolerance and ethical insensitivity. Participants viewed 2 videotaped scenarios and then responded to a semistructured interview protocol adapted from Bebeau and (...) Rest. After a 2-week interval, this procedure was repeated. Stability of the REST across time was determined by using the overall test-retest coefficient. Internal as well as interrater consistency was also calculated for each scenario. Overall findings indicate promise for the REST as a reliable measure to assess racial and ethnic sensitivity. (shrink)

This article presents data from the Growing up with Media study related to the implementation of a risk reduction protocol that resulted in three groups of youth: low-risk youth (no flags), youth flagged because of violence involvement and not clinically referred; and flagged youth who were referred to a team clinician due to additional risk considerations. Data are from 3,979 US youth 14–15 years of age recruited through social media between October 2018-August 2019. Four in ten youth were flagged for (...) review. Findings suggest that this methodology of identifying and reviewing cases appears to be working as intended: Not only did referred youth have more flags than non-referred youth, but post-hoc analyses suggested that these youth also had higher rates of psychosocial problems (e.g., non-victimization adversity, substance use, and depressed mood). The implementation of a risk reduction protocol such as the one described in this article adds a layer of human subject protection beyond the more standard list of websites and hotlines provided to all participants in most studies. This protocol leads the way for future studies to recreate a similar process to address concerning responses collected from survey research. (shrink)

Everyone, it seems, is talking and arguing about Evidence-Based Practice. Those therapies and assessments designated as EBP increasingly determine what is taught, researched, and reimbursed in health care. But exactly what is it, and how do you do it? The second edition of Clinician's Guide to Evidence-Based Practices is the concise, practitioner-friendly guide to applying EBPs in mental health. Step-by-step it explains how to conduct the entire EBP process-asking the right questions, accessing the best available research, appraising the research, translating (...) that research into practice, integrating that research with clinician expertise and patient characteristics, evaluating the entire enterprise, attending to the ethical considerations, and when done, moving the EBP process forward by teaching and disseminating it. This book will help you:. Formulate useful questions that research can address. Search the research literature efficiently for best practices. Make sense out of the research morass, sifting wheat from chaff. Incorporate patient values and diversity into the selection of EBP. Blend clinician expertise with the research evidence. Translate empirical research into practice. Ensure that your clients receive effective, research-supported services. Infuse the EBP process into your organizational setting and training methods. Identify and integrate ethics in the context of EBP Coauthored by a distinguished quartet of clinicians, researchers, and a health care librarian, the Clinician's Guide has become the classic for graduate students and busy professionals mastering EBP. ". (shrink)

Answering important public health questions often requires collection of sensitive information about individuals. For example, our understanding of how HIV is transmitted and how to prevent it only came about with people's willingness to share information about their sexual and drug-using behaviors. Given the scientific need for sensitive, personal information, researchers have a corresponding ethical and legal obligation to maintain the confidentiality of data they collect and typically promise in consent forms to restrict access to it and not to publish (...) identifying data.The interests of others, however, can threaten researchers' promises of confidentiality when legal demands are made to access research data. In some cases, the subject of the litigation is tightly connected to the research questions, and litigants' interest in the data is not surprising. Researchers conducting studies on tobacco or occupational or other chemical exposures, for example, are relatively frequent targets of subpoenas. (shrink)

COVID-19 vaccine refusal seems like a paradigm case of irrationality. Vaccines are supposed to be the best way to get us out of the COVID-19 pandemic. And yet many people believe that they should not be vaccinated even though they are dissatisfied with the current situation. In this paper, we analyze COVID-19 vaccine refusal with the tools of contemporary philosophical theories of responsibility and rationality. The main outcome of this analysis is that many vaccine-refusers are responsible for the belief that (...) they should not be vaccinated and epistemically rational in holding it. This is an important result because it provides insights into the legitimacy of certain public health policies. In particular, this result shows that a public health policy that would abandon the project of convincing certain vaccine-refusers with reasons – e.g., by simply making vaccination compulsory – is prima facie illegitimate. (shrink)

This essay provides an analysis of the role of affectivity in Martin Heidegger's writings from the mid to late 1920s. We begin by situating his account of mood within the context of his project of fundamental ontology in Being and Time. We then discuss the role of Befindlichkeit and Stimmung in his account of human existence, explicate the relationship between the former and the latter, and consider the ways in which the former discloses the world. To give a more vivid (...) and comprehensive picture of Heidegger's account of mood, we focus on the experience of anxiety by articulating both its function within fundamental ontology and, relatedly, its revelatory nature. We conclude by considering the place of emotions in Heidegger's thinking from this period. In a companion essay, ‘Affectivity in Heidegger II: Temporality, Boredom, and Beyond’, we complement our present analysis by revisiting the issue of affectivity in terms of Heidegger's discussion of temporality in Division II of Being and Time. We also expand our present discussion by considering the fundamental mood of boredom and other specific moods that Heidegger considers within his later thinking. (shrink)

The medical profession is observing a rising number of calls to action considering the threat that climate change poses to global human health. Theory-led bioethical analyses of the scope and weight of physicians’ normative duty towards climate protection and its conflict with individual patient care are currently scarce. This article offers an analysis of the normative issues at stake by using Korsgaard’s neo-Kantian moral account of practical identities. We begin by showing the case of physicians’ duty to climate protection, before (...) we succinctly introduce Korsgaard’s account. We subsequently show how the duty to climate protection can follow from physicians’ identity of being a healthcare professional. We structure conflicts between individual patient care and climate protection, and show how a transformation in physicians’ professional ethos is possible and what mechanisms could be used for doing so. An important limit of our analysis is that we mainly address the level of individual physicians and their practical identities, leaving out important measures to respond to climate change at the mesolevels and macrolevels of healthcare institutions and systems, respectively. (shrink)

Visual cortical prostheses (VCPs) have the potential to provide artificial vision for visually impaired persons. However, the nature and utility of this form of vision is not yet fully understood. Participants in the early feasibility trial for the Orion VCP were interviewed to gain insight into their experiences using artificial vision, their motivations for participation, as well as their expectations and assessments of risks and benefits. Analyzed using principles of grounded theory and an interpretive description approach, these interviews yielded six (...) themes, including: the irreducibility of benefit to device functionality, mixed expectations for short-term device functionality and long-term technological advancement of visual prostheses, and a broad range of risks, concerns, and fears related to trial participation. We argue that these narratives motivate a nuanced set of ethical considerations related to the complex relationship between functionality and benefit, the intersection of user experience with disability justice, and the import of expectations and indirect risks on consent. (shrink)

Objective This work disentangles moral tolerance from moral relativism and reveals their distinct personological meanings. Both constructs have long been of interest to moral philosophers, moral psychologists, and everyday people, and they may play prominent roles in the feasibility of modern diverse societies. However, they have been criticized as devaluing morality and as producing overly permissive societies. Moreover, although they lack necessary conceptual implications for each other, they are easily (and often) conflated. -/- Method Three studies included nine samples (total (...) N > 3,200, 40%–50% female, Mage = 38–40, 83% white). Participants completed (online) new measures of moral tolerance and moral relativism, along with measures of 40 additional constructs. -/- Results Results reveal robust psychometric quality of the new measures (the Moral Relativism Scale and the Moral Tolerance Scale), demonstrate that the constructs are empirically overlapping but separable, and highlight their distinct personological networks. Moral relativism was associated with liberal political views and a lowered valuing/enacting of moral values. Moral tolerance was weakly associated with liberal political views but was strongly related to a broad range of both liberal and conservative moral values. -/- Conclusion This work yields new tools for investigating moral character, and it reveals the differential meaning of two important moral constructs. (shrink)

This paper explores the relationship between romantic love and polyamory. Our central question is whether traditional norms of monogamy can be excised from romantic love so as to harmonize with polyamory’s ethical dimensions (as we construe them). How one answers this question bears on another: whether ‘polyamory’ should principally be understood in terms of romantic love or instead some alternative conception(s). Our efforts to address these questions begin by briefly motivating our favored approach to romantic love, a “narratival” one inspired (...) by 1930s cultural theorist Denis de Rougemont, wherein such love is exclusive, supernatural or promising transcendence, painful, impeded, and, ultimately, fatal. We maintain that, even once exclusivity is removed as an official component, tensions with polyamory’s ethical dimensions remain: romantic love’s other elements rationalize acting and feeling in ways that privilege a singular beloved above others. A tempting solution is to further revise romantic love. However, we are skeptical that this leaves space for distinctively romantic love. Our tentative proposal, then, is that polyamory’s ethical dimensions favor rejecting romantic love as ultimately desirable. (shrink)

Background Financial relationships between physicians and industry are extensive and public reporting of industry payments to physicians is now occurring. Our objectives were to describe physician recipients of large total payments from these seven companies, and to examine discrepancies between these payments and conflict of interest (COI) disclosures in authors’ concurrent publications. Methods The investigative journalism organization, ProPublica, compiled the Dollars for Docs database of payments to individuals from publically available data from seven US pharmaceutical companies during the period 2009 (...) to 2010. We examined the cohort of 373 physicians in this database who each received USD $100,000 or more in the reporting period 2009 to 2010. Results These physicians received a total of $52,600,624 during this period (mean payment per physician $141,020). The predominant specialties were internal medicine and psychiatry. 147 of these physicians authored a total of 134 publications in the first quarter of 2011 and 77% (103) of these publications provided a COI disclosure. 69% of the 103 publications did not contain disclosures of the payment listed in the Dollars for Docs database. Conclusions With increased public reporting of industry payments to physicians, it is apparent that large sums are being paid for services such as consulting and peer education. In over two-thirds of publications where COI disclosures were provided, the disclosures by physician authors did not include industry payments that were documented in the Dollars for Docs database. (shrink)

We give an overview of the practice of developing and using complex climate models, as seen from experiences in a major climate modelling center and through participation in the Coupled Model Intercomparison Project. We discuss the construction and calibration of models; their evaluation, especially through use of out-of-sample tests; and their exploitation in multi-model ensembles to identify biases and make predictions. We stress that adequacy or utility of climate models is best assessed via their skill against more naïve predictions. The (...) framework we use for making inferences about reality using simulations is naturally Bayesian, and has many points of contact with more familiar examples of scientific epistemology. While the use of complex simulations in science is a development that changes much in how science is done in practice, we argue that the concepts being applied fit very much into traditional practices of the scientific method, albeit those more often associated with laboratory work. (shrink)