We describe and analyze 13 cases handled by our ethics consultation service (ECS) in which families requested continuation of physiological support for loved ones after death by neurological criteria (DNC) had been declared. These ethics consultations took place between 2005 and 2013. Patients’ ages ranged from 14 to 85. Continued mechanical ventilation was the focal intervention sought by all families. The ECS’s advice and recommendations generally promoted “reasonable accommodation” of the requests, balancing compassion for grieving families with other ethical and (...) moral concerns such as stewardship of resources, professional integrity, and moral distress. In cases we characterized as finitegoal accommodation, a “reasonable accommodation” strategy proved effective in balancing stakeholders’ interests and goals, enabling steady progress toward resolution. When a family objected outright to a declaration of DNC and asked for an indefinite accommodation, the “reasonable accommodation” approach offered clinicians little practical direction, and resolution required definitive action by either the family or the clinical team. Based on our analysis and reflections on these 13 cases, we propose ethically justified and practical guidelines to assist healthcare professionals, administrators, and ECSs faced with similar cases. (shrink)

Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and suggest that this is a significant step (...) on the pathway to an eventual certification process for clinical ethics consultants. (shrink)

The content of dreams and changes to the self were investigated in students moving to University. In study 1, 20 participants completed dream diaries and memory tasks before and after they had left home and moved to university, and generated self images, “I am…” statements , reflective of their current self. Changes in “I ams” were observed, indicating a newly-formed ‘university’ self. These self, images and related autobiographical knowledge were found to be incorporated into recent dreams but not into dreams (...) from other periods. Study 2 replicated these findings in a different sample . We suggest that these data reflect a period of self-consolidation in which new experiences and self images are incorporated into autobiographical memory knowledge structures representing personal goals during sleep. (shrink)

In this paper we study the variety of order Hilbert algebras, which is the equivalent algebraic semantics of the order implicational calculus of Bull.

This study expands the application of deonance theory into organizations’ upper echelons by examining how CEOs imprinted with a sense of duty can influence managerial decision-making. We hypothesize an imprint of bounded autonomy, an ought-force that constrains their decision-making and understanding of behavioral freedom, influences duty-bound CEOs to self-report errors in past financial reporting. We test deonance theory propositions of instrumentality for behavioral expansion, namely loss avoidance and gain attainment, related to institutional ownership concentration and CEO equity ownership. We use (...) CEOs that are graduates of U.S. service academies as a proxy for duty-bound executives and find firms they lead are more likely to issue a financial restatement to correct a previous reporting error. This finding is robust to alternate explanations such as being error-prone, earnings management, auditor oversight, and risk behaviors. We also find evidence that deonance may be subject to behavioral expansion. The likelihood of issuing a restatement decreases as institutional ownership concentration and CEO equity ownership increases. This study shows imprinted deonance within the C-suite influences important organizational outcomes. (shrink)

ABSTRACT:Anomie is a condition in which normative guidelines for governing conduct are absent. Using survey data from a sample of U.S. manufacturing firms, we explore the impact of internal (cultural) and external (environmental) determinants of organizational anomie. We suggest that four internal organizational factors can generate or suppress organizational anomie, including strategic aggressiveness, long-term orientation, competitor orientation, and strategic flexibility. Similarly, we argue that external contextual factors, including competitive intensity and technological turbulence, can influence organizational anomie. We extend anomie and (...) ethics research by considering the impact of these firm cultural and environmental factors according to whether firms are publicly-traded or privately-held. Findings demonstrate that a number of firm cultural and environmental factors can generate or reduce anomie in firms. Moreover, strategic aggressiveness, long-term orientation, and strategic flexibility influence organizational anomie differently depending on whether the firm is publicly-traded or privately-held. Theoretical and practical implications of our findings are discussed. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

The distinctive security features of the Spanish electronic national identity card, known as Documento Nacional de Identidad electrónico, allow us to propose the usage of this cryptographic smart card in an authentication framework that can be used during the registration and login phases of internet services where the validation of the user’s age and real identity are key elements, as it is the case for example of the so-called social networks. Using this mechanism with NFC-capable devices, the identity and age (...) of the potential user can be determined, allowing or denying the access to the service based on that information. (shrink)

If distributed cognition is to become a general analytic frame, it needs to handle more aspects of cognition than just highly efficient problem solving. It should also handle learning. We identify four classes of distributed learning: induction, repurposing, symbiotic tuning, and mutual adaptation. The four classes of distributed learning fit into a two-dimensional space defined by the stability and adaptability of individuals and their environments. In all four classes of learning, people and their environments are highly interdependent during initial learning. (...) At the same time, we present evidence indicating that certain types of interdependence in early learning, most notably mutual adaptation, can help prepare people to be less dependent on their immediate environment and more adaptive when they confront new environments. We also describe and test examples of learning technologies that implement mutual adaptation. (shrink)

If distributed cognition is to become a general analytic frame, it needs to handle more aspects of cognition than just highly efficient problem solving. It should also handle learning. We identify four classes of distributed learning: induction, repurposing, symbiotic tuning, and mutual adaptation. The four classes of distributed learning fit into a two-dimensional space defined by the stability and adaptability of individuals and their environments. In all four classes of learning, people and their environments are highly interdependent during initial learning. (...) At the same time, we present evidence indicating that certain types of interdependence in early learning, most notably mutual adaptation, can help prepare people to be less dependent on their immediate environment and more adaptive when they confront new environments. We also describe and test examples of learning technologies that implement mutual adaptation. (shrink)

Although risky decision-making has been posited to contribute to the maladaptive behavior of individuals with psychopathic tendencies, the performance of psychopathic groups on a common task of risky decision-making, the Iowa Gambling Task (IGT; Bechara, Damasio, Damasio, & Anderson, 1994), has been equivocal. Different aspects of psychopathy (personality traits, antisocial deviance) and/or moderating variables may help to explain these inconsistent findings. In a sample of college students (N = 129, age 18–27), we examined the relationship between primary and secondary psychopathic (...) features and IGT performance. A measure of impulsivity was included to investigate its potential as a moderator. In a joint model including main effects and interactions between primary psychopathy, secondary psychopathy and impulsivity, only secondary psychopathy was significantly related to risky IGT performance, and this effect was not moderated by the other variables. This finding supports the growing literature suggesting that secondary psychopathy is a better predictor of decision-making problems than the primary psychopathic personality traits of lack of empathy and remorselessness. (shrink)

While outcomes for children with T-cell acute lymphoblastic leukemia have improved dramatically, survival rates for patients with relapsed/refractory disease remain dismal. Prior studies indicate that glucocorticoid resistance is more common than resistance to other chemotherapies at relapse. In addition, failure to clear peripheral blasts during a prednisone prophase correlates with an elevated risk of relapse in newly diagnosed patients. Here we show that intrinsic GC resistance is present at diagnosis in early thymic precursor T-ALLs as well as in a subset (...) of non-ETP T-ALLs. GC-resistant non-ETP T-ALLs are characterized by strong induction of JAK/STAT signaling in response to interleukin-7 stimulation. Removing IL7 or inhibiting JAK/STAT signaling sensitizes these T-ALLs, and a subset of ETP T-ALLs, to GCs. The combination of the GC dexamethasone and the JAK1/2 inhibitor ruxolitinib altered the balance between pro- and anti-apoptotic factors in samples with IL7-dependent GC resistance, but not in samples with IL7-independent GC resistance. Together, these data suggest that the addition of ruxolitinib or other inhibitors of IL7 receptor/JAK/STAT signaling may enhance the efficacy of GCs in a biologically defined subset of T-ALL.Leukemia advance online publication, 30 May 2017; doi:10.1038/leu.2017.136. (shrink)

Replaces communal altruism with communal egoism as a way of solving problems of too much violence and too little peace in the twenty-first century.

For a theory T, we study relationships among IΔ n +1 (T), LΔ n+1 (T) and B * Δ n+1 (T). These theories are obtained restricting the schemes of induction, minimization and (a version of) collection to Δ n+1 (T) formulas. We obtain conditions on T (T is an extension of B * Δ n+1 (T) or Δ n+1 (T) is closed (in T) under bounded quantification) under which IΔ n+1 (T) and LΔ n+1 (T) are equivalent. These conditions depend (...) on Th Πn +2 (T), the Π n+2 –consequences of T. The first condition is connected with descriptions of Th Πn +2 (T) as IΣ n plus a class of nondecreasing total Π n –functions, and the second one is related with the equivalence between Δ n+1 (T)–formulas and bounded formulas (of a language extending the language of Arithmetic). This last property is closely tied to a general version of a well known theorem of R. Parikh. Using what we call Π n –envelopes we give uniform descriptions of the previous classes of nondecreasing total Π n –functions. Π n –envelopes are a generalization of envelopes (see [10]) and are closely related to indicators (see [12]). Finally, we study the hierarchy of theories IΔ n+1 (IΣ m ), m≥n, and prove a hierarchy theorem. (shrink)

Controversy and activism have long been linked to the subject of primate research. Even in the midst of raging ethical debates surrounding fertility treatments, genetically modified foods and stem-cell research, there has been no reduction in the campaigns of activists worldwide. Plying their trade of intimidation aimed at ending biomedical experimentation in all animals, they have succeeded in creating an environment where research institutions, often painted as guilty until proven innocent, have avoided addressing the issue for fear of becoming targets. (...) One area of intense debate is the use of primates in stroke research. Despite the fact that stroke kills more people each year than AIDS and malaria, and less than 5% of patients are candidates for current therapies, there is significant opposition to primate stroke research. A balanced examination of the ethics of primate stroke research is thus of broad interest to all areas of biomedical research. (shrink)

The history of the Euclidean Steiner tree problem, which is the problem of constructing a shortest possible network interconnecting a set of given points in the Euclidean plane, goes back to Gergonne in the early nineteenth century. We present a detailed account of the mathematical contributions of some of the earliest papers on the Euclidean Steiner tree problem. Furthermore, we link these initial contributions with results from the recent literature on the problem.

The aim of this study was to investigate the consistency between the self-reports and teacher ratings of students’ emotional and social inclusion at school as well as for their academic self-concept. The German version of the Perceptions of Inclusion Questionnaire (PIQ) was administered to 329 grade 8 students (50.8% female, Mage = 14.5 years, SDage = 0.5 years) and their teachers. First, the three-dimensional structure of both PIQ versions was confirmed by confirmatory item factor analysis. The  and  coefficients (...) demonstrated good reliability for all scales. Second, a correlated trait-correlated method minus one model provided evidence that the method-specificity of teacher ratings was larger than the consistency between the self-reports and teacher ratings. Third, the results of a latent difference model indicated that general method effects can partly be explained by a student’s gender or special educational needs. Finally, the low consistency between self-reports and teacher rating is discussed. (shrink)

Controversy and activism have long been linked to the subject of primate research. Even in the midst of raging ethical debates surrounding fertility treatments, genetically modified foods and stem-cell research, there has been no reduction in the campaigns of activists worldwide. Plying their trade of intimidation aimed at ending biomedical experimentation in all animals, they have succeeded in creating an environment where research institutions, often painted as guilty until proven innocent, have avoided addressing the issue for fear of becoming targets. (...) One area of intense debate is the use of primates in stroke research. Despite the fact that stroke kills more people each year than AIDS and malaria, and less than 5% of patients are candidates for current therapies, there is significant opposition to primate stroke research. A balanced examination of the ethics of primate stroke research is thus of broad interest to all areas of biomedical research. (shrink)

Introduction Currently, The nature and scope of Clinical Ethics Protocols in Madrid are not well understood.Objectives The main objective is to describe the features of ‘guideline/recommendation’ type CEPs that have been or are being developed by existing Clinical Ethics Committees in Madrid. Secondary objectives include characterisation of those CECs that have been the most prolific in reference to CEP creation and implementation and identification of any trends in future CEP development.Methods We collected CEPs produced and in process by CECs accredited (...) in the public hospitals in Madrid, Spain, from 1996 to 2008.Results CECs developed 30 CEPs, with 10 more in process. The most common topic is refusal of treatment . If CEPs addressing terminal illness, Do-Not-Resuscitate orders and advance directives are placed into a separate ‘ethical problems at the end of life’ category, this CEP subject emerges as the most common . There is a relationship between the age of the CEC and the development of CEPs . CECs now seem to be more likely to engage in CEP development.Conclusions The CECs in Madrid, Spain, have developed a significant number of CEPs and there is a trend towards continued development. The most frequent topics are ethical problems at the end of life and refusal of treatment by the patient. (shrink)

The situation of historical knowledge: the historicized world -- The technology of historical knowledge: management-systems -- The logic of historical knowledge: causality, rationality, identity -- The organization of historical knowledge: categorical coordinators; rhetorical strategy -- The purpose of historical knowledge: comprehension.