In this case report, we describe a woman with advancing dementia who still retained decisional capacity and was able to clearly articulate her request for deactivation of her implanted cardiac pacemaker—a scenario that would result in her death. In this case, the patient had the autonomy to make her decision, but clinicians at an outside hospital refused to deactivate her pacemaker even though they were in unanimous agreement that the patient had capacity to make this decision, citing personal discomfort and (...) a belief that her decision seemed out of proportion to her suffering. We evaluated her at our hospital, found her to have decision-making capacity, and deactivated her pacer resulting in her death about 9 days later. While some clinicians may be comfortable discussing patient preferences for device deactivation in patients who are imminently dying, we can find no reports in the literature of requests for device deactivation from patients with terminal diagnoses who are not imminently dying. (shrink)

Quality and service improvement (QSI) research employs a broad range of methods to enhance the efficiency of healthcare delivery. QSI research differs from traditional healthcare research and poses unique ethical questions. Since QSI research aims to generate knowledge to enhance quality improvement efforts, should it be considered research for regulatory purposes? Is review by a research ethics committee required? Should healthcare providers be considered research participants? If participation in QSI research entails no more than minimal risk, is consent required? The (...) lack of consensus on answers to these questions highlights the need for ethical guidance. Three distinct approaches to classifying QSI research in accordance with existing ethical principles and regulations can be found in the literature. In the first approach, QSI research is viewed as distinct from other types of healthcare research and does not require regulation. In the second approach, QSI research falls within regulatory guidelines but is exempt from research ethics committee review. In the third approach, QSI research is deemed to be part of the learning healthcare system and, as such, is subject to a different set of ethical principles entirely. In this paper, we critically assess each of these views. While none of these approaches is entirely satisfactory, we argue that use of the ethical principles governing research provides the best means of addressing the numerous questions posed by QSI research. (shrink)

Plant-based milk alternatives–or mylks–have surged in popularity over the past ten years. We consider the politics and consumer subjectivities fostered by mylks as part of the broader trend towards ‘plant-based’ food. We demonstrate how mylk companies inherit and strategically deploy positive framings of milk as wholesome and convenient, as well as negative framings of dairy as environmentally damaging and cruel, to position plant-based as the ‘better’ alternative. By navigating this affective landscape, brands attempt to make mylk as simultaneously palatable and (...) disruptive to the status quo. We examine the politics of mylks through the concept of palatable disruption, where people are encouraged to care about the environment, health, and animal welfare enough to adopt mylks but to ultimately remain consumers of a commodity food. By encouraging consumers to reach for “plant-based” as a way to cope with environmental catastrophe and a life out of balance, mylks promote a neoliberal ethic: they individualize systemic problems and further entrench market mechanisms as solutions, thereby reinforcing the political economy of industrial agriculture. In conclusion, we reflect on the limits of the current plant-based trend for transitioning to more just and sustainable food production and consumption. (shrink)

This research explored how engineering student views of their responsibility toward helping individuals and society through their profession, so-called social responsibility, change over time. A survey instrument was administered to students initially primarily in their first year, senior year, or graduate studies majoring in mechanical, civil, or environmental engineering at five institutions in September 2012, April 2013, and March 2014. The majority of the students did not change significantly in their social responsibility attitudes, but 23 % decreased and 20 % (...) increased. The students who increased, decreased, or remained the same in their social responsibility attitudes over time did not differ significantly in terms of gender, academic rank, or major. Some differences were found between institutions. Students who decreased in social responsibility initially possessed more positive social responsibility attitudes, were less likely to indicate that college courses impacted their views of social responsibility, and were more likely to have decreased in the frequency that they participated in volunteer activities, compared to students who did not change or increased their social responsibility. Although the large percentage of engineering students who decreased their social responsibility during college was disappointing, it is encouraging that courses and participation in volunteer activities may combat this trend. (shrink)

Pragmatic randomized controlled trials are designed to evaluate the effectiveness of interventions in real-world clinical conditions. However, these studies raise ethical issues for researchers and regulators. Our objective is to identify a list of key ethical issues in pragmatic RCTs and highlight gaps in the ethics literature. We conducted a scoping review of articles addressing ethical aspects of pragmatic RCTs. After applying the search strategy and eligibility criteria, 36 articles were included and reviewed using content analysis. Our review identified four (...) major themes: 1) the research-practice distinction; 2) the need for consent; 3) elements that must be disclosed in the consent process; and 4) appropriate oversight by research ethics committees. 1) Most authors reject the need for a research-practice distinction in pragmatic RCTs. They argue that the distinction rests on the presumptions that research participation offers patients less benefit and greater risk than clinical practice, but neither is true in the case of pragmatic RCTs. 2) Most authors further conclude that pragmatic RCTs may proceed without informed consent or with simplified consent procedures when risks are low and consent is infeasible. 3) Authors who endorse the need for consent assert that information need only be disclosed when research participation poses incremental risks compared to clinical practice. Authors disagree as to whether randomization must be disclosed. 4) Finally, all authors view regulatory oversight as burdensome and a practical impediment to the conduct of pragmatic RCTs, and argue that oversight procedures ought to be streamlined when risks to participants are low. The current ethical discussion is framed by the assumption that the function of research oversight is to protect participants from risk. As pragmatic RCTs commonly involve usual care interventions, the risks may be minimal. This leads many to reject the research-practice distinction and question the need for informed consent. But the function of oversight should be understood broadly as protecting the liberty and welfare interest of participants and promoting public trust in research. This understanding, we suggest, will focus discussion on questions about appropriate ethical review for pragmatic RCTs. (shrink)

This article traces disagreements about the genetic effects of low-dose radiation exposure as waged by James Neel, a central figure in radiation studies of Japanese populations after World War II, and Yuri Dubrova, who analyzed the 1986 Chernobyl nuclear power plant accident. In a 1996 article in Nature, Dubrova reported a statistically significant increase in the minisatellite DNA mutation rate in the children of parents who received a high dose of radiation from the Chernobyl accident, contradicting studies that found no (...) significant inherited genetic effects among offspring of Japanese A-bomb survivors. Neel’s subsequent defense of his large-scale longitudinal studies of the genetic effects of ionizing radiation consolidated current scientific understandings of low-dose ionizing radiation. The article seeks to explain how the Hiroshima/nagasaki data remain hegemonic in radiation studies, contextualizing the debate with attention to the perceived inferiority of Soviet genetic science during the Cold War. (shrink)

Autism spectrum disorders (ASD) are thought to result in part from altered cortical excitatory-inhibitory balance; this pathophysiology may impact the generation of oscillations on EEG. We investigated premotor-parietal cortical physiology associated with praxis, which has strong theoretical and empirical associations with ASD symptomatology. 25 children with high-functioning ASD (HFA) and 33 controls performed a praxis task involving the pantomiming of tool use, while EEG was recorded. We assessed task-related modulation of signal power in alpha and beta frequency bands. Compared with (...) controls, subjects with HFA showed 27% less left central (motor/premotor) beta (18-22 Hz) event-related desynchronization (ERD) (p = 0.030), as well as 24% less left parietal alpha (7-13 Hz) ERD (p = 0.046). Within the HFA group, blunting of central ERD attenuation was associated with impairments in clinical measures of praxis imitation (r = -0.4; p = 0.04) and increased autism severity (r = 0.48; p = 0.016). The modulation of central beta activity is associated, among other things, with motor imagery, which may be necessary for imitation. Impaired imitation has been associated with core features of ASD. Altered modulation of oscillatory activity may be mechanistically involved in those aspects of motor network function that relate to the core symptoms of ASD. (shrink)

Our primary goal was to develop and validate a task that could provide evidence about how humans learn praxis gestures, such as those involving the use of tools. To that end, we created a video-based task in which subjects view a model performing novel, meaningless one-handed actions with kinematics similar to praxis gestures. Subjects then imitated the movements with their right hand. Trials were repeated 6 times to examine practice effects. EEG was recorded during the task. As a control, subjects (...) watched videos of a model performing a well-established (over learned) tool-use gesture. These gestures were also imitated 6 times. Demonstrating convergent validity, EEG measures of task-related cortical activation were similar in topography and frequency between the novel gesture task and the overlearned, praxis gesture task. As in studies assessing motor skill learning with simpler tasks, cortical activation during novel gesture learning decreased as the same gestures were repeated. In the control condition, repetition of overlearned tool-use gestures were also associated with reductions in activation, though to a lesser degree. Given that even overlearned, praxis gestures show constriction of EEG activity with repetition, it is possible that that attentional effects drive some of the repetition effects seen in EEG measures of activation during novel gesture repetition. (shrink)

Functional human brain mapping is commonly performed during invasive monitoring with intracranial electroencephalographic electrodes prior to resective surgery for drug­ resistant epilepsy. The current gold standard, electrocortical stimulation mapping, is time ­consuming, sometimes elicits pain, and often induces after discharges or seizures. Moreover, there is a risk of overestimating eloquent areas due to propagation of the effects of stimulation to a broader network of language cortex. Passive iEEG spatial-temporal functional mapping has recently emerged as a potential alternative to ESM. However, (...) investigators have observed less correspondence between STFM and ESM maps of language than between their maps of motor function. We hypothesized that incongruities between ESM and STFM of language function may arise due to propagation of the effects of ESM to cortical areas having strong effective connectivity with the site of stimulation. We evaluated five patients who underwent invasive monitoring for seizure localization, whose language areas were identified using ESM. All patients performed a battery of language tasks during passive iEEG recordings. To estimate the effective connectivity of stimulation sites with a broader network of task-activated cortical sites, we measured cortico-cortical evoked potentials elicited across all recording sites by single-pulse electrical stimulation at sites where ESM was performed at other times. With the combination of high gamma power as well as CCEPs results, we trained a logistic regression model to predict ESM results at individual electrode pairs. The average accuracy of the classifier using both STFM and CCEPs results combined was 87.7%, significantly higher than the one using STFM alone, indicating that the correspondence between STFM and ESM results is greater when effective connectivity between ESM stimulation sites and task-activated sites is taken into consideration. These findings, though based on a small number of subjects to date, provide preliminary support for the hypothesis that incongruities between ESM and STFM may arise in part from propagation of stimulation effects to a broader network of cortical language sites activated by language tasks, and suggest that more studies, with larger numbers of patients, are needed to understand the utility of both mapping techniques in clinical practice. (shrink)

Pragmatic comparative effectiveness randomized controlled trials evaluate the effectiveness of one interventions under real-world clinical conditions. The results of ceRCTs are often directly generalizable to everyday clinical practice, providing information critical to decision-making by patients, clinicians, and healthcare policymakers. The PRECIS-2 framework identifies nine domains that serve to score a trial on a continuum between very explanatory to very pragmatic. According to the framework, pragmatic trials may have one or more of the following features: there are fewer eligibility criteria for (...) participants, in an... (shrink)

Two theses figure centrally in work on the epistemology of disagreement: Equal Weight (‘EW’) and Uniqueness (‘U’). According to EW, you should give precisely as much weight to the attitude of a disagreeing epistemic peer as you give to your own attitude. U has it that, for any given proposition and total body of evidence, some doxastic attitude is the one the evidence makes rational (justifies) toward that proposition. Although EW has received considerable discussion, the case for U has not (...) been critically evaluated. Endorsing U, we argue, commits one to the highly controversial thesis that whatever fixes your rational attitudes can do so only by fixing what evidence you have. This commitment imposes a relatively demanding requirement on justified belief in U, one that we argue is not satisfied by what is currently the strongest available case for U, due to Roger White [2005]. Our challenge to U makes more trouble for its proponents than do the worries about U expressed by Gideon Rosen [2001] and Thomas Kelly [2010]. Moreover, if Kelly [2010] is correct in thinking that EW “carries with it a commitment to” U—a claim which we accept for reasons similar to Kelly’s but is beyond this paper’s scope (but see Ballantyne and Coffman [forthcoming])—then our challenge to U bears importantly on EW: to the extent that our challenge to U succeeds, EW also suffers. (shrink)

Two theses are central to recent work on the epistemology of disagreement: Conciliationism:?In a revealed peer disagreement over P, each thinker should give at least some weight to her peer's attitude. Uniqueness:?For any given proposition and total body of evidence, the evidence fully justifies exactly one level of confidence in the proposition. 1This paper is the product of full and equal collaboration between its authors. Does Conciliationism commit one to Uniqueness? Thomas Kelly 2010 has argued that it does. After some (...) scene-setting (?1), in ?2 we explain and criticize Kelly's argument, thereby defeating his larger argument that Conciliationism deserves no dialectical special treatment. But we argue further that Conciliationists are committed to a disjunction, one of whose disjuncts is Uniqueness, that amounts to an ?extremely strong and unobvious position? (??3?4). If we are correct, theorists should not treat Conciliationism as a default position in debates about the epistemic significance of disagreement. (shrink)

The societal and ethical impacts of emerging technological and business systems cannot entirely be foreseen; therefore, management of these innovations will require at least some ethicists to work closely with researchers. This is particularly critical in the development of new systems because the maximum degrees of freedom for changing technological direction occurs at or just after the point of breakthrough; that is also the point where the long-term implications are hardest to visualize. Recent work on shared expertise in Science & (...) Technology Studies (STS) can help create productive collaborations among scientists, engineers, ethicists and other stakeholders as these new systems are designed and implemented. But collaboration across these disciplines will be successful only if scientists, engineers, and ethicists can communicate meaningfully with each other. The establishment of a trading zone coupled with moral imagination present one method for such collaborative communication. (shrink)

The scope and severity of the opioid epidemic in the United States has prompted significant legislative intrusion into the patient-physician relationship. These proscriptive regulatory regimes mirror earlier legislation in other politically-charged domains like abortion and gun regulation. We draw on lessons from those contexts to argue that states should consider integrating their responses to the epidemic with existing medical regulatory structures, making physicians partners rather than adversaries in addressing this public health crisis.

This volume brings together twelve papers by linguists and philosophers contributing novel empirical and formal considerations to theorizing about vagueness. Three main issues are addressed: gradable expressions and comparison, the semantics of degree adverbs and intensifiers (such as 'clearly'), and ways of evading the sorites paradox.

While Dubourg and Baumard argue that predisposition toward exploration draws us to fictional environments, they fail to answer their titular question: “Why Imaginary Worlds?” Research in pretend play, psychological distancing, and theatre shows that being “imaginary” (i.e., any type of unreal, rather than only fantastically unreal) makes exploration of any fictional world profoundly different than that of real-life unfamiliar environments.

A substantial body of literature in the management discipline has evolved to make the case for and analyze the impacts of cross‐sector partnerships (CSPs). Yet, not all of these CSPs manifest the requisite collaborative propensities to achieve much more than superficial sustainability. Moreover, other disciplines like economics need to be brought to bear on analyses of such partnerships. In this article, we frame sustainable development challenges as collective action problems. We argue that over‐emphasizing the role of a single actor or (...) institution will not yield genuine sustainability. Instead, we propose that a collaborative orientation is necessary for business managers as they deal with challenges as expansive and complex as those presented by goals of the sustainability of the natural environment. Cross‐sector collaborative partnerships (CSCPs) are needed to achieve collective responsibility, wherein dialogic CSCPs issue in a new paradigm of collaborative markets. Market‐based solutions that ignore or minimize the important contributions that may be made by government, academia, and civil society organizations must give way to new models of collaboration across sectors. We identity specific challenges and opportunities for cross‐sector collaboration and provide case examples. There are important limits to addressing environmental and ethics problems from a single sector focus, and we show how meaningful sustainability can be facilitated within a dialogic cross‐sector collaborative perspective. (shrink)

This article describes a left-corner parser implemented within a cognitively and neurologically motivated distributed model of memory. This parser's approach to syntactic ambiguity points toward a tidy account both of surprisal effects and of locality effects, such as the parsing breakdowns caused by center embedding. The model provides an algorithmic-level account of these breakdowns: The structure of the parser's memory and the nature of incremental parsing produce a smooth degradation of processing accuracy for longer center embeddings, and a steeper degradation (...) when they are nested, in line with recall observations by Miller and Isard and speed-accuracy trade-off observations by McElree et al.. Modeling results show that this effect is distinct from the effects of ambiguity and exceeds the effect of mere sentence length. (shrink)

Expanding the Critical Animal Studies Imagination: Essays in Solidarity and Total Liberation pushes critical animal studies forward and outward by making new connections to movements and ideas that have been little engaged with in publication to the present. This book challenges critical animal studies adherents to expand their efforts of solidarity, mutual aid, and activism. Contributors to this volume extend invitations to those not familiar with critical animal studies to welcome them in with gestures of solidarity towards total liberation. Expanding (...) the Critical Animal Studies Imagination does not shy away from controversial topics but critically engages with them using care and tact. This is not controversy for the sake of being provocative, but not being afraid to target root causes of oppression. This book works toward coalition building to resist the current violence and build peaceful communities. (shrink)

Volume 19, Issue 10, October 2019, Page 101-103.

This research explored how engineering student views of their responsibility toward helping individuals and society through their profession, so-called social responsibility, change over time. A survey instrument was administered to students initially primarily in their first year, senior year, or graduate studies majoring in mechanical, civil, or environmental engineering at five institutions in September 2012, April 2013, and March 2014. The majority of the students did not change significantly in their social responsibility attitudes, but 23 % decreased and 20 % (...) increased. The students who increased, decreased, or remained the same in their social responsibility attitudes over time did not differ significantly in terms of gender, academic rank, or major. Some differences were found between institutions. Students who decreased in social responsibility initially possessed more positive social responsibility attitudes, were less likely to indicate that college courses impacted their views of social responsibility, and were more likely to have decreased in the frequency that they participated in volunteer activities, compared to students who did not change or increased their social responsibility. Although the large percentage of engineering students who decreased their social responsibility during college was disappointing, it is encouraging that courses and participation in volunteer activities may combat this trend. (shrink)

Non-consensual organ procurement from prisoners in China raises serious questions regarding the ethics of Chinese transplant research. In their article, published in this issue of JME, Higgins and colleagues address these questions through the lens of publication ethics. They argue that, ‘while there are potentially compelling justifications for use [of unethical research] under some circumstances, these justifications fail when unethical practices are ongoing’.1 Consequently, they recommend non-publication of Chinese transplant research and call for a mass retraction of the articles identified (...) in their review.2 To support their argument, Higgins and colleagues appeal to internationally recognised guidelines from the WHO3 and the World Medical Association, which assert that ‘executed prisoners must not be considered as organ and/or tissue donors’ due to the inability to acquire valid consent.4 Failing to declare an immediate publishing moratorium for transplant research involving prisoners in China, they argue, ‘undermines efforts to stop transplant-related human rights abuses, taints the evidence base, and renders those who publish and use the research complicit in the continuing harm’.5 We agree with Higgins and colleagues that non-consensual organ procurement from prisoners in China is a crime against humanity. Ongoing human rights violations in Chinese prisons are well documented and universally condemned. We also agree that the subsequent use of data acquired from unethical research is morally complex. Nonetheless, Higgins and colleagues’ arguments leave us with three …. (shrink)

Generalizing the work of Einstein and Mayer, it is assumed that at each point of space-time there exists an N-dimensional linear vector space with N≥5. This space is decomposed into a four-dimensional tangent space and an (N - 4)-dimensional internal space. On the basis of geometric considerations, one arrives at a number of fields, the field equations being derived from a variational principle. Among the fields obtained there are the electromagnetic field, Yang-Mills gauge fields, and fields that can be interpreted (...) as describing matter. As a simple example, the case N=6 is considered. (shrink)

Generalizing the work of Einstein and Mayer, it is assumed that at each point of space-time there exists a vector-spinor space with Nv vector dimensions and Ns spinor dimensions, where Nv=2k and Ns=2 k, k⩾3. This space is decomposed into a tangent space with4 vector and4 spinor dimensions and an internal space with Nv−4 vector and Ns−4 spinor dimension. A variational principle leads to field equations for geometric quantities which can be identified with physical fields such as the electromagnetic field, (...) Yang-Mills gauge fields, and wave functions of bosons and fermions. (shrink)