Context Opioid treatment agreements (OTAs) are documents that clinicians present to patients when prescribing opioids that describe the risks of opioids and specify requirements that patients must meet to receive their medication. Notwithstanding a lack of evidence that OTAs effectively mitigate opioids’ risks, professional organizations recommend that they be implemented, and jurisdictions increasingly require them. We sought to identify the jurisdictions that require OTAs, how OTAs might affect the outcomes of lawsuits that arise when things go wrong, and instances in (...) which the law permits flexibility for clinicians and health care institutions to adopt best practices. -/- Methods We surveyed the laws and regulations of all 50 states and the District of Columbia to identify which jurisdictions require the use of OTAs, the circumstances in which OTA use is mandatory, and the terms OTAs must include (if any). We also surveyed criminal and civil judicial decisions in which OTAs were discussed as evidence on which a court relied to make its decision to determine how OTA use influences litigation outcomes. -/- Findings Results show that a slight majority (27) of jurisdictions now require OTAs. With one exception, the jurisdictions’ requirements for OTA use are triggered at least in part by long-term prescribing. There is otherwise substantial variation and flexibility within OTA requirements. Results also show that even in jurisdictions where OTA use is not required by statute or regulation, OTA use can inform courts’ reasoning in lawsuits involving patients or clinicians. Sometimes, but not always, OTA use legally protects clinicians from liability. -/- Conclusions -/- Our results show that OTA use is entwined with legal obligations in various ways. Clinicians and health care institutions should identify ways for OTAs to enhance clinician–patient relationships and patient care within the bounds of relevant legal requirements and risks. (shrink)

Background In the wake of mandates for biomedical research to increase participation by members of historically underrepresented populations, community engagement (CE) has emerged as a key intervention to help achieve this goal.Methods Using interviews, observations, and document analysis, we examine how stakeholders in precision medicine research understand and seek to put into practice ideas about who to engage, how engagement should be conducted, and what engagement is for.Results We find that ad hoc, opportunistic, and instrumental approaches to CE exacted significant (...) consequences for the time and resources devoted to engagement and the ultimate impacts it has on research. Critical differences emerged when engagement and research decisionmaking were integrated with each other versus occurring in parallel, separate parts of the study organization, and whether community members had the ability to determine which issues would be brought to them for consideration or to revise or even veto proposals made upstream based on criteria that mattered to them. CE was understood to have a range of purposes, from instrumentally facilitating recruitment and data collection, to advancing community priorities and concerns, to furthering long-term investments in relationships with and changes in communities. These choices about who to engage, what engagement activities to support, how to solicit and integrate community input into the workflow of the study, and what CE was for were often conditioned upon preexisting perceptions and upstream decisions about study goals, competing priorities, and resource availability.Conclusions Upstream choices about CE and constraints of time and resources cascade into tradeoffs that often culminated in “pantomime community engagement.” This approach can create downstream costs when engagement is experienced as improvised and sporadic. Transformations are needed for CE to be seen as a necessary scientific investment and part of the scientific process. (shrink)

Taking up Lemke’s (2000) critical questions of how moments add up to lives and social life, we articulate theoretical and methodological frameworks for _perezhivanie_ and becoming, challenging binaries that splinter entangled flows of _perezhivanie_ into frozen categories. Working from a flat CHAT notion of assemblage to develop an ontology of moments, we stress consequentiality, arguing it emerges in intersections of embodied intensities (not only affective, but also indexical, intra-actional, and historic), the dispersed bio-cultural-historical weight of artifacts and practices, and dialogic (...) resonances across moments. Methodologically, we take an ethico-onto-epistemological perspective to systematically study perezhivanie. The bio-ecological model of rich environments (centered around meaningful complexity, agency, and individual optimization) offers both a key framework for understanding becoming and a design framework for transdisciplinary realizations of ethico-onto-epistemological practice. We illustrate these frameworks with examples from four research projects: a university physics lab group doing and writing an experiment, a former pastor managing bipolar disorder and rejecting faith, a sustained social justice education program at a university, and intersections of aging policies, media representations, and stroke survival in Brazil. Finally, we argue that an ontology of moments centered on consequentiality can illuminate _perezhivanie's_ relationship to becoming and that the model of enriched environments offers metrics to assess and design environments. (shrink)

The Institute of Medicine has returned the problem of medical error to the top of the health-care agenda. Its report that 44,000 to 98,000 patients die each year as a result of medical errors in American hospitals has renewed scholarly interest in health system quality control. In To Err Is Human, the IOM provides a vivid picture of a health-care system riven with serious quality problems. It calls for systems-based error-reduction methods borrowed from other high-risk industries and forcefully argues against (...) the traditional tendency to assign accountability primarily to individual physicians. Most errors, the IOM argues, can be successfully addressed by engineering systemic fail-safe protections against the inevitable failings of human actors. (shrink)

The Institute of Medicine has returned the problem of medical error to the top of the health-care agenda. Its report that 44,000 to 98,000 patients die each year as a result of medical errors in American hospitals has renewed scholarly interest in health system quality control. In To Err Is Human, the IOM provides a vivid picture of a health-care system riven with serious quality problems. It calls for systems-based error-reduction methods borrowed from other high-risk industries and forcefully argues against (...) the traditional tendency to assign accountability primarily to individual physicians. Most errors, the IOM argues, can be successfully addressed by engineering systemic fail-safe protections against the inevitable failings of human actors. (shrink)

Previous research has demonstrated that reversing the contrast of the eye region, which includes the eyebrows, affects the N170 ERP. To selectively assess the impact of just the eyes, the present study evaluated the N170 in response to reversing contrast polarity of just the iris and sclera in upright and inverted face stimuli. Contrast reversal of the eyes increased the amplitude of the N170 for upright faces, but not for inverted faces, suggesting that the contrast of eyes is an important (...) contributor to the N170 ERP. (shrink)

Digital contact tracing, in combination with widespread testing, has been a focal point for many plans to “reopen” economies while containing the spread of Covid‐19. Most digital contact tracing projects in the United States and Europe have prioritized privacy protections in the form of local storage of data on smartphones and the deidentification of information. However, in the prioritization of privacy in this narrow form, there is not sufficient attention given to weighing ethical trade‐offs within the context of a public (...) health pandemic or to the need to evaluate safety and effectiveness of software‐based technology applied to public health. (shrink)

In this chapter, we focus on the simple sounding question: What is it to have sex? On the assumption that having sex is what you do with all and only your sexual part-ners, this offers a way of focusing the question: What would it take for a sex robot to be a sex partner? In order to understand the significance of the development of robots with whom (or which) we can have sex, we need to know what it is to (...) have sex with a robot. And in order to know this, we have to know what it is to have sex, period. In the bulk of the chapter, we develop an account of shared sexual agency we think is a plausible precondition of genuinely having sex. In the final section, we remark briefly on the issue of what it would take to form a sexual we (as we call it) with a robot. For if we can do this, we can probably have sex with robots; but if we can’t, we can’t. (shrink)

Editors' introduction to Puncta's February 2022 Special Issue, "Pandemic Politics and Phenomenology.".

While previous research considering the emergence of strategic alliances has typically viewed their formation through a single theoretical lens, we suggest that multiple theoretical perspectives are needed to understand their complexity. This research conceptually integrates the resource-based view and institutional theory to assess variations in firm-level motivations to form strategic alliances. Applying these ideas to the context of complex environmental problems, we propose that strategic alliances typically are either competency- or legitimacy-oriented, and that four structural dimensions characterize both types of (...) alliances—organization learning, partner diversity, governance structure, and partner relations. We present research propositions that describe how alliances differ along these dimensions, and offer an important broader perspective on alliance formation that is applicable towards understanding their strategic and social outcomes. (shrink)

McCradden et al. propose to close the “AI chasm” between algorithms and clinically meaningful application using the norms of evidence-based medicine and clinical research, with the rat...

This paper offers a novel, qualitative approach to evaluating the outcomes of integrating humanities and ethics into a newly revised pre-clerkship medical education curriculum. The authors set out to evaluate medical students’ perceptions, learning outcomes, and growth in identity development. Led by a team of interdisciplinary scholars, this qualitative project examines multiple sources of student experience and perception data, including student essays, end-of-year surveys, and semi-structured interviews with students. Data were analyzed using deductive and inductive processes to identify key categories (...) and recurring themes. Results suggest that students not only engaged with the curricular content and met the stated learning objectives but also acknowledged their experience in the humanities and ethics curriculum as an opportunity to reflect, expand their perceptions of medicine (and what it means to be “in” medicine), connect with their classmates, and further cultivate their personal and professional identities. Results of this qualitative study show how and in what ways the ethics and humanities curriculum motivates students past surface-level memorization of factual knowledge and encourages thoughtful analysis and evaluation about how the course material relates to and influences their thinking and how they see themselves as future doctors. The comprehensive qualitative approach reflects a holistic model for evaluating the integration of humanities and ethics into the pre-clerkship medical education curriculum. Future research should examine if this approach provides a protective factor against the demonstrated ethical erosion and empathy decrease during clinical training. (shrink)

Fast and effective detection of the causative agent of malaria in humans, protozoan Plasmodium parasites, is of crucial importance for increasing the effectiveness of treatment and to control a devastating disease that affects millions of people living in endemic areas. The microscopic examination of Giemsa‐stained blood films still remains the gold‐standard in Plasmodium detection today. However, there is a high demand for alternative diagnostic methods that are simple, fast, highly sensitive, ideally do not rely on blood‐drawing and can potentially be (...) conducted by the patients themselves. Here, the history of Plasmodium detection is discussed, and advantages and disadvantages of diagnostic methods that are currently being applied are assessed. (shrink)

Graphical displays of simple moving geometrical figures have been repeatedly used to study the attribution of animacy in human observers. Yet little is known about the relevant movement characteristics responsible for this experience. The present study introduces a novel parametric research paradigm, which allows for the experimental control of specific motion parameters and a predictable influence on the attribution of animacy. Two experiments were conducted using 3D computer animations of one or two objects systematically introducing variations in the following aspects (...) of motion: directionality, discontinuity and responsiveness. Both experiments further varied temporal kinematics. Results showed that animacy experience increased with the time a moving object paused in the vicinity of a second object and with increasing complexity of interaction between the objects . The experience of animacy could be successfully modulated in a parametric fashion by the systematic variation of comparably simple differential movement characteristics. (shrink)

Background Over the last decade, the return of results (ROR) in precision medicine research (PMR) has become increasingly routine. Calls for individual rights to research results have extended the “duty to report” from clinically useful genetic information to traits and ancestry results. ROR has thus been reframed as inherently beneficial to research participants, without a needed focus on who benefits and how. This paper addresses this gap, particularly in the context of PMR aimed at increasing participant diversity, by providing investigator (...) and researcher perspectives on and questions about the assumed value of ROR in PMR.Methods Semi-structured interviews with a purposive sample of investigators and researchers across federally funded PMR studies in three national consortia, as well as observations of study activities, focused on how PM researchers conceptualize diversity and implement inclusive practices across research stages, including navigating ROR.Results Interviewees (1) validated the value of ROR as a benefit of PMR, while others (2) questioned the benefit of clinically actionable results to individuals in the absence of sufficient resources for translating findings into health care for diverse and disadvantaged populations; (3) expressed uncertainties in applying the presumed value of ROR as a benefit for non-clinical results; and (4) and debated when the promise of the value of ROR may undermine trust in PMR, and divert efforts to return value beyond ROR.Conclusions Conceptualizations of diversity and inclusion among PM researchers and investigators raise unique ethical questions where unexamined assumptions of the value of ROR inform study recruitment efforts to enroll minoritized and under-represented populations. A lack of consideration for resources and infrastructure necessary to translate ROR into actionable information may hinder trustworthy community-research relationships. Thus, we argue for a more intentional interrogation of ROR practices as an offer of benefit and for whom. (shrink)

In this paper, we discuss how phenomenology might cogently express the way painful experiences are layered with complex intersubjective meaning. In particular, we propose a critical conception of pain as an intricate multi-levelled phenomenon, deeply ingrained in the constitution of one’s sense of bodily self and emerging from a web of intercorporeal, social, cultural, and political relations. In the first section, we review and critique some conceptual accounts of pain. Then, we explore how pain is involved in complex ways with (...) modalities of pleasure and displeasure, enacted personal meaning, and contexts of empathy or shame. We aim to show why a phenomenology of pain must acknowledge the richness and diversity of peculiar painful experiences. The second section then weaves these critical insights into Husserlian phenomenology of embodiment, sensation, and localisation. We introduce the distinction between Body-Object and Lived-Body to show how pain presents intersubjectively. Furthermore, we stress that, while pain seems to take a marginal position in Husserl’s whole corpus, its role is central in the transcendental constitution of the Lived-Body, interacting with the personal, interpersonal, and intersubjective levels of experiential constitution. Taking a critical-phenomenological perspective, we then concretely explore how some people may experience structural conditions which may make their experiences more or less painful. (shrink)

The starting question in this article is: what does globalization mean philosophically? What matters for this article, is not inasmuch the content of the politico-moral claims or the ideological scope of worldviews as described by sociological and political sciences in the process of globalization, but rather a philosophical horizon that exceeds everyday political reality. This stems from a point of view that the debate on globalization and its alternatives is still too often protruded by ideological and idealist arguments. This article (...) will scrutinize what globalization actually means, considered from a philosophical standpoint. In order to investigate the meaning of globe in globalization, we turn to the philosophy of Jean-Luc Nancy. (shrink)

First, to what level of quality can medical ethics a spire, if it ignores callous discrimination in medrcal practice against large populations of the innocent poor? Second, how effective can such theories be in addressing the critical issues of medical and clinical ethics if they are unable to contribute to the closing of the gap of sociomedical disparity?Marcio Fabri dos Anjos, Medical Ethics in the Developing World: A Liberation Theology Perspective.

Little consensus exists about the effectiveness of transnational private governance in domains such as labor, the environment, or human rights. The paper builds on recent scholarship on labor standards to emphasize the role of labor agency in transnational private governance. It argues that the relationship between transnational private regulatory initiatives and labor agency depends on three competences: first, the ability of workers’ organizations to gain access to processes of employment regulation, implementation, and monitoring; second, their ability to insist on the (...) inclusion of employers and state agencies within such processes; and third, the ability of workers to effectively exercise leverage in pursuit of particular goals. The paper develops a framework, called hybrid production regime, for examining how workers’ capacity to act at the local level depends on how these three collective competences are addressed in the institutionalization of capital–labor relations between the transnational and national levels. (shrink)

Medicine and its allied health sciences have for too long been peripherally involved in work on human rights. Fifty years ago, the door to greater involvement was opened by Article 25 of the Universal Declaration of Human Rights, which underlined social and economic rights: “Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in (...) the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”. (shrink)

Graphic and gut-wrenching images of death, violence, and pain fill our news media, despite debate about their effect on audiences and their potential to harm their subjects. This research uses in-d...

Graphical AbstractVarious diagnostic methods are available to detect the six human pathogenic Plasmodium species that replicate within host erythrocytes and cause different types of malaria. Every currently available diagnostic method has distinct advantages and disadvantages. There is still a high demand for simple, fast, and highly sensitive alternative diagnostic methods that ideally do not rely on blood drawing and might be applied by the patient at home. In article number 1900138, Brian Gitta and Nicole Kilian discuss the history of (...) Plasmodium detection and assess advantages and disadvantages of diagnostic methods that are currently being applied. (shrink)

Statistical learning enables humans to involuntarily process and utilize different kinds of patterns from the environment. However, the cognitive mechanisms underlying the simultaneous acquisition of multiple regularities from different perceptual modalities remain unclear. A novel multidimensional serial reaction time task was developed to test 40 participants’ ability to learn simple first‐order and complex second‐order relations between uni‐modal visual and cross‐modal audio‐visual stimuli. Using the difference in reaction times between sequenced and random stimuli as the index of domain‐general statistical learning, a (...) significant difference and dissociation of learning occurred between the initial and final learning phases. Furthermore, we used a negative and positive occurrence‐frequency‐and‐reaction‐time correlation to indicate implicit and explicit learning, respectively, and found that learning simple uni‐modal patterns involved an implicit‐to‐explicit segue, while acquiring complex cross‐modal patterns required an explicit‐to‐implicit segue, resulting in a X‐shape crossing of regularity learning. Thus, we propose an X‐way hypothesis to elucidate the dynamic interplay between the implicit and explicit systems at two distinct stages when acquiring various regularities in a multidimensional probability space. (shrink)

Recent studies reveal some of the neurophysiological mechanisms involved in drug addiction. This prompts some theorists to claim that drug addiction diminishes responsibility. Stephen Morse however rejects this claim. Morse argues that these studies show that drug addiction involves neither compulsion, coercion, nor irrationality. He also adds that addicted people are responsible for becoming addicted and for failing to take measures to manage their addiction. After summarizing relevant neuroscience of addiction literature, this chapter engages critically with Morse to argue that (...) a subgroup of addicted people does meet plausible criteria for compulsion, coercion, or irrationality; that few addicted people are fully responsible for becoming addicted; and that some addicted people can be at least partly excused for failing to manage their addiction. Pickard and Lacey’s “responsibility without blame” approach is also suggested as a fruitful basis for future work in this field. (shrink)

Medicine and its allied health sciences have for too long been peripherally involved in work on human rights. Fifty years ago, the door to greater involvement was opened by Article 25 of the Universal Declaration of Human Rights, which underlined social and economic rights: “Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in (...) the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.”. (shrink)

While the agricultural knowledges and practices of Black, Indigenous, and People of Color and women have shaped agriculture in the US, these knowledges have been colonized, exploited, and appropriated, cleaving space for the presently dominant white male agricultural narrative. Simultaneously, these knowledges and practices have been transformed to fit within a society that values individualism, production, efficiency, and profit. The authors use a decolonial Feminist Political Ecology framework to highlight the ways in which the knowledges of Indigenous, Black, and women (...) farmers have been and are being colonized; a tradition that makes alternative agriculture a predominantly white space. The authors interviewed 10 BIPOC and women farmers in Colorado to understand what values and knowledges were shaping their often-appropriated agricultural practices. Three themes emerged: people, place, and patterns. By centering these values, farmers create relational agricultural practices that support the well-being of human and more-than-human beings. To support the widespread implementation of these practices, food systems practitioners must elevate the voices and knowledges of historically excluded farmers. Only then can truly just and equitable alternative agricultural practices be realized in the US. (shrink)

Previous discussions of the evolution of the self have diverged greatly in their estimates of the date at which the capacity for self-thought emerged, the factors that led self-reflection to evolve, and the nature of the evidence offered to support these disparate conclusions. Beginning with the assumption that human self-awareness involves a set of distinct cognitive abilities that evolved at different times to solve different adaptive problems, we trace the evolution of self-awareness from the common ancestor of humans and apes (...) to the beginnings of culture, drawing upon paleontological, anthropological, biological, and psychological evidence. These data converge to suggest that that modern self-thought appeared just prior to the Middle-Upper Paleolithic transition, approximately 60,000 years ago.Recto running head: Evolution of the Self. (shrink)

To assess whether and how environmental values and sense of place relate to sustainable farming practices, we conducted a study in South Kona, Hawaii, addressing environmental values, sense of place, and farm sustainability in five categories: environmental health, community engagement and food security, culture and history, education and research, and economics. We found that the sense of place and environmental values indexes showed significant correlation to each category of sustainability in both independent linear regressions and multivariate regression. In total, sense (...) of place explained a larger share of the overall farm performance. However, each indicator showed relative strengths; environmental values showed significantly higher correlation to environmental and educational practices. Furthermore the scales were complimentary, and the use of both scales greatly improved prediction of good farming practices from a multiple-impact perspective. With implications for community and environmental impacts, results suggest that a more comprehensive view of farmers’ environmental values and place connections may help illuminate individual farmers’ decisions and sustainability-related practices. (shrink)

Recent global efforts of the United States and England to withdraw from international institutions, along with recent challenges to human rights courts from Poland and Hungary, have been described as part of a growing global populist backlash against the liberal international order. Several scholars have even identified the recent threat of mass withdrawal of African states from the International Criminal Court (ICC) as part of this global populist backlash. Are the African challenges to the ICC part of a global populist (...) movement developing in Africa? More fundamentally, how are the African challenges to the ICC examples of populism, if at all? In this paper, I show that, while there is considerable overlap between the strategies used by particular African leaders to challenge the ICC and those typically considered populist, as well as a discernible thin populist ideology to sustain them, there is insufficient evidence of a larger anti-ICC populist movement in Africa. Although Africa is not as united against the ICC as the populist narrative suggests, the recent challenges to the Court from Africa pose a significant challenge to the Court, as the institution is still in the early stages of building its legitimacy. (shrink)

Human–robot interactions are often affected by error situations that are caused by either the robot or the human. Therefore, robots would profit from the ability to recognize when error situations occur. We investigated the verbal and non-verbal social signals that humans show when error situations occur in human–robot interaction experiments. For that, we analyzed 201 videos of five human–robot interaction user studies with varying tasks from four independent projects. The analysis shows that there are two types of error situations: social (...) norm violations and technical failures. Social norm violations are situations in which the robot does not adhere to the underlying social script of the interaction. Technical failures are caused by technical shortcomings of the robot. The results of the video analysis show that the study participants use many head movements and very few gestures, but they often smile, when in an error situation with the robot. The results suggest that participants do not see the robot as a social interaction partner with comparable communication skills. Our findings have implications for builders and evaluators of human–robot interaction systems. The builders need to consider including modules for recognition and classification of head movements to the robot input channels. The evaluators need to make sure that the presence of an experimenter does not skew the results of their user studies. (shrink)

Patientenselbstbestimmung und Patientenverfügungen haben zunehmende Bedeutung und Beachtung erfahren. In der vorliegenden qualitativen Studie wurden 15 Patientinnen und Patienten mit amyotropher Lateralsklerose —einer unheilbaren, chronisch-degenerativen Erkrankung mit vorhersehbarer Symptomatik—interviewt, um zu erfahren, welche Werte und Kriterien sie bei prospektiven Entscheidungen am Lebensende und bei der Abfassung von PV zugrunde legen. Die Auswertung erfolgte nach der Methode der „grounded theory“. Die befragten Patientinnen und Patienten befürworteten einen Verzicht auf lebenserhaltende Behandlungen, wenn sie keine hinreichenden Lebensmöglichkeiten mehr sahen, d. h. wenn sie (...) die aktuelle Lebensqualität für unzureichend erachteten und die Chance auf Besserung als gering einschätzten. Dem Patientenwillen sprachen sie bei der Entscheidungsfindung ein Vetorecht zu. Patientenverfügungen fassten sie erst ab, als sie keine Hoffnung mehr auf Besserung ihrer Erkrankung hatten. Sie verstanden diese als Instrumente zur vorsorglichen Erklärung ihres Wunsches, auf lebensverlängernde Maßnahmen zu verzichten, wenn die LM inakzeptabel geworden sind. Damit wollten sie sich gegenüber dem Arzt absichern, den sie in der Rolle eines Anwalts des Lebens sahen und mit dem sie daher ihre Behandlungswünsche nicht besprochen haben. Trotz vorhersehbarer Symptomatik legten sie in ihren PV keine spezifischen Behandlungswünsche nieder, sondern verwendeten allgemeine Formularmuster ohne konkreten Bezug zu ihrer Erkrankung. Daher bestehen auch bei dieser Patientengruppe Zweifel, ob die PV in einer konkreten Behandlungssituation hilfreich sind. (shrink)

Suppose you want to live a happy life. Who should you turn to for advice? We normally think that we know best about our own happiness. But recent work in psychology and neuroscience suggests that we are often mistaken about our own natures, and that sometimes scientists know us better than we know ourselves. Does this mean that to live a happy life we should ask scientists for advice rather than relying on our introspection? In what follows, we highlight ways (...) in which the science of happiness could help us live happy lives, but we also argue that, in other ways, our navel gazing will remain indispensable. (shrink)

This commentary analyzes the extent to which the incommensurability problem can be resolved through the proposed alternative method of integrative experiment design. We suggest that, although one aspect of incommensurability is successfully addressed (dimensional incommensurability), the proposed design space method does not yet alleviate another major source of discontinuity, which we call conceptual incommensurability.