Deep brain stimulation is an experimental procedure for treatment-resistant depression. Some results show promise, but blinded trials had limited success. Ethical questions center on vulnerability: especially on whether depressed patients can weigh the risks and benefits effectively, whether depression causes “desperation,” and whether media portrayals create unrealistic hopes. We interviewed 24 psychiatric inpatients with treatment-resistant depression, qualitatively analyzing their comments. Most had minimal interest in deep brain stimulators. Some might consider them if their depression worsened, if alternatives were exhausted, or (...) if the evidence were stronger. Fears focused on the surgery, adverse effects, and the novelty of the device. Patients felt the depression interfered with their ability to weigh the risks and benefits. Patients seemed highly attuned to the risks, and were skeptical that the treatment would be effective. We conclude that ethical concerns about vulnerability remain, yet patients with treatment-resistant depression were thoughtful and cautious about trying a novel therapy. (shrink)

What role should the physician's conscience play in the practice of medicine? Much controversy has surrounded the question, yet little attention has been paid to the possibility that disputants are operating with contrasting definitions of the conscience. To illustrate this divergence, we contrast definitions stemming from Abrahamic religions and those stemming from secular moral tradition. Clear differences emerge regarding what the term conscience conveys, how the conscience should be informed, and what the consequences are for violating one's conscience. Importantly, these (...) basic disagreements underlie current controversies regarding the role of the clinician's conscience in the practice of medicine. Consequently participants in ongoing debates would do well to specify their definitions of the conscience and the reasons for and implications of those definitions. This specification would allow participants to advance a more philosophically and theologically robust conversation about the means and ends of medicine. (shrink)

Conscientious objection among physicians is a perennial hot topic on both sides of the Atlantic. Sven Nordstrand's survey of Norwegian medical students adds fresh data to this ongoing debate.1Their starting point, whether doctors should be allowed to refuse any procedure to which they object on cultural, moral or religious grounds, is truly at the heart of the debate. Their finding that only 20.8% of students endorse this position is striking as it is less than half the number reported by Sophie (...) Strickland in her survey of medical students in the UK.2 It also suggests much less support for conscientious objection than was found among USA primary care physicians, where 78% agreed that “A physician should never do what he or she believes is morally wrong, no matter what experts say.”3These data invite speculation about why there is such dramatic variation between countries. Much can be made of Nordstrand's comments that in Norway “each citizen is assigned a particular general practitioner” and “In the Norwegian healthcare system the general practitioner has a crucial role as …. (shrink)

Background: Genetic tests for schizophrenia may introduce risks and benefits. Among young adults at clinical high risk for psychosis, little is known about their concerns and how they assess potential risks. Methods: We conducted semistructured interviews with 15 young adults at clinical high risk for psychosis to ask about their concerns. Results: Participants expressed concerns about test reliability, data interpretation, stigma, psychological harm, family planning, and privacy. Participants’ responses showed some departure from the ethics literature insofar as participants were primarily (...) interested in reporting their results to people to whom they felt emotionally close, and expressed little consideration of biological closeness. Additionally, if tests showed an increased genetic risk for schizophrenia, four clinical high-risk persons felt obligated to tell an employer and another three would “maybe” tell an employer, even in the absence of clinical symptoms. Conclusions: These findings suggest opportunities for clinicians and genetic counselors to intervene with education and support. (shrink)

What role should the physician's conscience play in the practice of medicine? Much controversy has surrounded the question, yet little attention has been paid to the possibility that disputants are operating with contrasting definitions of the conscience. To illustrate this divergence, we contrast definitions stemming from Abrahamic religions and those stemming from secular moral tradition. Clear differences emerge regarding what the term conscience conveys, how the conscience should be informed, and what the consequences are for violating one's conscience. Importantly, these (...) basic disagreements underlie current controversies regarding the role of the clinician's conscience in the practice of medicine. Consequently participants in ongoing debates would do well to specify their definitions of the conscience and the reasons for and implications of those definitions. This specification would allow participants to advance a more philosophically and theologically robust conversation about the means and ends of medicine. (shrink)

Background Although medical ethicists and educators emphasise patient-centred decision-making, previous studies suggest that patients often prefer their doctors to make the clinical decisions. Objective To examine the associations between a preference for physician-directed decision-making and patient health status and sociodemographic characteristics. Methods Sociodemographic and clinical information from all consenting general internal medicine patients at the University of Chicago Medical Center were examined. The primary objectives were to (1) assess the extent to which patients prefer an active role in clinical decision-making, (...) and (2) determine whether religious service attendance, the importance of religion, self-rated spirituality, Charlson Comorbidity Index, self-reported health, Vulnerable Elder Score and several demographic characteristics were associated with these preferences. Results Data were collected from 8308 of 11 620 possible participants. Ninety-seven per cent of respondents wanted doctors to offer them choices and to consider their opinions. However, two out of three (67%) preferred to leave medical decisions to the doctor. In multiple regression analyses, preferring to leave decisions to the doctor was associated with older age (per year, OR=1.019, 95% CI 1.003 to 1.036) and frequently attending religious services (OR=1.5, 95% CI 1.1 to 2.1, compared with never), and it was inversely associated with female sex (OR=0.6, 95% CI 0.5 to 0.8), university education (OR=0.6, 95% CI 0.4 to 0.9, compared with no high school diploma) and poor health (OR=0.6, 95% CI 0.3 to 0.9). Conclusions Almost all patients want doctors to offer them choices and to consider their opinions, but most prefer to leave medical decisions to the doctor. Patients who are male, less educated, more religious and healthier are more likely to want to leave decisions to their doctors, but effects are small. (shrink)

Progressive supranuclear palsy is a movement disorder with prominent tau neuropathology. Brain diseases with abnormal tau deposits are called tauopathies, the most common of which is Alzheimer's disease. Environmental causes of tauopathies include repetitive head trauma associated with some sports. To identify common genetic variation contributing to risk for tauopathies, we carried out a genome-wide association study of 1,114 individuals with PSP and 3,247 controls followed by a second stage in which we genotyped 1,051 cases and 3,560 controls for the (...) stage 1 SNPs that yielded P ≤ 10-3. We found significant previously unidentified signals associated with PSP risk at STX6, EIF2AK3 and MOBP. We confirmed two independent variants in MAPT affecting risk for PSP, one of which influences MAPT brain expression. The genes implicated encode proteins for vesicle-membrane fusion at the Golgi-endosomal interface, for the endoplasmic reticulum unfolded protein response and for a myelin structural component. © 2011 Nature America, Inc. All rights reserved. (shrink)

In this paper we use a critically reflective research approach to analyze our efforts at transformative learning in food systems education in a land grant university. As a team of learners across the educational hierarchy, we apply scholarly tools to the teaching process and learning outcomes of student-centered inquiries in a food systems course. The course, an interdisciplinary, lower division undergraduate course at the University of California, Davis is part of a new undergraduate major in Sustainable Agriculture and Food Systems. (...) We provide an overview of the course’s core elements—labs, exams, assignments, and lectures—as they relate to social constructivist learning theory and student-centered inquiries. Then, through qualitative analysis of students’ reflective essays about their learning experiences in the course, we demonstrate important transformative outcomes of student-centered inquiries: (1) most students confronted the commodity fetish and tried to reconcile tensions between what the food system is and ought to be, and (2) students repositioned themselves, their thinking, and social deliberation in relation to the food system. Students’ reflections point to the power of learning that emerges through their inquiry process, including in the field, and from critical self-reflection. We also highlight the importance of reflective essays in both reinforcing experiential learning and in helping instructors to better understand students’ learning vis-à-vis our teaching. (shrink)

The gap between the decision to engage in physical activity and subsequent behavioral enactment is considerable for many. Action control theories focus on this discordance in an attempt to improve the translation of intention into behavior. The purpose of this mini-review was to overview one of these approaches, the multi-process action control framework, which has evolved from a collection of previous works. The main concepts and operational structure of M-PAC was overviewed followed by applications of the framework in physical activity, (...) and concluded with unanswered questions, limitations, and possibilities for future research. In M-PAC, it is suggested that three layered processes build upon each other from the formation of an intention to a sustained profile of physical activity action control. Intention-behavior discordance is because of strategic challenges in goal pursuit and automatic tendencies. Regulatory processes are employed to hold the relationship between reflective processes and behavior concordant by countering these strategic challenges and automatic tendencies until the development of reflexive processes begin to co-determine action control. Results from 29 observational and preliminary experimental studies generally support the proposed M-PAC framework. Future research is needed to explore the temporal dynamic between reflexive and regulatory constructs, and implement M-PAC interventions in different forms, and at different levels of scale. (shrink)

This study examined the approaches used by two preservice elementary school teachers as they designed and taught antiracist social studies lessons about civil rights history during a community-based field experience. Using a theoretical framework of racial pedagogical content knowledge (RPCK), we identified three domains of RPCK needed to enact antiracist elementary social studies teaching and analyzed how these domains surfaced during lessons and interviews. Our cross-case analysis revealed that both preservice teachers struggled to balance presenting civil rights events as historically (...) significant while also calling their legacy into question. However, the preservice teacher who fostered dialogic and student-centered discussions was ultimately more successful with antiracist teaching. We provide implications for supporting elementary school teachers in developing social studies lessons that embody antiracism and teach the long civil rights movement. (shrink)

Perceived size is a function of viewing distance, retinal images size, and various contextual cues such as linear perspective and the size and location of neighboring objects. Recently, we demonstrated that illusion magnitudes of classic visual size illusions may be greatly enhanced or reduced by adding dynamic elements. Specifically, a dynamic version of the Ebbinghaus illusion (classically considered a “size contrast” illusion) led to a greatly enhanced illusory effect, whereas a dynamic version of the Corridor illusion (a “size constancy” illusion) (...) led to a greatly diminished illusory effect. Although these differences may arise from the different processes underlying these illusions (size contrast vs. size constancy), the dynamic variants we tested in our previous work also differed in the nature of the dynamic elements; specifically, whereas the Dynamic Ebbinghaus included a moving target and inducers that changed size and position, the Dynamic Corridor only included a moving target on a static background. Here, we explore further dynamic versions of the Ebbinghaus illusion and the Corridor and Ponzo illusions by separately manipulating three types of dynamic elements: target motion, context translation, and dynamic changes in context. Across five experiments examining 21 dynamic illusory configurations, adding target motion or a dynamically changing context separately resulted in little-to-no illusory effect. In contrast, the combination of target motion and a dynamically changing context led to a robust size illusion, consistent with an interactive effect. However, illusory effects that exceeded the matched classic, static illusory configuration were only observed for the dynamic versions of the Ebbinghaus illusion and the Revealed Ponzo illusions, in which the contextual elements changed size. We conclude that the combination of target motion and a dynamically changing context are necessary to produce dynamic size illusions, but that enhancement above and beyond static illusions may be largely specific to size contrast effects. Our results have important implications for the integration of motion signals, a ubiquitous environmental stimulus, in the perception of object size. (shrink)

The literature on affective determinants of physical activity is growing rapidly. The present paper aims to provide greater clarity regarding the definition and distinctions among the various affect-related constructs that have been examined in relation to PA. Affective constructs are organized according to the Affect and Health Behavior Framework, including: affective response to PA; incidental affect; affect processing; and affectively charged motivational states. After defining each category of affective construct, we provide examples of relevant research showing how each construct may (...) relate to PA behavior. We conclude each section with a discussion of future directions for research. (shrink)