This paper describes a practice innovation: the addition of formal weekly discussions of patients with prolonged PICU stay to reduce healthcare providers’ moral distress and decrease length of stay for patients with life-threatening illnesses. We evaluated the innovation using a pre/post intervention design measuring provider moral distress and comparing patient outcomes using retrospective historical controls. Physicians and nurses on staff in our pediatric intensive care unit in a quaternary care children's hospital participated in the evaluation. There were 60 patients in (...) the interventional group and 66 patients in the historical control group. We evaluated the impact of weekly meetings to establish goals of care for patients with longer than 10 days length of stay in the ICU for a year. Moral distress was measured intermittently and reported moral distress thermometer scores fluctuated. "Clinical situations" represented the most frequent contributing factor to moral distress. Post intervention, overall moral distress scores, measured on the moral distress scale revised, were lower for respondents in all categories, and on three specific items. Patient outcomes before and after PEACE intervention showed a statistically significant decrease in PRISM indexed LOS, a statistically significant increase in both code status changes DNR, and in-hospital death, with no change in patient 30 or 365 day mortality. The addition of a clinical ethicist and senior intensivist to weekly inter-professional team meetings facilitated difficult conversations regarding realistic goals of care. The study demonstrated that the PEACE intervention had a positive impact on some factors that contribute to moral distress and can shorten PICU length of stay for some patients. (shrink)

I am indebted to many people, especially Dorsey Armstrong, Shannon French, and Kenneth Hodges, for helpful discussions of this material. An early version of this essay was read at the Thirty-Sixth International Congress on Medieval Studies.This essay is dedicated to the glorious memory of Nina Lindsey.

Fiction can help make students better thinkers about some philosophical issues, but this does not mean it will make them morally better people.

Voyages et exils au cinéma, rencontres de l'altérité s'intéresse aux phénomènes d'hybridation entre cultures tels qu'ils se traduisent à l'écran, sans restriction géographique (cinémas américain, italien, africain, libanais, indien, taïwanais, japonais etc.). Si le voyage et l'exil des cinéastes sont sources de transferts culturels et esthétiques, le thème du voyage et de l'exil représenté au cinéma questionne la notion d'altérité en proposant une vision diversifiée de la rencontre entre autochtones et nouveaux arrivants. Dans un monde globalisé, mais qui continue de (...) s'interroger à la fois sur la mixité culturelle et le sens de la nation, le cinéma reflète ainsi les cultures plurielles dans leur richesse et leur vivacité, mais aussi les replis communautaires, les phénomènes d'imprégnation et bien entendu de domination culturelle. La caméra se désigne alors comme acteur, témoin et exégète de ces processus qui, s'ils ont une longue histoire et se développent tout au long du XXe siècle, culminent dans notre temps présent. (shrink)

Introduction Tourette Syndrome is a childhood onset disorder characterized by vocal and motor tics and often remits spontaneously during adolescence. For treatment refractory patients, Deep Brain Stimulation may be considered. Methods and Results We discuss ethical problems encountered in two adolescent TS patients treated with DBS and systematically review the literature on the topic. Following surgery one patient experienced side effects without sufficient therapeutic effects and the stimulator was turned off. After a second series of behavioural treatment, he experienced a (...) tic reduction of more than 50%. The second patient went through a period of behavioural disturbances that interfered with optimal programming, but eventually experienced a 70% tic reduction. Sixteen DBS surgeries in adolescent TS patients have been reported, none of which pays attention to ethical aspects. Discussion Specific ethical issues arise in adolescent TS patients undergoing DBS relating both to clinical practice as well as to research. Attention should be paid to selecting patients fairly, thorough examination and weighing of risks and benefits, protecting the health of children and adolescents receiving DBS, special issues concerning patient’s autonomy, and the normative impact of quality of life. In research, registration of all TS cases in a central database covering a range of standardized information will facilitate further development of DBS for this indication. Conclusion Clinical practice should be accompanied by ongoing ethical reflection, preferably covering not only theoretical thought but providing also insights in the views and perspectives of those concerned, that is patients, family members and professionals. (shrink)

This article deals both with greatly extended finite life and with immortality and uses the term ‘greatly extended life’ to cover both. Except where indicated, it proceeds from some assumptions adapted from Christine Overall. First, people would know the life expectancy in their society or would know that they were immortal. Second, everyone would have the opportunity to choose greatly extended life. Third, greatly extended life would not be mandatory; people would be able to opt out at any point.

The relationship between metacognition and mindreading was investigated by comparing the monitoring of one’s own learning and another person’s learning . Previous studies indicated that in self-paced study judgments of learning for oneself are inversely related to the amount of study time invested in each item. This suggested reliance on the memorizing-effort heuristic that shorter ST is diagnostic of better recall. In this study although an inverse ST–JOL relationship was observed for Self, it was found for Other only when the (...) Other condition followed the Self condition. The results were interpreted in terms of the proposal that the processes underlying experience-based metacognitive judgments are largely unconscious. However, participants can derive insight from observing themselves as they monitor their own learning, and transfer that insight to Other, thus exhibiting a shift from experience-based to theory-based judgments. Although different processes mediate metacognition and mindreading, metacognition can inform mindreading. (shrink)

There have been essentially two types of theoretical approaches to account for the grammatical relations associated with the causee argument of causative constructions. Ignoring the specifics of particular theories, there are transitivity based approaches in which the causee is a direct object when the embedded clause is intransitive, and an indirect object or oblique when the embedded clause is transitive. This pattern finds considerable cross-linguistic support. On the other hand, there are languages in which the causee exhibits alternative grammatical relations (...) irrespective of transitivity: the causee direct object correlates with direct causation, while indirect object or oblique causees are associated with indirect causation. Such phenomena have motivated a semantic approach.Focusing primarily on data from Spanish, we account for both sorts of phenomena by proposing a novel extension of Dowty's [(1991) Language 67, 547–619] proto-property proposal, thereby rendering it a comprehensive model of argument selection for both simple and complex predicates. According to Dowty's original Argument Selection Principle, the most proto-patientive argument in a single argument structure tends to be encoded as a direct object. In the case of causatives with intransitive base predicates, the most proto-patientive argument will be the causee. However, if the embedded clause is transitive, the causee will be less proto-patientive that the embedded patient, and will not be encoded as a direct object. Thus, the Argument Selection Principle, operating in a syntagmatic fashion over co-arguments, effectively derives the transitivity-determined causee encodings. In order to address the effects associated with the semantic approach, we develop paradigmatic interpretation of the Argument Selection Principle. That is, when the causee argument varies in degree of proto-patientivity, the most proto-patientive alternant is encoded as a direct object, and any decrease in proto-patientivity is reflected by relational encodings that are sequentially lower than direct object on the relational hierarchy. Thus, the transitivity and semantic effects of causee encoding are accounted for by the interaction of the syntagmatic and paradigmatic argument selection strategies. We propose that these two strategies represent organizing principles for argument selection information associated with lexical entries. (shrink)

Anyone who thinks contemporary American society is hopelessly contentious and lacking in shared values has probably not been paying attention to the way the popular media portray the hospice movement. Over and over, we are told such things as that “Humane care costs less than high-tech care and is what patients want and need,” that hospices are “the most effective and least expensive route to a dignified death,” that hospice personnel are “heroic,” that their “compassion and dedication seem inexhaustible,” and (...) that “few could argue with the powerful message that it is better [for dying patients] to leave wrapped in the love of family and care givers than locked in the cold, metallic embrace of a machine.“. (shrink)

My little girl has leukemia; she has had it for over a year, and now she needs at least five pints of blood a day. Not the whole blood, just the platelets. Most of our relatives and friends have given at least a few times. But we need more. Now I have to go to strangers.So begins Roberta Silman's short story, “Giving Blood,” a story about illness and charity. When the narrator's husband solicited blood donations at his workplace, “he thought (...) everyone would help…He must have asked a hundred people. Thirty gave. His officemate…turned green and said, ‘Oh, no, anything but that. I'm scared of needles.'”. (shrink)

Reserach work on Hindu doctrines and philosophy.

Offers a compelling vision of how to achieve and conduct a liberal but democratic society through the ideal of Neutrality--between people and ideas of the good--and using the tool of Neutral dialogue.

The relationship between affect and metacognitive processes has been largely overlooked in both the affect and the metacognition literatures. While at the core of many affect-cognition theories is the notion that positive affective states lead people to be more confident, few studies systematically investigated how positive affect influences confidence and strategic behaviour. In two experiments, when participants were free to control answer interval to general knowledge questions, participants induced with positive affect outperformed participants in a neutral affect condition. However, in (...) Experiment 1 positive affect participants showed larger overconfidence than neutral affect participants. In Experiment 2, enhanced salience of social cues eliminated this overconfidence disadvantage of positive affect relative to neutral affect participants, without compromising their enhanced performance. Notably, in both experiments, positive affect led to compromised social norms regarding the answers’ informativeness. Implications for both affect and metacognition are discussed. (shrink)

In this reply, we provide an analysis of Alter et al. response to our earlier paper. In that paper, we reported difficulty in replicating Alter, Oppenheimer, Epley, and Eyre’s main finding, namely that a sense of disfluency produced by making stimuli difficult to perceive, increased accuracy on a variety of reasoning tasks. Alter, Oppenheimer, and Epley argue that we misunderstood the meaning of accuracy on these tasks, a claim that we reject. We argue and provide evidence that the tasks were (...) not too difficult for our populations and point out that in many cases performance on our tasks was well above chance or on a par with Alter et al.’s participants. Finally, we reiterate our claim that the distinction between answer fluency and perceptual fluency is genuine, and argue that Thompson et al. provided evidence that these are distinct factors that have different downstream effects on cognitive processes. (shrink)

As medical professionals, we outline the science underlying disorders or differences of sexual development (DSD), discuss the nuances of sex and gender and how terminology can differ based on medical vs. non-medical context, briefly review the evidence of the ergogenic effects of hyperandrogenism, and discuss the medical complications with the hormonal contraceptive use currently dictated by World Athletics to allow DSD athletes to compete in the female category.

Initial Judgment of Solvability (iJOS) is a metacognitive judgment that reflects solvers’ first impression as to whether a problem is solvable. We hypothesized that iJOS is inferred by combining prior expectations about the entire task with heuristic cues derived from each problem’s elements. In two experiments participants first provided quick iJOSs for all problems, then attempted to solve them. We manipulated expectations by changing the proportion of solvable problems conveyed to participants, 33%, 50%, or 66%, while the true proportion was (...) the 50% for all. In Experiment 1 we used the non-verbal Raven’s matrices and examined nameability as the element-based heuristic cue. Unsolvable matrices were generated by switching locations of elements in original Raven’s matrices. In Experiment 2 we used the verbal Compound Remote Associate (CRA) problems and examined word’s frequency in the language as the element-based heuristic cue. Unsolvable CRAs were random word triads from the same word pool. The results were consistent in suggesting that quick iJOS integrates prior expectations and experience-based heuristic cues. Notably, iJOS was predictive for the subsequent solving attempt only for Raven’s matrices. (shrink)

Exhaustive study of concept of liberation of soul (Mokṣa) in six systems of Hindu philosophy and other schools.

We suggest that the accounts offered by the target articles could be strengthened by acknowledging the role of group selection and cultural niche construction in shaping the evolutionary trajectory of human music. We argue that group level traits and highly variable cultural niches can explain the diversity of human song, but the target articles' accounts are insufficient to explain such diversity.