During the initial phases of the COVID-19 pandemic, stress and anxiety were pervasive among the masses due to high morbidity and mortality. Besides the fear of coronavirus was also particularly driven by social media. Many people started to look for faith and spiritual connections to gain comfort. The role of spiritual ties and religious beliefs in relation to coping with pandemic stress gained the attention of researchers in some parts of the world. This cross-sectional survey aimed at assessing the intensity (...) of stress and anxiety symptoms experienced by people and how much they were alleviated by employing spiritual connections. The study sample comprises 795 respondents with 52% males and 48% females living in Saudi Arabia. The brief online study questionnaire collected data about background variables, anxiety and stress scale from DASS-21, and items from the WHOQOL instrument assessed the use of spiritual beliefs to cope. Multiple regression models were tested to determine the role of spiritual connections after adjusting demographic variables. Results illustrated that after adjusting for gender and age, participants' anxiety symptoms decreased by units with each unit increase in the use of spiritual connections, and participants’ stress symptoms reduce by units with each unit increase in coping with spirituality. Additionally, females’ risk to experience anxiety and stress symptoms was more than males and, respectively. An increase in age decreases the likelihood of experiencing anxiety symptoms and stress symptoms by and units respectively. Findings support the protective role of spiritual connections despite small beta coefficients. The social and cultural context in Saudi Arabia favors deep-rooted connections with spirituality and faith. Our findings support that the reliance on spiritual connections helped older people to deal with exaggerated fear during the initial phase of the COVID-19 pandemic and reduces the risk of experiencing anxiety and stress symptoms. Females and younger participants were relatively vulnerable to developing these symptoms. We discussed these findings considering some recent studies that reported similar relationships and made recommendations for future research. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 12.1 (2002) 95-102 [Access article in PDF] Bioethics Inside the Beltway Some Initial Reflections on NBAC Eric M. Meslin and Harold T. Shapiro On 3 October 2001, Executive Order 12975 expired, and with it so too did the National Bioethics Advisory Commission (NBAC). Established by President Bill Clinton in 1995, NBAC was the fifth national committee since 1974 created to advise the U.S. government (...) on bioethics policy. In the long political tradition in this country that national bioethics policy advice should use temporary rather than permanent bodies, NBAC followed in the footsteps of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1974-78); the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1980-83); the Ethics Advisory Board (1978-80); and the Biomedical Ethics Advisory Committee (1988-89). Arguably, other distinguished panels could lay claim to recognition as a "national bioethics committee" including the Advisory Committee on Human Radiation Experiments (ACHRE) (1994-95); the Fetal Tissue Transplantation Research Panel (1988); the Human Embryo Research Panel (1994); and the National Institutes of Health (NIH) Recombinant DNA Advisory Committee (RAC), which continues to function.These committees and commissions form a kind of a continuum, albeit occasionally interrupted by periods during which no such bodies existed. Each arose from a particular confluence of events and circumstances. NBAC was no different; its history can be traced both to a series of discussions within the White House Office of Science and Technology Policy beginning in 1993 (NBAC 1998a, p. 3), and to a specific recommendation from ACHRE that called for a national committee to address ethical issues in human subjects research (ACHRE 1995, p. 817). Nbac's Impact In his useful comparison of the accomplishments of the National Commission and the President's Commission, Brad Gray concluded that seven lessons were learned, the sixth of which was that "nothing substitutes for having a perceptible impact on either policy or practice" (Gray 1995, p. 304). Assessing NBAC's [End Page 95] impact on "policy or practice" is difficult, particularly given the fact that it so recently completed its work. More time may be needed before a full assessment can be undertaken of the impact of its six reports (and their total of 120 recommendations). Instead, in this essay we offer some reflections on NBAC's initial impact, using some specific examples of how bioethics gets done Inside the Beltway. Eliciting Reaction If immediate reaction by the White House is any measure of impact, then Cloning Human Beings (NBAC 1997) had a significant one. The day after he received this report in a Rose Garden ceremony, President Clinton submitted a bill to Congress that would have extended the moratorium on federal funding to create a child using somatic cell nuclear transfer. This bill never passed, nor has any other bill emerged that has enjoyed the support of the House and the Senate. Five states have enacted legislation to date, but these vary in their permissibility from bans on all forms of cloning to bans similar to the one proposed by NBAC, which recommended a time-limited prohibition only on somatic cell transfer to create a child (reproductive cloning).If the Cloning report elicited speedy action from the White House, this paled in comparison to the reaction that led to and, in turn, was created by Ethical Issues in Human Stem Cell Research (NBAC 1999a). Those who believe that government moves slowly need only be reminded of the events of 8-14 November 1998 (and, as we shall mention below, the further events of 14 July 1999). Some will recall that early in the second week of November 1998, James Thomson and his colleagues published in Nature and John Gearhart and his colleagues published in the Proceedings of the National Academy of Sciences that they had isolated and cultured human primordial stem cells and germ cells respectively. Within days of these remarkable reports, Advanced Cell Technology (ACT) announced via an article written by Nicholas Wade in the... (shrink)

The main aim of shamanic initiation among the Yanomami people of the Upper Orinoco River region in Venezuela is the metamorphosis of the human body into a cosmic body, or what I term "corporeal cosmogenesis." During the initiatory ordeal, the neophyte undergoes an intense experience of death through dismemberment by the spirits and subsequent rebirth, thus overcoming the human condition and becoming an individual living spirit. But, at the same time, he becomes a "collection" of other spirits who leave their (...) natural habitats—located on the mountaintops and in the forest—and move into the initiate's body, which becomes their abode. As the candidate surrenders his soul and humanness to the spirits, the latter become his personal allies and sources of power while imbuing the shaman's postmortem ego with certain properties that can best be described in holographic terms. After the shaman's biological death, his personal spirits become disembodied again and disperse back into the forest and on the mountaintops. When the shaman dies, his soul multiplies, as each of the disembodied spirits becomes a carrier of the shaman's soul image. In this way, through initiations, the shaman becomes a part of a dynamic cosmic circuity, as his hekura can be called upon to invade the bodies of new shamans, and start a cosmogonic initiatory act anew. (shrink)

While the WHO, public health experts, and political leaders have referenced solidarity as an important part of our responses to COVID‐19, I consider how we build solidarity during pandemics in order to improve the effectiveness of our responses. I use Prainsack and Buyx's definition of solidarity, which highlights three different tiers: (1) interpersonal solidarity, (2) group solidarity, and (3) institutional solidarity. Each tier of solidarity importantly depends on the actions and norms established at the lower tiers. Although empathy and solidarity (...) are distinct moral concepts, I argue that the affective component of solidarity is important for motivating solidaristic action, and empathetic accounts of solidarity help us understand how we actually build solidarity from tier to tier. During pandemics, public health responses draw on different tiers of solidarity depending on the nature, scope, and timeline of the pandemic. Therefore, I analyze both COVID‐19 and HIV/AIDS using this framework to learn lessons about how solidarity can more effectively contribute to our ongoing public health responses during pandemics. Whereas we used institutional solidarity during COVID‐19 in a top‐down approach to building solidarity that often overlooked interpersonal and group solidarity, we used those lower tiers during HIV/AIDS in a bottom‐up approach because governments and public health institutions were initially unresponsive to the crisis. Thus, we need to ensure that we have a strong foundation of respect, trust, and so forth, on which to build solidarity from tier to tier and promote whichever tiers of solidarity are lacking during a given pandemic to improve our responses. (shrink)

We use a cultural psychology approach to examine the relevance of the Health Belief Model for predicting a variety of behaviors that had been recommended by health officials during the initial stages of the COVID-19 lockdown for containing the spread of the virus and not overburdening the health system in Europe. Our study is grounded in the assumption that health behavior is activated based on locally relevant perceptions of threats, susceptibility and benefits in engaging in protective behavior, which requires careful (...) attention to how these perceptions might be structured and activated. We assess the validity of the HBM in two European countries that have been relatively understudied, using simultaneous measurements during acute periods of infection in Romania and Italy. An online questionnaire provided a total of valid answers from both countries. First, to understand individual difference patterns within and across populations, we fit a General Linear Model in which endorsement was predicted by behavior, country, their interaction, and a random effect for participants. Second, we assess the effect of demographics and health beliefs on prevention behaviors by fitting a multi-group path model across countries, in which each behavior was predicted by the observed health belief variables and demographics. Health beliefs showed stronger relationships with the recommended behaviors than demographics. Confirming previously reported relationships, self-efficacy, perceived severity, and perceived benefits were consistently related to the greater adoption of individual behaviors, whereas greater perceived barriers were related to lower adoption of health behaviors. However, we also point to important location specific effects that suggest that local norms shape protective behavior in highly contextualized ways. (shrink)

This study examined changes in the structural relationship among learner-centred classes perceived by Korean junior high school students, attitudes during class and academic achievement. A linear change model was identified as optimal, showing a steady increase over time for each parameter. The higher the initial value for learner-centred classes, the higher both the initial value and rate of change was for attitudes during class and academic achievement. The initial values for attitudes during class also had a significant effect on initial (...) values of academic achievement, suggesting that attitudes are important in increasing academic achievement. The rate of change of both learner-centred classes and attitudes during class significantly influenced the rate of change of academic achievement. (shrink)

Many countries have adopted new triage recommendations for use in the event that intensive care beds become scarce during the COVID‐19 pandemic. In addition to establishing the exact criteria regarding whether treatment for a newly arriving patient shows a sufficient likelihood of success, it is also necessary to ask whether patients already undergoing treatment whose prospects are low should be moved into palliative care if new patients with better prospects arrive. This question has led to divergent ethical guidelines. This paper (...) explores the distinction between withholding and withdrawing medical treatment during times of scarcity. As a first central point, the paper argues that a revival of the ethical distinction between doing and allowing would have a revisionary impact on cases of voluntary treatment withdrawal. A second systematic focus lies in the concern that withdrawal due to scarcity might be considered a physical transgression and therefore more problematic than not treating someone in the first place. In light of the persistent disagreement, especially concerning the second issue, the paper concludes with two pragmatic proposals for how to handle the ethical uncertainty: (1) triage protocols should explicitly require that intensive care attempts are designed as time‐limited trials based on specified treatment goals, and this intent should be documented very clearly at the beginning of each treatment; and (2) lower survival prospects can be accepted for treatments that have already begun, compared with the respective triage rules for the initial access of patients to intensive care. (shrink)

PurposeThis study aimed to investigate whether oxygenated hemoglobin generated during a motor imagery task is associated with the motor learning level of the task.MethodsWe included 16 right-handed healthy participants who were trained to perform a ball rotation task. Hemodynamic brain activity was measured using near-infrared spectroscopy to monitor changes in oxy-Hb concentration during the BR MI task. The experimental protocol used a block design, and measurements were performed three times before and after the initial training of the BR task as (...) well as after the final training. The BR count during training was also measured. Furthermore, subjective vividness of MI was evaluated three times after NIRS measurement using the Visual Analog Scale.ResultsThe results showed that the number of BRs increased significantly with training. VAS scores also improved with training. Furthermore, oxy-Hb concentration and the region of interest showed a main effect. An interaction was confirmed, and it was ascertained that the change in oxy-Hb concentrations due to training was different for each ROI. The most significant predictor of subjective MI vividness was supplementary motor area oxy-Hb concentration.DiscussionHemodynamic brain activity during MI tasks may be correlated with task motor learning levels, since significant changes in oxy-Hb concentrations were observed following initial and final training in the SMA. In particular, hemodynamic brain activity in the SMA was suggested to reflect the MI vividness of participants. (shrink)

The main purpose of this study is to become acquainted with the educational institutions in Ottoman Empire during and after the 18th century. In this respect, special attention is given to which initiatives were taken in terms of education and which educational institutions were established during the aforementioned period. The need to comply with the West in terms of science, culture, reasoning, and technological advancements has led to the questioning of the current madrasah system. Upon revising the educational system of (...) the madrasah, which had difficulties in being productive and attaining to the necessities of the time, there have been initiatives primarily to establish and structure military schools. These attempts to reform education was intensively seen as from the early 18th century. The above-mentioned changes and progress have gained momentum with the Tanzimat era. It was observed that during this period, many schools were established beyond military; education levels were clarified and; females were given right to study. Similar to Tanzimat era during the first Constitutional Monarchy and Autocracy eras, positive contributions toward educational reforms were made. However, beginning from the middle of the second Constitutional Monarchy era, the economic and social complications that the state was going through had a negative impact on the educational system and the practicality of the educational institutions.Summary: Education has been the most important factor in determining the social, economic, and cultural level of a society. The level of development, which is the determinant of the superiority of the nations to each other over the world, varies according to the importance given to education. To be a pioneer in the scientific sense, to be able to have technological opportunities, to make people live more comfortable and peaceful, to have more power in the economic field and to ensure the continuity of the nation that depending on all these, it will be possible with the understanding of education that can read the time and future well. The fact that world states are superior to each other in different periods of history is directly related to their understanding of education. It can be said that in the centuries following the beginning of the new age, especially the Western nations have taken a more positive step at this subject. The changes in both mental and action spheres such as XVI. century Renaissance movements, XVIII. century enlightenment movement and finally the industrial revolution triggered the development in the scientific and technological field. In these periods the importance given to thinking and the freedom of thought has been the main factor of the progress in the scientific field. The European nations, which went beyond their religion-based bigotry and prioritized the free and secular understanding, have become superior to other nations of the world. However, it is not quite possible to say that in the same periods the Ottoman Empire was able to adapt with the same speed to such accelerations of change and development that placed in Europe. One of the main reasons for this situation and perhaps most importantly is that the educational concept in the Ottoman Empire remained within a static structure in the last centuries. In particular, the matters such as the madrasa being away from productivity, the limitation of the understanding of the science only with religious sciences, has led to the problem of inability to adapt to the rapid transformation that in Europe. The first steps towards eliminating this weakness noticed by the state executives over time has been taken through the improvement and transformation of the Ottoman educational institutions. It is possible to say that the first attempts as to these restructures of education, which is also called as Westernization or modernization by the educational historians, has begun in the period of Sultan III. Selim. In the context of the Nizam-ı Cedid movement, a number of positive initiatives in education, such as the improvement of madrasas, the opening of military schools and translation activities, constitute the core of the changes that will take place in later periods. Immediately afterwards, in the period of II. Mahmut, making the reading and writing education compulsory, opening of Western-style junior high school, establishing medical and vocational schools that provide education at higher education level are considered as positive innovations of the period. The time interval from the proclamation of the Tanzimat edict until the First Constitutional monarchy is the period in which the institutionalization and structuring towards education in the Ottoman Empire is at the highest level. Besides many educational institutions in this process where the ministry responsible for education and training is established and the regulation containing the arrangements regarding this field is put into force, one of the most important initiatives made is laying the foundations of the Dâr al-Fünûn (Ottoman University) which is considered as the first university in this land. The fact that many educational institutions established in this period that are the roots of today's educational institutions is important in terms of demonstrating the accuracy of the initiatives within the mentioned period. In Meşrutiyet (the First Constitutional Monarchy) and the subsequent period of Mutlakiyet (Autocracy), contributions were provided on previous positive structuring. However, the social and economic problems experienced in the country since the second half of II. Meşrutiyet (the 2nd Constitutional Monarchy) have been effective in the inability of continuing innovations towards education. In this study, the educational institutions established in the Ottoman Empire before and after the Tanzimat period were discussed. The aim is not just to reveal what these schools are. It was also aimed to emphasize which areas in which schools are required to be based on which needs, which obstacles are encountered during the change of mentality in education, regulatory activities foreseen to overcome obstacles and to what extent they have been successful. In this regard, the signals of change as to the structure of educational institutions, which could be the source of most of the republic period, started from the beginning of 1700s and continued until World War II period. During this period of more than a hundred years, the political periods related to the structure and functioning of the state have also been influential in the structuring of educational institutions. In fact, the Reorganization (Tanzimat) period, which is known as ‘reform’ in the mentioned process, is considered as the stage where the change and transformation concerning education is the most. It is seen that the process of westernization still continues even though it is not with the same acceleration in the Constitutional Monarchy and Autocracy periods after the Reorganization period. When looking at the facility of educational institutions in chronological order, it is determined that there is a dominated understanding that prioritizes to train military staff in the military field and to have a competent army with the technological possibilities of the time, in other words, to create a strong defence system against the foreign powers of the country. Indeed, for the first time in order to give technical information about modern military, Hendesehane opened and started to operate in İstanbul in 1734 by Mahmut I; Mühendishâne-i Bahrî-i Hümâyûn, the school of the first military maritime was opened in 1775 in order to provide modern education; Mühendishâne-i Berrî-i Hümâyun was founded in 1795 in Istanbul, in order to train artillery and military officer (military engineer); Mekteb-i Harbiye, which was opened in 1835 to train officers, and Menşe-i Küttab-ı Askeri, which was established to train military scribes, contributed to the contemporary construction of the army. In the mentioned period, the most important change outside the military area was in the health area. In this sense, in order to meet the medical doctor needs of the army, Tıbhâne-i Amire was established in 1827. In 1867, the first civilian medical school, Mekteb-i Tıbbiye-i Mülkiye, started education and training. Another important innovation movement for education was in the field of law. In this context, the School Law was established in 1880. In order to train competent staff in administrative staff, the schools of the Mekteb-i Mülkiye, the schools of teacher, the schools that enable women to do education, the improvement of schools that train the clergy and the regulations based on this take attention as educational activities carried out in the mentioned period. (shrink)

Liquidity risk arises from the inability to unwind or hedge trading positions at the prevailing market prices. The risk of liquidity is a wide and complex topic as it depends on several factors and causes. While much has been written on the subject, there exists no clear-cut mathematical description of the phenomena and typical market risk modeling methods fail to identify the effect of illiquidity risk. In this paper, we do not propose a definitive one either, but we attempt to (...) derive novel mathematical algorithms for the dynamic modeling of trading volumes during the closeout period from the perspective of multiple-asset portfolio, as well as for financial entities with different subsidiary firms and multiple agents. The robust modeling techniques are based on the application of initial-value-problem differential equations technique for portfolio selection and risk management purposes. This paper provides some crucial parameters for the assessment of the trading volumes of multiple-asset portfolio during the closeout period, where the mathematical proofs for each theorem and corollary are provided. Based on the new developed econophysics theory, this paper presents for the first time a closed-form solution for key parameters for the estimation of trading volumes and liquidity risk, such as the unwinding constant, half-life, and mean lifetime and discusses how these novel parameters can be estimated and incorporated into the proposed techniques. The developed modeling algorithms are appealing in terms of theory and are promising for practical econophysics applications, particularly in developing dynamic and robust portfolio management algorithms in light of the 2007–2009 global financial crunch. In addition, they can be applied to artificial intelligence and machine learning for the policymaking process, reinforcement machine learning techniques for the Internet of Things data analytics, expert systems in finance, FinTech, and within big data ecosystems. (shrink)

Major neurocognitive changes occur during adolescence, making this phase as one of the most critical developmental period of life. Furthermore, this phase in life is also the time in youth substance use has its onset. Several studies demonstrated the differential associations of alcohol and cannabis use concerning the neurocognitive functioning of both males and females. Past and contemporary literature on gender-specific effects in neuroscience of addiction is predominantly based on cross-sectional datasets and data that is limited in terms of measurement (...) variability. Given the importance of gender-specific effects in addiction studies, and in order to address the two above-mentioned gaps in the literature, the present study aimed to compare neurocognitive functioning of male and female adolescents in the context of cannabis and alcohol use, while employing a longitudinal design with multiple repeated measurements. Participants were 3,826 high school students (47% female; mean age, 12.7), which were recruited from 31 high schools in the greater Montreal area. Participants were requested to complete annual surveys for five consequent years, from 7th to 11th grade, assessing their alcohol/cannabis use and neurocognitive functioning (working memory, delayed recall memory, perceptual reasoning, and inhibition control). The analytical strategy was focused on the longitudinal association between each predictor (female, male) and each of the outcomes (domains of neurocognitive functioning). Multilevel linear models assessed the association of alcohol and cannabis consumption and the four domains of neurocognitive functioning. Results revealed a gender by within-subject interaction, suggesting a weaker effect of yearly fluctuation of cannabis use on working memory among males compared to females. Our findings suggest a different pattern of neurocognitive impairment of female and male working memory after using cannabis over the course of adolescence. Early initiation of cannabis use potentially results in more spatial working memory deficits in female adolescents. This may negatively influence young females’ capacity in academic settings and lead to significant impairment in adulthood, which critically decreases the individual’s quality of life. (shrink)

The coronavirus pandemic has necessitated extraordinary human resilience in order to preserve and prolong life and social order. Risks to health and even life are being confronted by workers in health and social care, as well as those in roles previously never defined as “frontline,” such as individuals working in community supply chain sectors. The strategy adopted by the United Kingdom government in facing the challenges of the pandemic was markedly different from other countries. The present study set out to (...) examine what variables were associated with resilience, burnout, and wellbeing in all sectors of frontline workers, and whether or not these differed between the UK and Republic of Ireland. Individuals were eligible if they were a frontline worker in the UK or RoI during the pandemic. Part of a larger, longitudinal study, the participants completed an online survey to assess various aspects of their daily and working lives, along with their attitudes toward their government’s handling of the crisis, and measurement of psychological variables associated with heroism. A total of 1,305 participants provided sufficient data for analysis. UK-based workers reported lower wellbeing than the RoI-based participants. In multivariate models, both psychological and pandemic-related variables were associated with levels of resilience, burnout, and wellbeing in these workers, but which pandemic-related variables were associated with outcomes differed depending on the country. The judgment of lower timeliness in their government’s response to the pandemic appeared to be a key driver of each outcome for the UK-based frontline workers. These findings provide initial evidence that the different strategies adopted by each country may be associated with the overall wellbeing of frontline workers, with higher detriment observed in the UK. The judgment of the relatively slow response of the UK government to instigate their pandemic measures appears to be associated with lower resilience, higher burnout, and lower wellbeing in frontline workers in the UK. (shrink)

Patient participation is a fundamental principle in modern Western health care, but not necessarily simple to achieve. During hospital ward rounds, patient participation is further hindered by the multi-party nature of the encounter: at times, members of the medical team talk with each other rather than with the patient. This article examines patients’ opportunities to participate in ward round conversations when the patient is not the addressed recipient. The data consist of 3 hours of video-recorded ward rounds in a Finnish (...) hospital. Using conversation analysis, we study patients’ practices for getting a turn in different sequential environments. The patients monitor the ongoing conversation and exploit its sequential organisation by producing responsive turns and repair initiations, thus becoming active participants. They also produce their own initiatives, although sequential and multimodal constraints affect their possibilities for modifying the participation framework. The results of this study can be exploited to promote patient participation. (shrink)

BackgroundLiterature on issues relating to comprehension during the process of obtaining informed consent (IC) has largely focused on the challenges potential participants can face in understanding the IC documents, and the strategies used to enhance comprehension of those documents. In this review, we set out to describe the factors that have an impact on comprehension and the strategies used to enhance the IC process in sub-Saharan African countries.MethodsFrom November 2021 to January 2022, we conducted a literature search using a PRISMA (...) tool. We searched electronic databases (PubMed, EMBASE, EBSCOHOST) to identify relevant peer reviewed studies. We then reviewed the references of these articles to find additional literature that might have been missed through the initial search. We were particularly interested in full text articles in English that focused on the IC process in SSA published between 2006 and 2020. We included systematic reviews, and studies from Western and Asian countries that included data about SSA. We excluded articles that focused on medical interventions and studies that did not require IC.ResultsOut of the 50 studies included most were multi-country (n = 13) followed by single country studies in South Africa (n = 12); Kenya, Tanzania, Uganda (n = 5) each; Gambia, Ghana and Nigeria (n = 2)each ; and one each for Botswana, Malawi, Mali, Mozambique. We identified three areas of focus: (1) socio-cultural factors affecting IC; (2) gaps in the ethical and legal frameworks guiding the IC process; and (3) strategies used to improve participants’ understanding of IC.ConclusionOur review showed wide recognition that the process of achieving IC in SSA is inherently challenging, and there are limitations in the strategies aimed at improving comprehension in IC. We suggest that there is a need for greater flexibility and negotiation with communities to ensure that the approach to IC is suited to the diverse socio-cultural contexts. We propose moving beyond the literal translations and technical language to understanding IC comprehension from the participants’ perspectives and the researchers’ views, while examining contextual factors that impact the IC process. (shrink)

With the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), global researchers were confronted with major challenges. The German National Pandemic Cohort Network (NAPKON) was launched in fall 2020 to effectively leverage resources and bundle research activities in the fight against the coronavirus disease 2019 (COVID-19) pandemic. We analyzed the setup phase of NAPKON as an example for multicenter studies in Germany, highlighting challenges and optimization potential in connecting 59 university and nonuniversity study sites. We examined the ethics application (...) process of 121 ethics submissions considering durations, annotations, and outcomes. Study site activation and recruitment processes were investigated and related to the incidence of SARS-CoV-2 infections. For all initial ethics applications, the median time to a positive ethics vote was less than two weeks and 30 of these study sites (65%) joined NAPKON within less than three weeks each. Electronic instead of postal ethics submission (9.5 days (Q1: 5.75, Q3: 17) vs. 14 days (Q1: 11, Q3: 26), p value = 0.01) and adoption of the primary ethics vote significantly accelerated the ethics application process. Each study center enrolled a median of 37 patients during the 14-month observation period, with large differences depending on the health sector. We found a positive correlation between recruitment performance and COVID-19 incidence as well as hospitalization incidence. Our analysis highlighted the challenges and opportunities of the federated system in Germany. Digital ethics application tools, adoption of a primary ethics vote and standardized formal requirements lead to harmonized and thus faster study initiation processes during a pandemic. (shrink)

Globally, the COVID-19 pandemic is triggering a public health emergency and crisis on a large scale, with far-reaching effects and severe damage to all aspects of politics, economy, cultural and social life, and health. Consecutive outbreaks over the past nearly 2 years of “living with COVID-19” have forced most schools to physically close, resulting in the largest educational disruption in human history. In turbulent times of the COVID-19 crisis, school leaders are facing numerous major challenges germane to school governance and (...) leadership. The key objective of the study is to fully explore the prospective challenges principals are encountering in public schools in times of COVID-19. To fulfill the research purpose, a systematic literature review was carried out to investigate the leadership challenges. As a result, a total of 24 challenges were explored through SLR approach. Frequency analysis approach was initially applied to figure out the most significant challenges. Accordingly, seven challenges were found statistically significant as showing frequency ≥ 50 each. Irrevocably, the study works as a contribution to K-12 school leadership by providing guidance for current and future leaders in crisis based on practical investigation, experiences, and recommendations. Policy makers can leverage these findings to make necessary adjustments to school policy to better prepare school leaders for crisis. Additionally, the findings of the current study are believed to have profound implications for future research. These findings expand our current understanding on school leadership in time of crisis that needs further investigation. Subsequent studies can quantitatively and/or qualitatively validate these leadership challenges findings regarding a particular school context. (shrink)

Introduction: After the outbreak of COVID-19, psychological hotlines functioned as a main channel of psychological assistance and required a large number of professionals to provide services. These hotlines mostly offered a single-use service with short session times and allowed callers to retain anonymity. They functioned as a psychological counseling service for stress experienced in the COVID-19 public health emergency. Hotline psychological counselors must meet special competency requirements. The selection and evaluation tools for recruiting hotline counselors need to be developed.Materials and (...) Methods: The initial scale of competence for psychological hotline counselors was formed by expert evaluation based on theoretical constructs and by using the Delphi method. A link to the questionnaire was sent to a WeChat group of counselors from 36 major psychological hotlines in China in two stages. The questionnaire consisted of questions to elicit basic demographic information and the initial competence scale. In the first phase, 343 valid samples were used to perform exploratory factor analysis. In the second phase, 334 valid samples were used to perform confirmatory factor analysis. The status of the competence of psychological hotline counselors was also analyzed.Results: The factor structure of the Psychological Hotline Counselor Competence Scale was verified and defined in terms of skills, attitude, and knowledge. The results of exploratory factor analysis and confirmatory factor analysis showed that the scale has good reliability and validity. The McDonald’s omega for each factor was calculated. Meanwhile, it was found that the psychological hotline counselors’ self-assessed competence had a high average score.Conclusion: The Competence Scale for Psychological Hotline Counselors for Major Public Emergencies developed in this study has good reliability and validity, and can be a reliable tool for organizing psychological assistance and screening hotline psychological counselors during public emergencies in the future. (shrink)

COVID-19 Lockdown was particularly challenging for most mothers of people with intellectual disabilities, including those with Rett syndrome, leading to feelings of abandonment from healthcare services of their children. Within those days, telerehabilitation has represented a valid alternative to support physical activity and treatment, supporting parents in structuring their children’s daily routine at home. This article aims to describe the well-being level of two groups of mothers of girls and women with RTT who were involved in a home-based remotely supervised (...) motor rehabilitation program, respectively, before and during the COVID-19 Italian lockdown. Forty participants with classic RTT were recruited before the lockdown and randomly assigned to two groups that performed the intervention immediately before and during the lockdown, respectively. The intervention included an individualized daily physical activity program carried out for 12 weeks by participants’ parents and fortnightly supervised throughout Skype contacts to plan, monitor, and accommodate individual activities in the participant’s life at home. The short form Caregivers Well-Being Scale was collected for the mothers in each group 12 weeks before intervention, at intervention initiation, immediately after intervention termination, as well as at 12 weeks after intervention termination. Mothers of participants in the Group 1 showed a stable level of well-being across all four evaluations with a slight improvement during the lockdown, without significant change. Similarly, the well-being level of mothers in the Group 2 showed a statistically significant increase in their well-being between T2 and T3 and its reduction to the pre-intervention level between T3 and T4. The results suggest that the lockdown did not negatively affect the participants’ mothers’ well-being, leading to its improvement. Moreover, the proposed intervention could have supported the mothers in managing the new daily routine at home, positively affecting maternal well-being. (shrink)

Self-applied portable polysomnography is considered a promising tool to assess sleep architecture in field studies. However, no findings have been published regarding the appearance of a first-night effect within a sport-specific setting. Its absence, however, would allow for a single night sleep monitoring and hence minimize the burden on athletes while still obtaining the most important variables. For this reason, the aim of the study was to assess whether the effect appears in home-based sleep monitoring of elite athletes.The study sample (...) included eight male and 12 female German elite athletes from five different sports. Participants slept with a portable polysomnography for two nights, which they self-applied at night before going to bed. Time in bed and wake-up time in the morning were freely chosen by each individual athlete without any restrictions regarding time or sleeping environment. Participants were asked to keep the same location and time frame during the two days of monitoring and stick to their usual sleeping schedules. Sleep stages were manually scored using 30-s epochs. Sleep parameters and stages were later compared with the help of linear mixed models to investigate the factor time.Significant differences between the two nights were found for percentage of Non-REM sleep [T = −2,10, p < 0.05, d = −0.47, 95%-CI ] with small effect size, Total Wake Time [T = 2.30, p = 0.03, d = 0.51, 95%-CI ], Sleep Efficiency [T = −2.48, p = 0.02, d = −0.55, 95%-CI ], and Wake percentage [T = 2.47, p = 0.02, d = 0.55, 95%-CI ] with moderate effect sizes, and N3 Sleep Onset Latency [T = 3.37, p < 0.01, d = 0.75, 95%-CI ] with large effect size. Confidence Intervals for all other indices range from negative to positive values and hence specify, that parameters were not systematically negatively affected in the first night.Findings suggest that some individuals are more affected by the first-night effect than others. Yet, in order to keep the measurement uncertainties to a minimum, a more conservative approach with at least two monitoring nights should be used whenever possible, if no other supporting information on the athletes says otherwise. (shrink)

We now take for granted that despite the disproportionate contribution of females to initial growth of their progeny, there is little or no asymmetry in the contribution of males and females to the eventual character of their shared offspring. In fact, this key insight was only established towards the end of the eighteenth century by Joseph Koelreuter's pioneering plant breeding experiments. If males and females supply equal amounts of hereditary material, then the latter must double each time an embryo is (...) conceived. How then does the amount of this mysterious stuff not multiply exponentially from generation to generation? A compensatory mechanism for diluting the hereditary material must exist, one that ensures that if each parent contributes one half, each grandparent contributes a quarter, and each great grandparent merely an eighth. An important piece of the puzzle of how hereditary material is diluted at each generation has been elucidated over the past ten years. (shrink)

Multicellular organisms develop on a predictable schedule that depends on both cell‐intrinsic timers and sequential cell‐cell interactions mediated by extracellular signals. The interplay between intracellular timers and extracellular signals is well illustrated by the development of oligodendrocytes, the cells that make the myelin in the vertebrate central nervous system. An intrinsic timing mechanism operates in each oligodendrocyte precursor cell to limit the length of time the cell divides before terminally differentiating. This mechanism consists of two components, a timing component, which (...) depends on the mitogen platelet‐derived growth factor (PDGF) and measures elapsed time, and an effector component, which depends on thyroid hormone and stops cell division and initiates differentiation at the appropriate time. The cell‐cycle inhibitor p27/Kip1 accumulates in the precursor cells as they proliferate and is part of both components of the timer. It seems likely that similar timing mechanisms operate in other cell lineages. BioEssays 22:64–71, 2000. ©2000 John Wiley & Sons, Inc. (shrink)

This study aimed to capture how the coronavirus disease 2019 crisis disrupted and affected individuals’ goal pursuits and self-efficacy beliefs early during the lockdown phase of COVID-19. Participants impacted by lockdown regulations accessed an online questionnaire during a 10-day window from the end of March to early April 2020 and reported a significant personal goal toward which they had been working, and then completed quantitative and qualitative survey items tapping self-efficacy beliefs for goal achievement, subjective caring about the goal during (...) disrupted world events, and current pursuit or abandonment of the goal. The findings from both quantitative and qualitative measures demonstrated a significant drop in self-efficacy beliefs from before to during the pandemic with a large effect based on whether people thought they could still achieve their goal under current conditions. Over two-thirds of the sample was unsure or did not believe they could still carry out their goal, and over a quarter either abandoned or were uncertain they could pursue the goal. Despite this, people continued to care about their goals. Reasons for abandonment and strategies for coping with goals within the lockdown and beyond are discussed. (shrink)

During each school semester, students face an onslaught of material to be learned. Students work hard to achieve initial mastery of the material, but when they move on, the newly learned facts, concepts, and skills degrade in memory. Although both students and educators appreciate that review can help stabilize learning, time constraints result in a trade-off between acquiring new knowledge and preserving old knowledge. To use time efficiently, when should review take place? Experimental studies have shown benefits to long-term retention (...) with spaced study, but little practical advice is available to students and educators about the optimal spacing of study. The dearth of advice is due to the challenge of conducting experimental studies of learning in educational settings, especially where material is introduced in blocks over the time frame of a semester. In this study, we turn to two established models of memory—ACT-R and MCM—to conduct simulation studies exploring the impact of study schedule on long-term retention. Based on the premise of a fixed time each week to review, converging evidence from the two models suggests that an optimal review schedule obtains significant benefits over haphazard (suboptimal) review schedules. Furthermore, we identify two scheduling heuristics that obtain near optimal review performance: (a) review the material from μ-weeks back, and (b) review material whose predicted memory strength is closest to a particular threshold. The former has implications for classroom instruction and the latter for the design of digital tutors. (shrink)

A highly transmittable and pathogenic viral infection, COVID-19, has dramatically changed the world with a tragically large number of human lives being lost. The epidemic has created psychological resilience and unbearable psychological pressure among patients and health professionals. The objective of this study is to analyze investor psychology and stock market behavior during COVID-19. The psychological behavior of investors, whether positive or negative, toward the stock market can change the picture of the economy. This research explores Shanghai, Nikkei 225, and (...) Dow Jones stock markets from January 20, 2020, to April 27, 2020, by employing principal component analysis. The results showed that investor psychology was negatively related to three selected stock markets under psychological resilience and pandemic pressure. The negative emotions and pessimism urge investors to cease financial investment in the stock market, and consequently, the stock market returns decreased. In a deadly pandemic, the masses were more concerned about their lives and livelihood and less about wealth and leisure. This research contributes to the literature gap of investors’ psychological behavior during a pandemic outbreak. The study suggests that policy-makers should design a plan to fight against COVID-19. The government should manage the health sector’s budget to overcome future crises. (shrink)

During an initial palliative care assessment, a dying man discloses that he had killed several people whilst a young man. The junior doctor, to whom he revealed his story, consulted with senior palliative care colleagues. It was agreed that legal advice would be sought on the issue of breaching the man’s confidentiality. Two legal opinions conflicted with each other. A decision was made by the clinical team not to inform the police.In this article the junior doctor, the palliative medicine specialist, (...) a medical ethicist, and a lawyer consider the case from their various perspectives. (shrink)

The current COVID-19 pandemic has had obvious, well-documented devastating effects on people's physical health. In this research, we investigate its potential effects on people's mental health. Many people have experienced social isolation, as countries attempt to stem the spread of the disease through confinement and other forms of social distancing. Intuitively, such social isolation may increase feelings of loneliness, and people may take logical steps to reduce their feelings of social isolation and loneliness. One route is through the use of (...) social networking apps and messaging and VoIP apps. In this research, we investigate the effects of pandemic-induced social isolation on social networking and messaging apps, and potential related effects on loneliness. We surveyed young adults who are part of the Centennial cohort from three different countries and obtained their screen time usage data over a 4-week period starting from mid-March 2020. This sampling procedure allowed us to obtain data from respondents who were experiencing different degrees of mandated social isolation, which enabled us to determine whether social network and messaging app usage increased as a function of social isolation, and to test potential effects on levels of loneliness. Results showed that only social network usage increased in the initial stage of confinement as a function of lockdown initiation. Additionally, social network app usage was associated with increased feelings of loneliness, and this relation was mediated by fear of missing out. In contrast, messaging app usage was associated with decreased feelings of loneliness, and was unrelated to FOMO. These results suggest that technology may be useful for mitigating the impact of loneliness during social isolation but that it is necessary to promote usage of messaging and VoIP apps, rather than social networking apps, because they are directly associated with decreases in loneliness without increasing FOMO. (shrink)

No período em que a Igreja Católica vivia um processo conhecido como romanização, no Brasil começaram a surgir Faculdades e Universidades Católicas. Adjetivadas, tais instituições de ensino superior implicavam a alocação de recursos os mais variados por parte do aparelho eclesiástico, pois a qualificação atribuída era acompanhada da expectativa de um desempenho específico dentro do mais amplo processo de romanização. Este artigo objetiva abordar o contexto eclesial da época e, nele, a compreensão da Igreja acerca da sua relação com a (...) sociedade recifense, tendo como viés a atuação da Universidade Católica de Pernambuco, na cidade, e sua correspondência ao cenário estabelecido. Para escrevê-lo o autor fez revisão da literatura e pesquisa nos arquivos da própria UNICAP e da Vice-província do Brasil Setentrional da Companhia de Jesus; além disso, recorreu a depoimentos orais de ex-alunos e ex-professores. A análise empreendida permite afirmar que, em sua trajetória inicial, a Universidade correspondeu ao ser católico, se ele for entendido como sintonia com o modelo eclesial predominante na Igreja e ao papel dele decorrente. Palavras-chave : Igreja católica. Modelos eclesiais. Educação.During the period of time in which the Catholic Church experienced a process known as Romanization, there began to emerge Catholic colleges and universities in Brazil. Once having received the adjective Catholic, these institutions of higher education demanded of the ecclesiastic apparatus the allocation of the most varied resources, because the attributed qualification was accompanied by the expectancy of a specific performance inside the most ample process of Romanization. This article aims at accosting the ecclesiastic context of the time and, in it, the Churche’s understanding of its relationship with Recife’s society, taking as bias the acts of the Catholic University of Pernambuco (UNICAP) in the city and its correspondence to the established scenario. To write it, the author revised the literature and research in the archives of the UNICAP itself and of the vice-province of Northern Brazil of the Society of Jesus; furthermore, he analyzed the oral testimony of former students and teachers. The analysis undertaken allows us to affirm that during its initial steps the university fulfilled the exigencies made for being Catholic, if this term was being understood as being in tune with the ecclesiastic model predominant in the Church at the time and the role corresponding to it. Keywords : Catholic Church. Ecclesiastic models. Education. (shrink)

Intermediate filament (IF) protein tetramers contain two DNA‐ and core‐histone‐binding motifs in rotational symmetry in one and the same structural entity. We propose that IF protein oligomers might displace histone octamers from nucleosomes in the process of transcription initiation and elongation, to deposit them transiently on their α‐helical coiled‐coil domains. We further propose that structurally related proteins of the karyoskeleton, constructed from an α‐helical domain capable of coiled‐coil formation and a basic DNA‐binding region adjacent to it, may be similarly involved (...) in nucleosome activation. These proteins would function as auxiliary factors that disrupt nucleosomal structure to permit transcription and other DNA‐dependent processes to proceed expiditiously. (shrink)

Following the argument of Pusey et al. (in Nature Phys. 8:476, 2012), new interest has been raised on whether one can interpret state-vectors (pure states) in a statistical way (ψ-epistemic theories), or if each one of them corresponds to a different ontological entity. Each interpretation of quantum theory assumes different ontology and one could ask if the PBR argument carries over. Here we examine this question for histories formulations in general with particular attention to the co-event formulation. State-vectors appear as (...) the initial state that enters into the quantum measure. While the PBR argument goes through up to a point, the failure to meet some of the assumptions they made does not allow one to reach their conclusion. However, the author believes that the “statistical interpretation” is still impossible for co-events even if this is not proven by the PBR argument. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 12.4 (2002) 389-390 [Access article in PDF] IOM Report on the System for Protecting Human Research Participants Tom L. Beauchamp* In response to society's concerns about the use of human subjects in research, the Department of Health and Human Services commissioned the Institute of Medicine to perform a comprehensive assessment of current systems of research participant protection in the U.S., including recommendations for reform (...) (Committee 2002). Although the committee declared its frustration over the lack of data, it found ample evidence to indicate that there are pivotal weaknesses in the current system. First, it discovered dissatisfaction with the current system from virtually every quarter and at virtually every level. Second, it found evidence that IRBs are under severe strain and performing inadequately. Third, it found that the existing regulatory framework—the IRB system and the Common Rule—has not and probably now cannot react adequately to the constantly evolving research environment. Some of these problems might be handled through federal agencies, but the committee holds that the problems are more extensive and will require additional institutional support and professional attention.The committee found that federal protection requirements should be extended to every research project—private, public, or otherwise. Subjects should be, in this respect, equally protected in privately sponsored research.The committee found that the IRB system is in important respects a failure, especially when it alone is relied upon for ethics reviews in institutions. One set of problems concerns the proper education of IRB members. The committee recommends that all members henceforth be given a specialized knowledge of human research ethics. It finds that IRB deliberations commonly have been dominated by scientists, who often marginalize the perspectives of nonscientist members. It therefore recommends that unaffiliated members, nonscientists, local community representatives, and those representing the participant-perspective comprise at least 25 percent of the membership. It also recommends that no protocol be approved without three-quarters of the voting members concurring. [End Page 389]The committee recommends that institutions distinguish review aimed at (1) scientific merit, (2) conflict of interest, and (3) general Ethics Review. The distinction should more evenly distribute the work of institutional ethics review. The IRB should not conduct the initial scientific review nor should it be spending the bulk of its time purely in examining either scientific merit—as many IRBs now do—or conflict of interest. Instead, the conclusions of the scientific review should be submitted to the IRB for ethics-focused deliberations. Problems of both financial and nonfinancial conflicts of interest should be handled similarly, preferably by a committee properly distanced from the institution's interests.The committee underscores that consent must be understood on the model of an interactive dialogue between research staff and participants and not merely as a signed form or single-disclosure event. Conversations between the participant and the research staff should begin even prior to the point of enrollment and should be reinforced during each stage of the research. The committee finds that informed consent conversations and documents too often are being conceived as risk management tasks gauged to protect the institution from liability.The committee also believes that the system of protections established by a research program should be open to the public in order to foster and maintain the community's trust. Open communication should occur among all relevant stakeholders. The committee notes that currently no centralized system exists for the dissemination of information about clinical trials and other research activities.It urges reconsideration of present policies regarding compensation, finding that many research organizations provide at least short-term medical care for those who are injured, but that few organizations cover all potential risks and that many organizations have no effective policy of compensation. The report holds that providing reasonable compensation for bona fide instances of research harm is the only just system and is necessary to avoid diminished public trust.The committee holds that establishing the appropriate culture in research institutions will require sustained efforts to educate researchers, research administrators, IRB members, and... (shrink)

Peer interaction has been found to be conducive to learning in many settings. Knowledge co-construction has been proposed as one explanatory mechanism. However, KCC is a theoretical construct that is too abstract to guide the development of instructional software that can support peer interaction. In this study, we present an extensive analysis of a corpus of peer dialogs that we collected in the domain of introductory Computer Science. We show that the notion of task initiative shifts correlates with both (...) KCC and learning. Speakers take task initiative when they contribute new content that advances problem solving and that is not invited by their partner; if initiative shifts between the partners, it indicates they both contribute to problem solving. We found that task initiative shifts occur more frequently within KCC episodes than outside. In addition, task initiative shifts within KCC episodes correlate with learning for low pre-testers, and total task initiative shifts correlate with learning for high pre-testers. As recognizing task initiative shifts does not require as much deep knowledge as recognizing KCC, task initiative shifts as an indicator of productive collaboration are potentially easier to model in instructional software that simulates a peer. (shrink)

In recent studies of primates, the question has been raised whether competitive regimes are species-specific or should rather be considered as sex-specific. To study this problem we use an individual-oriented model called DomWorld in which artificial agents are equipped merely to group and compete. In former studies of this model, dominance style appeared to be strongly influenced by the intensity of aggression: by increasing only this intensity of aggression, a great number of the characteristics of an egalitarian society switched to (...) those of a despotic one. Here, we investigate, using DomWorld, a competitive regime of artificial males and females that differ exclusively in their fighting capacity; males having a higher intensity of aggression and a higher initial capacity of winning, such as may be due to a male-biased sexual dimorphism. Unexpectedly it appears that, in the model, even if the intensity of aggression of males is greater than that of females, their hierarchy is still significantly weaker and thus their society less differentiated and more egalitarian than that of females. The explanation is that, due to the higher initial dominance of males, single events of victory and defeat lead to less differentiation than among females. The greater the sexual difference in initial dominance between the sexes is the more egalitarian the males behave among themselves compared to the behaviour of the females among themselves. These effects are already visible during the initial phases of the hierarchical development. These results resemble findings among primates; in real primates their degree of sexual dimorphism may influence the competitive regime of each sex. (shrink)

In recent studies of primates, the question has been raised whether competitive regimes are species-specific or should rather be considered as sex-specific. To study this problem we use an individual-oriented model called DomWorld in which artificial agents are equipped merely to group and compete. In former studies of this model, dominance style appeared to be strongly influenced by the intensity of aggression: by increasing only this intensity of aggression, a great number of the characteristics of an egalitarian society switched to (...) those of a despotic one. Here, we investigate, using DomWorld, a competitive regime of artificial males and females that differ exclusively in their fighting capacity; males having a higher intensity of aggression and a higher initial capacity of winning, such as may be due to a male-biased sexual dimorphism. Unexpectedly it appears that, in the model, even if the intensity of aggression of males is greater than that of females, their hierarchy is still significantly weaker and thus their society less differentiated and more egalitarian than that of females. The explanation is that, due to the higher initial dominance of males, single events of victory and defeat lead to less differentiation than among females. The greater the sexual difference in initial dominance between the sexes is the more egalitarian the males behave among themselves compared to the behaviour of the females among themselves. These effects are already visible during the initial phases of the hierarchical development. These results resemble findings among primates; in real primates their degree of sexual dimorphism may influence the competitive regime of each sex. (shrink)

Aims. Currently, methylphenidate (MPH, trade name Ritalin) is the most widely prescribed medication for attention deficit/hyperactivity disorder (ADHD). We examined the ability of repeated MPH administration to produce a sensitized appetitive eagerness type response in laboratory rats, as indexed by 50-kHz ultrasonic vocalizations (50-kHz USVs). We also examined the ability of MPH to reduce play behavior in rats which may be partially implicated in the clinical efficacy of MPH in ADHD. Design. 56 adolescent rats received injections of either 5.0 mg/kg (...) MPH, or vehicle each day for 8 consecutive days, and a week later received a challenge injection of either MPH or vehicle. Measurements. Both play behavior (pins) and 50-kHz USVs were recorded after each drug or vehicle administration. Results. MPH challenge produced a substantial 73% reduction in play behavior during the initial treatment phase, and during the last test (1 week post drug), 50-kHz USVs were elevated approximately threefold only in animals with previous MPH experience. Conclusions. These data suggest that MPH treatment may lead to psychostimulant sensitization in young animals, perhaps by increasing future drug-seeking tendencies due to an elevated eagerness for positive incentives. Further, we hypothesize that MPH may be reducing ADHD symptoms, in part, by blocking playful tendencies, whose neuro-maturational and psychological functions remain to be adequately characterized. (shrink)

Kwaku Marfo, Danielle Garcia, Saira Khalique, Karen Berger, Amy LuMontefiore Medical Center, Bronx, NY, USABackground: Medication errors are a prime concern for all in healthcare. As such the use of information technologies in drug prescribing and administration has received considerable attention in recent years, with the hope of improving patient safety. Because of the complexity of drug regimens in renal transplant patients, occurrence of medication errors is inevitable even with a well adopted computerized physician order entering system. Our objective was (...) to quantify medication error type and frequency in an inpatient renal transplant unit.Methods: Systemic evaluation of all medication errors during an initial 10-day audit and a 28-day follow-up audit in an inpatient renal transplant unit. Each error was concurrently evaluated for potential to result in adverse patient consequences, error type and associated medication class.Results: A total of 103 clinically significant medication errors were detected during the 10-day and 28-day audit time periods. The most common errors were wrong medication dose ordered and wrong time of drug administration. Thirty-six out of 66 prescribing/ordering errors reached the patient.Conclusions: Even with utilization of computerized physician order entry system in an inpatient renal transplant unit, post-kidney transplant patients are at risk for adverse outcomes due to medication errors. The risk factors may be multifactorial and will require both organizational and technical approaches to resolve.Keywords: medication errors, CPOE, inpatient, renal transplant patients. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Many scholars have contended that Clare of Assisi’s original intention upon leaving her family home to take up religious life sometime around 1211 was to lead a life essentially like that of the mendicant friars.1 She and the women who soon joined her would be not only poor and penitential, but also itinerant and apostolic. Like the friars their life would be marked by both insertion into the world (...) and seclusion from it as they alternated between active service and recollected contemplation. The important proof text for this claim is a passage in a letter composed by Jacques de Vitry in 1216, just five years after Clare’s conversion. Many scholars, including Paul Sabatier, Luigi Pellegrini, Roberto Rusconi, Marco Bartoli, Ingrid Peterson, Chiara Frugoni, Giovanni Boccali, and Chiara Augusta Lainati believe the text to be the earliest witness to the manner of life led by Clare and her followers during their initial years.2 The letter has been used to argue further that the women were explicitly grouped together with the Lesser Brothers, were known by the parallel title of “Lesser Sisters,” and had the freedom to come and go as they wished during their early years in San Damiano.Since claims about the women’s early likeness to the friars’ mendicant way of life are often made as brief assertions resting on Jacques’s letter, I think it important to consider in a more detained fashion the provocative passage thought to support them. Closer scrutiny of Jacques’s text shows that while none of these claims can be entirely ruled out, importantly, none can be supported with any solid evidence. I agree essentially with scholars such as Lilly Zarncke, Ernest McDonnell, Maria Pia Alberzoni, Jacques Dalarun, and Lezlie Knox who consider the letter’s language too general to know if it refers specifically to Clare and her sisters.3 I suggest, furthermore, that there are reasons to conclude that this is certainly unlikely if the passage is interpreted to mean, specifically, that Clare and her sisters carried on an active apostolate outside of San Damiano.Jacques de Vitry is generally recognized as one of the most astute and forward-thinking observers of his time in terms of recognizing the importance of new religious groups. A Parisian master, canon regular, and bishop, Jacques had the opportunity to live in a variety of settings, including his native France, the Low Countries, Italy, and the holy land.4 In 1216, he traveled from Liège in the Low Countries to Perugia to be consecrated bishop by Honorius III, who himself had just been elevated to the papacy.5 Along with observations about other matters, Jacques shared the following comment about religious men and women in a letter that he sent almost certainly to a group of his friends back in Liège. He was writing in the early days of October 1216 as he was leaving Italy on a boat that would carry him to his new episcopal see in Acre. The letter, the first of six that survive, is prized not only for its reference to the Lesser Sisters, but also as the very first written testimony regarding the Franciscan movement in general. The great nineteenth-century historian Paul Sabatier thought it provided a more vivid and precise description of Francis’s ministry than any single passage contained in his early biographies.6 The passage, which represents less than seven percent of the entire letter, is rendered thus in a widely available English translation:I found one consolation in those parts, nevertheless: many men and women [multi enim utriusque sexus], rich and worldly, after renouncing everything for Christ, fled the world. They are called Lesser Brothers and Lesser Sisters [fratres minores et sorores minores]. They are held in great esteem by the Lord Pope and the cardinals. They do not occupy themselves with temporal affairs, but work each day with great desire and.. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 45, no. 1. © 2019 by Feminist Studies, Inc. 13 Stephanie Yingyi Wang When Tongzhi Marry: Experiments of Cooperative Marriage between Lalas and Gay Men in Urban China Ang Lee’s film The Wedding Banquet could be classic introductory material for tongzhi studies and, particularly, for research on cooperative marriage.1 In the film, Wai-Tung, a Taiwanese landlord who lives happily with his American boyfriend Simon in New York, (...) is troubled by his parents’ constant efforts to try and find him a bride. His partner Simon suggests he could arrange a marriage of convenience with WaiTung ’s tenant Wei Wei who is from mainland China and is also in need of a green card to stay in the United States. However, their plan backfires when Wai-Tung’s enthusiastic parents arrive in the United States and plan a big wedding banquet. As the film critic and scholar Chris 1. Tongzhi, literally “same purpose,” is the Chinese term for “comrade.” Since the 1990s, it has been appropriated to replace the more formal tóngxìnglìan (same-sex love) to refer to gay men and lalas (same-sex desiring women) in the Chinese-speaking world. The translation of xinghun as “cooperative marriage” is debatable, as xinghun literally means “pro-forma marriage.” In other works, “contract marriage,” “fake marriage,” or “pro-forma marriage” are used to refer to gay-lala marriage. Informed by Lucetta Kam’s work, I use “cooperative marriage ” to highlight that such marriage is not merely functional without sustenance, but is contingent on the cooperation and negotiation between multiple parties in the relationship, as my findings suggest. See Lucetta Yip Lo Kam, Shanghai Lalas: Female Tongzhi Communities and Politics in Urban China (Hong Kong: Hong Kong University Press, 2013), 85. winner of the 2018 Feminist Studies Graduate Student award 14 Stephanie Yingyi Wang Berry points out, analysis of the film rests not on any individual, but on the Confucian family as “it negotiates the interface with globally hegemonic American culture,” suggesting that there exists an understanding of gayness in the context of the family that is distinct in Chinese culture.2 Berry continues to argue that the moral ambivalence produced by the film is structured by different sets of values: the gay person is not merely concerned about individual identity fulfillment, but he also adjusts his actions to satisfy the family expectation; the parents, especially the father figure, is not merely a patriarch with strict moral provisions and standards, but someone who can allow for implicit negotiation to keep the surface harmony as long as he gets a grandson; the woman is not merely an independent agent freed from social constraints, but a bride who is also attached to emotional comfort and conjugal ideals. Just as The Wedding Banquet tactfully reveals one type of cooperative marriage with its mutual benefits and examines the multilayered complexity of each individual player in the marriage game, this research takes as its subject cooperative marriage between gay men and lalas as an exciting departure to understand queer subjectivities and queer kinship intersected with gender, sexuality, class, and tongzhi politics in urban China.3 Though seemingly monolithic, marriage and family have become contested terrains for tongzhi to negotiate their gender performance, queer desires, and aspirations for better lives. The transnational makings of gayness and rights-based identity politics have contributed to the increasing awareness of a cosmopolitan gay identity and the desiring of alternative life choices of Chinese tongzhi, which lays the very foundation of their motivation to seek ways to cope with the heteronormative family model. Coming out and gay marriage are upheld as primary tropes of identity politics, facilitated by the self-identified tongzhi grassroots groups that emerged during the initiation of AIDS work in 1994 for gay men and at the 1995 Fourth World Conference on Women, which gathered hundreds of lesbians from around the world in Beijing.4 How2. Chris Berry, “Wedding Banquet: A Family (Melodrama) Affair,” in his Chinese Films in Focus: 25 New Takes (London: British Film Institute, 2003), 183. 3. Lala is a slang term in China for same-sex desiring women and includes lesbian, bisexual, and trans women. 4. Katie King, “‘There Are No... (shrink)

Two essential periods may be identified in the early stages of the history of vitamin D-resistant rickets. The first was the period during which a very well known deficiency disease, rickets, acquired a scientific status: this required the development of unifying principles to confer upon the newly developing science of pathology a doctrine without which it would have been condemned to remain a collection of unrelated facts with very little practical application. One first such unifying principle was provided by the (...) notion of hygiene; while the blanket explanations provided by this notion alone were much too general to enable rickets to achieve scientific status, it did point out the need to look for specific external causes for the disease and to examine the life-style and dietary habits of the patients. The second phase of the conceptualization of the disease was the assumption of a specific cause — that is, using concepts developed in the area of infectious diseases. This was made possible by fundamental similarities between deficiency and infectious diseases, in spite of their apparent differences. Both types of illness have some of the characteristics of what Georges Canguilhem calls the ontological representation of disease as opposed to dysharmonic representations, which primarily concern the endocrine diseases. It is precisely this shift from one to the other manner of perceiving ill health that enabled the identification of the vitamin D-resistant rickets. Conceptualization of the notion of vitamin D resistancy required that the conditions causing the disease be looked for within the organism rather than outside it; this was thus the first time that endocrine concepts were applied to studying the physiology of vitamin D.The history of resistant rickets therefore represents an interesting model for understanding the growth of biomedical knowledge. It allows the development of a number of more general ideas on the question of the relationship between biology and medicine and on the thorny problem of specificity in medical thinking. As far as this topic is concerned it can be seen that there was an ongoing exchange between medical and biological thinking during the initial period up until 1937, and that one could deny any such specificity in medical thinking during this same period. Albright, for example, used human diseases as spontaneously produced models for experimental biology. It was also more feasible for an experimental biologist to administer toxic doses than for a clinician to do so.What, then, if any, is the place of the specificity of medical thinking in this history? The fact that medicine is characterized not only by it ccognitive content78 but also by its final aim, which is to restore health, makes it necessary to take factors other than objective knowledge into consideration. This is particularly evident in two aspects of medicine, therapeutics and nosology, and in approaching the notion of pathological individuality.Therapeutic activity has a largely empirical approach. Many drugs, such as cod-liver oil, were discovered empirically. Treatment often in the past, and still now, has proceeded by trial and error, upon no established theoretical basis. At this level the relationship between biology and medicine is roughly comparable to that between science and technology79 \3- that is, it is impossible to reduce either therapeutics or technical activities to the simple application of basic science. In this sense, the application of vitamin D to vitamin-resistant rickets is quite typical. Further-more, in the case studied here, the therapeutic activity heralds a definite breaking away from the medicatrix naturae of conventional medicine dating back to ancient times, and it embodies a new concept of the organism and of disease: no longer can the diseased organism be thought of as merely having a perturbed equilibrium requiring restoration by means of a natural style of medicine. On the contrary, vitamin D resistance is an obstacle that indicates profound biological dysfunction, to be rectified only by means of an extremely aggressive and therefore dangerous therapy. The therapy thus serves to reveal the severity of the dysfunction, thereby leading inevitably to conceptual innovation. This sheds light on the theoretical innovations of which the therapeutic activity is capable.Therapeutic activity is also influenced by notions of health and illness, normal and pathological states, none of which may be determined entirely objectively. For example, the term healing as used by Albright in the case of resistant rickets that he described may be discussed in this light.Nosology, or the classification of diseases, depends largely on the description of clinical syndromes, which are themselves mainly based on subjective elements (discomfort, disability, or the extent of a patient's suffering). The advent of pathological anatomy at the beginning of the nineteenth century disrupted classification by introducing the concept of localized anatomical lesions81-and, hence, an element of material objectivity \3- into nosology. Radiological examination further complicated matters by enabling the equivalent of an autopsy on living matter. Lastly, biological examination complicated nosology by showing that biological anomalies may exist in human beings without necessarily leading to a pathological condition. Medical thinking can choose to combine all these elements to describe a disease, but can also separate them and retain only a few, or a single one, according to requirements - as did Albright.The notion of biological and pathological individuality is fundamental to the development of medical thinking. Whatever its theoretical origin, medical thinking has since ancient times incorporated the idea that each individual reacts differently to the same treatment and his own specific pathological tendencies. I mentioned earlier that in the history of vitamin D-resistant rickets the notion of rachitic tendency reflected this type of thinking. After 1937, this history progressed by successively separating new individual entities, affecting smaller and smaller groups of individuals in each case. In other words, the need to understand and to define individual illness more closely required the development of new concepts and the construction of new individual categories of disease linking these concepts to older clinical, radiological, and biochemical elements. (shrink)