Conversation analysis (CA) of children-adult—interaction in various contexts has become an established field of research. However,child therapyhas received limited attention in CA. In child therapy, the general psychotherapeutic practice of achieving empathy faces particular challenges. In relation to this, our contribution sets out three issues for investigation and analysis: the first one is that practices of achieving empathy must be preceded by efforts aiming to establish which kind of individualized conversation works with this child (Midgley,2006). Psychotherapy process (...) researchers in adult therapy (Stiles et al.,2015) have found that therapists “invent” a new therapy for each patient (Norcross and Wampold,2018). The second issue is that it can be difficult for adults to understand the ways in which children express their conflicts and issues. In particular, play activities in therapy, e.g., with dolls, can open up additional scenarios of interaction. The play scenario can be used to disclose unformulated problems masked in everyday and family interactions. The third issue is how to respect the child's higher degree of vulnerability, compared with adult patients. How is it communicated and dealt with in therapy? We present an interaction analysis of a single case study of the first 20 min of a child therapy session with an adopted girl aged 4 years brought to treatment because of “unexplainable rage.” The session was videotaped; parents granted permission. We analyze this session using an applied version of CA. In our analysis, we describe “doing contrariness,” as a conversational practice producing epistemic and affiliative disruptions, while “avoiding doing contrariness” and “remedying contrariness” are strategies for preserving or restoring the affiliative dimension of a relationship (in child therapy). We show how these practices operate in various modes and how they are used by both parties in our case study to variously aid and impedethe achievement of empathy and understanding. (shrink)

The ‘global justice gap’ refers to the state of affairs in which the just entitlements of the global poor do not correlate with the justly enforceable duties of the global rich. The possibility of a global justice gap is controversial, because it is widely thought that claims of justice cannot exist unless they are matched up with corresponding duties. In this essay, I refute this sceptical view by showing that the global justice gap is indeed a theoretical possibility. My (...) class='Hi'>strategy is to argue for a particular way of understanding the concept of distributive justice which I call the ‘dual-component model of justice’. On this view, distributive justice is a single value with two distinct components: (1) a fairness component, which specifies the situation that people would be in if they lived under conditions of what I call ‘basic distributive fairness’, and (2) a legitimacy component, specifying the rights that people have according to what I call the ‘principles of justified coercion’, which limit the ways in which they may permissibly be coerced. The global justice gap arises when the two components of justice are not in alignment. This happens when, although it is within the collective capacity of the members of the developed world to bring the global distribution much closer to the ideal of basic distributive fairness, there are considerations that make it unjust to coerce them into exercising this capacity. (shrink)

An Asian Indian Hindu family chose no intervention and hospice care for their newborn with hypoplastic right heart syndrome as an ethical option, and the newborn expired after five days. Professional nursing integrates values-based practice and evidence-based care with cultural humility when providing culturally responsive family-centered culture care. Each person’s worldview is unique as influenced by culture, language, and religion, among other factors. The Nursing Team sought to understand this family’s collective Indian Hindu worldview and end-of-life beliefs, values, and practices, (...) in view of the unique aspects of the situation while the team integrated evidence-based strategies to provide family-centered culture care. Parental care choices conflicted with those of the Nursing Team, and some nurses experienced moral distress and cultural dissonance when negotiating their deeply held cultural and religious views to advocate for the family. The inability to reconcile and integrate a stressful or traumatic experience impacts nurses’ well-being and contributes to compassion fatigue. Nurses need to be intentional in accessing interventions that promote coping and healing and moral resilience. Reflection and cultural humility, assessment, and knowledge in context, increase evidence-based culture care and positive outcomes. U.S. society’s views on ethical behavior continue to evolve, and some may argue that the law should place more limits on parents’ right to choose or to refuse treatment for their infants and children. Moral distress can lead to moral resilience and satisfaction of compassion when nurses provide family-centered culture care with cultural responsiveness and integrate values-based practice with evidence-based care, and aim to first do no harm. (shrink)

This paper presents a case study that explores the application of systemic family therapy in working with children who are victims of violence within their family. The case study focuses on the Johnson family, comprising a father, mother, and their two children, who sought therapy after a traumatic incident of domestic violence. The therapeutic approach utilized a systemic family therapy framework, aiming to address the complex dynamics resulting from the violence and its impact on family members. The goals include providing (...) a safe environment for children to process their experiences, enhancing communication, promoting non-violent parenting, and strengthening the family’s support network. The interventions involved individual sessions with the children, family sessions, psychoeducation, and collaborative goal setting. Throughout the therapy process, significant improvements were observed, including enhanced communication, improved emotional well-being for the children, non-violent parenting strategies, and the development of a support network. The findings of this case study highlight the effectiveness of systemic family therapy in promoting healing, fostering healthy relationships, and creating a nurturing environment for children affected by family violence. (shrink)

When solving the problem of their placement of the orphans and children deprived of parental care, the parenting, which is carried out in family-type orphanages, foster families and adoptive families, became a priority. Translation into Ukrainian of Arleta James’ book «The science of parenting adopted children» will be a help for adoptive parents in its implementation. The book proposes the psychological characteristics of the arrived children and constructive practical advice on their parenting.

We use Homer and Sun Tzu as a background to better understand and reformulate confrontation, anger and violence in medicine, contrasting an unproductive ‘love of war’ with a productive ‘art of war’ or ‘art of strategy’. At first glance, it is a paradox that the healing art is not pacific, but riddled with militaristic language and practices. On closer inspection, we find good reasons for this cultural paradox yet regret its presence. Drawing on insights from Homer's The Iliad (...) and The Odyssey, we argue for better understanding of confrontation, anger, bullying, intimidation and violence in medicine in order to change the culture. For example, equating medicine with war is not a given condition of medicine but a convenient metaphor with historical origins and a historical trajectory. Other, non-martial metaphors, such as medicine as collaboration, may be more appropriate in an age of team-based care. Taking lessons from Homer, we suggest three key ways in which cold-hearted confrontation and anger in medicine can be transformed into productive, warm-hearted engagement: the transformation of angry impulse into reflection, moral courage and empathy. Thinking with Homer can offer an aesthetically and morally charged alternative to the current body of literature on topics, such as anger in doctors, and how this may be ‘managed’, without recourse to an instrumental economy where emotions are viewed as commodities, and emotional responses can be ‘trained’ through communication skills courses. (shrink)

Even though female food acquisition is an area of considerable interest in hunter-gatherer research, the ecological determinants of women’s economic decisions in these populations are still poorly understood. The literature on female foraging behavior indicates that there is considerable variation within and across foraging societies in the amount of time that women spend foraging and in the amount and types of food that they acquire. It is possible that this heterogeneity reflects variation in the trade-offs between time spent in food (...) acquisition and child care activities that women face in different groups of hunter-gatherers. In this paper we discuss the fitness trade-offs between food acquisition and child care that Hiwi and Ache women foragers might face. Multiple regression analyses show that in both populations the daily food acquisition of a woman’s spouse is negatively related to female foraging effort. In addition, nursing mothers spend less time foraging and acquire less food than do nonnursing women. As the number of dependents that a woman has increases, however, women also increase foraging time and the amount of food they acquire. Some interesting exceptions to these general trends are as follows: (a) differences in foraging effort between nursing and nonnursing women are less pronounced when fruits and roots are in season than in other seasons of the year; (b) foraging return rates decrease for Ache women as their numbers of dependents increase; and (c) among Ache women, the positive effect of number of dependents on foraging behavior is less pronounced when fruits are in season than at other times of the year. Lastly, in the Hiwi sample we found that postreproductive women work considerably harder than women of reproductive age in the root season but not in other seasons of the year. We discuss how ecological variation in constraints, the number of health insults to children that Hiwi and Ache mothers can avoid, and the fitness benefits they can gain from spending time in food acquisition and child care might account for differences and similarities in the foraging behaviors of subgroups of Hiwi and Ache mothers across different seasons of the year. Valid tests of the explanations we propose will require considerable effort to measure the relationship between maternal food acquisition, child care, and adverse health outcomes in offspring. (shrink)

Half of the 33.2 million people living with HIV today are women. Yet, responses to the epidemic are not adequately meeting the needs of women. This article critically evaluates how prevention of mother-to-child transmission (PMTCT) programs, the principal framework under which women's health is currently addressed in the global response to AIDS, have tended to focus on the prevention of HIV transmission from HIV-positive women to their infants. This paper concludes that more than ten years after their inception, PMTCT (...) programs still do not successfully ensure the adequate treatment, care and support of HIV-infected women. Of particular concern is the continued widespread use of single-dose nevirapine despite World Health Organization recommendations to employ more effective combination therapies that do not potentially jeopardize women's future treatment outcomes. In response, the article calls for a more comprehensive approach that places women's health needs at the centre of AIDS responses. This is critical in settings where the pandemic is generalized and there is a push to greatly expand PMTCT programs, as a more effective and equitable way of meeting the needs of women in the context of HIV. Without such a comprehensive approach, women will continue to be impacted disproportionately by the pandemic, and current strategies for prevention, including PMTCT, and treatment will not be as effective and responsive as they need to be. (shrink)

Despite significant efforts to support those bereaved by intrauterine death, they remain susceptible to avoidable psychological harm such as disenfranchised grief, misplaced guilt, and emotional shock. This is in part because the words available to describe intrauterine death—“miscarriage,” “spontaneous abortion,” and “pregnancy loss”—are referentially ambiguous. Despite appearing to refer to one event, they can refer to two distinct events: the baby’s death and his preterm delivery. Disenfranchised grief increases when people understand “miscarriage” as the physical process of preterm delivery alone, (...) for this obscures the baby’s death and excludes non-gestational parents, such as the father. Additionally, focusing on the delivery reinforces the mistaken idea that a gestational mother bears responsibility for her baby’s death, increasing misplaced guilt. When these terms instead shift the focus to the baby’s intrauterine death rather than the preterm delivery, they can obscure the physically difficult and often traumatic experience women have when they deliver their dead children, leaving women shocked by preterm delivery’s physical reality. Given their outsized role in framing the bereaved’s experiences, and their duty to avoid harming their patients, healthcare practitioners in particular should take special care to discuss intrauterine death and preterm delivery appropriately with patients and their families. Changing language to describe intrauterine death and preterm delivery clearly and precisely helps mitigate disenfranchised grief, misplaced guilt, and shock, while also helping to reframe the social response to intrauterine death, making it more obvious why certain steps, such as allowing bereavement leave following an intrauterine death, promote healing. (shrink)

The socioeconomic and ethnic characteristics of parents are some of the most important correlates of adverse health outcomes in childhood. However, the relationships between ethnic, economic, and behavioral factors and the health outcomes responsible for this pervasive finding have not been specified in child health epidemiology. The general objective of this paper is to propose a theoretical approach to the study of maternal behaviors and child health in diverse ethnic and socioeconomic environments. The specific aims are: (a) to (...) describe a causal pathway between the utility that women obtain through work outside the home and through child care and disease hazard rates in childhood using an optimization model; (b) to specify the influence of ethnic and socioeconomic factors on model constraints; (c) to use the model as a tool to learn about how different combinations of maternal wage labor and child care time might influence child health outcomes in diverse social contexts; (d) to identify parameters that will require measurement in future research; (e) to discuss research strategies that will enable us to obtain these measurements; and (f) to discuss the implications of the model for biostatistical modeling and public health intervention. Optimization models are powerful heuristic tools for understanding how ethnic, environmental, family, and personal characteristics can place important constraints on both the quality and quantity of care that women can provide to their children. They provide a quantitative appreciation for the difficult trade-offs that most women face between working in order to purchase basic goods that children cannot do without (e.g., food, clothing, shelter, health insurance), and increasing offspring well-being through child care (e.g., training in social skills, affection, protection from environmental hazards, help with homework). (shrink)

Taking Parenting Public makes a compelling case that parenting has become dangerously undervalued in America today. It calls for a new investment—both personal and public—into the work of raising children and argues that we are all "stockholders" in the next generation. With a foreword by Sylvia Ann Hewlett and Cornel West, Taking Parenting Public crosses boundaries to bring together thinkers from diverse fields spanning the political spectrum. It features contributions from distinguished experts in economics, political science, public policy, child (...) development, public health, history, and the media. While recent books have focused on working mothers or absent fathers, Taking Parenting Public is the first volume to take a comprehensive look at the common struggles of parents. These essays go beyond the usual chest-beating about busy parents torn between work and family demands to suggest bold solutions. Instead of the typical call for "parent replacement"—more child care, more after school programs and more mentors—the contributors offer fresh strategies for "parent replenishment," ways to put mothers and fathers back into the lives of their children not only as economic providers, but also as emotional and moral providers. (shrink)

Transient receptor potential vanilloid 4 (TRPV4), a member of the TRP superfamily, is a broadly expressed, cell surface‐localized cation channel that is activated by a variety of environmental stimuli. Importantly, TRPV4 has been increasingly implicated in the regulation of cellular morphology. Here we propose that TRPV4 and the cytoskeletal remodeling small GTPase RhoA together constitute an environmentally sensitive signaling complex that contributes to pathological cell cytoskeletal alterations during neurological injury and disease. Supporting this hypothesis is our recent work demonstrating direct (...) physical and bidirectional functional interactions of TRPV4 with RhoA, which can lead to activation of RhoA and reorganization of the actin cytoskeleton. Furthermore, a confluence of evidence implicates TRPV4 and/or RhoA in pathological responses triggered by a range of acute neurological insults ranging from stroke to traumatic injury. While initiated by a variety of insults, TRPV4–RhoA signaling may represent a common pathway that disrupts axonal regeneration and blood–brain barrier integrity. These insights also suggest that TRPV4 inhibition may represent a safe, feasible, and precise therapeutic strategy for limiting pathological TRPV4–RhoA activation in a range of neurological diseases. (shrink)

Background Genuine uncertainty on superiority of one intervention over the other is called equipoise. Physician-investigators in randomized controlled trials need equipoise at least in studies with more than minimal risks. Ideally, this equipoise is also present in patient-participants. In pediatrics, data on equipoise are lacking. We hypothesize that 1) lack of equipoise at enrolment among parents may reduce recruitment; 2) lack of equipoise during participation may reduce retention in patients assigned to a less favoured treatment-strategy. Methods We compared preferences (...) of parents/patients at enrolment, documented by a questionnaire, with preferences developed during follow-up by an interview-study to investigate equipoise of child-participants and parents in the BeSt-for-Kids-study. This trial in new-onset Juvenile Idiopathic Arthritis-patients consists of three strategies. One strategy comprises initial treatment with a biological disease-modifying-antirheumatic-drug, currently not standard-of-care. Semi-structured interviews were conducted with 23 parents and 7 patients, median 11 months after enrolment. Results Initially most parents and children were not in equipoise. Parents/patients who refused participation, regularly declined due to specific preferences. Many participating families preferred the biological-first-strategy. They participated to have a chance for this initial treatment, and would even consider stopping trial-participation when not randomized for it. Their conviction of superiority of the biological-first strategy was based on knowledge from internet and close relations. According to four parents, the physician-investigator preferred the biological-first-strategy, but the majority stated that she had no preferred strategy. In phase 2, preferences tended to change to the treatment actually received. Conclusions Lack of equipoise during enrolment did not reduce study recruitment, mainly due to the fact that preferred treatment was only available within the study. Still, when developing a trial it is important to evaluate whether the physicians’ research question is in line with preferences of the patient-group. By exploring so-called ‘informed patient-group’-equipoise, successful recruitment may be enhanced and bias avoided. In our study, lack of equipoise during trial-participation did not reduce retention in those assigned to a less favoured option. We observed a change for preference towards treatment actually received, possibly explained by comparable outcomes in all three arms. (shrink)

Members of the Clinical Ethics Consultation Affairs Standing Committee of the American Society for Bioethics and Humanities present a collection of insights and recommendations developed from their collective experience, intended for those engaged in the work of healthcare ethics consultation.

Federal guidelines require that informed consent be obtained from participants when they are enrolled in a research study. When conducting research with children, the guidelines utilize the term permission to describe parents' agreement to enroll their children in a study. The basic components of consent and permission are well described and identical, with the exception of the person for whom the decision to participate is being made. Beyond permission, when enrolling minor participants in research, affirmative agreement to participate in research (...) or assent must be obtained from the child participants themselves. The concept of children's assent to research, however, is poorly defined, resulting in inconsistency in its pursuit and, consequently, in its utility. The interface between cognitive development, emotional, and social development must be examined as it pertains to this special situation of decision making. For this process to meaningfully protect minors, the assent process must be clarified, decisions regarding parental veto power must be more convincingly justified, and researchers must be better educated and held accountable for the valid execution of this process. Strategies for implementing the assent process more effectively are presented. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Holly Flora’s published dissertation is a critical contribution to scholarship of the origins of the Meditationes Vitae Christi, a text strongly associated with the preaching and prayer habits of the early Franciscan order and perhaps the most representative example of the late-Medieval devotional and pictorial phenomenon often summarized as the “Vita Christi tradition.” For almost a century, art historians have invoked the MVC to explain iconographic innovations in late-Medieval (...) and Renaissance art, in particular the emergence of apocryphal images of the early life of Christ. In contrast to these earlier art-historical uses of this text, Flora advocates for a re-contextualization of the MVC. She joins scholars, in particular Isa Ragusa, who suggest that the didactic content and devotional strategies of the MVC reflect a particularly Franciscan strain of the Vita Christi, one aligned with the cura monialium , and argues that it was probably composed by a Franciscan friar for the spiritual benefit of a Poor Clare. The MVC’s distinctive emphasis on themes of virginity, silence, and enclosure support this interpretation, as do a series of interjected prompts or imperatives for the reader to visualize herself participating in poignant events that underscore the humanity of Christ and promote affective devotion. Flora sees the MVC as an attempt by a friar to reconcile the competing Franciscan notions of the vita activa and vita contemplativa in the interests of a cloistered nun under his care; the performative devotional strategies offered by the MVC would have afforded her the means to engage actively—even if only virtually—in a life of extreme poverty or to engage in charitable public giving as exemplified by the lives of Christ and the Virgin, opportunities Flora suggests were not readily available to a cloistered nun.Association of the MVC with the Poor Clares is bolstered by the manuscript that probably contains the closest witness to the original version of this text . The author’s compelling consideration of the textual, material, and pictorial content of Ms. ital. 115 supports the claim that it was made in Pisa around 1340–50 for the community of Poor Clares at the convent of San Martino. Although written on paper rather than parchment and painted in a humble watercolor technique, Ms. ital. 115 contains the lengthiest extant pictorial cycle of any version of the MVC, a characteristic that agrees with the image-centric devotional practices of medieval nuns. Flora’s comparison of those few MVC manuscripts that contain pictorial cycles of comparable length casts into relief those discrete iconographic characteristics of the Ms. ital. 115 cycle. Most telling are ubiquitous images of women that resemble Poor Clares, regular sewing companions of the Virgin, whose presence indicates the illuminators’ attentions to the interests and identities of their audience.Having established Ms. ital. 115’s Clarissan context, the remainder of the Devout Belief of the Imagination is a consideration of a Poor Clare’s interaction with the manuscript. Flora describes this experience as an intensely emotional didactic process that begins with instruction and culminates in imaginative devotional performances where Mary constitutes the main paradigm for female monastic conduct. The extensive account of the Virgin’s childhood in the Temple, for example, supplies a progressive lesson for a young nun on the virtues of discipline and devotion. The culmination of this spiritual maturation process is the extraordinary text-image structure of the Circumcision of the Christ child by his Mother. Not only does this event resonate with Franciscan typology, but as Flora demonstrates, Mary’s privileged position in sharing the suffering of Christ offers a powerful introduction to the affective devotional strategy that structures the viewer’s experience of the remainder of the manuscript. Extended pictorial sequences that follow metaphorically address the cloistered condition of a Poor Clare viewer and her particular spiritual needs. The Holy Family’s Flight into Egypt and their.. (shrink)

Interest in and initiation of farm-to-school (FTS) programs have increased in recent years, spurred on by converging public concerns about child obesity trends and risks associated with industrialization and distancing in the modern food system. A civic agriculture framework that more specifically considers civic engagement and problem solving offers insights about variations in the development and prospects for FTS programs. Drawing on comparative case studies of two emerging FTS initiatives in Pennsylvania—one in a rural setting and one in an (...) urban setting—this article examines the role of internal and external “champions” in launching FTS programs and fostering civic engagement. Farm-to-school community stakeholders across the two cases framed FTS in broadly similar terms of (1) redressing poor food environments; (2) improving student nutrition, health and well-being; and (3) revitalizing rural community through support of local agriculture. However, specific concerns and emphases differed across the rural and urban cases, illustrating the significance of local context for such programs. The article concludes by discussing the importance of frame bridging and frame extension as strategies for expanding the FTS movement, and also ensuring programs that correspond to the specific circumstances and possibilities of their social and geographic settings. (shrink)

Many of the good things which make human life worthwhile are essentially social, cannot be enjoyed by one person unless they are enjoyed together with others. And it is obvious that thinking in terms of the first-person plural, we/us, plays a large part in everyday life as people consider puzzlements (‘What should we do?’) and remark on the success of what they decided on (‘That worked out really well for us!’). Analytic philosophers should accept this at face value, recognising that (...) human beings are often co-subjects with each other, that there is irreducible plural intentionality. The paper explores how the existence of plural intentionality manifests itself in our concepts and ways of proceeding and how attempted ‘analysis’ of what goes on as the assemblage of many interlocking instances of singular intentionality distorts and misleads. (shrink)

It is widely believed that gendered expectations are communicated to children in the process of socialization. However, there is reason to ask whether and how gender is constructed in Black families. An early perspective that still continues to inform some contemporary research is assimilationism, which assumes that Black people embrace and pass on to their children the gender norms of the dominant white society. The Afrocentric perspective challenges this view, maintaining that the unique historical experiences of Blacks have militated against (...) an emphasis on rigid gender distinctions, and that relative gender neutrality exists in Black families' child-rearing practices. The development of multicultural feminist theory, which argues that the impact of race on gender varies by social class, implies that both assimilationism and Afrocentrism may be overgeneralizations. Yet, little systematic research has been done on whether race makes a difference in how parents view gender. The authors use data from surveys completed by a nonrandom sample of parents in 202 African American and 204 white families in two large metropolitan school districts to examine the impact of gender, race, and class on parents' self-reports of their immediate priorities and long-term goals for their children, their view of the parenting role, and their discipline strategies. The findings are consistent with multicultural feminist theory: Race and social class interact to shape the intergenerational construction of gender in families. (shrink)

BackgroundParent-mediated intervention has been studied in promoting skill acquisition or behavior change in the children with autism spectrum disorder. Most studies emphasize on the improvement of child’s core symptoms or maladaptive behaviors, making parental perceived competence and self-efficacy secondary. Yet, the evaluations of intervention implementation are under-reported, especially when translating such interventions into a new population or context. This research investigated the intervention implementation of a 12-week parent coaching intervention which was delivered through telehealth and tailored to Chinese population. (...) The intervention was based on the Parent-mediated Early Start Denver Model with culturally adapted lectures, manuals, and demonstration and commentary videos. This study aimed to evaluate the intervention implementation by assessing parents’ satisfaction, acceptability, appropriateness, and feasibility.MethodA randomized controlled trial was conducted with two telehealth conditions: self-directed and web+group therapy. Parents in the self-directed condition received intervention individually through the online learning platform. The web+group therapy condition navigated the same program with weekly 1.5-h group coaching sessions via videoconferencing. This mixed-methods study used a concurrent convergent design to evaluate the intervention implementation at post-intervention. The quantitative data was collected from the Program Evaluation Survey and the qualitative data was collected from five focus groups.ResultsParents in self-directed group reported significantly lower scores in total perceived competence than parents in web+group therapy condition, while there was no group difference on the total self-efficacy. Tailored feedback, demonstration and commentary videos, peer commenting, live coaching, and guided reflection were the top-five acceptable telehealth strategies that were strongly endorsed by parents. Family centered care, home-based intervention, strategies relative to daily activities, the remote learning platform, and the program-based community were elements that parents considered when evaluating the program’s appropriateness. Parent modeling, step-by-step instructions, and tailored feedback were key components in making intervention strategies feasible for parents to implement at home.ConclusionFindings indicate the application of telehealth was acceptable, appropriate, and feasible for Chinese parents. Group-based parent coaching intervention via videoconferencing could be a promising home-based service model to increase parental perceived competence. A large-scale RCT is needed to investigate the effectiveness of group-based PMI via telehealth. (shrink)

In this paper we argue that the responsibility for systematic community-based preventive medicine should not be made part of the role of the general practitioner (GP). Preventive medicine cannot be shown to be more effective than curative or supportive medicine. Therefore, the allocation of the large amount of general practice staff time and resources required for systematic preventive medicine should not come at the expense of the care of the sick and the suffering. The traditional healing role of the (...) GP requires a cooperative patient-centred approach, whereas systematic preventive medicine is driven by rigid pre-set protocols and is intrinsically paternalistic. Trying to merge the two approaches is detrimental to the doctor-patient relationship. Furthermore, a number of potential pitfalls are identified that may be encountered in the implementation of preventive medicine programmes in general practice: interference with the course of the consultation; inadequate explanation and consent; distortion of practice priorities as reflected in quality indicators; temptation to record inaccurate data; conflict of interests where the doctor is rewarded for performance; patient blaming; exacerbation of the health gap. We suggest that a more justifiable strategy would be for GPs to identify patients at high risk and offer them specific preventive advice when the opportunity presents itself and at a time when the patient is likely to be most amenable to cooperate. Opportunistic health promotion offers higher expectations of benefit, as well as a more equitable allocation of the risks associated with preventive medicine, than a systematic community-based approach. (shrink)

I explore the impact of memory altering technologies in the science fiction drama (2016–2020) in order to show that unreconciled altered traumatic memory may lead to a dystopian breakdown of society. I bring Miroslav Volf's theological perspectives on memory into conversation with the plot of Westworld in order to reveal connections between memory altering technologies and humanity's responsibility to remember rightly. Using Volf's theology of remembering as an interpretive lens, I analyze characters’ inability to remember rightly while recalling partial memories (...) of their trauma. In virtue of this examination, I contend that memory altering technologies may inhibit individuals from relational processes of healing, such as forgiveness. Consequently, I argue that this study leads to a richer understanding of the potential that memory altering technologies have for undermining humanity's ability to interact in a relational capacity, specifically in terms of forgiveness. (shrink)

During human evolutionary history, there were “trade-offs” between expending time and energy on child-rearing and mating, so both men and women evolved conditional mating strategies guided by cues signaling the circumstances. Many short-term matings might be successful for some men; others might try to find and keep a single mate, investing their effort in rearing her offspring. Recent evidence suggests that men with features signaling genetic benefits to offspring should be preferred by women as short-term mates, but there are (...) trade-offs between a mate's genetic fitness and his willingness to help in child-rearing. It is these circumstances and the cues that signal them that underlie the variation in short- and long-term mating strategies between and within the sexes. Key Words: conditional strategies; evolutionary psychology; fluctuating asymmetry; mating; reproductive strategies; sexual selection. (shrink)

BackgroundHigh levels of moral distress in nursing professionals, of which oncology nurses are particularly prone, can negatively impact patient care, job satisfaction, and retention.Aim“Positive Attitudes Striving to Rejuvenate You: PASTRY” was developed at a tertiary cancer center to reduce the burden of moral distress among oncology nurses.Research DesignA Quality Improvement (QI) initiative was conducted using a pre- and post-intervention design, to launch PASTRY and measure its impact on moral distress of the nursing unit, using Hamric’s Moral Distress Scale–Revised (MDS-R.) This (...) program consisted of monthly 60-minute sessions allowing nurses to address morally distressing events and themes, such as clinicians giving “false hope” to patients or families. The PASTRY program sessions were led by certified clinicians utilizing strategies of discussion and mind-body practices.ParticipantsClinical nurses working on an adult leukemia/lymphoma unit.Ethical considerationsThis was a QI initiative, participation was voluntary, MDS-R responses were collected anonymously, and the institution’s Ethics Committee oversaw PASTRY’s implementation.FindingsWhile improvement in moral distress findings were not statistically significant, the qualitative and quantitative findings demonstrated consistent themes. The PASTRY program received strong support from nurses and institutional leaders, lowered the nursing unit’s moral distress, led to enhanced camaraderie, and improved nurses’ coping skills.DiscussionMeasurement of moral distress is innately challenging due to its complexity. This study reinforces oncology nurses have measurable moral distress. Interventions should be implemented for a safe and healing environment to explore morally distressing clinical experiences. Poor communication among multidisciplinary team members is associated with moral distress among nurses. Programs like PASTRY may empower nurses to build support networks for change within themselves and institutions.ConclusionThis QI initiative shows further research on moral distress reduction should be conducted to verify findings for statistical significance and so that institutional programs, like PASTRY, can be created. (shrink)

Much of the fear and uncertainty around Zika epidemics stem from potential association between Zika virus complications on infected pregnant women and risk of their babies being born with microcephaly and other neurological abnormalities. However, much remains unknown about its mode of transmission, diagnosis and long-term pathogenesis. Worries of these unknowns necessitate the need for effective and efficient psychosocial programs and medical-legal strategies to alleviate and mitigate ZIKV related burdens. In this light, local and global efforts in maintaining fundamental health (...) principles of moral, medical and legal decision-making policies, and interventions to preserve and promote individual and collectiveHuman Rights, autonomy, protection of the most vulnerable, equity, dignity, integrity and beneficence that should not be confused and relegated by compassionate humanitarian assistance and support. This paper explores the potential medical and ethical-legal implications of ZIKV epidemics emergency response packages and strategies alongside optimizing reproductive and mental health policies, programs and best practice measures. Further long-term cross-borders operational research is required in elucidating Zika-related population-based epidemiology, ethical-medical and societal implications in guiding evidence-based local and global ZIKV maternal-child health complications related approaches and interventions. Core programs and interventions including future Zika safe and effective vaccines for global Zika immunization program in most vulnerable and affected countries and worldwide should be prioritized. (shrink)

Much of the fear and uncertainty around Zika epidemics stem from potential association between Zika virus complications on infected pregnant women and risk of their babies being born with microcephaly and other neurological abnormalities. However, much remains unknown about its mode of transmission, diagnosis and long-term pathogenesis. Worries of these unknowns necessitate the need for effective and efficient psychosocial programs and medical-legal strategies to alleviate and mitigate ZIKV related burdens. In this light, local and global efforts in maintaining fundamental health (...) principles of moral, medical and legal decision-making policies, and interventions to preserve and promote individual and collectiveHuman Rights, autonomy, protection of the most vulnerable, equity, dignity, integrity and beneficence that should not be confused and relegated by compassionate humanitarian assistance and support. This paper explores the potential medical and ethical-legal implications of ZIKV epidemics emergency response packages and strategies alongside optimizing reproductive and mental health policies, programs and best practice measures. Further long-term cross-borders operational research is required in elucidating Zika-related population-based epidemiology, ethical-medical and societal implications in guiding evidence-based local and global ZIKV maternal-child health complications related approaches and interventions. Core programs and interventions including future Zika safe and effective vaccines for global Zika immunization program in most vulnerable and affected countries and worldwide should be prioritized. (shrink)

As the expansion of the Internet and the digital formatting of all kinds of creative works move us further into the information age, intellectual property issues have become paramount. Computer programs costing thousands of research dollars are now copied in an instant. People who would recoil at the thought of stealing cars, computers, or VCRs regularly steal software or copy their favorite music from a friend's CD. Since the Web has no national boundaries, these issues are international concerns. The contributors-philosophers, (...) legal theorists, and business scholars, among others-address questions such as: Can abstract ideas be owned? How does the violation of intellectual property rights compare to the violation of physical property rights? Can computer software and other digital information be protected? And how should legal systems accommodate the ownership of intellectual property in an information age? Intellectual Property is a lively examination of these and other issues, and an invaluable resource for librarians, lawyers, businesspeople, and scholars. (shrink)

[Michael Tye] Externalism about thought contents has received enormous attention in the philosophical literature over the past fifteen years or so, and it is now the established view. There has been very little discussion, however, of whether memory contents are themselves susceptible to an externalist treatment. In this paper, I argue that anyone who is sympathetic to Twin Earth thought experiments for externalism with respect to certain thoughts should endorse externalism with respect to certain memories. /// [Jane Heal] Tye claims (...) that an externalist should say that memory content invoking natural kind concepts floats free of the setting where the memory is laid down and is at later times determined by the context in which the memory is revived. His argument assumes the existence of 'slow switching' of the meaning of natural kind terms when a person is transported from Earth to Twin Earth. But proper understanding of natural kind terms suggests that slow switching (contrary to what is often presupposed) is likely never to be completed. Hence the situation of a person unknowingly transported to Twin Earth is not that his memories switch content but rather that he gets two natural kinds confused. (shrink)

Defends the causal theory of vision and the disjunctive conception of visual experience and argues that they can be coherently combined. Reasons are given for accepting the causal theory of vision and the disjunctive conception of experience. Then, an objection is set out, according to which the disjunctive conception undermines the causal theory, either because the disjunctive conception is incompatible with the idea that visual experiences are caused by the objects we see or because the disjunctive conception removes the main (...) motivation for accepting a causal theory. Against this objection, it is shown how a disjunctive conception of experience can be combined with the causal theory. And it is argued that, even if we accept the disjunctive conception, the causal theory is still needed in order to understand two features of experiences: why they occur and how they have the objective content they do. (shrink)

If mental causal explanations are grounded in facts about physical causes and effects, and if there are no psychophysical laws, how can we avoid the conclusion that the mental is causally, and causally explanatorily, irrelevant? The chapter analyses the ways in which this objection has been raised against non‐reductive monism in general, and Davidson's anomalous monism in particular. Then a conception of explanatory relevance for non‐basic physical properties is set out: properties are candidates for explanatory relevance if they play a (...) role in a simple model of causal action; it is intelligible how a property can be causally explanatorily relevant only if it supervenes on low‐level physical properties; but such supervenience does not provide a self‐standing condition of explanatory relevance. A parallel model is developed for the mental case, exploiting the intuitive model of rational action and appealing to supervenience. Anomalous monism is thereby defended against one objection; but, it is argued, this defence challenges the original motivation for thinking that mental events must be physical events. (shrink)

Interpretationism in the philosophy of mind is often thought to conflict with the idea that beliefs and desires play a genuinely causal role. It is argued that there is in fact no such conflict and that a causal understanding of the mental is essential for realism about mental phenomena and about the relations between thought and reality. First, the chapter considers and responds to various reasons for thinking that the metaphysics of interpretationism is incompatible with a causal view of the (...) mental. Then it examines the view of philosophers who accept that rationalizing, interpretative stories and causal stories are both legitimate, but argue that no single account of anything can be simultaneously rationalizing and causal. Against that view, it is argued that, unless we see interpretative, psychological stories as themselves being causal stories, we cannot understand psychological explanation and we cannot understand how thought and experience can have the objective content they do. (shrink)

Introduces and explains the basic argument for a causal theory of action‐explanation, and defends it against various non‐causal views of action: explaining an action is explaining why something happened, and an explanation of why something happened is always a causal explanation. But what is involved in the claim that reason‐explanation is a form of causal explanation? The chapter begins to answer that question. First, it considers the relation between causal explanation, on the one hand, and the singular relation of causation, (...) on the other. Second, it considers the relation between mental causation and physical causation, defending the idea that we cannot take a purely mentalist view of mental causation. (shrink)

Interpretation is the process of ascribing propositional attitudes to an individual on the basis of what she says and does. Interpretationism is the view that we can gain an understanding of the nature of the mental by reflecting on the nature of interpretation. The chapter examines the arguments for and against holding that the interpretation of propositional attitudes is inseparable from the interpretation of language, that being interpretable as possessing a given attitude is a necessary condition for possessing it, and (...) that being interpretable as possessing an attitude is sufficient for possessing it. And it discusses whether interpretationists should claim that being interpretable as having thoughts is actually constitutive of having thoughts. (shrink)

We are social primates, for whom language-mediated co-operative thinking (‘co-cognition’) is a central element of our shared life. Psychological concepts may be illuminated by appreciating their role in enriching and improving such co-cognition — a role which is importantly different from that of enabling detailed prediction and control of thoughts and behaviour. This account of the nature of psychological concepts (‘co-cognitivism’) has social anti-individualism about thought content as a natural corollary. The combination of co-cognitivism and anti-individualism further suggests that, in (...) addition to the familiar first person authority with which we ascribe thoughts to ourselves, there may also be something deserving the name ‘second person authority’. (shrink)

Strategic alliances are increasingly common, as many organizations look towards various partnering arrangements. This second edition of Strategies of Cooperation extends the first edition's clear and comprehensive survey of strategic alliances. Presenting different disciplinary perspectives and numerous examples from the corporate world. The text has been thoroughly revised and updated, taking account of new theoretical models, and its coverage of case studies has been extended. It will be ideal for business students and managers alike wishing to understand the challenges of (...) managing alliances. (shrink)

How are we to explain the authority we have in pronouncing on our own thoughts? A 'constitutive' theory, on which a second-level belief may help to constitute the first-level state it is about, has considerable advantages, for example in relieving pressures towards dualism. The paper aims to exploit an analogy between authority in performative utterances and authority on the psychological to get a clearer view of how such a constitutive account might work and its metaphysical presuppositions.

Strategic alliances are increasingly common, as many organizations look towards various partnering arrangements. This second edition of Strategies of Cooperation extends the first edition's clear and comprehensive survey of strategic alliances. Presenting different disciplinary perspectives and numerous examples from the corporate world. The text has been thoroughly revised and updated, taking account of new theoretical models, and its coverage of case studies has been extended. It will be ideal for business students and managers alike wishing to understand the challenges of (...) managing alliances. (shrink)

There are modes of presentation of a person in thought corresponding to the first and third person pronouns. This paper proposes that there is also thought involving a second person mode of presentation of another, which might be expressed by an utterance involving ‘you’, but need not be expressed linguistically. It suggests that co-operative activity is the locus for such thought. First person thought is distinctive in how it supplies reasons for the subject to act. In co-operative action there is (...) first person plural intending and judging. So there is a way of thinking of another, when openly co-operating with him or her, which plays the distinctive role of giving reason for contribution to the co-operative activity. In slogan form, ‘you’ is ‘we minus I’. The way children learn to use second and third person pronouns is naturally explained on this view. Contrasting less sophisticated kinds of co-operative activity with more sophisticated forms, and considering some issues about common knowledge and commo.. (shrink)

Safe stair negotiation is an everyday task that children with developmental coordination disorder are commonly thought to struggle with. Yet, there is currently a paucity of research supporting these claims. We investigated the visuomotor control strategies underpinning stair negotiation in children with and without DCD by measuring kinematics, gaze behavior and state anxiety as they ascended and descended a staircase. A questionnaire was administered to determine parents' confidence in their child's ability to safely navigate stairs and their child's (...) fall history. Kinematics were measured using three-dimensional motion capture, whilst gaze was measured using mobile eye-tracking equipment. The parents of DCD children reported significantly lower confidence in their child's ability to maintain balance on the stairs and significantly more stair-related falls in the previous year compared to the parents of typically developing children. During both stair ascent and stair descent, the children with DCD took longer to ascend/descend the staircase and displayed greater handrail use, reflecting a more cautious stair negotiation strategy. No differences were observed between groups in their margin of stability, but the DCD children exhibited significantly greater variability in their foot-clearances over the step edge, which may increase the risk of a fall. For stair descent only, the DCD children reported significantly higher levels of state anxiety than the TD children and looked significantly further along the staircase during the initial entry phase, suggesting an anxiety-related response that may bias gaze toward the planning of future stepping actions over the accurate execution of an ongoing step. Taken together, our findings provide the first quantifiable evidence that safe stair negotiation is a significant challenge for children with DCD, and that this challenge is reflected by marked differences in their visuomotor control strategies and state anxiety levels. Whilst it is currently unclear whether these differences are contributing to the frequency of stair-related falls in children with DCD, our findings pave the way for future research to answer these important questions. (shrink)

Indexicality is a feature of predicates and predicate components (verbs, adjectives, adverbs and the like) as well as of referring expressions. With classic referring indexicals such as 'I' or 'that' a distinctive rule takes us from token and context to some item present in the content which is the semantic correlate of the token. Predicates and predicate components may function in an analogous fashion. For example 'thus' is an indexical adverb which latches onto some manner of performance present in its (...) context. 'John sang thus', said while indicating someone singing discordantly, claims that John sang discordantly. The phenomenon of predicatival indexicality is widespread in English and is expressed in a variety of idioms. Indexical predication plays important epistemological and psychological roles and the notion may have other interesting philosophical applications. (shrink)

A central theme in Wittgenstein’s post-Tractatus remarks on the limits of language is that we ‘cannot use language to get outside language’. One illustration of that idea is his comment that, once we have described the procedure of teaching and learning a rule, we have ‘said everything that can be said about acting correctly according to the rule’; ‘we can go no further’. That, it is argued, is an expression of anti-reductionism about meaning and rules. A framework is presented for (...) assessing the debate between reductionist and anti-reductionist readings of Wittgenstein’s views about meaning and use. It is argued that that debate cannot be settled merely by reference to Wittgenstein’s general opposition to reductionism. An important argument for anti-reductionism about rules and meaning, from Remarks on the Foundations of Mathematics, is discussed. Putative evidence of reductionism about meaning in the Brown Book is considered; an alternative reading is proposed. The nature of Wittgenstein’s anti-reductionism is examined. It is argued, first, that Wittgenstein accepts that semantic and normative facts supervene on non-semantic, non-normative facts and, second, that at many points his treatment of meaning and rules goes beyond the kind of pleonastic claim that is often taken to define non-reductionist, quietist, positions in philosophy. (shrink)

The purpose of this paper is to examine some contentions advanced by B. A. O. Williams in his books Descartes: The Project of Pure Enquiry and Ethics and the Limits of Philosophy . In particular I shall be concerned with the claims he makes about the nature of ethics—namely that it cannot be ‘objective’ or ‘realistic’ and that we may not hope for rational convergence in ethical judgments. My claims will be that Williams's case on these matters is importantly unclear (...) and incomplete and that we lack cogent reasons to accept the conclusions he offers us. But a good deal of scene-setting is necessary before we can pose the questions I wish to address. (shrink)

Human beings are social animals. A solitary life would be horrible for most of us. What makes life worthwhile is being with others and engaging in shared projects with them. To do justice to these facts, philosophers need to pay more attention to the first-person plural, we/us, and to rethink their accounts of value and virtue.

Methodological strategies for the identification and synthesis of ‘evidence’ to support decision‐making in relation to complex healthcare systems and practices This paper addresses the limitations of current methods supporting ‘evidence‐based health‐care’ in relation to complex aspects of care, including those questions that are best supported by descriptive or non‐empirical evidence. The paper identifies some new methods, which may be useful in aiding the synthesis of data in these areas. The methods detailed are broadly divided into those that facilitate the identification (...) of evidence and those that enable the interpretation of the data retrieved. To illustrate some of the issues involved, reference is made to a multimethod review recently completed by the authors, which aimed to identify factors that promote continuity in the transition from child to adult health and social care. It is argued that as healthcare organisations are becoming increasingly preoccupied with the evidence base of practice, such methods may help ensure that aspects of care and approaches that are outside the dominant pharmaco‐medical domain maintain a prominent position on the healthcare agenda while remaining open to external scrutiny. Healthcare professionals who use such approaches need to know their relative utility and benefits to inform clinical decisions, so as to ensure that best practice is observed. (shrink)

ABSTRACT This paper offers an account of the early career of Martha Kneale, née Hurst, and of the five papers she published between 1934 and 1950. One on metaphysical and logical necessity, from 1938, is particularly interesting. In it she considers the metaphysics of time and offers an explanation of ‘the necessity of the past’, which has some resemblance to Kripke’s ideas about metaphysical necessities, in that it assigns an important role to experience in how we come to know them. (...) But Kneale’s view is very different from Kripke’s, depending not on doctrines about rigid designation but rather on recognition of the failure of the atomist/empiricist account of ‘simple’ and ‘complex’ concepts. That account cannot deal with such things as the relations of the determinates of a determinable like colour. A plausible corollary of this, which Kneale exploits, is that some of our experience reveals to us that there are phenomena which are intrinsically complex in having multiple distinguishable aspects, but where those aspects are inseparable. Other of the papers show Kneale to have been pursuing interesting lines of thought about McTaggart’s argument against the reality of time and on the mind-body problem. (shrink)

How are we to explain the authority we have in pronouncing on our own thoughts? A 'constitutive' theory, on which a second-level belief may help to constitute the first -level state it is about, has considerable advantages, for example in relieving pressures towards dualism. The paper aims to exploit an analogy between authority in performative utterances and authority on the psychological to get a clearer view of how such a constitutive account might work and its metaphysical presuppositions.