Background: Pulsed dye laser is the gold standard for treatment of port-wine stain birthmarks but multiple treatments are required and complete resolution is often not achieved. Posttreatment vessel recurrence is thought to be a factor that limits efficacy of PDL treatment of PWS. Imiquimod 5% cream is an immunomodulator with antiangiogenic effects. Objective: We sought to determine if application of imiquimod 5% cream after PDL improves treatment outcome. Methods: Healthy individuals with PWS were treated with PDL and then randomized to (...) apply posttreatment placebo or imiquimod 5% cream for 8 weeks. Chromameter measurements for 57 PWS sites were taken at baseline and compared with measurements taken 8 weeks posttreatment. The Δa and ΔE were measured to quantify treatment outcome. Results: Two patients developed minor skin irritation. Other adverse effects were not noted. Average a was 0.43 for PDL + placebo sites and 1.27 for PDL + imiquimod sites indicating a greater reduction in erythema with imiquimod. Average E was 2.59 for PDL + placebo and 4.08 for PDL + imiquimod, again indicating a greater color improvement with imiquimod. Limitations: Effects were evaluated after a single treatment and duration of effect is unknown. Conclusion: Combined selective photothermolysis and antiangiogenic therapy may enhance PWS treatment efficacy. © 2011 by the American Academy of Dermatology, Inc. (shrink)

ABSTRACT:Despite widespread attention to corruption and organizational change in the literature, to our knowledge, no research has attempted to understand the linkages between these two powerful organizational phenomena. Accordingly, we draw on major theories in ethics, sociology, and management to develop a theoretical framework for understanding how organizational change can sometimes generate corruption. We extend anomie theory and ethical climate theory to articulate the deinstitutionalization of the normative control system and argue that, through this deinstitutionalization, organizations have the potential to (...) become incubators for corruption. We qualify this process by proposing conditions more ripe for anomie and under which this deinstitutionalization is more likely to occur, propounding moderating relationships that influence organizational reconfiguration. Examples of turbulence in the contemporary business environment that can trigger change highlight our discussion. We conclude with managerial implications, offering means by which the deleterious effects of corruption may be arrested or controlled. (shrink)

Ethical guidance for genomic research is increasingly sought and perceived to be necessary. Although there are pressing ethical issues in genomic research – concerning for example the recruitment of patients/participants; the process of taking consent; data sharing; and returning results to patients/participants – there is still limited useful guidance available for researchers/clinicians or for the research ethics committees who review such projects. This report outlines the ethical principles and guidance for genomic research co-produced with stakeholders during two workshops which took (...) place in the UK between November 2016 and May 2017. The stakeholders involved in these workshops included: healthcare professionals, genomic research teams, academics, patients, biobank managers, and representatives from the Health Research Authority, NHS Research Ethics Committees, patient support groups, pharmaceutical industry, and health policy think tanks. The co-produced principles and guidance are specifical... (shrink)

Cancer and its treatment pose challenges that affect not only patients but also their significant others, including intimate partners. Accumulating evidence suggests that couples’ ability to communicate effectively plays a major role in the psychological adjustment of both individuals and the quality of their relationship. Two key conceptual models have been proposed to account for how couple communication impacts psychological and relationship adjustment: the social-cognitive processing (SCP) model and the relationship intimacy (RI) model. These models posit different mechanisms and outcomes, (...) and thus have different implications for intervention. The purpose of this project is to test and compare the utility of these models using comprehensive and methodologically rigorous methods. Aims are: (1) to examine the overall fit of the SCP and RI models in explaining patient and partner psychological and relationship adjustment as they occur on a day-to-day basis and over the course of 1 year; (2) to examine the fit of the models for different subgroups (males vs. females, and patients vs. partners); and (3) to examine the utility of various methods of assessing communication by examining the degree to which baseline indices from different measurement strategies predict self-reported adjustment at 1-year follow up. The study employs a longitudinal, multi-method approach to examining communication processes including: standard self-report questionnaires assessing process and outcome variables collected quarterly over the course of 1 year; smartphone-based ecological momentary assessments to sample participant reports in real time; and laboratory-based couple conversations from which we derive observational measures of communicative behavior and affective expression, as well as vocal indices of emotional arousal. Participants are patients with stage II-IV breast, colon, rectal, or lung cancer and their spouses/partners, recruited from two NCI-designated comprehensive cancer centers. Results will be published in scientific journals, presented at scientific conferences, and conveyed to a larger audience through infographics and social media outlets. Findings will inform theory, measurement, and the design and implementation of efficacious interventions aimed at optimizing both patient and partner well-being. (shrink)

When ethics committees are consulted about patients who have or need court-appointed guardians, they lack empirical evidence about several common issues, including the relationship between guardianship and prolonged, potentially medically unnecessary hospitalizations for patients. To provide information about this issue, we conducted quantitative and qualitative analyses using a retrospective cohort from Veterans Healthcare Administration. To examine the relationship between guardianship appointment and hospital length of stay, we first compared 116 persons hospitalized prior to guardianship appointment to a comparison group (n (...) = 348) 3:1 matched for age, diagnosis, date of admission, and comorbidity. We then compared 91 persons hospitalized in the year following guardianship appointment to a second matched comparison group (n = 273). Mean length of stay was 30.75 days (SD = 46.70) amongst those admitted prior to guardianship, which was higher than the comparison group (M = 7.74, SD = 9.71, F = 20.75, p. (shrink)

Background: Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. (...) Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges. (shrink)

Background Pediatric critical care physician attitudes about withdrawal of ventricular assist devices and extracorporeal membrane oxygenation in cases of medical futility are poorly defined. Our aim was to define current attitudes regarding the withdrawal of these devices. Methods IRB-approved, cross-sectional observational survey conducted among pediatric critical care attending physicians and fellow physicians in the United States between 2016 and 2017. Data was collected anonymously and statistically analyzed. Results A total of 158 physicians responded with 67% being attending physicians. Compared to (...) a VAD, a higher percentage had taken care of a patient on ECMO where the device was turned off because care was believed to be futile, including currently. Nearly all reported that it can be ethically permissible to withdraw support from a patient with a VAD and on ECMO, but varied opinions existed as to who should ultimately make this decision if the patient/their family disagrees. More respondents agreed that a patient/their family should agree to withdrawal of VAD or ECMO support prior to initiation if futility is later determined and that protocols should be created for VAD and ECMO withdrawal. Conclusion Most pediatric critical care physicians felt that it can be ethically permissible to withdraw VAD and ECMO support. Our study indicates that pediatric VAD and ECMO withdrawal protocols are desired, but further investigation is needed to determine how to best design protocols that would incorporate multiple stakeholders. (shrink)

The people and the value of their experience, by N. T. Pratt.--From kingship to democracy, by J. P. Harland.--Democracy at Athens, by G. M. Harper.--Athens and the Delian League, by B. D. Meritt.--Socialism at Sparta, by P. R. Coleman-Norton.--Tyranny, by M. Mac Laren.--Federal unions, by C. A. Robinson.--Alexander and the world state, by O. W. Reinmuth.--The Antigonids, by J. V. A. Fine.--Ptolemaic Egypt: a planned economy, by S. L. Wallace.--The Seleucids: the theory of monarchy, by G. Downey.--The political status of (...) the independent cities of Asia Minor in the Hellenistic period, by D. Magie.--The ideal states of Plato and Aristotle, by W. J. Oates.--Epilogue, by A. C. Johnson.--Bibliography (p. 225-233).--Index, by H. V. M. Dennis, III. (shrink)

In his philosophy of ethics and time, Emmanuel Levinas highlighted the tension that exists between the "ontological adventure" of immediate experience and the "ethical adventure" of redemptive relationships-associations in which absolute responsibility engenders a transcendence of being and self. In an original commingling of philosophy and cinema study, Sam B. Girgus applies Levinas's ethics to a variety of international films. His efforts point to a transnational pattern he terms the "cinema of redemption" that portrays the struggle to connect to others (...) in redeeming ways. Girgus not only reveals the power of these films to articulate the crisis between ontological identity and ethical subjectivity. He also locates time and ethics within the structure and content of film itself. Drawing on the work of Luce Irigaray, Tina Chanter, Kelly Oliver, and Ewa Ziarek, Girgus reconsiders Levinas and his relationship to film, engaging with a feminist focus on the sexualized female body. Girgus offers fresh readings of films from several decades and cultures, including Frank Capra's _Mr. Smith Goes to Washington_ (1939), Federico Fellini's _La dolce vita_ (1959), Michelangelo Antonioni's _L'avventura_ (1960), John Huston's _The Misfits_ (1961), and Philip Kaufman's _The Unbearable Lightness of Being_ (1988). (shrink)

Philosophy and the scientific revolution / Daniel Garber -- Old history and introductory teaching in early modern philosophy : a response to Daniel Garber / Lisa Downing -- Meaning and metaphysics / Susan Neiman -- Evil and wonder in early modern philosophy : a response to Susan Neiman / Mark Larrimore -- The forgetting of gender / Nancy Tuana -- The forgetting of gender and the new histories of philosophy : a response to Nancy Tuana / Eileen O’Neill -- The (...) idea of early modern philosophy / Knud Haakonssen -- Response to Knud Haakonssen / Jeffrey Edwards -- Arguments over obligation : teaching time and place in moral philosophy / Ian Hunter -- Response to Ian Hunter / T.J. Hochstrasser -- Teaching the history of moral philosophy / J.B. Schneewind -- Historicism, moral judgment, and the good life : a response to J.B. Schneewind / Jennifer A. Herdt -- Integrating history of philosophy with history of science after Kant / Michael Friedman -- Response to Michael Friedman / Juliet Floyd -- Thought versus history : reflections on a French problem / Denis Kambouchner -- Response to Denis Kambouchner / Bé́atrice Longuenesse -- Teaching the history of philosophy in 19th-century Germany / Ulrich Johannes Schneider -- Response to Ulrich Johannes Schneider / Karl Ameriks -- Comment : philosophy in practice / Lorraine Daston -- A note from inside the teapot / Anthony Grafton -- Philosophy, history of philosophy, and L’histoire de l’esprit humain : a historiographical question and problem for philosophers / Jonathan Israel -- History and/or philosophy / Donald R. Kelly -- Historians look at the new histories of philosophy : roundtable discussion. (shrink)

Recent work in the ontology of music suggests that we will avoid confusion if we distinguish between two kinds of question that are typically posed in music ontology. Thus, a distinction has been made between fundamental ontology and higher-order ontology. The former addresses questions about the basic metaphysical options from which ontologists choose. For instance, are musical works types, indicated types, classes of particulars, or some other kind of entity? Higher-order ontology addresses the question of what lies ‘at the centre’ (...) of a specific form of music, such as rock or jazz—or perhaps classical music. The argument of this essay is, first, that a close examination of the best efforts in two of these territories shows that they have the effect of pressing the music in each sphere into implausible Procrustean beds. Second, it is argued that the general question that higher-order ontologies pose, that is, ‘What work-kind is it that lies at the centre of a given kind of music, F?’ is a question based on a mistaken but seductive assumption, namely that the concept of the work of F has actual application. In fact, these concepts—upon which higher-order ontology depends—are mere artefacts of philosophy. The question is also addressed why the assumption is so seductive. Finally, the question finally is posed about what, if anything, is implied from the foregoing about the traditional ontology of classical music. (shrink)

L B Daniels; Some Comments on ‘Value in Education’ by Johanna Burgess1, Journal of Philosophy of Education, Volume 8, Issue 2, 30 May 2006, Pages 237–250, https.

In "But Is It Art?", B. R. Tilghman argues in effect that art's necessary paracriticism on other areas of human activity and interest follows from the condition that artistic and aesthetic perceptions are matters of experiencing aspects. However, aspect-seeing is so common in many avenues of human endeavor that it fails to justify a special artistic paracriticism. The realm of art has a language which must be understood in its own right, as is the case for any social realm which (...) dominates a portion of language as a whole. (shrink)

Heidegger''s conception of death as an attitude toward life, overlooked in current literature on death and dying, offers potential for deepening our understanding of the care of non-critically ill patients. By breaking away from the notion of death as an event distinct from life and viewing it as an anticipated possibility at every moment of life, Heidegger provides insight into our attempts to evade death through our fundamental attitudes and value commitments, which in turn determine our behavior and actions. When (...) combined with a method of application — the Nietzschean principle of reversal — these insights permit the understanding of diverse types of human mentality confronted with significant situations. Among the most important applications of these conceptions is to persons in need of medical care, and the resultant types, which are sampled as hypothetical cases, carry important implications for the sensitive care and psychosocial management of non-terminally ill patients. (shrink)

Any comprehensive theory of narrative must accommodate both the justificational and the creative elements of narrative, the activities leading to narrative, and reflections upon the finished product. This examination of four levels of theory reveals the incompleteness of most extant theories, including those of Hayden White and Ricoeur. The four levels are: 1. narrative discourse and temporal language; 2. narrative and historical constructions; 3. narrative objects or stories; and 4. narrative functions and purposes. We remain far from our goal of (...) achieving a comprehensive theory. However, by placing theories and partial theories within a metatheoretical framework, we can see more clearly their nature, ramifications, and limits, thereby differentiating between the contributions and the philosophical fads. (shrink)

The present research examines whether the perceived uniqueness of one’s thoughts and salience of uniqueness motivations can influence attitude strength and resistance. Participants who rated their thoughts as relatively unique formed attitudes that showed greater correspondence with behavioral intentions to act on the attitude (Study 1). In Study 2, participants who recalled a previous purchase motivated by the desire to be unique (versus to fit in) after generating message counterarguments were less persuaded (more resistant) and reported greater willingness to act (...) on their (negative) attitude. Moreover, attitudes mediated the effect of the purchase manipulation on intentions to act on the attitude. (shrink)

An enormous amount of philosophical literature gets published nowadays. Some of it is good; some is fit only for pulping. We get into the habit not so much of reading as of glancing through the torrent that pours down on us. But sometimes special conditions arise. It so happened that I was forced to spend about a month in the hospital. I took with me the book Evolutionary Epistemology and the Logic of the Social Sciences: K. Popper and His Critics (...) [Evoliutsionnaia epistemologiia i logika sotsial'nykh nauk. K. Popper i ego kritiki] . I attentively read it through and without any irony I can say that I felt "legitimate pride and deep satisfaction." Legitimate pride for philosophy and deep satisfaction with the content of the book. And although readers of Problems of Philosophy [Voprosy filosofii] have already had the opportunity of reading a review of this book , I would like to return to it and make in passing a number of points about Popper's philosophy in general. (shrink)