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Mediante un análisis histórico y documental, se indaga en las posibles percepciones e influencias que en la vida de Sor Juana Inés de laCruz pudo haber tenido su exposición a los incipientes movimientos sociales y culturales de la época del virreinato en la Nueva España. A lo largo de su obra, la poeta novohispana se refiere a España y a la Nueva España. De la primera, recoge la tradición literaria y la transforma, dedica poemas a los representantes de (...) la monarquía y reconoce su propia herencia española; de la segunda, recoge la lengua nahua, el español mexicano y el eco de otras lenguas. (shrink)

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Receiving a diagnosis of cancer can be devastating. Cancer continues to be one of the most feared diagnoses, and experiencing pain is a major fear for people diagnosed with cancer. Cancer pain is complex in aetiology and can be acute or chronic and can be caused by various compression, ischaemic, neuropathic or inflammatory processes. Many people with cancer will experience excruciating pain, which is often underreported and undertreated. The reasons for this are complex and include various factors including fears and (...) beliefs held by patients. Cognitive factors are important modulators of pain and the appraisals, meanings and beliefs that people have in relation to illness, cancer, and pain, have implications in regard to help-seeking behaviours and the coping strategies people adopt. Cancer pain can impact a range of psycho-social factors across its course. Cancer pain relates to higher rates of psychological distress, anxiety and low mood, and the perception of pain intensity is, in turn, influenced by psychological factors. Cancer pain can negatively affect psychological health, and psycho-social factors can affect the pain experience. It has been suggested that people with a life-limiting illness experience ‘total pain’, and this can encompass psychological, social, practical, spiritual domains. Research demonstrates that cancer is predominantly an illness affecting older people, yet there is a higher risk of under-treated pain in this age group and there is a paucity of research into the subjective experiences of older people managing their cancer pain. Many older people are required to self-manage cancer pain at home as outpatients, due to drivers to keep people out of inpatient care, such as the high healthcare costs of inpatient treatment, and patients wanting to manage their illness, and die, at home. Our own research into this area found that the self-management of cancer pain involves a sequential and temporal process, which centres on perceptions of control. We describe how the older people in our study experienced a perceived loss of control, followed by a sense of gaining control over pain through various experience of certain internal and external factors. The assessment and treatment of physical pain should be done in combination with assessment and treatment of psycho-social and spiritual pain, and interventions for cancer pain need to focus on increasing positive affect and reducing helplessness. No person should suffer with poorly controlled pain and we argue for the need for further research in this area to ensure adequate treatment for all.Clinical Implications: Assessment and treatment of physical pain in people with cancer needs to be conducted in combination with assessment and treatment of psycho-social issues and spiritual pain. Psychological and behavioural approaches have strong evidence supporting their efficacy for reducing cancer pain. Interventions should target helplessness and focus on increasing positive affect through positive psychological states including fighting spirit and resilience. Person-centred interventions that focus on helping people with the search for meaning may help those with cancer pain derive positive benefits. (shrink)

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"Here is a unique and penetrating postmodernist invitation to reread Pascal's Pensées. With a full control on two centuries of Pascalian hermeneutics,Sara Melzer leads her readers into a passionate quest far beyond the worn-out search for a paleontological reconstruction of the Pensées's hypothetical final form. She rightly and deeply understands Pascal's writing--écriture--as the complex story of the "Fall of Truth into language." Such a perspective gives to Pascal's fragments a rejuvenated life, a newness, a dramatic and powerful voice (...) for our own culture. In brief, a welcome breeze of fresh air in the Pascalian world!" --Edouard Morot-Sir, The University of North Carolina at Chapel Hill "By approaching Pascal's Pensées from the point of view of contemporary critical theory, Melzer sheds new light on this well-known work. Her argument is clear, lucid, and cogent. She has a firm grasp of the major issues at stake in debates among literary critics. I think this is an important work that will be of interest not only to Pascal specialists but also to people who work in the general area of literary theory.... One of the genuine strengths of the book is the author's ability to discern the theological implications of issues that preoccupy literary theorists. This is particularly important at a time when students of theology and religion are becoming more and more interested in literary theory. They will find this analysis of Pascal very suggestive." --Mark Taylor, Williams College. (shrink)

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Categorical loudness scaling (CLS) measures provide useful information about an individual’s loudness perception across the dynamic range of hearing. A probability model of CLS categories has previously been described as a multi-category psychometric function (MCPF). In the study, a representative “catalog” of potential listener MCPFs was used in conjunction with maximum-likelihood estimation to derive CLS functions for participants with normal hearing and with hearing loss. The approach of estimating MCPFs for each listener has the potential to improve the accuracy of (...) the CLS measurements, particularly when a relatively low number of data points are available. The present study extends the MCPF approach by using Bayesian inference to select stimulus parameters that are predicted to yield maximum expected information (MEI) during data collection. The accuracy and reliability of the MCPF-MEI approach were compared to the standardized CLS measurement procedure (ISO16832:2006). A non-adaptive, fixed-level, paradigm served as a “gold-standard” for this comparison. The test time required to obtain measurements in the standard procedure is a major barrier to its clinical uptake. Test time was reduced from approximately 15 minutes to approximately 3 minutes with the MEI-adaptive procedure. Results indicated that the test-retest reliability and accuracy of the MCPF-MEI adaptive procedures were similar to the standardized CLS procedure. Computer simulations suggest that the reliability and accuracy of the MEI procedure were limited by intrinsic uncertainty of the listeners represented in the MCPF catalog. In other words, the MCPF provided insufficient predictive power to significantly improve adaptive-tracking efficiency under practical conditions. Concurrent optimization of both the MCPF catalog and the MEI-adaptive procedure have the potential to produce better results. Regardless of the adaptive-tracking method used in the CLS procedure, the MCPF catalog remains clinically useful for enabling maximum-likelihood determination of loudness categories. (shrink)

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There is an increased controversy surrounding Westerners' use of ayahuasca. One issue of importance is psychological resiliency of users and lack of screening by ayahuasca tourism groups in the Amazon. Given the powerful effects of ayahuasca coupled with lack of cultural support, Western users are at increased risk for psychological distress. Many Westerners who experience psychological distress following ayahuasca ceremonies report concurrently profound spiritual experiences. Because of this, it may be helpful to consider these episodes "spiritual emergencies," or crises resulting (...) from intense and transformative spiritual experiences. Although the author warns readers to avoid romantic comparisons of Western ayahuasca users to shamans, ethnographic data on indigenous shamanic initiates along with theory on liminality may be of some use to understand difficult experiences that accompany ayahuasca use. Given that psychotherapy is culturally sanctioned, therapists trained in treating spiritual crises can help Western ayahuasca users make meaning of their distress. Three case studies are offered as examples of individuals working through various sorts of crises following ayahuasca ceremonies. (shrink)

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Despite the enormous progress made in the advancement of health technologies over the last century, infectious diseases continue to cause significant morbidity and mortality in developing countries. Neglected diseases are a subset of infectious diseases that lack treatments that are effective, simple to use, or affordable. Neglected diseases primarily affect populations in poor countries that do not constitute a lucrative market sector, thus failing to provide incentives for the pharmaceutical industry to conduct R&D for these diseases. Of the treatments that (...) do exist for neglected diseases, most are completely out-dated, with poor side-effect profiles, cumbersome logistics of administration, and inadequate efficacy. Historically, the impetus for a majority of neglected disease research was driven by early 20th-century colonialism, and in the post-colonial era, these diseases have been virtually ignored. Of the 1556 New Chemical Entities brought to market during the 30-year period from 1975 to 2004, only 20 — less than 0.02% — were for neglected diseases. (shrink)

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We hypothesize that juvenile baboons are less efficient foragers than adult baboons owing to their small size, lower level of knowledge and skill, and/or lesser ability to maintain access to resources. We predict that as resources are more difficult to extract, juvenile baboons will demonstrate lower efficiency than adults will because of their lower levels of experience. In addition, we hypothesize that juvenile baboons will be more likely to allocate foraging time to easier-to-extract resources owing to their greater efficiency in (...) acquiring those resources.We use feeding efficiency and time allocation data collected on a wild, free-ranging, non-provisioned population of chacma baboons (Papio hamadryas ursinus) in the Moremi Wildlife Reserve, Okavango Delta, Botswana to test these hypotheses. The major findings of this study are:1. Juvenile baboons are significantly less efficient foragers than adult baboons primarily for difficult-to-extract resources.We propose that this age-dependent variation in efficiency is due to differences in memory and other cognitive functions related to locating food resources, as is indicated by the greater amount of time juvenile baboons spend searching for food. There is no evidence that smaller body size or competitive disruption influences the differences in return rates found between adult and juvenile baboons in this study.2. An individual baboon’s feeding efficiency for a given resource can be used to predict the duration of its foraging bouts for that resource.These results contribute both to our understanding of the ontogeny of behavioral development in nonhuman primates, especially regarding foraging ability, and to current debate within the field of human behavioral ecology regarding the evolution of the juvenile period in primates and humans. (shrink)

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Researchers have argued that bilingual speakers experience less emotion in their second language. However, some studies have failed to find differences in emotionality between first and second lang...

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The effective provision of psychotherapy services to individuals with intellectual disability requires consideration of ethical issues related to clinical competence, access to services, obligations to multiple parties, guardianship, and appropriate assessment practices. This article provides an overview of major ethical considerations with guidance for clarifying and resolving common ethical concerns. Psychologists are encouraged to expand access to psychotherapy services for this population while maintaining awareness of potential modifications, training needs, and boundaries of professional competence. The authors provide recommendations and resources (...) for effective and ethical treatment of psychotherapy clients with intellectual disabilities. (shrink)

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Emmanuel Levinas argues that justice is meaningful only to the extent that other persons are encountered in their individuality, as my neighbors, and not merely abstract citizens of a political community. That is, the political demand for justice arises from my ethical relationship with the other whose face I cannot look past. But despite his revolutionary ideas about the origins of justice, Levinas ultimately appeals to a very traditional view of justice in which persons are considered equal and comparable. and (...) responsibilities and rights are distributed evenly among them. In response to Levinas, I argue that insofar as justice is constructed by and for the ethicalrelationship, it must also be deconstructed by that relationship. If one takes seriously Levinas’s claim that asymmetrical ethical responsibility is the origin of justice, then one must also reject Levinas’s suggestion that justice involves viewing persons and responsibilities as comparable and symmetrical. (shrink)

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Why do some parents refuse to vaccinate their children? Why do some people keep guns at home, despite scientific evidence of risk to their family members? And why do people use antibiotics for illnesses they cannot possibly alleviate? When it comes to health, many people insist that science is wrong, that the evidence is incomplete, and that unidentified hazards lurk everywhere. In Denying to the Grave, Gorman and Gorman, a father-daughter team, explore the psychology of health science denial. Using several (...) examples of such denial as test cases, they propose six key principles that may lead individuals to reject "accepted" health-related wisdom: the charismatic leader; fear of complexity; confirmation bias and the internet; fear of corporate and government conspiracies; causality and filling the ignorance gap; and the nature of risk prediction. The authors argue that the health sciences are especially vulnerable to our innate resistance to integrate new concepts with pre-existing beliefs. This psychological difficulty of incorporating new information is on the cutting edge of neuroscience research, as scientists continue to identify brain responses to new information that reveal deep-seated, innate discomfort with changing our minds. Denying to the Grave explores risk theory and how people make decisions about what is best for them and their loved ones, in an effort to better understand how people think when faced with significant health decisions. This book points the way to a new and important understanding of how science should be conveyed to the public in order to save lives with existing knowledge and technology. (shrink)

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Recent research in ethics education shows a potentially problematic variation in content, curricular materials, and instruction. While ethics instruction is now widespread, studies have identified significant variation in both the goals and methods of ethics education, leaving researchers to conclude that many approaches may be inappropriately paired with goals that are unachievable. This paper speaks to these concerns by demonstrating the importance of aligning classroom-based assessments to clear ethical learning objectives in order to help students and instructors track their progress (...) toward meeting those objectives. Two studies at two different universities demonstrate the usefulness of classroom-based, formative assessments for improving the quality of students’ case responses in computational modeling and research ethics. (shrink)

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The COVID‐19 pandemic exposes underlying inequalities in our socio‐economic and health systems, such as gender‐based violence (GBV). In emergencies, particularly ones that involve quarantine, GBV often increases. Policymakers must utilize community expertise, technology and existing global guidelines to disrupt these trends in the early stages of the COVID‐19 epidemic. Gender norms and roles relegating women to the realm of care work puts them on the frontlines in an epidemic, while often excluding them from developing the response. It is critical to (...) value women’s roles in society and include their voices in the decision‐making process to avoid unintended consequences and ensure a comprehensive response that caters to the needs of the most vulnerable groups. (shrink)

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Strategic games require reasoning about other people’s and one’s own beliefs or intentions. Although they have clear commonalities with psychological tests of theory of mind, they are not clearly related to theory of mind tests for children between 9 and 10 years of age “Flobbe et al. J Logic Language Inform 17(4):417–442 (2008)”. We studied children’s (5–12 years of age) individual differences in how they played a strategic game by analyzing the strategies that they applied in a zero, first, and (...) second-order reasoning task. For the zero-order task, we found two subgroups with different accuracy levels. For the first-order task, subgroups of children applied different suboptimal strategies or an optimal strategy. For the second-order task only suboptimal strategies were present. Strategy use for all tasks was related to age. The 5- and 6-year old children were additionally tested on theory of mind understanding and executive functioning. Strategy-use in these children was related to working memory, but not to theory of mind after correction for age, verbal ability and general IQ. (shrink)

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In the 1930s, the Home Owners’ Loan Corporation (HOLC) graded the mortgage security of urban US neighborhoods. In doing so, the HOLC engaged in the practice, imbued with racism and xenophobia, of “redlining” neighborhoods deemed “hazardous” for lenders. Redlining has caused persistent social, political and economic problems for communities of color. Linkages between redlining and contemporary food access remain unexamined, even though food access is essential to well-being. To investigate this, we used a census tract-level measure of low-income and low (...) grocery store food access from the US Department of Agriculture Food Access Research Atlas, redlining data from Mapping Inequality Project, and demographic data from the American Community Survey. We employed generalized estimating equations with robust covariance estimates to analyze data pertaining to 10,459 census tracts in 202 US cities. Tracts that the HOLC graded as “C” (“decline in desirability”) and “D” (“hazardous”) had reduced contemporary food access compared to those graded “A” (“best”). Increases in contemporary census tract proportions of Black, Hispanic, or other racial/ethnic minority residents, as well as disabled residents, were associated with reduced food access. Increases in contemporary proportions of residents age 75 years and older or those without a car were associated with better food access. Tracts that underwent housing redevelopment since being graded had better food access, while those undergoing gentrification had reduced food access. Results suggest that issues of redlining, housing discrimination, racism, ableism, displacement, and food inaccessibility are deeply intertwined. (shrink)

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Our objective is to test an optimality model of human fertility that specifies the behavioral requirements for fitness maximization in order (a) to determine whether current behavior does maximize fitness and, if not, (b) to use the specific nature of the behavioral deviations from fitness maximization towards the development of models of evolved proximate mechanisms that may have maximized fitness in the past but lead to deviations under present conditions. To test the model we use data from a representative sample (...) of 7,107 men living in Albuquerque, New Mexico, between 1990 and 1993. The model we test proposes that low fertility in modern settings maximizes number of grandchildren as a result of a trade-off between parental fertility and next generation fertility. Results do not show the optimization, although the data do reveal a trade-off between parental fertility and offspring education and income.We propose that two characteristics of modern economies have led to a period of sustained fertility reduction and to a corresponding lack of association between income and fertility. The first is the direct link between costs of investment and wage rates due to the forces of supply and demand for labor in competitive economies. The second is the increasing emphasis on cumulative knowledge, skills, and technologies in the production of resources. Together they produce historically novel conditions. These two features of modern economies may interact with evolved psychological and physiological mechanisms governing fertility and parental investment to produce behavior that maximizes the economic productivity of lineages at the expense of fitness. If cognitive processes evolved to track diminishing returns to parental investment and if physiological processes evolved to regulate fertility in response to nutritional state and patterns of breast feeding, we might expect non-adaptive responses when returns from parental investment do not diminish until extremely high levels are reached. With high economic payoffs from parental investment, people have begun to exercise cognitive regulation of fertility through contraception and family planning practices. Those cognitive processes maynot have evolved to handle fitness trade-offs between fertility and parental investment. (shrink)

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Strategic games require reasoning about other people’s and one’s own beliefs or intentions. Although they have clear commonalities with psychological tests of theory of mind, they are not clearly related to theory of mind tests for children between 9 and 10 years of age “Flobbe et al. J Logic Language Inform 17(4):417–442 (2008)”. We studied children’s (5–12 years of age) individual differences in how they played a strategic game by analyzing the strategies that they applied in a zero, first, and (...) second-order reasoning task. For the zero-order task, we found two subgroups with different accuracy levels. For the first-order task, subgroups of children applied different suboptimal strategies or an optimal strategy. For the second-order task only suboptimal strategies were present. Strategy use for all tasks was related to age. The 5- and 6-year old children were additionally tested on theory of mind understanding and executive functioning. Strategy-use in these children was related to working memory, but not to theory of mind after correction for age, verbal ability and general IQ. (shrink)

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Experiential evidence shows that pain is associated with common meanings. These include a meaning of threat or danger, which is experienced as immediately distressing or unpleasant; cognitive meanings, which are focused on the long-term consequences of having chronic pain; and existential meanings such as hopelessness, which are more about the person with chronic pain than the pain itself. This interdisciplinary book - the second in the three-volume Meanings of Pain series edited by Dr Simon van Rysewyk - aims to better (...) understand pain by describing experiences of pain and the meanings these experiences hold for the people living through them. The lived experiences of pain described here involve various types of chronic pain, including spinal pain, labour pain, rheumatic pain, diabetic peripheral neuropathic pain, fibromyalgia, complex regional pain syndrome, endometriosis-associated pain, and cancer-related pain. Two chapters provide narrative descriptions of pain, recounted and interpreted by people with pain. Language is important to understanding the meaning of pain since it is the primary tool human beings use to manipulate meaning. As discussed in the book, linguistic meaning may hold clues to understanding some pain-related experiences, including the stigmatisation of people with pain, the dynamics of patient-clinician communication, and other issues, such as relationships between pain, public policy and the law, and attempts to develop a taxonomy of pain that is meaningful for patients. Clinical implications are described in each chapter. This book is intended for people with pain, their family members or caregivers, clinicians, researchers, advocates, and policy makers. (shrink)

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As children with Down syndrome (DS) typically manifest significant delays in language development, the research has pointed out the predictors of later language skills for this clinical population. The purpose of this study was to systematically explore the evidence for early predictors of language outcomes in infants and toddlers with DS from studies published between 2012 and 2022. After the search, nine studies met the inclusion criteria. The results indicated that maternal educational level, adaptive level of functioning, cognitive function, attention (...) skills, communicative intent of the child, early vocalizations, gestures, baby signs, parents’ translation of their children’s gestures into words, and vocabulary level are significant predictors of language outcomes in children with DS. These findings provide a timely and warranted summary of published work that contributes to current understanding of the development of language and communication in DS. They are therefore useful to researchers, clinicians, and families. (shrink)

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When animals choose between completing a cognitive task and “escaping,” proper interpretation of their behavior depends crucially on methodological details, including how forced and freely chosen tests are mixed and whether appropriate transfer tests are administered. But no matter how rigorous the test, it is impossible to go beyond functional similarity between human and nonhuman behaviors to certainty about human-like consciousness.

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Advancements in novel neurotechnologies, such as brain computer interfaces and neuromodulatory devices such as deep brain stimulators, will have profound implications for society and human rights. While these technologies are improving the diagnosis and treatment of mental and neurological diseases, they can also alter individual agency and estrange those using neurotechnologies from their sense of self, challenging basic notions of what it means to be human. As an international coalition of interdisciplinary scholars and practitioners, we examine these challenges and make (...) recommendations to mitigate negative consequences that could arise from the unregulated development or application of novel neurotechnologies. We explore potential ethical challenges in four key areas: identity and agency, privacy, bias, and enhancement. To address them, we propose democratic and inclusive summits to establish globally-coordinated ethical and societal guidelines for neurotechnology development and application, new measures, including “Neurorights,” for data privacy, security, and consent to empower neurotechnology users’ control over their data, new methods of identifying and preventing bias, and the adoption of public guidelines for safe and equitable distribution of neurotechnological devices. (shrink)

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We have examined healthcare staff attitudes of toward a blogging cancer patient who publishes critical posts about her treatment and their possible effect on patient-staff relationships and treatment decisions. We used two versions of a questionnaire containing a vignette based on a modified real case involving a 39-year-old cancer patient who complained on her blog about how she was encountered and the treatment she received. Initially she was not offered a new, and expensive treatment, which might have influenced her perception (...) of further encounters. In one version of the vignette, the team decides to put extra effort into both encounters and offers the expensive new cancer treatment. In the other version, the team decides to follow the clinic’s routine to the letter. Subsequently, blog postings became either positive or negative in tone. We also divided participants into value-neutral and value-influenced groups by asking how their trust in healthcare would be affected if the team’s suggestion were followed. A total of 56 % of the respondents faced with a team decision to ‘do something-extra’ in encounters would act in accordance with this ambition. Concerning treatment, 32 % would follow the team’s decision to offer a new and expensive treatment. A large majority of those who received the “follow-routine” version agreed to do so in encountering [94 % ]. Similar proportions were found regarding treatment [86 % ]. A total of 83 % of the value-neutral participants who received the “do-something-extra” version stated that they would act as the team suggested regarding encounters, while 57 % would do so in regard to treatment. Among the value-influenced participants who received the “do-something-extra” version, 45 % stated that they would make an extra effort to accommodate the patient and her needs, while the proportion for treatment was 22 %. Among those who had received the “follow-routine” version, a large majority agreed, and no difference was indicated between the value-neutral and the value-influenced participants. The present study indicates that healthcare staff is indeed influenced by reading a patient’s critical blog entries, largely regarding encounters, but also concerning treatment is concerned. Value-neutral healthcare personnel seem to exhibit a pragmatic attitude and be more inclined to heed and respond to a patient whose criticism may well be warranted. The study also indicates that healthcare staff is partly positive or negative to future blogging patients depending on how the issue has been framed. For future research we suggest as a bold hypothesis that the phrase “clinical routine” might conceal power aspects masquerading as adopted ethical principles. (shrink)

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Emotional, social, and cognitive intelligence competencies have been recognized as the most critical capabilities for organizations to acquire at all levels. For this reason, a wide body of research since the 1980s has demonstrated their positive impact on individual performance, career success, and wellbeing across sectors and professional roles, and a large number of theoretical contributions on how these competencies can be effectively developed has emerged over time. We focus attention on the developmental and learning processes of emotional, social, and (...) cognitive intelligence competencies that occur after formal training or educational courses provided by universities or certified organizations and directed to students or practitioners. Specifically, we conduct an exploratory literature review on the existing academic studies in order to identify the scholars and the pieces of research contributing most to the debate under investigation. This article aims at analyzing this body of research through a systematic review of the literature in order to: i) provide a comprehensive critical analysis of the distinctive features of the theoretical and methodological frameworks adopted to develop these competencies; ii) review the contexts in which the training initiatives analyzed by the literature have been delivered and the categories of learner involved; iii) discuss the learning outcomes of these educational programs and how they have been assessed; iv) identify gaps and inconsistencies in the current state of the literature, suggesting promising paths for future research; and v) stimulate insights for educators, human resource managers, executives, and policymakers by organizing and critically analyzing the extant contributions on competency development. This review represents the first attempt to systematize the methodologies of the educational programs for competency development and to assess their effectiveness in order to assist educators and executives in their ongoing efforts to equip students and employees with the relevant skills needed to achieve superior performance in the workplace. At the institutional level, policymakers should promote a dedicated agenda with concrete actions to equip people with emotional and social intelligence competencies. (shrink)

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Moral distress has been identified as an occupational hazard for clinicians caring for vulnerable populations. The aim of this systematic review was (i) to summarize the literature reporting on prevalence of, and factors related to, moral distress among nurses within acute mental health settings, and (ii) to examine the efficacy of interventions designed to address moral distress among nurses within this clinical setting. A comprehensive literature search was conducted in October 2022 utilizing Nursing & Allied Health, Embase, CINAHL, PsychInfo, and (...) PubMed databases to identify eligible studies published in English from January 2000 to October 2022. Ten studies met inclusion criteria. Four quantitative studies assessed moral distress among nurses in acute mental health settings and examined relationships between moral distress and other psychological and work-related variables. Six qualitative studies explored the phenomenon of moral distress as experienced by nurses working in acute mental health settings. The quantitative studies assessed moral distress using the Moral Distress Scale for Psychiatric Nurses (MDS-P) or the Work-Related Moral Stress Questionnaire. These studies identified relationships between moral distress and emotional exhaustion, depersonalization, cynicism, poorer job satisfaction, less sense of coherence, poorer moral climate, and less experience of moral support. Qualitative studies revealed factors associated with moral distress, including lack of action, poor conduct by colleagues, time pressures, professional, policy and legal implications, aggression, and patient safety. No interventions targeting moral distress among nurses in acute mental health settings were identified. Overall, this review identified that moral distress is prevalent among nurses working in acute mental health settings and is associated with poorer outcomes for nurses, patients, and organizations. Research is urgently needed to develop and test evidence-based interventions to address moral distress among mental health nurses and to evaluate individual and system-level intervention effects on nurses, clinical care, and patient outcomes. (shrink)

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Background Families whose child has unexplained intellectual or developmental differences often hope that a genetic diagnosis will lower barriers to community-based therapeutic and support services. However, there is little known about efforts to mobilize genetic information outside the clinic or how socioeconomic disadvantage shapes and constrains outcomes.Methods We conducted an ethnographic study with predominantly socioeconomically disadvantaged families enrolled in a multi-year genomics research study, including clinic observations and in-depth interviews in English and Spanish at multiple time points. Coding and thematic (...) development were used to collaboratively interpret fieldnotes and transcripts.Results Thirty-two families participated. Themes included familial expectations that a genetic diagnosis could be translated into information, understanding, and assistance to improve the quality of a child’s day-to-day life. After sequencing, however, genetic information was not readily converted into improved access to services beyond the clinic, with families often struggling to use a genetic diagnosis to advocate for their child.Conclusion Families’ ability to use a genetic diagnosis as an effective advocacy tool beyond the clinic was limited by the knowledge and resources available to them, and by the eligibility criteria used by therapeutic service providers’ – which focused on clinical diagnosis and functional criteria more than etiologic information. All families undertaking genomic testing, particularly those who are disadvantaged, need additional support to understand the limits and potential benefits of genetic information beyond the clinic. (shrink)

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We study statements about countable and well-ordered unions and their relation to each other and to countable and well-ordered forms of the axiom of choice. Using WO as an abbreviation for “well-orderable”, here are two typical results: The assertion that every WO family of countable sets has a WO union does not imply that every countable family of WO sets has a WO union; the axiom of choice for WO families of WO sets does not imply that the countable union (...) of countable sets is WO. (shrink)

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