Search

Ordinary human experience is embedded in a web of causal relations that link the brain to the body and the wider environment. However, there might be conditions in which brain activity supports consciousness even when that activity is fully causally isolated from the body and its environment. Such cases would involve what we call islands of awareness: conscious states that are neither shaped by sensory input nor able to be expressed by motor output. This Opinion paper considers conditions in which such islands might occur, including ex cranio brains, hemispherotomy, and in cerebral organoids. We examine possible methods for detecting islands of awareness, and consider their implications for ethics and for the nature of consciousness., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Ethical awareness (EA) enables nurses to recognize the ethical implications of all practice actions and is an important component of safe and quality nursing care. Evidence suggests that nurses may sometimes feel underprepared to recognize and address ethical issues as they arise in practice. The Ethical Awareness Scale (EAS) presented strong evidence as a psychometrically sound measure of EA in critical care nurses in pilot testing. The present study extends earlier work by (a) expanding the sample, (b) replicating the psychometric analyses, (c) more deeply investigating data-to-model fit, and (d) providing guidelines for the interpretation of EAS scores and subsequent practice-focused and educational interventions. Methods: This study utilized two sets of cross-sectional EAS survey results with ICU nurse respondents from two hospitals in New England. Invariance testing using simple OLS regression was conducted between the item estimates of both samples. The final Rasch analysis utilized a rating scale model. Finally, a score interpretation framework was developed. Results: 240 participants were included in the combined analysis. Nurses were predominantly female (93.1%), aged 25-35 (39.9%), and Bachelor's degree prepared (73.4%). Mean levels of EA were in the low/moderate range (M = 36.2/54). Cronbach's alpha of 0.86 was achieved. The Rasch analysis demonstrated a variable map structure consistent with the hypothesized item order, scoring categories that were sufficiently used by respondents, and adequate model-data fit. Conclusions: This study demonstrates that the EAS is a psychometrically sound and meaningful measure of EA in critical care nurses with item difficulty estimates that are invariant across samples. A raw score on the EAS can be practically interpreted, given the theoretical description of what a nurse at each level of the scale's continuum may "look" like in terms of EA using the diagnostic interpretation table. These findings have implications for nursing education and practice.

In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) updated the Guideline of Prevention, Detection, Evaluation and Management and Management of High Blood Pressure (HBP) in Adults. The purpose of the current study was to evaluate the potential impact of the 2017ACC/AHA HBP guideline on hypertension prevalence, awareness, and control rates. The data were collected from Physical Examination Center of the Second Hospital of Hebei Medical University from January 2012 to December 2017 (N = 66 977), including demographic information and risk factors of hypertension. The hypertension prevalence, awareness, and control rates of people were evaluated according to the new guideline. Additionally, the factors related to hypertension prevalence were also assessed. According to previous HBP guideline, hypertension prevalence, awareness, and control rate were 30.54%, 44.33%, and 13.04%, respectively. However, when the 2017 ACC/AHA HBP guideline was introduced, the population with hypertension increased from 20 453 to 34 460, the hypertension prevalence rate increased from 30.54% to 51.45%, the awareness rate decreased from 44.33% to 26.31%, and the control rate declined from 13.04% to 2.72%. The most newly diagnosed hypertension patients were from the low-risk population with young age and without the above histories. The 2017ACC/AHA HBP guideline indicated that high hypertension prevalence rate still existed with a substantial increase, while the awareness and control rates were relatively lowered., (©2019 Wiley Periodicals, Inc.)

Professional communities are experiencing scandals involving unethical and illegal practices daily. Yet it should not take a national major structure failure to highlight the importance of ethical awareness and behavior, or the need for the development and practice of ethical behavior in engineering students. Development of ethical behavior skills in future engineers is a key competency for engineering schools as ethical behavior is a part of the professional identity and practice of engineers. While engineering educators have somewhat established instructional methods to teach engineering ethics, they still rely heavily on teaching ethical awareness, and pay little attention to how well ethical awareness predicts ethical behavior. However the ability to exercise ethical judgement does not mean that students are ethically educated or likely to behave in an ethical manner. This paper argues measuring ethical judgment is insufficient for evaluating the teaching of engineering ethics, because ethical awareness has not been demonstrated to translate into ethical behavior. The focus of this paper is to propose a model that correlates with both, ethical awareness and ethical behavior. This model integrates the theory of planned behavior, person and thing orientation, and spheres of control. Applying this model will allow educators to build confidence and trust in their students' ability to build a professional identity and be prepared for the engineering profession and practice.

Background: Schizophrenia is a rare but devastating condition, affecting about 1% of the world's population and resulting in about 2% of the US health care expenditure. Major impediments to appropriate and timely care include misconceptions, high levels of stigma, and lack of public awareness. Facebook offers novel opportunities to understand public awareness and information access related to schizophrenia, and thus can complement survey-based approaches to assessing awareness that are limited in scale, robustness, and temporal and demographic granularity., Objective: The aims of this study were to (1) construct an index that measured the awareness of different demographic groups around schizophrenia-related information on Facebook; (2) study how this index differed across demographic groups and how it correlated with complementary Web-based (Google Trends) and non-Web-based variables about population well-being (mental health indicators and infrastructure), and (3) examine the relationship of Facebook derived schizophrenia index with other types of online activity as well as offline health and mental health outcomes and indicators., Methods: Data from Facebook's advertising platform was programmatically collected to compute the proportion of users in a target demographic group with an interest related to schizophrenia. On consultation with a clinical expert, several topics were combined to obtain a single index measuring schizophrenia awareness. This index was then analyzed for differences across US states, gender, age, ethnic affinity, and education level. A statistical approach was developed to model a group's awareness index based on the group's characteristics., Results: Overall, 1.03% of Facebook users in the United States have a schizophrenia-related interest. The schizophrenia awareness index (SAI) is higher for females than for males (1.06 vs 0.97, P<.001), and it is highest for the people who are aged 25-44 years (1.35 vs 1.03 for all ages, P<.001). The awareness index drops for higher education levels (0.68 for MA or PhD vs 1.92 for no high school degree, P<.001), and Hispanics have the highest level of interest (1.57 vs 1.03 for all ethnic affinities, P<.001). A regression model fit to predict a group's interest level achieves an adjusted R 2 =0.55. We also observe a positive association between our SAI and mental health services (or institutions) per 100,000 residents in a US state (Pearson r=.238, P<.001), but a negative association with the state-level human development index (HDI) in United States (Pearson r=-.145, P<.001) and state-level volume of mental health issues in United States (Pearson r=-.145, P<.001)., Conclusions: Facebook's advertising platform can be used to construct a plausible index of population-scale schizophrenia awareness. However, only estimates of awareness can be obtained, and the index provides no information on the quality of the information users receive online., (©Koustuv Saha, Ingmar Weber, Michael L Birnbaum, Munmun De Choudhury. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 08.05.2017.)

While the medical ethics literature has well explored the harm to patients, families, and the integrity of the profession in failing to disclose medical errors once they occur, less often addressed are the moral and professional obligations to take all available steps to prevent errors and harm in the first instance. As an expanding body of scholarship further elucidates the causes of medical error, including the considerable extent to which medical errors, particularly in diagnostics, may be attributable to cognitive sources, insufficient progress in systematically evaluating and implementing suggested strategies for improving critical thinking skills and medical judgment is of mounting concern. Continued failure to address pervasive thinking errors in medical decisionmaking imperils patient safety and professionalism, as well as beneficence and nonmaleficence, fairness and justice. We maintain that self-reflective and metacognitive refinement of critical thinking should not be construed as optional but rather should be considered an integral part of medical education, a codified tenet of professionalism, and by extension, a moral and professional duty.

The aim of this study was to investigate the use of a newly developed design game called BLOCKS to stimulate awareness of ethical responsibilities amongst engineering students. The design game was played by seventeen teams of chemical engineering students, with each team having to arrange pieces of colored paper to produce two letters each. Before the end of the game, additional constraints were introduced to the teams such that they faced similar ambiguity in the technical facts that the engineers involved in the Challenger disaster had faced prior to the space shuttle launch. At this stage, the teams had to decide whether to continue with their original design or to develop alternative solutions. After the teams had made their decisions, a video of the Challenger explosion was shown followed by a post-game discussion. The students' opinion on five Statements on ethics was tracked via a Five-Item Likert survey which was administered three times, before and after the ethical scenario was introduced, and after the video and post-game discussion. The results from this study indicated that the combination of the game and the real-life incident from the video had generally strengthened the students' opinions of the Statements.

During the past decade there has been growing interest in the development of practice guidelines on medical end-of-life decisions. A questionnaire about awareness and use of end-of-life decision guidelines was applied by e-mail in a cross-sectional survey among 1494 attendants of Austrian intensive care medicine conferences held in 2008. Of a total of 246 evaluable responses from physicians, only 140 said to have been aware of national end-of-life decision-making guidelines (56.9%). Those who read the recommendations at least in part believe to have derived benefit from the recommendations. Even though the response rate was low, Austrian intensive care medicine societies should be encouraged to better disseminate end-of-life decision guidelines among caregivers.

Objective: Awareness of the privileges and limits of one's role as physician, as well as recognition and respect for the patient as a human being, are central to ethical medical practice. The authors were particularly interested in examining the attitudes and perceived needs of psychiatric residents toward education on professional boundaries and relationships given the heightened current focus on professionalism and ethics., Methods: Residents from six psychiatric residencies provided views on professionalism and ethics education on a survey encompassing 10 domains of professionalism. The authors focus on residents' perceived need for education on boundaries in the psychiatrist-patient relationship and in peer-peer and supervisor-trainee interactions., Results: Respondents (N=134) felt that nine relationship and boundary issues arising during training should receive more education: being asked to work with inadequate supervision, resolving conflicts between attendings and trainees, resident health care, adequately caring for patients while adhering to work-hour guidelines, performing work beyond one's competence, mistreatment of residents, sexual/romantic relationships between faculty and trainees, mistreatment of medical students, and sexual/romantic relationships between residents and medical students (p<0.05 in all cases). In addition, 15 relationship and boundary issues arising during clinical practice were felt to warrant more education: responding to impaired colleagues, coping with mistakes in clinical care, reporting mistakes, balancing personal and professional life, resolving conflicts, writing prescriptions for friends or family, allocation of health care resources, providing medical advice to friends and family, physicians' social responsibilities, interacting with families, medicine as a profession, gender bias, being asked to falsify clinical information, accepting gifts from patients, and personal relationships with patients (p<0.05 in all cases)., Conclusion: The authors found a perceived need for more education for psychiatric residents for the majority of topics pertaining to boundaries and relationships. Residents who reported encountering ethical dilemmas more frequently wanted more education on these topics.

Neuropsychologists are occasionally asked to have neuropsychological testing observed via the presence of a third party, through one-way mirrors, or with audio or video monitoring or recording devices. The primary reasons for not allowing observation are its effect on the validity of the examination results and the security of copyrighted test materials. To overcome the problem of observer effects on the examinee's performance, some individuals have suggested that examinations be monitored or recorded without the examinee's awareness (i.e., secretly). However, secretive recording of neuropsychological interviews and testing is deceptive, which is inconsistent with ethical principles. In addition, such recording may affect the behavior of the examiner. For these reasons, neuropsychologists do not, and should not, encourage, condone, or engage in secret recording of neuropsychological interviews or testing.

Substitute decision-makers for severely disabled neonates who can be kept alive but who will require constant medical interventions and will die at the latest in their teens are faced with a difficult decision when trying to decide whether to keep the infant alive. By and large, the primary focus of their decision-making centers on what is in the best interests of the newborn. The best-interests criterion, in turn, is importantly conditioned by quality-of-life considerations. However, the concept of quality of life is logically and ethically different for patients with a developing as opposed to a developed awareness. Unfortunately, this difference is ignored by current quality-of-life considerations, there are no quality-of-life measures that take this difference into account, and decision-making proceeds entirely without acknowledging this fact. This note outlines why this is a problem and why there is a need for a new set of tools that incorporates this distinction if the substitute decision-makers are to apply the best-interest criterion in a meaningful way.

Ten new graduate speech pathologists recounted their experiences in managing workplace ethical dilemmas in semi-structured interviews. Their stories were analysed for elements that described the nature and management of the ethical dilemmas. Ethical reasoning themes were generated to reflect the participants' approaches to managing these dilemmas. Finally, a conceptual model, the Dynamic Model of Ethical Reasoning, was developed. This model incorporates the elements of awareness, independent problem solving, supported problem solving, and decision and outcome evaluation. Features of the model demonstrate the complexity of ethical reasoning and the challenges that new graduates encounter when managing ethical dilemmas. The results have implications for preparing new graduates to manage ethical dilemmas in the workplace.

Purpose: Direct-to-consumer genetic tests are increasingly available and may improve confidentiality, convenience, and accessibility. Amid ethical concerns and an uncertain regulatory landscape, the future of this mode of delivery is unclear. One class of products, nutrigenomic tests, is used to analyze DNA and lifestyle habits to assess health risks. Little information is available regarding awareness or use of such tests among consumers or physicians., Methods: We assessed consumers' awareness and use of nutrigenomic tests in the 2006 HealthStyles national survey (5250 respondents) and awareness among physicians in the 2006 DocStyles national survey (1250 respondents)., Results: In the HealthStyles survey, 14% of respondents were aware of nutrigenomic tests, and 0.6% overall had used these tests. Respondents who were aware of nutrigenomic tests tended to be young and educated with a high income. Many physicians (44%) were aware of nutrigenomic tests, although 41% of these physicians had never had a patient ask about such tests, and most (74%) had never discussed the results of a nutrigenomic test with a patient., Conclusions: These results provide insight into current trends in public demand and interest in nutrigenomic tests and will aid in assessing the impact of policies, efforts at public or provider education, and the evolution of the availability and demand for such tests.

This article is not meant to provide answers but to provoke thinking related to the questions we should be asking about the ethical personhood of aging adults. Are we covering over the rich opportunities to learn from their stories with an invisible cloak of transparency? Health care professionals have a moral obligation to rethink the assumptions that underlie their definitions of quality of life in aging. We cannot know what should be done unless we learn to listen to the life stories of aging people. This may even help us to see what is most real.

The teacher-learner relationship is subject to both internal and external influences that may lead to mistreatment and harassment of the student. The student who is mistreated may mistreat students when he or she becomes a teacher. The author describes an experiential program for residents at Brown Medical School from 1999 to 2002 in which residents, through role playing, helped produce teaching videotapes on medical student mistreatment. Fourteen residents had participated in the program to date. They reported that they had benefited from an increased awareness of the effects of student mistreatment and had learned how to handle mistreatment more effectively. They also reported increased sensitivity to others and improved self-awareness, qualities that they planned to incorporate into their professional identities and that should help them avoid mistreatment of students and residents later in their careers. Because preventing mistreatment from being transmitted to the next generation is an important way to increase medical professionalism, the author recommends that role-playing exercises dealing with mistreatment be a part of all residency education.