On the Fulfillment of Moral Obligation

This paper considers three general views about the nature of moral obligation and three particular answers (with which these views are typically associated) concerning the following question: if on Monday you lend me a book that I promise to return to you by Friday, what precisely is my obligation to you and what constitutes its fulfillment? The example is borrowed from W.D. Ross, who in The Right and the Good proposed what he called the Objective View of obligation, from which he inferred what is here called the First Answer to the question. In Foundations of Ethics Ross repudiated the Objective View in favor of the Subjective View, from which he inferred a Second Answer. In this paper each of the Objective and Subjective Views and the First and Second Answers are rejected in favor of the Prospective View and a Third Answer. The implications of the Prospective View for another question closely related to the original question are then investigated: what precisely is your right regarding my returning the book and what constitutes its satisfaction?     

西方社会能力的研究及启示

从20世纪70年代开始,社会能力的概念为国外研究者广为接受,有关社会能力的理论和实践探索不断深化扩展,西方学者对社会能力的定义和测量、对教师期望、成绩差异、危险行为以及对社会能力的结构、作用和培养方案进行的探讨,极大地增进了教育、心理学工作者对于儿童社会适应和认知发展的理解。西方学者关于社会能力的研究成果对于我国素质教育有着重要的启示。     

生育获得脐血行干细胞移植治疗重大遗传性疾病的风险和对策

通过生育获得脐带血行干细胞移植是治疗重大疾病的一条可行之路,但在治疗遗传性疾病时,当事家庭、检测机构和医疗机构三方都存在着极大的风险,特别是当事家庭很有可能要承受精神和经济上的更大打击,而且客观上造成患病或者携带者人群的进一步扩大,成为一个不可忽视的社会问题。有必要进行充分的伦理思考后提出尽可能周全的办法,以降低各方面的风险。     

浅谈ICU中肺损伤与急性呼吸窘迫综合征的防治

ICU中危重病人较多,急性肺损伤(ALI)与急性呼吸窘迫综合征(ARDS)较普通病房更为常见,常可由严重的感染、误吸、脓毒症、创伤、反复输血以及弥散性血管内凝血等因素引起,病理生理过程十分复杂,治疗也很困难,须从多个方面综合考虑,才能提高病人的生存率,挽救病人生命。     

Clinical Characterization and Risk Profile of Individuals Seeking Genetic Counseling for Hereditary Breast Cancer in Brazil

Hereditary breast cancer (HBC) accounts for 5–10% of breast cancer cases and it significantly increases the lifetime risk of cancer. Our objective was to evaluate the sociodemographic variables, family history of cancer, breast cancer (BC) screening practices and the risk profile of cancer affected or asymptomatic at-risk women that undergo genetic counseling for hereditary breast cancer in public Brazilian cancer genetics services. Estimated lifetime risk of BC was calculated for asymptomatic women using the Gail and Claus models. The majority of women showed a moderate lifetime risk of developing BC, with an average risk of 19.7% and 19.9% by the Gail and Claus models, respectively. The average prior probability of carrying a BRCA1/2 gene mutation was 16.7% and overall only 32% fulfilled criteria for a hereditary breast cancer syndrome as assessed by family history. We conclude that a significant number of individuals at high-risk for HBC syndromes may not have access to the benefits of cancer genetic counseling in these centers. Contributing factors may include insufficient training of healthcare professionals, disinformation of cancer patients; difficult access to genetic testing and/or resistance in seeking such services. The identification and understanding of these barriers is essential to develop specific strategies to effectively achieve cancer risk reduction in this and other countries were clinical cancer genetics is not yet fully established.     

Using Adult Learning Theory Concepts to Address Barriers to Cancer Genetic Risk Assessment in the African American Community

Utilization of cancer genetic risk assessment can be profoundly influenced by an individuals’ knowledge of risk assessment, attitudes regarding illness and healthcare, and affective reactions derived from social norms. Race and ethnicity play a powerful role in the development of an individual's attitudes and should be considered when attempting to understand a person's openness to cancer genetic risk assessment (Lannin et al., 1998). Until recently, however, cancer screening and prevention programs have been primarily based on data from studies conducted with the Caucasian population, yielding data that are not fully applicable to the African American community. In the last several years, research findings regarding African American's knowledge, attitudes, and feelings about genetic counseling and testing have grown (Matthews et al., 2000; Singer et al., 2004; Thompson et al., 2003). However, to the authors’ knowledge, these data have yet to be presented in a manner that both summarizes the barriers that African Americans have reported regarding cancer genetic risk assessment, while at the same time suggesting methods individual genetic counselors can utilize during community presentations to help address these barriers. This article will first summarize previous empirical findings regarding African Americans’ knowledge, attitudes, and feelings about cancer genetic risk assessment. The article will then apply adult learning theory to those findings to provide genetic counselors with practical, theory based techniques to apply toward community based educational programs with African American groups.     

Risk perception in Taiwan

In a questionnaire study, 51 Taiwanese college students were asked to judge 48 natural and human-made hazards on nine risk characteristics. Another group of 61 students were asked to rate the magnitude of 80 hazards and their attitudes toward these hazards. To evaluate the dimensionality of risk perception, participants' ratings for the nine risk characteristics were analyzed using Profile Analysis via Multidimensional Scaling approach. Two dimensions of risk perception were identified: (i) Involuntary versus Immediate Effect; and (ii) Delayed Effect versus Known to Science and Chronic. The relationships of risk perceptions and perceived public and private responsibilities in risk management were examined. Catastrophic, certain-to-be-fatal, dreaded, and uncontrollable risks were perceived as more deserving of public risk management, while controllable risks that were known to science, known to those exposed, and chronic were perceived as more deserving of private management. In particular, diseases are perceived as most deserving of private risk management and least deserving of public risk management; and technologies are perceived as most deserving of public risk management and least deserving of private risk management.     

前临床期痴呆的认知特征：当前研究进展和未来研究展望

在这篇文章中, 我将讨论从正常老化到痴呆, 这一通常被称为痴呆前临床阶段的认知功能的转变。研究表明, 阿尔茨海默症和血管性痴呆病人在临床确诊之前的几年中, 会出现明显的认知损伤。早期最突出的损伤存在于情节记忆、加工速度以及执行功能。这些功能性损伤与神经生物学研究证实的边缘系统和新皮层区存在多重损伤是相一致的。虽然早在临床诊段之前, 病人组和控制组的平均成绩存在巨大差异, 但同时这两组测试成绩的分布在很大程度上是重叠的。寻求降低这种重叠度的方法是未来研究的一个重要任务。这有可能通过将认知的和其他指标(如基于脑的、基因的、临床的、社会的)相结合构建预测模型来实现。此外, 在未来研究中以下三方面也是急需考虑问题: (a) 找出在 前临床期间认知功能急速下降的时间点: (b) 评估从前临床到临床诊断变化速率中存在的个体差异; (c) 确定特定因素与随后发生的痴呆之间的关联强度是如何随时间向临床确诊推进而逐渐变化的。     

I felt low and my purse feels light: depleting mood regulation attempts affect risk decision making

We propose that negative affect can induce people to engage in risky decisions. We test two alternative hypotheses as to how this effect may emerge. The mood repair hypothesis states that risky choices in risk decision making serve as a means to repair one's negative affect. The depletion hypothesis, in contrast, states that risky choices in risk decision making are the mere consequence of a state of depletion resulting from engagement in active mood regulation attempts. The results of a first laboratory study establish a link between risky choices in risk decision making and negative affect. Subsequent experiments provide evidence that depletion due to active mood regulation attempts, rather than mood repair, is the underlying process for this link. Copyright © 2008 John Wiley & Sons, Ltd.     

Better safe than sorry: Precautionary reasoning and implied dominance in risky decisions

In four studies, student and nonstudent participants evaluated the possible outcomes of binary decisions involving health, safety, and environmental risks (e.g., whether to issue a dam‐failure evacuation order). Many participants indicated that false positives (e.g., evacuation, but no dam failure) were better than true negatives (e.g., no evacuation and no dam failure), thereby implying that the more protective action dominated the less protective action. A common rationale for this response pattern was the precautionary maxim “better safe than sorry.” Participants apparently evaluated outcomes partly on the basis of the decisions that might lead to them, in conflict with consequentialist decision models. Consistent with this explanation, the prevalence of implied dominance decreased substantially when the emphasis on decisions was reduced. These results demonstrate that an initial preference for a decision alternative can alter the evaluation of possible consequences of both the preferred alternative and a competing alternative, suggesting positive feedback loops that reinforce the initial preference. The rationality of considering the decision itself as an attribute of possible outcomes is discussed. Copyright © 2009 John Wiley & Sons, Ltd.