Medical hermeneutics: Where is the “text” we are interpreting?

The present paper is a commentary on an article by Drew Leder [1]. Leder identifies a series of texts in the clinical encounter, emphasizes the central role of interpretation in making sense of each of these texts, and articulates ordering principles to guide the interpretive work.The metaphor of clinical work as textual explication, however, creates the expectation that there is a text somewhere to be found. Such an expectation invites doctors and patients to search for the text and runs the risk of conceptualizing patients as more static than they are. If one is to use the textual metaphor, one must appreciate the radical extent to which the clinical encounter is a mutually produced and shifting entity. The qualities of mutuality and indeterminacy are not those one usually associates with texts. One might ultimately be better served by a different metaphor based more directly on uncertainty.     

Peer review: Selecting the best science

The major challenge facing today’s biomedical researchers is the increasing competition for available funds. The competitive review process, through which the National Institutes of Health (NIH) awards grants, is built upon review by a committee of expert scientists. The NIH is firmly committed to ensuring that its peer review system is fair and objective. Wendy Baldwin, Ph.D., is Deputy Director for Extramural Research, National Institutes of Health. This paper is based on a presentation at a workshop, “Advances in Peer Review Research”, American Association for the Advancement of Science Meeting, Baltimore, MD, February 9, 1996.     

Competing interests: The need to control conflict of interests in biomedical research

Individual and institutional conflict of interests in biomedical research have becomes matters of increasing concern in recent years. In the United States, the growth in relationships — sponsored research agreements, consultancies, memberships on boards, licensing agreements, and equity ownership — between for-profit corporations and research universities and their scientists has made the problem of conflicts, particularly financial conflicts, more acute. Conflicts can interfere with or compromise important principles and obligations of researchers and their institutions, e.g., adherence to accepted research norms, duty of care to patients, and open exchange of information. Disclosure is a key component of a successful conflict policy. Commitments which conflict with a faculty member's primary obligations to teaching, research, administrative responsibilities, or patient care also need attention. Institutional conflict of interests present different problems, some of which are discussed in an analysis of an actual problem posed by two proposed clinical trials. This paper is adapted from a lecture presented to a Symposium on Scientific Integrity, Warsaw, Poland, 23 November 1995. Daniel Steiner was Vice-President and General Counsel of Harvard University (1972–92) and in that capacity became familiar with conflict of interest issues. He is currently Counsel to the Boston law firm. Ropes and Gray, and is Adjunct Lecturer in Public Policy at the John F. Kennedy School of Government. Harvard University.     

Mission and reconciliation from a Christian-Muslim relations perspective

The encounter between Islam and Christianity in the mission field has created shocks that have left indelible scars across the ages. These two religions, which have never hidden their missionary intentions, have at times engaged in the struggle for supremacy on the religious chessboard, not hesitating to encroach on each other. This state of affairs has led to frustrations and conflicts between the two religious systems that the passage of time has not been able to erase. Various organizations have attempted to bring Christians and Muslims together, among these the Programme for Christian-Muslim Relations in Africa. Reconciliation is possible. Although the path to reconciliation is still long, one who has already travelled on it gives us signs of hope. Only God can clear the path to effective reconciliation. This, however, must be combined with a new understanding of mission in both religious systems as well as a commitment on the part of both to embark on a new dynamic.     

父母冲突频率与青少年生活满意度的关系：青少年行为反应的中介作用

父母冲突与青少年的身心健康息息相关。本研究以366名青少年为被试,采用问卷调查法研究父母冲突频率与青少年生活满意度间的关系,以及父母冲突时青少年行为反应在其中的中介作用。结果表明：（1）父母冲突频率显著负向预测青少年生活满意度;（2）青少年的介入行为与生活满意度呈显著正相关,回避行为则与生活满意度呈显著负相关;（3）在主张–回避的父母冲突场景中,青少年的回避行为在父母冲突频率与生活满意度间起到部分中介作用,中介效应占总效应的22.90%。     

Conflicts of interest in science in Armenia

The author describes problems facing Armenia in reorganization of the structure of science in the post-socialist era with the aim of utilizing limited state resources more efficiently by reducing the number of separate scientific institutes, concentrating on essential core subjects required by the nation and encouraging all other projects to compete in the international arena for grant sponsorship. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

The content of internal conflicts: A personal values perspective

This paper highlights the importance of considering two facets of the content of internal conflicts: The concrete subject theme of the conflict and the abstract motivations that people perceive as being conflicted (e.g. values implicated in the conflict). The paper demonstrates how personal value priorities contribute to the understanding of internal conflicts. In two studies I examined the relationship between values and the content of internal conflicts. In Study 1 (N = 250), students described a central conflict that they were experiencing and analysed the values they perceived as opposing in their conflict. Results indicated that the reported conflicts were usually between values not conceptualized as motivationally opposite to each other. Furthermore, personal value priorities were related to the values implicated in the conflict both directly and indirectly by their effect on the themes of the conflicts. In Study 2 (N = 230), working parents analysed the values they perceive as coming in conflict in two work–family dilemmas. Findings supported the premise that values explain individual differences in the motivational meaning attributed to a conflict even when the conflict theme is held constant. Copyright © 2011 John Wiley & Sons, Ltd.     

Civilian Response Corps Force Review: The Application of Multi‐Criteria Decision Analysis to Prioritize Skills Required for Future Diplomatic Missions

Created by the State Department's Office of the Coordinator for Reconstruction and Stabilization, the Civilian Response Corps (CRC) contains a diverse pool of qualified and ready‐to‐deploy civilian professionals that support conflict prevention and response efforts in countries or regions that are at risk of, are currently in, or are transitioning from conflict or civil strife. As such, it is vital to optimize the CRC's skill groupings to maximize adaptability and responsiveness to highly uncertain and trying political conditions and crises across the globe. The nature of the CRC value proposition is such that determining which skill set compositions deliver the greatest benefit requires a multi‐faceted perspective that looks at a number of attributes and factors, both tangible and intangible. To meet these needs, an organizational decision‐making approach utilizing multi‐criteria decision analysis (MCDA) was applied to ensure that skill‐grouping allocations were determined in a logical and robust manner. The MCDA analysis allowed for a wide range of worldviews and perspectives, drawn from select members of academia and partner agencies of the CRC who provided their expert opinions on the expected demand for skill groupings commonly identified as most necessary in a civilian ‘surge’ capacity. These skills were assessed with reference to a values hierarchy of representative country scenarios, missions and sub‐missions identified by the Office of the Coordinator for Reconstruction and Stabilization. Of particular interest was the use of the MCDA method to prioritize CRC skill groupings and to help inform the Department of State's understanding of the ‘ideal’ proportion and types of civilian skills for inclusion in the CRC. Copyright © 2012 John Wiley & Sons, Ltd.     

Training the brain: fact and fad in cognitive and behavioral remediation

Putatively safe and effective for improving cognitive performance in both health and disease, products purported to train the brain appeal to consumers and healthcare practitioners. In an increasingly health-centered society, these applications constitute a burgeoning commercial market. Sparse evidence coupled with lack of scientific rigor, however, leaves claims concerning the impact and duration of such brain training largely unsubstantiated. On the other hand, at least some scientific findings seem to support the effectiveness and sustainability of training for higher brain functions such as attention and working memory. In the present paper we provide a tectonic integration and synthesis of cognitive training approaches. Specifically, we sketch the relative merits and shortcomings of these programs, which often appeal to parents who must choose between side-effect-laden medication and other less conventional options. Here we examine how neuroplasticity allows the healthy as well the impaired to benefit from cognitive training programs. We evaluate the evidence and consider whether brain training can be a stand-alone treatment or an adjunct to pharmacotherapy, outline promising future prospects, and highlight what training outcomes are plausible in line with available data. Future research would determine whether the field of brain training realizes its potential to revolutionize education and rehabilitation or withers away engulfed in controversy.     

Legal and Ethical Implications of Using Religious Beliefs as the Basis for Refusing to Counsel Certain Clients

This article addresses potential legal and ethical implications of lawsuits that have been brought when counselors and counseling students have used their religious beliefs as the basis for refusing to counsel lesbian, gay, bisexual, and transexual clients. Four lawsuits are reviewed, issues relevant to the cases are identified, and implications for counselor educators and counseling students are discussed.