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A causal roadmap for generating high-quality real-world evidence
- Lauren E. Dang, Susan Gruber, Hana Lee, Issa J. Dahabreh, Elizabeth A. Stuart, Brian D. Williamson, Richard Wyss, Iván Díaz, Debashis Ghosh, Emre Kıcıman, Demissie Alemayehu, Katherine L. Hoffman, Carla Y. Vossen, Raymond A. Huml, Henrik Ravn, Kajsa Kvist, Richard Pratley, Mei-Chiung Shih, Gene Pennello, David Martin, Salina P. Waddy, Charles E. Barr, Mouna Akacha, John B. Buse, Mark van der Laan, Maya Petersen
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- Journal:
- Journal of Clinical and Translational Science / Volume 7 / Issue 1 / 2023
- Published online by Cambridge University Press:
- 22 September 2023, e212
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Increasing emphasis on the use of real-world evidence (RWE) to support clinical policy and regulatory decision-making has led to a proliferation of guidance, advice, and frameworks from regulatory agencies, academia, professional societies, and industry. A broad spectrum of studies use real-world data (RWD) to produce RWE, ranging from randomized trials with outcomes assessed using RWD to fully observational studies. Yet, many proposals for generating RWE lack sufficient detail, and many analyses of RWD suffer from implausible assumptions, other methodological flaws, or inappropriate interpretations. The Causal Roadmap is an explicit, itemized, iterative process that guides investigators to prespecify study design and analysis plans; it addresses a wide range of guidance within a single framework. By supporting the transparent evaluation of causal assumptions and facilitating objective comparisons of design and analysis choices based on prespecified criteria, the Roadmap can help investigators to evaluate the quality of evidence that a given study is likely to produce, specify a study to generate high-quality RWE, and communicate effectively with regulatory agencies and other stakeholders. This paper aims to disseminate and extend the Causal Roadmap framework for use by clinical and translational researchers; three companion papers demonstrate applications of the Causal Roadmap for specific use cases.
Exposure to prenatal maternal distress and infant white matter neurodevelopment
- Catherine H. Demers, Maria M. Bagonis, Khalid Al-Ali, Sarah E. Garcia, Martin A. Styner, John H. Gilmore, M. Camille Hoffman, Benjamin L. Hankin, Elysia Poggi Davis
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- Journal:
- Development and Psychopathology / Volume 33 / Issue 5 / December 2021
- Published online by Cambridge University Press:
- 07 December 2021, pp. 1526-1538
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The prenatal period represents a critical time for brain growth and development. These rapid neurological advances render the fetus susceptible to various influences with life-long implications for mental health. Maternal distress signals are a dominant early life influence, contributing to birth outcomes and risk for offspring psychopathology. This prospective longitudinal study evaluated the association between prenatal maternal distress and infant white matter microstructure. Participants included a racially and socioeconomically diverse sample of 85 mother–infant dyads. Prenatal distress was assessed at 17 and 29 weeks’ gestational age (GA). Infant structural data were collected via diffusion tensor imaging (DTI) at 42–45 weeks’ postconceptional age. Findings demonstrated that higher prenatal maternal distress at 29 weeks’ GA was associated with increased fractional anisotropy, b = .283, t(64) = 2.319, p = .024, and with increased axial diffusivity, b = .254, t(64) = 2.067, p = .043, within the right anterior cingulate white matter tract. No other significant associations were found with prenatal distress exposure and tract fractional anisotropy or axial diffusivity at 29 weeks’ GA, or earlier in gestation.
Sustained high basal motion of the Greenland ice sheet revealed by borehole deformation
- Claudia Ryser, Martin P. Lüthi, Lauren C. Andrews, Matthew J. Hoffman, Ginny A. Catania, Robert L. Hawley, Thomas A. Neumann, Steen S. Kristensen
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- Journal:
- Journal of Glaciology / Volume 60 / Issue 222 / 2014
- Published online by Cambridge University Press:
- 10 July 2017, pp. 647-660
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Ice deformation and basal motion characterize the dynamical behavior of the Greenland ice sheet (GrIS). We evaluate the contribution of basal motion from ice deformation measurements in boreholes drilled to the bed at two sites in the western marginal zone of the GrIS. We find a sustained high amount of basal motion contribution to surface velocity of 44–73% in winter, and up to 90% in summer. Measured ice deformation rates show an unexpected variation with depth that can be explained with the help of an ice-flow model as a consequence of stress transfer from slippery to sticky areas. This effect necessitates the use of high-order ice-flow models, not only in regions of fast-flowing ice streams but in all temperate-based areas of the GrIS. The agreement between modeled and measured deformation rates confirms that the recommended values of the temperature-dependent flow rate factor A are a good choice for ice-sheet models.
Normal cortisol response to cold pressor test, but lower free thyroxine, after recovery from undernutrition
- Vinicius J. B. Martins, Andrea P. O. Neves, Márcia C. Garcia, Regina C. Spadari, Ana Paula G. Clemente, Maria P. de Albuquerque, Daniel J. Hoffman, Ana L. Sawaya
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- Journal:
- British Journal of Nutrition / Volume 115 / Issue 1 / 14 January 2016
- Published online by Cambridge University Press:
- 03 November 2015, pp. 14-23
- Print publication:
- 14 January 2016
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Undernutrition is a stressor with long-term consequences, and the effect of nutritional recovery on cortisol and thyroid hormone status is unknown. To investigate basal thyroid hormones and the cortisol response to a cold pressor test in children recovered from undernutrition, a cross-sectional study was undertaken on children (6–16 years) separated into four groups: control (n 41), stunted (n 31), underweight (n 27) and recovered (n 31). Salivary cortisol was collected over the course of 10 h: upon awakening, before and after an unpleasant and a pleasant stimulus. Cortisol upon awakening was highest in the stunted and lowest in the underweight groups: control=5·05 (95 % CI 3·71, 6·89) nmol/l, stunted=6·62 (95 % CI 3·97, 11·02) nmol/l, underweight=2·51 (95 % CI 1·75, 3·63) nmol/l and recovered=3·46 (95 % CI 2·46, 4·90) nmol/l (P=0·005). Girls had higher cortisol concentrations upon awakening compared with boys (P=0·021). The undernourished groups showed an elevated cortisol response both to the unpleasant stimulus and at the last measurement (16.00 hours) compared with that of the recovered group: AUC, control=2·07 (95 % CI 1·69, 2·45) nmol/l×30 min, stunted=2·48 (95 % CI 1·91, 3·06) nmol/l×30 min, underweight=2·52 (95 % CI 2·07, 2·97) nmol/l×30 min, recovered=1·68 (95 % CI 1·26, 2·11) nmol/l×30 min (P=0·042); and control=2·03 (95 % CI 1·75, 2·39) nmol/l×30 min, stunted=2·51 (95 % CI 1·97, 3·19) nmol/l×30 min, underweight=2·61 (95 % CI 2·16, 3·16) nmol/l×30 min, recovered=1·70 (95 % CI 1·42, 2·03) nmol/l×30 min (P=0·009). Lower free thyroxine (T4) was found in the recovered and stunted groups: control=1·28 (95 % CI 1·18, 1·39) pmol/l, stunted=0·98 (95 % CI 0·87, 1·10) pmol/l, underweight=1·10 (95 % CI 1·01, 1·21) pmol/l and recovered=0·90 (95 % CI 0·83, 0·99) pmol/l (P<0·001). Multivariate analysis showed a lower cortisol concentration along 10 h (06.00–16.00 hours) in the recovered compared with the other groups (P=0·017), and similar concentrations between the recovered and control group. In conclusion, the children with recovery in weight and height had a cortisol stress response similar to control but a lower basal free T4. Longitudinal studies are warranted to determine the extent of these endocrine changes after recovery of undernutrition and in adulthood.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
- Print publication:
- 27 April 2015, pp ix-xxx
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Contributors
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- By Lenard A. Adler, Pinky Agarwal, Rehan Ahmed, Jagga Rao Alluri, Fawaz Al-Mufti, Samuel Alperin, Michael Amoashiy, Michael Andary, David J. Anschel, Padmaja Aradhya, Vandana Aspen, Esther Baldinger, Jee Bang, George D. Baquis, John J. Barry, Jason J. S. Barton, Julius Bazan, Amanda R. Bedford, Marlene Behrmann, Lourdes Bello-Espinosa, Ajay Berdia, Alan R. Berger, Mark Beyer, Don C. Bienfang, Kevin M. Biglan, Thomas M. Boes, Paul W. Brazis, Jonathan L. Brisman, Jeffrey A. Brown, Scott E. Brown, Ryan R. Byrne, Rina Caprarella, Casey A. Chamberlain, Wan-Tsu W. Chang, Grace M. Charles, Jasvinder Chawla, David Clark, Todd J. Cohen, Joe Colombo, Howard Crystal, Vladimir Dadashev, Sarita B. Dave, Jean Robert Desrouleaux, Richard L. Doty, Robert Duarte, Jeffrey S. Durmer, Christyn M. Edmundson, Eric R. Eggenberger, Steven Ender, Noam Epstein, Alberto J. Espay, Alan B. Ettinger, Niloofar (Nelly) Faghani, Amtul Farheen, Edward Firouztale, Rod Foroozan, Anne L. Foundas, David Elliot Friedman, Deborah I. Friedman, Steven J. Frucht, Oded Gerber, Tal Gilboa, Martin Gizzi, Teneille G. Gofton, Louis J. Goodrich, Malcolm H. Gottesman, Varda Gross-Tsur, Deepak Grover, David A. Gudis, John J. Halperin, Maxim D. Hammer, Andrew R. Harrison, L. Anne Hayman, Galen V. Henderson, Steven Herskovitz, Caitlin Hoffman, Laryssa A. Huryn, Andres M. Kanner, Gary P. Kaplan, Bashar Katirji, Kenneth R. Kaufman, Annie Killoran, Nina Kirz, Gad E. Klein, Danielle G. Koby, Christopher P. Kogut, W. Curt LaFrance, Patrick J.M. Lavin, Susan W. Law, James L. Levenson, Richard B. Lipton, Glenn Lopate, Daniel J. Luciano, Reema Maindiratta, Robert M. Mallery, Georgios Manousakis, Alan Mazurek, Luis J. Mejico, Dragana Micic, Ali Mokhtarzadeh, Walter J. Molofsky, Heather E. Moss, Mark L. Moster, Manpreet Multani, Siddhartha Nadkarni, George C. Newman, Rolla Nuoman, Paul A. Nyquist, Gaia Donata Oggioni, Odi Oguh, Denis Ostrovskiy, Kristina Y. Pao, Juwen Park, Anastas F. Pass, Victoria S. Pelak, Jeffrey Peterson, John Pile-Spellman, Misha L. Pless, Gregory M. Pontone, Aparna M. Prabhu, Michael T. Pulley, Philip Ragone, Prajwal Rajappa, Venkat Ramani, Sindhu Ramchandren, Ritesh A. Ramdhani, Ramses Ribot, Heidi D. Riney, Diana Rojas-Soto, Michael Ronthal, Daniel M. Rosenbaum, David B. Rosenfield, Durga Roy, Michael J. Ruckenstein, Max C. Rudansky, Eva Sahay, Friedhelm Sandbrink, Jade S. Schiffman, Angela Scicutella, Maroun T. Semaan, Robert C. Sergott, Aashit K. Shah, David M. Shaw, Amit M. Shelat, Claire A. Sheldon, Anant M. Shenoy, Yelizaveta Sher, Jessica A. Shields, Tanya Simuni, Rajpaul Singh, Eric E. Smouha, David Solomon, Mehri Songhorian, Steven A. Sparr, Egilius L. H. Spierings, Eve G. Spratt, Beth Stein, S.H. Subramony, Rosa Ana Tang, Cara Tannenbaum, Hakan Tekeli, Amanda J. Thompson, Michael J. Thorpy, Matthew J. Thurtell, Pedro J. Torrico, Ira M. Turner, Scott Uretsky, Ruth H. Walker, Deborah M. Weisbrot, Michael A. Williams, Jacques Winter, Randall J. Wright, Jay Elliot Yasen, Shicong Ye, G. Bryan Young, Huiying Yu, Ryan J. Zehnder
- Edited by Alan B. Ettinger, Albert Einstein College of Medicine, New York, Deborah M. Weisbrot, State University of New York, Stony Brook
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- Neurologic Differential Diagnosis
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- 05 June 2014
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- 17 April 2014, pp xi-xx
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Stunted children gain less lean body mass and more fat mass than their non-stunted counterparts: a prospective study
- P. A. Martins, D. J. Hoffman, M. T. B. Fernandes, C. R. Nascimento, S. B. Roberts, R. Sesso, A. L. Sawaya
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- Journal:
- British Journal of Nutrition / Volume 92 / Issue 5 / November 2004
- Published online by Cambridge University Press:
- 09 March 2007, pp. 819-825
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- November 2004
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The aim of the present study was to analyse the changes in body composition of stunted children during a follow-up period and to test the hypothesis of a tendency to accumulate body fat as a consequence of undernutrition early in life. We selected fifty boys and girls aged 11 to 15, who were residents of slums in São Paulo, Brazil. Twenty were stunted (S) and thirty had normal stature (NS). The children's nutritional status and body composition were assessed through anthropometry and dual-energy X-ray absorptiometry, at the beginning of the present study and after 3 years, and changes in lean mass (LM and LM%) and fat mass (FM and FM%) were calculated. Stunted boys accumulated more body fat (FM%: S=1·62%, NS=−3·40%; P=0·003) and gained less lean mass (LM%: S=−1·46, NS=3·21%; P=0·004). Stunted girls gained less lean mass (S=7·87 kg, NS=11·96 kg; P=0·032) and had significantly higher values of FM% at follow-up when compared with their baseline values (P=0·008), whereas non-stunted girls had a non-significant difference in FM% over time (P=0·386). These findings are important to understand the factors involved in the increased prevalence of overweight and obesity among poor populations, which appear to be associated with hunger during infancy and/or childhood.
How automatic and representational is empathy, and why
- Martin L. Hoffman
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- Behavioral and Brain Sciences / Volume 25 / Issue 1 / February 2002
- Published online by Cambridge University Press:
- 23 January 2003, pp. 38-39
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The claim that empathy is both automatic and representational is criticized as follows: (a) five empathy-arousing processes ranging from conditioning and mimicry to prospective-taking show that empathy can be either automatic or representational, and only under certain circumstances, both; (b) although automaticity decreases, empathy increases with age and cognitive development; (c) observers' causal attributions can shift rapidly and produce more complex empathic responses than the theory allows.
Part V - Empathy and Moral Principles
- Martin L. Hoffman, New York University
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- Empathy and Moral Development
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- 05 June 2012
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- 13 April 2000, pp 219-220
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Part VI - Culture
- Martin L. Hoffman, New York University
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- Empathy and Moral Development
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- 05 June 2012
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- 13 April 2000, pp 271-272
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8 - Empathy's Limitations: Over-Arousal and Bias
- Martin L. Hoffman, New York University
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- Empathy and Moral Development
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- 05 June 2012
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- 13 April 2000, pp 197-218
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Summary
Having pointed up empathic motivation's positive contributions to prosocial moral action, I now turn to empathic motivation's limitations, expanding on the limitations I noted some time ago (Hoffman, 1984b, 1987). The limitations are due mainly to empathy's dependence on the intensity and salience of distress cues and the relationship between the victim and the observer. The first limitation is this: We generally expect the intensity of empathic arousal to increase with the salience and intensity of the victim's distress: the more intense and salient the cues of distress, the more intense the observer's empathic distress. But, if the signs of distress are too intense and salient, the observer's empathic distress may become aversive enough to be transformed into a feeling of personal distress. I call this “empathic over-arousal.”
The second limitation is empathy's vulnerability to two types of bias: “familiarity bias” and “here-and-now bias.” The research (chapter 2) shows that most people empathize with and help others in distress, including strangers (the victims in most of the research were strangers), but there is also evidence that most people empathize to a greater degree (their threshold for empathic distress is lower) with victims who are family members, members of their primary group, close friends, and people whose personal needs and concerns are similar to their own. And, because most empathyarousing processes (at least the primitive, less cognitive ones) depend on immediate situational and personal cues, people are vulnerable to empathic bias in favor of victims who are present in the immediate situation.
12 - The Universality and Culture Issue
- Martin L. Hoffman, New York University
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- Empathy and Moral Development
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- 05 June 2012
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- 13 April 2000, pp 273-284
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Summary
Since the Holocaust, cultural relativism is dead. We no longer have the luxury of assuming every culture's values or guiding principles will pass the moral test and that each is as good as any other. This does not mean there is only one principle that can pass the moral test. There may be several – one principle that passes the moral test better in one context, one that does better in another context, and in yet other contexts two or more perfectly sound moral principles that may conflict. For these reasons I applaud Kohlberg's and his followers' rejecting relativism and advocating a universal principle of justice. Justice surely meets any moral criterion, although I also place a high value on caring, which at times conflicts with justice (chapter 11) and I have a problem with Kohlberg and his followers: I have always found them rather vague on what justice means. When you get down to actual human behavior, justice can mean many things – punitive justice, retributive justice, distributive justice, meritocratic justice, egalitarian justice, justice based on need. Empathy appears to be congruent with all or most of these justice principles, as well as with caring (chapter 9). This suggests empathy may lay claim to being a universal prosocial moral motive, at least in societies that place high value on caring and justice.
Empathy's Biological Substrate
Another argument for empathy's universality is one I made some time ago (Hoffman, 1981).
6 - From Discipline to Internalization
- Martin L. Hoffman, New York University
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To recapitulate, transgression situations are those in which a person harms or is about to harm another. A transgression may be provoked, intentional, accidental, a by-product of interpersonal conflict, or a violation of another's expectations. The moral issue is whether the transgressor is motivated to avoid the harmful act or at least feels guilty and acts prosocially afterward, and whether he or she does these things even in the absence of witnesses. I have long argued that the foundation for guilt and the prosocial moral internalization necessary for combating egoistic needs in conflict and other transgression situations originates in discipline encounters, especially those in which children harm someone. Discipline encounters are settings in which parents attempt to change a child's behavior against the child's will. They begin when the child's behavior diverges from the parent's wishes and end when the child complies, the parent gives up, or an external event intervenes (doorbell rings). In an intensive study of preschoolers (Hoffman, 1963), the average encounter took 2 to 3 discipline attempts (though one took 17!), and, as in Schaffer and Crook's (1980) research, the children complied in over 80 percent of them.
Why single out discipline, when parents also nurture and express affection to their children, spend time playing with them, explain and interpret the world to them, and, above all, serve as models of acceptable moral behavior? For one thing, discipline encounters are important because they are frequent.
4 - Empathic Anger, Sympathy, Guilt, Feeling of Injustice
- Martin L. Hoffman, New York University
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To recapitulate what I have covered so far, I have defined empathy as an affective response more appropriate to another's situation than one's own, described five mechanisms of empathic arousal ranging from classical conditioning to role-taking, and delineated stages in the development of empathic distress. Despite the focus on empathic affect, I have also pointed out the important contributions of cognition to the arousal and development of empathic distress and generalizing beyond the immediate situation. In this final chapter on the bystander model, affect continues to share center stage with cognition – in this case, causal attribution.
Most people make spontaneous attributions about the cause of events (Weiner, 1985), and they surely do this when observing someone in distress. Depending on the attribution, their empathic distress may be reduced, neutralized, or transformed into other empathic affects. It may be reduced or neutralized when the victim is viewed as responsible for his own plight. Humans have a tendency, when the circumstances are ambiguous, to attribute the cause of another's action (but not their own action) to his own internal dispositions: the “fundamental attribution error” (Jones & Nisbett, 1971). They also have a tendency to blame the victim for his or her own misfortune in order to support their “belief in a just world” (I'll be safe if I don't act that way) (Lerner & Miller, 1978). But given the evidence that humans tend to empathize with and help others in distress (chapter 2), it seems clear that blaming victims is not incompatible with empathy.
5 - Guilt and Moral Internalization
- Martin L. Hoffman, New York University
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We now move from the innocent bystander model to one in which the observer is a transgressive participant – transgressive because he is harming or thinking of acting in a way that may harm another. A transgression may be provoked, intentional, accidental, a by-product of conflict, or a violation of another's legitimate expectations. The moral issue is whether the transgressor is motivated to avoid the harmful act or at least feels guilty and acts prosocially afterward, and whether he or she acts in these ways even in the absence of witnesses – the hallmark of moral internalization. This chapter, then, deals with guilt and moral internalization.
Just as the bystander model is the prototypic moral encounter for the development of empathy, especially empathic distress, the transgression model is the prototypic moral encounter for empathybased guilt, especially empathy-based transgression guilt. Transgression guilt differs from bystander guilt over inaction and from “Virtual guilt” which will be discussed in chapter 7. The transgression model is also the prototypic moral encounter for moral internalization.
Empathy-based guilt is the key prosocial motive in transgressions involving harm to others and looms large in this chapter. I first introduce empathy-based guilt, give evidence for its existence and prosocial motive property, and discuss its development. The theories of moral internalization are then summarized, after which I explain the special importance of socialization, especially discipline, for guilt and moral internalization, which introduces chapter 6.
Frontmatter
- Martin L. Hoffman, New York University
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3 - Development of Empathic Distress
- Martin L. Hoffman, New York University
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As I mentioned earlier, empathic distress seems like a simple response: One feels distressed when observing someone in actual distress. When we look at empathic distress in mature observers, however, its complexity is quickly apparent. First, empathic distress in mature observers includes a metacognitive awareness of oneself as responding empathically: One not only feels distressed but knows this feeling is a response to something unfortunate happening to someone else and to what one assumes to be the victim's feeling of pain or discomfort. Mature empathizers have thus passed the developmental milestone of acquiring a cognitive sense of themselves and others as separate physical entities with independent internal states, personal identities, and lives beyond the situation and can therefore distinguish what happens to others from what happens to themselves.
Second, mature observers have a sense of how they would feel and a general understanding of how most people would feel in the other's situation. Third, mature observers know that the other's outward behavior (facial expression, posture, voice tone) can reflect how he feels internally but they also know that these outward expressions of feeling can be controlled to some extent and mask the other's internal feeling. Furthermore, all of this knowledge plus any personal information a mature observer has about the victim are likely to be quickly integrated into an explanation of the cause of the victim's plight. In short, for a person to experience mature empathic distress, he must have a clear distinction between what happens too thers and what happens to himself and an understanding of how feelings are expressed and how they are shaped by events.
Part II - Transgression
- Martin L. Hoffman, New York University
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Subject Index
- Martin L. Hoffman, New York University
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11 - Multiple-Claimant and Caring-Versus-Justice Dilemmas
- Martin L. Hoffman, New York University
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In complex moral encounters, bystanders must choose which victim to help. I deal first with moral dilemmas within the caring domain and then dilemmas involving conflict between caring and justice. A third type, conflict between caring and duty or responsibility, is often a sub-variant of one of these.
MULTIPLE CLAIMANT DILEMMAS
Multiple claimant dilemmas in the caring domain that come to mind are people drowning or caught in a burning building; the bystander cannot help them all and must make a choice. There are other highly visible and controversial dilemmas: A doctor deciding whether to perform an abortion on a pregnant teenager – the moral claimants are the teenager, her parents who are concerned about her future, and, depending on its age, the fetus; a lawyer deciding whether to defend an accused murderer he or she believes is guilty – the moral claimants are the defendant who the law says has a right to a legal defense, the victim's family, and potential victims if the defendant goes free.
Another example is Kohlberg's hypothetical World War II air-raid warden who had to choose between remaining at his post or leaving to help his family when he heard his family's part of town was on fire. And the similar but very real dilemma faced by a nurse who was helping a victim of the Oklahoma City bombing when she heard the second bomb blast. She left the victim and rushed home to help her own family. She later said “I felt it was my family or her.”