Joseph Garcia

Background: Current interventions to enhance patient self-efficacy, a key mediator of health behavior, have limited primary care application. Objective: To explore the effectiveness of an office-based intervention for training resident physicians to use self-efficacy-enhancing interviewing techniques. Design: Randomized controlled trial. Participants: Family medicine and internal medicine resident physicians at an academic medical center. Measurements: Resident use of SEE IT was coded from audio recordings of the physician-patient portion of two standardized patient instructor training visits and two unannounced post-training SP visits, all involving common physical and mental health conditions and behavior change issues. One post-training SP visit involved health conditions similar to those experienced in training, while the other involved new conditions. Results: Experimental group residents demonstrated significantly greater use of SEE IT than controls, starting after the first training visit and sustained through the final post-training visit. The mean effect of the intervention was significant [adjusted incidence rate ratio for increased use of SEE IT∈=∈1.94 ]. There were no significant effects of resident gender, race/ethnicity, specialty, training level, or SP health conditions. Conclusions: SP instructors can teach resident physicians to apply SEE IT during SP office visits, and the effects extend to health conditions beyond those used for training. Future studies should explore the effects of the intervention on practicing physicians, physician use of SEE IT during actual patient visits, and its influence on patient health behaviors and outcomes.

Code-based cryptography is currently the second most promising post-quantum mathematical tool for quantum-resistant algorithms. Since in 2022 the first post-quantum standard Key Encapsulation Mechanism, Kyber (a latticed-based algorithm), was selected to be established as standard, and after that the National Institute of Standards and Technology post-quantum standardization call focused in code-based cryptosystems. Three of the four candidates that remain in the fourth round are code-based algorithms. In fact, the only non-code-based algorithm (SIKE) is now considered vulnerable. Due to this landscape, it is crucial to update previous results about these algorithms and their functioning. The Fujisaki-Okamoto transformation is a key part of the study of post-quantum algorithms and in this work we focus our analysis on Classic McEliece, BIKE and HQC proposals, and how they apply this transformation to obtain IND-CCA semantic security. Since after security the most important parameter in the evaluation of the algorithms is performance, we have compared the performance of the code-based algorithms of the NIST call considering the same architecture for all of them.

Covering a timely topic, which is more and more frequently in the news, this book offers vignettes that will sharpen the reader's ability to recognize and respond to difficult situations sparked by identity differences among faculty, staff, and students in college and university settings. The authors provide a systematic guide to addressing interpersonal conflicts that arise out of issues of identity difference, both for individuals and for campus work teams who provide direct service to students. Managing Diversity Flashpoints in Higher Education empowers readers to diagnose diversity flashpoint situations and positively address them without creating defensiveness and barriers to dialogue. The authors include an overview of the changing ethnic, racial, and gender composition of students in higher education in the United States and the major trends in campus responses to the changing student population. They offer an approach to creating higher education environments that welcome people of all cultural characteristics and promote civility on campus. The book is founded on the authors' research on diversity flashpoints in higher education for which they interviewed a national sample of student affairs professionals. The authors identified uncomfortable interpersonal situations with faculty members in which the discomfort arose from student identity difference. This process led to the formulation of strategies for using vignettes in professional development sessions

Tommie Shelby has offered an influential, carefully stated, and well-argued set of objections to any volitional analysis of racism (VAR) as consisting centrally in certain forms of race-based disregard. Here I hope to defend aspects of VAR by analyzing, evaluating, and sometimes countering several of his major contentions, which have stood unchallenged in the literature over more than two decades. First, I sketch and respond to his Methodological objection to VAR, which criticizes VAR's reliance on language and linguistic intuitions; then to a Psychological objection, which suggests that VAR implausibly distances an agent's intentions from her beliefs; and, finally, to a Psychopathological objection, which holds that VAR requires treating as unproblematic some psychological states better seen as aberrant. The following section treats three subtle counterexamples Shelby uses to challenge VAR's core contentions about what's necessary and what's sufficient for racism. I close with some gestures toward what I see as a promising approach, very different from his, to studying these topics.

I sketch and respond to Ryan Byerly’s distinction between a Value-Based Approach to assessing proposed accounts of a virtue-here, humility-and what he calls a Counterexample Based Approach. My first section, on method, argues that, though distinct, the two approaches are not mutually exclusive and answer different questions. Engaging his claim that the former approach is superior to the latter, I suggest that we apply Byerly’s own idea that there are different kinds of value to show, contra Byerly, each approach may be better than the other in different ways, and for different purposes. Adapting and applying a point from Aristotle and Aquinas, I suggest that Byerly’s core question--what kind of values a virtue has--may rely on a mistake, that of misunderstanding a virtue’s work of making people and things good as its possessing goodness itself. My latter section, on results, points out difficulties for Byerly's altruistic conception of humility and defends my own view, developed in an earlier “Philosophia” article, that humility is essentially a matter of remaining unimpressed with oneself. I conclude by engaging and rebutting Byerly’s contention that his analysis of humility best captures a certain religious view

This essay rebuts Gary Seay's efforts to show that committing euthanasia need not conflict with a physician's professional duties. First, I try to show how his misunderstanding of the correlativity of rights and duties and his discussion of the foundation of moral rights undermine his case. Second, I show aspects of physicians' professional duties that clash with euthanasia, and that attempts to avoid this clash lead to absurdities. For professional duties are best understood as deriving from professional virtues and the commitments and purposes with which the professional as such ought to act, and there is no plausible way in which her death can be seen as advancing the patient's medical welfare. Third, I argue against Prof. Seay's assumption that apparent conflicts among professional duties must be resolved through "balancing" and argue that, while the physician's duty to extend life is continuous with her duty to protect health, any duty to relieve pain is subordinate to these. Finally, I show that what is morally determinative here, as throughout the moral life, is the agent's intention and that Prof. Seay's implicitly preferred consequentialism threatens not only to distort moral thinking but would altogether undermine the medical (and any other) profession and its internal ethics.

Contrasting loving our neighbors with utilitarians’ demand to maximize good reveals important metatheoretic structures and dynamics that I call virtues- basing, input drive, role centering, and patient focus. First, love (good will) is a virtue; such virtues are foundational to both moral obligations and the impersonally valuable. Second, part of loving is acting lovingly. Whether and how I act lovingly, and how loving it is, is a matter of motivation; this input-driven account contrasts with highlighting actions’ outcome. Third, in regarding someone as our neighbor we view her in relation to ourselves; a role-centered perspective shows that a wide range of person-to-person role-relationships constitute moral life. Fourth, if our moral task is loving each person, the moral question is how we respond to each person’s relevant welfare and needs, focusing on those toward someone acts (moral patients), not on maximizing good across persons or producing an optimal world.