[Paradoxical lucidity and personal identity in patients with advanced dementia: change of paradigm?] / Lucidez paradójica e identidad personal en pacientes con demencia avanzada: ¿cambio de paradigma?

In this article we approach the concept of paradoxical lucidity (LP) (an unexpected, spontaneous, significant and relevant episode of communication or connection) in persons with advanced dementia. The existence of LP could change the paradigm of dementia as a degenerative, chronic, progressive and irreversible disease (where neuronal death plays the leading role), towards a model where functional deficits of neuronal networks acquire importance, which raises new potentially reversible therapeutic and rehabilitative possibilities. We analyze the ethical consequences that these episodes may have with respect to the implicated persons (patients, caregivers and professionals in charge of their care) and try to answer the following question: Do persons with advanced dementia continue to maintain their personal identity despite suffering cognitive impairment so severe?. The LP indicates that this is possible. In this work we make a transversal outline of the different concepts and theories of personal identity in these patients, from different areas of knowledge (philosophy, psychology, neuroscience).

Beyond the Pump: A Narrative Study Exploring Heart Memory.

The field of organ transplantation, particularly heart transplantation, has brought to light interesting phenomena challenging traditional understandings of memory, identity, and consciousness. Studies indicate that heart transplant recipients may exhibit preferences, emotions, and memories resembling those of the donors, suggesting a form of memory storage within the transplanted organ. Mechanisms proposed for this memory transfer include cellular memory, epigenetic modifications, and energetic interactions. Moreover, the heart's intricate neural network, often referred to as the "heart brain," communicates bidirectionally with the brain and other organs, supporting the concept of heart-brain connection and its role in memory and personality. Additionally, observations from hemispherectomy procedures highlight the brain's remarkable plasticity and functional preservation beyond expectations, further underscoring the complex interplay between the brain, body, and identity. However, ethical and philosophical questions regarding the implications of these findings, including the definition of death and the nature of personal identity, remain unresolved. Further interdisciplinary research is needed to unravel the intricacies of memory transfer, neuroplasticity, and organ integration, offering insights into both organ transplantation and broader aspects of neuroscience and human identity. Understanding these complexities holds promise for enhancing patient care in organ transplantation and deepens our understanding of fundamental aspects of human experience and existence.

When Suicide is not a Self-Killing: Advance Decisions and Psychological Discontinuity-Part I.

Derek Parfit's view of 'personal identity' raises questions about whether advance decisions refusing life-saving treatment should be honored in cases where a patient loses psychological continuity; it implies that these advance decisions would not be self-determining at all. Part I of this paper argues that this assessment of personal identity undermines the distinction between suicide and homicide. However, rather than accept that an unknown metaphysical 'further fact' underpins agential unity, one can accept Parfit's view but offer a different account of what it implies morally: that the social and legal bases for ascribing a persisting 'personal identity' maintain the distinction between homicide and suicide.

Identity Theft, Deep Brain Stimulation, and the Primacy of Post-trial Obligations.

Patient narratives from two investigational deep brain stimulation trials for traumatic brain injury and obsessive-compulsive disorder reveal that injury and illness rob individuals of personal identity and that neuromodulation can restore it. The early success of these interventions makes a compelling case for continued post-trial access to these technologies. Given the centrality of personal identity to respect for persons, a failure to provide continued access can be understood to represent a metaphorical identity theft. Such a loss recapitulates the pain of an individual's initial injury or illness and becomes especially tragic because it could be prevented by robust policy. A failure to fulfill this normative obligation constitutes a breach of disability law, which would view post-trial access as a means to achieve social reintegration through this neurotechnological accommodation.

Navigating Across Heritage and Destination Cultures: How Personal Identity and Social Identification Processes Relate to Domain-Specific Acculturation Orientations in Adolescence.

Personal identity and social identification processes can be challenging for adolescents belonging to an ethnic minority, who have to cope with the acculturation task of navigating several (and often conflictual) alternatives put forth by their cultural heritage community and destination society. Because identity and acculturation tasks are embedded in core domains of adolescents' life, this three-wave longitudinal study with ethnic minority adolescents (N = 244, 43.4% male; Mage = 14.9) examined how personal identity processes and social identifications are related to acculturation orientations in the education and friendship domains. Results of traditional cross-lagged models showed that, in the educational domain, adolescents who scored higher on cultural heritage maintenance compared to their peers, scored higher on commitment later on. In the friendship domain, stronger associations were found, such that adolescents who scored higher on cultural heritage maintenance compared to their peers, reported higher commitment and in-depth exploration later on, while those who scored higher on identification with friends reported over time also higher cultural heritage maintenance and destination culture adoption. Random-intercept crossed-lagged models indicated that, when adolescents reported above their own average on reconsideration of educational commitment, they reported increased cultural heritage maintenance later on. Furthermore, consistent associations (at baseline and over time) emerged. Overall, this study points to virtuous alliances between the fulfillment of tasks related to adolescents' identity development and acculturation.

Discussions of personal identity in genetic counseling supervision.

Fieldwork supervision is integral to genetic counseling students' training and has the potential to impact how included students feel in the genetic counseling field. For example, in related counseling fields, when supervisees and supervisors discuss their personal similarities or differences in ethnicity, supervisees report a stronger supervisory working alliance (SWA) (Journal of Multicultural Counseling and Development, 2001, 29, 102-113). However, the application of these studies on identity discussions to the genetic counseling field is currently unknown. The objective of this cross-sectional questionnaire-based study was to investigate (a) if genetic counseling students report having discussions of personal identity during fieldwork supervision, (b) who initiated any such discussions, (c) if there was a difference in the supervisory relationship between those who did and did not have discussions of personal identity, and (d) how students perceived the inclusivity of the genetic counseling profession and their genetic counseling programs. Discussions of personal identity were defined in this study as "discussions happening during supervision regarding how one or more aspects of personal identity impacts the provision of genetic counseling services and/or professional interactions" where personal identity included the student or supervisor's gender, sexual orientation, race, ethnicity, religion, disability status or other aspect of identity. Almost 40% of the participants (N = 190) reported discussing personal identity with their supervisor. For students identifying as white, discussions of personal identity were related to a stronger SWA (p = 0.014). However, for those with minoritized identities there was no relationship between the SWA and discussions of personal identity. Therefore, it is unclear from the current research whether discussions of personal identity can be an effective tool in improving inclusivity in the field of genetic counseling. Additional research is needed to explore the direct impact of identity discussions on the supervisory working alliance in genetic counseling supervision.

Impact of Experiential Education on the Intersectionality of Pharmacy Student Personal and Professional Identity Formation.

OBJECTIVE: The objective of this review was to summarize evidence relating to the impact of experiential education on the development of professional identity formation (PIF) and determine areas for future research and development to improve the integration of a professional identity within the student's unique personal identity within experiential education programs. METHODS: A systematic scoping review was conducted using the systematic evidence-based approach following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles published between 2012 and 2022 related to the development of PIF in relation to the experiential experience were researched using PubMed, MEDLINE, ScienceDirect, Eric, and JSTOR (search engines) to find relevant articles. RESULTS: A total of 986 articles were identified from the literature search. After undergoing an exclusion criterion, the total number of articles was reduced to 23 to be included in this review. Following the full-text review of the 23 articles, the authors identified common themes or domains and key findings relating to PIF and pharmacy experiential education. Articles were then assigned to 1 or more of the following domains: Experiential Education and PIF, Experiential Education and Professional Socialization, and Factors that influence PIF. CONCLUSION: This review found that professional identity is highly impacted by experiential education and that pharmacy students cannot rely on didactic teaching alone but need to be exposed to authentic practice settings early within their curriculum by means of experiential education.

The intersectionality of professional and personal identity formation in a virtual pre-health pathway program.

BACKGROUND AND PURPOSE: To describe the development and implementation of professional and personal identity formation content in a virtual pre-health pathway program. EDUCATIONAL ACTIVITY AND SETTING: Content within a six-week pre-health program for underrepresented and/or disadvantaged college students was redesigned to a virtual format with enhanced focus on professional and personal identity formation. Sessions on personal identity formation were also enhanced through a partnership with local mental health clinicians specializing in trauma-informed care and culturally relevant practices and strategies. FINDINGS: The 2020 and 2021 programs were restructured to include pharmacy professional identity formation content around the following weekly themes: Roadmap to Pharmacy, What Does it Mean to be a Pharmacist?, Expanding Knowledge of Pharmacy, Gaining Insight and Dispelling Myths, Practicing Knowledge and Exploration, and Moving Forward. These pre-pharmacy components emphasized diversity of career paths, pharmacy-based clinical services, and the pharmacist's role in promoting health equity. Overarching components of interprofessional collaboration coupled with health policy applications further emphasized the professional identity of a pharmacist in the collaborative design and delivery of health care. New personal identity formation sessions were implemented in tandem with this content and centering around the following themes: Supporting Scholars in Self-Authorship, Building a Community among Peers, and Strategies for Coping in Times of Challenge. SUMMARY: This project has the potential to serve as a model for the implementation of both personal and professional identity formation initiatives at other programs to promote pharmacy as a desirable and attainable career to pre-health students.

Analysis of Laboratory Skills Curricula Surrounding Professional Identity Formation in Doctor of Pharmacy Students.

OBJECTIVE: The purpose of this study was to describe how laboratory curricula in 6 pharmacy programs provides student pharmacist experiences to develop professional identity formation and explore personal identities. METHODS: Learning objectives for courses with laboratory components were independently reviewed and then reconciled to identify the associated historical professional identities, professional domains, and associated with personal identity from 6 pharmacy programs. Counts and frequencies for historical professional identities, domains, and personal identity associations were obtained by program and overall. RESULTS: Thirty-eight (2.0%) unique objectives were associated with personal identity. The most identified historical professional identity was healthcare provider (42.9%), followed by dispenser (21.7%). The highest professional domain identified was prepare/dispense/provide medications (28.8%) followed by communicate/counsel/educate (17.5%). CONCLUSION: Discordance between the historical identities and professional domains covered in the laboratory curricula was identified in this analysis. The prevalence of the "health care provider" professional identity in the laboratory curricula likely mimics what is currently seen in practice, but most lab activities fell under the domain of preparing and dispensing medication which may not be considered a component of healthcare provider professional identity. Going forward, educators must be intentional in the experiences we provide to students to help foster their professional and personal identity. Future research is needed to identify if this discordance is present in other classes along with research to identify intentional activities that can be incorporated to foster professional identity formation.

Which kind of sameness? Disambiguating two senses of identity with a novel linguistic task.

When people report that a person's identity has changed, what do they mean by this? Recent research has often assumed that participants are indicating a change in numerical, rather than qualitative, identity. Investigations into this matter have been hampered by the fact that English has no clear way to demarcate one type of identity from the other. To resolve this matter, we develop and test a novel task in Lithuanian, which has lexical markers for numerical and qualitative identity. We apply this task to intuitions about changes in moral capacities, which has previously shown to lead to high ratings in identity change. We discover that, when people say that a morally altered person is dramatically different, they mean the person is qualitatively transformed, but numerically intact. We conclude that this methodology is a valuable tool not only for illuminating the specific phenomenon of the moral self, but for general use in studying folk ascriptions of identity persistence.

The role of personal identity as a resource for college students during COVID-19.

Objective: We examined the role of personal identity vis-à-vis COVID-related outcomes among college students from seven U.S. campuses during spring/summer 2021. Participants: The present sample consisted of 1,688 students (74.5% female, age range 18-29). The sample was ethnically diverse, and 57.3% were first-generation students. Procedures: Students completed an online survey assessing personal identity synthesis and confusion, COVID-related worries, general internalizing symptoms, positive adaptation, and general well-being. Results: Personal identity synthesis was negatively related to COVID-related worries and general internalizing symptoms, and positively related to positive adaptation, both directly and indirectly through life satisfaction and psychological well-being. Personal identity confusion evidenced an opposing set of direct and indirect associations with outcome variables. Conclusions: Personal identity may potentially be protective against pandemic-related distress among college students, in part through its association with well-being. Reducing identity confusion and promoting identity synthesis are essential among college students during this and future pandemics.

Memories without Survival: Personal Identity and the Ascending Reticular Activating System.

Lockean views of personal identity maintain that we are essentially persons who persist diachronically by virtue of being psychologically continuous with our former selves. In this article, I present a novel objection to this variant of psychological accounts, which is based on neurophysiological characteristics of the brain. While the mental states that constitute said psychological continuity reside in the cerebral hemispheres, so that for the former to persist only the upper brain must remain intact, being conscious additionally requires that a structure originating in the brainstem-the ascending reticular activating system-be functional. Hence, there can be situations in which even small brainstem lesions render individuals irreversibly comatose and thus forever preclude access to their mental states, while the neural correlates of the states themselves are retained. In these situations, Lockeans are forced to regard as fulfilled their criterion of diachronic persistence since psychological continuity, as they construe it, is not disrupted. Deeming an entity that is never again going to have any mental experiences to be a person, however, is an untenable position for a psychological account to adopt. In their current form, Lockean views of personal identity are therefore incompatible with human neurophysiology.

The predictive effect of relative intuition on social entrepreneurship orientation: How do exploratory and exploitative learning and personal identity interact?

This study complements the stream of psychology studies on the effects of an individual's intuition on strategic decisions and how it shapes behavioral tendencies by extending how these effects evolve social entrepreneurship orientation in social entrepreneurship. Theoretically, we establish the nexus between relative intuition and social entrepreneurship orientation as well as the moderating roles of exploratory and exploitative learning and personal identity. Empirical validation of these nexuses was based on a cross-section of 276 certified social enterprises in China. The findings indicate that social entrepreneurs' relative intuition has a positive association with social entrepreneurship orientation. Exploratory and exploitative learning positively mediate the nexus between relative intuition and social entrepreneurship orientation. In addition, personal identity positively moderates the effects of exploratory and exploitative learning on social entrepreneurship orientation. Subsequently, we found that the link between relative intuition and social entrepreneurship orientation strengthens as the social entrepreneurs' personal identity increases. In this light, we identify relative intuition as the foundation of exploratory and exploratory learning for the development of social entrepreneurship orientation. Similarly, we shed light on how personal identity positively facilitates the roles of these factors by arousing dedication to the processes/stages of the pursuit of social entrepreneurship orientation goal attainment.

Is disease a threat to identity? A systematic review of parkinson's disease and personal identity.

Introduction: Parkinson's disease (PD) is a neurological condition that impacts the physical and psychological functioning of the patients. The physical and cognitive changes come with social stigma and threats to roles previously associated with their identities. Objectives: The current paper attempts to study the influence of the disease on the personal identity of the patients. Methods: A systematic review was done on PD and personal identity following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The Consolidated Criteria for Reporting Qualitative Research checklist was used to assess the quality of the papers. The selected papers were synthesized to understand the relationship between PD and personal identity. Results: The emerging themes were: (1) dissociation of old personal identity: (1.1) Influence of physical symptoms, (1.2) influence of society and stigma, and (1.3) threats to roles associated with identity and (2) changing family dynamics. A Model of Personal, Family, and Disease Dynamics was also developed based on clinical first-hand experience with the patients and the review. Conclusion: The personal identity of the PD patients shifts drastically as a result of their physical and psychosocial experiences. This also results in changed family dynamics, with the patient feeling sidelined due to loss of control and responsibilities in the family.

Obvious benefits but hidden costs: A critical exploration of the impact of adopting the "master narrative" in Alcoholics Anonymous.

INTRODUCTION: New members of Alcoholics Anonymous (AA) typically acquire a distinct "alcoholic" identity, including AA-specific understandings of their "alcoholism" and what it means to be in recovery. Although much qualitative research on AA has presented the experiences of members who have embraced this identity and have been wholly praising of AA, other theorists have been strongly critical of the organization, often arguing that it emulates a cult. To contribute towards reconciling these competing bodies of research, the current study aimed to critically explore the impact of adopting AA's master narrative. METHODS: The study involved 19 prospective, in-depth semi-structured interviews with six AA members recruited from meetings across Sydney, Australia. Data were analyzed thematically using a master narrative theoretical framework. RESULTS: The study identified three core components of AA's master narrative: (1) Powerlessness over alcohol ("alcoholics" are powerless over alcohol); (2) Internalized pathologization ("alcoholics" are mentally and emotionally sick, above and beyond their problems with alcohol); and (3) AA as the only solution for wellness (involvement in AA is the necessary requirement for "alcoholics" to become and remain well). Although most participants emphasized the positive experiences from internalizing the AA narrative, our analysis also revealed potentially negative ramifications of this narrative on their self-conceptions and worldviews that were seemingly unrecognized by participants themselves. CONCLUSIONS: The master narrative framework facilitated a critical and balanced exploration of AA members' experiences. Although AA's master narrative is valuable for members, it could also carry costs that need to be mitigated by resources both inside and outside of AA.

Young Creators: Perceptions of Creativity by Primary School Students in Malta.

Policymakers and employers insist that educational institutions prepare workforce-ready candidates fluent in the application of 21st Century Skills such as creativity. So far, only a few studies have explored the self-perceived creativity of students. This paper addresses this gap in literature by providing an understanding of how young students in upper primary feel about themselves as creative beings. Data for the present study was collected through an anonymous online survey that 561 students, aged 9-11 years and residing in Malta (EU), completed. In-depth responses were collected from a subset of the original sample made up of 101 students through an anonymous online form containing a set of questions. Data was analysed using regression analysis for the quantitative component and through thematic analysis for the qualitative part. Results indicate that, overall, students in Year 6 felt less creative than students in Year 5. Furthermore, findings show that the type of school attended impacted the students' perception of creativity. From a qualitative perspective, findings led to insights into (i) the interpretation of the term creativity and (ii) the impact of the school environment and how timetabling impacted students' creativity. The findings suggest that the student's perceived creative personal identity and the concrete manifestations that they engage in are influenced by environmental factors.

Future-like-ours as a metaphysical reductio ad absurdum argument of personal identity.

Don Marquis' future-like-ours account is regarded as the best secular anti-abortion position because he frames abortion as a wrongful killing via deprivation of a valuable future. Marquis objects to the reductio ad absurdum of contraception as being immoral because it is too difficult to identify an individual that is deprived of a future. To demonstrate why Marquis' treatment of the contraception reductio is flawed by his own future-like-ours line of reasoning, I offer an argument for why there is indeed a candidate for harm-the ovum-for it can be viewed as providing the functional foundation for a new life through (1) mitochondrial DNA inheritance, (2) paternal histone restructuring during fertilization, and (3) ability to initiate parthenogenesis. As evidenced by these distinct and natural features of ova, candidate (2) "some ovum or other" should be morally prioritized as the direct candidate for harm in the contraception reductio. By assessing the philosophical inconsistencies in Marquis' future-like-ours argument, this paper provides strong metaphysical grounds for rejecting the best secular anti-abortion position.

Alzheimer's, Advance Directives, and Interpretive Authority.

Philosophers have debated whether the advance directives of Alzheimer's patients should be enforced, even if patients seem content in their demented state. The debate raises deep questions about the nature of human autonomy and personal identity. But it tends to proceed on the assumption that the advance directive's terms are clear, whereas in practice they are often vague or ambiguous, requiring the patient's healthcare proxy to make difficult judgment calls. This practical wrinkle raises its own, distinct but related, philosophical question: what criteria may the proxy bring to bear when making such interpretive judgments on which the patient's life may depend? After defending a general policy of enforcing advance directives on normative (rather than metaphysical) grounds, I argue that when advance directives are vague, a patient's proxy may permissibly make her own fresh evaluation of the patient's life as a whole and, in so doing, consider how the patient's character as a demented person contributes or fails to contribute to that life.

Rewriting the genetic bond: Gene editing and our understanding of genetic parenthood.

One of the most prominent justifications for the use of germline gene editing (GGE) is that it would allow parents to have a "genetically related child" while preventing the transmission of genetic disorders. However, we argue that since future uses of GGE may involve large-scale genetic modifications, they may affect the genetic relatedness between parents and offspring in a meaningful way: Due to certain genetic modifications, children may inherit much less than 50% of their DNA from each parent. We show that the reduction in genetic relatedness between parents and offspring has three important social and legal implications. First, the desire for a genetically related child may end up not being the strong justification it is currently thought to be for the use of GGE. Second, prospective parents may be reluctant to use GGE because of a potential loss of genetic relatedness. Third, in some jurisdictions, parents who would not pass on "enough" DNA to their child may not be recognized as the child's legal parents. We further argue that the reduction in genetic relatedness challenges current conceptions of genetic parenthood that rely on the quantity of DNA shared with the child or on whether the child was directly derived from the parent's genes. We suggest that genetic parenthood should instead be determined based on the nature of the genetic modifications and whether the child's numerical identity has been preserved after the editing process.

Getting Smarter about Smart Cities: Improving Data Security and Privacy through Compliance.

Smart cities assure the masses a higher quality of life through digital interconnectivity, leading to increased efficiency and accessibility in cities. In addition, a huge amount of data is being exchanged through smart devices, networks, cloud infrastructure, big data analysis and Internet of Things (IoT) applications in the various private and public sectors, such as critical infrastructures, financial sectors, healthcare, and Small and Medium Enterprises (SMEs). However, these sectors require maintaining certain security mechanisms to ensure the confidentiality and integrity of personal and critical information. However, unfortunately, organizations fail to maintain their security posture in terms of security mechanisms and controls, which leads to data breach incidents either intentionally or inadvertently due to the vulnerabilities in their information management systems that either malicious insiders or attackers exploit. In this paper, we highlight the importance of data breaches and issues related to information leakage incidents. In particular, the impact of data breaching incidents and the reasons contributing to such incidents affect the citizens' well-being. In addition, this paper also discusses various preventive measures such as security mechanisms, laws, standards, procedures, and best practices, including follow-up mitigation strategies.