Biobanking of patient-derived materials is routine in health care, research, and public health emergencies. Ethical guidelines for biobanking address concerns including some about genetic materials, informed consent, confidentiality, regulatory environments, and standards of governance. This chapter identifies some limitations of existing guidelines that were apparent to one author during an Ebola outbreak, and specifies five ethical concerns about biobanking that warrant additional attention: misconceptions about biobanking, unknown consequences for donors, socioeconomic inequities that compound vulnerabilities, lasting and proportional benefits in North-South (...) research, and contextual challenges to disclosure and understanding. These affect patients, donors, health systems, research, and policy, and are amplified during public health emergencies. (shrink)

Sense of agency refers to the sense of initiating and controlling actions in order to influence events in the outside world. Recently, a distinction between implicit and explicit aspects of sense of agency has been proposed, analogous to distinctions found in other areas of cognition, notably learning. However, there is yet no strong evidence supporting separable implicit and explicit components of sense of agency. The so-called ‘Perruchet paradigm’ offers one of the few convincing demonstrations of separable implicit and explicit learning (...) systems. We adopted this approach to evaluate the implicit–explicit distinction in the context of a simple task in which outcomes were probabilistically caused by actions. In line with our initial predictions, we found evidence of a dissociation. We discuss the implications of this result for theories of sense of agency. (shrink)

If Einstein's equations are to describe a field theory of gravity in Minkowski spacetime, then causality requires that the effective curved metric must respect the flat background metric's null cone. The kinematical problem is solved using a generalized eigenvector formalism based on the Segré classification of symmetric rank 2 tensors with respect to a Lorentzian metric. Securing the correct relationship between the two null cones dynamically plausibly is achieved using the naive gauge freedom. New variables tied to the generalized eigenvector (...) formalism reduce the configuration space to the causality-respecting part. In this smaller space, gauge transformations do not form a group, but only a groupoid. The flat metric removes the difficulty of defining equal-time commutation relations in quantum gravity and guarantees global hyperbolicity. (shrink)

OBJECTIVE: To report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients. DESIGN: Retrospective descriptive study. SETTING: A cancer clinical trials unit in a large teaching hospital. PATIENTS: From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied. MAIN MEASUREMENT: Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated. RESULTS: (...) DNR orders were written for 64.4% of patients. Patients in pain (odds ratio 0.45, 95% CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95% CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patients were taken home to die, a more likely occurrence if the patient was over 75 years (odds ratio 0.12, 95% CI 0.04-0.34), had children (odds ratio 0.14, 95% CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95% CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95% CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge. CONCLUSIONS: DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20% of dying patients are taken home to die, in accordance with local custom. (shrink)

The oft-neglected issue of the causal structure in the flat spacetime approach to Einstein's theory of gravity is considered. Consistency requires that the flat metric's null cone be respected, but this does not automatically happen. After reviewing the history of this problem, we introduce a generalized eigenvector formalism to give a kinematic description of the relation between the two null cones, based on the Segre' classification of symmetric rank 2 tensors with respect to a Lorentzian metric. Then we propose a (...) method to enforce special relativistic causality by using the gauge freedom to restrict the configuration space suitably. A set of new variables just covers this smaller configuration space and respects the flat metric's null cone automatically. Respecting the flat metric's null cone ensures that the spacetime is globally hyperbolic, indicating that the Hawking black hole information loss paradox does not arise in the special relativistic approach to Einstein's theory. (shrink)

Recently the neglected issue of the causal structure in the flat space-time approach to Einstein's theory of gravity has been substantially resolved. Consistency requires that the flat metric's null cone be respected by the null cone of the effective curved metric. While consistency is not automatic, thoughtful use of the naive gauge freedom resolves the problem. After briefly recapitulating how consistent causality is achieved, we consider the flat Robertson–Walker Big Bang model. The Big Bang singularity in the spatially flat Robertson–Walker (...) cosmological model is banished to past infinity in Minkowski space-time. A modified notion of singularity is proposed to fit the special relativistic approach, so that the Big Bang becomes nonsingular. (shrink)

A physical framework has been proposed which describes manifestly covariant relativistic evolution using a scalar time τ. Studies in electromagnetism, measurement, and the nature of time have demonstrated that in this framework, electromagnetism must be formulated in terms of τ-dependent fields. Such an electromagnetic theory has been developed. Gravitation must also use of τ-dependent fields, but many references do not take the metric's dependence on τ fully into account. Others differ markedly from general relativity in their formulation. In contrast, this (...) paper outlines steps towards a τ-dependent classical intrinsic formulation of gravitation, patterned after general relativity, which we call parametrized general relativity (PGR). Given the existence of a preferred foliation, the Hamiltonian constraint is removed. We find that some nonmetricity in the connection is allowed, unlike in general relativity. Conditions on the allowable nonmetricity are found. Consideration of the initial value problem confirms that the metric signature should normally be O(3, 2) rather than O(4, 1). Following the lead of earlier works, we argue that concatenation (integration over τ) is unnecessary for relating parametrized physics to experience, and propose an alternative to it. Finally, we compare and contrast PGR with other relevant gravitational theories. (shrink)

Paralleling the formal derivation of general relativity as a flat spacetime theory, we introduce in addition a preferred temporal foliation. The physical interpretation of the formalism is considered in the context of 5-dimensional “parametrized” and 4-dimensional preferred frame contexts. In the former case, we suggest that our earlier proposal of unconcatenated parametrized physics requires that the dependence on τ be rather slow. In the 4-dimensional case, we consider and tentatively reject several areas of physics that might require a preferred foliation, (...) but find a need for one in the process (“flowing”) theory of time. We then suggest why such a foliation might reasonably be unobservable. (shrink)

In a framework describing manifestly covariant relativistic evolution using a scalar time τ, consistency demands that τ-dependent fields be used. In recent work by the authors, general features of a classical parametrized theory of gravitation, paralleling general relativity where possible, were outlined. The existence of a preferred “time” coordinate τ changes the theory significantly. In particular, the Hamiltonian constraint for τ is removed From the Euler-Lagrange equations. Instead of the 5-dimensional stress-energy tensor, a tensor comprised of 4-momentum density mid flux (...) density only serves as the source. Building on that foundation, in this paper we develop a linear approximate theory of parametrized gravitation in the spirit of the flat spacetime approach to general relativity. Using a modified form of Kraichnan's flat spacetime derivation of general relativity, we extend the linear theory to a family of nonlinear theories in which the flat metric and the gravitational field coalesce into a single effective curved metric. (shrink)