For medical interventions there is a gap between what clinical scientific research has established as likely to carry clinical benefit and what the National Institute for Clinical Excellence (NICE) has judged as cost-effective. This gap is the affordability gap. It is created by a value judgement made by NICE and affirmed by the Secretary of State for Health. This value judgement operates to affect other value judgements made in actual clinical situations where at least one choice of treatment falls into (...) the affordability gap. This paper considers how the creation of this affordability gap impacts upon actual clinical decisions. It explores these issues in the context of the choice between a drug-eluting stent and a bare metal stent for elective coronary angioplasty. It also argues that the option of an NHS procedure with a top-up fee to cover the cost of the affordability gap is a genuine one; that this option could improve clinical outcomes; that it is morally acceptable; and that the rules that prevent the utilization of this option should be relaxed. (shrink)

A large proportion of hospital inpatients are affected by cognitive impairment, posing challenges in the provision of their care in busy, fast-paced acute wards. Signs and symbols, known as visual identifiers, are employed in many U.K. hospitals with the intention of helping healthcare professionals identify and respond to the needs of these patients. Although widely considered useful, these tools are used inconsistently, have not been subject to full evaluation, and attract criticism for acting as a shorthand for a routinized response. (...) In order for visual identifiers to be used effectively in acute care settings, thorough consideration must be given to the ethical and legal issues that are engaged in this context, and their potential benefits and harms must be weighed and balanced. This paper proposes a set of legal and ethical principles that can be used to guide the implementation of visual identifiers. Together, these principles provide a framework applicable in the design and implementation phases to systematically identify relevant considerations arising from the use of these tools. We outline some tensions that arise between principles and conclude that selecting a preferred moral framework could help to guide decision-making, as does clarity around the purpose and objectives of the identifier. (shrink)

The Monographs produced by the International Agency for Research on Cancer (IARC) apply rigorous procedures for the scientific review and evaluation of carcinogenic hazards by independent experts. The Preamble to the IARC Monographs, which outlines these procedures, was updated in 2019, following recommendations of a 2018 expert Advisory Group. This article presents the key features of the updated Preamble, a major milestone that will enable IARC to take advantage of recent scientific and procedural advances made during the 12 years since (...) the last Preamble amendments. The updated Preamble formalizes important developments already being pioneered in the Monographs Programme. These developments were taken forward in a clarified and strengthened process for identifying, reviewing, evaluating and integrating evidence to identify causes of human cancer. The advancements adopted include strengthening of systematic review methodologies; greater emphasis on mechanistic evidence, based on key characteristics of carcinogens; greater consideration of quality and informativeness in the critical evaluation of epidemiological studies, including their exposure assessment methods; improved harmonization of evaluation criteria for the different evidence streams; and a single-step process of integrating evidence on cancer in humans, cancer in experimental animals and mechanisms for reaching overall evaluations. In all, the updated Preamble underpins a stronger and more transparent method for the identification of carcinogenic hazards, the essential first step in cancer prevention. (shrink)

For centuries medical schools in Britain and elsewhere had a fairly static curriculum based on what might be called the 'three Rs' of medicine, and consequently had to make room for new subjects as the need arose in a fashion which was sometimes makeshift. However, Southampton University has only had a medical school for six years, and therefore their course on medical ethics and legal medicine was carefully integrated into the curriculum after some preliminary experiments carried out by a subcommittee (...) which is continually reviewing the situation. Medical ethics has now a definite place in the fourth year, preceded by an introduction to ethical problems encountered in medicine in the first year. Not only do members of the medical faculty participate in this teaching but also members of the faculties of law and the arts. (shrink)

In research textbooks, and much of the research practice, they describe, qualitative processes and interpretivist epistemologies tend to dominate visual methodology. This article challenges the assumptions behind this dominance. Using exemplification from three existing visual data sets produced through one large education research project, this article considers the affordances and constraints of the research process focusing particularly on analysis. It examines how and when the visual can be incorporated, gives some critical reflections on the role and use of visual methods (...) to fulfil different research intents, and, in particular, considers combining large, open-ended data sets with acceptable and rigorous analysis techniques. We then explore arguments about the nature of visual data, what is considered epistemologically appropriate and the decision-making which accompanies any appraisal of process in education research. The intention is to challenge ourselves, and fellow visual methods researchers, to develop a more complete understanding of the theory and practice of visual research. (shrink)

As part of a larger research study, we present model language for disclosing financial interests in clinical research to potential research participants, and we describe the empirical basis and theoretical assumptions used in developing the language. The empirical process for creating appropriate disclosure language resulted in a generic disclosure statement for cases in which no risk to participants’ welfare or the scientific integrity of the research is expected, and nine more specific disclosure statements for cases in which some risk is (...) expected. The disclosure statements are not meant to be canonical, but were instead designed to reflect the typical situations in which disclosure of financial interest might be considered by an institutional review board or conflict of interest committee. Individual institutions could modify key phrases to suit their purposes, and others could use the language in future empirical work on informed consent to better refine the options for disclosing financial interests in clinical research. (shrink)

Many scientists and philosophers of science are troubled by the relative isolation of developmental from evolutionary biology. Reconciling the science of development with the science of heredity preoccupied a minority of biologists for much of the twentieth century, but these efforts were not corporately successful. Mainly in the past fifteen years, however, these previously dispersed integrating programmes have been themselves synthesized and so reinvigorated. Two of these more recent synthesizing endeavours are evolutionary developmental biology and developmental systems theory. While the (...) former is a bourgeoning and scientifically well-respected biological discipline, the same cannot be said of DST, which is virtually unknown among biologists. In this review, we provide overviews of DST and EDB, summarize their key tenets, examine how they relate to one another and to the study of epigenetics, and survey the impact that DST and EDB have had on biological theory and practice. (shrink)

This paper reports laboratory data for games that are played only once. These games span the standard categories: static and dynamic games with complete and incomplete information. For each game, the treasure is a treatment in which behavior conforms nicely to predictions of the Nash equilibrium or relevant refinement. In each case, however, a change in the payoff structure produces a large inconsistency between theoretical predictions and observed behavior. These contradictions are generally consistent with simple intuition based on the interaction (...) of payoff asymmetries and noisy introspection about others’ decisions. (shrink)

Developments in neuroscience have raised the possibility that pharmaceuticals may be used to enhance memory, mood, and attention in people who do not have an illness or disorder, a practice known as “cognitive enhancement.” We describe historical experiences with two medicinal drugs for which similar enhancement claims were made, cocaine in the late 19th and early 20th centuries, and amphetamines in the mid 20th century. These drugs were initially introduced as medicinal agents in Europe and North America before becoming more (...) widely used for a variety of purposes, including what would nowadays be considered cognitive enhancement. Their trajectory of use conformed to the typical use cycle of psychotropic drugs. There was an initial steep rise in prescribing for medical use, followed by expanded nonmedical use that was fueled by enthusiasm for the drugs’ effects. As the number of regular users increased, problems related to use (such as addiction) became apparent, societal concern increased, and laws were passed banning nonmedical use and eventually, medical use. This historical experience draws attention to the adverse side effects of enhancement use that only become apparent with regular, wide-scale use of a drug. We highlight the similarities between the enthusiasms for cocaine and amphetamines and the current enthusiasms for using prescription stimulants for cognitive enhancement. We argue bioethicists should not encourage the cognitive enhancement use of drugs such as methylphenidate in the absence of evidence on the efficacy and safety of their use for cognitive enhancement purposes. (shrink)

Previous meta-analyses support a female advantage in decoding non-verbal emotion (Hall, 1978, 1984), yet the mechanisms underlying this advantage are not understood. The present study examined whether the female advantage is related to greater female attention to the eyes. Eye-tracking techniques were used to measure attention to the eyes in 19 males and 20 females during a facial expression recognition task. Women were faster and more accurate in their expression recognition compared with men, and women looked more at the (...) eyes than men. Positive relationships were observed between dwell time and number of fixations to the eyes and both accuracy of facial expression recognition and speed of facial expression recognition. These results support the hypothesis that the female advantage in facial expression recognition is related to greater female attention to the eyes. (shrink)

My mother is losing her mother to Alzheimer's disease. Although my mother feels loss, I am connecting through my grandmother to our ancestors, including a deceased father and paternal grandmother. I am also connecting to a daughter who has lost her mother, through a grandmother who, through her loss of memory, is more open to kin networks than my mother. Through deepening connections to my maternal grandmother and to my daughter, I feel I am losing my mother. I look to (...) revolutionary mothering as a way to reconnect shattered bonds and find lost mothers. This article honors the important work of Saidiya Hartman, Dorothy Roberts, and countless revolutionary mothers. (shrink)

CITATION: Ewuoso, C., Hall, S. & Dierickx, K. 2017. How do healthcare professionals manage ethical challenges regarding information in healthcare professional/patient clinical interactions? a review of concept- or argument-based articles and case analyses. South African Journal of Bioethics and Law, 10:75-82, doi:10.7196/SAJBL.2017.v10i2.610.

The considerable attention to financial interests in clinical research has focused mostly on academic medical centers, even though the majority of clinical research is conducted in community practice settings. To fill this gap, this article maps the practices and policies in 73 community hospitals and several hundred specialized facilities around the country for reviewing clinical investigators’ financial relationships with research sponsors. Community hospitals face a substantially different mix of issues than academic medical centers do because their physician researchers are usually (...) not employees, and more of their studies are later-phase, multicenter trials. Accordingly, community physicians stand to benefit personally from per capita payments, but they tend to have less direct influence over research findings when compared with their academic peers. These and other contrasts require separate guidance for community-based organizations that takes into account their particular needs, circumstances, and institutional capacities. (shrink)

Modularity has become a central and remarkably useful concept in evolutionary developmental biology, offering an explanation of how independent, interacting units make possible developmental events and evolutionary changes. These modules exist at several different levels of organization, from genes to signal transduction pathways to cell populations. Cell populations, which are multicellular modules, provide an opportunity both to clarify our notion of modularity and to reexamine such central concepts as cell-to-cell communication. Rosine Chandebois’s work on “cell sociology” is reframed in the (...) language of modularity in order to show how groups of cells maintain their collective identity during development and how signaling information from the group’s environment is received by the constituent cells. In a “test case” for our account of multicellular modules, we consider the vertebrate neural crest, a migratory cell population made up of several subpopulations. The neural crest proves yet again to be a complex case, showing the importance of taking into account both developmental and evolutionary transformations of multicellular modules. (shrink)

Objective: There is a demonstrated link between the mental health and substance use comorbidities experienced by young adults, however the vast majority of psychological interventions are disorder specific. Novel psychological approaches that adequately acknowledge the psychosocial complexity and transdiagnostic needs of vulnerable young people are urgently needed. A modular skills-based program for emotion regulation and impulse control addresses this gap. The current one armed open trial was designed to evaluate the impact that 12 weeks exposure to ERIC alongside usual care (...) had on young people's ability to regulate emotions, as well as examine potential moderating mechanisms.Methods: Seventy nine young people were enrolled to the 12 week intervention period. Twenty one practitioners from youth and community health services delivered relevant ERIC modules adjunct to usual care. Linear mixed effects regression was used to examine change over time across the primary outcome of emotion dysregulation and secondary outcomes of depression, anxiety, stress, experiential avoidance and mindfulness. Moderation analyses were conducted to test whether the magnitude of change in emotion dysregulation moderated change over time in secondary outcomes.Results: Analyses revealed significant improvement in the primary outcome of emotion dysregulation with a moderate effect size, in addition to decreases in the secondary outcomes of depression, anxiety, stress and experiential avoidance. No improvements in mindfulness were reported. Moderation analyses revealed that the residualised change over time in emotion dysregulation moderated the change over time in symptoms of distress, depression, anxiety, stress, experiential avoidance, and mindfulness.Conclusion: Reductions in the severity of emotion dysregulation, depression, anxiety, stress and experiential avoidance are promising, and were evident despite the complexity of the participants and the diversity of the service setting. The improvements found in each outcome were only observed for those young people whose emotion regulation also improved, providing preliminary evidence for the role of emotion regulation as a key treatment target in this population. (shrink)

The UK launch of the Science Enterprise Challenge in 1999 has stimulated interest in the evolutions of science-based firms and this paper argues that Popper’s seminal diverse contributions to philosophy are directly relevant to them. It begins by commenting on the applications of both Kuhn’s and Popper’s concepts to technological (as against) scientific evolutions. It then suggests how Popper’s approaches are applicable to the development and assessment of new technology within the framework of Freeman’s stakeholders approach. Monsanto’s development of GMOs (...) is used as an illustrative case. (shrink)

Conrad Hal Waddington integrated genetics with embryology and evolution by formulating and providing experimental evidence for the mechanisms of canalization and genetic assimilation in the context of stabilizing selection, and by fostering an epigenetic rather than the prevailing gene-centered view of embryonic development and of evolutionary change in development and adult form. Waddington saw phenotypes as processes, not static structures and behaviors. Trained in geology at Cambridge, Waddington turned to experimental studies on the chemical nature of the primary organizer and (...) developed the concepts of evocation and individuation as separable components of embryonic induction. A move after WW II to Edinburgh provided Waddington with his professional home for the rest of his career, during which he integrated genetics and development into an evolutionarily relevant discipline. Our conception of embryonic development as a highly integrated series of canalized pathways owes much to Waddington’s development of the concepts of canalization, chreods, epigenetics, and the epigenotype. The integrated, heritable, epigenetic organization of embryonic development is Waddington’s lasting legacy to development. He demonstrated organismal response to environmental change and hidden genetic variation, integrated environmental responsiveness into heritable change in response to selection, and coupled development, environment, and evolution. (shrink)

This article argues that the goals of agricultural research in poor countries have changed substantially over the last four decades. In particular they have broadened from the early (and narrow) emphasis on food production to a much wider agenda that includes poverty alleviation, environmental degradation, and social inclusion. Conversely, agricultural research systems have proved remarkably resistant to the concomitant need for changes in research focus. As a result many, at both the national and international level, are under great strain. In (...) terms of public policy the article goes on to suggest that shortcomings of existing conceptual approaches to technology development could be supplemented by adopting analytical principles that view innovation in systemic terms. An approach where flows of knowledge between institutional nodes is a key to innovative performance (the “National Systems of Innovation” approach) is suggested as one such conceptual framework that might help supplement conventional policy analysis. (shrink)

Ecology is being introduced to Evolutionary Developmental Biology to enhance organism-, population-, species-, and higher-taxon-level studies. This exciting, bourgeoning troika will revolutionise how investigators consider relationships among environment, ontogeny, and phylogeny. Features are studied (and even defined) differently in ecology, development, and evolution. Form is central to development and evolution but peripheral to ecology. Congruence (i.e., homology) is applied at different hierarchical levels in the three disciplines. Function is central to ecology but peripheral to development. Herein, the supercategories form (‘isomorphic’ (...) or ‘allomorphic’), congruence (‘homologous’ or ‘homoplastic’), and function (‘adaptive’ or ‘nonadaptive’) are combined with two developmental mode (i.e., growth) categories (‘conformational’ or ‘nonconformational’) to provide a 16-class system for analysing features in studies in which ecology, development, and evolution are integrated. (shrink)

This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are dealing with professional boundary (...) issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. (shrink)

Embryonic development and ontogeny occupy whatis often depicted as the black box betweengenes – the genotype – and the features(structures, functions, behaviors) of organisms– the phenotype; the phenotype is not merelya one-to-one readout of the genotype. Thegenes home, context, and locus of operation isthe cell. Initially, in ontogeny, that cell isthe single-celled zygote. As developmentensues, multicellular assemblages of like cells(modules) progressively organized as germlayers, embryonic fields, anlage,condensations, or blastemata, enable genes toplay their roles in development and evolution.As modules, condensations are (...) fundamentaldevelopmental and selectable units ofmorphology (morphogenetic units) that mediateinteractions between genotype and phenotype viaevolutionary developmental mechanisms. In ahierarchy of emergent processes, gene networksand gene cascades (genetic modules) link thegenotype with morphogenetic units such ascondensations, while epigenetic processes suchas embryonic inductions, tissue interactionsand functional integration, link morphogeneticunits to the phenotype. To support theseconclusions I distinguish units of heredityfrom units of transmission and discussepigenetic inheritance by tracing the historyof relationship between embryology andevolution, especially the role(s) assigned tocells or to cellular components in generatingtheories of morphological change in evolution.The concept of cells as modular morphogeneticunits is modeled and illustrated using themammalian dentary bone. (shrink)

The evolution of sex in eukaryotes represents a paradox, given the “twofold” fitness cost it incurs. We hypothesize that the mutational dynamics of the mitochondrial genome would have favored the evolution of sexual reproduction. Mitochondrial DNA (mtDNA) exhibits a high‐mutation rate across most eukaryote taxa, and several lines of evidence suggest that this high rate is an ancestral character. This seems inexplicable given that mtDNA‐encoded genes underlie the expression of life's most salient functions, including energy conversion. We propose that negative (...) metabolic effects linked to mitochondrial mutation accumulation would have invoked selection for sexual recombination between divergent host nuclear genomes in early eukaryote lineages. This would provide a mechanism by which recombinant host genotypes could be rapidly shuffled and screened for the presence of compensatory modifiers that offset mtDNA‐induced harm. Under this hypothesis, recombination provides the genetic variation necessary for compensatory nuclear coadaptation to keep pace with mitochondrial mutation accumulation. (shrink)

Organic selection (the Baldwin Effect) by which an environmentally elicitedphenotypic adaptation comes under genotypic control following selectionwas proposed independently in 1896 by the psychologists James Baldwinand Conwy Lloyd Morgan and by the paleontologist Henry Fairfield Osborn.Modified forms of organic selection were proposed as autonomization bySchmalhausen in 1938, as genetic assimilation by Waddington in 1942, andas an explanation for evolution in changing environments or for speciationby Matsuda and West-Eberhard in the 1980s. Organic selection as amechanism mediating proximate environmental effects on the (...) evolution ofmorphology and behaviour is the topic of this essay. Discussion includesthe context in which organic selection was proposed, Lamarckian or neo-Lamarckian implications of organic selection, Waddingtons experimentalstudies demonstrating the existence and efficacy of genetic assimilation,stabilizing selection and norms of reaction favoured by Schmalhausen, andMatsudas search for a mechanism of organic selection in endocrine changesand in heterochrony. (shrink)