In many research studies, tumor biopsies are an unavoidable requirement for achieving key scientific aims. Yet some commentators view mandatory research biopsies as coercive and suggest they should be optional, or at least optional until further data are obtained regarding their scientific usefulness. Further complicating the ethical picture is the fact that some research biopsies offer a potential for clinical benefit to trial participants. We interviewed and surveyed a convenience sample of participants in phase I clinical trials at a single (...) institution. Our primary aim was to describe phase I participants’ understanding of whether a research biopsy offered them the prospect of medical benefit. We also endeavored to describe participants’ views about biopsies—specifically, the benefits of biopsies, if any, and whether biopsies were acceptable, risky, or discouraged trial participation. Finally, we collected data on demographics and attitudes to see if any strong correlations with misunderstanding, acceptability, or riskiness existed. Overall, the respondents tended to view research biopsies as acceptable, though they did not succeed in identifying the lack of benefit of a research biopsy. These findings call for renewed efforts in consent conversations and documents to carefully describe the benefits, or lack thereof, of research biopsies. (shrink)

This book is a collection of secondary essays on America's most important philosophic thinkers—statesmen, judges, writers, educators, and activists—from the colonial period to the present. Each essay is a comprehensive introduction to the thought of a noted American on the fundamental meaning of the American regime.

1. Transfer principles from N to On. A. Mahlo cardinals. B. Weakly compact cardinals. C. Ineffable cardinals. D. Ramsey cardinals. E. Ineffably Ramsey cardinals. F. Subtle cardinals. G. From N to (...) 4. Decidability of statements on N. 5. Decidability of statements on shrink)

S. Adams, W. Ambrose, A. Andretta, H. Becker, R. Camerlo, C. Champetier, J.P.R. Christensen, D.E. Cohen, A. Connes. C. Dellacherie, R. Dougherty, R.H. Farrell, F. Feldman, A. Furman, D. Gaboriau, S. Gao, V. Ya. Golodets, P. Hahn, P. de la Harpe, G. Hjorth, S. Jackson, S. Kahane, A.S. Kechris, A. Louveau,, R. Lyons, P.-A. Meyer, C.C. Moore, M.G. Nadkarni, C. Nebbia, A.L.T. Patterson, U. Krengel, A.J. Kuntz, J.-P. Serre, S.D. Sinel'shchikov, T. Slaman, Solecki, R. Spatzier, J. Steel, D. Sullivan, S. (...) Thomas, A. Valette, V.S. Varadarajan, B. Velickovic, B. Weiss, J.D.M. Wright, R.J. Zimmer. (shrink)

Let ℜ be an o-minimal expansion of (ℝ, <+) and (φk)k∈ℕ be a sequence of positive real numbers such that limk→+∞f(φk)/φk+1=0 for every f:ℝ→ ℝ definable in ℜ. (Such sequences always exist under some reasonable extra assumptions on ℜ, in particular, if ℜ is exponentially bounded or if the language is countable.) Then (ℜ, (S)) is d-minimal, where S ranges over all subsets of cartesian powers of the range of φ.

Attention and disruptive behavior disorders present considerable challenges for children and their parents. These challenges have led to the development of parenting programs; however, there is a paucity of literature that discusses the ethical dilemmas parent training researchers face. This article reviews ethical principles and professional standards relevant to parent training research and provides case material to illustrate the challenge of balancing ethical adherence and empirical rigor using three ethical issues that commonly arise in parent training research. In particular, this (...) article focuses on ethical issues surrounding confidentiality in a group setting, use of control groups, and limiting changes in medication/treatment status outside of the treatment protocol. (shrink)

My discussion addresses the differences between analytic and continental philosophy concerning the use of logic and exact reasoning in philosophical practice. These differences are mainly examined in the light of the controversial dominance of Hegel's concept of logic (and theory of concept) in twentieth-century continental philosophy. The inquiry is developed in two parts. In the first (Sections 1-2), I indicate some aspects of the analytic-continental divide, pointing to the role that the topic 'logic and philosophy' plays in it. In the (...) second part (Sections 3-6), I give a short account of the views of logic which are typical of the three main trends of continental philosophy (see Table 1). I also suggest how, with the aid of some typical analytical devices, some continental 'anti-logical' attitudes may be corrected, on their own terms. (shrink)

Edmund D. Pellegrino, John Collins Harvey, Kevin T. Fitzgerald, SJ; Must the Church be Mute Lest Its Truths be Distorted? A Response to Engelhardt, Christian bi.

Background: Decisions of patients, families, and health care providers about medical care at the end of life depend on many factors, including the societal culture. A pan-European study was conducted to determine the frequency and types of end of life practices in European intensive care units , including those in Israel. Several results of the Israeli subsample were different to those of the overall sample.Objective: The objective of this article was to explore these differences and provide a possible explanation based (...) on the impact of culture on end of life decision making.Method: All adult patients admitted consecutively to three Israeli ICUs who died or underwent any limitation of life saving interventions between 1 January 1999 and 30 June 2000 were studied prospectively . These patients were compared with a similar sample taken from the larger study carried out in 37 European ICUs. Patients were followed until discharge, death, or 2 months from the decision to limit therapy. End of life decisions were prospectively organised into one of five mutually exclusive categories: cardiopulmonary resuscitation , brain death, withholding treatment, withdrawing treatment, and active shortening of the dying process . The data also included patient characteristics , specific therapies limited, and the method of SDP.Results: The majority of patients had treatment withheld, none underwent SDP, 62 received CPR , 31 had brain death , and 18 underwent withdrawal of treatment . The primary reason given for limiting treatment was that the patient was unresponsive to therapy . End of life discussions were held with 132 families , the vast majority of which revolved around withholding treatment and the remainder concerned withdrawing treatment .There was a statistically significant association between the type of end of life decision and region—that is, the northern region of Europe, the central region, the southern region, and Israel.Conclusions: Regional culture plays an important part in end of life decision making. Differences relating to end of life decision making exist between regions and these differences can often be attributed to cultural factors. Such cultures not only affect patients and their families but also the health care workers who make and carry out such decisions. (shrink)

The Routledge Companion to Social and Political Philosophy is a comprehensive, definitive reference work, providing an up-to-date survey of the field, charting its history and key figures and movements, and addressing enduring questions as ...

As the gap between the need for and supply of human organs continues to widen, the aim of securing additional sources of these “gifts of the body” has become a seemingly overriding moral imperative, one that could—and some argue, should—override the widespread ban on organ markets. As a medical practice, organ transplantation entails the inherent risk that one human being, a donor, will become little more than a means to the end of healing for another human being and that he (...) or she will come to have a purely instrumental value. With the establishment of organ markets, not only will the harms of instrumentalization be a reality—the ends of medicine will be further compromised and confused. (shrink)

BackgroundAlthough patient advocates have developed templates for standard consent forms, evaluating patient preferences for first in human (FIH) and window of opportunity (Window) trial consent forms is critical due to their unique risks. FIH trials are the initial use of a novel compound in study participants. In contrast, Window trials give an investigational agent over a fixed duration to treatment naïve patients in the time between diagnosis and standard of care (SOC) surgery. Our goal was to determine the patient-preferred presentation (...) of important information in consent forms for these trials.MethodsThe study consisted of two phases: (1) analyses of oncology FIH and Window consents; (2) interviews of trial participants. FIH consent forms were analyzed for the location(s) of information stating that the study drug has not been tested in humans (FIH information); Window consents were analyzed for the location(s) of information stating the trial may delay SOC surgery (delay information). Participants were asked about their preferred placement of the information in their own trial’s consent form. The location of information in the consent forms was compared to the participants’ suggestions for placement. Results34 [17 FIH; 17 Window] of 42(81%) cancer patients approached participated. 25 consents [20 FIH; 5 Window] were analyzed. 19/20 FIH consent forms included FIH information, and 4/5 Window consent forms included delay information. 19/20(95%) FIH consent forms contained FIH information in the risks section 12/17(71%) patients preferred the same. Fourteen (82%) patients wanted FIH information in the purpose, but only 5(25%) consents mentioned it there. 9/17(53%) Window patients preferred delay information to be located early in the consent, before the “Risks” section. 3/5(60%) consents did this.ConclusionsDesigning consents that reflect patient preferences more accurately is essential for ethical informed consent; however, a one-size fits all approach will not accurately capture patient preferences. We found that preferences differed for FIH and Window trial consents, though for both, patients preferred key risk information early in the consent. Next steps include determining if FIH and Window consent templates improve understanding. (shrink)

An analytical investigation into compressible gas flow with slight rarefactions through the insect trachea and tracheoles during the closed spiracle phase is undertaken, and a complete set of asymptotic analytical solutions is presented. We first obtain estimates of the Reynolds and Mach numbers at the channel terminal ends where the tracheoles directly deliver respiratory gases to the cells, by comparing the magnitude of the different forces in the compressible gas flow. The 2D Navier–Stokes equations with a slip boundary condition are (...) used to investigate compressibility and rarefied effects in the trachea and tracheoles. Expressions for the velocity components, pressure gradients and net flow inside the trachea are then presented. Numerical simulations of the tracheal compressible flow are performed to validate the analytical results from this study. This work extends previous work of Arkilic et al. :167–178, 1997) on compressible flows through a microchannel. Novel devices for microfluidic compressible flow transport may be invented from results obtained in this study. (shrink)