BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

The evolution of internation relationships is studied by means of a mathematical model based on a popular rule of triadic interaction: the friend of my friend is my friend, the friend of my enemy is my enemy, the enemy of my enemy is my friend, the enemy of my friend is my enemy. The rule is shown to lead to the formation and preservation of unipolar and bipolar configurations of nations, with the strengths of relationships, both friendly and conflictual, intensifying (...) through time. These results confirm speculations originally made in static, graph theoretic studies of the balancing of relationships within individuals, small groups and systems of nations. (shrink)

A cross-sectional study to ascertain what the Singapore population would regard as material risk in the anaesthesia consent-taking process and identify demographic factors that predict patient preferences in medical decision-making to tailor a more patient-centered informed consent. A survey was performed involving patients 21 years old and above who attended the pre-operative evaluation clinic over a 1-month period in Singapore General Hospital. Questionnaires were administered to assess patients’ perception of material risks, by trained interviewers. Patients’ demographics were obtained. Mann–Whitney U (...) test and Kruskal-Wallis one-way analysis of variance was used. Statistical significance was taken at p < 0.05. Four hundred fourteen patients were eligible of which 26 refused to participate and 24 were excluded due to language barrier. 364 patients were recruited. A higher level of education, being employed and younger age group are factors identified in patients who wanted greater participation in medical decisions. Gender, marital status, type of surgery, and previous surgical history did not affect their level of participation. The complications most patients knew about were Nausea, Drowsiness and Surgical Wound Pain. Patients ranked Heart Attack, Death and Stroke as the most significant risks that they wanted to be informed about in greater detail. Most patients wanted to make a joint decision with the anaesthetist, instead of letting the doctor decide or deciding for themselves. Discussion with the anaesthetist is the preferred medium of communication compared to reading a pamphlet or watching a video. Age and educational level can influence medical decision-making. Despite the digital age, most patients still prefer a clinic consult instead of audio-visual multimedia for pre-operative anaesthetic counselling. The local population appears to place greater importance on rare but serious complications compared to common complications. This illustrates the need to contextualize information provided during informed consent to strengthen the doctor-patient relationship. (shrink)

Context The attitudes of medical professionals towards physician assisted dying have been widely discussed. Less explored is the level of agreement among physicians on the possibility of ‘rational suicide’—a considered suicide act made by a sound mind and a precondition of assisted dying legislation. Objective To assess attitudes towards rational suicide in a representative sample of senior doctors in England and Wales. Methods A postal survey was conducted of 1000 consultants and general practitioners randomly selected from a commercially available database. (...) The main outcome of interest was level of agreement with a statement about rational suicide. Results The corrected participation rate was 50%; 363 questionnaires were analysed. Overall 72% of doctors agreed with the possibility of rational suicide, 17% disagreed, and 11% were neutral. Doctors who identified themselves as being more religious were more likely to disagree. Some doctors who disagreed with legalisation of physician assisted suicide nevertheless agreed with the concept of rational suicide. Conclusions Most senior doctors in England and Wales feel that rational suicide is possible. There was no association with specialty. Strong religious belief was associated with disagreement, although levels of agreement were still high in people reporting the strongest religious belief. Most doctors who were opposed to physician assisted suicide believed that rational suicide was possible, suggesting that some medical opposition is best explained by other factors such as concerns of assessment and protection of vulnerable patients. (shrink)

Progressive supranuclear palsy is a movement disorder with prominent tau neuropathology. Brain diseases with abnormal tau deposits are called tauopathies, the most common of which is Alzheimer's disease. Environmental causes of tauopathies include repetitive head trauma associated with some sports. To identify common genetic variation contributing to risk for tauopathies, we carried out a genome-wide association study of 1,114 individuals with PSP and 3,247 controls followed by a second stage in which we genotyped 1,051 cases and 3,560 controls for the (...) stage 1 SNPs that yielded P ≤ 10-3. We found significant previously unidentified signals associated with PSP risk at STX6, EIF2AK3 and MOBP. We confirmed two independent variants in MAPT affecting risk for PSP, one of which influences MAPT brain expression. The genes implicated encode proteins for vesicle-membrane fusion at the Golgi-endosomal interface, for the endoplasmic reticulum unfolded protein response and for a myelin structural component. © 2011 Nature America, Inc. All rights reserved. (shrink)

Attention Restoration Theory proposes that exposure to natural environments helps to restore attention. For sustained attention—the ongoing application of focus to a task, the effect appears to be modest, and the underlying mechanisms of attention restoration remain unclear. Exposure to nature may improve attention performance through many means: modulation of alertness and one’s connection to nature were investigated here, in two separate studies. In both studies, participants performed the Sustained Attention to Response Task before and immediately after viewing a meadow, (...) ocean, or urban image for 40 s, and then completed the Perceived Restorativeness Scale. In Study 1, an eye-tracker recorded the participants’ tonic pupil diameter during the SARTs, providing a measure of alertness. In Study 2, the effects of connectedness to nature on SART performance and perceived restoration were studied. In both studies, the image viewed was not associated with participants’ sustained attention performance; both nature images were perceived as equally restorative, and more restorative than the urban image. The image viewed was not associated with changes in alertness. Connectedness to nature was not associated with sustained attention performance, but it did moderate the relation between viewing the natural images and perceived restorativeness; participants reporting a higher connection to nature also reported feeling more restored after viewing the nature, but not the urban, images. Dissociation was found between the physiological and behavioral measures and the perceived restorativeness of the images. The results suggest that restoration associated with nature exposure is not associated with modulation of alertness but is associated with connectedness with nature. (shrink)

The meanings collected by Mr. Lee seem very hard to extract from the Latin, neither do they seem to reflect the author's meaning. Surely the sense of the chapter is: The Cherusci ruined themselves with a long peace … when it comes to a fight, moderation and justice are … For example, the Cherusci were once virtuous and just, but now are called idle and foolish, and the success of the Chatti who conquered them has become prudence.

The following brief memoir of Wittgenstein needs a few preliminary words of explanation. Among those who attended his lectures and discussions in the years it covers was D. G. James, who later became Professor of English at Bristol University and then Vice-Chancellor of Southampton University. I met him both in Bristol and Southampton, and on one occasion suggested to him that some of us who had known Wittgenstein, but who had not become professional philosophers, might write down our recollections of (...) him, and that he and I should start. What prompted the suggestion was, I think, the publication of Norman Malcolm's book, and a feeling that the non-professionals might have something to contribute to the assessment of Wittgenstein, particularly as a person. I wrote a preliminary draft and sent it to James; but he never responded, there was much else to do, I let the matter rest, and now James is dead. I wrote in about the year 1960 on holiday and away from any books of reference and from my own notes of Wittgenstein's lectures and conversations. I have shown the typescript to a few interested people, but because of its preliminary and unfinished nature have not previously thought of publication. It has recently been suggested to me that it might be of more general interest, and I publish it now as it was written, with one or two trifling alterations. I am well aware of its limitations. It was intended to give an impression of Wittgenstein as a person rather than as a philosopher, and the rather miscellaneous collection of remarks in section 3 have that in view rather than any more strictly ‘philosophical’ intention. Others may well question some of the detail and disagree with some of the opinions expressed. And there are some things which I might put rather differently today. But if the memoir has any interest it is best left as it was written. (shrink)

We apply a cognitive modeling approach to the problem of measuring expertise on rank ordering problems. In these problems, people must order a set of items in terms of a given criterion (e.g., ordering American holidays through the calendar year). Using a cognitive model of behavior on this problem that allows for individual differences in knowledge, we are able to infer people's expertise directly from the rankings they provide. We show that our model-based measure of expertise outperforms self-report measures, taken (...) both before and after completing the ordering of items, in terms of correlation with the actual accuracy of the answers. These results apply to six general knowledge tasks, like ordering American holidays, and two prediction tasks, involving sporting and television competitions. Based on these results, we discuss the potential and limitations of using cognitive models in assessing expertise. (shrink)

For a set A of non-negative integers, let D be the set of non-negative differences of elements of A. Clearly, if A is computable, then D is computably enumerable. We show that every simple set which contains 0 is the difference set of some computable set and that every computably enumerable set is computably isomorphic to the difference set of some computable set. Also, we prove that there is a computable set which is the difference set of the complement of (...) some computably enumerable set but not of any computably enumerable set. Finally, we show that every arithmetic set is in the Boolean algebra generated from the computable sets by the difference operator D and the Boolean operations. (shrink)

ObjectiveCochlear explantation for purely elective (e.g. psychological and emotional) reasons is not well studied. Herein, we aim to provide data and expert commentary about elective cochlear implant (CI) removal that may help to guide clinical decision-making and formulate guidelines related to CI explantation.Data sourcesWe address these objectives via three approaches: case report of a patient who desired elective CI removal; review of literature and expert discussion by surgeon, audiologist, bioethicist, CI user and member of Deaf community.Review methodsA systematic review using (...) three scientific online databases was performed. Included articles addressed the benefits and/or complications of cochlear implantation in young children, CI explantation with or without revision surgery and the ethical debate between the medical and Deaf communities on cochlear implantation and explantation.ConclusionsThe medical and audiological perspectives identify a host of risks related to implant removal without reimplantation, including risk from surgery, general anaesthesia, cochlear ossification and poor audiometric outcomes. The member of the deaf community and bioethicist argue that physicians need to guide the principles of beneficence, non-maleficence and patient autonomy. Taken together, patient desires should be seen as paramount, if the patient is otherwise fit for surgery and well informed.Implications for practiceSimilar to the case of device implantation, device explantation should be a multidisciplinary and collaborative decision with the patient and the family’s desires at the centre. While every case is different, we offer a CI explantation discussion to assist in clinical decision-making, patient counselling and education. (shrink)

In most decision-making situations, there is a plethora of information potentially available to people. Deciding what information to gather and what to ignore is no small feat. How do decision makers determine in what sequence to collect information and when to stop? In two experiments, we administered a version of the German cities task developed by Gigerenzer and Goldstein (1996), in which participants had to decide which of two cities had the larger population. Decision makers were not provided with the (...) names of the cities, but they were able to collect different kinds of cues for both response alternatives (e.g., “Does this city have a university?”) before making a decision. Our experiments differed in whether participants were free to determine the number of cues they examined. We demonstrate that a novel model, using hierarchical latent mixtures and Bayesian inference (Lee & Newell, 2011) provides a more complete description of the data from both experiments than simple conventional strategies, such as the take–the–best or the Weighted Additive heuristics. (shrink)

W. H. Auden, the sometimes Greta Garbo of twentieth-century poetry, once told Stephen Spender that he liked America better than England because in America one could be alone. Further, in his introduction to The Criterion Book of Modern American Verse Auden remarked that while in England poets are considered members of a “clerkly caste,” in America they are an “aristocracy of one.” Certainly it does seem to be the individual poet—Whitman, Williams, Olson, Plath, O’Hara, Ginsberg—who has altered the landscape of (...) American poetry and prosody, not the group. And most American literary “movements,” as Robert Creeley has pointed out, are simply comprised of a few people who on occasion drink together, and who are as likely as not to end the evening in violent argument over an aesthetic or political point. Yet the notion of schools or movements remains, in mainstream historical criticism at least, a vital one. How many introductions to anthologies of American poetry, for example, continue to use such rubrics as the Transcendentals, the Populists, the Black Mountain poets, the Beats, the New York group? And while established poets often rebel from any sense that they are part of a larger community, which by definition is self-limiting, they are often complicit in their initial categorization. For poets as well as critics the idea of a school is often a useful fiction serving as both a kind of protective hothouse and a platform for getting a hearing.The most recent “group” of American poets—the first since the anthology wars of the early sixties really to be of more than passing interest and perhaps to be actually capable of bringing about a major shift of attention in American poetry and poetics—is the so-called “Language” school. Individual volumes by poets often considered part of this group number well into three figures now and there have been important journals and anthologies produced in a serious and sustained fashion by these writers. Yet in part because of what seems the essentially hermetic character of the project , there has been little notice of this activity by academic critics or reviewers.1 What I’d like to do here is briefly map a few major aspects of the territory, describing some of the practical and theoretical questions which seem to occupy many of these writers in their ongoing critique of the “workshop poem.” 1. Two important exceptions are discussions of some of this work in Stephen Fredman, Poet’s Prose: The Crisis in American Verse and Marjorie Perloff’s review “The Word as Such: L=A=N=G=U=A=G=E Poetry in the Eighties,” American Poetry Review 13 : 15-22. All further references to Perloff’s article, abbreviated “WS,” will be included in the text. For a discussion of the various Language poetry journals and anthologies, see my chapter “American Poetry, 1940s to the Present” in American Literary Scholarship: An Annual/1983, ed. Warren French , pp. 349-74. Lee Bartlett, an associate professor of English, has directed the University of New Mexico’s creative writing program for five years. Coeditor of the critical journal American Poetry, his Talking Poetry: Conversations in the Workshop with Contemporary Poets will be published this fall. Currently he is writing a biography of William Everson. (shrink)

Speakers often do not state requests directly but employ innuendos such as Would you like to see my etchings? Though such indirectness seems puzzlingly inefficient, it can be explained by a theory of the strategic speaker, who seeks plausible deniability when he or she is uncertain of whether the hearer is cooperative or antagonistic. A paradigm case is bribing a policeman who may be corrupt or honest: A veiled bribe may be accepted by the former and ignored by the latter. (...) Everyday social interactions can have a similar payoff structure (with emotional rather than legal penalties) whenever a request is implicitly forbidden by the relational model holding between speaker and hearer (e.g., bribing an honest maitre d’, where the reciprocity of the bribe clashes with his authority). Even when a hearer’s willingness is known, indirect speech offers higher-order plausible deniability by preempting certainty, gossip, and common knowledge of the request. In supporting experiments, participants judged the intentions and reactions of characters in scenarios that involved fraught requests varying in politeness and directness. (shrink)

Isolation in the back-country: George Chamier, G.B. Lancaster, Katherine Mansfield, John Mulgan, and Graham Billing -- Outsiders and misfits in fragmented social milieux: William Satchell, Vincent Pyke, John A. Lee, Robin Hyde, Frank Sargeson, and others -- The lonely and the alone in the fiction of Janet Frame -- Maurice Gee and postmodern isolation -- Women, isolation, and history: Fiona Kidman, Noel Hilliard, and Patricia Grace -- Cultural deracination and isolation : Witi Ihimaera, Keri Hulme, and Alan Duff.

This first volume in the Rutgers Series on Self and Social Identity presents a sophisticated and detailed analysis of some of the most fundamental issues facing scholars interested in studying self and identity. Chapters written by a world-class set of social scientists, from the fields of psychology, sociology, and anthropology, represent the diverse issues, perspectives, and controversies inherent in the recent wave of interest in the self, and suggest productive avenues of analysis and empirical research.

How are group-based identities related to intergroup conflict? When and how do ethnic, religious, and national identities lead to oppression, violence, rebellion, war, mass-murder, and genocide? How do intergroup conflicts change people's identities? How might social identity be harnessed in the service of reducing conflict between groups? The chapters in this book present a sophisticated and detailed interdisciplinary analysis of the most topical and fundamental issues involved in understanding identity and conflict.

One of Hume's most well-known works and a masterpiece of philosophy, A Treatise of Human Nature is indubitably worth taking the time to read.