This article focuses on maternal-fetal surgery (MFS) and on the concept of clinical equipoise that is a widely accepted requirement for conducting randomized controlled trials (RCT). There are at least three reasons why equipoise is unsuitable for MFS. First, the concept is based on a misconception about the nature of clinical research and the status of research subjects. Second, given that it is not clear who the research subject/s in MFS is/are, if clinical equipoise is to be used as a (...) criterion to test the ethical appropriateness of RCT, its meaning should be unambiguous. Third, because of the multidisciplinary character of MFS, it is not clear who should be in equipoise. As a result, we lack an adequate criterion for the ethical review of MFS protocols. In our account, which is based on Chervenak and McCullough's seminal work in the field of obstetric ethics, equipoise is abandoned. and RCT involving MFS can be ethically initiated when a multidisciplinary ethics review board (ERB), having an evidence-based assessment of the risks involved, is convinced that the value of answering the research hypothesis, for the sake of the health interests of future pregnant women carrying fetuses with certain congenital birth defects, justifies the actual risks research participants might suffer within a set limit of low/manageable. (shrink)

We distinguish three different readings of the intuitionistic notions of validity, soundness, and completeness with respect to the quantification occurring in the notion of validity, and we establish certain relations between the different readings. For each of the meta-logicalnotions considered we suggest that the "most natural" reading (which is not the same for all cases) is precisely the one which is required by the recent intuitionistic completeness theorems for IPC.

Depending on what one means by the main connective of logic, the -if..., then... -, several systems of logic result: classic and modal logics, intuitionistic logic or relevance logic. This book presents the underlying ideas, the syntax and the semantics of these logics. Soundness and completeness are shown constructively and in a uniform way. Attention is paid to the interdisciplinary role of logic: its embedding in the foundations of mathematics and its intimate connection with philosophy, in particular the philosophy of (...) language. Set theory is presented both as a conditio sine qua non for logic and as a interesting exact ontology. The study of infinite sets yields perplexing results. Formalization of informal number theory results in formal number theory; Godel's incompleteness is treated. At appropriate places attention is paid to paradoxes, intuitionism, conditionals, the historical development of logic, to logic programming and automated theorem proving for classical logic.". (shrink)

We distinguish three different readings of the intuitionistic notions of validity, soundness, and completeness with respect to the quantification occurring in the notion of validity, and we establish certain relations between the different readings. For each of the meta-logical notions considered we suggest that the “most natural” reading (which is not the same for all cases) is precisely the one which is required by the recent intuitionistic completeness theorems for IPC.

Julian H. Franklin, scholar of constitutionalism in the late sixteenth century, has extended his researches into the late seventeenth century with this fine work on Locke and Locke’s immediate sources. Franklin’s book is short, concise, well-focused and carefully argued. It is also thought-provoking to a degree one would not expect from the modesty or historicity of the subject. Controversy over this problem of political rhetoric and science, once heated while lives and fates were involved, is now cold, and the problem (...) no longer seems to be ours. Franklin follows the reasoning of past thinkers and deftly joins in when he can, providing for us an exemplary model of political theory on the quiet: he makes old arguments relevant to us without forcing them and he detaches us from our alleged necessities without resorting to silly hypotheses. (shrink)

Julian H. Franklin, scholar of constitutionalism in the late sixteenth century, has extended his researches into the late seventeenth century with this fine work on Locke and Locke’s immediate sources. Franklin’s book is short, concise, well-focused and carefully argued. It is also thought-provoking to a degree one would not expect from the modesty or historicity of the subject. Controversy over this problem of political rhetoric and science, once heated while lives and fates were involved, is now cold, and the problem (...) no longer seems to be ours. Franklin follows the reasoning of past thinkers and deftly joins in when he can, providing for us an exemplary model of political theory on the quiet: he makes old arguments relevant to us without forcing them and he detaches us from our alleged necessities without resorting to silly hypotheses. (shrink)

"Historical recurrence" is an idea of uncertain but considerable breadth conceived by G. W. Trompf. Vaguer and wider than the notion of a cycle, it can mean "typical changes" or that "history somehow repeats itself". Besides the cycle it is said to include the alternation view, the reciprocal view, the reenactment view, renaissance, recurrence proceeding from the uniformity of human nature, similarity, parallelism, and lessons of the past. As Trompf traces this idea from antiquity to the Reformation he points out (...) many along the way who somehow contributed to its formation but rests on three who chiefly formulated some version of it: Polybius, Luke, and Machiavelli. These are seen as historians—even Luke is "an historian of the Hellenistic period" —to whom history somehow repeats itself. (shrink)

Intuitionistically. a set has to be given by a finite construction or by a construction-project generating the elements of the set in the course of time. Quantification is only meaningful if the range of each quantifier is a well-circumscribed set. Thinking upon the meaning of quantification, one is led to insights?in particular, the so-called continuity principles?which are surprising from a classical point of view. We believe that such considerations lie at the basis of Brouwer?s reconstruction of mathematics. The predicate ?α (...) is lawless? is not acceptable, the lawless sequences do not form a well-circumscribed intuitionistic set, and quantification over lawless sequences does not make sense. (shrink)

Oxidative damage to DNA has been associated with neurodegenerative diseases. Developmental exposure to lead has been shown to elevate the Alzheimer's disease related beta-amyloid peptide , which is known to generate reactive oxygen species in the aging brain. This study measures the lifetime cerebral 8-hydroxy-2'-deoxyguanosine levels and the activity of the DNA repair enzyme 8-oxoguanine DNA glycosylase in rats developmentally exposed to Pb. Oxo8dG was transiently modulated early in life , but was later elevated 20 months after exposure to Pb (...) had ceased, while Ogg1 activity was not altered. Furthermore, an age-dependent loss in the inverse correlation between Ogg1 activity and oxo8dG accumulation was observed. The effect of Pb on oxo8dG levels did not occur if animals were exposed to Pb in old age. These increases in DNA damage occurred in the absence of any Pb-induced changes in copper/zinc-superoxide dismutase , manganese-SOD , and reduced-form glutathion . These data suggest that oxidative damage and neurodegeneration in the aging brain could be impacted by the developmental disturbances. (shrink)

The legitimacy of the dominant intensive meat production system with respect to the issue of animal welfare is increasingly being questioned by stakeholders across the meat supply chain. The current meat supply is highly undifferentiated, catering only for the extremes of morality concerns (i.e., conventional vs. organic meat products). However, a latent need for compromise products has been identified. That is, consumer differences exist regarding the trade-offs they make between different aspects associated with meat consumption. The heterogeneity in consumer demand (...) could function as a starting point for market segmentation, targeting and positioning regarding animal welfare concepts that are differentiated in terms of animal welfare and price levels. Despite this, stakeholders in the meat supply chain seem to be trapped in the dominant business model focused on low cost prices. This paper aims to identify conflicting interests that stakeholders in the meat supply chain experience in order to increase understanding of why heterogeneous consumer preferences are not met by a more differentiated supply of meat products produced at different levels of animal welfare standards. In addition, characteristics of the supply chain that contribute to the existence of high exit barriers and difficulty to shift to more animal-friendly production systems are identified. Following the analysis of conflicting interests among stakeholders and factors that contribute to difficulty to transform the existing dominant regime, different routes are discussed that may help and motivate stakeholders to overcome these barriers and stimulate the creation of new markets. (shrink)

Objective: To examine the current ethical review process of ethics committees in a non-pharmacological trial from the perspective of a clinical investigator.Design: Prospective collection of data at the Study Centre of the German Surgical Society on the duration, costs and administrative effort of the ERP of a randomised controlled multicentre surgical INSECT Trial between November 2003 and May 2005.Setting: Germany.Participants: 18 ethics committees, including the ethics committee handling the primary approval, responsible overall for 32 clinical sites throughout Germany. 8 ethics (...) committees were located at university medical schools and 10 at medical chambers. Duration was measured as days between submission and receipt of final approval, costs in euros and administrative effort by calculation of the product of the total number of different types of documents and the mean number of copies required .Results: The duration of the ERP ranged from 1 to 176 days. The median duration was 26 days at MSUs compared with 34 days at medical chambers. The total cost was €2947. 1 of 8 ethics committees at universities and 8 of 10 at medical chambers charged a median fee of €162 . The administrative effort for primary approval was 30. Four ethics committees required a higher administrative effort for secondary approval .Conclusion: The ERP for non-pharmacological multicentre trials in Germany needs improvement. The administrative process has to be standardised: the application forms and the number and content of the documents required should be identical or at least similar. The fees charged vary considerably and are obviously too high for committees located at medical chambers. However, the duration of the ERP was, with some exceptions, excellent. A centralised ethics committee in Germany for multicentre trials such as the INSECT Trial can simplify the ERP for clinical investigators in and outside the country. (shrink)

In recent times, daily, ordinary medical practices have incontrovertibly been developing under the condition of complexity. Complexity jeopardizes the moral core of practicing medicine: helping people, with their illnesses and suffering, in a medically competent way. Practical wisdom has been proposed as part of the solution to navigate complexity, aiming at the provision of morally good care. Practical wisdom should help practitioners to maneuver in complexity, where the presupposed linear ways of operating prove to be insufficient. However, this solution is (...) unsatisfactory, because the proposed versions of practical wisdom are too individualistic of nature, while physicians are continuously operating in varying teams, and dealing with complicated technologies and pressing structures. A second point of critique is, that these versions are theory based, and thus insufficiently attuned to the actual context of everyday medical practices. Now, our proposal is to use an approach of practical wisdom that enables medical practices to counter the complexity issue and to re-invent the moral core of medical practicing as well. This implies a practice oriented approach, as thematized by practice theory, qualitative empirical research from the inside, and abduction from actual performed practical wisdom towards an apt understanding of phronèsis. (shrink)

Background When anti-cancer treatments have been given market authorization, but are not (yet) reimbursed within a healthcare system, physicians are confronted with ethical dilemmas. Arranging access through other channels, e.g., hospital budgets or out-of-pocket payments by patients, may benefit patients, but leads to unequal access. Until now, little is known about the perspectives of physicians on access to non-reimbursed treatments. This interview study maps the experiences and moral views of Dutch oncologists and hematologists.Methods A diverse sample of oncologists and hematologists (...) (n = 22) were interviewed. Interviews were analyzed thematically using Nvivo 12 qualitative data software.Results This study reveals stark differences between physicians’ experiences and moral views on access to anti-cancer treatments that are not (yet) reimbursed: some physicians try to arrange other ways of access and some physicians do not. Some physicians inform patients about anti-cancer treatments that are not yet reimbursed, while others wait for reimbursement. Some physicians have principled moral objections to out-of-pocket payment, while others do not.Conclusion Oncologists and hematologists in the Netherlands differ greatly in their perspectives on access to expensive anti-cancer treatments that are not (yet) reimbursed. As a result, they may act differently when confronted with dilemmas in the consultation room. Physicians working in different healthcare systems may face similar dilemmas. (shrink)

Research on social influences often distinguishes between social and quality incentives to ascribe meaning to the value that popularity conveys. This study examines the neural correlates of those incentives through which popularity influences preferences. This research reports an functional magnetic resonance imaging experiment and a behavioral task in which respondents evaluated popular products with three focus perspectives; unspecified focus, focus on social aspects, and focus on quality. The results show that value derived with a social focus reflects inferences of approval (...) and reward value, and positively affects preferences. Value derived with a quality focus reflects inferences of quality and negatively affects preferences. This study provides evidence of two distinct inferential routes on both a neurological level, represented by different regions in the brain, and a behavioral level. These results provide the first evidence that a single popularity cue can in different ways influence the value derived from product popularity. (shrink)

This paper starts with an overview of C.G. Jung’s notion of archetypes. His ideas imply that Jungian archetypes can be viewed as the most general examples of the shared awarenesses that occur in groups of people of all sizes, ranging from families to humanity as a whole. The term ‘archetype’ is used in connection with such shared awarenesses in the subsequent discussion. The distinction that Jung made between archetypal representations and archetypes themselves is retained and emphasized. It is then pointed (...) out that archetypal representations are sets of Dawkins’ memes appearing in awareness. Pursuing the line of thought suggested by this, it is further proposed that the meme set can be regarded as analogous to the genotype in biology, while the representation itself resembles the phenotype in heuristically useful respects. Archetypes, as opposed to their representations, are the factors which predispose particular sets of memes to spread within a group of people and enter their awarenesses. It follows from the biological analogy that archetypes can be thought of as regularities that occur in an ‘ecology’ of representations. Because memes are subject to pseudo-Darwinian influences, parallels between the behaviour of representations and the phenomena of parasitology and epidemiology will sometimes be observed. The view of archetypes arrived at opens up a possibility that they might be responsible for some mass behaviours; e.g. those involved in the production of social movements such as Nazism or certain medical conditions of obscure aetiology. Archetypal representations possess in some circumstances the power to fill the consciousnesses of individuals ‘infected’ by them for long periods of time. These points are illustrated in a brief account of fatigue syndromes. Finally, should consciousness have a quantum theoretical basis, details of the epidemiology of archetypal representations will differ from those to be expected if it has no such basis. The phenomenon of alien abduction, presumed to be of archetypal origin, is discussed as an example. (shrink)

This interview study investigates the short- and long-term implications of incidental findings detected through brain imaging on research participants’ lives and their surroundings. For this study, nine participants of the Rotterdam Scan Study with an incidental finding were approached and interviewed. When examining research participants’ narratives on the impact of the disclosure of incidental findings, the authors identified five sets of tensions with regard to motivations for and expectations of research participation, preferences regarding disclosure, short- and long-term impacts and impacts (...) on self and others. The paper shows: that the impact of incidental findings may be greater than participants at first let on; incidental findings can have significant effects on participants’ social environment; and participants may not feel prepared for disclosure even if incidental findings have been discussed during the informed consent process. The authors call for investigators to be aware of research participants’ experiences and these short- and long-term impacts when designing suitable courses of action for the detection and management of incidental findings in research settings. (shrink)

Experiments are described, using electroencephalography (EEG) and simple tests of performance, which support the hypothesis that collapse of a quantum field is of importance to the functioning of the brain. The theoretical basis of our experiments is derived from Penrose (1989) who suggested that conscious decision-making is a manifestation of the outcome of quantum computation in the brain involving collapse of some relevant wave function. He also proposed that collapse of any wave function depends on a gravitational criterion. As different (...) brain areas are known to subserve different functions, we argue that `Penrose collapse' must occur in a particular brain area when performing a task that uses it. Further, taking an EEG from the area should amplify the gravitational prerequisite for collapse, so affecting task performance. There are no non-quantum theories which could lead one to expect that taking an EEG could directly affect task performance by subjects. The results of both pilot and main experiments indicated that task performance was indeed influenced by taking an EEG from relevant brain areas. Control experiments suggested that the influence was quantum mechanical in origin, and was not due to any experimental artefact. The results are statistically significant and merit attempts at replication in an independent laboratory, preferably with more sophisticated equipment than was available to us. (shrink)

Following a theme which increasingly interests people concerned with problems of sentience, this paper describes how consciousness might encode information. The idea that awareness is inseparable from Bose-Einstein condensation in the brain is identified as the most promising of the ‘quantum consciousness’ notions. It can be inferred from this idea that brain Bose condensates will have a geometrical structure, analagous to that of tapestries, which can encode information and to which knot theory can be applied.These notions are able to explain (...) otherwise puzzling features of conscious information handling and a neuroanatomically testable prediction is derived from them. Finally it's pointed out that they imply that any ‘strong’ panpsychist position is unnecessary. (shrink)

Research suggests that sedentary behavior is negatively associated with cognitive outcomes. Interrupting prolonged sitting has been shown to improve cognitive functions, including executive functioning, which is important for academic performance. No research has been conducted on the effect of standing on EF in VET students, who make up a large proportion of the adolescent population and who are known to sit more than other students of this age. In this study, we investigated the acute effects of reducing SB by short (...) time standing on EF in vocational education and training students. In a randomized crossover study, 165 VET students were first taught for 15 min in seated position. After this, they performed while seated the Letter Memory Test for updating, and the Color Shape Test for shifting and inhibition. Students were randomly assigned to a sitting or standing condition. All students were taught again for 15 min and then took the same tests in the condition they were allocated to, respectively, standing or seated. After 1 week, the test procedure was repeated, in which students switched conditions. Mixed model analyses showed no significant effect of sitting or standing on updating, shifting, or inhibition. Also, no significant differences were found for the order of condition on updating, shifting, or inhibition. Our results suggest that 40 min of standing does not significantly influence EF among VET students. (shrink)

Since the 1970s, estrogen have sometimes been used in adolescent girls to reduce very tall adult expected height. Worries about long-term effects have led to a proposal to link treatment data with cancer registers. How should one deal with informed consent for such a study? We designed a qualitative study with semi-structured telephone interviews. From 1200 women who were to be followed-up in cancer registers, we randomly selected 22 women. Major themes were a wish to be involved and a positive (...) attitude to the proposed register research. The women did not express worry after reading the study protocol, but did convey considerable frustration that this research had not been initiated earlier. Active consent was not seen as crucial. We found strong interest in a high participation rate and a concern over missing data. The selection of information and consent or the decision to go ahead without consent in register follow-up is a delicate balancing act. Study participants wish to be contacted, but acknowledge the primary goal of answering important questions. Our study provides support for safeguarding privacy in epidemiological linkage studies and in follow-up of medical treatment without losing the scientific value by requesting for informed consent. (shrink)