BackgroundAlthough the number of reporting guidelines has grown rapidly, few have gone through an updating process. The STARD statement (Standards for Reporting Diagnostic Accuracy), published in 2003 to help improve the transparency and completeness of reporting of diagnostic accuracy studies, was recently updated in a systematic way. Here, we describe the steps taken and a justification for the changes made.ResultsA 4-member Project Team coordinated the updating process; a 14-member Steering Committee was regularly solicited by the Project Team when making critical (...) decisions. First, a review of the literature was performed to identify topics and items potentially relevant to the STARD updating process. After this, the 85 members of the STARD Group were invited to participate in two online surveys to identify items that needed to be modified, removed from, or added to the STARD checklist. Based on the results of the literature review process, 33 items were presented to the STARD Group in the online survey: 25 original items and 8 new items; 73 STARD Group members (86 %) completed the first survey, and 79 STARD Group members (93 %) completed the second survey.Then, an in-person consensus meeting was organized among the members of the Project Team and Steering Committee to develop a consensual draft version of STARD 2015. This version was piloted in three rounds among a total of 32 expert and non-expert users. Piloting mostly led to rewording of items. After this, the update was finalized. The updated STARD 2015 list now consists of 30 items. Compared to the previous version of STARD, three original items were each converted into two new items, four original items were incorporated into other items, and seven new items were added.ConclusionsAfter a systematic updating process, STARD 2015 provides an updated list of 30 essential items for reporting diagnostic accuracy studies. (shrink)

In 1986, philosopher-bioethicist Samuel Gorovitz published an essay entitled “Baiting Bioethics,” in which he reported on various criticisms of bioethics that were “in print, or voiced in and around … the field” at that time, and set forth his assessment of their legitimacy. He gave detailed attention to what he judged to be the particularly fierce and “irresponsible attacks” on “the moral integrity” and soundness of bioethics contained in two papers: “Getting Ethics” by philosopher William Bennett and “Medical Morality Is (...) Not Bioethics,” coauthored by us. Gorovitz attributed some of the criticisms that bioethics was eliciting to the fact that this new, rapidly rising, and increasingly visible field had brought “scholars and practitioners together who otherwise would have little exposure to one another's disciplines. Their interactions are mutually enriching at times,” he declared, “but mutually baffling and even infuriating at other times.” In this latter regard, he suggested that “perhaps” Fox and Swazey's characterization of bioethics in the article he dissected “reflects a general revulsion at endeavors they see as inadequately like the social sciences or insufficiently respectful of them.” He went on to say that despite his objections to our “complaints” about bioethics—especially to our claim that “autonomy [had] been an unduly emphasized value” in the field—he had “a lingering sense” that there might be “a grain of truth” in them. Gorovitz ended his essay with an affirmation about the “benefit” that bioethics can derive from “responsible” and even from “irresponsible” criticism. “The unexamined discipline invites the philosopher's critical scrutiny no less than the unexamined life,” he aphoristically concluded. a. (shrink)

Les résultats quantitatifs que la psychologie et la physiologie n'ont cessé d'accumuler depuis le début du siecle à propos du sens tactile laissent apparaître aujourd'hui une certaine ambiguïteé. D'un côté en effet, la préoccupation de connaître les sensibilities cutanées spécifiques telles qu'elles se présentent de manière isolée à l'analyse objective des récepteurs stimulés: les sensations de chaud et de froid, de pression et de contact, de douleur, de vibration. D'un autre côté, le désir de sauvegarder l'unité fonctionnelle du sens tactile (...) c.a.d. sa spécificité propre par rapport aux quatre autres sens traditionnels. Ainsi, par exemple, une analyse neurophysiologique des récepteurs tactiles5 ne manque pas de mentionner plusieurs catégories fonctionnelles de la sensibilité cutanée: la douleur, comme signal d'un danger qui peut menacer l'existence de l'organisme; la perception des qualités d'un objet, comme intégration du toucher et de la kinesthésie au cours d'une exploration active de la main; les expériences somatiques complexes telles que le chatouillement et les sensations sexuelles. Pour le phénoménologue, un tel compromis s'apparente à une confusion et provient des positions épistémologiques qui ont animé l'orientation méthodologique des recherches, depuis la psychophysiologie mécaniste jusqu'à la psychologie cybernétique de l'information sensorielle. En cela, la domaine de la sensation tactile reste l'apanage de la psychophysique, et nous tenterons de clarifier pourquoi cette position ne peut aboutir qu'à des résultats problématiques. A partir d'une psychologie anthropologique du sens tactile,14 nous défendrons l'idée d'une psychologie comparée qui permettrait une investigation empirique, objective des comportements animaux, sur la base de prolégomènes phénoménologiques. (shrink)

To quote Yogi Berra, writing this editorial is a “déja vu all over again” experience for us. It entails not only collaborating once more as coauthors but also reiterating some of the criticisms and concerns that have figured prominently in virtually all our previous publications about bioethics—most recently in our book Observing Bioethics.

The author discusses the ways in which she finds the University of Pittsburgh Medical Center protocol for procuring organs from "non-heart-beating cadaver donors" medically and morally questionable and irreverent. She also identifies some of the factors that contributed to the composition of this troubling protocol, and to its institutional approval.

In 1999, Médecins Sans Frontières set out to explore and demonstrate the feasibility of preventing and treating HIV/AIDS in a so-called resource-poor, economically and socially disadvantaged setting. The first MSF mission to incorporate antiretroviral treatment into its HIV-AIDS-oriented medical program was undertaken in Bangkok. The second project was launched in Khayelitsha where MSF has been providing ARV treatment for persons with HIV/AIDS since May 2001. Khayelitsha is an enclave of some 500,000 inhabitants, most of whom live in corrugated-iron shacks, without (...) running water or electricity. Unemployment is extremely high; crime and violence are rampant. The general prevalence of HIV/AIDS is 26%, measured among pregnant women. The tuberculosis incidence rate is one of the world's highest for open-space sites. Unsurprisingly, TB/HIV coinfection is very high too: 63% of those with TB are also infected with HIV. (shrink)

They have watched, as insiders, the first fumbling attempts to transplant kidneys, then hearts, then live‐donated lobes of liver and lung. Now the two sociologists most closely identified with organ transplantation have concluded that they must leave the field.

“Bioethics is not just Bioethics.” This is the aphoristic way in which I have recurrently expressed my historical and social perspective on the significance of bioethics, whose import I regard as extending beyond the emergence, development, and establishment of an intellectual field that is primarily concerned with advances in biology and medicine, their relationship to illness and health, and their ethical concomitants. In my view, although they are expressed through the medium of medicine, some of the value and belief questions (...) with which bioethics has been preoccupied since its inception are connected with broad and deep moral issues that are integral to what the illustrious French sociologist Émile Durkheim... (shrink)

In the expanding repertoire of practices designed to increase the supply of organs for transplantation, non-heart-beating cadaver organ donation has generated an ongoing debate in the literature. The continuing stream of articles is disquieting in part because it documents a troubling "trial-and-error ethics" approach to the formulation of organ procurement policy, and because it raises serious questions about the reasons that the development of this policy is being mediated by published communication. In the light of concerns about the implicit support (...) and credibility that professional publications give to organ procurement policies, restraint in publishing articles about non-heart-beating organ donation as well as in devising such policies is strongly advocated. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Striving To Do Good:Well-Springs, Realities, and Paradoxes of Medical Humanitarian WorkRenée C. FoxThe voices that speak from the pages of these testimonial narratives are those of physicians who are engaged in medical humanitarian work. The preponderance of them are based in U.S. academic medical centers where they have clinical, teaching, and research responsibilities from which they regularly "commute" to care for patients in what the euphemistic language of "global (...) health" terms "resource-limited," rather than "poor" countries." This "hybrid life," as one of the physicians (Robert Riviello) refers to it, has transported them periodically to numerous African societies (to Algeria, Ethiopia, Gabon, Morocco, Rwanda, Sudan, Tanzania, and Uganda), to Haiti, to India and Nepal, and to Guatemala and Mexico. Three of the "stories" are written by physicians at work in the countries where they were born (Prasanta Tripathy in Eastern India, Sridevi Seetharam and colleagues in Southern India, and Paul Pierre, in Haiti).Only one group of physician-coauthors (Maricruz Merino, Jonathan Iralu, and Sonya Shin) write about their experiences in practicing medicine among poor and socially disadvantaged patients on the American mainland—in the setting of the Navajo Indian reservation in Gallup, New Mexico.All these physicians describe their involvement in humanitarian medicine as emanating from their commitment to "social justice," to "saving lives," and to "caring for the poor"; to their universalistic convictions about "human solidarity," and the non- otherness of others; to their indignation about the inequities and injustices of the world, particularly with regard to access to health care (in the words of Jeffrey Deal, "[They] deserve better. They all do"); and to their "passionate" desire, not just their "sense of duty," to help rectify these wrongs (Richard Keiden). I was struck by the fact that none of them uses the word "suffering" to describe the plight of the persons whom they feel they have been called to medically assist.Three of the physicians express the wellsprings of their motivation in religious terms. Richard Keiden refers to a "guiding principle of Judaism" on which his medical humanitarian work has been founded—"tzedakah"—which "translates as charity but actually means righteousness," is based on a "concept of social justice," and is "an obligation, not a choice." Robert Riveillo says that at the time of his graduation from high school he envisioned his "life's work as a long-term missionary surgeon"; he invokes "loving mercy," as well as justice, "in this work of solidarity" that he has undertaken; and he poignantly admits that "most days I still long to pack my things, my family, and our efforts and move to Africa for a life of direct service." What Jeffrey Deal writes is the most explicitly and ardently religious of all. He identifies his work as a physician in Sudan with Jesus's "desire for us to care [End Page 115] for the poor and downtrodden in His stead." He is haunted by his "failure" to deliver alive a "partially born" baby girl who for him incarnated "the least of the least" of whom Jesus "spoke passionately." And in touching "ever so briefly... [that] one, tiny being [he] encountered... [on ] that hot morning in Sudan," he attests, he "touched Jesus."Jeffrey Deal is not the only one who was so stricken by the death of a baby or a child. For a number of these physicians (Sadath Sayeed, Maneesh Batra, and for Sridevi Seetharam, Lisa Adams and their colleagues), it was a tragedy that they found hard to bear with "detached enlightenment" (Sayeed), or to accept. The most demonstrably heartbroken and morally outraged among them is Sadath Sayeed, who "wept uncontrollably" over the death of a baby boy, born "at home" in Haiti, "probably in one of the hundreds of make-shift tent cities." The baby was not breathing continuously, and was "handed" to him to care for. At the close of the "story " about this experience that he recounts, Sayeed lashes out with fury and angst at those who were likely to ask him, "How was it in Haiti?" Do you want to hear "my real answer?" he replies:... [L]et me summarize my last patient for you: Good luck Dad... (shrink)

Corporate governance is increasingly becoming an issue of global concern, not least because we are more and more living in a corporate world that transcends international boundaries. The main purpose and motivation of this study is to determine how the international community should motivate businesses in fostering exemplary corporate governance, therefore eliminating obstacles to ethically exemplary behavior. The empirical approach utilized here has been applied to 161 businesses, both listed and over-the-counter (OTC) companies, with the results indicating that ethical considerations, (...) corporate governance and organizational performance are inextricably linked and, to an extent, demonstrably proportional. This study also indicates a major finding that family management is a significant mediating variable of the ethical considerations of corporate governance and organizational performance. Finally, this study has developed an operational model of ethical considerations of corporate governance as a consultancy aid for businesses that wish to implement and/or boost their performance in respect to corporate governance. (shrink)

Twelve narratives written by surgeons on ethical decision-making are analyzed in this commentary. Several major themes in their narratives are discussed: the preponderance of end-of-life issues; the struggle to be inclusively empathetic, even under emotionally alienating circumstances; social justice; and the disagreement among colleagues about how to deal with patients in situations of medical uncertainty. The commentary not only discusses the areas of stress that the surgeons identify in their accounts. It also highlights phenomena and themes that are missing from (...) them, and calls for more work to be done gathering stories from surgeons to explore and explain the “gaps” in this narrative collection. (shrink)

Book reviewed in this article: The Puzzle People: Memoirs of a Transplant Surgeon. By Thomas E. Starzl.

Kant as anthropologist forms the center of attention in this collection of four lectures delivered at Yale University in 1955: John E. Smith explores the connection between questions "What can I know?" "What ought I to do?" and "What may I hope?" and the fourth question, "What is man?" George E. Schrader follows Kant's concepts of human will and character through their development in existentialism. René Wellek describes Kant's place among the aestheticians who raised and treated the question of the (...) place of man and his works of art in the realms of beauty and purpose. And C. W. Hendel examines Kant's concepts of reason, faith, hope, duty, law, freedom, responsibility, and peace in the world of the French and American revolutions and in ours.--R. F. T. (shrink)

In this paper a semantics for dynamic predicate logic is developed that uses sequence valued assignments. This semantics is compared with the usual relational semantics for dynamic predicate logic: it is shown that the most important intuitions of the usual semantics are preserved. Then it is shown that the refined semantics reflects out intuitions about information growth. Some other issues in dynamic semantics are formulated and discussed in terms of the new sequence semantics.

Originally published in 1954, on behalf of the National Institute of Economic and Social Research, this book presents a general review of British economic statistics in relation to the uses made of them for policy purposes. The text begins with an examination, in general terms, of the ways in which statistics can help in guiding or assessing policy, covering housing, coal, the development areas, agricultural price-fixing, the balance of external payments and the balance of the economy. The problems of statistical (...) application are then separately discussed under the headings of quality, presentation and availability, and organization. A full bibliography and reference table of principal British economic statistics are also included. This book will be of value to anyone with an interest in British economic history and statistics. (shrink)