Breaking bad news (BBN) to parents whose newborn has a major disease is an ethical dilemma. In Saudi Arabia, BBN about newborns is performed according to the parental preferences that have been reported from non-Arabic/non-Islamic countries. Saudi mothers' preferences about BBN have not yet been studied. Therefore, we aimed to elicit the preferences of Saudi mothers about BBN concerning newborns. We selected a convenience sample of 402 Saudi mothers, aged 18-50 years, who had no previous experience with BBN. We selected (...) them via a simple number-randomization scheme from the premises of a level III Saudi hospital between October of 2009 and January of 2011. We used a hypothetical situation (BBN about trisomy 21) to elicit their preferences about BBN concerning newborns via a structured verbal questionnaire composed of 12 multiple-choice questions. We expressed their preferences as percentages (95% confidence interval), and we used the Kendall's W test (W) to assess the degree of agreement in preferences. The Saudi mothers preferred that BBN be conducted with both parents together (64% [60-69]), albeit with weak levels of agreement (W = 0.29). They showed moderate agreement in their preferences that BBN should be conducted early (79% [75-83], W = 0.48), in detail (81% [77-85], W = 0.52), in person (88% [85-91], W = 0.58), and in a quiet setting (86% [83-90], W = 0.53). With extremely weak agreement, they preferred to have a known person present for support during BBN (56% [51-61], W = 0.01), to have close bodily contact with their babies (66% [61-70], W = 0.10), and to have no another patients present (64% [59-68], W = 0.08). They showed moderate levels of agreement in their desires to detail, in advance, their preferences about process of BBN by giving a reversible, written informed consent that could be utilized for guidance, if needed (80% [76-84], W = 0.36). In our experience, Saudi mothers' preferences about BBN concerning newborns are varied, suggesting that a "one-size-fits-all" approach is inappropriate. A reversible, written informed consent detailing their preferences about BBN that would be kept in their medical records and utilized for guidance, if needed, may be the best solution, given this level of diversity. These findings merit further study. (shrink)

In this paper, the authors have detected a new effect in the area of geomagnetism, related to the behavior of a magnetic dipole freely floating on water surface. An experiment is described in the present paper in which a magnetic dipole fixed upon a float placed on non- magnetized water surface undergoes displacement along with reorientation caused by fine structure of the earth's magnetic field. This fact can probably be explained by secular decrease of the earth's major dipole moment. Further, (...) a detailed study of the phenomenon may create interesting premises for its practical use, particularly for the analysis of fine structure of geomagnetic field and its time-dependent anomalies. A strange behavior of some sea fish species prior to strong earthquakes may be explained if the fish are assumed as 'live magnetic dipoles'. (shrink)

BackgroundPublic health scholars have long called for preparedness to help better negotiate ethical issues that emerge during public health emergencies. In this paper we argue that the concept of ethical preparedness has much to offer other areas of health beyond pandemic emergencies, particularly in areas where rapid technological developments have the potential to transform aspects of health research and care, as well as the relationship between them. We do this by viewing the ethical decision-making process as a behaviour, and conceptualising (...) ethical preparedness as providing a health research/care setting that can facilitate the promotion of this behaviour. We draw on an implementation science and behaviour change model, COM-B, to demonstrate that to be ethically prepared requires having the capability, opportunity, and motivation to work in an ethically prepared way.MethodsWe use two case examples from our empirical research—one pandemic and one non-pandemic related—to illustrate how our conceptualisation of ethical preparedness can be applied in practice. The first case study was of the UK NHSX COVID-19 contact tracing application case study involved eight in-depth interviews with people involved with the development/governance of this application. The second case involved a complex case regarding familial communication discussed at the UK Genethics Forum. We used deductive qualitative analysis based on the COM-B model categories to analyse the transcripbed data from each case study.ResultsOur analysis highlighted that being ethically prepared needs to go beyond merely equipping health professionals with skills and knowledge, or providing research governance actors with ethical principles and/or frameworks. To allow or support these different actors to utilise their skills and knowledge, a focus on the physical and social opportunity is important, as is a better understanding the role of motivation.ConclusionsTo understand ethical preparedness, we need to view the process of ethical decision-making as a behaviour. We have provided insight into the specific factors that are needed to promote this behaviour—using examples from both in the pandemic context as well as in areas of health research and medicine where there have been rapid technological developments. This offers a useful starting point for further conceptual work around the notion of being ethically prepared. (shrink)

Resumen. Se presentan los conceptos básicos de muestreo secuencial en sus cinco modalidades,incluyendo muestreo secuencial de tipo estándar, usando solo una densidad crítica, por una precisiónfija, por medio de presencia-ausencia y finalmente de tipo temporal. Se notan un ejemplo real para cadacaso. Se nota y se explica la importancia de la distribución de los datos y los pertinentes ecuaciones. Sepresentan a través de ejemplos reales las ecuaciones para estimar el tamaño óptimo de la muestra paracada uno de las cinco modalidades (...) del muestreo secuencial. Se enfatiza la ventaja económica de estetipo de muestreo.Palabras clave: Distribución de los datos, muestreo secuencial, tamaño óptimo de la muestra. Fundamental concepts of sequential sampling in all its types including standard sequentialsampling, sequential sampling using only one critical density, fixed precision sequential sampling,presence-absence sequential sampling, and time sequential sampling are highlighted. A real caseexample for each of the five sequential samplings is given. The relevance of data distribution forsequential sampling along with corresponding equations is provided and explained. Equations to assessthe optimal sample size for each case are noted and exemplified. The economic advantages of sequentialsampling in stressedKeywords: Data distribution, sample size, sequential sampling. (shrink)

Resumen. Se analizan de forma detallada las bases del muestreo multietápico, la estimación de submuestreo y el muestreo de respuesta aleatoria. Se presentan las ecuaciones pertinentes ejemplificando por medio de casos reales. También se argumentan las situaciones en donde se debe utilizar estos casos específicos. Palabras claves. Caso multietápico, muestreo de respuesta aleatoria, submuestreo.. The basics of multi-stage sampling, sub-sampling and random response sampling are analyzed. Detailed equations regarding these types of sampling are provided. The applications of these types of (...) samplings are denoted by means of real case studies. Keywords. Multi-stage sampling, sub-sampling, random response sampling. (shrink)

In the years 1878 and 1879 the American physicist Alfred Marshall Mayer published his experiments with floating magnets as a didactic illustration of molecular actions and forms. A number of physicists made use of this analogy of molecular structure. For William Thomson they were a mechanical illustration of the kinetic equilibrium of groups of columnar vortices revolving in circles round their common centre of gravity . A number of modifications of Mayer's experiments were described, which gave configurations which were more (...) or less analogous to Mayer's arrangements. It was Joseph John Thomson who, in publications between 1897 and 1907, used Mayer's results to obtain a good deal of insight into the general laws which govern the configuration of the electrons in his atomic model. This article is mainly concerned with Mayer's experiments with floating magnets and their use by a number of physicists. Through his experiments Mayer made a significant, although small, contribution to the theory of atomic structure. (shrink)

Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and (...) participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses’ ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses’ own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner. (shrink)

This paper challenges the traditional assumption that descriptive and prescriptive sciences are essentially distinct by presenting a study on the implicit normativity of the production and presentation of biomedical scientific facts within evidence-based medicine. This interdisciplinary study serves as an illustration of the potential worth of the concept of implicit normativity for bioethics in general and for integrated empirical ethics research in particular. It demonstrates how both the production and presentation of scientific information in an evidence-based decision-support contain implicit presuppositions (...) and values, which pre-structure the moral environment of the clinical process of decision-making. As a consequence, the evidence-based decision support did not only support the clinical decision-making process; it also transformed it in a morally significant way. This phenomenon undermines the assumption within much of the literature on patient autonomy that information disclosure is a conditional requirement before patient autonomy even starts; patient autonomy is already influenced during the production and presentation of information. These results imply an increased responsibility of those who produce and present evidence-based facts(i.e. scientists in general and physicians in particular). The insights of this study not only involve a different focus on both theory and practice of patient autonomy and informed consent, but they also call for a broader scope of morality than does traditional empirical research in bioethics. The concept of implicit normativity within integrated empirical ethics research calls for a strong cooperation between bioethicists and descriptive scientists, i.e., a cooperation that goes beyond the discipline-specific epistemic values and that takes place during all phases of the research process. (shrink)

Palabras claves. Métodos estadísticos, pruebas de hipótesisResumen. Se presentan de forma simple, breve y por medios de los ejemplos prácticos, los métodos estadísticos que sirven para demostrar la representatividad de una, dos o varias muestras basada en los parámetros poblacionales . Se indican la manera de reducir el tamaño del error experimental para aclarar el efecto significativo de los grupos o muestras bajo el interés . Además, se demuestran la forma de eliminar el efecto de las variables auxiliares o colaterales (...) causante del ruido o error en la estadística . También se nota el uso del modelo ANOVA Anidada para indicar la forma de segmentar la ANOVA en varias partes y de esta manera poder contestar preguntas más complejas. Finalmente, se describen e explican la forma de optimizar los recursos en la conducción de los experimentos y descubrir el efecto de la interacción entre las variables .Keywords. Hypothesis testing, statistical methods. Statistical methods that serve to represent, based upon population parameters of mean and variance, for one, tow or various samples taken from study populations are discussed. Ways to reduce the amount of experimental error in order to clarify the real effect of the treatments are demonstrated . The use of Covariance Analysis to show the pure effect of treatment free from the effect of collateral variables is also indicated. Nested ANOVA that allows division of ANOVA in several parts in order to answer complex questions is described and explained. Finally, the utility of Factorial Analysis for optimization of resource use as well as the illustration of interaction effects are noted and analyzed. (shrink)