The importance of communities in strengthening the ethics of international collaborative research is increasingly highlighted, but there has been much debate about the meaning of the term ‘community’ and its specific normative contribution. We argue that ‘community’ is a contingent concept that plays an important normative role in research through the existence of morally significant interplay between notions of community and individuality. We draw on experience of community engagement in rural Kenya to illustrate two aspects of this interplay: (i) that (...) taking individual informed consent seriously involves understanding and addressing the influence of communities in which individuals’ lives are embedded; (ii) that individual participation can generate risks and benefits for communities as part of the wider implications of research. We further argue that the contingent nature of a community means that defining boundaries is generally a normative process itself, with ethical implications. Community engagement supports the enactment of normative roles; building mutual understanding and trust between researchers and community members have been important goals in Kilifi, requiring a broad range of approaches. Ethical dilemmas are continuously generated as part of these engagement activities, including the risks of perverse outcomes related to existing social relations in communities and conditions of ‘half knowing’ intrinsic to processes of developing new understandings. (shrink)
F. H. George is Professor of Cybernetics at Brunel University in England. His book comprises eight chapters originally developed as lectures for a non-specialist audience. He points out the position of computer science among the sciences, explains its aims, procedures, and achievements to date, and speculates on its long-term implications for science in particular and society in general. Among the topics discussed are biological simulation and organ replacement, automated education, and the new philosophy of science. Each chapter concludes with a (...) brief summary. George's treatment of the technical details of his speciality is both illuminating and readable, thus serving as an excellent primer on one of the new technology's most important components. His wider forays into philosophy, economics, sociology, and religion are less happy, however; and unfortunately they take up a large part of the text. In general, they reveal that George identifies the methods of human advancement with the methods of the natural sciences in an equation whose rigidity would make even B. F. Skinner blush. Yet, the reader cannot claim that he was not forewarned; for in the introduction, D. J. Stewart, Chairman of the Rationalist Press Association, suggests that the current "swing of interest among young people away from the physical and biological sciences and towards the behavioural and social sciences... represents a symptom of disillusionment with science and technology and an attempted escape into irrationality."--J. M. V. (shrink)
1. The Commentariolum Petitionis is not in the Codex Mediceus of Cicero's correspondence with his brother Quintus, but it appears at the end of the letters to Quintus in the other manuscripts. It starts in the normal manner of a letter and is, or purports to be, a collection of tips on canvassing set in the particular context of M. Cicero's consular candidature in 64: a composition of his brother Quintus. It is printed as no. 12 in Tyrrell and Purser's (...) collection of Cicero's Letters. (shrink)
In this paper we study the relations between the fragment L of classical logic having just conjunction and disjunction and the variety D of distributive lattices, within the context of Algebraic Logic. We prove that these relations cannot be fully expressed either with the tools of Blok and Pigozzi's theory of algebraizable logics or with the use of reduced matrices for L. However, these relations can be naturally formulated when we introduce a new notion of model of a sequent calculus. (...) When applied to a certain natural calculus for L, the resulting models are equivalent to a class of abstract logics (in the sense of Brown and Suszko) which we call distributive. Among other results, we prove that D is exactly the class of the algebraic reducts of the reduced models of L, that there is an embedding of the theories of L into the theories of the equational consequence (in the sense of Blok and Pigozzi) relative to D, and that for any algebra A of type (2,2) there is an isomorphism between the D-congruences of A and the models of L over A. In the second part of this paper (which will be published separately) we will also apply some results to give proofs with a logical flavour for several new or well-known lattice-theoretical properties. (shrink)
The proto-code of ethics and conduct for European nurse directors was developed as a strategic and dynamic document for nurse managers in Europe. It invites critical dialogue, reflective thinking about different situations, and the development of specific codes of ethics and conduct by nursing associations in different countries. The term proto-code is used for this document so that specifically country-orientated or organization-based and practical codes can be developed from it to guide professionals in more particular or situation-explicit reflection and values. (...) The proto-code of ethics and conduct for European nurse directors was designed and developed by the European Nurse Directors Association’s (ENDA) advisory team. This article gives short explanations of the code’ s preamble and two main parts: Nurse directors' ethical basis, and Principles of professional practice, which is divided into six specific points: competence, care, safety, staff, life-long learning and multi-sectorial working. (shrink)
The objective of the study was to investigate the relationship between childhood IQ of parents and characteristics of their adult offspring. It was a prospective family cohort study linked to a mental ability survey of the parents and set in Renfrew and Paisley in Scotland. Participants were 1921-born men and women who took part in the Scottish Mental Survey in 1932 and the Renfrew/Paisley study in the 1970s, and whose offspring took part in the Midspan Family study in 1996. There (...) were 286 offspring from 179 families. Parental IQ was related to some, but not all characteristics of offspring. Greater parental IQ was associated with taller offspring. Parental IQ was inversely related to number of cigarettes smoked by offspring. Higher parental IQ was associated with better education, offspring social class and offspring deprivation category. There were no significant relationships between parental IQ and offspring systolic blood pressure, diastolic blood pressure, cholesterol, glucose, lung function, weight, body mass index, waist hip ratio, housing, alcohol consumption, marital status, car use and exercise. Structural equation modelling showed parental IQ associated with offspring education directly and mediated via parental social class. Offspring education was associated with offspring smoking and social class. The smoking finding may have implications for targeting of health education. (shrink)
BackgroundStreet-connected children and youth in low- and middle-income countries have multiple vulnerabilities in relation to participation in research. These require additional considerations that are responsive to their needs and the social, cultural, and economic context, while upholding core ethical principles of respect for persons, beneficence, and justice. The objective of this paper is to describe processes and outcomes of adapting ethical guidelines for SCCY’s specific vulnerabilities in LMIC.MethodsAs part of three interrelated research projects in western Kenya, we created procedures to (...) address SCCY’s vulnerabilities related to research participation within the local context. These consisted of identifying ethical considerations and solutions in relation to community engagement, equitable recruitment, informed consent, vulnerability to coercion, and responsibility to report.ResultsSubstantial community engagement provided input on SCCY’s participation in research, recruitment, and consent processes. We designed an assent process to support SCCY to make an informed decision regarding their participation in the research that respected their autonomy and their right to dissent, while safeguarding them in situations where their capacity to make an informed decision was diminished. To address issues related to coercion and access to care, we worked to reduce the unequal power dynamic through street outreach, and provided access to care regardless of research participation.ConclusionsAlthough a vulnerable population, the specific vulnerabilities of SCCY can to some extent be managed using innovative procedures. Engaging SCCY in ethical research is a matter of justice and will assist in reducing inequities and advancing their health and human dignity. (shrink)
During the period of conflict that led to the dissolution of the former Yugoslavia, the Serbian healthcare system suffered greatly; as a result, relationships between physicians and their patients reached an all-time low. After cessation of the various wars, a group of medical students attempted to assess the state of the patient–physician relationship in Serbia. Their study showed a relationship characterised by very meek patients and rather arrogant physicians. Empowered by their engagement, the medical students constructed a set of standards (...) for achieving a proper patient–physician relationship; physicians should be capable of hearing and understanding patients, with the result that the ensuing empowerment can enable patients and physicians to create a tool for changing the relationship between both parties. (shrink)
The traditional “realist” conception of physics, according to which human concepts, laws and theories can grasp the essence of a reality in our absence , seems incompatible with quantum formalism and it most fruitful interpretation. The proof rests on the violation by quantum mechanical formalism of some fundamental principles of the classical ontology. We discuss if the conception behind Einstein’s idea of a reality in our absence, could be still maintained and at which price. We conclude that quantum mechanical formalism (...) is not formulated on those terms, leaving for a separated paper the discussion about the terms in which it could be formulated and the onto-epistemological implications it might have. (shrink)
Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)
New trends in the economic systems management in the context of modern global challenges: collective monograph / scientific edited by M. Bezpartochnyi, in 2 Vol. // VUZF University of Finance, Business and Entrepreneurship. – Sofia: VUZF Publishing House “St. Grigorii Bogoslov”, 2020. – Vol. 1. – 309 p.
Background: The Declaration of Helsinki, the World Medical Association’s statement of ethical guidelines regarding medical research, is published in the three official languages of the WMA: English, French and Spanish.Methods: A detailed comparison of the three official language versions was carried out to determine ways in which they differed and ways in which the wording of the three versions might illuminate the interpretation of the document.Results: There were many minor linguistic differences between the three versions. However, in paragraphs 1, 6, (...) 29, 30 and in the note of clarification to paragraph 29, there were differences that could be considered potentially significant in their ethical relevance.Interpretation: Given the global status of the Declaration of Helsinki and the fact that it is translated from its official versions into many other languages for application to the ethical conduct of research, the differences identified are of concern. It would be best if such differences could be eliminated but, at the very least, a commentary to explain any differences that are unavoidable on the basis of language or culture should accompany the Declaration of Helsinki. This evidence further strengthens the case for international surveillance of medical research ethics as has been proposed by the WMA. (shrink)
This piece outlines concrete cases of benefit sharing that occur in relation to the sharing of human (biological) samples. For example, it surveys Indonesia’s decision, in 2006, to stop sharing virus samples of H5N1 (avian influenza) with the WHO Global Influenza Surveillance Network (GISN). It also outlines some of the ethical issues that arise in these cases.
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