In March 2003, President Bush declared the start of Operation Iraqi Freedom, the anticipated commencement of intensive American-led military operations in Iraq. With this declaration, the media began intense coverage of military operations from the field. For the first time, viewers were able to see images of actual events. This was due to three developments: the advancement of technology allowing immediate transmission of text and images, the actual presence of journalists identified as "embedded journalists" at military sites, and the fierce (...) competition among networks for viewers. One result of this constant coverage was significant pressure on decision makers within the television and cable news networks to decide within a matter of seconds which images to air. In particular, producers and broadcasters of competing networks experienced this pressure. Though the radio and broadcasting industry has a published code of standards, it is "general and advisory rather than specific and restrictive." Therefore, it did not address the unique time sensitive decision-making required within this new environment. Issues such as the security of soldiers, confidentiality of troop maneuvers, and the safety of the embedded journalists were critically important. Equally serious were the concerns about the impact of the immediate airing of information and violent images to the public. This research used Patrick Primeaux's ' mind-heart-sou¾ model of decision-making as its theoretical framework. The study investigated the gender and industry experience of selected professionals in a cable news network, MSNBC, to explore how ethical codes of behavior are integrated when people make decisions. Decision-making in both their professional and personal lives was examined. It is from this perspective that their professional decisions to air/not to air material from Operation Iraqi Freedom were studied. The findings on decisions about airing/not airing material from Operation Iraqi Freedom yielded both expected and unexpected results. There was no clear gender difference regarding ethical decision-making, but there was a difference when analyzed by industry experience. When the study focused on questions regarding the respondents' personal lives, the original hypothesis that there was a gender difference was validated. (shrink)
In this book MacDonald guides his reader through Luke-Acts from beginning to end to identify and interpret the author’s imitations of classical Greek poetry, arguing that Luke’s two-volume work was a prose epic to provide his readers with a foundation myth for the new social reality that the Christian Church had become.
Legal frameworks are in place to protect those who lack the capacity to consent to research, such as the Mental Capacity Act in the UK. Assent is sought instead from a proxy, usually a relative. However, the same legislation may, perversely, affect the welfare of those who lack capacity and of others by hindering the process of recruitment into otherwise potentially beneficial research. In addition, the onus of responsibility is moved from those who know most about the study (ie, the (...) scientific community) to those who know less (the proxies). In this paper, we describe the characteristics of a sample at different stages of the recruitment process of an influenza vaccine-based randomised control trial in elderly care home residents (the FEVER study). 62% (602/968) of potential subjects lacked capacity but only 29% (80/277) of those actually randomised. Older age, being female and living in an Elderly Mentally Ill care home were the only variables associated with lacking capacity. Considering this was a study based in a care home setting where the prevalence of dementia approximates 80%, the trial, like many others, was thus significantly biased. We believe that difficulties seeking proxy assent contributed significantly to this problem. Further thought should be given to how assent to enter research for those who lack capacity should be provided, and we suggest avenues for further discussion such as independent risk/benefit expert panels. (shrink)
Aim To ascertain the quantity and nature of gifts and items provided by the pharmaceutical industry in Australia to medical specialists and to consider whether these are appropriate in terms of justifiable ethical standards, empirical research and views expressed in the literature.
In base rate problems the estimated probability must equal the base rate only where random sampling is assumed. Otherwise there is uncertainty over and above that which can be included in any probability model and inductive inference is involved. Subjects should use base rates to the extent that the problem suggests a simple random sampling model.
There is increasing global pressure to ensure that pregnant women are responsibly and safely included in clinical research in order to improve the evidence base that underpins healthcare delivery during pregnancy. One supposed barrier to inclusion is the assumption that pregnant women will be reluctant to participate in research. There is however very little empirical research investigating the views of pregnant women. Their perspective on the benefits, burdens and risks of research is a crucial component to ensuring effective recruitment. The (...) Research In Pregnancy Ethics study set out to ascertain the views of pregnant women about research participation using an inductive thematic analysis. We conducted semi-structured interviews with 20 women who had participated in a double-blind randomised placebo controlled trial in Wellington while pregnant. Our results show that at least some pregnant women recognise the value and importance of research during pregnancy. The women we interviewed were deeply invested in the research process and outcomes. Key motivations for participating were altruism, playing a valuable civic role and the importance of research. The main perceived burdens related to inconvenience and time commitment. For some women, possible randomization to the placebo arm was regarded as a burden or disadvantage. (shrink)
The purpose of this study is to examine the importance that real patients attach to their right to withdraw from an on-going feasibility randomised trial (RCT) evaluating types and timings of breast reconstruction (two parallel trials) following mastectomy for breast cancer. Our results show that, while some respondents appreciated that exercising the right to withdraw would defeat the scientific objective of the trial, some patients with a surgical preference consented only given the knowledge they could withdraw if they were not (...) allocated to their preferred treatment. (shrink)
This paper is about the differences between probabilities and beliefs and why reasoning should not always conform to probability laws. Probability is defined in terms of urn models from which probability laws can be derived. This means that probabilities are expressed in rational numbers, they suppose the existence of veridical representations and, when viewed as parts of a probability model, they are determined by a restricted set of variables. Moreover, probabilities are subjective, in that they apply to classes of events (...) that have been deemed (by someone) to be equivalent, rather than to unique events. Beliefs on the other hand are multifaceted, interconnected with all other beliefs, and inexpressible in their entirety. It will be argued that there are not sufficient rational numbers to characterise beliefs by probabilities and that the idea of a veridical set of beliefs is questionable. The concept of a complete probability model based on Fisher's notion of identifiable subsets is outlined. It is argued that to be complete a model must be known to be true. This can never be the case because whatever a person supposes to be true must be potentially modifiable in the light of new information. Thus to infer that an individual's probability estimate is biased it is necessary not only to show that the estimate differs from that given by a probability model, but also to assume that this model is complete, and completeness is not empirically verifiable. It follows that probability models and Bayes theorem are not necessarily appropriate standards for people's probability judgements. The quality of a probability model depends on how reasonable it is to treat some existing uncertainty as if it were equivalent to that in a particular urn model and this cannot be determined empirically. Bias can be demonstrated in estimates of proportions of finite populations such as in the false consensus effect. However the modification of beliefs by ad hoc methods like Tversky and Kahneman's heuristics can be justified, even though this results in biased judgements. This is because of pragmatic factors such as the cost of obtaining and taking account of additional information which are not included even in a complete probability model. Finally, an analogy is drawn between probability models and geometric figures. Both idealisations are useful but qualitatively inadequate characterisations of nature. A difference between the two is that the size of any error can be limited in the case of the geometric figure in a way that is not possible in a probability model. (shrink)
Brock Macdonald1, Evi Vakiani2, Rhonda K Yantiss3, Jun Lee4, Robert S Brown Jr5, Samuel H Sigal61Division of Gastroenterology, Department of Medicine, University of California-San Francisco, San Francisco, CA, 2Department of Pathology, Memorial Sloan–Kettering Cancer Center, New York, NY, 3Department of Pathology and Laboratory Medicine, New York Weill Cornell Medical College, New York, NY, 4Division of Nephrology, Department of Medicine, Weill Cornell Medical College, New York, NY, 5Division of Gastroenterology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, (...) NY, 6Division of Gastroenterology and Hepatology, Department of Medicine, New York University, New York, NY, USA: The use of sirolimus as an alternative to calcineurin inhibitors for posttransplant immunosuppression is associated with a variety of inflammatory conditions. In this report, we describe the case of a 34-year-old man who developed abnormal liver tests 6 years after live-donor kidney transplantation and 5 years after initiation of sirolimus-based immunosuppression. Elevated aminotransferase levels persisted after withdrawal of potentially hepatotoxic medications, and serologic evaluation for viral hepatitis, autoimmune disease, and genetic disorders was unrevealing. Liver biopsy revealed prominent hepatocellular injury associated with a mixed inflammatory infiltrate and liver tests normalized within 2 weeks of discontinuation of sirolimus. In this report, we review previous reports of sirolimus hepatotoxicity and propose a unifying hypothesis for the various inflammatory conditions that have been attributed to sirolimus.Keywords: sirolimus, immunosuppression, transplant, inflammatory conditions, hepatotoxicity. (shrink)