Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino and (...) Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend to disadvantage individuals with barriers in access to care (3). There is mounting evidence of racial, ethnic, and socioeconomic disparities in access to medications for COVID-19 (4, 5). -/- One potential method to promote equitable allocation is to use a weighted lottery, which is an allocation strategy that gives all eligible patients a chance to receive the scarce treatment while also allowing the assignment of higher or lower chances according to other ethical considerations (6). We sought to assess the feasibility of implementing a weighted lottery to allocate scarce COVID-19 medications in a large U.S. health system and to determine whether the weighted lottery promotes equitable allocation. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Since the early 1980’s, with the clinical advent of in vitro fertilization resulting in so-called “test tube babies,” a wide array of ethical considerations and concerns regarding artificial womb technology (AWT) have been described. Recent breakthroughs in the development of extracorporeal neonatal life support by means of AWT have reinitiated ethical interest about this topic with a sense of urgency. Most of the recent ethical literature on the topic, however, pertains not to the more imminent scenario of a physiologically improved (...) method of neonatal care through AWT, but instead to the remote scenario of “complete ectogenesis” that imagines human gestation occurring entirely outside of the womb. This scoping review of the ethical literature on AWT spans from more abstract concerns about complete ectogenesis to more immediate concerns about the soon-to-be-expected clinical life support of what we term the fetal neonate or fetonate. Within an organizing framework of different stages of human gestational development, from conception to the viable premature infant, we discuss both already identified and newly emerging ethical considerations and concerns regarding AWT and the care of the fetonate. (shrink)

Automatic moving object detection and tracking is very important task in video surveillance applications. In the present work the well known background subtraction model and use of Gaussian Mixture Models have been used to implement a robust automated single object tracking system. In this implementation, background subtraction on subtracting consecutive frame-by-frame basis for moving object detection is done. Once the object has been detected it is tracked by employing an efficient GMM technique. After successful completion of tracking, moving object recognition (...) of those objects using well known Principal Component Analysis, which is used for extracting features and Manhattan based distance metric is used for subsequent classification purpose. The system is capable of handling entry and exit of an object. Such a tracking system is cost effective and can be used as an automated video conferencing system and also has applications like human tracking, vehicles monitoring, and event recognition for video surveillance. The proposed algorithm was tested on standard database on complex environments and the results were satisfactory. (shrink)

Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue that draws (...) both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. (shrink)

Psychopaths continue to be demonised by the media and estimates suggest that a disturbing percentage of the population has psychopathic tendencies. This timely and controversial new book summarises what we already know about psychopathy and antisocial behavior and puts forward a new case for its cause - with far-reaching implications. Presents the scientific facts of psychopathy and antisocial behavior. Addresses key questions, such as: What is psychopathy? Are there psychopaths amongst us? What is wrong with psychopaths? Is psychopathy due to (...) nature or nurture? And can we treat psychopaths? Reveals the authors' ground-breaking research into whether an underlying abnormality in brain development leaves psychopaths with an inability to feel emotion or fear. The resulting theory could lead to early diagnosis and revolutionize the way society, the media and the state both views and contends with the psychopaths in our midst. (shrink)

This study investigated the performance of boys with psychopathic tendencies and comparison boys, aged 9 to 17 years, on two tasks believed to be sensitive to amygdala and orbitofrontal cortex func- tioning. Fifty-one boys were divided into two groups according to the Psychopathy Screening Device (PSD, P. J. Frick & R. D. Hare, in press) and presented with two tasks. The tasks were the gambling task (A. Bechara, A. R. Damasio, H. Damasio, & S. W. Anderson, 1994) and the Intradimensional/ (...) Extradimensional (ID/ED) shift task (R. Dias, T. W. Robbins, & A. C. Roberts, 1996). The boys with psychopathic tendencies showed impaired performance on the gambling task. However, there were no group differences on the ID/ED task either for response reversal or extradimensional set shifting. The implications of these results for models of psychopathy are discussed. (shrink)

Initial responses to questionnaires used to assess participants' understanding of informed consent for malaria vaccine trials conducted in the United States and Mali were tallied. Total scores were analyzed by age, sex, literacy (if known), and location. Ninety-two percent (92%) of answers by United States participants and 85% of answers by Malian participants were correct. Questions more likely to be answered incorrectly in Mali related to risk, and to the type of vaccine. For adult participants, independent predictors of higher scores (...) were younger age and female sex in the United States, and male sex in Mali. Scores in the United States were higher than in Mali (P = 0.005). Despite this difference participants at both sites were well informed overall. Although interpretation must be qualified because questionnaires were not intended as research tools and were not standardized among sites, these results do not support concerns about systematic low understanding among research participants in developing versus developed countries. (shrink)

Currently, an emphasis is being placed on the integration of ethical issues into the business curriculum. This paper investigates the viability of using student group interaction to induce an upward movement in the stages of moral development as advanced by Kohlberg. The results of a classroom experiment using graduate business law students suggest that formulating groups that mix stages of moral development can provide a robust environment for upward movement. In addition, the results suggest strategies for formulating effective groups, based (...) upon entry levels as measured by the Defining Issues Test. (shrink)

In their article “Moral Hazards in Pediatrics” (2016), Brunnquell and Michaelson remind us that the child's perspective is of utmost importance when making health care decisions and express concern...

"By combining recent advances in the physical sciences with some of the novel ideas, techniques, and data of modern biology, this book attempts to achieve a new and different kind of evolutionary synthesis. I found it to be challenging, fascinating, infuriating, and provocative, but certainly not dull."--James H, Brown, University of New Mexico "This book is unquestionably mandatory reading not only for every living biologist but for generations of biologists to come."--Jack P. Hailman, Animal Behaviour , review of the first (...) edition "An important contribution to modern evolutionary thinking. It fortifies the place of Evolutionary Theory among the other well-established natural laws."--R.Gessink, TAXON. (shrink)

Background Psychiatric electroceutical interventions (PEIs) use electrical or magnetic stimulation to treat mental disorders and may raise different ethical concerns than other therapies such as medications or talk therapy. Yet little is known about stakeholders’ perceptions of, and ethical concerns related to, these interventions. We aimed to better understand the ethical concerns of a variety of stakeholder groups (patients with depression, caregivers of patients, members of the public, and psychiatrists) regarding four PEIs: electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), (...) deep brain stimulation (DBS), and adaptive brain implants (ABI).Methods We conducted a national survey of these four stakeholder groups, using an embedded video vignette experiment depicting a patient with treatment-resistant depression and her psychiatrist discussing the possibility of treatment with one of the four PEIs.Results Participants’ ethical concerns varied by stakeholder group, by PEI, and by the interaction of the two. The three non-clinician groups tended to have similar ethical concerns, but to differ from psychiatrists. Similar concerns were raised with regard to the two implantable technologies, DBS and ABI. Overall, there was relatively little concern about the involuntary use of PEIs, though some expressed concern about the adequacy of information provided during the consent process. There was also significant concern that patients may not receive helpful therapies.Conclusions To our knowledge, this is the first national survey that includes multiple stakeholder groups and multiple PEI modalities. A better understanding of the ethical concerns of stakeholders can help to shape clinical practice and health care policy regarding PEIs. (shrink)

This study investigates the ability of individuals with psychopathy to perform passive avoidance learning and whether this ability is modulated by level of reinforcement/punishment. Nineteen psychopathic and 21 comparison individuals, as defined by the Hare Psychopathy Checklist Revised (Hare, 1991), were given a passive avoidance task with a graded reinforcement schedule. Response to each rewarding number gained a point reward specific to that number (i.e., 1, 700, 1400 or 2000 points). Response to each punishing number lost a point punishment specific (...) to that number (i.e., the loss of 1, 700, 1400 or 2000 points). In line with predictions, individuals with psychopathy made more passive avoidance errors than the comparison individuals. In addition, while the performance of both groups was modulated by level of reward, only the performance of the comparison population was modulated by level of punishment. The results are interpreted with reference to a computational account of the emotional learning impairment in individuals with psychopathy. (shrink)

D. R. Fisher; IV*—Why Should I Be Just?, Proceedings of the Aristotelian Society, Volume 77, Issue 1, 1 June 1977, Pages 43–62, https://doi.org/10.1093/aristote.

Background: The factors influencing parents’ willingness to enroll their children in biobanks are poorly understood. This study sought to assess parents’ willingness to enroll their children, and their perceived benefits, concerns, and information needs under different consent and data-sharing scenarios, and to identify factors associated with willingness. Methods: This large, experimental survey of patients at the 11 eMERGE Network sites used a disproportionate stratified sampling scheme to enrich the sample with historically underrepresented groups. Participants were randomized to receive one of (...) three consent and data-sharing scenarios. Results: In total, 90,000 surveys were mailed and 13,000 individuals responded (15.8% response rate). 5737 respondents were parents of minor children. Overall, 55% (95% confidence interval 50–59%) of parents were willing to enroll their youngest minor child in a hypothetical biobank; willingness did not differ between consent and data-sharing scenarios. Lower educational attainment, higher religiosity, lower trust, worries about privacy, and attitudes about benefits, concerns, and information needs were independently associated with less willingness to allow their child to participate. Of parents who were willing to participate themselves, 25% were not willing to allow their child to participate. Being willing to participate but not willing to allow one’s child to participate was independently associated with multiple factors, including race, lower educational attainment, lower annual household income, public health care insurance, and higher religiosity. Conclusions: Fifty-five percent of parents were willing to allow their youngest minor child to participate in a hypothetical biobank. Building trust, protecting privacy, and addressing attitudes may increase enrollment and diversity in pediatric biobanks. (shrink)

: The introduction of transgenic organisms into agriculture has raised a firestorm of controversy. Many view the technology as a pathway to a much better future society, whereas others condemn it for endangering people and the environment. One defective argument against transgenics is the Unnatural Is Unethical argument (UIU). UIU attempts to prove if transgenic organisms are unnatural and all unnatural things are morally bad, then transgenics are morally bad. However, the argument fails once it is shown that there is (...) no plausible definition for "unnatural." Therefore, UIU should be abandoned in favor of arguments more likely to succeed. (shrink)

On the key concept of Maya, principle of unifying contradiction between Brahman and the world, cause and the effect, the subject and the object, according to Vedanta school in Hindu philosophy; a study.

In his article ‘A Cavalry Unit in the Army of Antigonus Monophthalmus: Asthippoi’, N. G. L. Hammond argues that the reading of the manuscript R at Diodorus 19. 29. 2 should be retained and that we should read ⋯π⋯ π⋯σι δ⋯ το⋯ς τε ⋯σθ⋯ππους ⋯νομαζομ⋯νους κα⋯ τοὺς ⋯κ τ⋯ν ἄνω κατοικο⋯ντων ⋯κτακοσιο⋯ς. The readings of F and its copy X, ⋯νθ⋯ππους, and the commonly accepted conjecture of Wesseling ⋯μɸ⋯ππους, should both be abandoned. Hammond's arguments for retaining this reading are that (...) between the variant readings of R and F, R ‘is the more often correct’ ; ⋯σθ⋯ππους, the reading of R, is preferable to F's ⋯νθ⋯ππους on the principle of ‘lectio difficilior’; the ‘difficulty’ of his lectio difficilior is made less by the arguments presented by A. B. Bosworth, 245 ff.), for the restoration at several places in the text of Arrian's Anabasis the word ⋯σθ⋯ταιροι, in place of the editorial emendation of πεζ⋯ταιροι. ‘For just as asthetairoi meant an élite group of Macedonian infantrymen,’ says Hammond, ‘so asthippoi should mean an élite group of Macedonian cavalrymen.’ He then proceeds to examine the passage and its context in an attempt to find confirmation of this proposition and comes to the conclusion that Diodorus' text says that there were 800 cavalrymen, broken into two groups, the asthippoi and ‘the men from the up-country settlers’; these, though having different names, had a close relationship to each other, as is shown by their being brigaded together. Following his derivation of asthetairoi as meaning ‘townsmen-companions’, i.e. companions recruited from the towns of Upper Macedonia, he argues that asthippoi were cavalry recruited from the towns of Upper Macedonia and that τοὺς ⋯κ τ⋯ν ἄνω κατοικο⋯ντων means ‘the sons of settlers in up-country Macedonia’. These 800, says Hammond, were both among Antigonus' best troops and ‘were Macedonians from Europe’. We thus appear, on Hammond's interpretation, to have here a group of 800 Macedonian élite cavalrymen, all of whom were recruited in Upper Macedonia's townships, but of whom some were chosen to be the cavalry-equivalent of the élite ‘townsmen-companions’ by their title of ‘townsmen-cavalry’, whilst the others, similarly recruited – but perhaps of a younger generation? – had no particular distinguishing title beyond ‘sons of settlers in up-country Macedonia’.Now, while it would be exciting to be able to add another one, possibly two Macedonian cavalry units to the Macedonian army of Philip, Alexander and the Successors, there are several aspects of Hammond's arguments that, it seems to me, are less than convincing. Thus, whilst it seems beyond reasonable doubt that ⋯σθ⋯ταιροι should be retained in the text of Arrian, appearing, as it does, six times, this is not an argument that ⋯σθ⋯ππους should be read in Diodorus' text. Both it and F's reading of ⋯νθ⋯ππους are hapax legomena and it is possible that both readings are wrong. But even if we retain ⋯σθ⋯ππους as the correct reading, Hammond's explanation of its meaning is open to objection on several counts. (shrink)

The common consensus on suicide seems to be that even if taking one's life is permissible on some basis, it cannot be morally obligatory. In fact, one argument often used against Utilitarianism is that the principle sometimes requires individuals to sacrifice themselves for the benefit of others, as in the case of healthy individuals who can donate all their life saving organs to those in need of transplants. However, a plausible philosophical case can be built for morally obligatory suicide. First, (...) although not a standard interpretation, it seems clear Kant thought some crimes so morally repugnant that the moral agent should commit suicide rather than performing the former. Using this interpretation, I will strengthen and defend a Kantian argument for morally obligatory suicide in situations of crimina carnis contra naturum. (shrink)

Open peer commentary on the article “Exploring the Depth of Dream Experience: The Enactive Framework and Methods for Neurophenomenological Research” by Elizaveta Solomonova & Xin Wei Sha. Upshot: A neurophenomenological approach to the enactive account of consciousness in general is supported by an account of how the brain functions in creating imagery of non-present objects and situations. Three types of non-sensory imagery are needed to ground our consciousness of sensory imagery: proprioceptive imagery, motor imagery, and what Eugene Gendlin calls the (...) “felt sense” of a situation. Dreams show clearly how we image situations without sensory input, a process that is clearly enactive rather than reactive. This enactive account of imagery then supports Gendlin’s method of interpreting dreams by comparing their “felt sense” to the felt sense of waking situations. (shrink)

Much speculation on the sources of Duhem's historical interests fails to account for the major shifts in these interests: neither his belief in the continuous development of physics nor his Catholicism, when his Church was encouraging the study of generally Aristotelian scholastic thought, led to any interest in mediaeval science before 1904. Equally, his own claim that he was merely testing his views on the nature of physical theory is easily squared only with earlier work with no trace of mediaeval (...) science. Behind this discontinuity lies a major crisis. Though not a positivist, Duhem had based all his work on assumptions acceptable to positivists. One of these, the sterility of the Middle Ages, was refuted by his chance discovery of evidence of genuine mediaeval science in the autumn of 1903, but that left the doctrine of scholastic sterility intact. (shrink)