BackgroundIn the Canadian Alliance for Healthy Hearts and Minds cohort, participants underwent magnetic resonance imaging of the brain, heart, and abdomen, that generated incidental findings. 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 were recruited with (...) a follow-up questionnaire administered to 909 participants 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% of participants, with the highest proportions found in the brain and abdomen. The majority of participants 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 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)
Os estudos deleuzianos sobre o cinema destacam a importância dos dois regimes semióticos (imagem-movimento e imagem-tempo) para a compreensão da nossa relação estética e epistemológica com as imagens em movimento. Pelo contrário, este artigo procura destacar os momentos de crise entre os dois regimes assinalando o carácter genérico de incerteza e ambiguidade da natureza das imagens mentais: enfraquecido o esquema sensório-motor que domina na montagem cinematográfica, as personagens, incapazes de agir, podem imaginar, desejar, sonhar, alucinar, e lembrar. Surgem novos tipos (...) de imagem: imagens-recordação, imagens-sonho e imagens-mundo. Como é que esses novos tipos de imagem nos fazem repensar a nossa habitual relação com o mundo e com a realidade? Com este artigo sobre a dimensão virtual e onírica do cinema, procuro contribuir para uma maior disseminação de um dos principais contributos de Gilles Deleuze para a filosofia do cinema: a distinção entre o imaginário e a realidade. (shrink)
Is God's foreknowledge compatible with human freedom? One of the most attractive attempts to reconcile the two is the Ockhamistic view, which subscribes not only to human freedom and divine omniscience, but retains our most fundamental intuitions concerning God and time: that the past is immutable, that God exists and acts in time, and that there is no backward causation. In order to achieve all that, Ockhamists distinguish ‘hard facts’ about the past which cannot possibly be altered from ‘soft facts’ (...) about the past which are alterable, and argue that God's prior beliefs about human actions are soft facts about the past. (shrink)
Subtitled "Ideas and Arguments from Plato to Sartre," this volume is intended, as are many others, to serve both as a textbook for introductory courses in philosophy and as an introduction to philosophic thinking. One of its goals, and one admirably achieved, is to provide some hearing both to all the very greatest figures in the history of western philosophy and to some major opposing traditions. No one can read the volume and fail to grasp something of the content and (...) spirit in the work of such men as Plato, Aristotle, Aquinas, Descartes, Hume, Kant, Wittgenstein and others. What makes Flew's work creative and original is a combination of factors. First of all, he combines in a very stimulating and integral way two methods commonly adopted in works of this kind, namely representative selections from original sources and expository and critical commentary. Almost one half of the work consists of material taken from the primary sources, but these selections are not set off in large chunks interspersed with commentary. Rather they are worked into the text to illustrate the thrust of the arguments and ideas involved, and thus we find Hobbes' militant manifesto of metaphysical materialism confronting the Eleatic Stranger's argument for the existence of "certain incorporeal Forms which are objects of the mind" in The Sophist, Hume's views on finality contrasted with the argument developed by Aquinas in his fifth way, and Frege's polemic against confusing the logical with the psychological set opposite the arguments of Locke concerning the meaning of human understanding. In addition, in offering his own critical comment Flew deliberately seeks to set forth his own conclusions even in areas that have been and are controversial. Thus the work is by no means an impersonal account but conveys something of the enthusiasm and excitement that the author experiences in trying to forge sound arguments and assess the soundness of arguments advanced by others--and this, for Flew, is the principal work of the philosopher. One could argue over many of the nuances that Flew's way of proceeding gives to the meaning of the philosophies discussed, but this in no way detracts from the value of this stimulating and exceptionally informative introduction.--W. E. M. (shrink)
Background:Despite the growing importance of spiritual care, the delivery of spiritual care is still an area of disagreement among healthcare providers.Objective:To develop a grounded theory about spiritual care delivery based on Iranian nurses’ perceptions and experiences.A grounded theory approach:A qualitative study using the grounded theory approach.Participants and research context:Data were collected through holding 27 interviews with 25 participants. The study setting was the Imam Khomeini Hospital Complex. Sampling was started purposively and continued theoretically. Data analysis was performed by the method (...) proposed by Strauss and Corbin.Ethical consideration:The study was approved by the Ethics Committee of Tarbiat Modares University and the agreement of the administrators of the study setting was got before starting the study.Results:The core category of the study was “Trust building” which reflected the nature of spiritual care delivery by nurses. Trust building was the result of eight main categories or strategies including creating a positive mentality at hospital admission, understanding patients in care circumstances, having a caring presence, adhering to care ethics, developing meaningful relationships, promoting positive thinking and energy, establishing effective communication with patients, and attempting to create a safe therapeutic environment. Poor interprofessional coordination negatively affected this process while living toward developing greater cognizance of divinity and adhering to the principles of professional ethics facilitated it. The outcome of the process was to gain a sense of partial psychological security.Conclusion:The “Trust building” theory can be used as a guide for describing and expanding nurses’ roles in spiritual care delivery, developing care documentation systems and clinical guidelines, and planning educational programs for nursing students and staff nurses. (shrink)
É bem conhecida a oposição estabelecida por Kant entre experiência possível e dialética, na medida em que esta última é caracterizada como a lógica da ilusão. Ao mesmo tempo, o modo de pensar metafísico, que ocorre dialeticamente, em sentido kantiano, é uma tendência inevitável da razão, expressa na exigência formal de completude das categorias. Como o pensar, enquanto exercício livre da razão, é em si mesmo mais amplo do que a atividade de conhecer, própria do entendimento, o pensar contém o (...) conhecimento, embora este se qualifique pelas regras e pelos limites determinantes da objetividade. A pergunta que tentaremos formular é se essa relação continente-conteúdo não poderia configurar também uma dependência da experiência em relação ao raciocínio dialético, que estaria de algum modo indicada na função reguladora das idéias da razão. Nesse caso, a oposição formal entre conhecer e pensar seria inseparável da inclusão estrutural (dependência) da experiência no âmbito da razão. Na raiz do problema estaria talvez a tensão (dialética) entre a aspiração subjetiva de totalidade e as exigências objetivas de limitação e segmentação da experiência e a forma da experiência teria de ser finalmente concebida a partir de um fundo de inteligibilidade problemática. Dialectics and experienceThe separation of possible experience as objective knowledge and dialetics as a non-objective or non-theoretical knowledge is one of the most important aspects of kantian critical philosophy. But Kant also says that the activity of reason, as a pure thinking, has more amplitude than understanding knowledge. So we could say that theoric knowledge would depend on rational ( and non-theoretical) knowledge, as something contained in it. If we accept that, the consequence would be a relation of dependence between the form of objective knowledge and the background of a problematic even doubtful inteligible knowledge. (shrink)
Wittgenstein’s concepts shed light on the phenomenon of schizophrenia in at least three different ways: with a view to empathy, scientific explanation, or philosophical clarification. I consider two different “positive” wittgensteinian accounts―Campbell’s idea that delusions involve a mechanism of which different framework propositions are parts, Sass’ proposal that the schizophrenic patient can be described as a solipsist, and a Rhodes’ and Gipp’s account, where epistemic aspects of schizophrenia are explained as failures in the ordinary background of certainties. I argue that (...) none of them amounts to empathic-phenomenological understanding, but they provide examples of how philosophical concepts can contribute to scientific explanation, and to philosophical clarification respectively. (shrink)
An important contribution to the foundations of probability theory, statistics and statistical physics has been made by E. T. Jaynes. The recent publication of his collected works provides an appropriate opportunity to attempt an assessment of this contribution.