Study objectives The emergency department (ED) provides an arena for patient enrolment into a variety of research studies even for non-critically ill patients. Given the types of illness, time constraints and sense of urgency that exists in the ED environment, concern exists about whether research subjects in the ED can provide full consent for participation. We sought to identify enrolled research subjects' perspectives on the informed consent process for research conducted in the ED. Methods This was a prospective, observational study (...) of ED subjects, 18 years or older, who had been approached to participate in research in the ED and who were judged to have decision-making capacity. Exclusions were critical illness and refusal to participate. Subjective were followed up within 1 week after enrolling using structured phone interviews by trained interviewers. Results During the study period, 229 eligible patients were approached to participate in both a target study and this study. Of these, 66% (150/229) agreed to participate in this study, at least to the extent of allowing us access to their demographic data. The study participant group was similar in terms of gender to this particular ED's patient population but had significantly more African-Americans and persons older than 45. Conclusion Despite rigorous time constraints and rapid throughput times, the majority of subjects who consented to research participation in the ED felt that they were sufficiently informed and had adequate time to decide to participate. (shrink)

BackgroundPhysical activity is known to improve mental health, and is regarded as safe and desirable for uncomplicated pregnancy. In this novel study, we aim to evaluate whether there are associations between maternal physical activity during pregnancy and neonatal brain cortical development.MethodsForty-four mother/newborn dyads were included in this longitudinal study. Healthy pregnant women were recruited and their physical activity throughout pregnancy were documented using accelerometers worn for 3–7 days for each of the 6 time points at 4–10, ∼12, ∼18, ∼24, ∼30, (...) and ∼36 weeks of pregnancy. Average daily total steps and daily total activity count as well as daily minutes spent in sedentary/light/moderate/vigorous activity modes were extracted from the accelerometers for each time point. At ∼2 weeks of postnatal age, their newborns underwent an MRI examination of the brain without sedation, and 3D T1-weighted brain structural images were post-processed by the iBEAT2.0 software utilizing advanced deep learning approaches. Cortical surface maps were reconstructed from the segmented brain images and parcellated to 34 regions in each brain hemisphere, and mean cortical thickness for each region was computed for partial correlation analyses with physical activity measures, with appropriate multiple comparison corrections and potential confounders controlled.ResultsAt 4–10 weeks of pregnancy, mother’s daily total activity count positively correlated (FDR corrected P ≤ 0.05) with newborn’s cortical thickness in the left caudal middle frontal gyrus (rho = 0.48, P = 0.04), right medial orbital frontal gyrus (rho = 0.48, P = 0.04), and right transverse temporal gyrus (rho = 0.48, P = 0.04); mother’s daily time in moderate activity mode positively correlated with newborn’s cortical thickness in the right transverse temporal gyrus (rho = 0.53, P = 0.03). At ∼24 weeks of pregnancy, mother’s daily total activity count positively correlated (FDR corrected P ≤ 0.05) with newborn’s cortical thickness in the left (rho = 0.56, P = 0.02) and right isthmus cingulate gyrus (rho = 0.50, P = 0.05).ConclusionWe identified significant relationships between physical activity in healthy pregnant women during the 1st and 2nd trimester and brain cortical development in newborns. Higher maternal physical activity level is associated with greater neonatal brain cortical thickness, presumably indicating better cortical development. (shrink)

The purpose of this essay is to investigate and critically analyse some of the formative factors which led to the spiritual maturation of a leading Vīraśaiva saint, Basava. This inquiry focuses on a single event in the life of this great reformer of medieval times, i.e. his spiritual conflict leading to his rejection of the upanayana ceremony. The study will proceed through an investigation of the earliest and subsequent sources which veil the personality of Basava. The traditional view will be (...) challenged as one-sided. By critically comparing the sources, a more comprehensive and plausible account will be suggested. (shrink)

The fertilizing ability of spermatozoa is inhibited by certain substances present in the seminal fluid. Most of these antifertility factors are proteinaceous in nature and differ in their physical characteristics. They inhibit fertilization by inhibiting either motility, capacitation, acrosome reaction or penetration of the ovum investments by the spermatozoa. This review describes and discusses the properties of these factors and their possible role, individually and collectively, in the regulation of fertility.

Background Regarding controversial medical services, many have argued that if physicians cannot in good conscience provide a legal medical intervention for which a patient is a candidate, they should refer the requesting patient to an accommodating provider. This study examines what US physicians think a doctor is obligated to do when the doctor thinks it would be immoral to provide a referral. Method The authors conducted a cross-sectional survey of a random sample of 2000 US physicians from all specialties. The (...) primary criterion variable was agreement that physicians have a professional obligation to refer patients for all legal medical services for which the patients are candidates, even if the physician believes that such a referral is immoral. Results Of 1895 eligible physicians, 1032 (55%) responded. 57% of physicians agreed that doctors must refer patients regardless of whether or not the doctor believes the referral itself is immoral. Holding this opinion was independently associated with being more theologically pluralistic, describing oneself as sociopolitically liberal, and indicating that respect for patient autonomy is the most important bioethical principle in one's practice (multivariable ORs, 1.6–2.4). Conclusions Physicians are divided about a professional obligation to refer when the physician believes that referral itself is immoral. These data suggest there is no uncontroversial way to resolve conflicts posed when patients request interventions that their physicians cannot in good conscience provide. (shrink)

In this paper I hope to show that a conception of human rights requires a view of the social ideal and the good life, and requires a view of the nature of human community. But what I say in favor of these points hardly amounts to a demonstration. Instead I try to exhibit how we think and talk about rights in general, and what the presuppositions of such thought and talk are. Throughout, I emphasize the pragmatic side of rights-discourse and (...) I try to establish some of the contexts in which such discourse can be significantly employed. Much of what I say is motivated by the consideration that an historically important factor in the generation of various rights, their acknowledgement and implementation, and their extension to increasingly larger segments of the population, has been the claims put forward and the demands made by individuals and groups against individuals and groups. This factor constitutes a suggestive clue for the development of a theory of rights. The treatment here, however, is largely programmatic and fragmentary. The space allotted does not permit more. Moreover, I lead up to—but do not go into—the social ideal and the human community. The title of this essay indicates its limited scope. The above points are, of course, hardly novel; many older writers laid great stress upon them. But of late they have not received the attention that they in my view deserve. What does it mean for someone to maintain a conception of human rights? How is this conception given any concrete content? The answers to these questions, I believe, ultimately lead to a consideration of social ideals and the human community. What follows is meant to stimulate new thinking on these old-fashioned topics. (shrink)

** The primary topic of this dissertation is the study of the relationships between parts and wholes as described by particular physical theories, namely generalized probability theories in a quasi-classical physics framework and non-relativistic quantum theory. ** A large part of this dissertation is devoted to understanding different aspects of four different kinds of correlations: local, partially-local, no-signaling and quantum mechanical correlations. Novel characteristics of these correlations have been used to study how they are related and how they can be (...) discerned via Bell-type inequalities that give non-trivial bounds on the strength of the correlations. ** The study of quantum correlations has also prompted us to study a) the multi-partite qubit state space with respect to its entanglement and separability characteristics, and b) the differing strength of the correlations in separable and entangled qubit states. Results include a novel classification of multipartite (partial) separability and entanglement, strong constraints on the monogamy of entanglement and of non-local correlations, and many new entanglement detection criteria that are directly experimentally accessible. ** Because of the generality of the investigation these results also have strong foundational as well as philosophical repercussions for the different sorts of physical theories as a whole; notably for the viability of hidden variable theories for quantum mechanics, for the possibility of doing experimental metaphysics, for the question of holism in physical theories, and for the classical vs. quantum dichotomy. (shrink)

Bhattacharyya, K. The Advaita concept of subjectivity.--Deutsch, E. Reflections on some aspects of the theory of rasa.--Nakamura, H. The dawn of modern thought in the East.--Organ, T. Causality, Indian and Greek.--Chatterjee, M. On types of classification.--Lacombe, O. Transcendental imagination.--Bahm, A. J. Standards for comparative philosophy.--Herring, H. Appearance, its significance and meaning in the history of philosophy.--Chang Chung-yuan. Pre-rational harmony in Heidegger's essential thinking and Chʼan thought.--Staal, J. F. Making sense of the Buddhist tetralemma.--Enomiya-Lassalle, H. M. The mysticism of Carl Albrecht (...) and Zen.--Parrinder, G. The nature of mysticism.--Cairns, G. E. Axiological contributions of East and West to the spiritual development of mankind.--Mayeda, S. Śaṇkara's view of ethics.--Mercier, A. On peace.--Barlingay, S. S. A discussion of some aspects of Gaudapāda's philosophy. (shrink)

Misattributed paternity or ‘false’ paternity is when a man is wrongly thought, by himself and possibly by others, to be the biological father of a child. Nowadays, because of the progression of genetics and genomics the possibility of finding misattributed paternity during familial genetic testing has increased. In contrast to other medical information, which pertains primarily to individuals, information obtained by genetic testing and/or pedigree analysis necessarily has implications for other biologically related members in the family. Disclosing or not a (...) misattributed paternity has a number of different biological and social consequences for the people involved. Such an issue presents important ethical and deontological challenges. The debate centres on whether or not to inform the family and, particularly, whom in the family, about the possibility that misattributed paternity might be discovered incidentally, and whether or not it is the duty of the healthcare professional to disclose the results and to whom. In this paper, we consider the different perspectives and reported problems, and analyse their cultural, ethical and legal dimensions. We compare the position of HCPs from an Italian and British point of view, particularly their role in genetic counselling. We discuss whether the Oviedo Convention of the Council of Europe can be seen as a basis for enriching the debate. (shrink)

This white paper aims to identify an open problem in 'Quantum Physics and the Nature of Reality' -namely whether quantum theory and special relativity are formally compatible-, to indicate what the underlying issues are, and put forward ideas about how the problem might be addressed.

Background: Debates over legalisation of physician-assisted suicide or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period.Methods: The data from Oregon comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands comprised all four (...) government-commissioned nationwide studies of end-of-life decision making and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought.Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured , people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups.Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. (shrink)

Background: Hospital nurses are frequently the first care givers to receive a patient’s request for euthanasia or physician-assisted suicide (PAS). In France, there is no consensus over which medical practices should be considered euthanasia, and this lack of consensus blurred the debate about euthanasia and PAS legalisation. This study aimed to investigate French hospital nurses’ opinions towards both legalisations, including personal conceptions of euthanasia and working conditions and organisation. Methods: A phone survey conducted among a random national sample of 1502 (...) French hospital nurses. We studied factors associated with opinions towards euthanasia and PAS, including contextual factors related to hospital units with random-effects logistic models. Results: Overall, 48% of nurses supported legalisation of euthanasia and 29%, of PAS. Religiosity, training in pallative care/pain management and feeling competent in end-of-life care were negatively correlated with support for legalisation of both euthanasia and PAS, while nurses working at night were more prone to support legalisation of both. The support for legalisation of euthanasia and PAS was also weaker in pain treatment/palliative care and intensive care units, and it was stronger in units not benefiting from interventions of charity/religious workers and in units with more nurses. Conclusions: Many French hospital nurses uphold the legalisation of euthanasia and PAS, but these nurses may be the least likely to perform what proponents of legalisation call “good” euthanasia. Improving professional knowledge of palliative care could improve the management of end-of-life situations and help to clarify the debate over euthanasia. (shrink)

Collection of essays around the work of H.L.A. Hart.

Like the virtue it purports to explain, St Thomas Aquinas' treatment of modestia in the Summa Theologiae is something that can easily be overlooked. Such neglect is unfortunate, for it is liable to obscure the surprising character of Aquinas' account, departing as it does from many of his philosophical sources , to say nothing of our own contemporary assumptions. This novel treatment is especially significant given its potential value in addressing the social and political needs of the current age, for (...) rather than being the virtue least fitted for contemporary life, the modesty that emerges in Thomas' moral theology may have an enduring civic significance. This essay therefore begins with an exegesis of Aquinas' account of modestia and concludes with an analysis of its political dimensions. (shrink)

Background In 2002, Belgium set a legal framework for euthanasia, whereby granting and performing euthanasia is entrusted entirely to physicians, and—as advised by Belgian Medical Deontology—in the context of a trusted patient–physician relationship. Euthanasia is, however, rarely practiced, so the average physician will not attain routine in this matter. Aim To explore how general practitioners in Flanders (Belgium) deal with euthanasia. This was performed via qualitative analysis of semistructured interviews with 52 general practitioners (GPs). Results Although GPs can understand a (...) patient's request for euthanasia, their own willingness to perform it is limited, based on their assumption that legal euthanasia equates to an injection that ends life abruptly. Their willingness to perform euthanasia is affected by the demanding nature of a patient's request, by their views on what circumstances render euthanasia legitimate and by their own ability to inject a lethal dose. Several GPs prefer increasing opioid dosages and palliative sedation to a lethal injection, which they consider to fall outside the scope of euthanasia legislation. Conclusions Four attitudes can be identified: (1) willing to perform euthanasia; (2) only willing to perform as a last resort; (3) feeling incapable of performing; (4) refusing on principle. The situation where GPs have to consider the request and—if they grant it—to perform the act may result in arbitrary access to euthanasia for the patient. The possibility of installing transparent referral and support strategies for the GPs should be further examined. Further discussion is needed in the medical profession about the exact content of the euthanasia law. (shrink)

The purpose of this note is to examine the notion of obligations to future generations, a notion that finds increasing use in discussions of social policies and programs, particularly as concerns population distribution and control and environment control. Thus, it may be claimed, the solution of problems in these areas is not merely a matter of enhancing our own good, improving our own conditions of life, but is also a matter of discharging an obligation to future generations.