The considerable attention to financial interests in clinical research has focused mostly on academic medical centers, even though the majority of clinical research is conducted in community practice settings. To fill this gap, this article maps the practices and policies in 73 community hospitals and several hundred specialized facilities around the country for reviewing clinical investigators’ financial relationships with research sponsors. Community hospitals face a substantially different mix of issues than academic medical centers do because their physician researchers are usually (...) not employees, and more of their studies are later-phase, multicenter trials. Accordingly, community physicians stand to benefit personally from per capita payments, but they tend to have less direct influence over research findings when compared with their academic peers. These and other contrasts require separate guidance for community-based organizations that takes into account their particular needs, circumstances, and institutional capacities. (shrink)
Background Paediatric clinical research faces unique challenges that compromise optimal recruitment of children into clinical trials. A main barrier to enrolment of children is parental misconceptions about the research process. In developing countries, there is a knowledge gap regarding parental perceptions of and attitudes towards their children's participation in clinical trials. Objective To explore such perceptions and attitudes in Lebanese parents. Study design 33 in-depth interviews were conducted with parents with and without previous research experience. Interviews were tape-recorded, transcribed in (...) colloquial Arabic, and later subjected to thematic analysis. Results Benefit/risk ratio assessment was a major determinant of parental consent. Fear of adverse events or painful procedures in research was a recurring theme in most interviews. Whereas perception of direct benefit to the child, trust in the physician or institution, financial gains or having a positive previous experience in research facilitated consent, a complex informed consent form and misunderstanding of the term ‘randomisation’ hindered parental approval of participation. Conclusion Lebanese parents have perceptions of and attitudes towards children's participation in clinical trials that are similar to those reported from the industrialised world. Improving communication with parents and building trust between researchers and parents is important for successful recruitment. Investigators planning to conduct paediatric trials in developing countries need to simplify consent forms and devise new ways to explain randomisation. (shrink)
The spinal cord provides an alternative model for nerve tissue grafting experiments. Anatomo-functional correlations are easier to make here than in any other region of the CNS because of a direct implication of spinal cord neurons in sensorimotor activities. Lesions can be easily performed to isolate spinal cord neurons from descending inputs. The anatomy of descending monoaminergic systems is well defined and these systems offer a favourable paradigm for lesion-graft experiments.
The paper reviews the current situation regarding a new theory of brain dynamics put forward by the authors in an earlier publication. Motivation for the theory is discussed in terms of two issues: the long-standing problem of accounting for the stability and nonlocal properties of memory, and the experimental and theoretical evidence against the classical theory of brain action. It is shown that the new theory provides an explanation and a conceptually unifying framework for phenomena of brain action that resist (...) classical explanation. Further independent experiments provide strong additional support for the theory. The fact that this theory incorporates quantum mechanisms in an essential way is considered to be of wide scientific interest in view of the unique status of the brain in relation to the physical, biological, and mental orders in nature. (shrink)
Objectives: To assess French district nurses’ opinions towards euthanasia and to study factors associated with these opinions, with emphasis on attitudes towards terminal patients.Design and setting: An anonymous telephone survey carried out in 2005 among a national random sample of French district nurses.Participants: District nurses currently delivering home care who have at least 1 year of professional experience. Of 803 district nurses contacted, 602 agreed to participate .Main outcome measures: Opinion towards the legalisation of euthanasia , attitudes towards terminal patients (...) .Results: Overall, 65% of the 602 nurses favoured legalising euthanasia. Regarding associated factors, this proportion was higher among those who discuss end-of-life issues with terminal patients , who consider competent patients should always be told their prognosis and who value the role of advance directives and surrogates in end-of-life decision-making for incompetent patients . Women and older nurses were less likely to favour legalising euthanasia, as were those who believed in a god who masters their destiny.Conclusions: French nurses are more in favour of legalising euthanasia than French physicians; these two populations contrast greatly in the factors associated with this support. Further research is needed to investigate how and to what extent such attitudes may affect nursing practice and emotional well-being in the specific context of end-of-life home care. (shrink)
In the last few decades, the historiographical categories rationalism and empiricism have been criticized for their limitations to explain the complex positions and the links held by the philosophers tradiotnally attached to them. This narrative was firstly conceived by Kantian German historians and began to become standard at the turn of the twentieh century. Nonetheless, nineteenth-century French historiography developed other narratives by which early modern philosophers were classified according to alternative criteria. In the first edition of Histoire comparée des systémes (...) de philosophie (1804), Joseph-Marie Degérando distinguishes three first-order early modern schools founded by Bacon, Descartes and Leibniz, respectively. Degérando introduces the empiricism and rationalism distinction as one among others, and not as the fundamental one. In addition, he separates empiricism from experimental philosophy. The last one, along with speculative philosophy, is said to conciliate senses and reason. As a result, this account offers philosophical groupings different from those constructed by the standard narrative. Furthermore, it draws on labels and classification criteria which were part of the early modern philosophical discourse. (shrink)
IntroductionTourette Syndrome is a childhood onset disorder characterized by vocal and motor tics and often remits spontaneously during adolescence. For treatment refractory patients, Deep Brain Stimulation may be considered.Methods and ResultsWe discuss ethical problems encountered in two adolescent TS patients treated with DBS and systematically review the literature on the topic. Following surgery one patient experienced side effects without sufficient therapeutic effects and the stimulator was turned off. After a second series of behavioural treatment, he experienced a tic reduction of (...) more than 50%. The second patient went through a period of behavioural disturbances that interfered with optimal programming, but eventually experienced a 70% tic reduction. Sixteen DBS surgeries in adolescent TS patients have been reported, none of which pays attention to ethical aspects.DiscussionSpecific ethical issues arise in adolescent TS patients undergoing DBS relating both to clinical practice as well as to research. Attention should be paid to selecting patients fairly, thorough examination and weighing of risks and benefits, protecting the health of children and adolescents receiving DBS, special issues concerning patient’s autonomy, and the normative impact of quality of life. In research, registration of all TS cases in a central database covering a range of standardized information will facilitate further development of DBS for this indication.ConclusionClinical practice should be accompanied by ongoing ethical reflection, preferably covering not only theoretical thought but providing also insights in the views and perspectives of those concerned, that is patients, family members and professionals. (shrink)
RESUMEN Las tensiones y los vínculos posibles entre razón y violencia son un problema mayor para la filosofía. La obra de Eric Weil se consagra precisamente al análisis de las figuras históricas de dicha tensión, y su obra mayor, Logique de la Philosophie, desarrolla lo fundamental de dicho propósito. Se analiza la manera como Weil, desde la categoría de la acción -última categoría concreta de la filosofía-, en vínculo con las categorías precedentes (absoluto, obra, finito) y con las categorías formales (...) (sentido y sabiduría), enfrenta este desafío siempre nuevo para la filosofía. ABSTRACT The tensions and potential links between reason and violence are a significant philosophical problem. Eric Weil's systematic work, as well as his numerous articles and lectures, is dedicated to the analysis of the historical figures of such tensions. His major work, Logique de la Philosophie, develops that objective. The article analyzes how Weil faces this always new challenge for philosophy, on the basis of the category of action -the last concrete category of his philosophy-, together with the preceding categories (absolute, unmediated particular, finite) and the formal categories (meaning and wisdom). RESUMO As tensões e os vínculos possíveis entre razão e violência são um problema maior para a filosofia. A obra de Eric Weil se consagra precisamente à análise das figuras históricas dessa tensão, e sua obra maior, Logique de la Philosophie, desenvolve o fundamental desse propósito. Analisa-se a maneira como Weil, a partir da categoria da ação -última categoria concreta da filosofia-, em vínculo com as categorias precedentes (absoluto, obra, finito) e com as categorias formais (sentido e sabedoria), enfrenta esse desafio sempre novo para a filosofia. (shrink)
Through films, we can see many aspects of a country and its times: culture, morality and religion, and views on life and death. The best films can both entertain audiences and provide viewers with opportunities to think about fundamental human problems. In this article, we use Departures (Okuribito) to examine the contemporary Japanese view of life and death. All sorts of deaths are depicted and each scene provides an insight into the contemporary Japanese view of death. We use the medium (...) of film to consider the issue of death: what death is, the relationship that exists between life and death, and how the impurity and dignity of the dead are recognised by contemporary Japanese people. The ritual of ‘encoffinment’ will also be discussed, and what it suggests and reveals about Japanese views on what happens to a person when they die, and what requirements exist for someone to be able to depart from this world to the afterlife. The view of death depicted in Departures is thought to accept and even hope for a worldview that postulates continuity between life and death, wherein not only the soul but also personal individuality continues on as it existed in life. The rite of encoffinment is required to relieve the family's grief as well as to wipe away the impurity of the dead. The Japanese traditional view that the ‘dead are impure’ seems to die hard. It is also suggested that complicated and ambivalent attitudes towards the dead exist among contemporary Japanese people. (shrink)
A complement clause is used instead of a noun phrase; for example one can say either I heard [the result] or I heard [that England beat France]. Languages differ in the grammatical properties of complement clauses, and the types of verbs which take them. Some languages lack a complement clause construction but instead employ other construction types to achieve similar ends; these are called complementation strategies. The book explores the variety of types of complementation found across the languages of the (...) world, their grammatical properties and meanings. Detailed studies of particular languages, including Akkadian, Israeli, Jarawara, and Pennsylvania German, are framed by R. M. W. Dixon's introduction, which sets out the range of issues, and his conclusion, which draws together the evidence and the arguments. This book will interest scholars of typology, language universals, syntax, information structure, and language contact in departments of linguistics and anthropology, as well as advanced and graduate students taking courses in these subjects. (shrink)
If a hereditary predisposition to colorectal cancer or breast cancer is diagnosed, most guidelines state that clinical geneticists should request index patients to inform their at-risk relatives about the existence of this condition in their family, thus enabling them to consider presymptomatic genetic testing. Those identified as mutation carriers can undertake strategies to reduce their risk of developing the disease or to facilitate early diagnosis. This procedure of informing relatives through the index patient has been criticised, as it results in (...) relatively few requests for genetic testing, conceivably because a certain number of relatives remain uninformed. This pilot study explored attitudes toward informing family members and relevant practices among clinical geneticists. In general, clinical geneticists consider it to be in the interests of family members to be informed and acknowledge that this goal is not accomplished by current procedures. The reasons given for maintaining present practices despite this include clinical ‘mores’, uncertainty about the legal right of doctors to inform family members themselves, and, importantly, a lack of resources. We discuss these reasons from an ethical point of view and conclude that they are partly uninformed and inconsistent. If informing relatives is considered to be in their best interests, clinical geneticists should consider informing relatives themselves. In the common situation in which index patients do not object to informing relatives, no legal obstacles prevent geneticists from doing so. An evaluation of these findings among professionals may lead to a more active approach in clinical practice. (shrink)
On 5 August 1968, publication of the Harvard Committee’s report on the subject of “irreversible coma” established a standard for diagnosing death on neurological grounds. On the same day, the 22nd World Medical Assembly met in Sydney, Australia, and announced the Declaration of Sydney, a pronouncement on death, which is less often quoted because it was overshadowed by the impact of the Harvard Report. To put those events into present-day perspective, the authors reviewed all papers published on this subject and (...) the World Medical Association web page and documents, and corresponded with Dr A G Romualdez, the son of Dr A Z Romualdez. There was vast neurological expertise among some of the Harvard Committee members, leading to a comprehensible and practical clinical description of the brain death syndrome and the way to diagnose it. This landmark account had a global medical and social impact on the issue of human death, which simultaneously lessened reception of the Declaration of Sydney. Nonetheless, the Declaration of Sydney faced the main conceptual and philosophical issues on human death in a bold and forthright manner. This statement differentiated the meaning of death at the cellular and tissue levels from the death of the person. This was a pioneering view on the discussion of human death, published as early as in 1968, that should be recognised by current and future generations. (shrink)
ABSTRACT Real-time graphical interval logic is a modal logic for reasoning about time in which the basic modality is the interval. The logic differs from other logics in that it has a natural intuitive graphical representation that resembles the timing diagrams drawn by system designers. We have developed an automted deduction system for the logic, which includes a theorem prover and a user interface. The theorem prover checks the validity of proofs in the logic and produces counterexamples to invalid proofs. (...) The user interface includes a graphical editor that enables the user to create graphical formulas on a workstation display, and a database and proof manager that tracks proof dependencies and allows graphical formulas to be stored and retrieved. In this paper we describe the logic, the automated deduction system, and an application to robotics. (shrink)
Although activated spinal cord glia contribute importantly to neuropathic pain, how nerve injury activates glia remains controversial. It has recently been proposed, on the basis of genetic approaches, that toll-like receptor 4 may be a key receptor for initiating microglial activation following L5 spinal nerve injury. The present studies extend this idea pharmacologically by showing that TLR4 is key for maintaining neuropathic pain following sciatic nerve chronic constriction injury. Established neuropathic pain was reversed by intrathecally delivered TLR4 receptor antagonists derived (...) from lipopolysaccharide. Additionally, -naltrexone, -naloxone, and -naloxone, which we show here to be TLR4 antagonists in vitro on both stably transfected HEK293-TLR4 and microglial cell lines, suppressed neuropathic pain with complete reversal upon chronic infusion. Immunohistochemical analyses of spinal cords following chronic infusion revealed suppression of CCI-induced microglial activation by -naloxone and -naloxone, paralleling reversal of neuropathic pain. Together, these CCI data support the conclusion that neuron-to-glia signaling through TLR4 is important not only for initiating neuropathic pain, as suggested previously, but also for maintaining established neuropathic pain. Furthermore, these studies suggest that the novel TLR4 antagonists -naloxone and -naloxone can each fully reverse established neuropathic pain upon multi-day administration. This finding with -naloxone is of potential clinical relevance. This is because -naloxone is an antagonist that is inactive at the -opioid selective receptors on neurons that produce analgesia. Thus, these data suggest that -opioid antagonists such as -naloxone may be useful clinically to suppress glial activation, yet -opioid agonists suppress pain. (shrink)
We demonstrate by use of a simple one-dimensional model of a square barrier imbedded in an infinite potential well that decoherence is enhanced by chaotic-like behavior. We, moreover, show that the transition h→0 is singular. Finally it is argued that the time scale on which decoherence occurs depends, on the degree of complexity of the underlying quantum mechanical system, i.e., more complex systems decohere relatively faster than less complex ones.
As part of a larger research study, we present model language for disclosing financial interests in clinical research to potential research participants, and we describe the empirical basis and theoretical assumptions used in developing the language. The empirical process for creating appropriate disclosure language resulted in a generic disclosure statement for cases in which no risk to participants’ welfare or the scientific integrity of the research is expected, and nine more specific disclosure statements for cases in which some risk is (...) expected. The disclosure statements are not meant to be canonical, but were instead designed to reflect the typical situations in which disclosure of financial interest might be considered by an institutional review board or conflict of interest committee. Individual institutions could modify key phrases to suit their purposes, and others could use the language in future empirical work on informed consent to better refine the options for disclosing financial interests in clinical research. (shrink)