PURPOSE: To evaluate the effects of social support on comprehension and recall of consent form information in a study of Parkinson disease patients and their caregivers.DESIGN and METHODS: Comparison of comprehension and recall outcomes among participants who read and signed the consent form accompanied by a family member/friend versus those of participants who read and signed the consent form unaccompanied. Comprehension and recall of consent form information were measured at one week and one month respectively, using Part A of the (...) Quality of Informed Consent Questionnaire .RESULTS: The mean age of the sample of 143 participants was 71 years . Analysis of covariance was used to compare QuIC scores between the intervention group and control group . In the 1-week model, no statistically significant intervention effect was found . However, the intervention status by patient status interaction was statistically significant . In the 1-month model, no statistically significant intervention effect was found . Again, however, the intervention status by patient status interaction was statistically significant . At both time periods, intervention group patients scored higher on the QuIC than did intervention group caregivers, and control group patients scored lower on the QuIC than did control group caregivers.IMPLICATIONS: Social support played a significant role in enhancing comprehension and recall of consent form information among patients. (shrink)
Objective: To determine the views of people with multiple sclerosis (MS) and professionals in relation to confidentiality, consent and access to data within a proposed MS register in the UK. Design: Qualitative study using focus groups (10) and interviews (13). Setting: England and Northern Ireland. Participants: 68 people with MS, neurologists, MS nurses, health services management professionals, researchers, representatives from pharmaceutical companies and social care professionals. Results: People with MS expressed open and altruistic views towards the use of their personal (...) information to facilitate service provision and research, placing trust in responsible guardianship and legitimate use of their information. Participant’s proposed that people with MS should be able to select their individual level of involvement in a register using levels of consent. It was agreed that access to the register should be governed by a guardianship committee composed of a range of stakeholders. People with MS did not wish their details to be used by marketing agencies and did not consider this a legitimate use of their data. Whilst participants were positive of the role a register could play in promoting research, participants felt that access to data by pharmaceutical industries should be administered by the guardianship committee. People with MS are concerned should their employers be able to access their personal information. Professionals were more cautious than people with MS in their approach to the use of patient personal data within a register. Conclusions: Whilst all stakeholders were positive of the benefits of an MS register, development of such a resource must incorporate robust data security and guardianship measures in order to ensure that, whilst opportunities are maximised, risks to the privacy of individuals and legal challenges to professionals are avoided. (shrink)
BackgroundThere is increasing need for peer reviewers as the scientific literature grows. Formal education in biostatistics and research methodology during residency training is lacking. In this pilot study, we addressed these issues by evaluating a novel method of teaching residents about biostatistics and research methodology using peer review of standardized manuscripts. We hypothesized that mentored peer review would improve resident knowledge and perception of these concepts more than non-mentored peer review, while improving review quality.MethodsA partially blinded, randomized, controlled multi-center study (...) was performed. Seventy-eight neurology residents from nine US neurology programs were randomized to receive mentoring from a local faculty member or not. Within a year, residents reviewed a baseline manuscript and four subsequent manuscripts, all with introduced errors designed to teach fundamental review concepts. In the mentored group, mentors discussed completed reviews with residents. Primary outcome measure was change in knowledge score between pre- and post-tests, measuring epidemiology and biostatistics knowledge. Secondary outcome measures included level of confidence in the use and interpretation of statistical concepts before and after intervention, and RQI score for baseline and final manuscripts.ResultsSixty-four residents completed initial review with gradual decline in completion on subsequent reviews. Change in primary outcome, the difference between pre- and post-test knowledge scores, did not differ between mentored and non-mentored residents. Significant differences in secondary outcomes included mentored residents reporting enhanced understanding of research methodology, understanding of manuscripts, and application of study results to clinical practice compared to non-mentored residents. There was no difference between groups in level of interest in peer review or the quality of manuscript review assessed by the Review Quality Instrument.ConclusionsWe used mentored peer review of standardized manuscripts to teach biostatistics and research methodology and introduce the peer review process to residents. Though knowledge level did not change, mentored residents had enhanced perception in their abilities to understand research methodology and manuscripts and apply study results to clinical practice. (shrink)
I argue for two principles by combining which we can construct a sound cosmological argument. The first is that for any true proposition p's if ‘there is an explanation for p's truth’ is consistent then there is an explanation for p's truth. The second is a modified version of the principle that for any class, if there is an explanation for the non-emptiness of that class, then there is at least one non-member of that class which causes it not to (...) be empty. (shrink)
You have a body, but you are a soul or self. Without your body, you could still exist. Your body could be and perhaps is outlasted by the immaterial substance which is your soul or self. Thus the substance dualist. Most substance dualists are Cartesians. The self, they suppose, is essentially conscious: it cannot exist unless it thinks or wills or has experiences. In this paper I sketch out a different form of substance dualism. I suggest that it is not (...) consciousness but another immaterial feature which is essential to the self, a feature in one way analogous to a non-dispositional taste. Each self has moreover a different feature of this general kind. If this is right then simple and straightforward answers are available to some questions which prove troublesome to the Cartesian, consciousness-requiring type of substance dualist. I mean the questions, How can the self exist in dreamless sleep?, What distinguishes two simultaneously existing selves, and What makes a self the same self as a self which exists at some other time? (shrink)
Some people have supposed that utility is good in itself, non-in-strumentally good, as distinct from good because conducive to other good things. And in modern versions of this view, utility often means want-satisfaction, as distinct from pleasure or happiness. For your want that p to be satisfied, is it necessary that you know or believe that p, or sufficient merely that p is true? However that question is answered, there are problems with the view that want-satisfaction is a non-instrumental good. (...) What if you want something only because you have a false belief? What if the time at which you want that p is fifty or five hundred years before the time to which p itself refers? To meet these difficulties, qualifications have to be introduced, and much has been written about how exactly these qualifications are to be framed.1 There is however what may be a rather more serious objection to the view that want-satisfaction is a non-instrumental good, or rather to the combination of that view with the principle that it is sufficient for your want that p to be satisfied simply that p is true. The objection is that this combination forces you to give undue weight to the mere acquisition of desires when you come to make judgements about changes in the value of things. It forces you to say that for any true proposition p, which initially you do not want to be true, your mere acquisition of a desire that p will, other things being equal, make the world better. Non-instrumental value can be increased merely by multiplying desires, even though everything else remains the same. Surely, however, improving the world is not as easy as that. (shrink)
When do two mental items belong to the same life? We could be content with the answer -just when they have certain volitional qualities in common. An affinity is noted between that theory and Berkeley's early doctrine of the self. Some rivals of the volitional theory invoke a spiritual or physical owner of mental items. They run a risk either of empty formality or of causal superstition. Other rivals postulate a non-transitive and symmetrical relation in the set of mental items. (...) They must allow in consequence either for joint ownership of one and the same mental item, or for incompatible simultaneous decisions by one and the same person, or for new forms of death. This makes them disquieting. Another rival invokes a transitive and symmetrical relation defined in terms of co-consciousness. Even that allows for incongruous simultaneities. The volitional theory is free from such disadvantages. (shrink)
Context: Immunity includes cognitive concepts: the organism is thought to specifically recognize foreign materials and develop a memory of these encounters. Vaccines are thought to work by enhancing this immunological memory. Lymphocytes are key cells and specific antibodies are key molecules in immune recognition. Antibodies are blood proteins called “immunoglobulins.” Spontaneously formed immunoglobulins are seen as “natural” antibodies to dietary components and commensal bacteria. Immune cognition is used simply as a didactic metaphor. Problem: Do the cognitive aspects of immunology stem (...) from the activities of cells and molecules, or are they ascribed by the immunologist operating as a human observer? (1) An immense variety of immunoglobulins may bind to the same antigen with different binding energies. It is the immunologist who arbitrates the boundary between those that are specific (and declared antibodies) and those that are not. Specific antibodies serve as functional labels pasted onto natural immunoglobulins, as if they were recognizing elements. Is this “arbitration” the true cognitive event ascribed to immunoglobulins and lymphocytes? (2) A major impasse exists between progress in experimental immunology and its translation into clinical results. A proper understanding of immunological activity demands a wider view of an organism’s biology and, also, of the interference of human observers in delineating experimental realities, such as the specificity of immune recognition. Maturana’s biology of cognition and language provides one such approach. Method: Use of Maturana’s biology of cognition and language concepts to describe immunological activity. Results: A whole new understanding of immunological activity is suggested. Implications: A major change in the way of seeing is proposed that may eventually help the translation of this knowledge into clinical results. Furthermore, the immune system may also become a proper model for cognitive analyses. (shrink)
Tycho Brahe's lunar theory, mostly the work of his assistant Christian Longomontanus, published in the Progymnasmata , was the most advanced and accurate lunar theory yet developed. Its principal innovations are: the introduction of equant motion for the first inequality in order to separate the determination of direction and distance; a more accurate limit for the second inequality although requiring a more complex calculation; additional inequalities of the variation and, in place of the annual inequality in Tycho's earlier theory, a (...) reduction in the equation of time; in the latitude theory a variation of the inclination of the orbital plane and an inequality of the motion of the nodes; a reduction in the range of variation of distance, parallax, and apparent diameter. Some of these were already present in Tycho's earlier lunar theory , but all were changed in notable ways. Twenty years later Longomontanus published a modified version of the lunar theory in Astronomia Danica , for the purpose of facilitating the calculation through new correction tables, and also explained his reasons for parts of the theory in the Progymnasmata. This paper is a technical study of both lunar theories. (shrink)
In “Potential Subjects’ Responses to an Ethics Questionnaire in a Phase I Study of Deep-Brain Stimulation in Early Parkinson’s Disease,” Finder, Bliton, Gill, Davis, Konrad, and Charles undertake informed consent research on what they describe as a Phase I trial of deep brain stimulation for Parkinson’s disease. We argue that the authors should have more carefully characterized the nature of the DBS study at the start of their clinical study.
The idea that deep brain stimulation induces changes to personality, identity, agency, authenticity, autonomy and self is so deeply entrenched within neuroethics discourses that it has become an unchallenged narrative. In this article, we critically assess evidence about putative effects of DBS on PIAAAS. We conducted a literature review of more than 1535 articles to investigate the prevalence of scientific evidence regarding these potential DBS-induced changes. While we observed an increase in the number of publications in theoretical neuroethics that mention (...) putative DBS-induced changes to patients’ postoperative PIAAAS, we found a critical lack of primary empirical studies corroborating these claims. Our findings strongly suggest that the theoretical neuroethics debate on putative effects of DBS relies on very limited empirical evidence and is, instead, reliant on unsubstantiated speculative assumptions probably in lieu of robust evidence. As such, this may reflect the likelihood of a speculative neuroethics bubble that may need to be deflated. Nevertheless, despite the low number of first-hand primary studies and large number of marginal and single case reports, potential postoperative DBS changes experienced by patients remain a critical ethical concern. We recommend further empirical research in order to enhance theoretical neuroethics work in the area. In particular, we call for the development of better instruments capable of capturing potential postoperative variations of PIAAAS. (shrink)
Conceptualization and measurement of organizational commitment involve different dimensions that include economic, affective, as well as moral aspects labelled in the literature as: 'continuance', 'affective' and 'normative' commitment. This multidimensional framework emerges from the convergence of different research lines. Using Aristotle's philosophical framework, that explicitly considers the role of the will in human commitment, it is proposed a rational explanation of the existence of mentioned dimensions in organizational commitment. Such a theoretical proposal may offer a more accurate definition of 'affective (...) commitment' that distinguishes feelings from rational judgments. The use of a philosophical explanation coherent with psychological findings also allows the discovery of a wider moral concept of 'normative commitment'. (shrink)
The article Deflating the "DBS causes personality changes" bubble, written by Frederic Gilbert, J. N. M. Viaña and C. Ineichen, was originally published electronically on the publisher’s internet portal on 19 June 2018 without open access.
A systematic study of rational or justified belief, which throws fresh light on current debates about foundations and coherence theories of knowledge, the validation of induction and moral scepticism. Dr Nathan focuses attention on the largely unsatisfiable desires for active and self-conscious assurance of truth liable to be engendered by philosophical reflection about total belief-systems and the sources of knowledge. He extracts a kernel of truth from the doctrine that a regress of justification is both necessary and impossible, contrasts the (...) resultant scepticism with more familiar complaints about the inapplicability of supposedly essential cognitive concepts and explores the feasibility of non-Humean modes of consolation. This is an original and carefully constructed book, which will interest professional philosophers and advanced students of epistemology. (shrink)
Beneath metaphysical problems there often lies a conflict between what we want to be true and what we believe to be true. Nathan provides a general account of the resolution of this conflict as a philosophical objective, showing that there are ways of thinking it through systematically with a view to resolving or alleviating it. The author also studies in detail a set of interrelated conflicts about the freedom and the reality of the will. He shows how difficult it is (...) to find a freedom either of decision or of action which is both an object of reflective desire and an object of rational belief. He also examines conflicts about volition as such, contending that the veridicality of volitional experience is no less easy to doubt than the veridicality of our experience of colors. In this context, arguments emerge for a voluntarist theory of the self. Nathan's important book will be essential reading for all philosophers interested in free will, volition, the self, and the methodology of metaphysics. (shrink)
When Did I Begin? investigates the theoretical, moral, and biological issues surrounding the debate over the beginning of human life. With the continuing controversy over the use of in vitro fertilization techniques and experimentation with human embryos, these issues have been forced into the arena of public debate. Following a detailed analysis of the history of the question, Reverend Ford argues that a human individual could not begin before definitive individuation occurs with the appearance of the primitive streak about (...) two weeks after fertilization. This, he argues, is when it becomes finally known whether one or more human individuals are to form from a single egg. Thus, he questions the idea that the fertilized egg itself could be regarded as the beginning of the development of the human individual. The author also differs sharply, however, from those who would delay the beginning of the human person until the brain is formed, or until birth or the onset of conscious states. (shrink)