Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

The spatial dynamics of the optical emission from an array of 50 times 50 individual microcavity plasma devices is investigated. The array is operated in argon and argon-neon mixtures close to atmospheric pressure with an ac voltage. The optical emission is analysed with phase and space resolution. It has been found that the emission is not continuous over the entire ac period, but occurs once per half period. Each of the observed emission phases shows a self-pulsing of the discharge, with (...) several bursts of emission of fixed width and repetition rate. The number of emission bursts depends on applied voltage and frequency. Spatially resolved measurements prove that the emission bursts are formed by overlapping emission pulses from single discharge cavities. Intensity differences between positive and negative half-wave can be interpreted through spatially resolved measurements of single discharge cavities. (shrink)

Conflicts have arisen between communities and operators of confined animal feeding as farms have become bigger in order to maintain their competitiveness. These conflicts have been difficult to resolve because measuring and allocating the benefits and costs of livestock production is difficult. This papers demonstrates a policy tool for promoting compromise whereby the community gets reduced negative impacts from livestock while at the same time continues to benefit from livestock jobs, taxes, and related economic activity. Public economic benefits and public (...) economic costs of confined animal feeding operations are estimated for every farm and affected house in Craven County, North Carolina. The results show public economic benefits of $5.7 million and public economic costs of $2.2 million, but that the ratio of benefits to costs for individual farm-house pairs varies in important ways across the 26 hog farms in Craven County. (shrink)

By the time this essay is published, it will be a matter of weeks before doctors and nurse practitioners in Canada can legally end the lives (by medical assistance in dying, or MAID) of non-dying p...

Background The use of lengthy, detailed, and complex informed consent forms is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in (...) biomedical research. Methods This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 to 5. Results Of the 2484 questionnaires distributed, 2113 were returned. The majority of respondents considered most elements required in the ICF to be ‘moderately important’ to ‘very important’ for their decision making. Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF. Conclusions Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF. (shrink)

A total of 1918 loci, detected by the hybridization of 938 expressed sequence tag unigenes from 26 Triticeae cDNA libraries, were mapped to wheat homoeologous group 4 chromosomes using a set of deletion, ditelosomic, and nulli-tetrasomic lines. The 1918 EST loci were not distributed uniformly among the three group 4 chromosomes; 41, 28, and 31% mapped to chromosomes 4A, 4B, and 4D, respectively. This pattern is in contrast to the cumulative results of EST mapping in all homoeologous groups, as reported (...) elsewhere, that found the highest proportion of loci mapped to the B genome. Sixty-five percent of these 1918 loci mapped to the long arms of homoeologous group 4 chromosomes, while 35% mapped to the short arms. The distal regions of chromosome arms showed higher numbers of loci than the proximal regions, with the exception of 4DL. This study confirmed the complex structure of chromosome 4A that contains two reciprocal translocations and two inversions, previously identified. An additional inversion in the centromeric region of 4A was revealed. A consensus map for homoeologous group 4 was developed from 119 ESTs unique to group 4. Forty-nine percent of these ESTs were found to be homoologous to sequences on rice chromosome 3, 12% had matches with sequences on other rice chromosomes, and 39% had no matches with rice sequences at all. Limited homology was found between wheat ESTs on homoeologous group 4 and the Arabidopsis genome. Forty-two percent of the homoeologous group 4 ESTs could be classified into functional categories on the basis of blastX searches against all protein databases. (shrink)

Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid organ transplant, thirty-nine (...) (65.0 per cent) for candidates and twenty-one (35.0 per cent ) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent, p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often navigated communication challenges between transplant and non-transplant healthcare professionals and patients and families. (shrink)

Objective: To determine whether a moral reasoning exercise can improve response quality to surveys of healthcare priorities Methods: A randomised internet survey focussing on patient age in healthcare allocation was repeated twice. From 2574 internet panel members from the USA and Canada, 2020 (79%) completed the baseline survey and 1247 (62%) completed the follow-up. We elicited respondent preferences for age via five allocation scenarios. In each scenario, a hypothetical health planner made a decision to fund one of two programmes identical (...) except for average patient age (35 vs 65 years). Half of the respondents (intervention group) were randomly assigned to receive an additional moral reasoning exercise. Responses were elicited again 7 weeks later. Numerical scores ranging from –5 (strongest preference for younger patients) to +5 (strongest preference for older patients); 0 indicates no age preference. Response quality was assessed by propensity to choose extreme or neutral values, internal consistency, temporal stability and appeal to prejudicial factors. Results: With the exception of a scenario offering palliative care, respondents preferred offering scarce resources to younger patients in all clinical contexts. This preference for younger patients was weaker in the intervention group. Indicators of response quality favoured the intervention group. Conclusions: Although people generally prefer allocating scarce resources to young patients over older ones, these preferences are significantly reduced when participants are encouraged to reflect carefully on a wide range of moral principles. A moral reasoning exercise is a promising strategy to improve response quality to surveys of healthcare priorities. (shrink)

A crisis continues to brew within the pharmaceutical research and development (R&D) enterprise: productivity continues declining as costs rise, despite ongoing, often dramatic scientific and technical advances. To reverse this trend, we offer various suggestions for both the expansion and broader adoption of modeling and simulation (M&S) methods. We suggest strategies and scenarios intended to enable new M&S use cases that directly engage R&D knowledge generation and build actionable mechanistic insight, thereby opening the door to enhanced productivity. What M&S requirements (...) must be satisfied to access and open the door, and begin reversing the productivity decline? Can current methods and tools fulfill the requirements, or are new methods necessary? We draw on the relevant, recent literature to provide and explore answers. In so doing, we identify essential, key roles for agent-based and other methods. We assemble a list of requirements necessary for M&S to meet the diverse needs distilled from a collection of research, review, and opinion articles. We argue that to realize its full potential, M&S should be actualized within a larger information technology framework—a dynamic knowledge repository—wherein models of various types execute, evolve, and increase in accuracy over time. We offer some details of the issues that must be addressed for such a repository to accrue the capabilities needed to reverse the productivity decline. (shrink)

Frederick Dretske′s views on the nature of seeing, the possibility of knowledge, the nature of content or non-natural meaning, the nature of behavior, and the role of content in teh causal explanation of behavior have been profoundly important. Dretske and His Critics contains original discussions of these issues by Joh Heil, Stuart Cohen, David H Sanford, Jaegwon Kim, Fred Adams, Daniel Dennett, Robert Cummins, Terence Horgan and Brian McLaughlin. Each chapter is responded to by Dretske himslef.

We show that for random bit strings, Up, with probability, image, the first order quantifier depth D) needed to distinguish non-isomorphic structures is Θ, with high probability. Further, we show that, with high probability, for random ordered graphs, G≤,p with edge probability image, D)=Θ, contrasting with the results for random graphs, Gp, given by Kim et al. [J.H. Kim, O. Pikhurko, J. Spencer, O. Verbitsky, How complex are random graphs in first order logic? Random Structures and Algorithms 26 119–145] of (...) D)=log1/pn+O. (shrink)

Is Leo Strauss truly an intellectual forebear of neoconservatism and a powerful force in shaping Bush administration foreign policy? _The Truth about Leo Strauss_ puts this question to rest, revealing for the first time how the popular media came to perpetuate an oversimplified view of a complex and wide-ranging philosopher. In doing so, it corrects our perception of Strauss, providing the best general introduction available to the political thought of this misunderstood figure. Catherine and Michael Zuckert—both former students of Strauss—guide (...) readers here to a nuanced understanding of how Strauss’s political thought fits into his broader philosophy. Challenging the ideas that Strauss was an inflexible conservative who followed in the footsteps of Nietzsche, Heidegger, and Carl Schmitt, the Zuckerts contend that Strauss’s signature idea was the need for a return to the ancients. Through their work, they conclude that Strauss was a sober defender of liberal democracy, aware of both its strengths and its weaknesses. Balanced and accessible, _The Truth about Leo Strauss_ is a must-read for anyone who wants to more fully comprehend this enigmatic philosopher and his much-disputed legacy. “_The Truth about Leo Strauss_ is the most balanced and insightful book yet written about Strauss’s thought, students, and political influence. It dispels myths promulgated by both friends and foes and persuasively traces the conflicting paths that American thinkers indebted to Strauss have taken.”—William Galston, Brookings Institution. (shrink)

Standard defences of preservationism, and of the intrinsic value of nature more generally, are vulnerable to at least three objections. The first of these comes from social constructivism, the second from the claim that it is incoherent to argue that nature is both 'other' and something with which we can feel unity, whilst the third links defences of nature to authoritarian objectivism and dangerously misanthropic normative dichotomies which set pure nature against impure humanity. I argue that all these objections may (...) be answered by recasting the relationship between man and nature into a tripartite spectrum of ontological form between nature and artifact, with the key question being the extent to which nature has been humanised in accordance with certain modes of strongly instrumental rationality, these in turn being defined by reference to the split between abstract reason and natural feeling which was exacerbated by specific elements in the Enlightenment period. This new model may grant normative force by linking external nature to a broader conception of human psychological wellbeing than that offered by the quantitatively orientated models of human rationality and agency. (shrink)

A numerical classification was performed on 69 elements with 54 chemicaland physicochemical properties. The elements fell into clusters in closeaccord with the electron shell s-, p- andd-blocks. The f-block elements were not included forlack of sufficiently complete data. The successive periods ofs- and p-block elements appeared in an ovalconfiguration, with d-block elements lying to one side. Morethan three axes were required to give good representation of thevariation, although the interpretation of the higher axes is difficult.Only 15 properties were scorable for (...) the noble gases, but despite thepaucity of properties reflecting chemical reactivity, analysis of the 69elements on these properties still showed the major features seen fromthe full set. (shrink)

A scholarly edition of a work by David Hume. The edition presents an authoritative text, together with an introduction, commentary notes, and scholarly apparatus.

Beyond the Learning Curve reviews and considers the psychology of skill acquisition. In so doing the authors propose a whole new theory of mental function - demonstrating that the mind is subject to the same natural laws as the physical world. Accessibly written, 'Beyond the learning curve' is a thought provoking and challenging new text for students and researchers in the cognitive sciences.

Poverty violates fundamental human values through its impact on individuals and on human environments, and it goes against the core values of democratic societies. Drawing on numerous scientific studies as well as his own experience witnessing the systematic poverty in his home country of South Africa, H. P. P. [Hennie] Lötter presents a holistic profile of poverty and its effects on human lives all the while accounting for the complexity of each individual case. He argues that shared ethical values must (...) guide the planning and distribution of aid and that our society must reevaluate our notions of justice and reimagine the role of the state in order to enable collective human responsibility for poverty’s successful eradication. (shrink)

Rid and Wendler propose the development of a Patient Preference Predictor (PPP), an actuarial model for predicting incapacitated patient’s life-sustaining treatment preferences across a wide range of end-of-life scenarios. An actuarial approach to end-of-life decision making has enormous potential, but transferring the logic of actuarial prediction to end-of-life decision making raises several conceptual complexities and logistical problems that need further consideration. Actuarial models have proven effective in targeted prediction tasks, but no evidence supports their effectiveness in the kind of broad (...) spectrum prediction task that is the proposed goal of the PPP. We argue that a more focused approach, targeting specific medical conditions and generating treatment predictions based on the preferences of individuals with actual disease experience, is both more firmly grounded in past research and is a more prudent initial strategy for exploring the efficacy of actuarial prediction in end-of-life decision making. (shrink)

(1) It remains to be seen if in the field of Psychiatry just as in that of Psychology the verbal output of a subject can be submitted to verification. Many statements of a highly emotional character being merely symptoms of certain dispositions have no direct communicative sense at all.(2) It being one of the characteristics of the mentally ill to loose contact and exchange of ideas with other people, the question naturally suggests itself if this symptom may be at the (...) bottom of the phenomenon of these persons taking refuge in logical and ideological terminologies, their talk being a kind of verbal autism. (shrink)

The proposition that Jesus was ‘Bad, Mad or God’ is central to C.S. Lewis's popular apologetics. It is fêted by American Evangelicals, cautiously endorsed by Roman Catholics and Protestants, but often scorned by philosophers of religion. Most, mistakenly, regard Lewis's trilemma as unique. This paper examines the roots of this proposition in a two thousand year old theological and philosophical tradition (that is, aut Deus aut malus homo), grounded in the Johannine trilemma (‘unbalanced liar’, or ‘demonically possessed’, or ‘the God (...) of Israel come amongst his people’). Jesus can only be understood in the context of the Jewish religious categories he was born into; therefore, for Lewis, Jesus is who he reveals himself to be. Jesus' self-understanding reflects his identity, his triune salvific role; this is for Lewis, the transposed reality of divine Sonship. Reason and logic are paramount here, reflected in the structure of Lewis's argument. Lewis's trilemma is not so much a proof of God's existence, but a question, a dilemma, where each and every person must come to a decision. For all its perceived faults, its simplistic language, Lewis's trilemma still is a very successful piece of Christian apologetic, grounded in a serious philosophical and theological tradition. (shrink)

One approach to the analysis of ethical dilemmas in medical practice uses the “four principles plus scope” approach. These principles are: respect for autonomy, beneficence, non-maleficence and justice, along with concern for their scope of application. However, conflicts between the different principles are commonplace in psychiatric practice, especially in forensic psychiatry, where duties to patients often conflict with duties to third parties such as the public. This article seeks to highlight some of the specific ethical dilemmas encountered in forensic psychiatry: (...) the excessive use of segregation for the protection of others, the ethics of using mechanical restraint when clinically beneficial and the use of physical treatment without consent. We argue that justice, as a principle, should be paramount in forensic psychiatry, and that there is a need for a more specific code of ethics to cover specialised areas of medicine like forensic psychiatry. This code should specify that in cases of conflict between different principles, justice should gain precedence over the other principles. (shrink)

This article explores the influence of Stoicism and religion on Adam Smith. While other commentators have argued either that the main influence on Smith was Stoicism or that it was religion, the two influences have not been explicitly linked. In this article I attempt to make such a link, arguing that Smith can be seen as belonging to the strand of Christian Stoicism chiefly associated with his teacher, Francis Hutcheson. Finally, some comments are made about the implications of this interpretation (...) for current understanding of the work of Adam Smith. (shrink)

table ronde du Centre national de la recherche scientifique, Paris, 27-29 mars 1979. Huygens et la France (Paris, Vrin, 1981, p. 99-114) CHRISTIAAN HUYGENS VU PAR LEIBNIZ par Albert HEINEKAMP (*) (Leibniz-Archiv, Hannover) Les ...

First Published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.