Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such (...) framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion. (shrink)

Participants in clinical research sometimes view participation as therapy or exaggerate potential benefits, especially in phase I or phase II trials. We conducted this study to discover what methods might improve cancer patients’ understanding of early-phase clinical trials. We randomly assigned 130 cancer patients from three U.S. medical centers who were considering enrollment in a phase I or phase II cancer trial to receive either a multimedia intervention or a National Cancer Institute pamphlet explaining the trial and its purpose. Intervention (...) participants were 32 times more likely to believe that the trial’s purpose was to examine safety and 60 % less likely to believe they would experience long-term benefit or cure. There was no difference in enrollment decision. However, while patients’ understanding of the trial’s purpose improved and expectations of long-term benefit diminished, half the respondents still believed they would experience long-term benefit or cure from participation. Therefore, we conclude that multimedia interventions such as this one may help oncologists to explain the risks and benefits of early-phase cancer trials in a way that patients can more easily understand, helping them to make more informed decisions about participation. But further research into other factors that influence patients’ beliefs about the outcome of enrollment is needed, both to modify the interventions and to determine how malleable patient beliefs are. (shrink)

Recent legislation, such as the Patient Self-Determination Act, establishes advance directives as an acceptable procedural means of incorporating patients’ preferences for life-sustaining treatments into their medical care. Advance directives can enhance medical decision making since they provide patients with an opportunity to communicate their preferences before suffering from an acute illness that may preclude their ability to do so.Although patients expect discussions about life-sustaining therapies to be initiated by their physicians, very little is known about what prompts physicians to discuss (...) advance directives with their patients. As in other areas of clinical decision making, there is evidence that patients’ sociodemographic factors influence whether discussions about advance directives occur between patients and their physicians. In one study of persons with the acquired immunodeficiency syndrome, those who had not had discussions about advance directives with their physicians tended to be non-white, have no prior hospitalization, and were more likely to have been cared for in a health maintenance organization than in a teaching hospital. (shrink)

Recent legislation, such as the Patient Self-Determination Act, establishes advance directives as an acceptable procedural means of incorporating patients’ preferences for life-sustaining treatments into their medical care. Advance directives can enhance medical decision making since they provide patients with an opportunity to communicate their preferences before suffering from an acute illness that may preclude their ability to do so.Although patients expect discussions about life-sustaining therapies to be initiated by their physicians, very little is known about what prompts physicians to discuss (...) advance directives with their patients. As in other areas of clinical decision making, there is evidence that patients’ sociodemographic factors influence whether discussions about advance directives occur between patients and their physicians. In one study of persons with the acquired immunodeficiency syndrome, those who had not had discussions about advance directives with their physicians tended to be non-white, have no prior hospitalization, and were more likely to have been cared for in a health maintenance organization than in a teaching hospital. (shrink)

Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such (...) framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion. (shrink)

As part of an ethics course, health professions students were asked to identify ethical issues and to propose resolutions before and after a class discussion of a case involving confidentiality and substance abuse. Students listed an average of 2.4 issues before and 3.6 issues after the discussion. After discussion 50 per cent of students made explicit changes in their proposed resolution. Opinions varied widely on breaching confidentiality and the responsibility for protecting the patient's health. After the discussion almost 20 per (...) cent of the class felt it was acceptable to breach confidentiality as long as the patient was unaware. Many students identified more with the health care provider than with the patient. The presence of substance abuse altered many students' views on confidentiality. In this experience students were less rigorous in their application of principles, creating an excellent opportunity for teaching through exploration of the complexity of ethical decision-making in a specific case. (shrink)

This collection of essays, offered in honor of the distinguished career of prominent political philosophy professor Clifford Orwin, brings together internationally renowned scholars to provide a wide context and discuss various aspects of the virtue of “humanity” through the history of political philosophy.

This collection of essays, offered in honor of the distinguished career of prominent political philosophy professor Clifford Orwin, brings together internationally renowned scholars to provide a wide context and discuss various aspects of the virtue of “humanity” through the history of political philosophy.

Peter Abelard (1079–1142 ce) was the most wide‐ranging philosopher of the twelfth century. He quickly established himself as a leading teacher of logic in and near Paris shortly after 1100. After his affair with Heloise, and his subsequent castration, Abelard became a monk, but he returned to teaching in the Paris schools until 1140, when his work was condemned by a Church Council at Sens. His logical writings were based around discussion of the “Old Logic”: Porphyry's Isagoge, aristotle'S Categories and (...) On Interpretation and boethius'S textbook on topical inference. They comprise a freestanding Dialectica (“Logic”; probably c.1116), a set of commentaries (known as the Logica [Ingredientibus], c. 1119) and a later (c. 1125) commentary on the Isagoge (Logica Nostrorum Petititoni Sociorum or Glossulae). In a work Abelard called his Theologia, issued in three main versions (between 1120 and c.1134), he attempted a logical analysis of trinitarian relations and explored the philosophical problems surrounding God's claims to omnipotence and omniscience. The Collationes (“Debates,” also known as “Dialogue between a Christian, a Philosopher and a Jew”; probably c.1130) present a rational investigation into the nature of the highest good, in which the Christian and the Philosopher (who seems to be modeled on a philosopher of pagan antiquity) are remarkably in agreement. The unfinished Scito teipsum (“Know thyself,” also known as the “Ethics”; c.1138) analyses moral action. (shrink)

O‐glycosylation is the post‐translational process whereby carbohydrate is added to hydroxylated amino acids of proteins. The major O‐glycosylation pathway in animal cells is involved in the synthesis of oligosaccharides linked by N‐acetylgalactosamine to serine or threonine residues in ‘mucin‐type’ proteins or their analogs. In this review, we discuss the evidence for the cellular localization of the biosynthetic steps in this pathway and propose a simplified, consensus version. We also propose variations of the simple pathway to account for its heterogeneity and (...) variability in different cell types and differentiation states. (shrink)

Emerging research shows a strong connection between brain areas governing cognition and motor behavior. Yet, research investigating the negative aftereffects of cognitive control exertion on task performance has not considered the potential role of areas governing motor behavior. The present study investigated the effects of high cognitive control exertion on task self-efficacy and exercise performance in children. A secondary purpose was to investigate whether motor coordination influences the change in exercise performance differently following low versus high cognitive control exertion. Participants (...) (N = 70) performed two isometric handgrip endurance trials separated by a Stroop task, which was either congruent (low cognitive control) or incongruent (high cognitive control). Motor coordination was assessed prior to the first endurance trial. Task self-efficacy for performing the second endurance trial was assessed following the Stroop task. Participants in the high cognitive control condition reported lower task self-efficacy and showed a reduction in endurance exercise performance. Task self-efficacy mediated the cognitive control – performance relationship. Participants scoring lower on motor coordination showed the greatest declines in exercise performance following high cognitive control, whereas motor coordination did not affect performance following low cognitive control. The results of this study provide evidence that task self-efficacy and exercise performance are also negatively affected in children following high cognitive control, and interestingly, these effects are exacerbated among those scoring lower in motor coordination. We recommend future research investigate motor coordination as a potential mechanism for the reductions in both cognitive and physical task performance following the prolonged exertion of high cognitive control. (shrink)

Theorem A. Let M be a left R-module such that Th(M) is small and weakly minimal, but does not have Morley rank 1. Let $A = \mathrm{acl}(\varnothing) \cap M$ and $I = \{r \in R: rM \subset A\}$ . Notice that I is an ideal. (i) F = R/I is a finite field. (ii) Suppose that a, b 0 ,...,b n ∈ M and a b̄. Then there are s, r i ∈ R, i ≤ n, such that sa + (...) ∑ i ≤ n r ib i ∈ A and $s \not\in I$ . It follows from Theorem A that algebraic closure in M is modular. Using this and results in [B1] and [B2], we obtain Theorem B. Let M be as in Theorem A. Then Vaught's conjecture holds for Th(M). (shrink)

We investigate the algebraic structure of the upper semi-lattice formed by the recursively enumerable Turing degrees. The following strong generalization of Lachlan's Nonsplitting Theorem is proved: Given n ≥ 1, there exists an r.e. degree d such that the interval $\lbrack\mathbf{d, 0'}\rbrack \subset\mathbf{R}$ admits an embedding of the n-atom Boolean algebra B n preserving (least and) greatest element, but also such that there is no (n + 1)-tuple of pairwise incomparable r.e. degrees above d which pairwise join to 0' (and (...) hence, the interval $\lbrack\mathbf{d, 0'}\rbrack \subset\mathbf{R}$ does not admit a greatest-element-preserving embedding of any lattice L which has n + 1 co-atoms, including B n + 1 ). This theorem is the dual of a theorem of Ambos-Spies and Soare, and yields an alternative proof of their result that the theory of R has infinitely many one-types. (shrink)

The apparently paradoxical nature of self-deception has attracted a great deal of controversy in recent years. Focussing on those aspects of the phenomenon which involve the holding of "contradictory" beliefs, it is our intention to argue that this presents no "paradox" if a non-classical, "paraconsistent", doxastic logic is adopted. (On such logics, see, for example, N. C. A. da Costa, 'On the theory of inconsistent formal systems', Notre Dame J Formal Logic 11(1974), 497-510, and A. I. Arruda, 'A survey of (...) paraconsistent logic', in A. I. Arruda, N. C. A da Costa and R Chuaqui, _Mathematical Logic in Latin America, North-Holland, 1984, pp. 1-41.). (shrink)

The purpose of this brief paper is to show that the primary problem of technology, like all problems related to possibilities and actions, is the conceptualiadequacyof the intentions and values it implies, and not, as many critics have suggested, its social effects. Presupposed for this statement and evaluation is an interpretation of experience called here experiential idealism. On the basis of this position some suggestions are made about the meaning of technology and its correlative possibilities and constraints.

It is a safe prediction that, especially now with cultural contacts freely flowing between East and West in both directions, the Hungarian thinker Istvan Bibo will soon be given full accolade as one of the most outstanding political theorists of this century, in stature equal to the �greats� in the entire European tradition of political thought. Bibo's significance far exceeds local, parochial interests. While profoundly original and organically stemming from Hungarian culture, Bibo belongs also to the �West�. If his political (...) thought is to be epitomized in one succinct phrase, it is �the realism of moralism�, or the almost flawless synthesis of a deeply radical, morally infused vision and value-system with the hard-nosed, unsentimental realist-s insight into enduring problems of politics and society. This synthesis is �almost� flawless: in the closing section of this article I will advance a few constructively critical remarks concerning some questionable points in the trajectory of Bibo's thought. (shrink)

The immediate motive occasioning this letter was the worker E. Kopanitsyn's letter to the newspaper Izvestiia in which he eloquently recounts his difficulties with a new machine manufactured in a factory in the city of Cheliabinsk. After telling what effort it had cost him to get this machine going, Kopanitsyn in a fit of temper exclaims: "I am completely unable to understand one simple thing: How could such a machine come into being at all? The hands of many workers touched (...) it, except that these were not working hands. Can it really be true that no one, not a single person, was aroused enough to say: Just what are we doing here, brothers?". (shrink)