Background: Financial conflict of interest in clinical research is an area of active debate. While data exist on the perspectives and roles of academic institutions, investigators, industry sponsors, and scientific journals, little is known about the perspectives of potential research participants.Methods: The authors surveyed potential research participants over the internet, using the Harris Interactive Chronic Illness Database. A potential research participant was defined by: self report of diagnosis by a health care professional and willingness to participate in clinical trials. Email (...) invitations were sent to 20 205 persons with coronary artery disease, breast cancer, or depression; a total of 6363 persons were screened; of these, 86% or 5478 met inclusion criteria and completed the survey. The outcome measures were respondents’ ratings on: importance of knowing conflict of interest information, whether its disclosure ought to be required, and its effect on willingness to participate—across seven widely discussed scenarios of financial conflicts of interest .Results: Majority responded that knowing conflict of interest information was “extremely” or “very” important; a larger majority felt financial conflicts of interest should be disclosed as part of informed consent . In all seven scenarios, a majority was still willing to participate but in some scenarios a sizable minority would be wary of participation. Respondents were more wary of individual than institutional conflicts of interest. Illness group and sociodemographic factors had modest effects and did not affect the main trends.Conclusions: The prevailing practice of non-disclosure of financial conflicts of interest in clinical research appears contrary to the values of potential research participants. (shrink)

Over the last 20+ years, multinational corporations have been confronted with accusations of abuse of market power and unfair and unethical business conduct especially as it relates to their overseas operations and supply chain management. These accusations include, among others, worker exploitation in terms of unfairly low wages, excessive work hours, and unsafe work environment; pollution and contamination of air, ground water and land resources; and, undermining the ability of natural government to protect the well-being of their citizens. MNCs have (...) responded to these accusations by creating voluntary codes of conduct which commit them to specific standards for addressing these issues. These codes are created at both the industry-wide and the individual company level. Unfortunately, these codes have generated little credibility and public trust because their compliance claims cannot be independently verified, and they lack transparency and full public disclosure. In this article, we present a case study of the voluntary code of conduct by Mattel, Inc., the world’s largest toy company. The code, called the Global Manufacturing Principles, confronts the general criticism leveled against voluntary codes of conduct by creating detailed standards of compliance, independent external monitoring of the company’s compliance with its code of conduct, and making full, and uncensored public disclosure of the audit findings and company’s response in terms of remedial action. We present a detailed account of how Mattel’s voluntary code of conduct was created, implemented, and ultimately abandoned over 9 years. We provide an evaluative analysis of the company’s GMP compliance throughout its life span, which suggests a bell-shaped curve, where early top management commitments were met with pockets of resistance from operational groups, who were concerned about balancing GMP compliance efforts with traditional performance criteria. The early stage response from Mattel’s top management was quick and supported with the requisite resources. As a result, the compliance process accelerated, becoming increasingly more robust and effective. The success of code compliance and increased transparency in public disclosure energized field managers with a sense of professional satisfaction and publicly recognized accomplishments. The decline in GMP compliance was equally steep. When all the easily attainable targets had been reached at the company-operated plants, addressing vendor plants’ compliance presented a new set of challenges, which taxed corporate resources and management commitment. It would seem that value-based and ethics-oriented considerations, i.e., doing the right thing for the right reason, were no longer the driving force for Mattel’s management. Mattel did not see any economic benefit from its proactive stance, when competitors did not seem to suffer adverse consequences for not following suit. The final contributing factor to the code’s abandonment was a widely publicized series of product recalls which absorbed top management’s attention. (shrink)

Point-of-care testing (POCT) is a sensitive, specific and rapid form of testing for the presence of HIV antibodies. Post-exposure prophylaxis for HIV infection can reduce seroconversion rates by up to 80%. Needlestick injuries are the second commonest cause of occupational injury in the NHS and 20% of these occur during operations. In the NHS, in order to protect staff and patients from the risk of bloodborne viruses such as HIV, it is mandatory to report such injuries; however, numerous studies have (...) shown that many groups, particularly doctors, are reluctant to do so. This article outlines the arguments for and against the introduction of preoperatively seeking consent from patients to have their blood tested for HIV via POCT in order to improve the reporting rates of needlestick injuries incurred during surgery and to protect staff from infection. (shrink)

Juvenal opens his eighth Satire with the question stemmata quid faciunt?, supplies an answer in line 20, nobilitas sola est atque unica virtus, and devotes the rest of the poem to exhorting his addressee to virtuous activity, both by negative exempla drawn from the degenerate nobility and by positive exempla drawn from the plebs, novi homines and the like. In lines 39–70 he addresses one particularly self-important noble and attempts to deflate his bombastic pride: in 56–67 he adduces an extended (...) illustration from the animal world, apparently such as was common in the schools of rhetoric. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:19. HUME AND BARKER ON THE LOGIC OF DESIGN I find myself in complete agreement with what I take to be the main thesis of Stephen Barker's paper. It is certainly a mistake to concentrate our attention on the negative critique which Hume directed at the modes of argument of his rationalist predecessors and contemporaries and directed even more at the mode of certain conviction with which they presented (...) conclusions arrived at by arguments that did not have a logically compelling force. Hume was very much concerned with the problem of just what kind of force an argument that was not logically compelling could have; and he was even more concerned (perhaps) with the problem of how the logical structure of non-compelling argument could best be exhibited so that the logic of the argument would not be confused with its force. He made significant contributions to both of these problems; and I think he knew what he was doing well enough not to deserve the charge of inconsistency which Barker seems inclined to bring against him. There are some questions which he did not address, for the very good reason that they could only arise, or at least they could only be formulated clearly, as a result of the clarification of our ideas and our situation that Hume himself achieved. His distinction between "relations of ideas" and "matters of fact" may be overly simplistic. But in all its simplicity this distinction is powerful enough to enable Hume to deal quite shortly with any claim that it is inconsistent to want to achieve this goal of knowing and saying what is true, just because we have shown that we have no logical guarantee that we shall achieve it. Christian orthodoxy has always maintained that we are all of us equally "sinners"; but no orthodox Christian moralist has ever maintained the Stoic paradox that all sins are equal. It is precisely because we know that we cannot achieve Stoic wisdom that we cannot possibly be tempted to 20. accept that paradox. Hume's achievement was to show that (in spite of the serpent's false promise) our situation with respect to knowledge has always been just as parlous as our situation with respect to action. But even in these unhappy circumstances it is not inconsistent to strive for whatever measure of truth we can achieve; and to strive at the same time for absolute logical clarity about the limits of our insight and about the comparative merits of all proposed approaches to the goal. But I must not devote my time to an issue that Barker wisely asks us to keep an open mind about. I want to discuss the form and substance of the arguments with which Barker supports the thesis that I do agree with, rather than take up an aside of his that I happen not to agree with. So then, first, let us consider the fault that he finds in the "fifth way" of Thomas. He says that it "begs the question". It "obscures the nexus of controversy" because the first premiss of the syllogism makes a crucial assumption that needs to be proved. Now I deny that the "fifth way" obscures the nexus of controversy in that way. Thomas (and all of his competent hearers) knew perfectly well that his first premiss had not been universally accepted. He was stating the view of Aristotle about the generally purposive character of nature, and he knew that it had been doubted. But he did not think that a rational believer could hesitate about the choice between Aristotle's position and that of the atheist defenders of chance. Anyone who did hesitate was a fool, and arguments could not touch him. That some men were fools, and could "say in their heart, 'There is no God'", was part of the "problem of evil" which we must consign trustfully to the inscrutable wisdom of God (save in so far as Scripture reveals to us the origin of and reason for our fallen condition). In Hume's world, Aristotle's conception of the orderliness of Nature had been supplanted by Newton's. Newton accepted the atomist view that "natural bodies... (shrink)

Over the last 20+ years, multinational corporations (MNCs) have been confronted with accusations of abuse of market power and unfair and unethical business conduct especially as it relates to their overseas operations and supply chain management. These accusations include, among others, worker exploitation in terms of unfairly low wages, excessive work hours, and unsafe work environment; pollution and contamination of air, ground water and land resources; and, undermining the ability of natural government to protect the well-being of their citizens. MNCs (...) have responded to these accusations by creating voluntary codes of conduct which commit them to specific standards for addressing these issues. These codes are created at both the industry-wide and the individual company level. Unfortunately, these codes have generated little credibility and public trust because their compliance claims cannot be independently verified, and they lack transparency and full public disclosure. In this article, we present a case study of the voluntary code of conduct by Mattel, Inc., the world's largest toy company. The code, called the Global Manufacturing Principles (GMP), confronts the general criticism leveled against voluntary codes of conduct by (a) creating detailed standards of compliance, (b) independent external monitoring of the company's compliance with its code of conduct, and (c) making full, and uncensored public disclosure of the audit findings and company's response in terms of remedial action. We present a detailed account of how Mattel's voluntary code of conduct was created, implemented, and ultimately abandoned over 9 years. We provide an evaluative analysis of the company's GMP compliance throughout its life span, which suggests a bellshaped curve, where early top management commitments were met with pockets of resistance from operational groups, who were concerned about balancing GMP compliance efforts with traditional performance criteria. The early stage response from Mattel's top management was quick and supported with the requisite resources. As a result, the compliance process accelerated, becoming increasingly more robust and effective. The success of code compliance and increased transparency in public disclosure energized field managers with a sense of professional satisfaction and publicly recognized accomplishments.The decline in GMP compliance was equally steep. When all the easily attainable targets had been reached at the company-operated plants, addressing vendor plants' compliance presented a new set of challenges, which taxed corporate resources and management commitment. It would seem that value-based and ethicsoriented considerations, i. e., doing the right thing for the right reason, were no longer the driving force for Mattel's management. Mattel did not see any economic benefit from its proactive stance, when competitors did not seem to suffer adverse consequences for not following suit. The final contributing factor to the code's abandonment was a widely publicized series of product recalls which absorbed top management's attention. (shrink)

Volume 20, Issue 10, October 2020, Page W4-W7.

Rationale, aims and objectives To compare the pharmacotherapeutic approaches to diabetic hypertension of family physicians (FPs) and general practitioners (GPs). Methods A retrospective prescription-based study was conducted in 15 out of a total of 20 health centres, involving 115 primary care physicians – 77 FPs and 38 GPs, representing 74% of the primary care physicians of Bahrain. Prescriptions were collected during May and June 2000 to comprise a study population of 1266 diabetic-hypertensive patients. Results As monotherapy, angiotensin-converting enzyme (ACE) inhibitors (...) (37.9%) and β-blockers (38.3%) were the most commonly prescribed classes of antihypertensives by FPs and GPs, respectively. Calcium channel blockers (CCBs) were ranked third by both categories of physicians. For two-drug combinations, a β-blocker and an ACE inhibitor was the combination of choice for both physician categories. Patients managed by the FPs were more likely to receive a β-blocker–CCB combination (17.4 vs. 14.9%) or a diuretic–ACE inhibitor combination (16.7 vs. 11.4%) and less likely to receive a β-blocker–diuretic combination (11.8 vs. 16.7%) than those managed by the GPs. The proportion of patients receiving antihypertensive combinations was 40.6 and 38.5% for FPs and GPs, respectively. While the GPs prescribed CCB as a monotherapy to the elderly most often, the FPs choice was a β-blocker. Diuretics were less preferred by both FPs and GPs. β-Blocker–ACE inhibitor was again the most preferred combination of both FPs and GPs. FPs prescribed CCB–β-blocker combinations more often than GPs (P = 0.01), whereas CCB–ACE inhibitor combinations were less preferred (P = 0.09). A trend towards excessive use of short-acting nifedipine as monotherapy for elderly patients, both by FPs and by GPs, was noticed. Glibenclamide, alone or in combination with metformin, was the foremost antidiabetic drug prescribed by FPs and GPs. Middle-aged (45–64 years) patients seen by GPs were more likely to receive glibenclamide than those treated by FPs (P = 0.001) and less likely to receive gliclazide (P = 0.01). Combinations of a β-blocker with either glibenclamide or insulin were prescribed considerably more often by GPs.Conclusions Within the same practice setting, a substantial difference was observed between FPs and GPs in terms of preference for different classes of drugs in the management of diabetic hypertension. The compliance of both FPs and GPs was suboptimal; overall, the compliance of the FPs was closer to the recommended guidelines, however. Educational programmes should specifically address these inadequacies in order to improve the quality of health care. (shrink)

Intensive professional testing of children with disabilities is becoming increasingly prominent within the field of children’s rehabilitation. In this paper we question the high quality ascribed to standardized assessment procedures. We explore testing practices using a hermeneutic-phenomenological approach analyzing data from interviews and participant observations among 20 children with disabilities and their parents. All the participating children have extensive experience from being tested. This study reveals that the practices of testing have certain limitations when confronted with the lived experience of (...) those who are being tested. Testing seems to transmit the experts’ view of what is important, correct and admirable, and the way in which an individual child fulfills such requirements and fits in with the predetermined standard. Regular testing may result in insecurity on the part of the tested individual, and possibly to a lack of confidence in their body and the way it functions. For the individual being tested the meaning of testing is primarily related to passing or not passing the test requirements. Given the meaning of testing, children with disabilities may experience repeated testing as an ordeal that they are expected to put up with. By illuminating the experiences of the ones exposed to testing, this paper offers new insight for professionals to gauge more accurately the quality of contemporary testing practice. (shrink)

SummaryA health facility-based approach to delivering anthelminthic drugs to children aged 12–59 months in Zambia was compared with an approach where community-directed treatment was added to the HF approach. This paper reports on the socio-demographic factors associated with treatment coverage in the HF+ComDT and HF areas after 18 months of implementation. Data were collected by interviewing 288 and 378 caretakers of children aged 12–59 months in the HF+ComDT and HF areas, respectively. Bivariate and multivariate logistic regression analyses were used for (...) data analysis. Statistically significant predictors of a child being treated were: a child coming from the HF+ComDT area, being 12–36 months old, the family having lived in the area for >20 years, coming from a household with only one under-five child and living ≤3 km from the health facility. It is concluded that socio-demographic factors are of public health relevance and affect treatment coverage in both the HF+ComDT and the HF approaches. The implementation and strengthening of interventions like ComDT that bring treatment closer to households will enable more children to have access to treatment. (shrink)

The text of the tract De arcubus similibus was published for the first time by M. Curtze in 1887. However, after examining some more Latin manuscripts and the Arabic MS Oxford, Bodleian Library, Marsh 663 it appeared, that Curtze's edition was rather an adaptation. Also Curtze's suggestion that Jordanus Nemorarius was the author was very probably wrong. The author of the tract was the Egyptian mathematician Ahmed ibn Jusuf as appears from the Latin manuscripts, and its translator, very probably, Gerard (...) of Cremona. In the tract Ahmed tried to prove, that the assertion ‘similar arcs are also equal arcs’ was wrong . His starting points were the propositions Euclid III, 20 and 21. Consequently, the tract can be looked upon as a commentary on the third book of the Elements. (shrink)

First published in 1985, the _Handbook for Achieving Gender Equity Through Education_ quickly established itself as the essential reference work concerning gender equity in education. This new, expanded edition provides a 20-year retrospective of the field, one that has the great advantage of documenting U.S. national data on the gains and losses in the efforts to advance gender equality through policies such as Title IX, the landmark federal law prohibiting sex discrimination in education, equity programs and research. Key features include:_ (...) Expertise_ – Like its predecessor, over 200 expert authors and reviewers provide accurate, consensus, research-based information on the nature of gender equity challenges and what is needed to meet them at all levels of education._ Content Area Focus_ – The analysis of gender equity within specific curriculum areas has been expanded from 6 to 10 chapters including mathematics, science, and engineering._ Global/Diversity Focus_ – Global gender equity is addressed in a separate chapter as well as in numerous other chapters. The expanded section on gender equity strategies for diverse populations contains seven chapters on African Americans, Latina/os, Asian and Pacific Island Americans, American Indians, gifted students, students with disabilities, and lesbian, gay, bisexual, and transgender students. _ Action Oriented_ – All chapters contain practical recommendations for making education activities and outcomes more gender equitable. A final chapter consolidates individual chapter recommendations for educators, policymakers, and researchers to achieve gender equity in and through education._ New Material_ – Expanded from 25 to 31 chapters, this new edition includes: *more emphasis on male gender equity and on sexuality issues; *special within population gender equity challenges ; *coeducation and single sex education; *increased use of rigorous research strategies such as meta-analysis showing more sex similarities and fewer sex differences and of evaluations of implementation programs; *technology and gender equity is now treated in three chapters; *women’s and gender studies; *communication skills relating to English, bilingual, and foreign language learning; and *history and implementation of Title IX and other federal and state policies. Since there is so much misleading information about gender equity and education, this _Handbook_ will be essential for anyone who wants accurate, research-based information on controversial gender equity issues—journalists, policy makers, teachers, Title IX coordinators, equity trainers, women’s and gender study faculty, students, and parents. (shrink)

Background: Although fair distribution of healthcare services for older patients is an important challenge, qualitative research exploring clinicians’ considerations in clinical prioritisation within this field is scarce. Objectives: To explore how clinicians understand their professional role in clinical prioritisations in healthcare services for old patients. Design: A semi-structured interview-guide was employed to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis. Participants: 20 physicians and 25 nurses working in public hospitals and nursing homes (...) in different parts of Norway. Results and interpretations: The clinicians struggle with not being able to attend to the comprehensive needs of older patients, and being unfaithful to professional ideals and expectations. There is a tendency towards lowering the standards and narrowing the role of the clinician. This is done in order to secure the vital needs of the patient, but is at the expense of good practice and holistic role modelling. Increased specialisation, advances and increase in medical interventions, economical incentives, organisational structures, and biomedical paradigms, may all contribute to a narrowing of the clinicians’ role. Conclusion: Distributing healthcare services in a fair way is generally not described as integral to the clinicians’ role in clinical prioritisations. If considerations of justice are not included in clinicians’ role, it is likely that others will shape major parts of their roles and responsibilities in clinical prioritisations. Fair distribution of healthcare services for older patients is possible only if clinicians accept responsibility in these questions. (shrink)

Person‐specific evidence was developed as a grounded theory by analyzing 20 selected case descriptions from interventions using the guided self‐determination method with people with various long‐term health conditions. It explains the mechanisms of mobilizing relational capacity by including person‐specific evidence in shared decision‐making. Person‐specific self‐insight was the first step, achieved as individuals completed reflection sheets enabling them to clarify their personal values and identify actions or omissions related to self‐management challenges. This step paved the way for sharing these insights and (...) challenges in a relationship with a supportive health professional, who could then rely on person‐specific evidence instead of assumptions or a narrow disease perspective for shared decision‐making. Trust in the evidence encouraged the supportive health professional to transfer it to the interdisciplinary team. Person‐specific evidence then enhanced the ability of team members to apply general evidence in a meaningful way. The increased openness achieved by individuals through these steps enabled them to eventually share their new self‐insights in daily life with other people, decreasing loneliness they experienced in self‐management. Relational capacity, the core of the theory, is mobilized in both people with long‐term health conditions and healthcare professionals. Further research on person‐specific evidence and relational capacity in healthcare is recommended. (shrink)

Book synopsis: Aristotle's probing inquiry into some of the fundamental problems of philosophy, The Metaphysics is one of the classical Greek foundation-stones of western thought, translated from the with an introduction by Hugh Lawson-Tancred in Penguin Classics. The Metaphysics presents Aristotle's mature rejection of both the Platonic theory that what we perceive is just a pale reflection of reality and the hard-headed view that all processes are ultimately material. He argued instead that the reality or substance of things lies in (...) their concrete forms, and in so doing he probed some of the deepest questions of philosophy: What is existence? How is change possible? And are there certain things that must exist for anything else to exist at all? The seminal notions discussed in The Metaphysics - of 'substance' and associated concepts of matter and form, essence and accident, potentiality and actuality - have had a profound and enduring influence, and laid the foundations for one of the central branches of Western philosophy. Hugh Lawson-Tancred's lucid translation is accompanied by a stimulating introduction in which he highlights the central themes of one of philosophy's supreme masterpieces. Aristotle (384-22 BC) studied at the Academy of Plato for 20 years and then established his own school and research institute, 'The Lyceum'. His writings, which were of extraordinary range, profoundly affected the whole course of ancient and medieval philosophy and are still eagerly studied and debated by philosophers today. (shrink)

Background: A fair distribution of healthcare services for older patients is an important challenge, but qualitative research exploring clinicians’ consideration in daily clinical prioritisation in healthcare services for the aged is scarce.Objectives: To explore what kind of criteria, values, and other relevant considerations are important in clinical prioritisations in healthcare services for older patients.Design: A semi-structured interview-guide was used to interview 45 clinicians working with older patients. The interviews were analysed qualitatively using hermeneutical content analysis and template organising style.Participants: 20 (...) physicians and 25 nurses working in public hospitals and nursing homes in different parts of Norway.Results and interpretations: Important dilemmas relate to under-provision of community care and comprehensive approaches, and over-utilisation of certain specialised services. Overt ageism is generally not reported, but the healthcare services for the aged seem to be inadequate due to more subtle processes, for example, dominating considerations and ideals and operating conditions that do not pay sufficient attention to older patients’ needs and considerations of justice. Clinical prioritisations are described as being dominated by adapting traditional biomedical approaches to the operating conditions. Many of the clinicians indicate that there is a potential for improving end of life decisions and for reducing exaggerated use of life-prolonging treatment and hospitalisations.Conclusion: The interviews in this study indicate that considerations of justice and patients’ perspectives should be given more attention to strike a balance between specialised medical approaches and more general and comprehensive approaches in healthcare services for older patients. (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 report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients. DESIGN: Retrospective descriptive study. SETTING: A cancer clinical trials unit in a large teaching hospital. PATIENTS: From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied. MAIN MEASUREMENT: Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated. RESULTS: (...) DNR orders were written for 64.4% of patients. Patients in pain (odds ratio 0.45, 95% CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95% CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patients were taken home to die, a more likely occurrence if the patient was over 75 years (odds ratio 0.12, 95% CI 0.04-0.34), had children (odds ratio 0.14, 95% CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95% CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95% CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge. CONCLUSIONS: DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20% of dying patients are taken home to die, in accordance with local custom. (shrink)

This paper reports a study of planning processes in the five-disc Tower of London (TOL) task in 20 younger and 20 older adult participants. A concurrent direct ''think-aloud'' method was used to obtain data on planning processes prior to moving discs in the TOL. A check was made of the effects of verbalising by comparing performance data from the experimental groups with data from control groups who did not verbalise during planning or moving. Verbalising slowed down planning and moving but (...) did not appear to distort the participants' approaches to the task. Older and younger participants did not differ in average moves taken to solve the tasks. However, older participants' planning was less complete and more error-prone than that of younger participants. The planning processes were characterised as showing a means-ends ''goal selection'' strategy. In this strategy participants (1) identify a single active goal disc at the start, (2) select moves and move sequences to enable the placing of the current goal disc in its target position, and (3) continue in this way until all discs are in their target positions. Age differences were found in the planning stage, during which there was no stimulus support and hence a substantial working memory load. During the move phase there was stimulus support and hence little loading of working memory. Age differences in moves required were not found in the move phase. As older participants tend to have depleted working memory capacity the present results suggest that working memory is heavily loaded in TOL planning but less so in the move phase of TOL. (shrink)

This paper reports a study of the roles of visuo-spatial and verbal working memory capacities in solving a planning task - the five-disc Tower of London (TOL) task. An individual differences approach was taken. Sixty adult participants were tested on 20 TOL tasks of varying difficulty. Total moves over the 20 TOL tasks was taken as a measure of performance. Participants were also assessed on measures of fluid intelligence (Raven's matrices), verbal short-term storage (Digit span), verbal working memory span (Silly (...) Sentence span), visuo-spatial short-term storage (Visual Pattern span and Corsi Block span), visuo-spatial working memory (Corsi Distance Estimation), visuo-spatial processing speed (Manikin test), and verbal speed (Rehearsal speed). Exploratory factor analysis using an oblique rotation method revealed three factors which were interpreted as (1) a visuo-spatial working memory factor, (2) an age-speed factor, and (3) a verbal working memory factor. The visuo-spatial and verbal factors were only moderately correlated. Performance on the TOL task loaded on the visuo-spatial factor but did not load on the other factors. It is concluded that the predominant goal-selection strategy adopted in solving the TOL relies on visuo-spatial working memory capacity and particularly involves the active ''inner scribe'' spatial rehearsal mechanism. These correlational analyses confirm and extend results previously obtained by use of dual task methods, (Phillips, Wynn, Gilhooly, Della Sala, & Logie, 1999). (shrink)

Objectives Disclosures of funding sources and conflicts of interests (COI) in published peer-reviewed journal articles have recently begun to receive some attention, but many critical questions remain, for example, how often such reporting occurs concerning research conducted in the developing world and what factors may be involved. Design Of all articles indexed in Medline reporting on human subject HIV research in 2007 conducted in four countries (India, Thailand, Nigeria and Uganda), this study explored how many disclosed a funding source and (...) COI, and what factors are involved. Results Of 221 articles that met the criteria, 67.9% (150) disclosed the presence or absence of a funding source, but only 20% (44) disclosed COI. Studies from Uganda were more likely, and those from Nigeria were less likely to mention a funding source (p<0.001). Of articles in journals that had adopted International Committee of Medical Journal Editors (ICMJE) guidelines, 56% did not disclose COI. Disclosure of funding was more likely when: ≥50% of the authors and the corresponding author were from the sponsoring country, the sponsor country was the USA, and the articles were published in journals in which more of the editors were from the sponsoring countries. Conclusions Of the published studies examined, over a third did not disclose funding source (ie, whether or not there was a funding source) and 80% did not disclose whether COI existed. Most articles in ICMJE-affiliated journals did not disclose COI. These data suggest the need to consider alteration of policies to require that published articles include funding and COI information, to allow readers to assess articles as fully as possible. (shrink)

BackgroundConventionally, transcranial direct current stimulation (tDCS) aims to focalize the current reaching the target region-of-interest (ROI). The focality can be quantified by the dose-target-determination-index (DTDI). Despite having a uniform tDCS setup, some individuals receive focal stimulation (high DTDI) while others show reduced focality (“non-focal”). The volume of cerebrospinal fluid (CSF), gray matter (GM), and white matter (WM) underlying each ROI govern the tDCS current distribution inside the brain, thereby regulating focality.AimTo determine the regional volume parameters that differentiate the focal and (...) non-focal groups.MethodsT1-weighted images of the brain from 300 age-sex matched adults were divided into three equal groups- (a) Young (20 ≤ × < 40 years), (b) Middle (40 ≤ × < 60 years), and (c) Older (60 ≤ × < 80 years). For each group, inter and intra-hemispheric montages with electrodes at (1) F3 and right supraorbital region (F3-RSO), and (2) CP5 and Cz (CP5-Cz) were simulated, targeting the left- Dorsolateral Prefrontal Cortex (DLPFC) and -Inferior Parietal Lobule (IPL), respectively. Both montages were simulated for two current doses (1 and 2 mA). For each individual head simulated for a tDCS configuration (montage and dose), the current density at each region-of-interest (ROI) and their DTDI were calculated. The individuals were categorized into two groups- (1) Focal (DTDI ≥ 0.75), and (2) Non-focal (DTDI < 0.75). The regional volume of CSF, GM, and WM of all the ROIs was determined. For each tDCS configuration and ROI, three 3-way analysis of variance was performed considering- (i) GM, (ii) WM, and (iii) CSF as the dependent variable (DV). The age group, sex, and focality group were the between-subject factors. For a given ROI, if any of the 3 DV’s showed a significant main effect or interaction involving the focality group, then that ROI was classified as a “focal ROI.”ResultsRegional CSF was the principal determinant of focality. For interhemispheric F3-RSO montage, interaction effect (p < 0.05) of age and focality was observed at Left Caudate Nucleus, with the focal group exhibiting higher CSF volume. The CSF volume of focal ROI correlated positively (r ∼ 0.16, p < 0.05) with the current density at the target ROI (DLPFC). For intrahemispheric CP5-Cz montage, a significant (p < 0.05) main effect was observed at the left pre- and post-central gyrus, with the focal group showing lower CSF volume. The CSF volume correlated negatively (r ∼ –0.16, p < 0.05) with current density at left IPL. The results were consistent for both current doses.ConclusionThe CSF channels the flow of tDCS current between electrodes with focal ROIs acting like reservoirs of current. The position of focal ROI in the channel determines the stimulation intensity at the target ROI. For focal stimulation in interhemispheric F3-RSO, the proximity of focal ROI reserves the current density at the target ROI (DLPFC). In contrast, for intrahemispheric montage (CP5-Cz), the far-end location of focal ROI reduces the current density at the target (IPL). (shrink)

This article aims to shed light on Hegel's conception of colonialism and its implications for the postcolonial reception of Hegel. Drawing on the abundant literature on the topic, it begins by engaging with Hegel's understanding of colonialism through a close reading of relevant passages of his works, in particular the Heidelberg Vorlesungen über Naturrecht und Staatswissenschaft (1817–18), the Grundlinien der Philosophie des Rechts (1821), the Vorlesungen über die Philosophie des Rechts (1819/20, 1821/22, 1822/23, 1824/25) and the Vorlesungen über die Philosophie (...) der Weltgeschichte (1822/23, 1830). Having mapped and reconstructed Hegel's conception of colonialism through his writings and lectures, the article argues that his account of Europe's modern colonial expansion is based primarily on economic considerations, rather than on civilizational assumptions proclaiming the spiritual superiority of European peoples—to which Hegel nevertheless subscribes. The conclusion explores distinct and divergent postcolonial perspectives for engaging with the contemporary legacy of Hegelianism. It addresses, on the one hand, Tibebu's critical reading of Hegel's philosophical enterprise as ‘the coldest rationalisation of genocidal murder and carnage’ based on ‘paradigmatic apartheid’ and, on the other, Brennan's redemptive reading of Hegel, which values his theoretical contribution to the shaping of 20th century anticolonial thought. After contrasting these two interpretations, the article argues in favour of postcolonial strategies for critical reappropriation and sabotage of the legacy of Hegel's philosophy. (shrink)

Volume 20, Issue 7, July 2020, Page 150-152.

This is a field-based disguised case which describes a dilemma faced by the protagonists; do they continue to do business with a land developer who has assisted them in the past when now the developer chooses to, against their recommendations, also do business with their ex-business partner? The problem for the characters in question is whether or not to work on a project that will yield them a net profit of $4 million dollars given the fact it would require them (...) to work in the same development as their former business associate. The central characters are afraid that their ex-partner will be a destabilizing factor in the development of the project and that their work sites will be in jeopardy of being vandalized. Several factors complicate this situation including: the developer’s desire for a quick land purchase, the developer’s changing the discount rate from 20% to 10% perhaps based upon difficulties that surrounded the first land deal, the protagonists’ plans to build their own homes in this new development, and the negative relationship between the protagonists and the ex-business partner. The case has a difficulty level appropriate for a sophomore or junior level course. The case is designed to be taught in one class period and is expected to require between three to five hours of outside preparation by students. (shrink)

Mr Shewring, C.Q. XXV. 14, gives statistics of the clausulae favoured in Aristotle's Ethics. I have applied them to test a few conjectural emendations that I happen to have published, with the following encouraging results: Emendations that substitute a good clausula for a bad one: 96a 18 στερον λγομεν for στερον λγομεν κb, στερον λεγον cet. 09b 5 αυτος φλκειν [δεν]. 48a 14 κλαστον τθεμεν [κα γκρατ κα σφρονα]. 63b 13 τν φιλαν [καθπερ ερηται]. 71a 35 ατν <δον εναι . (...) Emendations that substitute one good clausula for another: 97a 9 τ ατ τοτ for τ ατ τοτο γαθν κb, τ ατ or ατ τ γαθν cet. 25a 22 τν γαθν [κα γνοεν αυτν]. I may be pardoned for omitting my one or two alterations that substitute a bad clausula for a good one. My text adopts a MS. variant, or a conjecture of another scholar, similarly supported by Mr. Shewring's test in the following places: 99b 6, 02a 20, 10b 31, 15a 8, 20a 22, 20b 2, 22a 28, 32a 11, 33a 1, 34b 33, 50b 34, 53a 1, 59a 3, 61a 2, 63a 3, 64a 23, 66a 34, 75a 6, 79a 22. (shrink)

Introduction In 2007, a national review committee was instituted in The Netherlands to review cases of active ending of life for newborns. It was expected that 15–20 cases would be reported. To date, however, only one case has been reported to this committee. Reporting is essential to obtain societal control and transparency; the possible explanations for this lack of reporting were therefore explored. Methods Data on end-of-life decision-making were scrutinised from Dutch nation-wide studies (1995, 2001 and 2005), before institution of (...) the committee. Physicians received a questionnaire about their medical decision-making for stratified samples of deceased infants up to 1 year, drawn from the central death registry. Results In 2005, 58% of all deaths were preceded by an end-of-life decision, compared with 68% in 2001 and 62% in 1995. The use of drugs with a possible life-shortening effect tended to be lower. In 2005, all four cases in the study in which an infants' life was actively ended were preceded by a decision to forego life-prolonging treatment. In three cases, the infant's life expectancy was short; one case involved a longer life expectancy. Discussion The expected number of cases is probably an overestimation due to changes in medical practice such as the tendency to attribute less life-shortening effects to opioids. The lack of reports is probably also associated with requirements in the regulation; it may be difficult to fulfil them due either to time constraints or the nature of the suffering that is addressed. If societal control of active ending of life is considered useful, changes in the regulation may be needed. (shrink)

Objectives: In this study the author aimed to provide information for researchers to help them with the selection of suitable databases for finding medical ethics literature. The quantity of medical ethical literature that is indexed in different existing electronic bibliographies was ascertained. Method: Using the international journal index Ulrich’s Periodicals Directory, journals on medical ethics were identified. The electronic bibliographies indexing these journals were analysed. In an additional analysis documentalists indexing bioethical literature were asked to name European journals on medical (...) ethics. The bibliographies indexing these journals were examined. Results: Of 290 journals on medical ethics 173 were indexed in at least one bibliography. Current Contents showed the highest coverage with 66 (22.8%) journals indexed followed by MEDLINE (22.1%). By a combined search in the top ten bibliographies with the highest coverage, a maximum coverage of 45.2% of all journals could be reached. All the bibliographies showed a tendency to index more North American than European literature. This result was verified by the supplementary analysis of a sample of continental European journals. Here EMBASE covered the highest number of journals (20.6%) followed by the Russian Academy of Sciences Bibliographies (19.2%). Conclusion: A medical ethics literature search has to be carried out in several databases in order to reach an adequate collection of literature. The databases one wishes to combine should be carefully chosen. There seems to be a regional bias in the most popular databases, favouring North American periodicals compared with European literature on medical ethics. (shrink)

Of the many works he wrote during 1848, his "richest and most fruitful year," Kierkegaard specified Practice in Christianity as "the most perfect and truest thing." In his reflections on such topics as Christ's invitation to the burdened, the imitatio Christi, the possibility of offense, and the exalted Christ, he takes as his theme the requirement of Christian ideality in the context of divine grace. Addressing clergy and laity alike, Kierkegaard asserts the need for institutional and personal admission of the (...) accommodation of Christianity to the culture and to the individual misuse of grace. As a corrective defense, the book is an attempt to find, ideally, a basis for the established order, which would involve the order's ability to acknowledge the Christian requirement, confess its own distance from it, and resort to grace for support in its continued existence. At the same time the book can be read as the beginning of Kierkegaard's attack on Christendom. Because of the high ideality of the contents and in order to prevent the misunderstanding that he himself represented that ideality, Kierkegaard writes under a new pseudonym, Anti-Climacus. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:?;5. HUME AND SPINOZA It is strange that there has been so little interest in comparing two great philosophers, Hume and -Spinoza, who were both so important and influential in bringing about the decline of traditional religion. Jessop's bibliography indicates no interest in Hume and Spinoza up to the 1930 's. The Hume conferences of 1976, as far as I have been able to 2 determine, avoided the topic. (...) In one of the better new Hume volumes, Livingston and King, Hume, A Re-evaluation, 3 Spinoza is cited twice, and once incorrectly at that. On the other hand, in the massive new Spinoza volume edited by Siegfried Hessing, Speculum Spinozanun 1677-1977, Hume is mentioned four times, but only one of these has any real relevance to Hume's views vis-a-vis Spinoza's. Some discussion of Hume's comments, usually brief, occurs in the commentators. B. M. Laing, in David Hume, (London 1932), has just three short references to Spinoza. John Laird, in Hume's Philosophy of Human Nature, (London 1932) has a couple of cursory references to Spinoza, plus a bit more extended statement of Pierre Bay le" s critique of him. In H. H. Price, Hume's Theory of the External World, (Oxford 1940), there is one paragraph on Hume and Spinoza. In Norman Kemp Smith, The Philosophy of David Hume (London 1941), there are three references to Spinoza. Rachel Kydd, Reason and Conduct in Hume's Treatise (Oxford 194 6), has the greatest number of references to Spinoza. She was concerned to compare him with Hume on other matters than are dealt with in this paper, namely Spinoza's theory of reason and 9 the passions. In contrast, André Leroy, David Hume, (Paris 1953), has just one paragraph on Spinoza dealing with the immateriality of the soul; and Ernest C. Mossner, in his monumental Life of David Hume, (Austin 1954), has only one reference to Spinoza - James Beattie's denunciation of Hume, Hobbes, Malebranche, Leibniz and Spinoza. Lastly, in a fairly recent commentary by James Noxon, Spinoza is mentioned 66. three times, but not for anything in Hume's text. Noxon does point out (p. 75) that Spinoza is not mentioned in ] 2 Hume's correspondence. John H. Randall has offered an explanation for this neglect of Spinoza by Hume scholars, namely that "Hume stands for all time as the antithesis of Spinoza in his thought". In the England of Hume's day, Spinoza was little known, but still better known at the time than he was in France or England. Spinoza's Tractatus Theologico-Politicus 14 had been twice translated into English anonymously. He had been attacked by Bishop Stillingfleet, by John Evelyn, by Berkeley and several others. But Spinoza was not a major figure, except to the English Deists, and to Hume's early patron, the Chevalier Andrew Michael Ramsay. Most of the information known about Spinoza came from Pierre Bayle' s Historical and Critical Dictionary, where the article "Spinoza" is the longest in the Dictionary, about three hundred pages in length. My suspicion, or hypothesis, is that Hume first became interested in Spinoza through Ramsay, and then learned what he knew about Spinoza from Bayle' s article. When the young David Hume went to France to write his A Treatise of Human Nature in 1734, he went first to see the Chevalier Ramsay, who entertained Hume for about two weeks. Ramsay was a leading Scottish Catholic, was the teacher of Bonnie Prince Charlie, a leading Scottish revolutionary, 18 as well as the Grand Master of the Free Masons. With Ramsay's eclectic views it is not odd that he had a serious interest in Spinoza's theory, and that he was composing answers to it. Ramsay advised Hume about his own book, and Hume felt he had to show Ramsay the Treatise before he 19 brought it back to England. In the Treatise there is a not too well studied section on Spinoza, Of the immateriality of the soul 20 (T240-45). In introducing Spinoza into the discussion of 67. the immateriality of the soul, Hume follows what was common practice in his day, namely to insult Spinoza and his theory... (shrink)

> Wealthy nations must do much more, much faster. The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference 26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature (...) and protect health. Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades.1 The science is unequivocal; a global increase of 1.5°C above the preindustrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse.2 3 Despite the world’s necessary preoccupation with COVID-19, we cannot wait for the pandemic to pass to rapidly reduce emissions. Reflecting the severity of the moment, this editorial appears in health journals across the world. We are united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory. The risks to health of increases above 1.5°C are now well established.2 Indeed, no temperature rise is ‘safe’. In the past 20 years, heat-related mortality among people aged over 65 has increased by more than 50%.4 Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality.5 6 Harms disproportionately affect the most vulnerable, including children, older populations, ethnic minorities, poorer communities and those with underlying health problems.2 4 Global heating is also contributing to the decline in …. (shrink)

At Aen. 6.562–627 the Sibyl gives Aeneas a description of the criminals in Tartarus and the punishments to which they are condemned. The criminals are presented to us in several groups. The first consists of mythical figures, the Titans , the sons of Aloeus , Salmoneus , Tityos and Ixion and Pirithous . Next Virgil turns away from mythical figures to particular categories of criminal. He mentions those who hated their brothers, who assaulted a parent, who cheated a cliens, who (...) gloated over wealth they had acquired without setting aside a part for their family, who were put to death for adultery, and those who, breaking their masters' trust, made war on their country . The reference to the contemporary scene is unmistakable. The mention of a cliens indicates that we have moved from Greece to Rome. Moreover, ‘quique ob adulterium caesi’ brings to mind Augustus' concern over moral standards, the subject of legislation in 28 B.c., 18 B.c. and A.d. 9; the lex Iulia de adulteriis coercendis gave to fathers of adulteresses the right to put to death both guilty parties. Thirdly, ‘arma...impia’ is an obvious reference to civil war , which as Servius argues is more narrowly defined by ‘nee veriti dominorum fallere dextras’ so as to exclude Caesar and Octavian: undoubtedly the allusion is to the war against Sextus Pompeius, which Augustan propaganda chose to represent as a war against runaway slaves. Virgil continues by sketching the penalties paid in Tartarus by such men . While doing so, however, he retreats once again into the realm of mythology: the punishments he describes are those more normally associated with Sisyphus and Ixion . This reversion is completed at 617–20 where, confusingly, Virgil denies that he has been alluding to events of contemporary significance by naming two mythical personages, Theseus and Phlegyas . Virgil therefore implies, but then denies, contemporary relevance. It is this kind of protean elusiveness which makes the contemporary allusions in Virgil so difficult to pin down. (shrink)

In a well-known apocryphal story, Theresa of Avila falls off the donkey she was riding, straight into mud, and injures herself. In response, she seems to blame God for her fall. A playful if indignant back and forth ensues. But this is puzzling. Theresa should never think that God is blameworthy. Why? Apparently, one cannot blame what one worships. For to worship something is to show it a kind of reverence, respect, or adoration. To worship is, at least in part, (...) to praise. You cannot praise and blame simultaneously. Indeed, Paul counsels against “back-talk” against God, suggesting we lack the standing to blame our creator (Romans 9:20). Drawing on Strawsonian theorizing about praise and blame, this paper argues that, surprisingly, a person can both blame and worship God. Although blameful worship is possibly epistemically akratic, it may sometimes be acceptable given our nature as finite, emotional beings. In fact, blaming God might on occasion be the only way we have to stand with God’s goodness despite apparent evidence of evil in the world. This suggestion, I’ll argue, should change the way we think about the problem of evil. The problem has interpersonal and moral psychological dimensions that merit serious attention. (shrink)