Clozapine is a very effective drug with both significant benefits and significant risks in treatment-resistant schizophrenia. Informed consent is generally accepted as both desirable and necessary in order to ensure that the patient’s human rights and dignity are respected. Disclosure is a key element of informed consent. It is unclear if the adequate documentation of disclosure is standard practice before initiation of clozapine. The aim of this study was to assess the adequacy of the documentation of disclosure in consent to (...) clozapine treatment in an adult mental health service and to develop guidelines on disclosure. The method was a retrospective analysis of charts of patients given clozapine who received the drug through the pharmacy of a single North Dublin psychiatric hospital. Results show that current practice has evident gaps. The professional, ethical and legal issues are discussed. (shrink)

BackgroundInternationally, patient access to notes is increasing. This has been driven by respect for patient autonomy, often recognised as a primary tenet of medical ethics: patients should be able to access their records to be fully engaged with their care. While research has been conducted on the impact of patient access to outpatient and primary care records and to patient portals, there is no such review looking at access to hospital medical records in real time, nor an ethical analysis (...) of the issues involved in such a change in process.MethodsThis study employed a systematic review framework in two stems, to integrate literature identified from two searches: Medline, CINAHL and Scopus databases were conducted, (for (1) hospitalised patients, patient access to records and its effects on communication and trust within the doctor-patient relationship; and (2) patient access to medical records and the ethical implications identified). The qualitative and quantitative results of both searches were integrated and critically analysed.Results3954 empirical and 4929 ethical studies were identified; 18 papers representing 16 studies were identified for review (12 empirical and 6 ethical). The review reveals a consensus that our current approach to giving information to patients – almost exclusively verbally – is insufficient; that patient access to notes is a welcome next step for patient-centred care, but that simply allowing full access, without explanation or summary, is also insufficient. Several ethical implications need to be considered: increased information could improve patient trust and knowledge but might transfer an (unwelcome) sense of responsibility to patients; doctors and patients have conflicting views on how much information should be shared and when; sharing written information might increase the already significant disparity in access to health care, and have unforeseen opportunity costs. The impact on medical practice of sharing notes in real time will also need to be evaluated.ConclusionsThe review presents encouraging data to support patient access to medical notes. However, sharing information is a critical part of clinical practice; changing how it is done could have significant empirical and ethical impacts; any changes should be carefully evaluated. (shrink)

In the Forest of the Blind: The Eurasian Journey of Faxian’s Record of Buddhist Kingdoms. By Matthew W. King. New York: Columbia University Press. Pp. xvi + 294. $160 (cloth); $40 (paper).

Evolving practice requires peer review of clinical ethics (CE) consultation for quality assessment and improvement. Many institutions have identified the chart note as the basis for this process, but to our knowledge, electronic health record (EHR) systems are not necessarily designed to easily include CE consultation notes. This article provides a framework for the inclusion of CE consultation notes into the formal EHR, describing a developed system in the Epic EHR that allows for the elaborated electronic notation of (...) the CE chart note. The implementation of the “meaningful use” criteria for EHR, mandated by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, requires that health professionals meet certain standards for quality, efficiency, and safety, all of which overlap with the goals of standardization, peer review, and quality improvement within CE consultation. (shrink)

The theory of separation assumes, with provocation, that an organization cannot reconcile profits and social function. Organizations can reconcile these two, apparently contrasting, missions, by considering emotions, especially moral emotions, to create a genuine motivation for focusing on goals beyond simple economic earnings and protecting organizations or groups of people from dysfunctional attitudes and behaviors, as well as considering the important role of the stakeholder accountability. Using the PRISMA method, we created a review of records using keywords relating to (...) a socio-emotional value within organizations, with a particular focus on the last 20 years. We used the SCOPUS database and, after removing irrelevant records, we used the VOSviewer tool to create a cluster map of different areas in this topic. Some records cite the socio-emotional value that is related to organizational and employee suffering, while other articles consider it a positive factor that improves performance and prevents problems in organizations. (shrink)

Introduction: The aim of this review was to systematically synthesize the published literature describing the psychological and behavioral correlates of recreational running in adults, defined as running for leisure, with or without a competitive component.Methods: Quantitative research published in peer-reviewed journals until January 2021 were included. Studies were identified through MEDLINE, PsycINFO, SPORTDiscus, and Web of Science and were included in this review if they were aimed at recreational running, included general adult samples, and assessed psychological or behavioral (...) correlates of recreational running.Results: Fifty-six articles reporting 58 studies met the eligibility criteria and were included. There were 27 cross-sectional studies, 12 longitudinal studies, and 19 trials. Twenty-eight studies assessed antecedents of running behavior, and 25 studies used running behavior as treatment or predictor of a given effect or outcome. Four studies examined both predictors and outcomes of running. Thirty-one studies showed poor quality, while 20 had fair and 7 good quality. Motives were the most frequently studied antecedent of running behavior, and results suggest that the highest-ranked or more prevalent motives were physical health, psychological motives, and personal achievement. Additionally, perceived control, attitude toward running, intention and subjective norms, self-efficacy, and social support may have also played a role in the adoption of recreational running. Moreover, improvements in mood and well-being were the most frequently reported positive outcomes of running. Reductions in depression, anxiety, and stress were also reported in included studies.Discussion: To our knowledge, this is the first systematic review on this topic. The identification of behavioral and psychological correlates of recreational running across populations can contribute to inform and guide a public policy agenda, focused on helping people sustain regular physical activity, through a modality they have chosen and appear to enjoy.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=68954, identifier: CRD42017068954. (shrink)

ZusammenfassungIn einem Modellprojekt soll durch die Einführung einer persönlichen, einrichtungsübergreifenden, elektronischen Patientenakte nicht nur die Behandlungskontinuität verbessert, sondern auch das Recht auf informationelle Selbstbestimmung dahingehend realisiert werden, dass jeder Patient zum Administrator einer Datencloud gemacht wird, die alle seine Gesundheitsdaten enthält. Eine systematische Literaturrecherche zum Thema „elektronische Patientenakten “ soll mögliche ethische Herausforderungen in Verbindung mit der oben genannten PEPA antizipieren. Von initial 2487 Publikationen wurden 51 Publikationen ausgewertet: 30 empirische Studien, 10 medizinethische Analysen und 11 Meinungspapiere. In den empirischen (...) Studien wurden als erste Effekte einer EPA vor allem eine vollständigere medizinische Aktenlage beschrieben. Mit der Einsichtsmöglichkeit für den Patienten in die EPA konnten zusätzlich ein besseres Krankheitsverständnis und damit erhöhte Compliance des Patienten nachgewiesen werden. Eine Verbesserung der Behandlungsqualität wurde auf die Fehlervermeidung durch Patienteneinsicht, effektivere Nutzung der Arzt-Patienten-Besuche und das verbesserte Verständnis für das Therapiekonzept zurückgeführt. Ebenfalls wurde in den Studien eine Stärkung des Vertrauensverhältnisses von Arzt und Patient beschrieben. Bedenken gab es im Vorfeld vieler Studien hinsichtlich des Datenschutzes, eines möglichen Verlustes der persönlichen Arzt-Patienten-Beziehung und einer potentiellen Überforderung des Patienten. In der Beurteilung der EPA spielte die Abwägung zwischen ärztlicher Fürsorge und Patientenautonomie eine große Rolle. Die von medizinethischer Seite geäußerten Bedenken bezüglich eines Vertrauensverlustes oder einer Störung des Arzt-Patienten-Verhältnisses konnten in den empirischen Studien nicht bestätigt werden. Die befürchteten Risiken im Datenschutz wurden von den Betroffenen zugunsten des potentiellen Nutzens einer EPA abgewogen. Unter Wahrung des Datenschutzes hat daher die PEPA das Potential, durch die Mitbeteiligung des Patienten das Arzt-Patienten-Verhältnis positiv zu beeinflussen. Die spezifischen ethischen Herausforderungen, die mit der Co-Verwaltung der PEPA einhergehen, werden im Modellprojekt untersucht. (shrink)

Background The COVID-19 pandemic forced governments, multilateral public health organisations and research institutions to undertake research quickly to inform their responses to the pandemic. Most COVID-19-related studies required swift approval, creating ethical and practical challenges for regulatory authorities and researchers. In this paper, we examine the landscape of ethics review processes in Africa during public health emergencies (PHEs). Methods We searched four electronic databases (Web of Science, PUBMED, MEDLINE Complete, and CINAHL) to identify articles describing ethics review processes (...) during public health emergencies and/or pandemics. We selected and reviewed those articles that were focused on Africa. We charted the data from the retrieved articles including the authors and year of publication, title, country and disease(s) reference, broad areas of (ethical) consideration, paper type, and approach. Results Of an initial 4536 records retrieved, we screened the titles and abstracts of 1491 articles, and identified 72 articles for full review. Nine articles were selected for inclusion. Of these nine articles, five referenced West African countries including Liberia, Guinea and Sierra Leone, and experiences linked to the Ebola virus disease. Two articles focused on South Africa and Kenya, while the other two articles discussed more general experiences and pitfalls of ethics review during PHEs in Africa more broadly. We found no articles published on ethics review processes in Africa before the 2014 Ebola outbreak, and only a few before the COVID-19 outbreak. Although guidelines on protocol review and approval processes for PHEs were more frequently discussed after the 2014 Ebola outbreak, these did not focus on Africa specifically. Conclusions There is a gap in the literature about ethics review processes and preparedness within Africa during PHEs. This paper underscores the importance of these processes to inform practices that facilitate timely, context-relevant research that adequately recognises and reinforces human dignity within the quest to advance scientific knowledge about diseases. This is important to improve fast responses to PHEs, reduce mortality and morbidity, and enhance the quality of care before, during, and after pandemics. (shrink)

Internet Alley is much more a book about regional history than about politics, economics, or history of technology, yet it draws extensively on all of these fields. The book is stronger for its interdisciplinarity, but as a result does not sit comfortably within any traditional historical discourse. Historians of science or technology not dealing with northern Virginia in the twentieth century will find little of help in this book.

Current societal changes and challenges demand a broader role of technological universities, thus opening the question of how their role evolved over time and how to frame their current responsibility. In response to urgent calls for debating and redefining the identity of contemporary technological universities, this paper has two aims. The first aim is to identify the key characteristics and orientations marking the development of technological universities, as recorded in the history of engineering education. The second aim is to articulate (...) the responsibility of contemporary technological universities given their different orientations and characteristics. For this, we first provide a non-systematic literature review of the key pedagogical orientations of technological universities, grounded in the history of engineering education. The five major orientations of technological universities presented in the paper are technical, economic, social, political, and ecological. We then use this historical survey to articulate the responsibilities of contemporary technological universities reflecting the different orientations. Technological universities can promote and foster the development of scientific, professional, civic, legal, or intra- and inter- generational responsibility. We argue that responsibility is not specific to any particular orientation, such that the concept is broadened to complement each orientation or mix of orientations of a technological university. Our contribution thus serves as a call for technological universities to self-reflect on their mission and identity, by offering a lens for identifying the orientations they currently foster and making explicit the responsibility arising from their current orientation or the ones they strive to cultivate. (shrink)

Digital Pills are an innovative drug-device technology that permits to combine traditional medications with a monitoring system that automatically records data about medication adherence as well as patients’ physiological data. Although DP are a promising innovation in the field of digital medicine, their use has also raised a number of ethical concerns. These ethical concerns, however, have been expressed principally from a theoretical perspective, whereas an ethical analysis with a more empirically oriented approach is lacking. There is also a lack (...) of clarity about the empirical evidence available concerning the application of this innovative digital medicine. To map the studies where DP have been tested on patients and discuss the ethically relevant issues evident therein, we performed a scoping review of the empirical literature concerning DP. Our search allowed us to identify 18 papers reporting on studies where DP were tested on patients. These included studies with different designs and involving patients with a variety of conditions. In the empirical literature, a number of issues with ethical relevance were evident. At the patient level, the ethical issues include users’ interaction with DP, personal sphere, health-related risks and patients’ benefits. At the provider level, ethically relevant issues touch upon the doctor-patient relationship and the question of data access. At the societal level, they concern the benefits to society, the quality of evidence and the dichotomy device-medicine. We conclude that evidence concerning DP is not robust and that more research should be performed and study results made available to evaluate this digital medicine. Moreover, our analysis of the ethically relevant aspects within empirical literature underscores that there are concrete and specific open questions that should be tackled in the ethical discussion about this new technological solution. (shrink)

Epictetus, a former slave who lived in Rome during Nero’s reign but was exiled (along with all those who practiced philosophy in Rome) to Greece by Domitian’s decree in 93 CE, espoused an austere ethical philosophy which aimed at happiness (eudaimonia), or tranquility (ataraxia), through the delimitation of valuation to things within one’s control. Although Epictetus never set to writing his beliefs, his disciple Arrian recorded eight books of his sayings (entitled Discourses [ διατριβαί ] of which only four books (...) survive) and edited a compendium entitled the Handbook ( Ἐγχειρίδιον). In his preface to the volume under review, editor Theodore Scaltsas writes that “there is no message that would be of greater value in the face of today’s threats to society than Epictetus’ ‘bear and forbear.'” (1) Although Epictetus’ “forbearance” is not exactly the philosophy of hope much in vogue in contemporary politics, there is no doubt that Epictetus offers a perennial source of strength and self-reliance. (shrink)

BackgroundPsychotherapy interventions increasingly utilize digital technologies to improve access to therapy and its acceptability. Opportunities that digital technology potentially creates for art therapy reach beyond increased access to include new possibilities of adaptation and extension of therapy tool box. Given growing interest in practice and research in this area, it is important to investigate how art therapists engage with digital technology or how practice might be safely adapted to include new potential modes of delivery and new arts media.MethodsAn integrative (...) class='Hi'>review of peer-reviewed literature on the use of digital technology in art therapy was conducted. The methodology used is particularly well suited for early stage exploratory inquiries, allowing for close examination of papers from a variety of methodological paradigms. Only studies that presented empirical outcomes were included in the formal analysis.FindingsOver 400 records were screened and 12 studies were included in the synthesis, pertaining to both the use of digital technology for remote delivery and as a medium for art making. Included studies, adopting predominantly qualitative and mixed methods, are grouped according to their focus on: art therapists’ views and experiences, online/distance art therapy, and the use of digital arts media. Recurring themes are discussed, including potential benefits and risks of incorporating digital technology in sessions with clients, concerns relating to ethics, resistance toward digital arts media, technological limitations and implications for therapeutic relationship and therapy process. Propositions for best practice and technological innovations that could make some of the challenges redundant are also reviewed. Future directions in research are indicated and cautious openness is recommended in both research and practice.ConclusionThe review documents growing research illustrating increased use of digital technology by art therapists for both online delivery and digital art making. Potentially immense opportunities that technology brings for art therapy should be considered alongside limitations and challenges of clinical, pragmatic and ethical nature. The review aims to invite conversations and further research to explore ways in which technology could increase relevance and reach of art therapy without compromising clients’ safety and key principles of the profession. (shrink)

In recent years, two challenges stand out against scientific realism: the argument from the underdetermination of theories by evidence (UTE) and the pessimistic induction argument (PI). In his book, Kyle Stanford accepts the gravity of these challenges, but argues that the most serious and powerful challenge to scientific realism has been neglected. The problem of unconceived alternatives (PUA), as he calls it, is introduced in chapter one and refined in chapter two. In short, PUA holds that throughout history scientists have (...) failed to conceive alternative theories roughly equally well-confirmed to the theories of the day by the available evidence and, crucially, that such alternatives eventually were conceived and adopted by some section of the scientific community. PUA is a version of UTE, but, unlike its kin, enjoys substantial historical support. It leads to a sort of pessimistic induction that Stanford brands ‘the new induction’ (NI), according to which we should be doubtful about the truth claims of current theories since the historical record suggests that unconceived alternatives are typically lurking in the shadows. His proposal contains two important shifts of focus: First, there is a shift from artificially produced rival theories - of the kind typically talked about in the underdetermination debate - to actual rivals. Second, instead of focusing on empirically equivalent rivals, he urges a shift to rivals that are more or less equally well-confirmed to existing theories by the available evidence at a given point in time. Prima facie, PUA sounds like a welcome addition to the anti-realist arsenal, drawing on historical evidence to support the induction that current theories probably face genuine alternatives waiting to be conceived. (shrink)

Ethical research conduct is a cornerstone of research practice particularly when research participants include vulnerable populations. This study mapped the extent of reporting ethical research practices in studies conducted among refugees and war-affected populations in the Arab World, and assessed variations by time, country of study, and study characteristics. An electronic search of eight databases resulted in 5668 unique records published between 2000 and 2013. Scoping review yielded 164 eligible articles for analyses. Ethical research practices, including obtaining institutional approval, (...) access to the community/research site, and informed consent/assent from the research participants, were reported in 48.2, 54.9, and 53.7% of the publications, respectively. Institutional approval was significantly more likely to be reported when the research was biomedical in nature compared to public health and social, when the study employed quantitative compared to qualitative or mixed methodologies, and when the journal required a statement on ethical declarations. Institutional approval was least likely to be reported in papers that were sole-authored, when these did not mention a funding source, or when published in national journals. Similar results were obtained for access to the community site and for seeking informed consent/assent from study participants. The responsibility of inadequacies in adherence to ethical research conduct in crisis settings is born by a multitude of stakeholders including funding agencies, institutional research boards, researchers and international relief organizations involved in research, as well as journal editors, all of whom need to play a more proactive role for enhancing the practice of ethical research conduct in conflict settings. (shrink)

BackgroundThe areas of Research Ethics (RE) and Research Integrity (RI) are rapidly evolving. Cases of research misconduct, other transgressions related to RE and RI, and forms of ethically questionable behaviors have been frequently published. The objective of this scoping review was to collect RE and RI cases, analyze their main characteristics, and discuss how these cases are represented in the scientific literature.MethodsThe search included cases involving a violation of, or misbehavior, poor judgment, or detrimental research practice in relation to (...) a normative framework. A search was conducted in PubMed, Web of Science, SCOPUS, JSTOR, Ovid, and Science Direct in March 2018, without language or date restriction. Data relating to the articles and the cases were extracted from case descriptions.ResultsA total of 14,719 records were identified, and 388 items were included in the qualitative synthesis. The papers contained 500 case descriptions. After applying the eligibility criteria, 238 cases were included in the analysis. In the case analysis, fabrication and falsification were the most frequently tagged violations (44.9%). The non-adherence to pertinent laws and regulations, such as lack of informed consent and REC approval, was the second most frequently tagged violation (15.7%), followed by patient safety issues (11.1%) and plagiarism (6.9%). 80.8% of cases were from the Medical and Health Sciences, 11.5% from the Natural Sciences, 4.3% from Social Sciences, 2.1% from Engineering and Technology, and 1.3% from Humanities. Paper retraction was the most prevalent sanction (45.4%), followed by exclusion from funding applications (35.5%).ConclusionsCase descriptions found in academic journals are dominated by discussions regarding prominent cases and are mainly published in the news section of journals. Our results show that there is an overrepresentation of biomedical research cases over other scientific fields compared to its proportion in scientific publications. The cases mostly involve fabrication, falsification, and patient safety issues. This finding could have a significant impact on the academic representation of misbehaviors. The predominance of fabrication and falsification cases might diverge the attention of the academic community from relevant but less visible violations, and from recently emerging forms of misbehaviors. (shrink)

Personal review record, as a form of personally identifiable information, refers to the past review information of a reviewer. The disclosure of reviewers’ personal information on electronic commerce websites has been found to substantially impact consumers’ perception regarding the credibility of online reviews. However, personal review record has received little attention in prior research. The current study investigated whether the disclosure of personal review record influenced consumers’ information processing and decision making by adopting (...) event-related potentials measures, as ERPs allow for a nuanced examination of the neural mechanisms that underlie cognitive processes. At the behavioral level, we found that the purchase rate was higher and that the reaction time was shorter when the review record was disclosed, indicating that the disclosed condition was more favorable to the participants. Moreover, ERPs data showed that the disclosed condition induced an attenuated N400 component and an increased LPP component relative to the undisclosed condition, suggesting that the former condition gave rise to less cognitive and emotional conflict and to more positive evaluations. Thus, by elucidating potential cognitive and neural underpinnings, this study demonstrates the positive impact of reviewers’ disclosure of personal review record on consumers’ purchase decisions. (shrink)

BackgroundThe time that children and young people spend in nature and outdoor spaces has decreased significantly over the past 30 years. This was exacerbated with a further 60% decline post-COVID-19. Research demonstrating that natural environments have a positive impact on health and wellbeing has led to prescription of nature-based health interventions and green prescribing, although evidence for its use is predominantly limited to adults. Growing evidence also shows the impact of arts on all aspects of health and wellbeing. However, what (...) has received scant attention in literature is the interconnection between the two: arts and nature.AimsThis review synthesizes the literature surrounding the interconnectedness between arts and nature, and their impact on the health and wellbeing of children and young people.MethodsEight major electronic databases were systematically searched, while hand-searching included 20 journals, six books, and contact with experts. The review was conducted using the Cochrane handbook for systematic reviews, PRISMA guidelines and TIDieR template. All stages were conducted independently by two researchers and the protocol was published on PROSPERO.ResultsAlthough 9,314 records were identified, only 11 records were included as most studies focused either on arts or nature, but not both. Studies were conducted in United Kingdom, United States, Ireland, Australia, and Hong Kong, in a range of spaces such as forests, woodlands, beaches, parks, fields, gardens, and school playgrounds. The review encompasses data from 602 participants in total.DiscussionArts-in-nature offered an inclusive medium to engage all children and young people, especially those who might otherwise remain disinterested about environmental issues and disengaged with educational programs. Further, arts-in-nature provided stimuli to increase nature connectivity, understand environmental issues and explore ways to prevent environmental disasters. This led to higher environmental awareness and pro-environmental behaviors, and potential decrease in eco-anxiety.ConclusionAlthough the quality of qualitative studies was high, the quality of quantitative studies was low or unclear, thus quantitative evidence is still at its infancy. Implications for research, policy, and practice are discussed, such as methods and activities to strengthen future interventions. Scaling-up existing interventions may lead to wider recognition and inclusion of arts-in-nature in future health guidelines, including green prescribing. (shrink)

Anna Chavlovski,1 Greg A Knoll,1–3 Timothy Ramsay,4 Swapnil Hiremath,1–3 Deborah L Zimmerman1–31University of Ottawa, 2Ottawa Hospital, 3Kidney Research Centre, Ottawa Hospital Research Institute, 4Ottawa Methods Centre, Ottawa, ON, CanadaBackground: In patients with end-stage renal disease, use of vitamin D and calcium-based phosphate binders have been associated with progression of vascular calcification that might have an impact on renal transplant candidacy. Our objective was to examine management of mineral metabolism in patients wait-listed for renal transplant and to determine the impact on (...) cardiac perfusion imaging.Methods: Data was collected retrospectively on patients wait-listed for a renal transplant, being either active and on hold. Demographic data, medications, serum concentrations of calcium, phosphate, parathyroid hormone, and cardiac perfusion imaging studies were collected from the electronic health record. Chi-square and Student’s t-tests were used to compare active and on-hold patients as appropriate. Logistic regression was used to examine variables associated with worsening cardiac imaging studies.Results: The wait-listed patients were of mean age 56 ± 14 years and had been on dialysis for 1329 ± 867 days. On-hold patients had received a significantly greater total dose of calcium and were more likely to have developed worsening cardiovascular imaging studies. Total doses of calcium and calcitriol were associated with worsening cardiovascular imaging studies.Conclusion: Patients on hold on the renal transplant waiting list received higher total doses of calcium. A higher total dose of calcium and calcitriol was also associated with worsening cardiovascular imaging. Time on dialysis before transplant has been associated with worse post-transplant outcomes, and it is possible that the total calcium and calcitriol dose received contributed to these inferior outcomes.Keywords: dialysis, calcium, cardiac, transplantation. (shrink)

BackgroundElectronic patient record (EPR) technology is a key enabler for improvements to healthcare service and management. To ensure these improvements and the means to achieve them are socially and ethically desirable, careful consideration of the ethical implications of EPRs is indicated. The purpose of this scoping review was to map the literature related to the ethics of EPR technology. The literature review was conducted to catalogue the prevalent ethical terms, to describe the associated ethical challenges and opportunities, (...) and to identify the actors involved. By doing so, it aimed to support the future development of ethics guidance in the EPR domain.MethodsTo identify journal articles debating the ethics of EPRs, Scopus, Web of Science, and PubMed academic databases were queried and yielded 123 eligible articles. The following inclusion criteria were applied: articles need to be in the English language; present normative arguments and not solely empirical research; include an abstract for software analysis; and discuss EPR technology.ResultsThe medical specialty, type of information captured and stored in EPRs, their use and functionality varied widely across the included articles. Ethical terms extracted were categorised into clusters ‘privacy’, ‘autonomy’, ‘risk/benefit’, ‘human relationships’, and ‘responsibility’. The literature shows that EPR-related ethical concerns can have both positive and negative implications, and that a wide variety of actors with rights and/or responsibilities regarding the safe and ethical adoption of the technology are involved.ConclusionsWhile there is considerable consensus in the literature regarding EPR-related ethical principles, some of the associated challenges and opportunities remain underdiscussed. For example, much of the debate is presented in a manner more in keeping with a traditional model of healthcare and fails to take account of the multidimensional ensemble of factors at play in the EPR era and the consequent need to redefine/modify ethical norms to align with a digitally-enabled health service. Similarly, the academic discussion focuses predominantly on bioethical values. However, approaches from digital ethics may also be helpful to identify and deliberate about current and emerging EPR-related ethical concerns. (shrink)

In this work, the author deals with the source of Ottoman Family Law, its application examples and its transformation adventure, together with theory, based on court records in different cities. It reflects the examples of the concrete side of the practical applications of Islamic family law, the Hanafi sect in particular, reflected in the registers in the Ottoman Empire. In general, the application is in accord with the views in fiqh sources. However, the views in the fürû sources of the (...) Ḥanafī sect on some controversial issues caused difficulties in practice. In order to eliminate the troubled situations, the state power sought a solution by intervening with kanunnâme, adâletnâme and fermans at the request of Sheikh al-Islam. In addition to these records regarding the implementation of Islamic family law, the book also includes, the observations and notes of travelers, ambassadors and researchers who had been in the Ottoman country. Particular emphasis is placed on the parts that reflect the contradiction. The subject in the book is examined two parts as Classical Period and Ottoman Family Law in post-Tanzimat. In second chapter, it is stated that a radical change was made in the Islamic/Ottoman family law by including the views of four sects with the preparation of Hukûk-ı Aile Kararnamesi. (shrink)

A cluster of experiments on “Change Blindness”, “Inattentional Blindness” and associated phenomena appear to demonstrate extremely counter intuitive results. According to one plausible characterisation, these results show that we consciously take in far less of the visual world than it seems we are aware of. It is worth briefly summarising the results of two recent sets of experiments, in order to give a flavour of this work. In ‘Gorillas in our Midst’ (Simons, D. and Chabris, C., Perception, 1999, 28), subjects (...) were asked to perform a task that involved watching a video of a casual basketball game that lasts for about a minute. The task involves counting the number of consecutive passes between members of the one of the teams. While the basketball is being thrown from player to player, something unexpected takes place: a person dressed in a black gorilla-suit walks through the play, stops briefly in the centre of the picture, thumps his chest, and then walks off. Although most subjects correctly record the number of passes made by the team, at least half of these subjects fail to notice the gorilla-suited interloper, who is visible for about nine seconds. When shown the video sequence a second time they are amazed to observe what they had previously overlooked. (shrink)

This article explores the ethical concerns and protections that may be required when individually identifiable data originally collected solely for clinical or administrative purposes are used in research or evaluation. It asks the following broad question with respect to the interim policy developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) to protect the rights and welfare of participants in its programs: For those programs and projects not classified as research, are the protections and system for review (...) adequate? Background information on SAMHSA's interim policy is provided, along with issues and questions related to the use of clinical and administrative records in research and evaluation. The article concludes with recommendations for modifying the existing participant protection guidelines, based on the preceding discussion of issues and questions. (shrink)

The two aims of the paper were to systematically review and critique social science and linguistic text analyses of nursing records in order to inform future research in this emerging area of research. Systematic searches in reference databases and in citation indexes identified 12 articles that included analyses of the social and linguistic features of records and recording. Two reviewers extracted data using established criteria for the evaluation of qualitative research papers. A common characteristic of nursing records was the (...) economical use of language with local meanings that conveyed little information to the uninitiated reader. Records were dominated by technocratic‐medical discourse focused on patients’ bodies, and they depicted only very limited aspects of nursing practice. Nurses made moral evaluations in their categorisation of patients, which reflected detailed surveillance of patients’ disturbing behaviour. The text analysis methods were rarely transparent in the articles, which could suggest research quality problems. For most articles, the significance of the findings was substantiated more by theoretical readings of the institutional settings than by the analysis of textual data. More probing empirical research of nurses’ records and a wider range of theoretical perspectives has the potential to expose the situated meanings of nursing work in healthcare organisations. (shrink)

Augmentative and alternative communication brain-computer interface systems are intended to offer communication access to people with severe speech and physical impairment without requiring volitional movement. As the field moves toward clinical implementation of AAC-BCI systems, research involving participants with SSPI is essential. Research has demonstrated variability in AAC-BCI system performance across users, and mixed results for comparisons of performance for users with and without disabilities. The aims of this systematic review were to describe study, system, and participant characteristics reported (...) in BCI research, summarize the communication task performance of participants with disabilities using AAC-BCI systems, and explore any differences in performance for participants with and without disabilities. Electronic databases were searched in May, 2018, and March, 2021, identifying 6065 records, of which 73 met inclusion criteria. Non-experimental study designs were common and sample sizes were typically small, with approximately half of studies involving five or fewer participants with disabilities. There was considerable variability in participant characteristics, and in how those characteristics were reported. Over 60% of studies reported an average selection accuracy ≤70% for participants with disabilities in at least one tested condition. However, some studies excluded participants who did not reach a specific system performance criterion, and others did not state whether any participants were excluded based on performance. Twenty-nine studies included participants both with and without disabilities, but few reported statistical analyses comparing performance between the two groups. Results suggest that AAC-BCI systems show promise for supporting communication for people with SSPI, but they remain ineffective for some individuals. The lack of standards in reporting outcome measures makes it difficult to synthesize data across studies. Further research is needed to demonstrate efficacy of AAC-BCI systems for people who experience SSPI of varying etiologies and severity levels, and these individuals should be included in system design and testing. Consensus in terminology and consistent participant, protocol, and performance description will facilitate the exploration of user and system characteristics that positively or negatively affect AAC-BCI use, and support innovations that will make this technology more useful to a broader group of people.Clinical trial registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018095345, PROSPERO: CRD42018095345. (shrink)

Research Ethics, Volume 18, Issue 1, Page 3-12, January 2022. Consent is one necessary foundation for ethical research and it’s one of the research ethics committee’s major roles to ensure that the consent process meets acceptable standards. Although on Oxford ‘A’ REC we’ve been impressed by the thought and work put into this aspect of research ethics, we’ve continued to have concerns about the suitability and effectiveness of consent processes in supporting decision making, particularly for clinical trials. There’s poor understanding (...) of what people want to help them decide; current processes don’t provide the best grounding for informed consent and there’s inadequate public involvement. We’ve also found a lack of proportionality with researchers failing to adapt consent procedures in proportion to the burdens and consequences of the study. As a result, people are often not best helped to make an informed choice when asked to join a research study. To address these concerns, we considered how we might improve this aspect of research ethics review. Recognising the central importance of the dialogue between the volunteer and researcher, we’ve drawn up a model or flowchart of what we deem good consent practice, proposing consent should be built around four simple steps:Step 1: Introducing the study and the choices: helping the potential participants get an overview of the proposal and introducing the key issues.Step 2: Explaining all the details of the study using the detailed Participant Information Sheet.Step 3: After a gap, if necessary, reviewing and checking understanding.Step 4: Reaching agreement and recording consent.These steps, we believe, could help all involved and this article lays out ways we might improve participant choice while complying with accepted principles and current regulations. (shrink)

This review of issues and research is in two parts: 1) practical problems surrounding patient-held records and 2) ethical arguments for and against patient-held records. We argue that research on patient-held records indicates that there are no substantial practical drawbacks and considerable ethical benefits to be derived from giving patients custody of their medical records.

According to a 17th-century European fantasy, certain sponges were used in the South Seas to record and transmit sound. A message spoken into one of these sponges would be exactly replayed when a recipient squeezed it appropriately, even across great distances in time and space. It's hard for us to remember just how magical it is, in a natural world made up solely of warring elements, that any information can be enduringly stored, transported without distortion, and precisely reproduced. Our (...) lives are irretrievably tangled with artificial systems which keep their contents ordered and immune from melding, and we trust that our computers won't creatively blend our files overnight. But despite our best efforts to tidy our own minds, the blurry and insistently productive operations of human memory, in contrast, often resist both control and understanding. (shrink)

Neurological interventions are sometimes used to prevent criminal behavior. For instance, in some jurisdictions, sex offenders can be compelled to undergo treatment designed to reduce sexual desire. As David Birks and Thomas Douglas observe in their introduction to this volume, “chemical castration” may be just the tip of the iceberg. As neuroscience advances, it could reveal many other ways to control criminality. For instance, pharmacological treatments may help combat violent behavior or drug abuse. Such “crime-preventing neurointerventions” have been controversial. On (...) the one hand, proponents argue that CPNs could be both more effective and more humane than incarceration. On the other, critics argue that coercively imposed CPNs violate individual rights and that society has a poor track record of using medical interventions for social control. The nineteen original essays in this book comprehensively cover and effectively advance the moral debate over the appropriate use of CPNs. (shrink)

SCSS President Stephen M. Krason wrote this letter in response to a review about a book he edited and contributed to in the SCSS’s Catholic Social Thought Book Series, The Crisis of Religious Liberty: Reflections from Law, History, and Catholic Social Thought. The review, which appeared in The Journal of Church and State, was mostly favorable to the book but made erroneous assertions and a false and unmerited conclusion about the sources Krason used in his Afterword in the (...) book. Krason also sent the letter to the editor of the Journal, but they apparently don’t run letters and did not make an exception with this one. Krason also sent a copy of this letter to the other contributors to the book and includes it here out of a sense of the need to have a public record of a response to a published book review that, of course, was publicly disseminated. (shrink)

Bob Hale’s distinguished record of research places him among the most important and influential contemporary analytic metaphysicians. In his deep, wide ranging, yet highly readable book Necessary Beings, Hale draws upon, but substantially integrates and extends, a good deal his past research to produce a sustained and richly textured essay on — as promised in the subtitle — ontology, modality, and the relations between them. I’ve set myself two tasks in this review: first, to provide a reasonably thorough (...) (if not exactly comprehensive) overview of the structure and content of Hale’s book and, second, to a limited extent, to engage Hale’s book philosophically. I approach these tasks more or less sequentially: Parts I and 2 of the review are primarily expository; in Part 3 I adopt a somewhat more critical stance and raise several issues concerning one of the central elements of Hale’s account, his essentialist theory of modality. (shrink)

Socially assistive devices such as care robots or companions have been advocated as a promising tool in elderly care in Western healthcare systems. Ethical debates indicate various challenges. An important part of the ethical evaluation is to understand how users interact with these devices and how interaction influences users’ perceptions and their ability to express themselves. In this review, we report and critically appraise findings of non-comparative empirical studies with regard to these effects from an ethical perspective.Electronic databases and (...) other sources were queried using a comprehensive search strategy generating 9851 records. Studies were screened independently by two authors. Methodological quality of studies was assessed. For 22 reports on 21 datasets using a non-comparative design a narrative synthesis was performed.Data shows positive findings in regard to attitudes and emotional reactions of users. Varying perception of a social relation and social presence are the most commonly observed traits of interaction. Users struggle with understanding technical complexities while functionality of the devices is limited. This leads to a behavioral alignment of users towards the requirements of the devices to be able to make use of them.This evidence adds to three important ethical debates on the use of socially assistive devices in healthcare in regard to (1) reliability of existing empirical evidence to inform normative judgements, (2) ethical significance of the social presence of devices and (3) user autonomy in regard to behavioral alignment. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:January 28, 2009 (12:22 pm) G:\WPData\TYPE2802\russell 28,2 051red.wpd russell: the Journal of Bertrand Russell Studies n.s. 28 (winter 2008–09): 171–90 The Bertrand Russell Research Centre, McMaster U. issn 0036-01631; online 1913-8032 eviews A RELATIONAL DISPUTE Sébastien Gandon iufz/zphier / U. Blaise Pascal 63000 Clermont-Ferrand, France [email protected] Stewart Candlish. The Russell/Bradley Dispute and Its SigniWcance for TwentiethCentury Philosophy. Basingstoke and New York: Palgrave Macmillan, 2007. Pp. xix, 235. isbn 978-0-230-50685-5. (...) £49.99; us$84.95 (hb). Candlish’s book aims at giving a “fair” description of the notorious Russell/ Bradley dispute, that is, a more balanced one than the version that is usually told. The standard account is the one given by Russell, and, as Russell was a party of the debate, it is no surprise that he seriously misconstrued Bradley’s arguments. Attempting to set the historical record straight, Candlish then opposes Russell’s description of the dispute. The author is quite clear, however, on the fact that he does not himself endorse the Idealistic point of view (p. xi). The two Wrst chapters of the book are introductory: the Wrst one is a presentation of the stereotypical picture that the author intends to demolish, while the second is an outline of Bradley’s metaphysics. Chapters 3 and 4 are devoted to a confrontation between Russell and Bradley’s theories of judgment and truth. Chapters 5 and 6 are dedicated to a rehabilitation of Bradley’s writings about relation. In these four chapters, Candlish attempts to show that Russell’s arguments against Bradley were not as devastating as they are supposed to be, and that Bradley’s insights were quite powerful—so much so that they have been rediscovered by some later philosophers, such as Wittgenstein, for instance. The concluding chapter is an attempt to explain the decline of monistic idealism after Bradley. Candlish does not only aim at oTering a “fair” account of the Russell/Bradley dispute. This goal is extended by a more general plea for the introduction of an historical perspective in analytic philosophy. According to Candlish, “our implicit acceptance of a distorted version of philosophy’s recent past has serious consequences ” (p. 19): one of them is that, by misunderstanding our own history, we “misunderstand ourselves and the nature of what we are about” (ibid.); another is that, by being deprived of any way to connect what we do in philosophy January 28, 2009 (12:22 pm) G:\WPData\TYPE2802\russell 28,2 051red.wpd 172 Reviews with what some of the philosophers of the past have done, “we may, as a result, fall under the impression that only we, and those obviously like us, are really doing philosophy, at least as it ought to be done” (ibid.). From this perspective, Russell’s confrontation with Bradley seems to represent a rather good topic: not only does it epitomize a turning-point in Russell’s intellectual evolution and in the emergence of the new tradition, but it also shows how easily the new and victorious analytic philosophy has misconstrued its own history. If I entirely share Candlish’s conviction about the necessity of introducing an historical perspective in analytical philosophy, I am not convinced by Candlish’s own reconstruction of the dispute. In a nutshell, what I Wnd very useful in the book is all that concerns Bradley, and some of the parts devoted to Russell (especially, the analysis of his theory of judgment). What I do not agree with is, Wrst, Candlish’s way of doing history of philosophy; second, his treatment of Russell’s works; and third, his general conception of the use of logic in philosophy. Candlish really succeeds in expounding to the modern eye both the coherence of Bradley’s thought, and the diUculty of grasping it. His analysis of the role Bradley gave to “intellectual satisfaction” (pp. 26–7, 33) and to the “principles of suUcient reason” (pp. 46–7) is very enlightening—it explains why Bradley, while endorsing a kind of methodological scepticism, denied that ultimate contingencies were given in experience (p. 48). Candlish also does a great job of presenting... (shrink)

Conflicts of interest held by researchers remain a focus of attention in clinical research. Biases related to these relationships have the potential to directly impact the quality of healthcare by influencing decision-making, yet conflicts of interest remain underreported, inconsistently described, and difficult to access. Initiatives aimed at improving the disclosure of researcher conflicts of interest are still in their infancy but represent a vital reform that must be addressed before potential biases associated with conflicts of interest can be mitigated and (...) trust in the impartiality of clinical evidence restored. In this review, we examine the prevalence of conflicts of interest, evidence of the effects that disclosed and undisclosed conflicts of interest have had on the reporting of clinical evidence, and the emerging approaches for improving the completeness and consistency of disclosures. Through this review of emerging technologies, we recognize a growing interest in publicly accessible registries for researcher conflicts of interest and propose five desiderata aimed at maximizing the value of such registries: mandates for ensuring that researchers keep their records up to date; transparent records that are made available to the public; interoperability to allow researchers, bibliographic databases, and institutions to interact with the registry; a consistent taxonomy for describing different classes of conflicts of interest; and the ability to automatically generate conflicts of interest statements for use in published articles. (shrink)

Over the last forty years, Donald Davidson has been one of the most influential, but least accessible voices in philosophy. There are several reasons why it is hard to come to grips with his work. First, his language is dense, even by the standards of analytic philosophy; while at the same time his thought is highly organic, so that it is difficult to make sense of one idea without an understanding of his whole program. Davidson never attempted to write a (...) book that would provide an easy entry into the interconnections between his many influential and controversial views. Nor did he attempt to record the evolution of his thought, keeping track of how reconsiderations on one point would affect the tenability of the others. It is perhaps a good thing too, for as the volume to be reviewed here makes clear, such a massive project would have left him with little time for his later contributions to philosophy. (shrink)

Abstract Context: Established in 1997, Summa Health System’s Medical Ethics Committee (EC) serves as an educational, supportive, and consultative resource to patients/families and providers, and serves to analyze, clarify, and ameliorate dilemmas in clinical care. In 2009 the EC conducted its 100th consult. In 2002 a Palliative Care Consult Service (PCCS) was established to provide supportive services for patients/families facing advanced illness; enhance clinical decision-making during crisis; and improve pain/symptom management. How these services affect one another has thus far been (...) unclear. Objectives: This study describes EC consults: types, reasons, recommendations and utilization, and investigates the impact the PCCS may have on EC consult requests or recommendations. Methods: Retrospective reviews of 100 EC records explored trends and changes in types of consults, reasons for consults, and EC recommendations and utilization. Results: There were 50 EC consults each in the 6 years pre- and post-PCCS. Differences found include: (1) a decrease in number of reasons for consult requests (133–62); (2) changes in top two reasons for EC consult requests from ‘Family opposed to withdrawing life-sustaining treatment (LST)’ and ‘Patient capacity in question’ to ‘Futility’ and ‘Physician opposed to providing LST’; (3) changes in top two recommendations given by the EC from ‘Emotional Support for Patient/Family’ and ‘Initiate DNR Order’ to ‘Comfort Care’ and ‘Withdraw Treatment.’ Overall, 88% of recommendations were followed. Conclusion: PCCS availability and growth throughout the hospital may have influenced EC consult requests. EC consults regarding family opposition to withdrawing LST and EC recommendations for patient/family support declined. Content Type Journal Article Pages 1-16 DOI 10.1007/s10730-011-9170-9 Authors Jessica Richmond Moeller, Department of Psychiatry and Behavioral Sciences, Akron General Medical Center, 400 Wabash Ave, Akron, OH 44307, USA Teresa H. Albanese, Health Services Research and Education Institute, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Kimberly Garchar, Kent State University, 6000 Frank Ave., N.W, North Canton, OH 44720, USA Julie M. Aultman, Department of Family and Community Medicine, Northeast Ohio Medical University, P.O. Box 95, Rootstown, OH 44272, USA Steven Radwany, Palliative Care and Hospice Services, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Dean Frate, Internal Medicine, Palliative Care and Hospice Services, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)

BackgroundArtificial intelligence has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have potential for advancing health equity within and between countries, we must consider the ethical implications of its deployment in order to mitigate its potential harms, particularly for the most vulnerable. This scoping review addresses the following (...) question: What ethical issues have been identified in relation to AI in the field of health, including from a global health perspective?MethodsEight electronic databases were searched for peer reviewed and grey literature published before April 2018 using the concepts of health, ethics, and AI, and their related terms. Records were independently screened by two reviewers and were included if they reported on AI in relation to health and ethics and were written in the English language. Data was charted on a piloted data charting form, and a descriptive and thematic analysis was performed.ResultsUpon reviewing 12,722 articles, 103 met the predetermined inclusion criteria. The literature was primarily focused on the ethics of AI in health care, particularly on carer robots, diagnostics, and precision medicine, but was largely silent on ethics of AI in public and population health. The literature highlighted a number of common ethical concerns related to privacy, trust, accountability and responsibility, and bias. Largely missing from the literature was the ethics of AI in global health, particularly in the context of low- and middle-income countries.ConclusionsThe ethical issues surrounding AI in the field of health are both vast and complex. While AI holds the potential to improve health and health systems, our analysis suggests that its introduction should be approached with cautious optimism. The dearth of literature on the ethics of AI within LMICs, as well as in public health, also points to a critical need for further research into the ethical implications of AI within both global and public health, to ensure that its development and implementation is ethical for everyone, everywhere. (shrink)