Objective: To determine the views of people with multiple sclerosis (MS) and professionals in relation to confidentiality, consent and access to data within a proposed MS register in the UK. Design: Qualitative study using focus groups (10) and interviews (13). Setting: England and Northern Ireland. Participants: 68 people with MS, neurologists, MS nurses, health services management professionals, researchers, representatives from pharmaceutical companies and social care professionals. Results: People with MS expressed open and altruistic views towards the use of their personal (...) information to facilitate service provision and research, placing trust in responsible guardianship and legitimate use of their information. Participant’s proposed that people with MS should be able to select their individual level of involvement in a register using levels of consent. It was agreed that access to the register should be governed by a guardianship committee composed of a range of stakeholders. People with MS did not wish their details to be used by marketing agencies and did not consider this a legitimate use of their data. Whilst participants were positive of the role a register could play in promoting research, participants felt that access to data by pharmaceutical industries should be administered by the guardianship committee. People with MS are concerned should their employers be able to access their personal information. Professionals were more cautious than people with MS in their approach to the use of patient personal data within a register. Conclusions: Whilst all stakeholders were positive of the benefits of an MS register, development of such a resource must incorporate robust data security and guardianship measures in order to ensure that, whilst opportunities are maximised, risks to the privacy of individuals and legal challenges to professionals are avoided. (shrink)

Reumen. Se describen las bases del muestreo conglomerado y muestreo sistemático. Se presentan lasecuaciones pertinentes y aquellas para la estimación del tamaño óptimo de muestreo para cada tipo demuestreo. Se demuestra la aplicación práctica de éstos clases de muestreo por medio de ejemplosreales.Palabras claves. Muestreo conglomerado, muestreo sistemático, tamaño óptimo de la muestra.. Cluster sampling and systematic sampling are described and their equations are provided.Real examples are given in order to show the applications of these types of samplings. Equations toestimate (...) optimal sample sizes are also noted.Keywords. Cluster sampling, optimal sample size, systematic sampling. (shrink)

Objective To study how doctors care for their patients, both medically and as fellow humans, through observing their conduct in patient–doctor encounters. Design Qualitative study in which 101 videotaped consultations were observed and analysed using a Grounded Theory approach, generating explanatory categories through a hermeneutical analysis of the taped consultations. Setting A 500-bed general teaching hospital in Norway. Participants 71 doctors working in clinical non-psychiatric departments and their patients. Results The doctors were concerned about their patients' health and how their (...) medical knowledge could be of service. This medical focus often over-rode other important aspects of the consultations, especially existential elements. The doctors actively directed the focus away from their patients' existential concerns onto medical facts and rarely addressed the personal aspects of a patient's condition, treating them in a biomechanical manner. At the same time, however, the doctors attended to their patients with courteousness, displaying a polite and friendly attitude and emphasising the relationship between them. Conclusions The study suggests that the main failing of patient–doctor encounters is not a lack of courteous manners, but the moral offence patients experience when existential concerns are ignored. Improving doctors' social and communication skills cannot resolve this moral problem, which appears to be intrinsically bound to modern medical practice. Acknowledging this moral offence would, however, be the first step towards minimising the effects thereof. (shrink)

Resumen. Se presentan los conceptos básicos de muestreo secuencial en sus cinco modalidades,incluyendo muestreo secuencial de tipo estándar, usando solo una densidad crítica, por una precisiónfija, por medio de presencia-ausencia y finalmente de tipo temporal. Se notan un ejemplo real para cadacaso. Se nota y se explica la importancia de la distribución de los datos y los pertinentes ecuaciones. Sepresentan a través de ejemplos reales las ecuaciones para estimar el tamaño óptimo de la muestra paracada uno de las cinco modalidades (...) del muestreo secuencial. Se enfatiza la ventaja económica de estetipo de muestreo.Palabras clave: Distribución de los datos, muestreo secuencial, tamaño óptimo de la muestra. Fundamental concepts of sequential sampling in all its types including standard sequentialsampling, sequential sampling using only one critical density, fixed precision sequential sampling,presence-absence sequential sampling, and time sequential sampling are highlighted. A real caseexample for each of the five sequential samplings is given. The relevance of data distribution forsequential sampling along with corresponding equations is provided and explained. Equations to assessthe optimal sample size for each case are noted and exemplified. The economic advantages of sequentialsampling in stressedKeywords: Data distribution, sample size, sequential sampling. (shrink)

Resumen. Se analizan de forma detallada las bases del muestreo multietápico, la estimación de submuestreo y el muestreo de respuesta aleatoria. Se presentan las ecuaciones pertinentes ejemplificando por medio de casos reales. También se argumentan las situaciones en donde se debe utilizar estos casos específicos. Palabras claves. Caso multietápico, muestreo de respuesta aleatoria, submuestreo.. The basics of multi-stage sampling, sub-sampling and random response sampling are analyzed. Detailed equations regarding these types of sampling are provided. The applications of these types of (...) samplings are denoted by means of real case studies. Keywords. Multi-stage sampling, sub-sampling, random response sampling. (shrink)

Palabras claves. Métodos estadísticos, pruebas de hipótesisResumen. Se presentan de forma simple, breve y por medios de los ejemplos prácticos, los métodos estadísticos que sirven para demostrar la representatividad de una, dos o varias muestras basada en los parámetros poblacionales . Se indican la manera de reducir el tamaño del error experimental para aclarar el efecto significativo de los grupos o muestras bajo el interés . Además, se demuestran la forma de eliminar el efecto de las variables auxiliares o colaterales (...) causante del ruido o error en la estadística . También se nota el uso del modelo ANOVA Anidada para indicar la forma de segmentar la ANOVA en varias partes y de esta manera poder contestar preguntas más complejas. Finalmente, se describen e explican la forma de optimizar los recursos en la conducción de los experimentos y descubrir el efecto de la interacción entre las variables .Keywords. Hypothesis testing, statistical methods. Statistical methods that serve to represent, based upon population parameters of mean and variance, for one, tow or various samples taken from study populations are discussed. Ways to reduce the amount of experimental error in order to clarify the real effect of the treatments are demonstrated . The use of Covariance Analysis to show the pure effect of treatment free from the effect of collateral variables is also indicated. Nested ANOVA that allows division of ANOVA in several parts in order to answer complex questions is described and explained. Finally, the utility of Factorial Analysis for optimization of resource use as well as the illustration of interaction effects are noted and analyzed. (shrink)

In an international survey of rationing we have found that European physicians encounter scarcity-related ethical difficulties, and are dissatified with the resolution of many of these cases. Here we further examine survey results to explore whether ethics support services would be potentially useful in addressing scarcity related ethical dilemmas. Results indicate that while the type of help offered by ethics support services was considered helpful by physicians, they rarely referred difficulties regarding scarcity to ethics consultation. We propose that ethics consultants (...) could assist physicians by making the process less difficult, and by contributing to decisions being more ethically justifiable. Expertise in bringing considerations of justice to bear on real cases could also be useful in recognising an unjust limit, as opposed to a merely frustrating limit. Though these situations are unlikely to be among the most frequently referred to ethics support services, ethics consultants should be prepared to address them. (shrink)

Recent data indicate that under a specific posthypnotic suggestion to circumvent reading, highly suggestible subjects successfully eliminated the Stroop interference effect. The present study examined whether an optical explanation could account for this finding. Using cyclopentolate hydrochloride eye drops to pharmacologically prevent visual accommodation in all subjects, behavioral Stroop data were collected from six highly hypnotizables and six less suggestibles using an optical setup that guaranteed either sharply focused or blurred vision. The highly suggestibles performed the Stroop task when naturally (...) vigilant, under posthypnotic suggestion not to read, and while visually blurred; the less suggestibles ran naturally vigilant, while looking away, and while visually blurred. Although visual accommodation was precluded for all subjects, posthypnotic suggestion effectively eliminated Stroop interference and was comparable to looking away in controls. These data strengthen the view that Stroop interference is neither robust nor inevitable and support the hypothesis that posthypnotic suggestion may exert a top-down influence on neural processing. (shrink)

Empirical research pertaining to cardiopulmonary resuscitation (CPR), clinician behaviors related to do-not-resuscitate (DNR) orders and substituted judgment suggests potential contributions to medical ethics. Research quantifying the likelihood of surviving CPR points to the need for further philosophical analysis of the limitations of the patient autonomy in decision making, the nature and definition of medical futility, and the relationship between futility and professional standards. Research on DNR orders has identified barriers to the goal of patient involvement in these life and death (...) discussions. The initial data on surrogate decision making also points to the need for a reexamination of the moral basis for substituted judgment, the moral authority of proxy decision making and the second-order status of the best interests standard. These examples of empirical research suggest that an interplay between empirical research, ethical analysis and policy development may represent a new form of interdisciplinary scholarship to improve clinical medicine. (shrink)

Book reviewed in this article: The New Health Care For Profit: Doctors and Hospitals in a Competitive Environment. Edited by Bradford H. Gray The Healing Mission and the Business Ethic. By Robert M. Cunningham The Medical Industrial Complex. By Stanley Wohl.

Background: Islam and Muslims are underrepresented in the medical literature and the influence of physician’s cultural beliefs and religious values upon the clinical encounter has been understudied. Objective: To elicit the perceived influence of Islam upon the practice patterns of immigrant Muslim physicians in the USA. Design: Ten face-to-face, in-depth, semistructured interviews with Muslim physicians from various backgrounds and specialties trained outside the USA and practising within the the country. Data were analysed according to the conventions of qualitative research using (...) a modified grounded-theory approach. Results: There were a variety of views on the role of Islam in medical practice. Several themes emerged from our interviews: (1) a trend to view Islam as enhancing virtuous professional behaviour; (2) the perception of Islam as influencing the scope of medical practice through setting boundaries on career choices, defining acceptable medical procedures and shaping social interactions with physician peers; (3) a perceived need for Islamic religious experts within Islamic medical ethical deliberation. Limitations: This is a pilot study intended to yield themes and hypotheses for further investigation and is not meant to fully characterise Muslim physicians at large. Conclusions: Immigrant Muslim physicians practising within the USA perceive Islam to play a variable role within their clinical practice, from influencing interpersonal relations and character development to affecting specialty choice and procedures performed. Areas of ethical challenges identified include catering to populations with lifestyles at odds with Islamic teachings, end-of-life care and maintaining a faith identity within the culture of medicine. Further study of the interplay between Islam and Muslim medical practice and the manner and degree to which Islamic values and law inform ethical decision-making is needed. (shrink)

Background: Thrombolytic drugs to treat an acute ischaemic stroke reduce the risk of death or major disability. The treatment is, however, also associated with an increased risk of potentially fatal intracranial bleeding. This confronts the patient with the dilemma of whether or not to take a risk of a serious side effect in order to increase the likelihood of a favourable outcome. Objective: To explore acute stroke patients’ perception of risk and willingness to accept risks associated with thrombolytic drug treatment. (...) Design: Eleven patients who had been informed about thrombolytic drug treatment and had been through the process of deciding whether or not to participate in a thrombolytic drug trial went through repeated qualitative, semistructured interviews. Results: Many patients showed a limited perception of the risks connected with thrombolytic drug treatment. Some perceived the risk as not relevant to them and were reluctant to accept that treatment could cause harm. Others seemed to be aware that treatment would mean exposure to risk. The patients’ willingness to take a risk also varied substantially. Several statements revealed ambiguity and confusion about being involved in a decision about treatment. The patients’ reasoning about risk was put into the context of their health-related experiences and life histories. Several patients wanted the doctor to be responsible for the decisions. Conclusion: Acute stroke patients’ difficulties in perceiving and processing information about risk may reduce their ability to be involved in clinical decisions where risks are involved. (shrink)

The United Nations Educational, Scientific and Cultural Organization recently declared transhumance pastoralism as an Intangible Cultural Heritage of Humanity. The notion of heritage seeks to recognize the culture behind the seasonal grazing movements along herding routes, between distant and dissimilar ecosystems. The pastoral families move with their herds from pasturelands used during the winter (winter-lands) to areas pastured during the summer (summer-lands). Whereas this is a key step towards the recognition of the cultural dimension associated to this ancient practice, a (...) relevant feature of transhumance pastoralism is its strong linkage with environmental dynamics. This activity developed in a spatiotemporal and co-evolutionary trajectory, which gave rise to a pastoral territory. A territory is the union or linkage of a meaning with a specific place, that is, the space that is appropriated and valued, both symbolically and instrumentally, by human groups. Hence, the pastoral territory represents the socio-ecological system that integrates a pastoral-based community with the natural environment that it inhabits. We propose a co-evolutionary approach to analyzing some key attributes of transhumant pastoralism, which modulate the socio-ecological interdependence. Based on a study case from Northwest Patagonia, Argentina, we identified and characterized seven attributes: (I) mobility, (II) connectivity, (III) temporal synchrony, (IV) local interdependence, (V) local ecological knowledge, (VI) adaptive capacity legacy, and (VII) mixture of land tenure. We discuss these features as examples that represent keystone socio-ecological attributes for the recognition of transhumant pastoral territories as a biocultural heritage. (shrink)

Both syntactic and semantic solutions are given for the entailment problem of duality theory. The test algebra theorem provides both a syntactic solution to the entailment problem in terms of primitive positive formulae and a new derivation of the corresponding result in clone theory, viz. the syntactic description of $\operatorname{Inv(Pol}(R))$ for a given set R of finitary relations on a finite set. The semantic solution to the entailment problem follows from the syntactic one, or can be given in the form (...) of an algorithm. It shows, in the special case of a purely relational type, that duality-theoretic entailment is describable in terms of five constructs, namely trivial relations, intersection, repetition removal, product, and retractive projection. All except the last are concrete, in the sense that they are described by a quantifier-free formula. It is proved that if the finite algebra $\underline{M}$ generates a congruence-distributive variety and all subalgebras of $\underline{M}$ are subdirectly irreducible, then concrete constructs suffice to describe entailment. The concept of entailment appropriate to strong dualities is also introduced, and described in terms of coordinate projections, restriction of domains, and composition of partial functions. (shrink)

That brings me to the crux of my disagreement with Hillis Miller. The central contention is not simply that I am sometimes, or always, wrong in my interpretation, but instead that I—like other traditional historians—can never be right in my interpretation. For Miller assents to Nietzsche's challenge of "the concept of 'rightness' in interpretation," and to Nietzsche's assertion that "the same text authorizes innumerable interpretations : there is no 'correct' interpretation."1 Nietzsche's views of interpretation, as Miller says, are relevant to (...) the recent deconstructive theorists, including Jacques Derrida and himself, who have "reinterpreted Nietzsche" or have written "directly or indirectly under his aegis." He goes on to quote a number of statements from Nietzsche's The Will to Power to the effect, as Miller puts it, "that reading is never the objective identifying of a sense but the importation of meaning into a text which had no meaning 'in itself.'" For example: "Ultimately, man finds in things nothing but what he himself has imported into them." "In fact interpretation is itself a means of becoming master of something."2 On the face of it, such sweeping deconstructive claims might suggest those of Lewis Carroll's linguistic philosopher, who asserted that meaning is imported into a text by the interpreter's will to power: "The question is," said Alice, "whether you can make words mean so many different things.""The question is," said Humpty Dumpty, "which is to be master—that's all." But of course I don't believe that such deconstructive claims are, in Humpty Dumpty fashion, simply dogmatic assertions. Instead, they are conclusions which are derived from particular linguistic premises. I want, in the time remaining, to present what I make out to be the elected linguistic premises, first of Jacques Derrida, then of Hillis Miller, in the confidence that if I misinterpret these theories, my errors will soon be challenged and corrected. Let me eliminate suspense by saying at the beginning that I don't think that their radically skeptical conclusions from these premises are wrong. On the contrary, I believe that their conclusions are right—in fact, they are infallibly right, and that's where the trouble lies. · 1. "Tradition and Difference," Diacritics 2 : 8, 12.· 2. Ibid. M. H. Abrams’s contributions to Critical Inquiry include "Rationality and Imagination in Cultural History: A Reply to Wayne Booth" and "Behaviorism and Deconstruction: A Comment on Morse Peckham's 'The Infinitude of Pluralism'". (shrink)

In this study, some new hypotheses and techniques are presented to obtain some new analytical solutions to the generalized Kawahara equation. As a particular case, some traveling wave solutions to both Kawahara equation and modified Kawahara equation are derived in detail. Periodic and soliton solutions to this family are obtained. The periodic solutions are expressed in terms of Weierstrass elliptic functions and Jacobian elliptic functions. For KE, some direct and indirect approaches are carried out to derive the periodic and localized (...) solutions. For mKE, two different hypotheses in the form of WSEFs are used to derive the periodic and localized solutions. Also, the cnoidal wave solutions in the form of JEFs are obtained. As a realistic physical application, the solutions obtained can be dedicated to studying many nonlinear waves that propagate in plasma. (shrink)

The words 'true value' assume an existential relationship with the thing being measured. There is assumed to exist some aspect of the thing being measured that is independent of its relationship to the person who is interested in the result of the measurement. Yet measurement is a response to the need of an observer to know something about the real world. There is therefore an epistemological aspect to measurement. Some aspect of measurement has to do with the observer as a (...) knower of the result of the measurement. The paper considers electrical measurement. It proposes that these relationships correspond to two distinct kinds of measurement: one has the characteristic that there does exist such a thing as a true value, though it cannot be known: in the other kind, no such thing as true value even exists. The notion of true value is very useful, and for the kind of measurement where such a thing does not exist, the paper defines an alternative that has the advantage that it can actually be known under some circumstances in calibration. (shrink)

We make a brief review of the Kramers escape rate theory for the probabilistic motion of a particle in a potential well U(x), and under the influence of classical fluctuation forces. The Kramers theory is extended in order to take into account the action of the thermal and zero-point random electromagnetic fields on a charged particle. The result is physically relevant because we get a non-null escape rate over the potential barrier at low temperatures (T → 0). It is found (...) that, even if the mean energy is much smaller than the barrier height, the classical particle can escape from the potential well due to the action of the zero-point fluctuating fields. These stochastic effects can be used to give a classical interpretation to some quantum tunneling phenomena. Relevant experimental data are used to illustrate the theoretical results. (shrink)

We consider the simple case of a nonrelativistic charged harmonic oscillator in one dimension, to investigate how to take into account the radiation reaction and vacuum fluctuation forces within the Schrödinger equation. The effects of both zero-point and thermal classical electromagnetic vacuum fields, characteristic of stochastic electrodynamics, are separately considered. Our study confirms that the zero-point electromagnetic fluctuations are dynamically related to the momentum operator p=−i ℏ ∂/∂ x used in the Schrödinger equation.

A worldwidemental health crisis is expected, as millions worldwide fear death and disease while being forced into repeated isolation. Thus, there is a need for new proactive approaches to improve mental resilience and prevent mental health conditions. Since the 1990s, art has emerged as an alternative mental health therapy in the United States and Europe, becoming part of the social care agenda. This article focuses on how visual esthetic experiences can create similar patterns of neuronal activity as those observed when (...) the reward system is activated. The activation of the reward structures could have a stress buffering effect, given the interdependence observed between the reward and stress systems. Therefore, could visual esthetic experiences stimulate mental resilience? And if this were the case, could art-based interventions be offered for mental health in the context of COVID-19 and beyond? (shrink)

The hopes and fears expressed in the debate on human enhancement are not always based on a realistic assessment of the expected possibilities. Discussions about extreme scenarios may at times obscure the ethical and policy issues that are relevant today. This paper aims to contribute to an adequate and ethically sound societal response to actual current developments. After a brief outline of the ethical debate concerning neuro-enhancement, it describes the current state of the art in psychopharmacological science and current uses (...) of psychopharmacological enhancement, as well as the prospects for the near future. It then identifies ethical issues regarding psychopharmacological enhancements that require attention from policymakers, both on the professional and on the governmental level. These concern enhancement research, the gradual expansion of medical categories, off-label prescription and responsibility of doctors, and accessibility of enhancers on the Internet. It is concluded that further discussion on the advantages and drawbacks of enhancers on a collective social level is still needed. (shrink)

In this book, a dozen distinguished scholars in the field of the history of philosophy and science investigate aspects of the commentary tradition on Aristotle's De generatione et corruptione, one of the least studied among Aristotle's treatises in natural philosophy. Many famous thinkers such as Johannes Philoponus, Albert the Great, Thomas Aquinas, John Buridan, Nicole Oresme, Francesco Piccolomini, Jacopo Zabarella, and Galileo Galilei wrote commentaries on it. The distinctive feature of the present book is that it approaches this commentary tradition (...) as a coherent whole, thereby ignoring the usual historiographical distinctions between the Middle Ages, the Renaissance, and the seventeenth century. Frans de Haas and Henk Kubbinga address the Greek commentary tradition on De generatione et corruptione. Simone van Riet's essay is devoted to the Latin version of Avicenna's third treatise of his Kitab al Shifa, which discusses Aristotle's De generatione et corruptione. James Otte traces the intricate history of the identification of the Latin translator of Aristotle's treatise as Burgundio of Pisa. The essay by John Murdoch explores the fortuna of atomistic arguments in the Latin commentary tradition. Jurgen Sarnowsky, Henk Braakhuis, and Stefano Caroti examine various themes in the commentaries that were produced by the so-called Buridan School, that is, John Buridan, Albert of Saxony, Nicholas Oresme, and Marsilius of Inghen. The article by Silvia Donati focuses on the influential commentary by the Expositor, Giles of Rome. The final essay, written by Anita Guerrini, tackles Robert Boyle's attitude in the Origin of Forms and Qualities toward such Aristotelian key concepts as forms, matter, qualities, and mixture. These essays are prefaced by a preliminary survey by Hans Thijssen of Aristotle's text, its Latin translations and its Greek, Arabic and Latin commentaries. (shrink)

The physical interpretation of induced representation intertwining as a process of materialization or localization is extrapolated to mappings (which are not intertwinings) between configuration and momentum representations. Propagation of extended particles composed of an external and an internal mode is a combination of two generalized materializations and two generalized localizations. Our aim is to submit, in the spinless case, the idea that mappings from external representations to internal ones are possible alternatives, probability amplitudes of which must be summed up in (...) the whole propagator. However, it turns out that they lead to different final states and then correspond to 64 different propagators and not to alternatives of the same propagation. In addition to being transitions from one location to another, these propagations contain processes of interconversion between internal and external modes which are responsible for creation and annihilation of the extended particle. The physical interpretations are striking, while the mathematical stricture is poor. Inconsistencies of the model are outlined. (shrink)