Systematic pluralism does not purport to be a new philosophy. Rather, it is a position on positions, a discovery of something previously unrecognized in the nature of philosophical thought. Further, “since the special arts and sciences are particular embodiments of philosophic principles, a pluralism at the level of philosophy implies a similar pluralism at the level of the special arts and sciences.” Therefore, the claims of systematic pluralism are not limited to philosophy but the position has something fundamental to report (...) about all departments of human thought, resulting in the characteristic movement between levels of generality, from widest philosophical import to narrowest disciplinary application, which appears over and over again in the writings of systematic pluralists and which is well exemplified by the essays in this issue of The Monist, the first of any publication dedicated entirely to the examination of discoveries which are now over half a century old. (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 ethical recruitment of participants with neurological disorders in clinical research requires obtaining initial and ongoing informed consent. The purpose of this study is to characterize barriers faced by research personnel in obtaining informed consent from research participants with neurological disorders and to identify strategies applied by researchers to overcome those barriers. This study was designed as a web-based survey of US researchers with an optional follow-up interview. A subset of participants who completed the survey were selected using a stratified (...) purposeful sampling strategy and invited to participate in an in-depth qualitative interview by phone or video conference. Data were analyzed using a mixed methods approach, including content analysis of survey responses and thematic analysis of interview responses. Over 1 year, 113 survey responses were received from US research personnel directly involved in obtaining informed consent from participants in neurological research. Frequently identified barriers to informed consent included: cognitive and communication impairments (e.g. aphasia), unrealistic expectations of research participants, mistrust of medical research, time constraints, literacy barriers, lack of available social support, and practical or resource-related constraints. Strategies to enhance informed consent included: involving close others to support participant understanding of study-related information, collaborating with more experienced research personnel to facilitate training in obtaining informed consent, encouraging participants to review consent forms in advance of consent discussions, and using printed materials and visual references. Beyond conveying study-related information, researchers included in this study endorsed ethical responsibilities to support deliberation necessary to informed consent in the context of misconceptions about research, unrealistic expectations, limited understanding, mistrust, and/or pressure from close others. Findings highlight the importance of training researchers involved in obtaining informed consent in neurological research to address disease-specific challenges and to support the decision-making processes of potential research participants and their close others. (shrink)

PURPOSE: To evaluate the effects of social support on comprehension and recall of consent form information in a study of Parkinson disease patients and their caregivers.DESIGN and METHODS: Comparison of comprehension and recall outcomes among participants who read and signed the consent form accompanied by a family member/friend versus those of participants who read and signed the consent form unaccompanied. Comprehension and recall of consent form information were measured at one week and one month respectively, using Part A of the (...) Quality of Informed Consent Questionnaire .RESULTS: The mean age of the sample of 143 participants was 71 years . Analysis of covariance was used to compare QuIC scores between the intervention group and control group . In the 1-week model, no statistically significant intervention effect was found . However, the intervention status by patient status interaction was statistically significant . In the 1-month model, no statistically significant intervention effect was found . Again, however, the intervention status by patient status interaction was statistically significant . At both time periods, intervention group patients scored higher on the QuIC than did intervention group caregivers, and control group patients scored lower on the QuIC than did control group caregivers.IMPLICATIONS: Social support played a significant role in enhancing comprehension and recall of consent form information among patients. (shrink)

Category-specific impairments of object recognition and naming are among the most intriguing disorders in neuropsychology, affecting the retrieval of knowledge about either living or nonliving things. They can give us insight into the nature of our representations of objects: Have we evolved different neural systems for recognizing different categories of object? What kinds of knowledge are important for recognizing particular objects? How does visual similarity within a category influence object recognition and representation? What is the nature of our semantic knowledge (...) about different objects? We review the evidence on category-specific impairments, arguing that deficits even for one class of object cannot be accounted for in terms of a single information processing disorder across all patients; problems arise at contrasting loci in different patients. The same apparent pattern of impairment can be produced by damage to different loci. According to a new processing framework for object recognition and naming, the hierarchical interactive theory, we have a hierarchy of highly interactive stored representations. HIT explains the variety of patients in terms of lesions at different levels of processing and different forms of stored knowledge used both for particular tasks and for particular categories of object. Key Words: category-specific deficits; functional imaging; hierarchical models; interactive activation models; neuropsychology; object recognition; perceptual and functional knowledge. (shrink)

As multiparty interactions with single courses of coordinated action, workplace meetings place particular interactional demands on participants who are not primary speakers as they work to initiate turns and to interactively coordinate with displays of recipiency from co-participants. Drawing from a corpus of 26 hours of videotaped workplace meetings in a midsized US city, this article reports on multimodal practices – phonetic, prosodic, and bodily-visual – used for coordinating turn transition and for consolidating recipiency in these specialized speech exchange systems. (...) Practices used by self-selecting non-primary speakers as they secure turns in meetings include displays of close monitoring of current speakers’ emerging turn structure, displays of heightened interest as current turns approach possible completion, and turn initiation practices designed to pursue and, in a fine-tuned manner, coordinate with displays of recipiency on the parts of other participants as well as from reflexively constructed ‘target’ recipients. By attending to bodily-visual action, as well as phonetics and prosody, this study contributes to expanding accounts for turn taking beyond traditional word-based grammar. (shrink)

Background: Informed consent is regarded as a contract between autonomous and equal parties and requires the elements of information disclosure, understanding, voluntariness and consent. The validity of informed consent for critically ill patients has been questioned. Little is known about how these patients experience the process of consent.Objective: The aim of this study was to explore critically ill patients’ experience with the principle of informed consent in a clinical trial and their ability to give valid informed consent.Design: 11 stroke patients (...) who had been informed about thrombolytic treatment and had been through the process of deciding whether or not to participate in a thrombolysis trial went through repeated qualitative semistructured interviews.Results: None of the patients had any clear understanding of the purpose of the trial. Neither did they understand the principles of randomisation and voluntariness. Reasons for giving or not giving consent were trust, conceptions of benefits and risks and altruism. Several patients found it immoral to involve patients in the consent procedure and argued that this was the doctors’ responsibility. Others argued that it is a duty to question patients and perceived it as a sign of being treated with respect and dignity. A majority of the patients found the consent process vague and ambiguous.Conclusions: The results indicate that the principle of informed consent from critically ill patients cannot be seen as a contract between equal and autonomous parties. Further studies are needed to explore critically ill patients’ experiences with the process of informed consent. (shrink)

Transcranial magnetic stimulation, EEG, and behavioral studies by our group implicate spurious activation of speech perception neurocircuitry in the genesis of auditory hallucinations in schizophrenia. The neurobiological basis of these abnormalities remains uncertain, however. We review our ongoing studies, which suggest that altered cortical coupling underlies speech processing in schizophrenia and is expressed via disrupted gamma resonances and impaired corollary discharge function of self-generated verbal thought.

Sensory deficits are a feature of autism and schizophrenia, as well as the upper end of their non-clinical spectra. The mismatch negativity, an index of pre-attentive auditory processing, is particularly sensitive in detecting such deficits; however, little is known about the relationship between the visual MMN to facial emotions and autism and schizophrenia spectrum symptom domains. We probed the vMMN to happy, sad, and neutral faces in 61 healthy adults, and evaluated their degree of autism and schizophrenia spectrum traits using (...) the Autism Spectrum Quotient and Schizotypal Personality Questionnaire. The vMMN to happy faces was significantly larger than the vMMNs to sad and neutral faces. The vMMN to happy faces was associated with interpersonal difficulties as indexed by AQ Communication and Attention to Detail subscales, and SPQ associated with more interpersonal difficulties. These data suggest that pre-attentive processing of positive affect might be more specific to the interpersonal features associated with autism and schizophrenia. These findings add valuable insights into the growing body of literature investigating symptom-specific neurobiological markers of autism and schizophrenia spectrum conditions. (shrink)

Starting with Houtkoop and Mazeland’s study of discourse units, and touching upon recent studies aimed at detailing unit projection in interaction, this article argues that the drive toward abstract and discrete models for units and unit projection is potentially misleading. While it has been established that to engage in talk-in-interaction, as it unfolds in real time, participants rely on projectable units, research aimed at defining units unintentionally backgrounds the contingency inherent in interaction. A central function of language for collaborative action (...) is the management of simultaneously unfolding facets of action, sound production, gesture, and grammar – produced by multiple participants. This article draws upon classic and current data analyses foregrounding linguistic/interactional practices designed to manage local contingencies. It is argued that attention to participants’ regular methods for managing and exploiting contingencies be incorporated from the outset in our descriptions of language and the nature of unit building in interaction. (shrink)

The purpose of this study was to evaluate, revise, and extend the Informed Consent Ontology (ICO) for expressing clinical permissions, including reuse of residual clinical biospecimens and health data. This study followed a formative evaluation design and used a bottom-up modeling approach. Data were collected from the literature on US federal regulations and a study of clinical consent forms. Eleven federal regulations and fifteen permission-sentences from clinical consent forms were iteratively modeled to identify entities and their relationships, followed by community (...) reflection and negotiation based on a series of predetermined evaluation questions. ICO included fifty-two classes and twelve object properties necessary when modeling, demonstrating appropriateness of extending ICO for the clinical domain. Twenty-six additional classes were imported into ICO from other ontologies, and twelve new classes were recommended for development. This work addresses a critical gap in formally representing permissions clinical permissions, including reuse of residual clinical biospecimens and health data. It makes missing content available to the OBO Foundry, enabling use alongside other widely-adopted biomedical ontologies. ICO serves as a machine-interpretable and interoperable tool for responsible reuse of residual clinical biospecimens and health data at scale. (shrink)

Background: There is little research into medical students’ or doctors’ attitudes to abortion, yet knowing this is important, as policy makers should be aware of the views held by professionals directly involved in abortion provision and changing views may have practical implications for the provision of abortion in the future. Methods: We surveyed 300 medical students about their views on abortion, their beliefs about the status of the fetus and the rights of the mother, their attitude towards UK law and (...) their willingness to be involved in abortion provision as qualified doctors. Results: 62% of medical students were pro-choice, 33% pro-life and 7% undecided. Students’ views correlated with gender, year of study and holding a religious belief. Their beliefs about abortion, the status of the fetus and the rights of women significantly correlated with their attitudes towards the UK law and their willingness to be involved in abortion provision. Students’ willingness to be involved in abortion provision was related to their views on abortion, the extent of participation required, the circumstances of the pregnancy and the stage of pregnancy. Conclusions: The percentage of pro-choice students was lower than that found in research on general practitioners’ attitudes to abortion. It is unclear whether this is because students become more pro-choice as they progress through their medical career or because there is genuinely a change in attitudes to abortion. (shrink)

This book is a collection of secondary essays on America's most important philosophic thinkers—statesmen, judges, writers, educators, and activists—from the colonial period to the present. Each essay is a comprehensive introduction to the thought of a noted American on the fundamental meaning of the American regime.

We summarise and respond to the main points made by the commentators on our target article, which concern: whether structural similarity can play a causal role in normal object identification and in neuropsychological deficits for living things, the nature of our structural knowledge of the world, the relations between sensory and functional knowledge of objects, and the nature of our functional knowledge about living things, whether we need to posit a “core” semantic system, arguments that can be marshalled from evidence (...) on functional imaging, the causal mechanisms by which category differences can emerge in object representations, and the nature of our knowledge about categories other than living and nonliving things. We also highlight points raised in our article that seem to be accepted. (shrink)

Decisions about targeting medical assistance in humanitarian contexts are fraught with dilemmas ranging from non-availability of basic services, to massive demographic and epidemiological shifts, and to the threat of insecurity and evacuations. Aid agencies are obliged, due to capacity constraints and competing priorities, to clearly define the objectives and the beneficiaries of their actions. That aid agencies have to set limits to their actions is not controversial, but the process of defining the limits raises ethical questions. In MSF, frameworks for (...) resource allocation are subject to constant reflection and reiteration, and perspectives are sought at all levels, from implementers at the programme level to the operational directors at headquarters. The perspectives of the programmes staff hold considerable weight as they have the knowledge and experience with particular communities to assess the degree of vulnerability and need, and are also the people who ultimately have to give explanations to beneficiaries when changes or closures are going to be instituted. Humanitarian agencies have a responsibility to ensuring that their workers are prepared to reflect on these dilemmas, and challenge the status quo when it costs lives. (shrink)

An adequate approach to any of Aristotle's qualitative parts of tragedy must be grounded in an understanding of their hierarchical ranking within the Poetics. Any "whole" must present "a certain order in its arrangement of parts" ,1 and in a drama each part is "for the sake of" the one "above" it. Contrary to Rosenstein's formulation, for instance, the Aristotelian view is that character as a form "concretizes" and individualizes thought as matter. Rosenstein's question as to whether "these . . (...) . indeed form a genuine disjunction" should not even arise. By ignoring the hierarchy, and therefore collapsing it, Rosenstein weakens his otherwise sound assertion that tragedy is not philosophy. Such is the result, whether intended or not, of holding that "thought must also be some form or concretization of action, just as plot and character are" . This vocabulary seems to suggest in the end that a tragic work is organized by philosophical "themes." "To understand spoken thought as an object of imitation in this manner is to understand it not merely as a content or object being imitated . . . but as the supposedly valid expression of an interpretation of the doings of the aesthetically worked world generally. . . . Thought in this sense becomes theme" . · 1. Unless otherwise noted, all quotations of Aristotle are from The Basic Works of Aristotle, ed. Richard McKeon . James E. Ford responds in this essay to Leon Rosenstein's "On Aristotle and Thought in the Drama" . An assistant professor of English at Brigham Young University—Hawaii Campus, he is currently writing on interpretative theory. See also: "Metaphor and Transcendence" by Karsten Harries in Vol. 5, No. 1. (shrink)

Background Nursing students must graduate prepared to bravely enact the art and science of nursing in environments infiltrated with ethical challenges. Given the necessity and moral obligation of nurses to engage in discourse within nursing ethics, nursing students must be provided a moral supportive learning space for these opportunities. Situating conversations and pedagogy within a brave space may offer a framework to engage in civil discourse while fostering moral courage for learners. Research Objective The aim of this research is to (...) explore the influence of a structured self-assessment tool called the ESA “Engagement Self-Assessment” on the alignment and creation of a brave space in a nursing ethics course. Research Design This study used an exploratory, cross-sectional survey design. Participants and Study Setting Data from 39 undergraduate nursing students enrolled in a nursing healthcare ethics & law course using the ESA were recruited. Ethical Considerations Participation was voluntary and informed without coercion. Written consent was obtained prior to participation. Research ethics approval was obtained by the Institutional Research Ethics Board of the recruited participants (Ethics # 2022-23-03). Findings The ESA provided structured self-reflection on the impact of shared vulnerability within a brave space. However, commitment to a brave space was not strongly influenced by the ESA, but rather by a mutual “commitment to others.” Conclusion A teaching tool such as an ESA can be used to facilitate instructor expectations of civil discourse and discussion of difficult topics. Rules of engagement such as those found in brave spaces can help transform fear of vulnerability into authentic growth for learners. A morally supportive learning space can support critical opportunities for ethical development. This study provides insight into how self-assessment and the use of a brave space in nursing ethics education can facilitate a morally supportive learning space. (shrink)

Acknowledging the perils of interdisciplinary and applied conversation analysis, this essay argues for clarity in articulating relationships between methods, addressing, in particular, the language used to formulate claims regarding how participants’ post hoc reflections relate to findings from CA analyses.

© 2014 Taylor Francis. The Centers for Disease Control and Prevention recommends routine human immunodeficiency virus testing of every client presenting for services in venues where HIV prevalence is high. Because older adults have particularly poor prognosis if they receive their diagnosis late in the course of HIV disease, any screening provided to younger adults in these venues should also be provided to older adults. We examined aging-related disparities in recent and ever HIV testing in a probability sample of at-risk (...) adults seeking services in needle exchange sites, sexually transmitted disease clinics, and Latino community clinics that provide HIV testing. Using multiple logistic regression with generalized estimating equations, we estimated associations between age category and each HIV testing outcome. Even after controlling for covariates such as recent injection drug use, older adults had 40% lower odds than younger adults did of having tested in the past 12 months or ever. Aging-related disparities in HIV testing exist among clients of these high HIV prevalence venues and may contribute to known aging-related disparities in late diagnosis of HIV infection and poor long-term prognosis. (shrink)

Systematic pluralism does not purport to be a new philosophy. Rather, it is a position on positions, a discovery of something previously unrecognized in the nature of philosophical thought. Further, “since the special arts and sciences are particular embodiments of philosophic principles, a pluralism at the level of philosophy implies a similar pluralism at the level of the special arts and sciences.” Therefore, the claims of systematic pluralism are not limited to philosophy but the position has something fundamental to report (...) about all departments of human thought, resulting in the characteristic movement between levels of generality, from widest philosophical import to narrowest disciplinary application, which appears over and over again in the writings of systematic pluralists and which is well exemplified by the essays in this issue of The Monist, the first of any publication dedicated entirely to the examination of discoveries which are now over half a century old. (shrink)

Customer behavior, market dynamics, and technological advances have made it challenging for marketing theorists to provide comprehensive explanations and actionable insights. Although there are numerous substantive marketing frameworks, no formal marketing theory exists. This study aims to develop the first formal grounded theory in marketing by incorporating artificial intelligence and Forde's conceptual framework as a guiding lens. Charmaz's constructivist grounded theory tradition and Forde's conceptual framework and data analysis strategy were employed for this purpose. The data analysis strategy used with (...) grounded theory’s constant compare-and-contrast method comprises holistic and systems thinking, dramaturgical and situational analysis, perspective-taking, and deconstruction. To evaluate Glaser’s assertion that all is data, artificial intelligence was incorporated into the research as the data source for retrieving the theoretical samples to address the primary research question: How can Forde's conceptual framework and artificial intelligence be leveraged to develop a formal marketing theory grounded in evidence? Of significance was the emergence of democratic marketing behaviors and the normalization of anti-democratic marketing approaches leveraged to manipulate buyers or gain access to segments of customers. Buyers and sellers can simultaneously benefit from and be prejudiced by marketing exchange dynamics. This finding lends credibility to the newly emerged framework of strategic actions where empowerment and disempowerment are leveraged to achieve specific goals. Considering this finding, it is suggested that businesses view marketing as a symbiotic relationship between two power centers, buyers and sellers, who respectively strive to maintain human dignity and sustainability. Researchers are encouraged to apply the framework across substantive areas, international markets, public relations, political campaigns, and others. (shrink)

Background: Ethics support services are growing in Europe to help doctors in dealing with ethical difficulties. Currently, insufficient attention has been focused on the experiences of doctors who have faced ethical difficulties in these countries to provide an evidence base for the development of these services.Methods: A survey instrument was adapted to explore the types of ethical dilemma faced by European doctors, how they ranked the difficulty of these dilemmas, their satisfaction with the resolution of a recent ethically difficult case (...) and the types of help they would consider useful. The questionnaire was translated and given to general internists in Norway, Switzerland, Italy and the UK.Results: Survey respondents ranged in age from 28 to 82 years, and averaged 25 years in practice. Only a minority reported having access to ethics consultation in individual cases. The ethical difficulties most often reported as being encountered were uncertain or impaired decision-making capacity , disagreement among caregivers and limitation of treatment at the end of life . The frequency of most ethical difficulties varied among countries, as did the type of issue considered most difficult. The types of help most often identified as potentially useful were professional reassurance about the decision being correct , someone capable of providing specific advice , help in weighing outcomes and clarification of the issues . Few of the types of help expected to be useful varied among countries.Conclusion: Cultural differences may indeed influence how doctors perceive ethical difficulties. The type of help needed, however, did not vary markedly. The general structure of ethics support services would not have to be radically altered to suit cultural variations among the surveyed countries. (shrink)

The internet is widely used for health information and support, often by vulnerable people. Internet-based research raises both familiar and new ethical problems for researchers and ethics committees. While guidelines for internet-based research are available, it is unclear to what extent ethics committees use these. Experience of gaining research ethics approval for a UK study (SharpTalk), involving internet-based discussion groups with young people who self-harm and health professionals is described. During ethical review, unsurprisingly, concerns were raised about the vulnerability of (...) potential participants. These were dominated by the issue of anonymity, which also affected participant safety and consent. These ethical problems are discussed, and our solutions, which included: participant usernames specific to the study, a closed website, private messaging facilities, a direct contact email to researchers, information about forum rules displayed on the website, a ‘report’ button for participants, links to online support, and a discussion room for forum moderators. This experience with SharpTalk suggests that an approach to ethics, which recognises the relational aspects of research with vulnerable people, is particularly useful for internet-based health research. The solutions presented here can act as guidance for researchers developing proposals and for ethics committees reviewing them. (shrink)

While there has been significant discussion in the health sciences and ethics literatures about problems associated with publication practices (e.g., ghost- and gift-authorship, conflicts of interest), there has been relatively little practical guidance developed to help researchers determine how they should fairly allocate credit for multi-authored publications. Fair allocation of credit requires that participating authors be acknowledged for their contribution and responsibilities, but it is not obvious what contributions should warrant authorship, nor who should be responsible for the quality and (...) content of the scientific research findings presented in a publication. In this paper, we review arguments presented in the ethics and health science literatures, and the policies or guidelines proposed by learned societies and journals, in order to explore the link between author contribution and responsibility in multi-author multidisciplinary health science publications. We then critically examine the various procedures used in the field to help researchers fairly allocate authorship. (shrink)

This thesis examines the key moral principles that should govern decision-making by police and military when using lethal force. To this end, it provides an ethical analysis of the following question: Under what circumstances, if any, is it morally justified for the agents of state-sanctioned security institutions to use lethal force, in particular the police and the military? Recent literature in this area suggests that modern conflicts involve new and unique features that render conventional ways of thinking about the ethics (...) of armed conflict, and the use of lethal force, as inadequate or redundant. In particular, there is an increased concern with the moral difficulties created by “non-standard” cases. This is where the police or military are obliged to operate outside their conventional contexts. In such non-standard cases, on what moral basis can (or should) state actors – especially the police and military – use lethal force? One approach argues that there is nothing morally exceptional about the use of lethal force by police or military. This says the only available moral justification for using lethal force is killing in self-defence or defence of others. In contrast, I use an institutional approach to develop a moral framework for the state’s morally exceptional use of lethal force. The institutional approach is concerned with the ends (telos) or purpose of a social institution. It says that the moral purpose of a social institution alters the moral responsibilities of its agents; what is referred to as role morality. My analysis demonstrates that there is an important moral distinction between justified killing in self-defence and state-sanctioned uses of lethal force. My claim is that police and military uses of lethal force are not morally justified in the same way as the average person’s use of lethal force (i.e. self-defence or defence of others). Instead, I argue that the state-sanctioned institutional role of police and military give these state actors special moral duties, and therefore exceptional moral justification, for using lethal force. I argue that the institutional end of the police is the preservation of public safety. This includes using lethal force where it is necessary to protect life and prevent serious injury to jurisdictional inhabitants. In contrast, a morally responsible state uses military force to defend the “common good.” That is, when it is necessary to defend the peaceful functioning of a state from armed threats or other forms of political violence. I then conclude that non-standard cases require the addition of jus ad vim (or the just use of military force short-of-war) as a hybrid element to the moral framework for the state-sanctioned use of lethal force. This provides a better way of applying ethics to the use of military force when defending the common good against serious threats in non-standard cases. This is because jus ad vim complements the conventional military paradigm by permitting the use of military capabilities to defend the common good. But, at the same time, it inhibits the move towards the more destructive levels of violence characteristic of conventional warfighting. (shrink)

Objective: To examine changes in patients’ desired control of the deep brain stimulator and perception of global life control throughout DBS.Methods: A consecutive cohort of 52 patients with Parkinson’s disease was recruited to participate in a prospective longitudinal study over three assessment points. Semi-structured interviews assessing participants’ desire for stimulation control and perception of global control were conducted at all three points. Qualitative data were coded using content analysis. Visual analog scales were embedded in the interviews to quantify participants’ perceptions (...) of control over time.Results: Participants reported significant increases in their perception of global control over time and significant declines in their desired control of the stimulation. These changes were unrelated to improvements in motor symptoms. Improvements in global control were negatively correlated with a decline in desired stimulation control. Qualitative data indicate that participants have changed, nuanced levels of desired control over their stimulators. Increased global life control following DBS may be attributed to increased control over PD symptoms, increased ability to engage in valued activities, and increased overall self-regulation, while other domains related to global control remained unaffected by DBS.Conclusions: There are few empirical data documenting patients’ desire for stimulation control throughout neuromodulation and how stimulation control is related to other aspects of control despite the growing application of neuromodulation devices to treat a variety of disorders. Our data highlight distinctions in different types of control and have implications for the development of patient-controlled neurostimulation devices. (shrink)

The concept of regulatory ‘checkpoints’ in the eukaryotic cycle has proved to be a fruitful one. Here, its applicability to the bacterial cell cycle is examined. A primitive DNA damage checkpoint operates in E. coli such that, after exposure to ultraviolet light, while excision repair occurs, chromosome replication continues very slowly with the production of discontinuous daughter strands. The slower the rate of excision of photoproducts, the greater the delay before the normal rate of DNA replication is restored, the additional (...) time for repair ensuring that normal survival is maintained. A model is proposed in which replication rate is controlled by the ratio of RecAcoated to uncoated single stranded regions of DNA in the replication fork. There are also two cell division inhibitors SulA (=SfiA) and SfiC under the control of the SOS system and sensitive to DNA damage, but they are irrelevant to the survival of wild‐type bacteria under normal conditions. In strains where SulA and SfiC do not operate, inhibition is not influenced by the rate of excision repair and so fails one of the criteria for a DNA damage checkpoint, namely the monitoring of the DNA for the level of residual damage. (shrink)

BackgroundThere is increasing need for peer reviewers as the scientific literature grows. Formal education in biostatistics and research methodology during residency training is lacking. In this pilot study, we addressed these issues by evaluating a novel method of teaching residents about biostatistics and research methodology using peer review of standardized manuscripts. We hypothesized that mentored peer review would improve resident knowledge and perception of these concepts more than non-mentored peer review, while improving review quality.MethodsA partially blinded, randomized, controlled multi-center study (...) was performed. Seventy-eight neurology residents from nine US neurology programs were randomized to receive mentoring from a local faculty member or not. Within a year, residents reviewed a baseline manuscript and four subsequent manuscripts, all with introduced errors designed to teach fundamental review concepts. In the mentored group, mentors discussed completed reviews with residents. Primary outcome measure was change in knowledge score between pre- and post-tests, measuring epidemiology and biostatistics knowledge. Secondary outcome measures included level of confidence in the use and interpretation of statistical concepts before and after intervention, and RQI score for baseline and final manuscripts.ResultsSixty-four residents (82%) completed initial review with gradual decline in completion on subsequent reviews. Change in primary outcome, the difference between pre- and post-test knowledge scores, did not differ between mentored (−8.5%) and non-mentored (−13.9%) residents (p = 0.48). Significant differences in secondary outcomes (using 5-point Likert scale, 5 = strongly agree) included mentored residents reporting enhanced understanding of research methodology (3.69 vs 2.61; p = 0.001), understanding of manuscripts (3.73 vs 2.87; p = 0.006), and application of study results to clinical practice (3.65 vs 2.78; p = 0.005) compared to non-mentored residents. There was no difference between groups in level of interest in peer review (3.00 vs 3.09; p = 0.72) or the quality of manuscript review assessed by the Review Quality Instrument (RQI) (3.25 vs 3.06; p = 0.50).ConclusionsWe used mentored peer review of standardized manuscripts to teach biostatistics and research methodology and introduce the peer review process to residents. Though knowledge level did not change, mentored residents had enhanced perception in their abilities to understand research methodology and manuscripts and apply study results to clinical practice. (shrink)

There is a widely acknowledged shortage of and an increasing demand for transplantable human organs and tissues (e.g., kidney, heart, lung, liver, cornea) in developed and developing countries around the world. In response to this need, Lott and Savulescu (2007) propose the creation of a human embryonic stem (hESC) bank to facilitate the equitable and efficient dissemination of human leukocyte anti- gen (HLA) matched tissues and organs to patients in need of replacement. Although not an unreasonable proposal, the authors go (...) on to make a much stronger claim. They argue that hESCs are such important tools for addressing the massive unmet global need for organs that it is ethically justified to require mandatory banking of spare embryos, and they argue for the use of financial (or other) inducements to procure embryos for the derivation of hESCs. (shrink)

In seeking to clarify the concept of conflict of interest (COI) in debates about physician–industry relationships, Howard Brody (2011) highlights the extent to which the prob- lem turns on a common pejorative understanding of COI. Whether it is the academic or public policy “pharmapologists” or “pharmascolds” talking about COI, there is often a straightforward and overly simplistic correlation made: that is, a conflict of interest—by definition—leads to fraudulent or corrupt behavior. The same type of reasoning is com- monly found in (...) discussions about COI outside the health sciences, most notably in news stories about the awarding of government contracts or the behaviour of corporate executives. The problem is that in focusing on dramatic failures to manage COI (e.g., around Vioxx), there is a tendency to strongly associate COI with extreme forms of financial and even criminal misconduct, leaving the public, policymakers, academics, and professionals with a skewed and limited understanding of the concept. (shrink)

Honorable Mention, Joseph Levenson Prize, Association for Asian Studies By the middle of the third century B.C.E. in China there were individuals who sought to become transcendents deathless, godlike beings endowed with supernormal powers. This quest for transcendence became a major form of religious expression and helped lay the foundation on which the first Daoist religion was built. Both xian and those who aspired to this exalted status in the centuries leading up to 350 C.E. have traditionally been portrayed as (...) secretive and hermit-like figures. This groundbreaking study offers a very different view of xian-seekers in late classical and early medieval China. It suggests that transcendence did not involve a withdrawal from society but rather should be seen as a religious role situated among other social roles and conceived in contrast to them. Robert Campany argues that the much-discussed secrecy surrounding ascetic disciplines was actually one important way in which practitioners presented themselves to others. He contends, moreover, that many adepts were not socially isolated at all but were much sought after for their power to heal the sick, divine the future, and narrate their exotic experiences. The book moves from a description of the roles of xian and xian-seekers to an account of how individuals filled these roles, whether by their own agency or by others or, often, by both. Campany summarizes the repertoire of features that constituted xian roles and presents a detailed example of what analyses of those cultural repertoires look like. He charts the functions of a basic dialectic in the self-presentations of adepts and examines their narratives and relations with others, including family members and officials. Finally, he looks at hagiographies as attempts to persuade readers as to the identities and reputations of past individuals. His interpretation of these stories allows us to see how reputations were shaped and even co-opted sometimes quite surprisingly into the ranks of xian. Making Transcendents provides a nuanced discussion that draws on a sophisticated grasp of diverse theoretical sources while being thoroughly grounded in traditional Chinese hagiographical, historiographical, and scriptural texts. The picture it presents of the quest for transcendence as a social phenomenon in early medieval China is original and provocative, as is the paradigm it offers for understanding the roles of holy persons in other societies. (shrink)

Honorable Mention, Joseph Levenson Prize, Association for Asian Studies By the middle of the third century B.C.E. in China there were individuals who sought to become transcendents deathless, godlike beings endowed with supernormal powers. This quest for transcendence became a major form of religious expression and helped lay the foundation on which the first Daoist religion was built. Both xian and those who aspired to this exalted status in the centuries leading up to 350 C.E. have traditionally been portrayed as (...) secretive and hermit-like figures. This groundbreaking study offers a very different view of xian-seekers in late classical and early medieval China. It suggests that transcendence did not involve a withdrawal from society but rather should be seen as a religious role situated among other social roles and conceived in contrast to them. Robert Campany argues that the much-discussed secrecy surrounding ascetic disciplines was actually one important way in which practitioners presented themselves to others. He contends, moreover, that many adepts were not socially isolated at all but were much sought after for their power to heal the sick, divine the future, and narrate their exotic experiences. The book moves from a description of the roles of xian and xian-seekers to an account of how individuals filled these roles, whether by their own agency or by others or, often, by both. Campany summarizes the repertoire of features that constituted xian roles and presents a detailed example of what analyses of those cultural repertoires look like. He charts the functions of a basic dialectic in the self-presentations of adepts and examines their narratives and relations with others, including family members and officials. Finally, he looks at hagiographies as attempts to persuade readers as to the identities and reputations of past individuals. His interpretation of these stories allows us to see how reputations were shaped and even co-opted sometimes quite surprisingly into the ranks of xian. Making Transcendents provides a nuanced discussion that draws on a sophisticated grasp of diverse theoretical sources while being thoroughly grounded in traditional Chinese hagiographical, historiographical, and scriptural texts. The picture it presents of the quest for transcendence as a social phenomenon in early medieval China is original and provocative, as is the paradigm it offers for understanding the roles of holy persons in other societies. (shrink)

: Decisions about funding health services are crucial to controlling costs in health care insurance plans, yet they encounter serious challenges from intellectual property protection—e.g., patents—of health care services. Using Myriad Genetics' commercial genetic susceptibility test for hereditary breast cancer (BRCA testing) in the context of the Canadian health insurance system as a case study, this paper applies concepts from social contract theory to help develop more just and rational approaches to health care decision making. Specifically, Daniels's and Sabin's "accountability (...) for reasonableness" is compared to broader notions of public consultation, demonstrating that expert assessments in specific decisions must be transparent and accountable and supplemented by public consultation. (shrink)

Objective Our study sought to (1) describe the practices and preferences of Colombian adolescents in accessing sexual and reproductive health services: accompanied versus alone; (2) compare actual practices with stated preferences; and (3) determine age and gender differences regarding the practice and these stated preferences. -/- Methods 812 participants aged 11–24 years old answered a survey in two Profamilia clinics in the cities of Medellin and Cali in Colombia. A cross-sectional analysis was performed to compare participants’ answers based on the (...) variables of gender and age. -/- Results A quarter of participants visited the clinic alone (25.4%). Females were more likely to go alone in comparison to males (26.3% vs 14.1%; p = 0.031), and older participants went alone more often than younger participants (p < 0.001). Most participants – 72.7% (95 %CI: 69.3–75.9) – expressed a preference in being accompanied to the clinic, and more than 90% had their preferences met. The preferences of older participants were, however, less likely to be met than those of younger participants (p < 0.001), notably, because they predominantly wanted to be accompanied. -/- Conclusion Contemporary public health and bioethics literature advocates in favor of developing health services that better meet the preferences of adolescents. The present research highlights an apparent blind spot related to the role that others (e.g., parents, friends, partners) can or should play in accompanying adolescent patients when they access sexual and reproductive health services. Respecting adolescents’ preferences, and hence their autonomy, is not simply a matter of ensuring freedom from constraints (e.g., their right and ability to go alone). Rather, it should also consider the liberty to choose whether to be accompanied when accessing SHRS and by whom. (shrink)

Imagine that you are part of the editorial board of a young bioethics journal committed to publishing open access (OA) and to ensuring accessibility to high quality and innovative scholarship. To support junior and interna- tional scholars who might not otherwise find places for their work in the leading Western bioethics journals, you do not charge author fees. Imagine also that you have no financial resources to pay for a professional website, auto- mated submissions manager, or even a part-time coordina- (...) tor: Your government has cut all grants for journals, you cannot go to industry for private funding because of the evident risk of apparent conflicts of interest, and your strapped-for-cash institution cannot afford to offer you any support. If one of the major publishers were to approach you to sign a deal, the temptation would be strong to accept. However, this would likely mean putting aside your ideals: It would be impossible to stay a “Green OA” publication (i.e., free of author publication charges) or supportive of junior and international scholars (because of pressures to “increase credibility” through artificially high rejection rates, for example). (shrink)