The current ethical norms of genomic biobanking creating and maintaining large repositories of human DNA and/or associated data for biomedical research have generated criticism from every angle, at both the practical and theoretical levels. The traditional research model has involved investigators seeking biospecimens for specific purposes that they can describe and disclose to prospective subjects, from whom they can then seek informed consent. In the case of many biobanks, however, the institution that collects and maintains the biospecimens may not itself (...) be directly involved in research, instead banking the biospecimens and associated data for other researchers. Moreover, the future uses of biospecimens may be unknown, if not unknowable, at the time of collection. Biobanking may thus stretch the meanings of inform and consent to their breaking point: if you cannot inform subjects about what their biospecimens will be used for, what can they consent to? Given that informed consent by individual subjects is the ethical gold standard, the seeming dilution of the concept in the context of biobanking is a profound problem. (shrink)

Reality medical television, an increasingly popular genre, depicts private medical moments between patients and healthcare providers. Journalists aim to educate and inform the public, while the participants in their documentaries—providers and patients—seek to heal and be healed. When journalists and healthcare providers work together at the bedside, moral problems precipitate. During the summer of 2010, ABC aired a documentary, Boston Med, featuring several Boston hospitals. We examine the ethical issues that arise when journalism and medicine intersect. We provide a framework (...) for evaluating the potential benefits and harms of reality medical television, highlighting critical issues such as informed consent, confidentiality, and privacy. (shrink)

The earlier volume in this series dealt with two religions of Indian origin, namely, Buddhism and Jainism. The Indian religious scene, however, is characterized by not only religions which originated in India but also by religions which entered India from outside India and made their home here. Thus religious life in India has been enlivened throughout its history by the presence of religions of foreign origin on its soil almost from the very time they came into existence. This volume covers (...) three such religions—Zoraoastrianism, Judaism, and Islam. In the case of Zoraostianism, even its very beginnings are intertwined with India, as Zoroastrianism reformed a preexisting religion which had strong links to the Vedic heritage of India. This relationship took on a new dimension when a Zoroastrian community, fearing persecution in Persia after its Arab conquest, sought shelter in western India and ultimately went on to produce India’s pioneering nationalist in the figure of Dadabhai Naoroji ( 1825-1917), also known as the Grand Old Man of India. Jews found refuge in south India after the destruction of the Temple by the Romans in 70 C.E. and have remained a part of the Indian religious scene since then, some even returning to Israel after it was founded in 1948. Islam arrived in Kerala as soon as it was founded and one of the earliest mosques in the history of Islam is found in India. Islam differs from the previously mentioned religions inasmuch as it went on to gain political hegemony over parts of the country for considerable periods of time, which meant that its impact on the religious life of the subcontinent has been greater compared to the other religions. It has also meant that Islam has existed in a religiously plural environment in India for a longer period than elsewhere in the world so that not only has Islam left a mark on India, India has also left its mark on it. Indeed all the three religions covered in this volume share this dual feature, that they have profoundly influenced Indian religious life and have also in turn been profoundly influenced by their presence in India. (shrink)

The earlier volume in this series dealt with two religions of Indian origin, namely, Buddhism and Jainism. The Indian religious scene, however, is characterized by not only religions which originated in India but also by religions which entered India from outside India and made their home here. Thus religious life in India has been enlivened throughout its history by the presence of religions of foreign origin on its soil almost from the very time they came into existence. This volume covers (...) three such religions—Zoraoastrianism, Judaism, and Islam. In the case of Zoraostianism, even its very beginnings are intertwined with India, as Zoroastrianism reformed a preexisting religion which had strong links to the Vedic heritage of India. This relationship took on a new dimension when a Zoroastrian community, fearing persecution in Persia after its Arab conquest, sought shelter in western India and ultimately went on to produce India’s pioneering nationalist in the figure of Dadabhai Naoroji ( 1825-1917), also known as the Grand Old Man of India. Jews found refuge in south India after the destruction of the Temple by the Romans in 70 C.E. and have remained a part of the Indian religious scene since then, some even returning to Israel after it was founded in 1948. Islam arrived in Kerala as soon as it was founded and one of the earliest mosques in the history of Islam is found in India. Islam differs from the previously mentioned religions inasmuch as it went on to gain political hegemony over parts of the country for considerable periods of time, which meant that its impact on the religious life of the subcontinent has been greater compared to the other religions. It has also meant that Islam has existed in a religiously plural environment in India for a longer period than elsewhere in the world so that not only has Islam left a mark on India, India has also left its mark on it. Indeed all the three religions covered in this volume share this dual feature, that they have profoundly influenced Indian religious life and have also in turn been profoundly influenced by their presence in India. (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)

Recent literature has highlighted issues of racial discrimination in medicine. In order to explore the sometimes subtle influence of racial determinants in decisions about resource allocation, we present the case of a 53-year-old Australian Aboriginal woman with end-stage renal failure. The epidemiology of renal failure in the Australian Aboriginal population and amongst other indigenous peoples is discussed. We show that the use of utilitarian outcome criteria for resource allocation may embody subtle racial discrimination where consideration is not given to issues (...) of justice, race, culture and gender. It is only where the processes by which resources are allocated are transparent, clearly defined and based upon consultation with individual patients that issues and justice are likely to be adequately addressed. (shrink)

Robust stakeholder engagement in health research requires broad communicative integration, not only of patients but also other stakeholders such as health system leaders, clinicians, and researcher...

To contribute to the continuing challenge of explaining how managers identify stakeholders and assess their salience, in this article, we chronicle the history, assess the impact, and evaluate the possibilities opened by Mitchell, Agle, and Wood (MAW-1997). We do so through two types of qualitative analysis, and also through utilizing a quantitative network analysis tool. The first qualitative analysis categorizes the major contributions of the most influential papers succeeding MAW-1997; the second identifies and compares the relevant issues with MAW-1997 (...) at the time of initial publication and today. We apply main path analysis, a quantitative tool, to map how this scholarly domain has evolved. These three analyses robustly depict the impact of MAW-1997 and the ensuing scholarly conversation, and they enable us to illustrate the current state and trajectory of stakeholder identification and salience scholarship. We close by discussing pressing topics related to the broader body of stakeholder theory literature. (shrink)

While many "benchtop-to-bedside" research pathways have been developed in "Type I" translational medicine, vehicles to facilitate "Type II" and "Type III" translation that convert scientific data into clinical and community interventions designed to improve the health of human populations remain elusive. Further, while a high percentage of physicians endorse the principle of citizen leadership, many have difficulty practicing it. This discrepancy has been attributed, in part, to lack of training and preparation for public advocacy, time limitation, and institutional resistance. As (...) translational medicine and physician-citizenship implicate social, political, economic and cultural factors, both enterprises require "integrative" research strategies that blend insights from multiple fields of study, as well as rhetorical acumen in adapting messages to reach multiple audiences. This article considers how argumentation theory's epistemological flexibility, audience attentiveness, and heuristic qualities, combined with concepts from classical rhetoric, such as rhetorical invention, the synecdoche, and ethos, yield tools to facilitate translational medicine and enable physician-citizenship. (shrink)

In 2000, US Secretary of Health and Human Services Secretary Tommy Thompson mobilized the US public health infrastructure to deal with escalating trends of excess body weight. A cornerstone of this effort was a report entitled The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity. The report stimulated a great deal of public discussion by utilizing the distinctive public health terminology of an epidemic to describe the growing prevalence of obesity in the US population. We suggest (...) that the ensuing controversy was fueled in part by the report's ambiguous usage of the evocative term “epidemic.” In some passages, the report seems to use “epidemic” in a literal sense, suggesting that rising prevalence of excess body weight should be defined technically as a disease outbreak. Other passages of the report present the same key term metaphorically, leaving readers with the impression that the epidemic language is invoked primarily for rhetorical effect. Here, we explore dynamics and implications of both interpretations. This analysis sheds light on the ongoing public argument about the appropriate societal response to steadily increasing body sizes in the US population; likewise, it capitalizes on the accumulated knowledge that the field of public health has garnered from combating diverse historic epidemics. Our interdisciplinary approach deploys critical tools from the fields of rhetoric, sociology and epidemiology. In particular, we draw from metaphor theory and public address scholarship to elucidate how the Call to Action frames public deliberation on obesity. We turn to the applied public health literature to develop a reading of the report that suggests a novel approach to the problem—application of the Epidemic Investigation protocol to streamline the public health response and reframe the public argument about obesity. (shrink)

Nucleation and motion of kink pairs on partial dislocations are examined by elasticity theory for materials with a high Peierls stress. Two approaches are used: one considers the change in average stacking-fault energy due to alloying elements and the other considers the change in local SFE due to a nearby solute atom. Both approaches highlight the role of SFE on kink nucleation, propagation and annihilation and both furnish strain rate as a function of stress, temperature and SFE. Model predictions are (...) compared with yield stress data for two systems: firstly, an intermetallic, MoSi 2 , which softens for alloying elements that decrease the SFE and hardens for Re additions that increase the SFE; secondly, a ceramic oxide, MgO-Al 2 O 3 spinel, which softens with increasing addition of excess alumina and at the same time exhibits a decrease in SFE. The average SFE approach agrees qualitatively with the data while quantitative agreement is obtained with the local SFE approach. The possibility is considered that the model applies to other materials, such as TiAl, HfV 2 and Fe 3 Al, which show softening with certain alloying additions. One requirement is that the dislocations are dissociated more than a few atomic distances; otherwise kink nucleation occurs on the perfect dislocation . Hence the model does not apply to materials such as bcc metals which only have a core dissociation. Normal hardening effects of solutes from size and modulus misfits are additive with any softening effects from a decrease in SFE and so may mask the latter, as occurs for W additions to MoSi 2. (shrink)

Rationale: Deep brain stimulation (DBS) of the hippocampus is proposed for enhancement of memory impaired by injury or disease. Many pre-clinical DBS paradigms can be addressed in epilepsy patients undergoing intracranial monitoring for seizure localization, since they already have electrodes implanted in brain areas of interest. Even though epilepsy is usually not a memory disorder targeted by DBS, the studies can nevertheless model other memory-impacting disorders, such as Traumatic Brain Injury (TBI). Methods: Human patients undergoing Phase II invasive monitoring for (...) intractable epilepsy were implanted with depth electrodes capable of recording neurophysiological signals. Subjects performed a delayed-match-to-sample (DMS) memory task while hippocampal ensembles from CA1 and CA3 cell layers were recorded to estimate a multi-input, multi-output (MIMO) model of CA3-to-CA1 neural encoding and a memory decoding model (MDM) to decode memory information from CA3 and CA1 neuronal signals. After model estimation, subjects again performed the DMS task while either MIMO-based or MDM-based patterned stimulation was delivered to CA1 electrode sites during the encoding phase of the DMS trials. Each subject was sorted (post hoc) by prior experience of repeated and/or mild-to-moderate brain injury (RMBI), TBI, or no history (control) and scored for percentage successful delayed recognition (DR) recall on stimulated vs. non-stimulated DMS trials. The subject’s medical history was unknown to the experimenters until after individual subject memory retention results were scored. Results: When examined compared to control subjects, both TBI and RMBI subjects showed increased memory retention in response to both MIMO and MDM-based hippocampal stimulation. Furthermore, effects of stimulation were also greater in subjects who were evaluated as having pre-existing mild-to-moderate memory impairment. Conclusion: These results show that hippocampal stimulation for memory facilitation was more beneficial for subjects who had previously suffered a brain injury (other than epilepsy), compared to control (epilepsy) subjects who had not suffered a brain injury. This study demonstrates that the epilepsy/intracranial recording model can be extended to test the ability of DBS to restore memory function in subjects who previously suffered a brain injury other than epilepsy, and support further investigation into the beneficial effect of DBS in TBI patients. (shrink)

Clinical trials for acute conditions such as myocardial infarction and stroke pose challenges related to informed consent due to time limitations, stress, and severe illness. Consent processes shou...

Book reviewed in this article: Artificial Reproduction: A Social Investigation. By R. Snowden, G.D. Mitchell, and E. M. Snowden. Redefining Human Life: Reproductive Technologies and Social Policy. By Robert H. Blank. Reproductive Ethics. By Michael D. Bayles.

Let κ be a cardinal which is measurable after generically adding ${\beth_{\kappa+\omega}}$ many Cohen subsets to κ and let ${\mathcal G= ( \kappa,E )}$ be the κ-Rado graph. We prove, for 2 ≤ m < ω, that there is a finite value ${r_m^+}$ such that the set [κ] m can be partitioned into classes ${\langle{C_i:i (...) G}$ in ${\mathcal G}$ such that ${[\mathcal{G} ^\ast ] ^m\cap C_i}$ is monochromatic. It follows that ${\mathcal{G}\rightarrow (\mathcal{G} ) ^m_{<\kappa/r_m^+}}$ , that is, for any coloring of ${[ \mathcal {G} ] ^m}$ with fewer than κ colors there is a copy ${\mathcal{G} ^{\prime}}$ of ${\mathcal{G}}$ such that ${[\mathcal{G} ^{\prime} ] ^{m}}$ has at most ${r_m^+}$ colors. On the other hand, we show that there are colorings of ${\mathcal{G}}$ such that if ${\mathcal{G} ^{\prime}}$ is any copy of ${\mathcal{G}}$ then ${C_i\cap [\mathcal{G} ^{\prime} ] ^m\not=\emptyset}$ for all ${i 2 we have ${r_m^+ > r_m}$ where r m is the corresponding number of types for the countable Rado graph. (shrink)

Background Duty to care is integral to nursing practice. Personal obligations that normally conflict with professional obligations are likely amplified during a public health emergency such as COVID-19. Organizations can facilitate a nurse’s ability to fulfill the duty to care without compromising on personal obligations. Research Aim The study aimed to explore the relationships among duty to care, perception of supportive environment, perceived stress, and COVID-19-specific anxieties in nurses working directly with COVID-19 patients. Research Design The study design was a (...) cross-sectional descriptive study using an online survey. It was conducted at an ANCC Magnet® designated 385-bed acute care teaching hospital located in a suburban area. Participants and Research Context Included in this study were 339 medical surgical nurses working directly with COVID-19 patients during the early phase of the pandemic. Ethical Considerations The study was reviewed by the institution’s clinical research committee and determined to be exempt. A survey invitation letter with a voluntary implied consent agreement was sent to participants with a description of the research study attached to the anonymous survey. Results Nurses with specific COVID-19-related anxieties were more likely to agree that it was ethical to abandon the workplace during a pandemic. Conclusions Organizations can and ought to mitigate the negative effects of COVID-19 on duty to care in future pandemics and healthcare emergencies by incorporating several recommendations derived from this study. (shrink)

Volume 20, Issue 8, August 2020, Page W12-W13.

Self, Language, and World: Problems from Kant, Sellars, and Rosenberg Edited by James R. O'Shea and Eric M. Rubenstein Introduction KANT Willem deVries, Kant, Rosenberg, and the Mirror of Philosophy David Landy, The Premise That Even Hume Must Accept LANGUAGE AND MIND William G. Lycan, Rosenberg On Proper Names Douglas Long, Why Life is Necessary for Mind: The Significance of Animate Behavior Dorit Bar-On and Mitchell Green, Lionspeak: Communication, Expression, and Meaning David Rosenthal, The Mind and Its Expression MIND (...) AND KNOWLEDGE Jeffrey Sicha, The Manifest Image: the Sensory and the Mental Bruce Aune, Rosenberg on Knowing Joseph C. Pitt, Sellarsian Antifoundationalism and Scientific Realism Matthew Chrisman, The Aim of Belief and the Goal of Truth: Reflections on Rosenberg James O’Shea, Conceptual Thinking and Nonconceptual Content: A Sellarsian Divide ONTOLOGY Anton Koch, Persons as Mirroring the World Eric M. Rubenstein, Form and Content, Substance and Stuff Ralf Stoecker, On Being a Realist About Death William G. Lycan, Biographical Remarks on Jay F. Rosenberg Scholarly Publications of Jay F. Rosenberg. (shrink)

These essays represent an important contribution to modern philosophical theology. They begin with an appreciation of Basil Mitchell's work and then discuss the role of reason in the justification of Christian theism, giving special attention to the nature of informal reasoning in religion and science. The latter essays examine particular arguments raised by specific religious concepts, covering such topics as the problem of evil, conspicuous sanctity, atonement, and the Eucharist. Drawn from a wide spectrum of philosophers and theologians, the (...) contributors include Maurice Wiles, Grace M. Jantzen, Gordon Kaufman, J.R. Lucas, Rom Harr'e, Richard Swinburne, and Michael Dummett. (shrink)

A starting-point for the philosophical examination of theological belief, by A. Farrer.--The possibility of theological statements, by I. M. Crombie.--Revelation, by A. Farrer.--How theologians reason, by G. C. Stead.--The soul, by J. R. Lucas.--The grace of God, by B. Mitchell.--Religion and morals, by R. M. Hare.--"We" in modern philosophy, M. B. Foster.

Masterfully interweaving political, religious, and historical themes, _Not by Reason Alone_ creates a new interpretation of early modern political thought. Where most accounts assume that modern thought followed a decisive break with Christianity, Joshua Mitchell reveals that the line between the age of faith and that of reason is not quite so clear. Instead, he shows that the ideas of Luther, Hobbes, Locke, and Rousseau draw on history, rather than reason alone, for a sense of political authority. This erudite (...) and ambitious work crosses disciplinary boundaries to expose unsuspected connections between political theory, religion, and history. In doing so, it offers a view of modern political thought undistorted by conventional distinctions between the ancient and the modern, and between the religious and the political. "Original.... A delight to read a political philosopher who takes the theologies of Hobbes and Locke seriously." —J. M. Porter, _Canadian Journal of History_ "Mitchell's argument both illuminates and fascinates.... An arresting, even stunning, contribution to our study of modern political thought."—William R. Stevenson, Jr., _Christian Scholar's Review_. (shrink)

The philosophical papers comprising this volume range from process metaphysics and theology, through the phenomenological study of intentionality, to the foundations of geometry and of the system of real numbers. New light, it is thought, is shed on all these topics, some of them being of the highest interest and under intensive investigation in contemporary philosophical discussion. Metaphysi cians, process theologians, semanticists, theorists of knowledge, phenomenologists, and philosophers of mathematics will thus find in this book, it is hoped, helpful materials (...) and methods. The categoreal scheme of Whitehead's Process and Reality is discussed rather fully from a logical point of view in the first paper [I] in the light of the author's previous work on the logico-metaphysical theory of events. The clarification that results is thought to provide a new depth and precision to the problem of interpreting one of the most difficult books in the recent history of metaphysics and cosmol ogy. A detailed examination of some aspects of Hartshorne's recent Creative Synthesis and Philosophic Method is given in II. This book is perhaps the most significant work on process philosophy since Process and Reality itself, and its logical underpinnings thus merit a full critical discussion. (shrink)