BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

A repository of clinically associated Staphylococcus aureus (Sa) isolates is used to semi‐automatically generate a set of application ontologies for specific subfamilies of Sa‐related disease. Each such application ontology is compatible with the Infectious Disease Ontology (IDO) and uses resources from the Open Biomedical Ontology (OBO) Foundry. The set of application ontologies forms a lattice structure beneath the IDO‐Core and IDO‐extension reference ontologies. We show how this lattice can be used to define a strategy for the construction of a new (...) taxonomy of infectious disease incorporating genetic, molecular, and clinical data. We also outline how faceted browsing and query of annotated data is supported using a lattice application ontology. (shrink)

The issue of the theory-ladenness of observation has long troubled philosophers of science, largely because it seems to threaten the objectivity of science. However, the way in which prior beliefs influence the perception of data is in part an empirical issue that can be investigated by cognitive psychology. This point is illustrated through an experimental analogue of scientific data-interpretation tasks in which subjects judging the covariation between personality variables based their judgments on pure data, their theoretical intuitions about the variables, (...) or both data and prior theoretical beliefs. Results showed that the perceived magnitude of correlations was greatest when subjects relied solely on theoretical intuitions; that data-based judgments were drawn in the direction of those prior beliefs; but that exposure to data nonetheless moderated the strength of the prior theories. In addition, prior beliefs were found to influence judgments only after a brief priming interval, suggesting that subjects needed time to retrieve their theoretical intuitions from memory. These results suggest ways to investigate the processes mediating theory-laden observation, and, contrary to the fears of positivist philosophers, imply that the theory-ladenness of observation does not entail that theoretical beliefs are immune to data. (shrink)

Introduction, W G Runciman Social Evolution in Primates: The Role of Ecological Factors and Male Behaviour, Carel P van Schaik Determinants of Group Size in Primates: A General Model, R I M Dunbar Function and Intention in the Calls of Non-Human Primates, Dorothy L Cheney & Robert M Seyfarth Why Culture is Common, but Cultural Evolution is Rare, Robert Boyd & Peter J Richerson An Evolutionary and Chronological Framework for Human Social Behaviour, Robert A Foley Friendship and the Banker?s Paradox: (...) Other Pathways to the Evolution of Adaptations for Altruism, John Tooby & Leda Cosmides The Early Prehistory of Human Social Behaviour: Issues of Archaeological Inference and Cognitive Evolution, Steven Mithen The Emergence of Biologically Modern Populations in Europe: A Social and Cognitive ?Revolution??, Paul Mellars Responses to Environmental Novelty: Changes in Men?s Marriage Strategies in a Rural Kenyan Community, Monique Borgerhoff Mulder Genetic Language Impairment: Unruly Grammars, M Gopnik, J Dalalakis, S E Fukuda, S Fukuda & E Kehayia The Emergence of Cultures among Wild Chimpanzees, Christophe Boesch Terrestriality, Bipedalism and the Origin of Language, Leslie C Aiello Conclusions, John Maynard Smith. (shrink)

This book offers 32 texts and case studies from across a wide range of business sectors around a managerial framework for Sustainable Business. The case studies are developed for and tested in executive education programmes at leading business schools. The book is based on the premise that the key for managing the sustainable business is finding the right balance over time between managing competitiveness and profitability AND managing the context of the business with its political, social and ecological risks and (...) opportunities. In that way, a sustainable business is highly responsive to the demands and challenges from both markets and societies and managers embrace the complexity, ambivalence and uncertainty that goes along with this approach. The book presents a framework that facilitates the adoption of best business practice. This framework leads executives through a systematic approach of strategic analysis and business planning in risk management, issues management, stakeholder management, sustainable business development and strategic differentiation, business model innovation and developing dynamic capabilities. The approach helps broaden the understanding of what sustainable performance means, by protecting business value against sustainability risks and creating business value from sustainability opportunities. (shrink)

First Published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.

The embodied simulation of smiles involves motor activity that often changes the perceivers' own emotional experience (e.g., smiling can make us feel happy). Although Niedenthal et al. mention this possibility, the psychological processes by which embodiment changes emotions and their consequences for processing other emotions are not discussed in the target article's review. We argue that understanding the processes initiated by embodiment is important for a complete understanding of the effects of embodiment on emotion perception.

ObjectiveCo-morbid insomnia and sleep apnea is a common and debilitating condition that is more difficult to treat compared to insomnia or sleep apnea-alone. Emerging evidence suggests that cognitive behavioral therapy for insomnia is effective in patients with COMISA, however, those with more severe sleep apnea and evidence of greater objective sleep disturbance may be less responsive to CBTi. Polysomnographic sleep study data has been used to predict treatment response to CBTi in patients with insomnia-alone, but not in patients with COMISA. (...) We used randomized controlled trial data to investigate polysomnographic predictors of insomnia improvement following CBTi, versus control in participants with COMISA.MethodsOne hundred and forty five participants with insomnia and sleep apnea [apnea-hypopnea index ≥ 15] were randomized to CBTi or no-treatment control. Mixed models were used to investigate the effect of pre-treatment AHI, sleep duration, and other traditional, and novel [quantitative electroencephalography ] polysomnographic predictors of between-group changes in Insomnia Severity Index scores from pre-treatment to post-treatment.ResultsCompared to control, CBTi was associated with greater ISI improvement among participants with; higher AHI, less wake after sleep onset, and less N3 sleep. No quantitative electroencephalographic, or other traditional polysomnographic variables predicted between-group ISI change.DiscussionAmong participants with COMISA, higher OSA severity predicted a greater treatment-response to CBTi, versus control. People with COMISA should be treated with CBTi, which is effective even in the presence of severe OSA and objective sleep disturbance. (shrink)

While valuable work has been done addressing clinical ethics within established healthcare systems, we anticipate that the projected growth in acquisitions of community hospitals and facilities by large tertiary hospitals will impact the field of clinical ethics and the day-to-day responsibilities of clinical ethicists in ways that have yet to be explored. Toward the goal of providing clinical ethicists guidance on a range of issues that they may encounter in the systematization process, we discuss key considerations and potential challenges in (...) implementing system-wide ethics consultation services. Specifically, we identify four models for organizing, developing, and enhancing ethics consultation activities within a system created through acquisitions: train-the-trainer, local capacity-building, circuit-riding, and consolidated accountability. We note each model’s benefits and challenges. To our knowledge, this is the first paper to consider the broader landscape of issues affected by consolidation. We anticipate that clinical ethicists, volunteer consultants, and hospital administrators will benefit from our recommendations. (shrink)

Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA (...) PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions. (shrink)

The interrogation of Meletus in the Apology at 24c4–28al is not infrequently seen as a typical case of all that is intellectually and artistically dissatisfying in Plato's practice of the genre of philosophical dialogue: not only are we presented with a philosopher who makes some claim to being committed to setting a particularly stringent standard for honesty in argumentation making sophistical arguments, but we are presented also with a cardboard interlocutor who is forced by the hand of Plato to acquiesce (...) to those arguments in a fashion that is completely dissatisfying to the reader. The best anyone seems to do to save Plato from these charges of artistic incompetence and intellectual dishonesty is to appeal to such a level of historical accuracy for the text that the stupidity of Meletus' responses can be attributed to the stupidity of Meletus himself, or to point out features of the political and legal situation that might prevent Meletus from answering the questions by drawing on his true motivation—which is presumably more coherent. Taylor says of this passage:The humour of the situation is that the prosecutor cannot venture to say what he means by either of his charges without betraying the fact that, owing to the ‘amnesty’, the matters complained of are outside of the competency of the court… Hence, when Meletus is pressed to explain what he means, he has to take refuge in puerile nonsense. (shrink)

The COVID-19 pandemic revealed numerous weaknesses in pandemic preparedness and response, including underfunding, inadequate surveillance, and inequitable distribution of countermeasures. To overcome these weaknesses for future pandemics, WHO released a zero draft of a pandemic treaty in February, 2023, and subsequently a revised bureau's text in May, 2023. COVID-19 made clear that pandemic prevention, preparedness, and response reflect choices and value judgements. These decisions are therefore not a purely scientific or technical exercise, but are fundamentally grounded in ethics. The latest (...) treaty draft reflects these ethical considerations by including a section entitled Guiding Principles and Approaches. Most of these principles are ethical—they establish core values that undergird the treaty. Unfortunately, the treaty draft's set of principles are numerous, overlapping, and show inadequate coherence and consistency. We propose two improvements to this section of the draft pandemic treaty. First, key guiding ethical principles should be clearer and more precise than they currently are. Second, the link between ethical principles and policy implementation should be clearly established and define boundaries on acceptable interpretation, ensuring that signatories abide by these principles. (shrink)

In recent discussions concerning the definition of argument, it has been maintained that the word ‘argument’ exhibits the process-product ambiguity, or an act/object ambi-guity. Drawing on literature on lexical ambiguity we argue that ‘argument’ is not ambiguous. The term ‘argument’ refers to an object, not to a speech act. We also examine some of the important implications of our argument by considering the question: what sort of abstract objects are arguments?

Natural selection is commonly interpreted as the fundamental mechanism of evolution. Questions about how selection theory can claim to be the all-sufficient explanation of evolution often go unanswered by today's neo-Darwinists, perhaps for fear that any criticism of the evolutionary paradigm will encourage creationists and proponents of intelligent design.In Biological Emergences, Robert Reid argues that natural selection is not the cause of evolution. He writes that the causes of variations, which he refers to as natural experiments, are independent of (...) natural selection; indeed, he suggests, natural selection may get in the way of evolution. Reid proposes an alternative theory to explain how emergent novelties are generated and under what conditions they can overcome the resistance of natural selection. He suggests that what causes innovative variation causes evolution, and that these phenomena are environmental as well as organismal.After an extended critique of selectionism, Reid constructs an emergence theory of evolution, first examining the evidence in three causal arenas of emergent evolution: symbiosis/association, evolutionary physiology/behavior, and developmental evolution. Based on this evidence of causation, he proposes some working hypotheses, examining mechanisms and processes common to all three arenas, and arrives at a theoretical framework that accounts for generative mechanisms and emergent qualities. Without selectionism, Reid argues, evolutionary innovation can more easily be integrated into a general thesis. Finally, Reid proposes a biological synthesis of rapid emergent evolutionary phases and the prolonged, dynamically stable, non-evolutionary phases imposed by natural selection. (shrink)

v. 1. Nicomachean ethics. Politics. The Athenian Constitution. Rhetoric. On Poetics.--v. 2. Logic.--v. 3. Physics. Metaphysics. On the soul. Short physical treaties.--v. 4. On the heavens. On generation and corruption. Meteorology. Biological treatises.