In their paper, “Helpful Lessons and Cautionary Tales: How Should COVID-19 Drug Development and Access Inform Approaches to Non-Pandemic Diseases?” Holly Fernandez Lynch and colleagues have present...

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)

The importance of communities in strengthening the ethics of international collaborative research is increasingly highlighted, but there has been much debate about the meaning of the term ‘community’ and its specific normative contribution. We argue that ‘community’ is a contingent concept that plays an important normative role in research through the existence of morally significant interplay between notions of community and individuality. We draw on experience of community engagement in rural Kenya to illustrate two aspects of this interplay: (i) that (...) taking individual informed consent seriously involves understanding and addressing the influence of communities in which individuals’ lives are embedded; (ii) that individual participation can generate risks and benefits for communities as part of the wider implications of research. We further argue that the contingent nature of a community means that defining boundaries is generally a normative process itself, with ethical implications. Community engagement supports the enactment of normative roles; building mutual understanding and trust between researchers and community members have been important goals in Kilifi, requiring a broad range of approaches. Ethical dilemmas are continuously generated as part of these engagement activities, including the risks of perverse outcomes related to existing social relations in communities and conditions of ‘half knowing’ intrinsic to processes of developing new understandings. (shrink)

BackgroundThe potential contribution of community engagement to addressing ethical challenges for international biomedical research is well described, but there is relatively little documented experience of community engagement to inform its development in practice. This paper draws on experiences around community engagement and informed consent during a genetic cohort study in Kenya to contribute to understanding the strengths and challenges of community engagement in supporting ethical research practice, focusing on issues of communication, the role of field workers in 'doing ethics' on (...) the ground and the challenges of community consultation.MethodsThe findings are based on action research methods, including analysis of community engagement documentation and the observations of the authors closely involved in their development and implementation. Qualitative and quantitative content analysis has been used for documentation of staff meetings and trainings, a meeting with 24 community leaders, and 40 large public and 70 small community group meetings. Meeting minutes from a purposive sample of six community representative groups have been analysed using a thematic framework approach.ResultsField workers described challenges around misunderstandings about research, perceived pressure for recruitment and challenges in explaining the study. During consultation, leaders expressed support for the study and screening for sickle cell disease. In community meetings, there was a common interpretation of research as medical care. Concerns centred on unfamiliar procedures. After explanations of study procedures to leaders and community members, few questions were asked about export of samples or the archiving of samples for future research.ConclusionsCommunity engagement enabled researchers to take account of staff and community opinions and issues during the study and adapt messages and methods to address emerging ethical challenges. Field workers conducting informed consent faced complex issues and their understanding, attitudes and communication skills were key influences on ethical practice. Community consultation was a challenging concept to put into practice, illustrating the complexity of assessing information needs and levels of deliberation that are appropriate to a given study. (shrink)

The aim of this study was to explore the existence of moral distress among nurses in Lilongwe District of Malawi. Qualitative research was conducted in selected health institutions of Lilongwe District in Malawi to assess knowledge and causes of moral distress among nurses and coping mechanisms and sources of support that are used by morally distressed nurses. Data were collected from a purposive sample of 20 nurses through in-depth interviews using a semi-structured interview guide. Thematic analysis of qualitative data was (...) used. The results show that nurses, irrespective of age, work experience and tribe, experienced moral distress related to patient/nursing care. The major distressing factors were inadequate resources and lack of respect from patients, guardians, peers and bosses. Nurses desire teamwork and ethics committees in their health institutions as a means of controlling and preventing moral distress. There is a need for creation of awareness for nurses to recognize and manage moral distress, thus optimizing their ability to provide quality and uncompromised nursing care. (shrink)

В монографии рассматривается соотношение индивидуальных и универсальных начал в праве как эффективное средство решения многих правовых проблем, как руководство в законодательной и судебной деятельности.

ABSTRACTPrevious research has shown that, in comparison to neutral stimuli, false memories for high arousing negative stimuli are greater after very fast presentation and limited attention at study. However, full compared to limited attention conditions still produce comparably more false memories for all stimuli types. Research has also shown that emotional stimuli benefit from a period of consolidation. What effect would such consolidation have on false memory formation even when attention is limited at study? The aim of the present study (...) was to investigate the effect of fast presentation on false memory production for negatively-arousing and neutral items over time using the DRM paradigm. Sixty-eight participants studied Negative and neutral DRM lists with fast or slow presentation conditions. Half completed a recognition test immediately and half completed a recognition test after one-week. Results revealed that, for fast presentation, negative critical lures increased after one week and were comparab... (shrink)

Volume 19, Issue 10, October 2019, Page 99-101.

Conscious macrostates are usually assumed to be emergent from the underlying physical microstates comprising the brain and nervous system of biological organisms. However, a major problem with this assumption is that consciousness is essentially nonmeasurable unlike all other proven emergent properties of physical systems. In an earlier paper, using a no-go theorem, it was shown that conscious states cannot be comprised of processes that are physical in nature (Reason, 2019). Combining this result with another unrelated work on causal emergence in (...) physical systems (Hoel, Albantakis and Tononi, 2013), we show in this paper that conscious macrostates are not emergent from physical systems and they also do not supervene on physical microstates. An important implication of our work is that there must be some form of violation of energy conservation in biological systems that are conscious. (shrink)

The purpose of the article is the analysis of the causes of the systemic crisis that hit modern civilization through the description of its main structures, identifying the relationship between its elements, assessments of their heuristic potential. This will open up opportunities for finding ways to resolve this crisis, new directions of civilizational development. Theoretical basis of the research are the systems analysis, socio-philosophical and philosophical-anthropological approaches as well as the analysis of scientific developments in the field of global studies. (...) Originality lies in the fact that this article is the first to show the connection between the main structural elements of human civilization as a system. Change in one of the parameters leads to a change in all the others, together with a change in civilization as a whole. Conclusions. The reason for the deep crisis that hit modern civilization is its imbalance as a system. The most important elements of this system are population size, resources and technology, and the core is consciousness in its individual and collective forms. The perception, processing, and use of information, which is a defining civilizational resource, as well as the stability of the entire system depend on the state of consciousness. Consciousness, based on old, obsolete principles and stereotypes, is unable to cope with the most acute challenges of time. New consciousness, since it is formed, will mark the transition to a new theoretical picture of the world and a model of human behavior, in which people will act, driven by proven knowledge, and not willfulness and prejudice. The idea of forming a productive information environment where the ideas of constructiveness and creative work will dominate rather than consumerism and destruction, as is the case at present, must become the categorical imperative of the new consciousness. (shrink)

In light of a history of categorical exclusion, it is critical that pregnant people are included in research to help improve the knowledge base and interventions needed to address public health. Yet the volatile legal landscape around reproductive rights in the United States threatens to undue recent progress made toward the greater inclusion of pregnant people in research. We offer ethical and practical guidance for researchers, sponsors, and institutional review boards to take specific steps to minimize legal risks and ensure (...) the ethical conduct of research with pregnant people in an evolving legal environment. (shrink)

Questions pertaining to socialist democracy and human rights and freedoms have now been advanced to the front lines of the ideological struggle between the forces of socialism, peace, and democracy, on the one hand, and those of imperialism, war, and reaction, on the other. This is due to the content and features of the worldwide development of societies today, one direction of which is a universal increase in the political self-awareness and social activity of the working class and the entire (...) mass of the toiling population. The final document of the 1976 Conference of Communist and Workers' Parties of Europe emphasizes: "The historical necessity of replacing capitalist society with a socialist society established in accordance with the will of each people is becoming evident to ever broader strata of the public." The great achievements of socialism and the successes of socialist democracy serve as an inspiring example in the heroic struggle of the working class and its allies for peace and social progress. (shrink)

The concept of interpretation is applicable to any forms of knowledge, including systems of religious knowledge, designing the ideal model of the subject of religious veneration. The author analyzes the epistemological features of theology as a form of spiritual culture, its formation in ancient culture. It is shown that the epistemological basis for overcoming mythological consciousness was the decentralization of thinking, i.e. development of the ability of consciousness in the construction of the image, the picture of the world to correct (...) the position of the subject, to take into account the relativity of the reference system, from the standpoint of which the subject perceives the object and transforms it into an operational system of thinking. Decentration of thinking provided the overcoming of the subjective mental boundaries of the field, giving the thinking nature of universality. Historical stages and moments of this process - the transformation of mythology into forms of folk art, mythopoetic epic, in the form of religious consciousness. In line with such transformations of archaic consciousness, cultural and historical prerequisites of theology emergence were formed. They are represented in mythopoetic art, ancient mythography, early traditions of critical and rationalistic interpretation of the myth, etc. The article shows the formation of allegorical theology, which became possible in the era of individualization of artistic creativity, when the visible was the difference between the motive and the purpose of activity, creative idea and its embodiment, figuratively-poetic and rationally-conceptual ways of reflecting the world, when the image of reality and its personal meaning began to be realized as different States of consciousness. The main function of any theology is the interpretation of abstract models of the subject of religious veneration. (shrink)

В монографии проводится системный анализ социальной философия одного из самых значительных отечественных социальных мыслителей Б. Н. Чичерина. Для читателей, интересующихся историей отечественной социально-философской мысли.