A paradigm for peace discovered in the cosmopolitan neighborhoods of poor urban immigrants.

In Spoils of War, a diverse group of distinguished contributors suggest that acts of aggression resulting from the racism and sexism inherent in social institutions can be viewed as a sort of "war," experienced daily by women of color.

Mitochondria are increasingly being recognized as information hubs that sense cellular changes and transmit messages to other cellular components, such as the nucleus, the endoplasmic reticulum (ER), the Golgi apparatus, and lysosomes. Nonetheless, the interaction between mitochondria and the nucleus is of special interest because they both host part of the cellular genome. Thus, the communication between genome‐bearing organelles would likely include gene expression regulation. Multiple nuclear‐encoded proteins have been known to regulate mitochondrial gene expression. On the contrary, no mitochondrial‐encoded (...) factors are known to actively regulate nuclear gene expression. MOTS‐c (mitochondrial open reading frame of the 12S ribosomal RNA type‐c) is a recently identified peptide encoded within the mitochondrial 12S ribosomal RNA gene that has metabolic functions. Notably, MOTS‐c can translocate to the nucleus upon metabolic stress (e.g., glucose restriction and oxidative stress) and directly regulate adaptive nuclear gene expression to promote cellular homeostasis. It is hypothesized that cellular fitness requires the coevolved mitonuclear genomes to coordinate adaptive responses using gene‐encoded factors that cross‐regulate the opposite genome. This suggests that cellular gene expression requires the bipartite split genomes to operate as a unified system, rather than the nucleus being the sole master regulator. (shrink)

The appendages of the adult fruit fly and other insects and Arthropods develop from secondary embryonic fields that form after the primary anterior/posterior and dorsal/ventral axes of the embryo have been determined. In Drosophila, the position and fate of the different fields formed within each segment are determined by genes acting along both embryonic axes, within individual segments, and within specific fields. Since the major architectural differences between most Arthropod classes and orders involve variations in the number, type and morphology (...) of body appendages, the elucidation of the embryology and molecular genetics of the origin and patterning of insect limb fields may help to facilitate an understanding of both the mechanism of appendage formation and some of the major steps in the morphological evolution of the Arthropods. In this review, we will discuss recent studies that have advanced our understanding of both the origin and patterning of Drosophila leg and wing secondary fields. These results provide fresh insights into potentially general mechanisms of how body parts develop and evolve. (shrink)

Within the popular consciousness, Emma Goldman has become something of an icon, a symbol for rebellion and women’s rights. But there has been surprisingly little substantive analysis of her influence on social, political, and feminist theory. In _Feminist Interpretations of Emma Goldman,_ Weiss and Kensinger present essays that resist a simplistic understanding of Goldman and instead attempt to examine her thinking in its proper social, historical, and philosophical context. Only by considering the sources, influences, and specific significance of Goldman’s ideas (...) can her proper place in feminist theory be truly understood. In addition to the editors, the contributors are Martha A. Ackelsberg, Kathryn Pyne Addelson, Lynne M. Adrian, Berenice A. Carroll, Voltairine de Cleyre, Janet E. Day, Candace Falk, Kathy E. Ferguson, Marsha Aileen Hewitt, Lori Jo Marso, Jonathan McKenzie, Alix Kates Shulman, Craig Stalbaum, Jason Wehling, and Alice Wexler. (shrink)

Objective: There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this. -/- Methods: We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a “Points to (...) Consider” (P2C) document, and convened a national expert panel to review and critique the P2C. -/- Results: We developed the P2C to aid informaticists designing an advanced query tool for an electronic health record (EHR) system in Indianapolis. The P2C consists of six questions (“Points”) that frame important ethical issues, apply accepted principles of bioethics and Fair Information Practices, comment on how questions might be answered, and address implications for patient care. -/- Discussion: The P2C is intended to clarify whatis at stake when designers try to accommodate potentially competing ethical commitments and logistical realities. The P2C was developed to guide informaticists who were designing a query tool in an existing EHR that would permit patient granular control. While consideration of ethical issues is coming to the forefront of medical informatics design and development practices, more reflection is needed to facilitate optimal collaboration between designers and ethicists. This report contributes to that discussion. (shrink)

This thought-provoking text explores the ethical dimensions of the professional nursing practice. The authors discuss important topics such as inter-professional relationships, collective action, nursing research, and educational requirements within the context of professional commitment. Providing a balance between an empirical and a philsophical framework, the book stimulates the reader to ponder, analyze and evaluate the professional and ethical aspects of these issues.

In lieu of an abstract, here is a brief excerpt of the content:Human Nature in Nineteenth-Century British Novels:Doing the MathJoseph Carroll, Jonathan Gottschall, John A. Johnson, and Daniel J. KrugerIThree broad ambitions animate this study. Building on research in evolutionary social science, we aimed (1) to construct a model of human nature—of motives, emotions, features of personality, and preferences in marital partners; (2) use that model to analyze some specific body of literary texts and the responses of readers to (...) those texts, and (3) produce data—information that could be quantified and could serve to test specific hypotheses about those texts.Evolutionary social science is still in the process of constructing a full and adequate model of human nature. Evolutionary social scientists know much already about how human reproductive behavior and human sociality fit into the larger pattern of human evolution. They still have much to learn, though, about the ways literature and the other arts enter into human nature. Our model of human nature draws on our knowledge of imaginative culture, integrates that knowledge with evolutionary theories of culture, and produces data that enable us to draw conclusions on an issue of broad significance for both literary study and evolutionary social science: the adaptive function of literature and the other arts.1In order to make advances in knowledge, it is necessary to choose some particular subject. Genetics is a basic science that applies to all organisms, but geneticists first got an empirical fix on their subject by focusing minutely, with Mendel, on peas, and, with Morgan, on fruit flies. In place of peas and flies, we have taken as our subject British novels of [End Page 50] the longer nineteenth century (Austen to Forster). As a literary topic, the subject is fairly broad, but our theoretical and methodological aims ultimately extend well beyond the specialist fields of British novels, the nineteenth century, British literature, narrative fiction, or even literary scholarship generally. This study is designed to engage the attention of literary scholars in all fields and also to engage the attention of social scientists. If it achieves its aims, this study would help persuade literary scholars that empirical methods offer rich opportunities for the advancement of knowledge about literature, and it would help persuade social scientists that the quantitative study of literature can shed important light on fundamental questions of human psychology and human social interaction. Our own research team combines these two prospective audiences. Two of us (Carroll and Gottschall) have been trained primarily as literary scholars, and two of us (Johnson and Kruger) primarily as social scientists.The focal point for this study is "agonistic" structure: the organization of characters into protagonists, antagonists, and minor characters. The central question in the study is this: does agonistic structure reflect evolved dispositions for forming cooperative social groups? Suppressing or muting competition within a social group enhances group solidarity and organizes the group psychologically for cooperative endeavor. Our chief hypothesis was that protagonists and good minor characters would form communities of cooperative endeavor and that antagonists would exemplify dominance behavior. If this hypothesis proved correct, the ethos reflected in the agonistic structure of the novels would replicate the egalitarian ethos of hunter-gatherers, who stigmatize and suppress status-seeking in potentially dominant individuals. If suppressing dominance in hunter-gatherers fulfills an adaptive social function, and if agonistic structure in the novels engages the same social dispositions that animate hunter-gatherers, our study would lend support to the hypothesis that literature fulfills an adaptive social function.2One of our chief working hypotheses is that when readers respond to characters in novels, they respond in much the same way, emotionally, as they respond to people in everyday life. They like or dislike them, admire them or despise them, fear them, feel sorry for them, or are amused by them. In writing fabricated accounts of human behavior, novelists select and organize their material for the purpose of generating such responses, and readers willingly cooperate with this purpose. They participate vicariously in the experiences depicted and form personal opinions about the qualities of the characters. Authors and readers [End Page 51] thus collaborate in producing a simulated experience of emotionally responsive evaluative judgment. If agonistic structure is a... (shrink)

Lewis makes a strong case for the interdependence and integration of emotion and cognitive processes. Yet, these processes exhibit considerable independence in early life, as well as in certain psychopathological conditions, suggesting that the capacity for their integration emerges as a function of development. In some circumstances, the concept of highly interactive emotion and cognitive systems seems a viable alternative hypothesis to the idea of systems integration.

A substantial body of theoretical literature testifies to the evolutionary functions of emotions. Relatively little has been written about their developmental functions. This article discusses the developmental functions of emotions from the perspective of differential emotions theory (DET; Izard, 1977, 1991). According to DET, although all the emotions retain their adaptive and motivational functions across the lifespan, different sets of emotions may become relatively more prominent in the different stages of life as they serve stage-related developmental processes. In the first (...) section, we present a brief overview of relevant aspects of the theory. In the second section, we discuss how emotions play a central role in helping the individual achieve developmental milestones and tasks during four major periods of life: Infancy, toddler through preschool years, middle to late childhood, and adolescence. The underlying thesis of this article is that emotions play a central role in stimulating social cognitive attainments at each stage of development. (shrink)

Building on evidence for embodied representations, we investigated whether Spanish spatial terms map onto the NEAR/FAR perceptual division of space. Using a long horizontal display, we measured congruency effects during the processing of spatial terms presented in NEAR or FAR space. Across three experiments, we manipulated the task demands in order to investigate the role of endogenous attention in linguistic and perceptual space mapping. We predicted congruency effects only when spatial properties were relevant for the task but not when attention (...) was allocated to other features. Results showed faster responses for words presented in Near-space in all experiments. Consistent with our hypothesis, congruency effects were observed only when a reaching estimate was requested. Our results add important evidence for the role of top-down processing in congruency effects from embodied representations of spatial terms. (shrink)

Building on evidence for embodied representations, we investigated whether Spanish spatial terms map onto the NEAR/FAR perceptual division of space. Using a long horizontal display, we measured congruency effects during the processing of spatial terms presented in NEAR or FAR space. Across three experiments, we manipulated the task demands in order to investigate the role of endogenous attention in linguistic and perceptual space mapping. We predicted congruency effects only when spatial properties were relevant for the task but not when attention (...) was allocated to other features. Results showed faster responses for words presented in Near-space in all experiments. Consistent with our hypothesis, congruency effects were observed only when a reaching estimate was requested. Our results add important evidence for the role of top-down processing in congruency effects from embodied representations of spatial terms. (shrink)

How far has the Darwinian revolution come? To what extent have evolutionary ideas penetrated into the social sciences and humanities? Are the “science wars” over? Or do whole blocs of disciplines face off over an unbridgeable epistemic gap? To answer questions like these, contributors to top journals in 22 disciplines were surveyed on their beliefs about human nature, culture, and science. More than 600 respondents completed the survey. Scoring patterns divided into two main sets of disciplines. Genetic influences were emphasized (...) in the evolutionary social sciences, evolutionary humanities, psychology, empirical study of the arts, philosophy, economics, and political science. Environmental influences were emphasized in most of the humanities disciplines and in anthropology, sociology, education, and women's or gender studies. Confidence in scientific explanation correlated positively with emphasizing genetic influences on behavior, and negatively with emphasizing environmental influences. Knowing the current actual landscape of belief should help scholars avoid sterile debates and ease the way toward fruitful collaborations with neighboring disciplines. (shrink)

We present a new axiomatization of the classical discounted expected utility model, which is primarily used as a decision model for consumption streams under risk. This new axiomatization characterizes discounted expected utility as a model that satisfies natural extensions of standard axioms as in the one-period case and two additional axioms. The first axiom is a weak form of time separability. It only requires that the choice between certain constant consumption streams and lotteries should be made by just taking into (...) account the time periods where the consumption is different. The second axiom, the time–probability equivalence, requires that risk and time preferences basically work in the same way. Moreover, we prove that preferences satisfying the natural extensions of the standard axioms as well as the first axiom can be represented in a simple form relying on three functions linked to the risk or time preferences in simple situations. Finally, we illustrate that several examples that are not fully time separable satisfy all our axioms except for the time–probability equivalence. (shrink)

Depression experienced by older adults is proving an increasing global health burden, with rates generally 7% and as high as 27% in the USA. This is likely to significantly increase in coming years as the number and proportion of older adults in the population rises all around the world. Therefore, it is imperative that the effectiveness of approaches to the prevention and treatment of depression are understood. Creative arts interventions, including art, dance movement, drama and music modalities, are utilised internationally (...) to target depression and depressive symptoms in older adults. This includes interventions led by trained arts therapists as well as other health and arts professionals. However, to date there has not been a systematic review that reports effects and examines the processes (why) and mechanisms (how) of creative arts interventions are used to address depression in this older age group. This systematic review of studies on creative arts interventions for older adults experiencing depression examined: outcomes of four creative arts modalities (art, dance movement, drama, and music); with particular attention paid to processes documented as contributing to change in each modality; and mechanisms considered to result from these processes. Our analysis of 75 articles (17 art, 13 dance, 4 drama and 41 music) indicates mostly significant quantitative or positive qualitative findings, particularly for interventions led by creative arts therapists. Mechanisms of change gleaned from the studies that were common across modalities include physical (e.g. increased muscle strength; neurochemical effects, such as endorphin release), intra-personal (e.g. enhanced self-concept, strengthened agency and mastery; processing and communication of emotions), cultural (e.g. creative expression, aesthetic pleasure), cognitive (e.g. stimulation of memory) and social (e.g. increased social skills and connection), that were all considered to contribute to reduced depression and symptoms. Recommendations for future research include a stronger focus on testing of processes and mechanisms. (shrink)

Taking a fresh look at questions that have long troubled teachers committed to social change, No Angel in the Classroom provides a richly conceptualized and down-to-earth account of feminist teaching in higher education. Long-time feminist educator, Berenice Malka Fisher, gives a nuanced interpretation of second wave feminist consciousness-raising that bridges the gap between feminist activism and the academy. Candid classroom stories bring out the myths embedded in many activist ideals of the 1970s, while Fisher's informed analysis builds on these (...) tensions, offering a complex amount of experience, emotion, thought, and action in feminist teaching. (shrink)

Background: Expanded newborn screening generates incidental results, notably carrier results. Yet newborn screening programmes typically restrict parental choice regarding receipt of this non-health serving genetic information. Healthcare providers play a key role in educating families or caring for screened infants and have strong beliefs about the management of incidental results. Methods: To inform policy on disclosure of infant sickle cell disorder (SCD) carrier results, a mixed-methods study of healthcare providers was conducted in Ontario, Canada, to understand attitudes regarding result management (...) using a cross-sectional survey (N = 1615) and semistructured interviews (N = 42). Results: Agreement to reasons favouring disclosure of SCD carrier results was high (65.1%–92.7%) and to reasons opposing disclosure was low (4.1%–18.1%). Genetics professionals expressed less support for arguments favouring disclosure (35.3%–78.8%), and more agreement with arguments opposing disclosure (15.7%–51.9%). A slim majority of genetics professionals (51.9%) agreed that a reason to avoid disclosure was the importance of allowing the child to decide to receive results. Qualitatively, there was a perceived “duty” to disclose, that if the clinician possessed the information, the clinician could not withhold it. Discussion: While a majority of respondents perceived a duty to disclose the incidental results of newborn screening, the policy implications of these attitudes are not obvious. In particular, policy must balance descriptive ethics (ie, what providers believe) and normative ethics (ie, what duty-based principles oblige), address dissenting opinion and consider the relevance of moral principles grounded in clinical obligations for public health initiatives. (shrink)

Sex differences in aggressive behavior are probably adaptive but the costs and benefits of risky aggression to women and men may be different from those suggested in Campbell's target article. Moreover, sex differences are more likely to reflect differences in the costs of aggression to females and males rather than differences in its benefits.

Social cognition is the ability to identify, understand, and interpret mental states and emotions. Psychopathic traits are typically described in two ways; Primary: shallow affect, emotional detachment, and relationship difficulties, and Secondary Psychopathic Traits: antisocial traits, impulsiveness, and emotional dysregulation. People with high psychopathic traits tend to perform lower on measures of social cognition. This study investigated the relationship of social cognition to primary and secondary psychopathic traits in a non-clinical sample, and investigated the psychometric properties of the Reading the (...) Mind in the Eyes Test Short Forms. A community-based male sample was recruited through an online platform. Psychopathic traits were measured using Levenson, Kiehl, and Fitzpatrick's Self-Report Psychopathy Scale, and stratified into Primary and Secondary Psychopathic traits. Secondary validation of the RMET Short Forms was completed investigating scale reliability, and validity. Findings suggest excellent psychometrics in a large community cohort for the RMET Short Forms, with significant negative correlations on social cognitive performance and high self-report psychopathy. The item valence within the social cognitive measure was also examined, and correlated significantly with both Primary and Secondary Psychopathic traits. This study provides further validation of the RMET Short Forms, and adds to the literature on the scale by investigating performance on short-form specific valence. This study further suggests that in a non-clinical community sample of males, that higher psychopathic traits correlated significantly, and negatively, with social cognitive performance. (shrink)

Na doença falciforme, o genótipo HbSS da anemia falciforme, considerado a forma mais grave, prevalente no continente africano, tem alta morbidade e mortalidade. Objetivo: identificar se a estrutura instalada na atenção às pessoas com anemia falciforme e seus familiares, contribui para a redução da mortalidade precoce em Angola. Material e Método: pesquisa exploratória descritiva, realizada em Luanda-Angola, no período entre agosto e dezembro de 2022. Foram aplicados questionários estruturados para 20 pessoas com doença falciforme e 15 familiares, todos com mais (...) de 21 anos. A metodologia utilizada foi bola de neve. Para análise e discussão dos dados, foi utilizado o referencial teórico de Donabedian, com ênfase no eixo estrutura. Resultados: diagnóstico feito por sinais e sintomas, idade do diagnóstico entre 1 e 5 anos. A crise de dor predominou entre eventos agudos. Conclusão: inexistência de estrutura instalada de saúde em Luanda que garantam no serviço público gratuito o acesso à medicamentos, transfusão de sangue, vacinas especiais e exames complementares. A transferência de tecnologias sociais da organização de sociedade civil brasileira para a de Luanda mostra ser adequada. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Human Nature in Nineteenth-Century British Novels:Doing the MathJoseph Carroll, Jonathan Gottschall, John A. Johnson, and Daniel J. KrugerIThree broad ambitions animate this study. Building on research in evolutionary social science, we aimed (1) to construct a model of human nature—of motives, emotions, features of personality, and preferences in marital partners; (2) use that model to analyze some specific body of literary texts and the responses of readers to (...) those texts, and (3) produce data—information that could be quantified and could serve to test specific hypotheses about those texts.Evolutionary social science is still in the process of constructing a full and adequate model of human nature. Evolutionary social scientists know much already about how human reproductive behavior and human sociality fit into the larger pattern of human evolution. They still have much to learn, though, about the ways literature and the other arts enter into human nature. Our model of human nature draws on our knowledge of imaginative culture, integrates that knowledge with evolutionary theories of culture, and produces data that enable us to draw conclusions on an issue of broad significance for both literary study and evolutionary social science: the adaptive function of literature and the other arts.1In order to make advances in knowledge, it is necessary to choose some particular subject. Genetics is a basic science that applies to all organisms, but geneticists first got an empirical fix on their subject by focusing minutely, with Mendel, on peas, and, with Morgan, on fruit flies. In place of peas and flies, we have taken as our subject British novels of [End Page 50] the longer nineteenth century (Austen to Forster). As a literary topic, the subject is fairly broad, but our theoretical and methodological aims ultimately extend well beyond the specialist fields of British novels, the nineteenth century, British literature, narrative fiction, or even literary scholarship generally. This study is designed to engage the attention of literary scholars in all fields and also to engage the attention of social scientists. If it achieves its aims, this study would help persuade literary scholars that empirical methods offer rich opportunities for the advancement of knowledge about literature, and it would help persuade social scientists that the quantitative study of literature can shed important light on fundamental questions of human psychology and human social interaction. Our own research team combines these two prospective audiences. Two of us (Carroll and Gottschall) have been trained primarily as literary scholars, and two of us (Johnson and Kruger) primarily as social scientists.The focal point for this study is "agonistic" structure: the organization of characters into protagonists, antagonists, and minor characters. The central question in the study is this: does agonistic structure reflect evolved dispositions for forming cooperative social groups? Suppressing or muting competition within a social group enhances group solidarity and organizes the group psychologically for cooperative endeavor. Our chief hypothesis was that protagonists and good minor characters would form communities of cooperative endeavor and that antagonists would exemplify dominance behavior. If this hypothesis proved correct, the ethos reflected in the agonistic structure of the novels would replicate the egalitarian ethos of hunter-gatherers, who stigmatize and suppress status-seeking in potentially dominant individuals. If suppressing dominance in hunter-gatherers fulfills an adaptive social function, and if agonistic structure in the novels engages the same social dispositions that animate hunter-gatherers, our study would lend support to the hypothesis that literature fulfills an adaptive social function.2One of our chief working hypotheses is that when readers respond to characters in novels, they respond in much the same way, emotionally, as they respond to people in everyday life. They like or dislike them, admire them or despise them, fear them, feel sorry for them, or are amused by them. In writing fabricated accounts of human behavior, novelists select and organize their material for the purpose of generating such responses, and readers willingly cooperate with this purpose. They participate vicariously in the experiences depicted and form personal opinions about the qualities of the characters. Authors and readers [End Page 51] thus collaborate in producing a simulated experience of emotionally responsive evaluative judgment. If agonistic structure is a... (shrink)

Randomized controlled trial trial designs exist on an explanatory-pragmatic spectrum, depending on the degree to which a study aims to address a question of efficacy or effectiveness. As conceptualized by Schwartz and Lellouch in 1967, an explanatory approach to trial design emphasizes hypothesis testing about the mechanisms of action of treatments under ideal conditions, whereas a pragmatic approach emphasizes testing effectiveness of two or more available treatments in real-world conditions. Interest in, and the number of, pragmatic trials has grown substantially (...) in recent years, with increased recognition by funders and stakeholders worldwide of the need for credible evidence to inform clinical decision-making. This increase has been accompanied by the onset of learning healthcare systems, as well as an increasing focus on patient-oriented research. However, pragmatic trials have ethical challenges that have not yet been identified or adequately characterized. The present study aims to explore the views of key stakeholders with respect to ethical issues raised by the design and conduct of pragmatic trials. It is embedded within a large, four-year project that seeks to develop guidance for the ethical design and conduct of pragmatic trials. As a first step, this study will address important gaps in the current empirical literature with respect to identifying a comprehensive range of ethical issues arising from the design and conduct of pragmatic trials. By opening up a broad range of topics for consideration within our parallel ethical analysis, we will extend the current debate, which has largely emphasized issues of consent, to the range of ethical considerations that may flow from specific design choices. Semi-structured interviews with key stakeholders, across multiple jurisdictions, identified based on their known experience and/or expertise with pragmatic trials. We expect that the study outputs will be of interest to a wide range of knowledge users including trialists, ethicists, research ethics committees, journal editors, regulators, healthcare policymakers, research funders and patient groups. All publications will adhere to the Tri-Agency Open Access Policy on Publications. (shrink)

Noel Carroll, film scholar and philosopher, offers the first serious look at the aesthetics of horror. In this book he discusses the nature and narrative structures of the genre, dealing with horror as a "transmedia" phenomenon. A fan and serious student of the horror genre, Carroll brings to bear his comprehensive knowledge of obscure and forgotten works, as well as of the horror masterpieces. Working from a philosophical perspective, he tries to account for how people can find pleasure (...) in having their wits scared out of them. What, after all, are those "paradoxes of the heart" that make us want to be horrified? (shrink)

Paraesthetics' is a neologism invented by David Carroll to unlock the extra-aesthetic relationship between art and literature in the work of Michel Foucault, ...

Abstract:A synthesis of the two theoretical bases of business ethics—normative philosophy and descriptive social science—is called for. Examples from the literature are used to demonstrate that to ignore the descriptive aspects of moral behavior is to risk unreal philosophy, and that to ignore the normative aspects is to risk amoral social science. Business ethics is portrayed as a single unified field, in which fact-value distinctions are inappropriate.

This is a review of Marc Lange's _Natural Laws in Scientific Practice<D>.

ObjectivesTo describe reporting of informed consent in pragmatic trials, justifications for waivers of consent and reporting of alternative approaches to standard written consent. To identify factors associated with (1) not reporting and (2) not obtaining consent.MethodsSurvey of primary trial reports, published 2014–2019, identified using an electronic search filter for pragmatic trials implemented in MEDLINE, and registered in ClinicalTrials.gov.ResultsAmong 1988 trials, 132 (6.6%) did not include a statement about participant consent, 1691 (85.0%) reported consent had been obtained, 139 (7.0%) reported a (...) waiver and 26 (1.3%) reported consent for one aspect (eg, data collection) but a waiver for another (eg, intervention). Of the 165 trials reporting a waiver, 76 (46.1%) provided a justification. Few (53, 2.9%) explicitly reported use of alternative approaches to consent. In multivariable logistic regression analyses, lower journal impact factor (p=0.001) and cluster randomisation (p<0.0001) were significantly associated with not reporting on consent, while trial recency, cluster randomisation, higher-income country settings, health services research and explicit labelling as pragmatic were significantly associated with not obtaining consent (all p<0.0001).DiscussionNot obtaining consent seems to be increasing and is associated with the use of cluster randomisation and pragmatic aims, but neither cluster randomisation nor pragmatism are currently accepted justifications for waivers of consent. Rather than considering either standard written informed consent or waivers of consent, researchers and research ethics committees could consider alternative consent approaches that may facilitate the conduct of pragmatic trials while preserving patient autonomy and the public’s trust in research. (shrink)