Ethical approval must be obtained before medical research can start. We describe the differences in EA for an pseudonymous, non-interventional, observational European study. Sixteen European national coordinators of the international study on very old intensive care patients answered an online questionnaire concerning their experience getting EA. N = 8/16 of the NCs could apply at one single national ethical committee, while the others had to apply to various regional ECs and/or individual hospital institutional research boards. The time between applying for (...) EA and the first decision varied between 7 days and 300 days. In 9/16 informed consent from the patient was not deemed necessary; in 7/16 informed consent was required from the patient or relatives. The upload of coded data to a central database required additional information in 14/16. In 4/16 the NCs had to ask separate approval to keep a subject identification code list to de-pseudonymize the patients if questions would occur. Only 2/16 of the NCs agreed that informed consent was necessary for this observational study. Overall, 6/16 of the NCs were satisfied with the entire process and 8/16 were unsatisfied. 11/16 would welcome a European central EC that would judge observational studies for all European countries. Variations in the process and prolonged time needed to get EA for observational studies hampers inclusion of patients in some European countries. This might have a negative influence on the external validity. Further harmonization of ethical approval process across Europe is welcomed for low-risk observational studies. Getting ethical approval for low-risk, non-interventional, observational studies varies enormously across European countries. (shrink)
In this analysis we discuss the change in criteria for triage of patients during three different phases of a pandemic like COVID-19, seen from the critical care point of view. Availability of critical care beds has become a hot topic, and in many countries, we have seen a huge increase in the provision of temporary intensive care bed capacity. However, there is a limit where the hospitals may run out of resources to provide critical care, which is heavily dependent on (...) trained staff, just-in-time supply chains for clinical consumables and drugs and advanced equipment. In the first phase, we can still do clinical prioritisation and decision-making as usual, based on the need for intensive care and prognostication: what are the odds for a good result with regard to survival and quality of life. In the next, the resources are mostly available, but the system is stressed by many patients arriving over a short time period and auxiliary beds in different places in the hospital being used. We may have to abandon admittance of patients with doubtful prognosis. In the last phase, usual medical triage and priority setting may not be sufficient to decrease inflow and there may not be enough intensive care unit beds available. In this phase different criteria must be applied using a utilitarian approach for triage. We argue that this is an important transition where society, and not physicians, must provide guidance to support triage that is no longer based on medical priorities alone. (shrink)
Aristotle's theory of intellect is notoriously difficult, due basically to the scarcity of textual evidence. It has therefore always been controversial and often subject to the systematic biases of its interpretators. In order to provide a fresh and objective perspective on the text itself this book offers a detailed study of the fundamental text, Aristotle's De anima III 4-5, by giving an improved Greek text, extensive commentary, and discussion. An examination of several other important Aristotelian passages on the intellect is (...) also included. The analysis shows that Aristotle distinguishes clearly between the active and the passive intellect, but that the active intellect is not actively involved in cognitive processes, such as abstraction, but the pure principle of actuality in the soul. On this basis ancient and medieval commentators identified the human and divine intellects. (shrink)
Nothingness plays an essential role throughout the work of Meister Eckhart. The function of this concept, however, changed during the development of his thought. Despite this change nothingness remains always associated with the theory of analogy which lies at the core of Eckhart's attempt to explain the radical difference between God and creation and the complete dependency of all being on its unitary and transcendent ground.
The unity of God and man in the intellect is the fundamental teaching of Meister Eckhart on which he bases the system of his thoughts. Since there is a metaphysical and a psychological aspect to this teaching the book naturally falls into two parts: The first part is devoted to the analysis of divine nature, the second examines the human soul. God and man are essentially the same in their highest point: God's innermost essence is unity, which Eckhart identifies with (...) intellect. But intellect is also the highest peak in the human soul, the famous spark. By studying both Eckhart's German and Latin works, from the early Parisian Questions to the German sermons, this study also shows the unity of Eckhart's thought in all genres of writing. (shrink)
The controversy between Richard Wagner and his critic Eduard Hanslick is well known, but rarely looked at in detail. It is mostly believed that Hanslick was unable to see Wagner's genius, stuck deeply in an antiquated aesthetical world. By reassessing Wagner's and Hanslick's letters and publications it can be seen, however, that Hanslick's detailed criticism (and also appreciation) was much more objective and less spiteful than is often assumed.
