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)

This research investigates how consumers’ ethical brand perceptions are affected by differentially valenced information. Drawing on literature from person-perception formation and using a sequential, mixed method design comprising qualitative interviews and two experiments with a national representative population sample, our findings show that only when consumers perceive their judgment of a brand’s ethicality to be pertinent, do they process information holistically and in line with the configural model of impression formation. In this case, negative information functions as a diagnostic cue (...) to form an unethical brand perception, irrespective of other positive information at hand. However, in the case where processing relevance of the un/ethical information provided is low, brand perception formation is algebraic, in which case positive information can counterbalance and neutralize the detrimental impact of brand misbehavior. Our findings extend existing research on consumer perceived ethicality as well as consumer reactions to corporate social responsibility and sustainability initiatives, which has so far assumed the asymmetric impact of negative information on ethical perceptions and consumer attitudes to be prevalent. We derive a range of academic and managerial implications and present a number of important avenues for future research. (shrink)

This article is incorrectly classified as Review Paper in the online and print publication. The correct classification for this article is Original Paper. The publisher apologizes for the inconvenience caused.

The majority of Dutch physicians feel pressure when dealing with a request for euthanasia or physician-assisted suicide. This study aimed to explore the content of this pressure as experienced by general practitioners. We conducted semistructured in-depth interviews with 15 Dutch GPs, focusing on actual cases. The interviews were transcribed and analysed with use of the framework method. Six categories of pressure GPs experienced in dealing with EAS requests were revealed: emotional blackmail, control and direction by others, doubts about fulfilling the (...) criteria, counterpressure by patient’s relatives, time pressure around referred patients and organisational pressure. We conclude that the pressure can be attributable to the patient–physician relationship and/or the relationship between the physician and the patient’s relative, the inherent complexity of the decision itself and the circumstances under which the decision has to be made. To prevent physicians to cross their personal boundaries in dealing with EAS request all these different sources of pressure will have to be taken into account. (shrink)

Depletion of mitochondrial endo/exonuclease G‐like (EXOG) in cultured neonatal cardiomyocytes stimulates mitochondrial oxygen consumption rate (OCR) and induces hypertrophy via reactive oxygen species (ROS). Here, we show that neurohormonal stress triggers cell death in endo/exonuclease G‐like‐depleted cells, and this is marked by a decrease in mitochondrial reserve capacity. Neurohormonal stimulation with phenylephrine (PE) did not have an additive effect on the hypertrophic response induced by endo/exonuclease G‐like depletion. Interestingly, PE‐induced atrial natriuretic peptide (ANP) gene expression was completely abolished in endo/exonuclease (...) G‐like‐depleted cells, suggesting a reverse signaling function of endo/exonuclease G‐like. Endo/exonuclease G‐like depletion initially resulted in increased mitochondrial OCR, but this declined upon PE stimulation. In particular, the reserve capacity of the mitochondrial respiratory chain and maximal respiration were the first indicators of perturbations in mitochondrial respiration, and these marked the subsequent decline in mitochondrial function. Although pathological stimulation accelerated these processes, prolonged EXOG depletion also resulted in a decline in mitochondrial function. At early stages of endo/exonuclease G‐like depletion, mitochondrial ROS production was increased, but this did not affect mitochondrial DNA (mtDNA) integrity. After prolonged depletion, ROS levels returned to control values, despite hyperpolarization of the mitochondrial membrane. The mitochondrial dysfunction finally resulted in cell death, which appears to be mainly a form of necrosis. In conclusion, endo/exonuclease G‐like plays an essential role in cardiomyocyte physiology. Loss of endo/exonuclease G‐like results in diminished adaptation to pathological stress. The decline in maximal respiration and reserve capacity is the first sign of mitochondrial dysfunction that determines subsequent cell death. (shrink)

This article reviews the Dutch societal debate on euthanasia/assisted suicide in dementia cases, specifically Alzheimer's disease. It discusses the ethical and practical dilemmas created by euthanasia requests in advance directives and the related inconsistencies in the Dutch legal regulations regarding euthanasia/assisted suicide. After an initial focus on euthanasia in advanced dementia, the actual debate concentrates on making euthanasia/assisted suicide possible in the very early stages of dementia. A review of the few known cases of assisted suicide of people with so-called (...) early dementia raises the question why requests for euthanasia/assisted suicide from patients in the early stage of Alzheimer's disease are virtually non-existent. In response to this question two explanations are offered. It is concluded that, in addition to a moral discussion on the limits of anticipatory choices, there is an urgent need to develop research into the patient's perspective with regard to medical treatment and care-giving in dementia, including end-of-life care. (shrink)

Neste livro Gombrich discute as idéias e as posturas específicas que tiveram influência decisiva na prática da arte renascentista. Todos os estudos aqui reunidos tratam de algo a que se pode chamar clima renascentista de opiniões sobre a arte, além da influência desse clima sobre a prática e a crítica da arte.

To the historian of art, it is evident that the two authors’ notion of ‘art’ is of very recent date, and not shared by everybody. They claim: ‘The purpose of art, surely, is not merely to depict or represent reality -- for that can be accomplished very easily with a camera -- but to enhance, transcend, or even to distort reality’ . They do not explain how one could photograph Paradise or Hell, the Creation of the World, the Passion of (...) Christ, or the escapades of the ancient gods -- all subjects that can be found represented in our museums. Nor is it more legitimate to generalize from certain Indian conventions of representing the female nude than it is for the academic tradition to take the Venus de Medici for the same purpose. Even a fleeting visit to one of the great museums might serve to convince the authors that few of the exhibits conform to the laws of art they postulate. [followed by response from V.S. Ramachandran]. (shrink)

In this paper, we explore the conceptual problems arising when using network analysis in person- centered care (PCC) in psychiatry. Personalized network models are potentially helpful tools for PCC, but we argue that using them in psychiatric practice raises boundary problems, i.e., problems in demarcating what should and should not be included in the model, which may limit their ability to provide clinically-relevant knowledge. Models can have explanatory and representational boundaries, among others. We argue that we can make more explicit (...) what kind of questions personalized network models can address in PCC, given their representational and explanatory boundaries, using perspectival reasoning. (shrink)

Resumo Não há dúvida que tanto Kant como Hegel viram os seus respectivos trabalhos, como contribuições para aquilo que consideravam ser a “metafísica”. No entanto, a autora argumenta, que isto só deve ser compreendido, tendo presente, as concepções de metafísica de cada um dos autores. A autora, começando pela distinção implícita entre metafísica geral e metafísica especial na Crítica da Razão Pura, argumenta que Kant, Fichte, Schelling e Hegel comprometeram-se com uma investigação que, até essa altura, era do domínio da (...) metafísica geral. A autora, concentrando-se na noção de sistema de razão pura, tal como aludido na Crítica da Razão Pura, mostra, que os sucessores de Kant, interpretaram erroneamente a distinção kantiana entre crítica e sistema, o que permitiu elaborarem um sistema completo de razão pura, contrário àquilo que era intenção de Kant. Palavras-chave : Fichte, Hegel, idealismo alemão, Kant, metafísica, sistemaThere is no doubt that both Kant and Hegel saw their work as contributions to what they considered metaphysics proper. Yet what they meant by this, I argue, can only be understood by taking into account their own conception of metaphysics. Starting from Kant’s implicit distinction between general metaphysics and special metaphysics in the Critique of Pure Reason, I argue that Kant, Fichte, Schelling and Hegel engaged in the investigation that used to be carried out in general metaphysics. Focusing on the notion of a system of pure reason intimated in the Critique of Pure Reason, I show, moreover, that Kant’s successors, while misinterpreting the Kantian distinction between critique and system, elaborated a method that made it possible to produce a complete system of pure reason, albeit one that differed from the system Kant had in mind. Keywords : Fichte, german idealism, Hegel, Kant, metaphysics, system. (shrink)

Syltern et al. (2022) propose a new approach to decision-making at the limit of viability: by default, intensive care will be initiated for every infant born in “the gray zone” of viability. This w...