In many regions around the world, those at highest risk for acquiring HIV are young adults and adolescents. Young men who have sex with men in the USA are the group at greatest risk for HIV acquisition, particularly if they are part of a racial or ethnic minority group.1 Adolescent girls and young women have the highest incidence rates of any demographic subgroup in sub-Saharan Africa.2 To reverse the global AIDS pandemic’s toll on these high-risk groups, it is important to (...) deploy the most effective HIV prevention tools to young MSM in the USA, to adolescent girls and young women in sub-Saharan Africa, and to any other adolescents and young adults at high risk for HIV as products are proven to be safe and efficacious. Although prevention interventions with proven efficacy, such as oral pre-exposure prophylaxis, are available,3–8 they have not been sufficient to stem the tide and an expanded prevention toolkit is urgently needed to serve these populations. The field of HIV prevention continues to identify promising leads in the development of new biomedical prevention products, either delivering antiviral drug topically or systemically. The dapivirine ring has been shown to provide modest protection and is currently being tested in open label studies while injectable cabotegravir is being tested in a large efficacy trial for preventing HIV acquisition. Advances in the field of HIV prevention mean that scientists and regulators must plan for how they will bring prevention tools to populations at high risk for HIV as they conduct efficacy and effectiveness trials. For instance, safety data from younger age groups can also be used in combination with efficacy data from adult studies, where appropriate, as bridging studies to expand labelling to younger ages. If these …. (shrink)

A gas in a box is perhaps the most important model system studied in thermodynamics and statistical mechanics. Usually, studies focus on the gas, whereas the box merely serves as an idealized confinement. The present article focuses on the box as the central object and develops a thermodynamic theory by treating the geometric degrees of freedom of the box as the degrees of freedom of a thermodynamic system. Applying standard mathematical methods to the thermody- namics of an empty box allows (...) equations with the same structure as those of cosmology and classical and quantum mechanics to be derived. The simple model system of an empty box is shown to have interesting connections to classical mechanics, special relativity, and quantum field theory. (shrink)

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)

Background: Black, Asian and minority ethnic groups have a high need for organ transplantation but deceased donation is low. This restricts the availability of well-matched organs and results in relatively long waiting times for transplantation, with increased mortality risks. Objective: To identify barriers to organ donor registration and family consent among the BAME population, and to develop and evaluate a training intervention to enhance communication with ethnic minority families and identify impacts on family consent. Methods: Three-phase programme comprising community-based (...) research involving two systematic reviews examining attitudes and barriers to organ donation and effective interventions followed by 22 focus groups with minority ethnic groups; hospital-based research examining staff practices and influences on family consent through ethics discussion groups with staff, a study on intensive care units and interviews with bereaved ethnic minority families; and development and evaluation of a training package to enhance cultural competence among ICU staff. Setting: Community focus group study in eight London boroughs with high prevalence of ethnic minority populations. Hospital studies at five NHS hospital trusts. Participants: Community studies: 228 focus group participants; hospital studies: 35 nurses, 28 clinicians, 19 hospital chaplains, 25 members of local Organ Donation Committees, 17 bereaved family members; and evaluation: 66 health professionals. Data sources: Focus groups with community residents, systematic reviews, qualitative interviews and observation in ICUs, EDGs with ICU staff, bereaved family interviews and questionnaires for trial evaluation. Review methods: Systematic review and narrative synthesis. Results: Community studies: Organ Donor Register – different ethnic/faith and age groups were at varying points on the ‘pathway’ to organ donor registration, with large numbers lacking knowledge and remaining at a pre-contemplation stage. Key attitudinal barriers were uncertainties regarding religious permissibility, bodily concerns, lack of trust in health professionals and little priority given to registration, with the varying significance of these factors varying by ethnicity/faith and age. National campaigns focusing on ethnic minorities have had limited impact, whereas characteristics of effective educational interventions are being conducted in a familiar environment; addressing the groups’ particular concerns; delivery by trained members of the lay community; and providing immediate access to registration. Interventions are also required to target those at specific stages of the donation pathway. Hospital studies: family consent to donation – many ICU staff, especially junior nurses, described a lack of confidence in communication and supporting ethnic minority families, often reflecting differences in emotional expression, faith and cultural beliefs, and language difficulties. The continuing high proportion of family donation discussions that take place without the collaboration of a specialist nurse for organ donation reflected consultants’ views of their own role in family consent to donation, a lack of trust in SNODs and uncertainties surrounding controlled donations after circulatory death. Hospital chaplains differed in their involvement in ICUs, reflecting their availability/employment status, personal interests and the practices of ICU staff. Evaluation: professional development package – a digital versatile disk-based training package was developed to promote confidence and skills in cross-cultural communication. Initial evaluation produced positive feedback and significant affirmative attitudinal change but no significant difference in consent rate over the short follow-up period with requirements for longer-term evaluation. Limitations: Participants in the focus group study were mainly first-generation migrants of manual socioeconomic groups. It was not permitted to identify non-consenting families for interview with data regarding the consent process were therefore limited to consenting families. Conclusions: The research presents guidance for the effective targeting of donation campaigns focusing on minority ethnic groups and provides the first training package in cultural competence in the NHS. Future work: Greater evaluation is required of community interventions in the UK to enhance knowledge of effective practice and analysis of the experiences of non-consenting ethnic minority families. Funding: The National Institute for Health Research Programme Grants for Applied Research programme. (shrink)

This short study attempts to demonstrate the importance for Rabelais's thought and art of the "Platonic-Hermetic" current in antique and Renaissance intellectual history. The demonstration is weakened by the author's failure to sketch a history of this tradition, and one is left to gather from intermittent allusions and from footnotes whom he considers its principle spokesmen and what he considers its main tenets and spokesmen to be. According to Masters, Rabelais's writing is grounded in a Platonic dialectic which plays with (...) the tensions between reality and appearance, intellect and matter, soul and body, God and man. The presence of the divine in human affairs is manifested by such images as the androgyne and the pantagruelion. The recurrent Rabelaisian image of drinking can be understood on several levels. In its most literal sense, it points to the pleasure of festive conviviality. At a higher level, it involves the enlightened exchange of ideas, and at the highest, evoked in the episode of the Dive Bouteille, drinking suggests the acquisition of self-knowledge and, with self-knowledge, all other knowledge proper to the human mind. The Hermetic sciences can lead man in three directions: downward to the black arts; outward toward a salutary investigation of the world; or finally upward to an "intuitive dialectic" and a mystical union with the godhead. Although Masters' interpretations of specific images and episodes sometimes lack tact, his erudition should enhance the book's interest both for intellectual historians and Rabelaisian specialists.--T. M. G. (shrink)

Background This article describes the issues encountered when designing a study to evaluate recruitment of minority ethnic groups into clinical cancer research in order to monitor adherence to the principles for good practice set out in the Department of Health, Research Governance Framework, England. Methods (i) A review of routine data sources to determine whether their usefulness as a source of data on prevalence of cancer in the population by ethnic category. (ii) A local case study at one hospital trust (...) to ascertain whether the ethnicity of cancer trial participants was representative of admitted cancer patients. Results (i) The lack of a comparator population makes it problematic to assess recruitment levels by ethnic group in clinical research. (ii) The odds of being in a trial were 30% lower for a member of a minority ethnic group compared to a white cancer patient after adjusting for disease, age and gender, OR 0.70 (0.53 to 0.94). These results differed for each ethnic group; Asian patients did not appear under-represented while Black and Chinese did so. However, there are important caveats to the findings based on the limited recording of ethnicity. Conclusions The lack of available data on the ethnicity of participants in clinical research and the prevalence of cancer in the population according to ethnicity makes it difficult to design a study to monitor representation of minority ethnic groups. This information is necessary to assess adherence to the Research Governance Framework principle that research evidence reflects the diversity of the population. (shrink)

High-level improvising musicians master idiosyncratic gesture vocabularies that allow them to express themselves in unique ways. The full use of such vocabularies is nevertheless challenged when improvisers incorporate electronics in their performances. To control electronic sounds and effects, they typically use commercial interfaces whose physicality is likely to limit their freedom of movement. Based on Jim Black's descriptions of his ideal digital musical instrument, embodied improvisation gestures, and stage performance constraints, we develop the concept of a modular wearable MIDI (...) interface to closely meet the needs of professional improvisers, rather than proposing a new generic instrument that would require substantial practice to adapt improvisational techniques already acquired. Our research draws upon different bodies of knowledge, from theoretical principles on collaboration and embodiment to wearable interface design, in order to create a digital vest called Track It, Zip It that features two innovative on-body sensors. Allowing for sound control, these sensors are seamlessly integrated with Black's improvisational gesture vocabulary. We then detail the design process of three TIZI prototypes structured by the outcomes of a performance test with Black, a public performance by a novice improviser during the 2017 International Guthman Musical Instrument Competition, and measurements of sensor responses. After commenting on the strengths and weaknesses of the final TIZI prototype, we discuss how our interdisciplinary and collective process involving a world-class improviser at the very center of the design process can provide recommendations to designers who wish to create interfaces better adapted to high-level performers. Finally, we present our goals for the future creation of a wireless version of the vest for a female body based on Diana Policarpo's artistic vision. (shrink)

Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino (...) and Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend to disadvantage individuals with barriers in access to care (3). There is mounting evidence of racial, ethnic, and socioeconomic disparities in access to medications for COVID-19 (4, 5). -/- One potential method to promote equitable allocation is to use a weighted lottery, which is an allocation strategy that gives all eligible patients a chance to receive the scarce treatment while also allowing the assignment of higher or lower chances according to other ethical considerations (6). We sought to assess the feasibility of implementing a weighted lottery to allocate scarce COVID-19 medications in a large U.S. health system and to determine whether the weighted lottery promotes equitable allocation. (shrink)

The structure of the thermal equilibrium state of a weakly interacting Bose gas is of current interest. We calculate the density matrix of that state in two ways. The most effective method, in terms of yielding a simple, explicit answer, is to construct a generating function within the traditional framework of quantum statistical mechanics. The alternative method, arguably more interesting, is to construct the thermal state as a vector state in an artificial system with twice as many degrees of freedom. (...) It is well known that this construction has an actual physical realization in the quantum thermodynamics of black holes, where the added degrees of freedom correspond to the second sheet of the Kruskal manifold and the thermal vector state is a state of the Unruh or the Hartle–Hawking type. What is unusual about the present work is that the Bogolubov transformation used to construct the thermal state combines in a rather symmetrical way with Bogolubov's original transformation of the same form, used to implement the interaction of the nonideal gas in linear approximation. In addition to providing a density matrix, the method makes it possible to calculate efficiently certain expectation values directly in terms of the thermal vector state of the doubled system. (shrink)

I had my accident on the rugby field on July 29, 2000 about 2.00 p.m. during a simple line - out, even before the ball was thrown in. I t just felt like another simple case of concussion , I staggered to the sideline, the coach asked me “what ’s wrong”? He said I told him I just felt sick and to put me back on the field in 10 minutes. Then I collapsed, eventually blacked out and then was rushed (...) to hospital unconscious in an ambulance with them struggling drastically to keep me alive. Af ter three days of being in there, they thought I was alright and were going to send me home. Then it star ted happening. First I nearly collapsed again tak ing a shower . For days the spe - cialists didn’t k now what was wrong with me. M y girlfriend at the time, who had rushed down from Wanak a when she had heard it had happened went mad at the specialists to do something. Af ter six days of going in and out of seizures, finally af ter what seemed like all the tests k nown to man, they said I had suffered several brain stem strokes then one massive major one, which altogether had lef t me diagnosed with the ex tremely rare and unk nown condition only k nown to a few as “ locked in syndrome”. (shrink)

Stolen Legacy by George G.M. James refutes the Euro-centric myth that the origin of Western philosophy is Greek. First published in 1954, this book was seminal in leading to a radical reappraisal of a philosophical system long thought to be of European origin. It is an essential work in the syllabus for the study of Western philosophy.

In this paper we consider an intuitionistic variant of the modal logic S4 (which we call IS4). The novelty of this paper is that we place particular importance on the natural deduction formulation of IS4— our formulation has several important metatheoretic properties. In addition, we study models of IS4— not in the framework of Kirpke semantics, but in the more general framework of category theory. This allows not only a more abstract definition of a whole class of models but also (...) a means of modelling proofs as well as provability. (shrink)

Knowledge of the ethical and legal basis of medicine is as essential to clinical practice as an understanding of basic medical sciences. In the UK, the General Medical Council requires that medical graduates behave according to ethical and legal principles and must know about and comply with the GMC’s ethical guidance and standards. We suggest that these standards can only be achieved when the teaching and learning of medical ethics, law and professionalism are fundamental to, and thoroughly integrated both vertically (...) and horizontally throughout, the curricula of all medical schools as a shared obligation of all teachers. The GMC also requires that each medical school provides adequate teaching time and resources to achieve the above. We reiterate that the adequate provision and coordination of teaching and learning of ethics and law requires at least one full-time senior academic in ethics and law with relevant professional and academic expertise. In this paper we set out an updated indicative core content of learning for medical ethics and law in UK medical schools and describe its origins and the consultative process by which it was achieved. (shrink)

'Marina G. Ogden offers a competitive and comprehensive outlook of the prominent Russian thinker Lev Shestov. This valuable book, based on the archive sources, provides a good historical background for Shestov's investigations which is very important for the better understanding not only Russian religious thought, but also Western philosophy of the twentieth century.'- Professor Teresa Obolevitch, The Pontifical University of John Paul II, Krakow 'The pioneering Russian existentialist Lev Shestov influenced Camus, Bataille, Celan and many others. In this absorbing study, (...) Marina G. Ogden shows how his "parable" of the many-eyed Angel of Death anticipates much recent thinking about trauma and its effect in setting a life on a unique and sometimes creative path.'- David M. Black, the author of Why Things Matter: The place of values in science, psychoanalysis and religion At the beginning of the twentieth century the Russian émigré philosopher Lev Shestov (1866-1938) challenged traditional philosophical norms and brought the individual experience of the anxiety of death to the forefront of philosophical investigation. Based on new research and translations of Shestov's unpublished manuscripts, notes and correspondence, this book analyses the thoughts of one of the most influential thinkers of the past century in an interdisciplinary context. While uncovering the roots of the philosopher's existential position, the author traces Shestov's 'wandering through souls' of the world's most significant philosophers and writers within the context of a historical and biographical narrative, offering a close reading of his thinking in its chronological progression. A new interpretation of Shestov's philosophy, this comparative and hermeneutical analysis focuses on the thinker's continual search for meaning on the question of human mortality. Bringing together up-to-date research findings in Russian, English and French, an evolutionary analysis of the key notions in Shestov's philosophy the problems of truth, revelation, faith and death - is carried out in conjunction with the ideas of such pivotal figures in Western culture as Fyodor Dostoevsky, William James, Edmund Husserl, Karl Jaspers, Martin Buber and Sigmund Freud. (shrink)

Hume discusses the distinction of reason to explain how we distinguish things inseparable, and so identical, e.g., the color and figure of a white globe. He says we note the respect in which the globe is similar to a white cube and dissimilar to a black sphere, and the respect in which it is dissimilar to the first and similar to the second. Unfortunately, Hume takes these differing respects of resemblance to be identical with the white globe itself. Contradiction (...) results, undermining his theory of abstraction. The way out is apparently to admit an intrinsic complexity in even simple things. (shrink)

Aristotle argued that you need some wealth to live well. The Stoics argued that you could live well with or without wealth. But the Cynics argued that wealth is a hinderance. For the Cynics, a good life consists in self-sufficiency, or being able to rule and help yourself. You accomplish this by living simply and naturally, and by subjecting yourself to rigorous philosophical exercises. Cynics confronted people to get them to abandon extraneous possessions and positions of power to live better. (...) And while the Cynics were experts in living in this way, their ascetic lifestyles made their message curious to some audiences. This paper reflects on Cynic ascetic practices and the ways others perceived them. (shrink)

Traditionally clinicians have determined their patients' resuscitation status without consultation. This has been condemned as morally indefensible in cases where not for resuscitation (NFR) orders are based on quality of life considerations and when the patient's true wishes are not known. Such instances would encompass most resuscitation decisions in elderly patients. Having previously involved patients in CPR decision-making, we chose formally to explore the reasons behind the choices made. Although the patients were not upset, and readily decided at the time (...) of initial consultation, on later analysing the decision-making we found poor understanding of the procedure, poor recall of information given and in some cases evidence of harm. This may be attributed to impaired decision-making capacity of elderly hospitalised patients as previously shown, or to the discomfort precipitated by having to contemplate the apparent immediacy of cardiac arrest by these patients. We propose that subscribing to autonomy as a general principle needs to be balanced against particular cases where distress may be caused by, or result in, diminished competence and limited autonomy. (shrink)

Next SectionFollowing the influential Gifford and Reith lectures by Onora O’Neill, this paper explores further the paradigm of individual autonomy which has been so dominant in bioethics until recently and concurs that it is an aberrant application and that conceptions of individual autonomy cannot provide a sufficient and convincing starting point for ethics within medical practice. We suggest that revision of the operational definition of patient autonomy is required for the twenty first century. We follow O’Neill in recommending a principled (...) version of patient autonomy, which for us involves the provision of sufficient and understandable information and space for patients, who have the capacity to make a settled choice about medical interventions on themselves, to do so responsibly in a manner considerate to others. We test it against the patient–doctor relationship in which each fully respects the autonomy of the other based on an unspoken covenant and bilateral trust between the doctor and patient. Indeed we consider that the dominance of the individual autonomy paradigm harmed that relationship. Although it seems to eliminate any residue of medical paternalism we suggest that it has tended to replace it with an equally (or possibly even more) unacceptable bioethical paternalism. In addition it may, for example, lead some doctors to consider mistakenly that unthinking acquiescence to a requested intervention against their clinical judgement is honouring “patient autonomy” when it is, in fact, abrogation of their duty as doctors. (shrink)

In _Violence and Civility_, Étienne Balibar boldly confronts the insidious causes of violence, racism, nationalism, and ethnic cleansing worldwide, as well as mass poverty and dispossession. Through a novel synthesis of theory and empirical studies of contemporary violence, the acclaimed thinker pushes past the limits of political philosophy to reconceive war, revolution, sovereignty, and class. Through the pathbreaking thought of Derrida, Balibar builds a topography of cruelty converted into extremism by ideology, juxtaposing its subjective forms and its objective manifestations. Engaging (...) with Marx, Hegel, Hobbes, Clausewitz, Schmitt, and Luxemburg, Balibar introduces a new, productive understanding of politics as antiviolence and a fresh approach to achieving and sustaining civility. Rooted in the principles of transformation and empowerment, this theory brings hope to a world increasingly divided even as it draws closer together. (shrink)

To speak of ‘the real subject’ or ‘the primary aim’ of a Platonic dialogue usually means to magnify one aspect of it at the expense of other aspects as important. Such is not my intention. It is quite clear, however, without prejudice to the philosophic value of any of the topics discussed, that the Protagoras is an attack upon the sophists as represented by Protagoras, the greatest of them. Hippias and Prodicus are present and some of the great man's glory (...) is reflected upon them; they are also no doubt to some extent implicated in his defeat, though they seem quite unaware of the fact. (shrink)