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 study examines the ontological similarity between the concept of competitor orientation and questionable intelligence-gathering efforts. Respondents from the hotel industry were surveyed with self-administered questionnaires. Exploratory factor analysis was carried out to identify the structure underlying variables of market orientation and ethical judgment on questionable intelligence-gathering efforts. The results suggest that the surveyed hotel managers are unable to distinguish the legitimate tactics of competitor orientation from the questionable practice of industrial espionage.

Background The use of lengthy, detailed, and complex informed consent forms is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in (...) biomedical research. Methods This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 to 5. Results Of the 2484 questionnaires distributed, 2113 were returned. The majority of respondents considered most elements required in the ICF to be ‘moderately important’ to ‘very important’ for their decision making. Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF. Conclusions Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF. (shrink)

Access to legal information is fundamental to access to justice. Yet accessibility refers not only to making legal documents available to the public, but also rendering legal information comprehensible to them. A vexing problem in bringing legal information to the public is how to turn formal legal documents such as legislation and judgments, which are often highly technical, to easily navigable and comprehensible knowledge to those without legal education. In this study, we formulate a three-step approach for bringing legal knowledge (...) to laypersons, tackling the issues of navigability and comprehensibility. First, we translate selected sections of the law into snippets (called CLIC-pages), each being a small piece of article that focuses on explaining certain technical legal concept in layperson’s terms. Second, we construct a Legal Question Bank, which is a collection of legal questions whose answers can be found in the CLIC-pages. Third, we design an interactive CLIC Recommender. Given a user’s verbal description of a legal situation that requires a legal solution, CRec interprets the user’s input and shortlists questions from the question bank that are most likely relevant to the given legal situation and recommends their corresponding CLIC pages where relevant legal knowledge can be found. In this paper we focus on the technical aspects of creating an LQB. We show how large-scale pre-trained language models, such as GPT-3, can be used to generate legal questions. We compare machine-generated questions against human-composed questions and find that MGQs are more scalable, cost-effective, and more diversified, while HCQs are more precise. We also show a prototype of CRec and illustrate through an example how our 3-step approach effectively brings relevant legal knowledge to the public. (shrink)

The counseling process involves attention, emotional perception, cognitive appraisal, and decision-making. This study aimed to investigate cognitive appraisal and the associated emotional processes when reading short therapists' statements of motivational interviewing (MI). Thirty participants with work injuries were classified into the pre-contemplation (PC,n= 15) or readiness stage of the change group (RD,n= 15). The participants viewed MI congruent (MI-C), MI incongruent (MI-INC), or control phrases during which their electroencephalograms were captured. The results indicated significant Group × Condition effects in the (...) frontally oriented late positive complex (P600/LPC). The P600/LPC's amplitudes were more positive-going in the PC than in the RD group for the MI congruent statements. Within the PC group, the amplitudes of the N400 were significantly correlated (r= 0.607–0.649) with the participants' level of negative affect. Our findings suggest that the brief contents of MI statements alone can elicit late cognitive and emotional appraisal processes beyond semantic processing. (shrink)

© 2015, Springer-Verlag Berlin Heidelberg.Genetic studies have identified single nucleotide polymorphisms associated with the risk of prostate cancer. It remains unclear whether such genetic variants are associated with disease aggressiveness. The NCI-SPORE Genetics Working Group retrospectively collected clinicopathologic information and genotype data for 36 SNPs which at the time had been validated to be associated with PC risk from 25,674 cases with PC. Cases were grouped according to race, Gleason score and aggressiveness. Statistical analyses were used to compare the frequency (...) of the SNPs between different disease cohorts. After adjusting for multiple testing, only PC-risk SNP rs2735839 was significantly and inversely associated with aggressive and high-grade disease in European men. Similar associations with aggressive and high-grade disease were documented in African-American subjects. The G allele of rs2735839 was associated with disease aggressiveness even at low PSA levels in both European and African-American men. Our results provide further support that a PC-risk SNP rs2735839 near the KLK3 gene on chromosome 19q13 may be associated with aggressive and high-grade PC. Future prospectively designed, case-case GWAS are needed to identify additional SNPs associated with PC aggressiveness. (shrink)

Introduction: Probationers, offenders with less serious and non-violent offences, and under statutory supervision, have low levels of self-esteem and physical health, and high level of family conflict, and poorer quality of family relationships. This study examined the effectiveness of the existing probation service and the additional use of a positive family holistic health intervention to enhance physical, psychological, and family well-being in probationers and relationships with probation officers.Methods: Probationers under the care of the Hong Kong Social Welfare Department were randomized (...) into a care-as-usual control group, a brief intervention group receiving two 1-h individual sessions [of a brief theory-based positive family holistic health intervention integrating Zero-time Exercise and positive psychology themes of “Praise and Gratitude” in the existing probation service], or a combined intervention group receiving BI and a 1-day group activity with family members. The outcomes were physical activity, fitness performance, self-esteem, happiness, anxiety and depression symptoms, life satisfaction, quality of life, family communication and well-being, and relationships with probation officers. Self-administered questionnaires and simple fitness tests were used at baseline, 1-month and 3-month follow-up. Linear mixed model analysis was used to compare difference in the changes of outcome variables among groups, adjusted of sex, age, and baseline values. Focus group interviews were conducted. Thematic content analysis was used.Results: 318 probationers were randomized into CAU, BI, or CI group. CAU showed enhanced physical activity, fitness performance and psychological health, and family communication with small effect sizes. BI and CI showed further improved physical activity, family communication and family well-being. Additionally, CI reported greater improvements in the relationships with probation officers than CAU with a small effect size. CI also reported greater increases in physical activity and family communication than BI with small to moderate effect sizes. Qualitative feedbacks corroborated the quantitative findings.Conclusion: Our trial provided the first evidence of the effectiveness of probation service and the additional use of an innovative, relatively low-cost, theory-based brief positive family holistic health intervention. This intervention may offer a new model for enhancing probation service.Trial Registration: The research protocol was registered at the National Institutes of Health. (shrink)

How should we shape the practice of pastoral care, especially in the context of bioethical counseling? Martin Luther grounded it in a mutual dialogue of brethren. Friedrich Schleiermacher transformed this Protestant understanding according to the modern ideals of freedom and responsibility for oneself. In response to the other basic question of pastoral care: What is the human soul?, Sigmund Freud overcame the Platonic model undergirding Schleiermacher's account. Whoever seeks to care for his own soul and the soul of the other (...) should learn from Freud. One of the most fruitful consequences of such study lies in the formation of a mature religiosity. Another such consequence concerns the pastor's aspiring to an attitude of self-control in counseling. Building one's own competence on the experience and the knowledge of Freud can help one counteract the temptation to transfer one's own (unconscious) wishes onto the conversation partner and conversely to ward off transference from the other onto oneself. On the level of ideals and ultimate principles, however, Christian pastors, unlike Freud, will not see fate and the anonymous forces of Eros and Thanatos, as the ultimate last horizons of human self-understanding. Instead, the good news of sinful man's justification by God transcends even the limits of human existence imposed by fate. (shrink)

The International Classification of Functioning, Disability and Health (ICF), designed by the WHO, attempts to provide a holistic model of functioning and disability by integrating a medical model with a social one. The aim of this article is to analyze the ICF’s claim to holism. The following components of the ICF’s complexity are analyzed: (1) health condition, (2) body functions and structures, (3) activity, (4) participation, (5) environmental factors, (6) personal factors, and (7) health. Although the ICF claims to be (...) holistic, it presupposes a monistic materialistic ontology. We indicate some limitations of this ontology, proposing instead: (a) a pluralistic–holistic ontology (PHO) and (b) a multidimensional view of the human being, with individual and environmental aspects, in relation to three levels of reality implied by the PHO. For the ICF to attain its holistic claim, the interactions between its components should be based on (a) and (b). (shrink)

Geleitwort von Prof. P. Nicki -- Dr. Hermann Freund im Gespräch mit Prof. Dr. Dr. Hinderk M. Emrich -- Die Angst und der existentielle Sprung -- Die neue Zeit -- Der gedachte Gott -- Wie kommt das Ich zum Du? - Hysterie als Lebensform -- Was heisst, sich entscheiden? - Zur Theologie der Freiheit -- Re-formation der Reformation -- Das metaphysische und zugleich dämonische Wesen des Schlosses in Franz Kafkas Schloss-Roman -- Nachwort von Wolfgang Teichert: Epiphanie oder wo sprechende Philosophie (...) und Theologie aufhören müssen -- Literatur -- Verzeichnis der Mitwirkenden -- Abbildungsverzeichnis. (shrink)

In this paper, we will explain and analyse a phenomenological distinction between two kinds of actions. The distinction we have in mind is the difference between those actions that actors try, or are satisfied, to carry out, in like situations, ‘in the same way’, and all other actions. We call the first kind ‘mimeomorphic actions’ and the second kind ‘polimorphic actions’. We will define these two kinds of actions, and their species, on the basis of their characteristic intentions and experiences, (...) and thus our inquiry falls broadly into the phenomenology of action. The latter has been defined by D. W. Smith as the “description of the experience of acting, or doing something”. (shrink)

Medical screening is justified on the strength of the assumption that the earlier disease is detected, the better it is for the patient. On examination, however, the assumption turns out to be severely flawed, and inadequate anyway, since it is not only the patient with whom we should be concerned, but healthy people as well. Instead of making assumptions about the ill, we should prove a test's overall benefit to the individual taking it before we recommend it.

Gareth Evans' proposal, as amended by Steven Neale –that a definite pronoun with a quantifiedantecedent that does not bind it has the sense ofa definite description – has been challenged inthe singular case by appeal to counter-examplesinvolving failure of the uniqueness condition forthe legitimacy of a singular description. Thischallenge is here extended to the plural.Counter-examples are provided by cases in which aplural description `the Fs' does not denote,despite the propriety of the use of `they' or`them' it is to replace, because (...) of failure ofcumulativeness. A noncumulative predicate isnot distributive, and conditions for thelegitimacy of `the Fs' designed to accommodatenondistributive `Fs' are given in the context ofa two sorted theory with generalized quantifiers.Failure of cumulativeness is not to be confusedwith failure of maximality as Neale and othersdefine it. If not all Fs are Gs, `The Fs are Gs'is false; but it does not follow that `the Fs' isillegitimate; and if `Fs' is distributive. it isso only if there are no Fs. These differencesgranted, I give a partial defense of theEvans–Neale proposal from deficiencies in analternative based on the views of P. T.Geach. (shrink)

In this essay I first provide a brief explanation of the principle of double effect (PDE) and the propositions that it entails regarding the distinction betweenintention and foresight (I/F distinction) and the distinction’s relevance to ethical evaluation. Then I address several recent critiques of PDE and the I/F distinctionby influential ethicists including Judith Jarvis Thomson, Tom Beauchamp and James Childress, and Jonathan Bennett. I argue that none of these critiques issuccessful. In the process of refuting the critiques, I also give (...) prima facie reason to believe that the I/F distinction is relevant to evaluation of agents and their actions and that PDE is a defensible ethical principle. (shrink)

Claims regarding collective or group mental states are fairly commonplace: we speak of things like the belief of the Church, the will of the faculty, and the opinion of the Supreme Court, often without considering what such claims really mean and whether they are true in any interesting sense. In this paper I take a threefold approach: first, I articulate several ways in which a group might be said to have beliefs and other mental states. Second, I explore the implications, (...) positive and negative, of these accounts of collective mental states. Third, I give a brief defense of my own view despite its somewhat disturbing implications for our membership in Church, State, and other groups. (shrink)

In this paper, we will explain and analyse a phenomenological distinction between two kinds of actions. The distinction we have in mind is the difference between those actions that actors try, or are satisfied, to carry out, in like situations, ‘in the same way’, and all other actions. We call the first kind ‘mimeomorphic actions’ and the second kind ‘polimorphic actions’. We will define these two kinds of actions, and their species, on the basis of their characteristic intentions and experiences, (...) and thus our inquiry falls broadly into the phenomenology of action. The latter has been defined by D. W. Smith as the “description of the experience of acting, or doing something”. (shrink)