One method for investigating the neurobiology of consciousness is to experimentally manipulate consciousness as a variable and then visualize the resultant functional brain changes with advanced imaging techniques. To begin investigation into this area, healthy volunteers underwent positron emission tomography scanning while listening to randomized word lists in both conscious and unconscious conditions. Following anaesthesia, subjects had no explicit memories. Nonetheless, subjects demonstrated implicit memory on a forced-choice test . These subsequent memory scores were correlated with regional brain metabolism measured (...) during encoding. Conscious recall and unconscious recognition memory demonstrated considerable anatomic overlap in correlating significantly with relative glucose metabolism in auditory verbal memory areas. However, only conscious recall correlated with mediodorsal thalamic nucleus activity; unconscious recognition memory did not. These findings suggest that conscious versus unconscious memory distinctions may depend on the presence or absence of correlated thalamic activity, and directly implicate the thalamus in the neurobiology of consciousness. (shrink)

Background: People with a personality disorder suffer from enduring inflexible patterns in cognitions and emotions, leading to significant subjective distress, affecting both self and interpersonal functioning. In clinical practice, Dance Movement Therapy is provided to clients with a PD, and although research continuously confirms the value of DMT for many populations, to date, there is very limited information available on DMT and PD. For this study, a systematic literature review on DMT and PD was conducted to identify the content of (...) the described DMT interventions and the main treatment themes to focus upon in DMT for PD.Methods: A systematic search was conducted across the following databases: EMBASE, MEDLINE, PubMed, WEB OF SCIENCE, PsycINFO/OVID, and SCOPUS following the PRISMA guidelines. The Critical Appraisal Skills Programme for qualitative studies was used to rank the quality of the articles. The Oxford Center for Evidence-based Medicine standards were applied to determine the hierarchical level of best evidence. Quantitative content analysis was used to identify the intervention components: intended therapeutic goals, therapeutic activities leading to these goals, and suggested therapeutic effects following from these activities. A thematic synthesis approach was applied to analyze and formulate overarching themes.Results: Among 421 extracted articles, four expert opinions met the inclusion criteria. Six overarching themes were found for DMT interventions for PD: self-regulation, interpersonal relationships, integration of self, processing experiences, cognition, and expression and symbolization in movement/dance. No systematic descriptions of DMT interventions for PD were identified. A full series of intervention components could be synthesized for the themes of self-regulation, interpersonal relationships, and cognition. The use of body-oriented approaches and cognitive strategies was in favor of dance-informed approaches.Conclusions: Dance movement therapists working with PD clients focus in their interventions on body-related experiences, non-verbal interpersonal relationships, and to a lesser extent, cognitive functioning. A methodological line for all intervention components was synthesized for the themes of self-regulation, interpersonal relationships, and cognition, of importance for developing systematic intervention descriptions. Future research could focus on practitioners' expertise in applying DMT interventions for PD to develop systematic intervention descriptions and explore the suitability of the identified themes for clinical application. Clients' experiences could offer essential insights on how DMT interventions could address PD pathology and specific PD categories. (shrink)

© 2016 Regents of the University of California.The Review summarizes much of particle physics and cosmology. Using data from previous editions, plus 3,062 new measurements from 721 papers, we list, evaluate, and average measured properties of gauge bosons and the recently discovered Higgs boson, leptons, quarks, mesons, and baryons. We summarize searches for hypothetical particles such as supersymmetric particles, heavy bosons, axions, dark photons, etc. All the particle properties and search limits are listed in Summary Tables. We also give numerous (...) tables, figures, formulae, and reviews of topics such as Higgs Boson Physics, Supersymmetry, Grand Unified Theories, Neutrino Mixing, Dark Energy, Dark Matter, Cosmology, Particle Detectors, Colliders, Probability and Statistics. Among the 117 reviews are many that are new or heavily revised, including those on Pentaquarks and Inflation. The complete Review is published online in a journal and on the website of the Particle Data Group. The printed PDG Book contains the Summary Tables and all review articles but no longer includes the detailed tables from the Particle Listings. A Booklet with the Summary Tables and abbreviated versions of some of the review articles is also available. (shrink)

A total of 1918 loci, detected by the hybridization of 938 expressed sequence tag unigenes from 26 Triticeae cDNA libraries, were mapped to wheat homoeologous group 4 chromosomes using a set of deletion, ditelosomic, and nulli-tetrasomic lines. The 1918 EST loci were not distributed uniformly among the three group 4 chromosomes; 41, 28, and 31% mapped to chromosomes 4A, 4B, and 4D, respectively. This pattern is in contrast to the cumulative results of EST mapping in all homoeologous groups, as reported (...) elsewhere, that found the highest proportion of loci mapped to the B genome. Sixty-five percent of these 1918 loci mapped to the long arms of homoeologous group 4 chromosomes, while 35% mapped to the short arms. The distal regions of chromosome arms showed higher numbers of loci than the proximal regions, with the exception of 4DL. This study confirmed the complex structure of chromosome 4A that contains two reciprocal translocations and two inversions, previously identified. An additional inversion in the centromeric region of 4A was revealed. A consensus map for homoeologous group 4 was developed from 119 ESTs unique to group 4. Forty-nine percent of these ESTs were found to be homoologous to sequences on rice chromosome 3, 12% had matches with sequences on other rice chromosomes, and 39% had no matches with rice sequences at all. Limited homology was found between wheat ESTs on homoeologous group 4 and the Arabidopsis genome. Forty-two percent of the homoeologous group 4 ESTs could be classified into functional categories on the basis of blastX searches against all protein databases. (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)

Recent EEG studies on the early postmortem interval that suggest the persistence of electrophysiological coherence and connectivity in the brain of animals and humans reinforce the need for further investigation of the relationship between the brain’s activity and the dying process. Neuroscience is now in a position to empirically evaluate the extended process of dying and, more specifically, to investigate the possibility of brain activity following the cessation of cardiac and respiratory function. Under the direction of the Center for Healthy (...) Minds at the University of Wisconsin-Madison, research was conducted in India on a postmortem meditative state cultivated by some Tibetan Buddhist practitioners in which decomposition is putatively delayed. For all healthy baseline and postmortem subjects presented here, we collected resting state electroencephalographic data, mismatch negativity, and auditory brainstem response. In this study, we present HB data to demonstrate the feasibility of a sparse electrode EEG configuration to capture well-defined ERP waveforms from living subjects under very challenging field conditions. While living subjects displayed well-defined MMN and ABR responses, no recognizable EEG waveforms were discernable in any of the tukdam cases. (shrink)

We compare a “Mach-Zehnder interferometer in time” for cold neutrons with its well-known spatial counterpart and demonstrate the intimate connection between space and time for both setups. Further, we outline a combined space-time interferometer, which coherently splits a wavepacket in longitudinal and lateral direction. On the way towards time interferometry “neutron computer holography” seems to be an attractive application. It allows the three-dimensional reconstruction of an object from the scattered intensity, but in contrast to holography with light, there is no (...) need for a reference wave. On the other hand, the possible resolution is worse than in the light case. (shrink)

Signs of mankind's solidarity, by J. R. Nelson.--Mankind, Israel and the nations in the Hebraic heritage, by M. Greenberg.--Christian insights from biblical sources, by C. Maurer.--Muhammad and all men, by D. Rahbar.--The impact of New World discovery upon European thought of man, by E. J. Burrus.--The effects of colonialism upon the Asian understanding of man, by J. G. Arapura.--Religious pluralism and the quest for human community, by S. J. Samartha.--From Confucian gentleman to the new Chinese 'political' man, by D. A. (...) Robinson.--The scientific revolution and the unity of man, by B. Towers.--Language and communication, by E. A. Nida.--Man and the son of man, by J. Moltmann.--The potentiality of conciliarity: communion, conscience, council, by W. B. Blakemore.--Oneness must mean wholeness, by J. R. Nelson. (shrink)

The focus of this study was to analyze the content, distribution, and comparative genome relationships of 996 chromosome bin-mapped expressed sequence tags accounting for 2266 restriction fragments on the homoeologous group 3 chromosomes of hexaploid wheat. Of these loci, 634, 884, and 748 were mapped on chromosomes 3A, 3B, and 3D, respectively. The individual chromosome bin maps revealed bins with a high density of mapped ESTs in the distal region and bins of low density in the proximal region of the (...) chromosome arms, with the exception of 3DS and 3DL. These distributions were more localized on the higher-resolution group 3 consensus map with intermediate regions of high-mapped-EST density on both chromosome arms. Gene ontology classification of mapped ESTs was not significantly different for homoeologous group 3 chromosomes compared to the other groups. A combined analysis of the individual bin maps using 537 of the mapped ESTs revealed rearrangements between the group 3 chromosomes. Approximately 232 of the consensus mapped ESTs matched sequences on rice chromosome 1 and revealed large- and small-scale differences in gene order. Of the group 3 mapped EST unigenes ∼21 and 32% matched the Arabidopsis coding regions and proteins, respectively, but no chromosome-level gene order conservation was detected. (shrink)

Because no single person or group holds knowledge about all aspects of research, mechanisms are needed to support knowledge exchange and engagement. Expertise in the research setting necessarily includes scientific and methodological expertise, but also expertise gained through the experience of participating in research and/or being a recipient of research outcomes. Engagement is, by its nature, reciprocal and relational: the process of engaging research participants, patients, citizens and others brings them closer to the research but also brings the research closer (...) to them. When translating research into practice, engaging the public and other stakeholders is explicitly intended to make the outcomes of translation relevant to its constituency of users. In practice, engagement faces numerous challenges and is often time-consuming, expensive and ‘thorny’ work. We explore the epistemic and ontological considerations and implications of four common critiques of engagement methodologies that contest: representativeness, communication and articulation, impacts and outcome, and democracy. The ECOUTER methodology addresses problems of representation and epistemic foundationalism using a methodology that asks, “How could it be otherwise?” ECOUTER affords the possibility of engagement where spatial and temporal constraints are present, relying on saturation as a method of ‘keeping open’ the possible considerations that might emerge and including reflexive use of qualitative analytic methods. This paper describes the ECOUTER process, focusing on one worked example and detailing lessons learned from four other pilots. ECOUTER uses mind-mapping techniques to ‘open up’ engagement, iteratively and organically. ECOUTER aims to balance the breadth, accessibility and user-determination of the scope of engagement. An ECOUTER exercise comprises four stages: engagement and knowledge exchange; analysis of mindmap contributions; development of a conceptual schema ; and feedback, refinement and development of recommendations. ECOUTER refuses fixed truths but also refuses a fixed nature. Its promise lies in its flexibility, adaptability and openness. ECOUTER will be formed and re-formed by the needs and creativity of those who use it. (shrink)

Like _Beyond All Appearances_,_ _which it supplements, Paul Weiss’s new book is a fundamental work which faces all the hard issues which are not only at the heart of philosophy but at the core of our entire culture. Readers of Mr. Weiss’s phenomenology of religion will need no introduction to this new work which expands and clari­fies many of the issues raised in _Beyond All Appearances. _However, no knowl­edge of Paul Weiss’s previous books is required to understand and appreciate this (...) brilliant new exposition. Weiss’s plain style makes his ideas accessible to all intelligent readers, whether or not they have been trained as professional philosophers. Here in _First Considerations _Mr. Weiss addresses himself to such topics as actuality, internalization, evidence, names, substance, being, natures and possibilities, existence, unity and the cosmos—issues which have engrossed him as a moral philosopher and meta­physician throughout his distinguished career. In his progress through the ideas and issues expounded in this new book Mr. Weiss is concerned with the human condition distinctive of this species of ours. Rigorously applied, his moral philosophy is as complete and thorough as that of any of the major thinkers, and provides as complete a guide as, for example, that of Buddhism. A highly original work, no doubt well in advance of current trends in philosophy, _First Considerations _will provoke further thought and discussion and will be regarded as a seminal work in modern philosophical approaches. (shrink)

We tested the hypothesis that perception of an alternative image in ambiguous figures would be manifest as high-frequency (gamma) components that become synchronized over multiple scalp sites as a ''cognitive binding'' process occurs. For 171 combinations of data from 19 electrodes, obtained from 17 subjects and 10 replicate stimuli, we calculated the difference in correlation between the response to first seeing an ambiguous figure and when the alternative percept for that figure became consciously realized (cognitively bound). Numerous statistically significant correlation (...) differences occurred in all frequency bands tested with ambiguous-figure stimulation, but not in two kinds of control data (a reaction-time test to sound stimuli and a no-task, mind-wandering test). Statistically significant correlation changes were widespread, involving frontal, parietal, central, and occipital regions of both hemispheres. Correlation changes were evident at each of five frequency bands, ranging up to 62.5 Hz. Most of the statistically significant correlation changes were not between adjacent sites but between sites relatively distant, both ipsilateral and contralateral. Typically, these correlation changes occurred in more than one frequency band. These results suggest that cognitive binding is a distinct mental state that is reliably induced by ambiguous-figure perception tasks. Coherent oscillations at multiple frequencies may reflect the mechanism by which such binding occurs. Moreover, different coherent frequencies may mediate different components of the total cognitive-binding process. (shrink)

Objective To assess parental permission for a neonate's research participation using the MacArthur competence assessment tool for clinical research (MacCAT-CR), specifically testing the components of understanding, appreciation, reasoning and choice. Study Design Quantitative interviews using study-specific MacCAT-CR tools. Hypothesis Parents of critically ill newborns would produce comparable MacCAT-CR scores to healthy adult controls despite the emotional stress of an infant with critical heart disease or the urgency of surgery. Parents of infants diagnosed prenatally would have higher MacCAT-CR scores than parents (...) of infants diagnosed postnatally. There would be no difference in MacCAT-CR scores between parents with respect to gender or whether they did or did not permit research participation. Participants Parents of neonates undergoing cardiac surgery who had made decisions about research participation before their neonate's surgery. Methods The MacCAT-CR. Results 35 parents (18 mothers; 17 fathers) of 24 neonates completed 55 interviews for one or more of three studies. Total scores: magnetic resonance imaging (mean 36.6, SD 7.71), genetics (mean 38.8, SD 3.44), heart rate variability (mean 37.7, SD 3.30). Parents generally scored higher than published subject populations and were comparable to published control populations with some exceptions. Conclusions The MacCAT-CR can be used to assess parental permission for neonatal research participation. Despite the stress of a critically ill neonate requiring surgery, parents were able to understand study-specific information and make informed decisions to permit their neonate's participation. (shrink)

Purpose: Our aim was to determine if self-determined motivation (SDM) in elite, men’s soccer changes over time and differs as a function of age, skill-grouping, and engagement in soccer play and practice. We tested predictions from the Developmental Model of Sport Participation (DMSP) regarding relations between practice and play and SDM among both elite and non-elite samples. Methods: Elite youth soccer players in the UK (n = 31; from the Under 13/U13 yr and U15 yr age groups) completed practice history (...) and motivation questionnaires at time1 (T1) and ~2 years later (T2: now U15 yr & U17 yr). Non-elite players (n = 32; from U15 yr and U17 yr) completed the same questionnaires at T2 only. Results: For the elite groups, global SDM decreased over time for the current U17 group (from U15), but no change was seen for the current U15 group (from U13). Age group differences at T2 mirrored these data, with U17 players showing lower global SDM and higher controlled motivation than U15 elites. The non-elite players did not show age group differences, but elites scored higher for global SDM and autonomous motivation than non-elites. The recent hours accumulated in practice negatively correlated with global SDM in elite and non-elite groups, but play was unrelated to measures of motivation. Conclusions: Differences in SDM as a function of age and skill point towards the dynamic nature of these motivations over time, likely a result of proximity to external rewards related to professional status. Although high volumes of practice are related to lower global SDM in both skill groups, the absence of any relations between SDM and soccer play does not support a key prediction related to the DMSP. (shrink)

Objective: The objectives of this study are to understand the current functions, structure and operation of hospital ethics committees (HECs) in Shanghai and to facilitate their improvement. Methods: (1) A questionnaire survey, (2) interviews with secretaries and (3) on-site document reviews of HECs in Shanghai were used in the study, which surveyed 33 hospitals. Results: In Shanghai, 57.56% of the surveyed hospitals established HECs from 1998 to 2005. Most HECs used bioethical review of research involving human subjects as well as (...) bioethical review or consultation regarding medical care services and administrative decision- making. Of the surveyed HECs, 14.3% did not provide any formal bioethical training to the HECs’ members and many HECs had no standard operating procedures. Some HECs had no clear definition of what was “conflict of interest” that should be considered by the HECs, while 44.4% of the HECs did not perform continuing review. Discussion: After the issues of related national regulations, more and more hospitals established HECs in Shanghai, but the functions of HECs need to be further developed and formal training on bioethics should be provided to HEC members. To assure the independence and good performance of HECs, the conflict of interest procedure, the standard operating procedures and bioethical review should be improved. Conclusion: HECs in Shanghai had developed in the preceding 10 years and they played great roles in protecting the rights and welfare of human subjects and patients; some areas need improvement. (shrink)

This study investigated the performance of boys with psychopathic tendencies and comparison boys, aged 9 to 17 years, on two tasks believed to be sensitive to amygdala and orbitofrontal cortex func- tioning. Fifty-one boys were divided into two groups according to the Psychopathy Screening Device (PSD, P. J. Frick & R. D. Hare, in press) and presented with two tasks. The tasks were the gambling task (A. Bechara, A. R. Damasio, H. Damasio, & S. W. Anderson, 1994) and the Intradimensional/ (...) Extradimensional (ID/ED) shift task (R. Dias, T. W. Robbins, & A. C. Roberts, 1996). The boys with psychopathic tendencies showed impaired performance on the gambling task. However, there were no group differences on the ID/ED task either for response reversal or extradimensional set shifting. The implications of these results for models of psychopathy are discussed. (shrink)

Background:Clinical investigation is a growing field employing increasing numbers of nurses. This has created a new specialty practice defined by aspects unique to nursing in a clinical research context: the objectives, setting, and nature of the nurse–participant relationship. The clinical research nurse role may give rise to feelings of ethical conflict between aspects of protocol implementation and the duty of patient advocacy, a primary nursing responsibility. Little is known about whether research nurses experience unique ethical challenges distinct from those experienced (...) by nurses in traditional patient-care settings.Research objectives:The purpose of the study was to describe the nature of ethical challenges experienced by clinical research nurses within the context of their practice.Research design:The study utilized a qualitative descriptive design with individual interviews.Participants and research context:Participating nurses self-identified as having experienced ethical challenges during screening. The majority were Caucasian, female, and worked in outpatient settings. Approximately 50% had > 10 years of research experience.Ethical considerations:The human subjects review board approved the study. Written informed consent was obtained.Findings:Predominant themes were revealed: the inability to provide a probable good, or/do no harm, and dual obligations. The following patterns and subthemes emerged: conflicted allegiances between protocol implementation, needs of the participant, desire to advance science, and tension between the nurse–patient therapeutic relationship versus the research relationship.Discussion:Participants described ethical challenges specific to the research role. The issues are central to the nurse–participant relationship, patient advocacy, the nurse’s role in implementing protocols, and/or advancing science.Conclusion:Ethical challenges related to the specialized role of clinical research nurses were identified. More research is warranted to fully understand their nature and frequency and to identify support systems for resolution. (shrink)

The editor of this text has brought together fifteen selections representing some of the major contributions philosophers have made to the study of the aims of education. This anthology is organized into three parts: classical, modern and analytic philosophies of education. Each selection is preceded by the editor’s one page introduction, which unfortunately is far too short to prepare the student to deal technically with the material. In the part devoted to classical writings on education, texts from Plato and Aristotle (...) are offered with no regard to the cultural setting, while the excerpts from Locke, Rousseau and Kant seem to be presented principally with a concern for moral education. The five modern selections are far more interesting, particularly those from Dewey and Russell. The material from Maritain and Whitehead is preponderantly practical, though Sidney Hook’s defense of Dewey will afford the student an appreciation of careful argument. By far the most engaging part of the book is the last, comprising significant selections from Scheffler, Ryle and Jane Roland Martin. A portion of R. S. Peters’ Authority, Responsibility and Education is reprinted, but surprisingly enough, Peters’ far better book, Ethics and Education, is neglected. Cahn presents a short essay of his own, "Is There an Analytic Philosophy of Education?" which he probably would have modified had he been acquainted with Peters’ recent work. The likely use of this anthology is the teacher education course commonly referred to coincidentally by the same title. It is to Cahn’s credit that he has attempted to expose the education student to genuine philosophy, yet this anthology presents a mere mass of material without an effort at providing direction, structure or synthesis. The serious philosophical work of systematically analyzing education, culture, self and meaning still remains as much a task as it did before, though now thanks to Cahn some of the working materials for such an endeavor have been made more available.—J. T. K. (shrink)

Early versions of satellite and radiosonde datasets suggested that the tropical surface had warmed more than the troposphere, while climate models consistently showed tropospheric amplification of surface warming in response to human-caused increases in greenhouse gases. We revisit such comparisons here using new observational estimates of surface and tropospheric temperature changes. We find that there is no longer a serious discrepancy between modeled and observed trends in the tropics. Our results contradict a recent claim that all simulated temperature trends in (...) the tropical troposphere are inconsistent with observations. This claim was based on the use of older radiosonde and satellite datasets and on two methodological errors: the neglect of observational trend uncertainties introduced by interannual climate variability and application of an inappropriate statistical “consistency test”.This emerging reconciliation of models and observations has two primary explanations. First, because of changes in the treatment of buoy and satellite information, new surface temperature datasets yield slightly reduced tropical warming relative to earlier versions. Second, recently developed satellite and radiosonde datasets now show larger warming of the tropical lower troposphere. In the case of a new satellite dataset from remote sensing systems, enhancedRSS warming is due to an improved procedure of adjusting for inter-satellite biases. When the RSS-derived tropospheric temperature trend is compared with four different observed estimates of surface temperature change, the surface warming is invariably amplified in the tropical troposphere, consistent with model results. Even if we use data from a second satellite dataset with smaller tropospheric warming than in remote sensing systems RSS, observed tropical lapse rates are not significantly different from those in all model simulations.Our results contradict a recent claim that all simulated temperature trends in the tropical troposphere and in tropical lapse rates are inconsistent with observations. This claim was based on the use of older radiosonde and satellite datasets and on two methodological errors: the neglect of observational trend uncertainties introduced by interannual climate variability and application of an inappropriate statistical “consistency test”. (shrink)

PLoS ONE 3(3): e1897. doi:10.1371/journal.pone.

Since the time of Hume and Maine de Biran there have been two dominant views concerning our experience or perception of causality: Humians maintain that there is no direct experience of a causal link between successive events, while followers of Maine de Biran have argued that there is an internal experience of causality. By devising a series of ingenious experiments, Michotte attempts to show that both traditions are mistaken, and that there are causal impressions in the realm of external experience. (...) Whether or not one agrees with Michotte's conclusions, this study does effectively show the relevance of experimental data to an understanding of the perception of causality. There is a forward by R. C. Oldfield, several appendices bringing the research up to date, and a helpful commentary by T. R. Miles.—R. J. B. (shrink)

Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)

The aim of the present investigation was to describe and to classify significant ethical problems encountered by the members of the staff during the daily clinical work at a hospital medical department. A set of definitions was prepared for the purpose, including the definition of a 'significant ethical problem'. During a three month period 426 inpatients and 173 outpatients were admitted. Significant ethical problems were encountered during the management of 106 in-patients (25 per cent) and 9 out-patients (5 per cent). (...) No significant difference was found between the frequency of ethical problems in female and male patients, but a positive correlation was noted between the number of problems and the patients' age. The problem types were classified according to a problem list. The results of this investigation suggest that greater attention must be paid to discussions about ethical problems among doctors and other categories of health personnel and that, among others, medical students ought to be taught the analysis of ethical problems. (shrink)

Descartes plays a strange role in modern philosophy. Called the "father" of modern philosophy, he is more like a Freudian father where his "sons" feel the need to overthrow him. Perhaps no other philosopher has been "refuted" more than Descartes has. Indeed, a unifying characteristic of many diverse contemporary philosophic movements has been its anti-Cartesianism. But as so often happens in the history of philosophy, we are coming to realize that Descartes himself was not a "Cartesian." This study which is (...) designed "to help the undergraduate and graduate students in understanding Descartes' philosophy" is organized around the central philosophic issues raised in the Meditations. It is not a historical or a philosophic reconstruction of Descartes. Nor is Kenny concerned to give a last ditch defense of Descartes. Kenny takes Descartes seriously, defending him against false objections and criticizing Descartes where Kenny thinks he has gone astray. In the course of his analysis, Kenny exhibits his knowledge of Descartes' corpus and the growing literature in Anglo-Saxon philosophy dealing with Descartes. At times, Kenny doesn't do full justice to some of the objections and interpretations of Descartes. And one wishes that his own interpretations were developed in greater detail. But Kenny certainly succeeds in making Descartes "come alive" and showing us how he still is relevant for contemporary philosophic inquiry.--R. J. B. (shrink)

Placebo-controlled trials are controversial when individuals might be denied existing beneficial medical interventions. In the case of malaria, most patients die in rural villages without healthcare facilities. An artesunate suppository that can be given by minimally skilled persons might be of value when patients suddenly become too ill for oral treatment but are several hours from a facility that can give injectable treatment for severe disease. In such situations, by default, no treatment is (or can be) given until the patient (...) reaches a facility, making the placebo control design clinically relevant; alternative bioequivalence designs at the facility would misrepresent reality and risk incorrect conclusions. We describe the ethical issues underpinning a placebo-controlled trial in severe malaria. To protect patients and minimise risk, all patients were referred immediately to hospital so that each had a higher chance of prompt treatment through participation. There was no difference between artesunate and placebo in patients who reached clinic rapidly; among those who could not, a single artesunate suppository significantly reduced death or permanent disability, a finding of direct and indirect benefit to patients in participating villages and elsewhere. (shrink)

Measures of student ethical sensitivity and their increases help to answer questions such as whether accounting ethics should be taught at all. We investigate different sensitivity measures and alternatives to the well-established Defining Issues Test (DIT-2, Rest, J. R. et al. [1999, Postconventional Moral Thinking: A Neo-Kohlbergian Approach (Lawrence Erlbaum Associates, Mahwah, NJ]), frequently used to measure the effects of undergraduate accounting ethics education. Because the DIT measures cognitive development, which increases with age, the DIT scores for younger accounting students (...) are typically lower, have limited range, and are not likely to vary sufficiently with corresponding choices in ethical dilemmas. Since the DIT measures only the moral judgment component of ethical decision-making, we consider the multidimensional ethical scale (MES) to allow respondents to provide explanations for their moral and other judgments. The MES has been used to measure attitudes related to justice, utility, contractualism, egoism, and relativism. Unfortunately, the MES is not comparable in one-dimension to the DIT, and unlike the DIT, the MES has no theoretical or objective base. Therefore, we construct a comparable one-dimensional relative measure, a Composite MES Score, obtained from previous research on practicing accountants. We compare the reliability of this measure to the DIT in explaining the ethical choices of 54 specially chosen, somewhat homogeneous students, whose ages range from 18 to 19, and who are taking a second semester freshman accounting course at a private, religion-affiliated university. These particular students are relatively untrained in the formal use of questionable accounting choices. These students are less likely to recognize the dilemmas of the MES and are also less likely to demonstrate sufficient variation in their DIT scores, traditionally low for freshmen students. As freshmen, they are recent graduates of high school and more likely guided by other ethical influences including friends, family, or contractual obligations (some of the MES constructs) rather than higher cognitive development. This study confirms suspicions. We find the DIT scores do not vary sufficiently to explain the moral reasoning of freshmen. For eight dilemmas and 24 choices we find the DIT score correlates with only three choices, whereas the MES regression models have at least one significant construct for 23 out of 24 ethical choices. The Composite MES Score (a relative measure) also explains 23 out of 24 choices and is statistically related to the DIT in only one of the choices. Unlike the DIT, the Composite MES permits pretest and retesting with different dilemmas to evaluate changes in ethical sensitivity. These results argue for relative rather than absolute measures of sensitivity and guides beyond cognitive development (the DIT-score) to explain undergraduate student sensitivity. (shrink)

Thucydides, II. 28, records an eclipse of the sun in the summer of the first year of the Peloponnesian war. It can be no other than the annular eclipse of the 3rd of August, 431 B.C. He describes the phenomenon so accurately and with so many details that we can hardly doubt that he observed it himself — Tο δ' αủτο θέρονς γονμηνι κατά σελήγηγ, σπερ και μόγογ δοκει ειναι γιγνεσθαι δνγατόγ, ό λιος έξέλιπε μετά μεσημβριαγ και πάλιγ άγ επληρθη, (...) γενόμενος μηνοειδής και άστέρν τινν έκΦανέντων. (shrink)

I must start with an apologia. My original paper, ``Minds, Machines and Gödel'', was written in the wake of Turing's 1950 paper in Mind, and was intended to show that minds were not Turing machines. Why, then, didn't I couch the argument in terms of Turing's theorem, which is easyish to prove and applies directly to Turing machines, instead of Gödel's theorem, which is horrendously difficult to prove, and doesn't so naturally or obviously apply to machines? The reason was that (...) Gödel's theorem gave me something more: it raises questions of truth which evidently bear on the nature of mind, whereas Turing's theorem does not; it shows not only that the Gödelian well-formed formula is unprovable-in-the-system, but that it is true. It shows something about reasoning, that it is not completely rule-bound, so that we, who are rational, can transcend the rules of any particular logistic system, and construe the Gödelian well-formed formula not just as a string of symbols but as a proposition which is true. Turing's theorem might well be applied to a computer which someone claimed to represent a human mind, but it is not so obvious that what the computer could not do, the mind could. But it is very obvious that we have a concept of truth. Even if, as was claimed in a previous paper, it is not the summum bonum, it is a bonum, and one it is characteristic of minds to value. A representation of the human mind which could take no account of truth would be inherently implausible. Turing's theorem, though making the same negative point as Gödel's theorem, that some things cannot be done by even idealised computers, does not make the further positive point that we, in as much as we are rational agents, can do that very thing that the computer cannot. I have however, sometimes wondered whether I could not construct a parallel argument based on Turing's theorem, and have toyed with the idea of a von Neumann machine. A von Neumann machine was a black box, inside which was housed John von Neumann.. (shrink)

Taking away grains from a heap of rice, at what point is there no longer a heap? It seems small changes – removing a single grain – can’t make a difference to whether or not something is a heap; but big changes obviously do. How can this be, since big changes are nothing but small changes chained together?

Background:The theoretical framework of Jϋrgen Habermas suggests that effective communication requires competent participants with an objective attitude that complies with the rules and worlds designated as objective, social and subjective. This situation determines communicative action, which stimulates the search for mutual understanding and results in a process of interaction that promotes self-determination.Objectives:In this study, the discharge letters of patients with myocardial infarction were explored regarding the provision of information. The patient’s right to information and the duty of informing were analysed (...) according to the perspective of Jϋrgen Habermas.Research design:This was a cross-sectional analysis of all discharge letters that were directly related to nursing interventions regarding the provision of information to 106 patients. In this major study, the difficulties faced by patients who experienced a myocardial infarction and the changes in their lifestyles were analysed based on the type of information received.Ethical considerations:The hospital Ethics Committee approved the study, which complied with ethical principles and required informed consent.Findings:In the nursing letters, interventions related to the provision of information were conducted at an average of 3.59 interventions per patient. For 8.5% of the patients, however, no interventions related to the provision of information were performed. The most common area of information during hospitalisation was related to the management of signs and symptoms and applied to 90.6% patients.Discussion:The nursing interventions did not cover patient education, transition processes or awareness of the disease. Thus, the right to information can be questioned.Conclusion:Information is a right, and communication is extremely important. Health professionals should be aware of this importance regarding both care management and the satisfaction guarantee. The sharing of information by health professionals based on their competency is essential for patients to exercise their right to self-determination and decision-making. (shrink)

This paper begins with a puzzle regarding Lewis' theory of radical interpretation. On the one hand, Lewis convincingly argued that the facts about an agent's sensory evidence and choices will always underdetermine the facts about her beliefs and desires. On the other hand, we have several representation theorems—such as those of (Ramsey 1931) and (Savage 1954)—that are widely taken to show that if an agent's choices satisfy certain constraints, then those choices can suffice to determine her beliefs and desires. In (...) this paper, I will argue that Lewis' conclusion is correct: choices radically underdetermine beliefs and desires, and representation theorems provide us with no good reasons to think otherwise. Any tension with those theorems is merely apparent, and relates ultimately to the difference between how 'choices' are understood within Lewis' theory and the problematic way that they're represented in the context of the representation theorems. For the purposes of radical interpretation, representation theorems like Ramsey's and Savage's just aren't very relevant after all. (shrink)

A unifying theory of general anesthetic-induced unconsciousness must explain the common mechanism through which various anesthetic agents produce unconsciousness. Functional-brain-imaging data obtained from 11 volunteers during general anesthesia showed specific suppression of regional thalamic and midbrain reticular formation activity across two different commonly used volatile agents. These findings are discussed in relation to findings from sleep neurophysiology and the implications of this work for consciousness research. It is hypothesized that the essential common neurophysiologic mechanism underlying anesthetic-induced unconsciousness is, as with (...) sleep-induced unconsciousness, a hyperpolarization block of thalamocortical neurons. A model of anesthetic-induced unconsciousness is introduced to explain how the plethora of effects anesthetics have on cellular functioning ultimately all converge on a single neuroanatomic/neurophysiologic system, thus providing for a unitary physiologic theory of narcosis related to consciousness. (shrink)

This paper addresses several questions related to the nature, production, and use of animal-human (a-h) chimeras. At the heart of the issue is whether certain types of a-h chimeras should be brought into existence, and, if they are, how we should treat such creatures. In our current research environment, we recognize a dichotomy between research involving nonhuman animal subjects and research involving human subjects, and the classification of a research protocol into one of these categories will trigger different ethical standards (...) as to the moral permissibility of the research in question. Are a-h chimeras entitled to the more restrictive and protective ethical standards applied to human research subjects? We elucidate an Aristotelian-Thomistic metaphysical framework in which to argue how such chimeras ought to be defined ontologically. We then examine when the creation of, and experimentation upon, certain types of a-h chimeras may be morally permissible. (shrink)