The evolution of microstructure upon partial crystallization and its influence on the mechanical properties such as hardness, elastic modulus and viscosity in a La 55 Al 25 Cu 10 Ni 5 Co 5 bulk metallic glass alloy are studied. Specimens with various volume fractions of crystalline phases were obtained by annealing the as-cast amorphous alloy above its glass transition temperature and were characterized by transmission electron microscopy. Microscopic examination of the heat-treated samples shows short-range-ordered domains prior to nanocrystallization within the (...) amorphous matrix, followed by the growth and impingement of the crystallites. Whereas the hardness of the annealed samples increases linearly with increasing crystallinity, the elastic modulus and the viscosity both increase abruptly when the crystalline volume fraction is about 40 vol.%, with a only minor variation on either side of this range. The sudden rises in the modulus and viscosity are similar to those in the literature data on the fracture strength of partially crystallized bulk amorphous alloys that shows a steep drop in strength at 30-50 vol.% crystallinity. On the basis of the microscopic observations, it is suggested that the interaction and formation of rigid networks of crystalline phases upon the attainment of a critical second-phase volume fraction may be the possible reason for the sudden change in mechanical properties. Percolation theory is utilized in further substantiating this hypothesis. (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)

According to the expressive view of voting, a voter derives expressive utility from casting a vote. We present two possible sources of expressive utility: social interaction with voters having the same political preferences, and interestingness of the election. First, it has been suggested that a voter's expressive utility may increase when there are more voters having the same political preference. We extend this line of study and test the hypothesis that a voter's expressive utility increases as the number of voters (...) having the same political preferences increases in the local community, where interaction occurs more frequently with others than it does with others in distant communities. Second, we propose and test the other hypothesis, that voters’ expressive utility is larger when the election is more interesting. Using 2008 parliamentary election data from Korea, where the election consists of both 245 single-member districts and only one nationwide district for proportional representatives, we find supporting evidence for these two arguments: the turnout rate is significantly and positively related to the share of proportional representation votes for the largest party in each single-member district; the turnout rate is also significantly and positively related to the number of polls for single-member district election conducted by major broadcasting companies, which we use as a proxy variable for interestingness of the election. (shrink)

Religion is intrinsically social, and hence irretrievably organizational, although organization is often seen as the darker side of the religious experience--power, routinization, and bureaucracy. Religion and secular organizations have long received separate scholarly scrutiny, but until now their confluence has been little considered. This interdisciplinary collection of mostly unpublished papers is the first volume to remedy the deficit. The project grew out of a three-year inquiry into religious institutions undertaken by Yale University's Program on Non-Profit Organizations and sponsored by the (...) Lilly Endowment. The scholars who took part in this effort weree challenged to apply new perspectives to the study of religious organizations, especially that strand of contemporary secular organizational theory known as "New Institutionalism." The result was this groundbreaking volume, which includes papers on various aspects of such topics as the historical sources and patterns of U.S. religious organizations, contemporary patterns of denominational authority, the congregation as an organization, and the interface between religious and secular institutions and movements. The contributors include an interdisciplinary mix of scholars from economics, history, law, social administration, and sociology. (shrink)

Most donated organs in the United States come from brain dead donors, while a small percentage come from patients who die in “controlled,” or expected, circumstances, typically after the family or surrogate makes a decision to withdraw life support. The number of organs available for transplant could be substantially if donations were permitted in “uncontrolled” circumstances–that is, from people who die unexpectedly, often outside the hospital. According to projections from the Institute of Medicine, establishing programs permitting “uncontrolled donation after circulatory (...) determination of death,” or uDCDD, throughout the United States has the potential to provide 22,000 more donation opportunities annually. In contrast, U.S. controlled donation after circulatory determination of death, or cDCDD, cases have increased progressively over the past decade from 87 to 848 donors, but currently account for only 10.6 percent of all deceased donors. Following the IOM recommendations, several projects exploring the feasibility of uDCDD were funded by the federal government, including a grant from the Health Resources and Services Administration that supported a pilot project in New York City in which the authors of this article participated.A key feature of our protocol, and indeed of many uDCDD protocols, is the initiation of preservation methods such as chest compressions and extracorporeal membrane oxygenation shortly after death in order to perfuse and preserve the donor's organs. Critics of uDCDD argue that the means of determining death deviates from generally ascribed principles. They assert that reinstituting circulation in order to preserve organs has the effect of “undoing” the prior determination of death. The result is that cDCDD is widely accepted and practiced routinely even though it only marginally increases the number of organs available for transplantation, and uDCDD is widely considered unacceptable despite being ethically embraced and proven to significantly increase organ donation opportunities in other countries. This article explores the evolution of this counterintuitive state of affairs and calls for a policy that, in line with the IOM report, allows for both cDCDD and uDCDD protocols. (shrink)

Background: Funding organisations and research ethics committees should play a part in strengthening attention to gender equality in clinical research. In the research policy of European Union , funding measures have been taken to realise this, but such measures are lacking in the EU policy regarding RECs.Objective: To explore how RECs in Austria, Germany, Ireland, The Netherlands and Sweden deal with gender equality issues by asking two questions: Do existing procedures promote representation of women and gender expertise in the committee? (...) How are sex and gender issues dealt with in protocol evaluation?Methods: Two RECs were selected from each country. Data were obtained through interviews with key informants and content analysis of relevant documents .Results: All countries have rules to ensure the presence of women on RECs; gender expertise is not required. Drug study protocols are carefully evaluated, sometimes on a formal basis, as regards the inclusion of women of childbearing age. The reason for excluding either one of the sexes or including specific groups of women or making a gender-specific risk–benefit analysis are investigated by some RECs. Such measures are, however, neither defined in the regulations nor integrated in review tools.Conclusions: The RECs investigated in five European member states are found to pay limited attention to gender equality in their working methods and, in particular in protocol evaluation. Policy and regulations of EU are needed to strengthen attention to gender equality in the work of RECs. (shrink)

Introduction Stored human samples and the establishment of biobanks are increasing in the world. Along with this there are the questions of ethics that arise such as the correct method of obtaining informed consent for research on stored samples and the policies involved in collaborative research using collected samples. This study is an attempt to evaluate the researchers, academics and policy makers' views on these ethical aspects. Methods This was an anonymised study involving a Sri Lankan population of researchers, ethics (...) committee members, and policy makers. A self administered questionnaire was utilised as the study instrument. The questionnaire captured four major areas of interest: demographic characteristics of respondents, their attitudes on informed consent policy, their opinion on rights of collaborating researchers, their attitudes on dealing with international differences in regulatory frameworks. Results The study included 55 responders with 40/55 agreeing that donors should receive the option of giving informed consent for future research, with 31/55 considering multiple- type consent options most appropriate. Regarding the issue of shared samples in collaborative research majority agreed that source country ethics review committee approval was necessary 53/55. Conclusion The study concludes that sample donors should be given the option of giving advance consent to unspecified future research provided that future research is approved by an ethics committee. In collaborative research, it is necessary to involve ethics committees from donor countries in the research approval process. (shrink)

Due to the potential ethical and psychological implications of screening, and especially inregard of screening on children without available and acceptable therapeutic measures, there is a common view that such procedures are not advisable. As part of an independent research- and bioethical case study, our aim was therefore to explore and describe bioethical issues among a representative sample of participant families (n = 17,055 children) in the ABIS (All Babies In South-east Sweden) research screening for Type 1 diabetes (IDDM).The primary (...) aim is the identification of risk factors important for the development of diabetes and other multifactorial immune-mediated diseases. Four hundred, randomly chosen, participant mothers were asked to complete a questionnaire exploring issues of information, informed consent, bio-material, confidentiality and autonomy, and of prevention/intervention. 293 completed the questionnaire, resulting in a response rate of 73.3%. The majority of questions had the form of 6-point Likert-type response scales (1–6).We found that the majority of respondents felt calm in regard of samples and written material, and also concerning the possibility of their child in the future being identified as having high risk of developing Type 1 diabetes. An important finding concerning access and control of mainly biological data was indicated, with the respondents expressing concern for potential future use. We believe our findings indicate that this kind of empirical studies can substantially contribute to our understanding of bioethical issues of medical research involving genetics. Issues, such as safeguards ensuring theethical criteria of autonomy and respect, were emphasised by our respondents. We believe theissues brought up may promote further discussion, and do suggest issues for consideration by, among others, researchers, bioethicists and Institutional Review Boards. (shrink)

Background Informed consent confers upon participants the right to decline or accept participation in a study in equal measure. Consent declines can be used as a potential metric to assess the adequacy of the informed consent process. Limited literature is available on the reporting of consent declines in Clinical Research. We evaluated randomized controlled trials published in three high-impact factor journals for consent declines to assess the extent of exertion of autonomy by research participants. Methods CONSORT flow charts in RCTs (...) published in New England Journal of Medicine, The Lancet and Journal of the American Medical Association between 2012 and 2015 were evaluated. The total and per journal proportion of RCTs reporting consent declines was calculated. Percentage of consent declines was also compared based on number of centers and type of setting. Between-groups analysis was done using Chi Square, Chi Square for trend and a Crude odds ratio [95% C.I] were calculated. Results Only 3.7% of the published articles were RCTs. Of the 1103 RCTs, only 532 reported consent declines. JAMA had the highest RCTs reporting consent declines, the Lancet [129,150/781,924, 16.5%] had the most participants declining consent. Difference was significant using Chi square for linear trend [ p < 0.00001]. Consent decline rate was higher in developed countries relative to developing countries [cOR: 2.27, p < 0.000001] and in single centric versus multicentric studies [cOR : 3.63, p < 0.0000001]. Conclusion Both authors and journal editors need to ensure better reporting of consent declines. (shrink)

A caregiver from the dominant U.S. culture and a patient from a very different culture can resolve cross‐cultural disputes about treatment, not by compromising important values, but by focusing on the patient's goals.

Due to the potential ethical and psychological implications of screening, and especially inregard of screening on children without available and acceptable therapeutic measures, there is a common view that such procedures are not advisable. As part of an independent research- and bioethical case study, our aim was therefore to explore and describe bioethical issues among a representative sample of participant families (n = 17,055 children) in the ABIS (All Babies In South-east Sweden) research screening for Type 1 diabetes (IDDM).The primary (...) aim is the identification of risk factors important for the development of diabetes and other multifactorial immune-mediated diseases. Four hundred, randomly chosen, participant mothers were asked to complete a questionnaire exploring issues of information, informed consent, bio-material, confidentiality and autonomy, and of prevention/intervention. 293 completed the questionnaire, resulting in a response rate of 73.3%. The majority of questions had the form of 6-point Likert-type response scales (1–6).We found that the majority of respondents felt calm in regard of samples and written material, and also concerning the possibility of their child in the future being identified as having high risk of developing Type 1 diabetes. An important finding concerning access and control of mainly biological data was indicated, with the respondents expressing concern for potential future use. We believe our findings indicate that this kind of empirical studies can substantially contribute to our understanding of bioethical issues of medical research involving genetics. Issues, such as safeguards ensuring theethical criteria of autonomy and respect, were emphasised by our respondents. We believe theissues brought up may promote further discussion, and do suggest issues for consideration by, among others, researchers, bioethicists and Institutional Review Boards. (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)

Nature contact has associations with emotional ill-being and well-being. However, the mechanisms underlying these associations are not fully understood. We hypothesised that increased adaptive and decreased maladaptive emotion regulation strategies would be a pathway linking nature contact to ill-being and well-being. Using data from a survey of 600 U.S.-based adults administered online in 2022, we conducted structural equation modelling to test our hypotheses. We found that (1) frequency of nature contact was significantly associated with lesser emotional ill-being and greater emotional (...) well-being, (2) effective emotion regulation was significantly associated with lesser emotional ill-being and greater emotional well-being, and (3) the associations of higher frequency of nature contact with these benefits were partly explained via emotion regulation. Moreover, we found a nonlinear relationship for the associations of duration of nature contact with some outcomes, with a rise in benefits up to certain amounts of time, and a levelling off after these points. These findings support and extend previous work that demonstrates that the associations of nature contact with emotional ill-being and well-being may be partly explained by changes in emotion regulation. (shrink)

We treat science as a Hayekian social order whose distinctive emergent characteristic is the generation of knowledge. We model modern science as an institutional form that principally relies on publication with citation and its effects on individual reputation in order to study the possible effects of funding on science. We develop a taxonomy of three broad categories of effect: those having to do with the direction followed by scientific activity, those involving the operational and financial stability of both the physical (...) institutions integral to scientific work and the scientists themselves, and those due to distortions of the basic knowledge-generating procedures of science. It is argued that, while directional effects of funding are ubiquitous, destabilizing and distorting effects are much more likely to emerge when funding sources are concentrated than when they are decentralized. Further, when funding is accompanied by regulatory oversight, the possibilities for distortion are significantly increased. Examples of such effects actually occurring under the current U.S. funding regime are discussed. (shrink)

Traditional forms of farming, herding, and fishing are remarkably adapted to African conditions but these traditional approaches are being overtaken by modern pressures, particularly population growth. According to a report published by the Office of Technology Assessment (OTA), a nonpartisan analytical support agency of the U. S. Congress, one promising way to help African farmers and herders would be for development assistance organizations to focus more attention on the various forms of low-resource agriculture that predominate in Africa.In keeping with OTA's (...) mission and primary audience, “Enhancing Agriculture in Africa: A Role for U. S. Development Assistance” (1988) is a policy-oriented synthesis of available technical information. The report provides Congress with a range of options that, if pursued, could help Africans enhance agriculture, increase their food security, and improve their lives.This paper is drawn from the larger OTA report, and it focuses on the role technology might play in enhancing low-resource agriculture. Readers should see the full assessment (OTA, 1988) for more information on policy considerations; the specific technologies mentioned; or a complete list of advisory panel members, workshops and participants, and commissioned papers.OTA's report comes at a critical time: for a variety of reasons—ranging from changing values to increased budget constraints—U. S. foreign assistance policy is undergoing a fundamental reevaluation. This review of the potential of low-resource agriculture, and options the United States might pursue to enhance this approach, was intended to aid in this reevaluation. (shrink)

Western studies tend to view Byzantine philosophy either as a minor offshoot of western European thought, or a handy storehouse for documents and ideas until they are needed. A scholar of philosophy (Aristotle U. of Thessaloniki), Tatakis (1896-1996) finds the view limiting, pointing out that during the Roman period, few Greeks learned Latin but Romans were not considered educated without a founding in Greek, and that Byzantine Christianity has its own trajectory unconcerned with how it deviates from western orthodoxy.

We critically evaluate arguments in a recent Journal of Law, Medicine & Ethics article by Svoboda, Adler, and Van Howe disputing the 2012 affirmative infant male circumcision policy recommendations of the American Academy of Pediatrics. We provide detailed evidence in explaining why the extensive claims by these opponents are not supported by the current strong scientific evidence. We furthermore show why their legal and ethical arguments are contradicted by a reasonable interpretation of current U.S. and international law and ethics. After (...) all considerations are taken into account it would be logical to conclude that failure to recommend male circumcision early in infancy may be viewed as akin to failure to recommend childhood vaccination to parents. In each case, parental consent is required and the intervention is not compulsory. Our evaluation leads us to dismiss the arguments by Svoboda et al. Instead, based on the evidence, infant male circumcision is both ethical and lawful. (shrink)

Growing evidence suggests that natural environments – whether in outdoor or indoor settings – foster psychological health and physiological relaxation, indicated by increased wellbeing, reduced stress levels, and increased parasympathetic activity. Greater insight into differential psychological aspects modulating psychophysiological responses to nature-based relaxation videos could help understand modes of action and develop personalized relaxation interventions. We investigated heart rate variability as an indicator of autonomic regulation, specifically parasympathetic activity, in response to a 10-min video intervention in two consecutive studies as (...) well as heart rate. We hypothesized that a nature-based relaxation video elicits HRV increase and HR decrease, with response magnitude being affected by aspects of early life adversity and trait mindfulness. In Study 1, N = 60 participants watched a relaxation video intervention depicting different natural scenery. We analyzed changes in HR and respiratory sinus arrhythmia as a standard HRV measure, both based on 3-min segments from the experimental session, in multiple growth curve models. We found a decrease in HR and increase of RSA during the video intervention. Higher paternal care and lower trait mindfulness observing skills were associated with higher RSA values before but not during video exposure. In Study 2, N = 90 participants were assigned to three video conditions: natural scenery from Study 1, meditation video, or short clip from “The Lord of the Rings.” Again, HR decreased, and RSA increased during video segments, yet without expected group differences across different video types. We found higher parental care and lower parental overprotection to predict higher RSA at different times during the experiment. Interestingly, lower paternal overprotection predicted overall higher RSA. These results suggest a generic relaxation effect of video interventions on autonomic regulation that we discuss in light of different theories mapping restorative effects of natural environments. Further, psychological characteristics like aspects of early life adversity and trait mindfulness could contribute to individual differences in autonomic regulation. This study contributes to a better understanding of autonomic and psychological responses to relaxation videos. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

We report specific heat and μSR measurements on Th and/or B substituted UBe13. The specific heat data show that either Th or B substitution reduces the Kondo temperature TK and increases the entropy at the superconducting transition by almost 20%, indicating an enhanced density of states. However, whereas μSR shows clear evidence for magnetic correlations for Th substitutions, no magnetism is observed for B substitutions. The enhanced specific heat jump in the B-substituted material is associated with a change in the (...) superconducting properties as TK is reduced. (shrink)

Evidence‐based interventions have been developed and used to prevent HIV infections among black men who have sex with men (MSM) in Canada and the United States; however, the degree to which interventions address racism and other interlocking oppressions that influence HIV vulnerability is not well known. We utilize integrative antiracism to guide a review of HIV prevention intervention studies with black MSM and to determine how racism and religious oppression are addressed in the current intervention evidence base. We searched CINAHL, (...) PsychInfo, MEDLINE and the CDC compendium of evidence‐based HIV prevention interventions and identified seventeen interventions. Three interventions targeted black MSM, yet only one intervention addressed racism, religious oppression, cultural assets and religious assets. Most interventions' samples included low numbers of black MSM. More research is needed on interventions that address racism and religious oppression on HIV vulnerability among black MSM. Future research should focus on explicating mechanisms by which multiple oppressions impact HIV vulnerability. We recommend the development and integration of social justice tools for nursing practice that aid in addressing the impacts of racism and other oppressions on HIV vulnerability of black MSM. (shrink)

Participants in clinical research sometimes view participation as therapy or exaggerate potential benefits, especially in phase I or phase II trials. We conducted this study to discover what methods might improve cancer patients’ understanding of early-phase clinical trials. We randomly assigned 130 cancer patients from three U.S. medical centers who were considering enrollment in a phase I or phase II cancer trial to receive either a multimedia intervention or a National Cancer Institute pamphlet explaining the trial and its purpose. Intervention (...) participants were 32 times more likely to believe that the trial’s purpose was to examine safety and 60 % less likely to believe they would experience long-term benefit or cure. There was no difference in enrollment decision. However, while patients’ understanding of the trial’s purpose improved and expectations of long-term benefit diminished, half the respondents still believed they would experience long-term benefit or cure from participation. Therefore, we conclude that multimedia interventions such as this one may help oncologists to explain the risks and benefits of early-phase cancer trials in a way that patients can more easily understand, helping them to make more informed decisions about participation. But further research into other factors that influence patients’ beliefs about the outcome of enrollment is needed, both to modify the interventions and to determine how malleable patient beliefs are. (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)

Seit dem 2. nachchristlichen Jahrhundert werden die Schriften von Aristoteles kommentiert. Diese Ausgabe enthält griechische Kommentare zu seinem Werk vom 3. bis 8. Jahrhundert n. Chr., u. a. von Alexander von Aphrodiensias, Themistios, Joh. Philoponus, Simplicius in griechischer Sprache.

Miqdādī Iṣfahānī, ʻAlī - Correspondence ; Islamic ethics ; Sufi poetry, Persian.

We present some techniques in c.c.c. forcing, and apply them to prove consistency results concerning the isomorphism and embeddability relations on the family of ℵ 1 -dense sets of real numbers. In this direction we continue the work of Baumgartner [2] who proved the axiom BA stating that every two ℵ 1 -dense subsets of R are isomorphic, is consistent. We e.g. prove Con). Let K H , be the set of order types of ℵ 1 -dense homogeneous subsets of (...) R with the relation of embeddability. We prove that for every finite model L , : Con iff L is a distributive lattice. We prove that it is consistent that the Magidor-Malitz language is not countably compact. We deal with the consistency of certain topological partition theorems. E.g. We prove that MA is consistent with the axiom OCA which says: “If X is a second countable space of power ℵ 1 , and { U 0 ,\h.;, U n−1 } is a cover of D ▪ X x X -} x,x> ¦ x ϵ X } consisting of symmetric open sets, then X can be partitioned into { X i \brvbar; i ϵ ω } such that for every i ϵ ω there is l such that D ⊇ U l ”. We also prove that MA+OCA [xrArr] 2 ℵ 0 = ℵ 2. (shrink)

Avec son livre r cent, Locke and French materialism (Oxford 1991), John Yolton - connu de longue date pour avoir le premier focalis le contexte th ologique et moral du nouveau 'way of ideas' chez Locke - a donn le signal de d part d'une exploration de la place de Locke dans la lutte philosophique en France au dix-septi me si cle. Prenant acte que le th me, pourtant majeur, des id es inn es dans la r ception fran aise (...) de Locke n'a pas encore re u l'attention qu'il m rite, le pr sent livre poursuit une analyse approfondie de la fortune de la pol mique contre les id es inn es chez les philosophes fran ais, de Jean Le Clerc (1688) Saint-Lambert (1801). Apr s une pr sentation du sc nario mis en place au dix-septi me si cle (Descartes, Malebranche, Locke), on suit dans un ordre chronologique l' volution de la critique des id es inn es chez les philosophes fran ais jusqu' la defense d'une tabula rasaabsolue la fin du si cle (Helv tius, d'Holbach), passant par plusieurs tapes qui marquent chacune la fois un aboutissement et un nouveau point de d part dans la radicalisation progressive du leitmotiv lanc par Locke: consid r es comme le pilier m me de la m taphysique chr tienne, les id es inn es sont d nonc es de fa on de plus en plus radicale, d'abord dans le Refuge, ensuite en France sur une route jalonn e d'affaires' (Voltaire 1734, Prades 1751, Helv tius 1758, d'Holbach 1770). Or, si la pol mique contre les id es inn es semble voluer selon une logique interne n cessaire, ce livre d voile en m me temps l'existence d'une critique des id es inn es plus proche de la cause apolog tique par son souci de pr server l'immat rialit de l' me, l'existence de Dieu et celle d'une loi naturelle (morale) objective et absolue. Enfin, on voit par les r sultats de cette enqu te comment, aujourd'hui, le d bat entre l'inn et l'acquis, toujours d'actualit, trouve ses origines dans l'histoire retrac e ici - comme d'ailleurs plus g n ralement la s cularisation et ses diff rents avatars, mat rialisme, nihilisme, ath isme. Remerciements. (shrink)