Increasing ethical attention and debate is focusing on whether individuals who take part in clinical trials should be given access to post-trial care. However, the main focus of this debate has been upon drug trials undertaken in low-income settings. To broaden this debate, we report findings from interviews with individuals (n = 24) who participated in a clinical trial of a closed-loop system, which is a medical device under development for people with type 1 diabetes that automatically adjusts blood glucose (...) to help keep it within clinically recommended ranges. Individuals were recruited from UK sites and interviewed following trial close-out, at which point the closed-loop had been withdrawn. While individuals were stoical and accepting of the requirement to return the closed-loop, they also conveyed varying degrees of distress. Many described having relaxed diabetes management practices while using the closed-loop and having become deskilled as a consequence, which made reverting back to pre-trial regimens challenging. Participants also described unanticipated consequences arising from using a closed-loop. As well as deskilling, these included experiencing psychological and emotional benefits that could not be sustained after the closed-loop had been withdrawn and participants reevaluating their pre- and post-trial life in light of having used a closed-loop and now perceiving this life much more negatively. Participants also voiced frustrations about experiencing better blood glucose control using a closed-loop and then having to revert to using what they now saw as antiquated and imprecise self-management tools. We use these findings to argue that ethical debates about post-trial provisioning need to be broadened to consider potential psychological and emotional harms, and not just clinical harms, that may result from withdrawal of investigated treatments. We also suggest that individuals may benefit from information about potential nonclinical harms to help make informed decisions about trial participation. (shrink)

BackgroundMulti-centre studies generally cost more than single-centre studies because of larger sample sizes and the need for multiple ethical approvals. Multi-centre studies include clinical trials, clinical quality registries, observational studies and implementation studies. We examined the costs of two large Australian multi-centre studies in obtaining ethical and site-specific approvals.MethodsWe collected data on staff time spent on approvals and expressed the overall cost as a percent of the total budget.ResultsThe total costs of gaining approval were 38 % of the budget for (...) a study of 50 centres (mean cost AUD $6960 per site) and 2 % for a study of 11 centres (mean cost AUD $2300 per site). Seventy-five and 90 % of time was spent on repeated tasks, respectively, and many time-consuming tasks, such as reformatting documents, did nothing to improve the study design or participant safety.ConclusionsImprovements have been made to the ethical approval application system, but more gains could be made without increasing risks of harm to research participants. We propose that ethical review bodies and individual sites publish statistics on how long they take to process approvals which could then be nationally benchmarked. (shrink)

Stronger collaboration between government organizations (GOs), NGOs, and rural people has long been advocated as a means of enhancing the responsiveness, efficiency, and accountability of GOs and NGOs. This paper reviews the arguments and evidence for specific types of collaboration for sustainable agricultural development, setting it into the context of Korten's (1980) concept of “learning process.” Taking recent examples from Udaipur District in India, it reviews the experiences and potential of collaboration, arguing that, while informal interaction increases and enriches the (...) fabric of pluralist development, certain strategic decisions often require a degree of formality. These include decisions on the development of human resources — here both the users and providers of services. Moreover, human resource development (HRD) must be viewed in the context of the mandates, aspirations, and systems of accountability and rewards of the institutions concerned. These determine whether institutions develop and expand their own human resources or draw upon those of others by collaborating with them. Individuals engaged in these organizations can be more effectively induced to collaborate with others by combinations of flexibility and appropriate reward systems than they can be forced to do so by instructions or commands. Several conclusions follow: decisions to act together are unlikely to progress unless translated into concrete actions; authority to take local-level decisions in GOs needs strengthening if they are to provide the necessary flexibility; and, although collaboration should in principle be built on the comparative advantage of different types of organization, in practice, each will have to incorporate the skills of the other, at least to some level, if they are to communicate effectively. NGOs and GOs must also enhance their understanding of farmers' ability to make demands on external organizations. Edging towards collaboration is a delicate and painstaking process. Only if many of the above conditions are given due priority will early examples have something to offer to the numerous NGOs, GOs and international agencies wishing to learn from them. (shrink)

Farrington has written a fascinating and provocative introduction to fourth-century Greece in the form of a cultural dispute between the Garden, the Academy, and the Lyceum. In the political and religious chaos of the late fourth century, Epicurus appears as a radical social reformer, not the recluse of earlier interpreters, bent on returning Greek society to its primitive ideal of friendship. While in agreement with Plato that Greek society was desperately sick, his remedy was antithetical to Plato's and heavily (...) dependent on the later Aristotle. Friendship not justice, freedom not authority, individuality not universality, sensory experience not a priori axioms--these were the hallmarks of Epicurus' desired reform. The practical, almost prophetic direction of Epicurus' philosophy emerges most clearly in his bitter opposition to political religion, used by the ruling class to keep the people in line and typified by Plato's insistence on religious orthodoxy in his republic. Against this background, Epicurus' theology, as well as his physics, serves as a polemical thrust designed to release men from superstition and irrational fear of would-be gods. Farrington's obvious delight in Epicurus, together with his desire to set right past misinterpretations of his thought, make the account all the more interesting to read. The final chapter traces Epicurean influence in later Roman thought, notably in the Platonist Cicero and the Stoic Seneca, its decline in the Middle Ages, and its rebirth in the Renaissance. The book concludes with a brief but adequate bibliography of ancient and modern works.--J. G. G. (shrink)

Does our future lie in global citizenship?

Recent studies indicate that mammalian chromosomes contain discretecis‐acting loci that control replication timing, mitotic condensation, and stability of entire chromosomes. Disruption of the large non‐coding RNA gene ASAR6 results in late replication, an under‐condensed appearance during mitosis, and structural instability of human chromosome 6. Similarly, disruption of the mouse Xist gene in adult somatic cells results in a late replication and instability phenotype on the X chromosome. ASAR6 shares many characteristics with Xist, including random mono‐allelic expression and asynchronous replication timing. (...) Additional “chromosome engineering” studies indicate that certain chromosome rearrangements affecting many different chromosomes display this abnormal replication and instability phenotype. These observations suggest that all mammalian chromosomes contain “inactivation/stability centers” that control proper replication, condensation, and stability of individual chromosomes. Therefore, mammalian chromosomes contain four types ofcis‐acting elements, origins, telomeres, centromeres, and “inactivation/stability centers”, all functioning to ensure proper replication, condensation, segregation, and stability of individual chromosomes. (shrink)

A definitive study of the great "philosopher of industrial science." Dr. Farrington pinpoints Bacon as the first man to grasp the revolutionary possibilities of man's increasing control over natural forces. The author sees Bacon's plan for the total reform of society by the application of science to production as the central theme of his life.

Vaesen infers unique properties of mind from the appearance of specific cultural innovation – a correlation without causal direction. Shifts in habitat, population density, and group dynamics are the only independently verifiable incentives for changes in cultural practices. The transition from Acheulean to Late Stone Age technologies requires that we consider how population and social dynamics affect cultural innovation and mental function.

This work has been selected by scholars as being culturally important and is part of the knowledge base of civilization as we know it. This work is in the public domain in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. Scholars believe, and we concur, that this work is important enough to be (...) preserved, reproduced, and made generally available to the public. To ensure a quality reading experience, this work has been proofread and republished using a format that seamlessly blends the original graphical elements with text in an easy-to-read typeface. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

This book, originally published in 1965, discusses the political implication of the spread of science in antiquity. It reveals how the real Greek spirit of scientific research was crushed by Plato and Aristotle, long thought-of as searchers for truth. Historian such as Polybius and Livey and the poets Pinder and Virgil are seen in a new light when set against this background of social struggle.

This book, originally published in 1965, discusses the political implication of the spread of science in antiquity. It reveals how the real Greek spirit of scientific research was crushed by Plato and Aristotle, long thought-of as searchers for truth. Historian such as Polybius and Livey and the poets Pinder and Virgil are seen in a new light when set against this background of social struggle.

The first English translation of Fichte’s second set of 1804 lectures on the Wissenschaftslehre.

Orthologic is defined by weakening the axioms and rules of inference of the classical propositional calculus. The resulting Lindenbaum-Tarski quotient algebra is an orthoimplication algebra which generalizes the author's implication algebra. The associated order structure is a semi-orthomodular lattice. The theory of orthomodular lattices is obtained by adjoining a falsity symbol to the underlying orthologic or a least element to the orthoimplication algebra.

This new edition of Law and Medical Ethics continues to chart the ever-widening field that the topics cover. The interplay between the health caring professions and the public during the period intervening since the last edition has, perhaps, been mainly dominated by wide-ranging changes in the administration of the National Health Service and of the professions themselves but these have been paralleled by important developments in medical jurisprudence.