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)

There is growing interest in the use of technology to enhance the tracking and quality of clinical information available for patients in disaster settings. This paper describes the design and evaluation of the Wireless Internet Information System for Medical Response in Disasters (WIISARD).

© 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)

Objective: To develop an approach for seeking informed consent to examine tissues retained from a previous study of sudden infant death syndrome as part of a study on asthma, and to document responses and participation rate.Design: Pilot open-ended approach to 10 volunteer SIDS parents, followed by staged approach to seek consent from the target SIDS families for the asthma study.Participants: Parents of SIDS infants known to SIDS and Kids Victoria and parents of SIDS infants from the 1991–2 SIDS in Victoria (...) case–control study.Main outcomes: Qualitative responses of the piloted parents and study parents, and participation rates.Results: The pilot group responses were used to refine the written material to be provided. Of the 72 families for which contact details were available, 45 gave verbal consent for contact by the Victorian Institute of Forensic Medicine regarding the asthma study, three refused and 24 did not respond to two letters. Thirty-three completed consent forms, all positive for participation in the asthma study, giving a positive response rate of 73% .Conclusions: The use of postmortem tissue for research is acceptable to the next of kin when an approach is sensitive to their concerns and needs and is made by experienced counsellors from a familiar organisation. Despite the painful memories evoked by the approach of the research group, the acceptance rate among those who could be contacted was high. (shrink)

An alternative notion of an existential quantifier on four-valued Łukasiewicz algebras is introduced. The class of four-valued Łukasiewicz algebras endowed with this existential quantifier determines a variety which is denoted by \. It is shown that the alternative existential quantifier is interdefinable with the standard existential quantifier on a four-valued Łukasiewicz algebra. Some connections between the new existential quantifier and the existential quantifiers defined on bounded distributive lattices and Boolean algebras are given. Finally, a completeness theorem for the monadic four-valued (...) Łukasiewicz predicate calculus corresponding to the dual of the alternative existential quantifier is proven. (shrink)

Austin attacks the view that language is referential, based on the simplistic division of utterances into the ‘descriptive’ and ‘evaluative’, using his notion of performative utterances. Such utterances, in the appropriate circumstances, are neither descriptive nor evaluative, but count as actions, i.e., create the situation rather than describing or reporting on it. In saying ‘I promise to go’ one is making a promise, not stating that one is making it. A performative promise is not, and does not involve, the statement (...) that one is promising. It is an act of a distinctive sort, the very sort named by the performative verb. And, according to Austin, making explicit what one is doing is not describing what one is doing or stating that one is doing it. (shrink)

Austin takes on the problem of other minds, of how to respond to the question ‘how do you know?’, if this question is raised with regard to the thoughts, feelings, sensations, minds of other creatures. This problem has traditionally been understood as the problem of justifying our belief in the existence of other minds. Austin argues that believing in other persons, in authority and testimony, is an essential part of the act of communicating, and as such is an irreducible part (...) of our experience. While we can state certain advantages of communicative performances, there is no justification for our doing them as such. (shrink)

On the meta-level, ‘A Plea for Excuses’, sometimes regarded as the manifesto of ordinary language philosophy, illustrates Austin’s method of approaching philosophical issues, by patiently analysing the subtleties of ordinary language, by example. On the object level, the key distinction with regard to human actions that appear to be worthy of blame, Austin holds to be between a justification, which denies that the performed action was wrong, and an excuse, which instead denies that the agent was responsible for performing it. (...) Austin gives careful attention to particular cases of exculpatory speech, including precise word order and varying emphasis, etymological studies, and the special function of adverbial qualifying phrases, and shows how legal precedents and abnormal psychology may also be helpful in understanding why some efforts to excuse fail. In the final analysis, excuses are properly seen as setting limits to the ascription of moral responsibility, by stating explicitly how they differ from the more usual cases. (shrink)

‘The Meaning of a Word’ is a polemic against the view that philosophy can be done by way of pinning down the meaning of words used in philosophising. Its argument is threefold: the first part argues that ‘the meaning of a word’ is, in general, if not always, a dangerous nonsensephrase, in the sense that there is no simple and handy appendage of a word called ‘the meaning of “x”’. The second part applies this conclusion to problems that rely on (...) the assumption that phrases like ‘the meaning of a word’ or ‘part of the meaning of the word’ are not completely undefined, proposing that we are using a working-model for philosophical problems which fails to fit the facts that we really wish to talk about. The third part addresses the problem of universals, which, according to Austin, boils down to the question of why we call different things, say two chairs in your living room, by the same name, that is, ‘chair’. Austin examines the phrase ‘having the same meaning’ in order to reveal the different reasons we have for calling different things by the same name. (shrink)

A cross-sectional study to ascertain what the Singapore population would regard as material risk in the anaesthesia consent-taking process and identify demographic factors that predict patient preferences in medical decision-making to tailor a more patient-centered informed consent. A survey was performed involving patients 21 years old and above who attended the pre-operative evaluation clinic over a 1-month period in Singapore General Hospital. Questionnaires were administered to assess patients’ perception of material risks, by trained interviewers. Patients’ demographics were obtained. Mann–Whitney U (...) test and Kruskal-Wallis one-way analysis of variance was used. Statistical significance was taken at p < 0.05. Four hundred fourteen patients were eligible of which 26 refused to participate and 24 were excluded due to language barrier. 364 patients were recruited. A higher level of education, being employed and younger age group are factors identified in patients who wanted greater participation in medical decisions. Gender, marital status, type of surgery, and previous surgical history did not affect their level of participation. The complications most patients knew about were Nausea, Drowsiness and Surgical Wound Pain. Patients ranked Heart Attack, Death and Stroke as the most significant risks that they wanted to be informed about in greater detail. Most patients wanted to make a joint decision with the anaesthetist, instead of letting the doctor decide or deciding for themselves. Discussion with the anaesthetist is the preferred medium of communication compared to reading a pamphlet or watching a video. Age and educational level can influence medical decision-making. Despite the digital age, most patients still prefer a clinic consult instead of audio-visual multimedia for pre-operative anaesthetic counselling. The local population appears to place greater importance on rare but serious complications compared to common complications. This illustrates the need to contextualize information provided during informed consent to strengthen the doctor-patient relationship. (shrink)

‘Agathon and Eudaimonia in the Ethics of Aristotle’ is a response to an article on the meaning of Agathon in the Ethics of Aristotle, published by H. A. Pritchard in 1935. In this paper, Pritchard argued that Aristotle regarded Agathon to mean ‘conducive to our happiness’ and, consequently, that he maintained that every deliberate action stems, ultimately, from the desire to become happy. Austin finds fault with this view: first, Agathon in Aristotle does not have a single meaning, and a (...) fortiori not the one Pritchard suggested; secondly, if one had to summarise the meaning of ‘being agathon’ in one phrase, then ‘being desired’ cannot fulfil this function, for there are other objects of desire besides τό άγαθόν. (shrink)

Criticises G. E. Moore’s highly influential proposal that ascriptions of agent ability implying freedom of choice or action, what the agent could do, are analyzable as conditional statements regarding what the agent would do under certain circumstances. Austin objects against Moore that some uses of ‘if’ are non-conditional and goes on to examine the uses of these non-conditional cases. Moore’s proposal also lies at the heart of some compatibilist theories of free will and determinism. Austin argues determinism to be a (...) pseudo-problem, so long as it remains a notion that is not itself clear cut. (shrink)

Concerned with the question of whether descriptions of identity, i.e. describing X as Y, amount to the same as statements of identity, i.e. stating that X equals Y. Austin characteristically tackles this question by investigating into the nature of a number of relevant speech acts, such as ‘calling’, ‘describing’, and ‘stating’. He concludes negatively that none of the speech acts discussed can be safely used in philosophy in a general way. However, the construction of models of speech situations reveals their (...) underlying complexity: such models are plainly too complicated to accommodate the standard subject-predicate or class-membership models that a straightforward answer to the question raised in this paper would depend on. (shrink)

Deals with the question of whether there is a use of ‘is true’ that is the primary or generic name for that which at bottom we are always saying ‘is true’. Austin discusses the views that truth is primarily a property of beliefs and of true statements. He goes on to argue that the word ‘true’ denotes the validity of an intended correspondence between a representation and what it represents, and dismantles confusions about the meaning of the words that underlie (...) such a view, such as ‘fact that’ and ‘corresponds’. (shrink)

In the late seventies at the Centre for Computers and Law research was started to find means for supporting lawyers' work with the aid of a computer. The research project was called JURICAS. In 1982 a prototype of a JURICAS system was produced and since 1986 seven advisory packages have been brought out on the market in the Netherlands. These packages consist of two main parts, an author's shell and an advisory program. The user cannot make changes to either the (...) shell or the program.In 1988 the JURICAS author's shell became commercially available. A buyer has to make his own advisory program and fill it with his expertise to produce an advisory package. To facilitate the designing, the typing in and the testing of a package a number of utility programs are included in the author's system. (shrink)

A Dirac-like equation for a massive field obeying the classical Proca equations of motion (PMO) is proposed in close analogy with Majorana’s construct for Maxwell electrodynamics. Its underlying algebraic structure is examined and a plausible physical interpretation is discussed. The behavior of the PMO equations in the presence of an external electromagnetic field is also investigated in the low energy limit, via unitary transformations similar to the Foldy-Wouthuysen canonical transformation for a Dirac fermion.

The aim of this study is to understand the place of Aristotle’s dialectic in his overall theory of intellectual activity. On the way to this goal, the reader is treated to a novel and exciting interpretation of the nature of dialectic. Evans argues that Aristotelian dialectic is a method for progressing from what is intelligible to some group of discussants to what is intelligible without qualification. Evans goes behind this distinction to discover how dialectic can be, as Aristotle claims, the (...) road to the first principles of all the sciences. (shrink)

Observational indications combined with analyses of analogue and emergent gravity in condensed matter systems support the possibility that there might be two distinct energy scales related to quantum gravity: the scale that sets the onset of quantum gravitational effects $E_{\rm B}$ (related to the Planck scale) and the much higher scale $E_{\rm L}$ signalling the breaking of Lorentz symmetry. We suggest a natural interpretation for these two scales: $E_{\rm L}$ is the energy scale below which a special relativistic spacetime emerges, (...) $E_{\rm B}$ is the scale below which this spacetime geometry becomes curved. This implies that the first ‘quantum’ gravitational effect around $E_{\rm B}$ could simply be that gravity is progressively switched off, leaving an effective Minkowski quantum field theory up to much higher energies of the order of $E_{\rm L}$ . This scenario may have important consequences for gravitational collapse, inasmuch as it opens up new possibilities for the final state of stellar collapse other than an evaporating black hole. (shrink)

The term "stakeholder engagement" has gained increasing prominence over the last few years. This prominence is fueled by a range of issues such as an increased dissatisfaction with business's focus on stockholder/shareholder interests and the demands for greater transparency from business following major business scandals. A perceived response to this issue in South Africa has been the inclusion of guidelines on stakeholder engagement in the King II Report on Corporate Governance. Despite this growing interest, there has not been clarity on (...) how companies engage with their stakeholders and specifically with how they identify and prioritize their stakeholders. The study sought to establish the reporting practices of South African business in relation to stakeholder identification and prioritization through a content analysis of their annual reports. The findings are discussed and recommendations on the two aspects of stakeholder engagement presented. (shrink)

Austin discusses the existence, origin, and resemblance of concepts, primarily by discussing the meaning of ‘concept’ and ‘universal’. He argues that, although sometimes it may not be harmful to talk about concepts, we neither understand the meaning of ‘concept’, nor the meaning of ‘acquiring and possessing concepts’, nor a view of concept resemblance as non-sensuous acquaintance or awareness, challenging philosophers who couch their theories in such terms to illuminating them first.

A reconstruction based on previously unpublished notes, of Austin’s views of the Line and Cave allegories in Plato’s Republic. In these drafts, Austin discusses the prominent issues that arise in the context of Plato’s Line allegory, e.g. the questions of division and continuity, and shows how the different stages in the Cave allegory correspond to individual sections of the Line.