Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

The spatial dynamics of the optical emission from an array of 50 times 50 individual microcavity plasma devices is investigated. The array is operated in argon and argon-neon mixtures close to atmospheric pressure with an ac voltage. The optical emission is analysed with phase and space resolution. It has been found that the emission is not continuous over the entire ac period, but occurs once per half period. Each of the observed emission phases shows a self-pulsing of the discharge, with (...) several bursts of emission of fixed width and repetition rate. The number of emission bursts depends on applied voltage and frequency. Spatially resolved measurements prove that the emission bursts are formed by overlapping emission pulses from single discharge cavities. Intensity differences between positive and negative half-wave can be interpreted through spatially resolved measurements of single discharge cavities. (shrink)

Conflicts have arisen between communities and operators of confined animal feeding as farms have become bigger in order to maintain their competitiveness. These conflicts have been difficult to resolve because measuring and allocating the benefits and costs of livestock production is difficult. This papers demonstrates a policy tool for promoting compromise whereby the community gets reduced negative impacts from livestock while at the same time continues to benefit from livestock jobs, taxes, and related economic activity. Public economic benefits and public (...) economic costs of confined animal feeding operations are estimated for every farm and affected house in Craven County, North Carolina. The results show public economic benefits of $5.7 million and public economic costs of $2.2 million, but that the ratio of benefits to costs for individual farm-house pairs varies in important ways across the 26 hog farms in Craven County. (shrink)

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

By the time this essay is published, it will be a matter of weeks before doctors and nurse practitioners in Canada can legally end the lives (by medical assistance in dying, or MAID) of non-dying p...

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)

A crisis continues to brew within the pharmaceutical research and development (R&D) enterprise: productivity continues declining as costs rise, despite ongoing, often dramatic scientific and technical advances. To reverse this trend, we offer various suggestions for both the expansion and broader adoption of modeling and simulation (M&S) methods. We suggest strategies and scenarios intended to enable new M&S use cases that directly engage R&D knowledge generation and build actionable mechanistic insight, thereby opening the door to enhanced productivity. What M&S requirements (...) must be satisfied to access and open the door, and begin reversing the productivity decline? Can current methods and tools fulfill the requirements, or are new methods necessary? We draw on the relevant, recent literature to provide and explore answers. In so doing, we identify essential, key roles for agent-based and other methods. We assemble a list of requirements necessary for M&S to meet the diverse needs distilled from a collection of research, review, and opinion articles. We argue that to realize its full potential, M&S should be actualized within a larger information technology framework—a dynamic knowledge repository—wherein models of various types execute, evolve, and increase in accuracy over time. We offer some details of the issues that must be addressed for such a repository to accrue the capabilities needed to reverse the productivity decline. (shrink)

Objective: To determine whether a moral reasoning exercise can improve response quality to surveys of healthcare priorities Methods: A randomised internet survey focussing on patient age in healthcare allocation was repeated twice. From 2574 internet panel members from the USA and Canada, 2020 (79%) completed the baseline survey and 1247 (62%) completed the follow-up. We elicited respondent preferences for age via five allocation scenarios. In each scenario, a hypothetical health planner made a decision to fund one of two programmes identical (...) except for average patient age (35 vs 65 years). Half of the respondents (intervention group) were randomly assigned to receive an additional moral reasoning exercise. Responses were elicited again 7 weeks later. Numerical scores ranging from –5 (strongest preference for younger patients) to +5 (strongest preference for older patients); 0 indicates no age preference. Response quality was assessed by propensity to choose extreme or neutral values, internal consistency, temporal stability and appeal to prejudicial factors. Results: With the exception of a scenario offering palliative care, respondents preferred offering scarce resources to younger patients in all clinical contexts. This preference for younger patients was weaker in the intervention group. Indicators of response quality favoured the intervention group. Conclusions: Although people generally prefer allocating scarce resources to young patients over older ones, these preferences are significantly reduced when participants are encouraged to reflect carefully on a wide range of moral principles. A moral reasoning exercise is a promising strategy to improve response quality to surveys of healthcare priorities. (shrink)

Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid organ transplant, thirty-nine (...) (65.0 per cent) for candidates and twenty-one (35.0 per cent ) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent, p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often navigated communication challenges between transplant and non-transplant healthcare professionals and patients and families. (shrink)

We show that for random bit strings, Up, with probability, image, the first order quantifier depth D) needed to distinguish non-isomorphic structures is Θ, with high probability. Further, we show that, with high probability, for random ordered graphs, G≤,p with edge probability image, D)=Θ, contrasting with the results for random graphs, Gp, given by Kim et al. [J.H. Kim, O. Pikhurko, J. Spencer, O. Verbitsky, How complex are random graphs in first order logic? Random Structures and Algorithms 26 119–145] of (...) D)=log1/pn+O. (shrink)

Frederick Dretske′s views on the nature of seeing, the possibility of knowledge, the nature of content or non-natural meaning, the nature of behavior, and the role of content in teh causal explanation of behavior have been profoundly important. Dretske and His Critics contains original discussions of these issues by Joh Heil, Stuart Cohen, David H Sanford, Jaegwon Kim, Fred Adams, Daniel Dennett, Robert Cummins, Terence Horgan and Brian McLaughlin. Each chapter is responded to by Dretske himslef.

A scholarly edition of a work by David Hume. The edition presents an authoritative text, together with an introduction, commentary notes, and scholarly apparatus.

Standard defences of preservationism, and of the intrinsic value of nature more generally, are vulnerable to at least three objections. The first of these comes from social constructivism, the second from the claim that it is incoherent to argue that nature is both 'other' and something with which we can feel unity, whilst the third links defences of nature to authoritarian objectivism and dangerously misanthropic normative dichotomies which set pure nature against impure humanity. I argue that all these objections may (...) be answered by recasting the relationship between man and nature into a tripartite spectrum of ontological form between nature and artifact, with the key question being the extent to which nature has been humanised in accordance with certain modes of strongly instrumental rationality, these in turn being defined by reference to the split between abstract reason and natural feeling which was exacerbated by specific elements in the Enlightenment period. This new model may grant normative force by linking external nature to a broader conception of human psychological wellbeing than that offered by the quantitatively orientated models of human rationality and agency. (shrink)

A numerical classification was performed on 69 elements with 54 chemicaland physicochemical properties. The elements fell into clusters in closeaccord with the electron shell s-, p- andd-blocks. The f-block elements were not included forlack of sufficiently complete data. The successive periods ofs- and p-block elements appeared in an ovalconfiguration, with d-block elements lying to one side. Morethan three axes were required to give good representation of thevariation, although the interpretation of the higher axes is difficult.Only 15 properties were scorable for (...) the noble gases, but despite thepaucity of properties reflecting chemical reactivity, analysis of the 69elements on these properties still showed the major features seen fromthe full set. (shrink)

Rid and Wendler propose the development of a Patient Preference Predictor (PPP), an actuarial model for predicting incapacitated patient’s life-sustaining treatment preferences across a wide range of end-of-life scenarios. An actuarial approach to end-of-life decision making has enormous potential, but transferring the logic of actuarial prediction to end-of-life decision making raises several conceptual complexities and logistical problems that need further consideration. Actuarial models have proven effective in targeted prediction tasks, but no evidence supports their effectiveness in the kind of broad (...) spectrum prediction task that is the proposed goal of the PPP. We argue that a more focused approach, targeting specific medical conditions and generating treatment predictions based on the preferences of individuals with actual disease experience, is both more firmly grounded in past research and is a more prudent initial strategy for exploring the efficacy of actuarial prediction in end-of-life decision making. (shrink)

The cortical visual mechanisms involved in processing spatial relationships remain subject to debate. According to one current view, the ''dorsal stream'' of visual areas, emanating from primary visual cortex and culminating in the posterior parietal cortex, mediates this aspect of visual processing. More recently, others have argued that while the dorsal stream provides egocentric coding of visual location for motor control, the separate ''ventral'' stream is needed for allocentric spatial coding. We have assessed the visual form agnosic patient DF, whose (...) lesion mainly affects the ventral stream, on a prehension task requiring allocentric spatial coding. She was presented with transparent circular disks. Each disk had circular holes cut in it. DF was asked to reach out and grasp the disk by placing her fingers through the holes. The disks either had three holes (for forefinger, middle finger, and thumb) or two holes (for forefinger and thumb). The distance between the forefinger and thumb holes, and the orientation of the line formed by them, were independently varied. DF was quite unable to adjust her grip aperture or her hand orientation in the three-hole task. Although she was able to orient her hand appropriately for the two-hole disks, she still remained unable to adjust her grip aperture to the distance between the holes. These findings are consistent with the idea that allocentric processing of spatial information requires a functioning ventral stream, even when the information is being used to guide a motor response. (shrink)

This article explores the influence of Stoicism and religion on Adam Smith. While other commentators have argued either that the main influence on Smith was Stoicism or that it was religion, the two influences have not been explicitly linked. In this article I attempt to make such a link, arguing that Smith can be seen as belonging to the strand of Christian Stoicism chiefly associated with his teacher, Francis Hutcheson. Finally, some comments are made about the implications of this interpretation (...) for current understanding of the work of Adam Smith. (shrink)

One approach to the analysis of ethical dilemmas in medical practice uses the “four principles plus scope” approach. These principles are: respect for autonomy, beneficence, non-maleficence and justice, along with concern for their scope of application. However, conflicts between the different principles are commonplace in psychiatric practice, especially in forensic psychiatry, where duties to patients often conflict with duties to third parties such as the public. This article seeks to highlight some of the specific ethical dilemmas encountered in forensic psychiatry: (...) the excessive use of segregation for the protection of others, the ethics of using mechanical restraint when clinically beneficial and the use of physical treatment without consent. We argue that justice, as a principle, should be paramount in forensic psychiatry, and that there is a need for a more specific code of ethics to cover specialised areas of medicine like forensic psychiatry. This code should specify that in cases of conflict between different principles, justice should gain precedence over the other principles. (shrink)

table ronde du Centre national de la recherche scientifique, Paris, 27-29 mars 1979. Huygens et la France (Paris, Vrin, 1981, p. 99-114) CHRISTIAAN HUYGENS VU PAR LEIBNIZ par Albert HEINEKAMP (*) (Leibniz-Archiv, Hannover) Les ...

The European Union welfare standardsfor intensively kept pigs have steadilyincreased over the past few years and areproposed to continue in the future. It isimportant that the cost implications of thesechanges in welfare standards are assessed. Theaim of this study was to determine theprofitability of rearing pigs in a range ofhousing systems with different standards forpig welfare. Models were constructed tocalculate the cost of pig rearing (6–95 kg) in afully-slatted system (fulfilling minimum EUspace requirements, Directive 91630/EEC); apartly-slatted system; a high-welfare,straw-based system (...) (complying with the UK-basedRoyal Society for the Prevention of Cruelty toAnimals, Freedom Food standards) and afree-range system. The models were also used toassess the consequences of potential increasesin space allowance, and to estimate the cost ofrearing pigs under organic standards.The cost of rearing pigs ranged from92.0 p/kg carcass weight (cw) and 94.6 p/kgcw forthe partly-slatted and fully-slatted systems,to 98.8 p/kgcw and 99.3 p/kgcw for the FreedomFood and free-range systems respectively. Whenspace allowance was increased by 60% to levelsin a recent proposal to revise pig welfareDirective (91/630/EEC), the rearing costs wereunchanged for the free-range system but rose by4.6 p/kgcw for the fully-slatted system. Rearingcosts under organic standards were 31% higherthan in the free-range system. These resultssuggest that improved pig welfare can beachieved with a modest increase in cost. (shrink)

Most jurisdictions require that a mental capacity assessment be conducted using a functional model whose definition includes several abilities. In England and Wales and in increasing number of countries, the law requires a person be able to understand, to retain, to use or weigh relevant information and to communicate one’s decision. But interpreting and applying broad and vague criteria, such as the ability ‘to use or weigh’ to a diverse range of presentations is challenging. By examining actual court judgements of (...) capacity, we previously developed a descriptive typology of justifications used in the application of the Mental Capacity Act criteria. We here critically optimise this typology by showing how clear definitions—and thus boundaries—between the criteria can be achieved if the ‘understanding’ criterion is used narrowly and the multiple rationales that fall under the ability to ‘use or weigh’ are specifically enumerated in practice. Such a typology-aided practice, in theory, could make functional capacity assessments more transparent, accountable, reliable and valid. It may also help to create targeted supports for decision making by the vulnerable. We also discuss how the typology could evolve legally and scientifically, and how it lays the groundwork for clinical research on the abilities enumerated by the MCA. No data are available. This paper does not report any original data. (shrink)

First Published in 1999. Routledge is an imprint of Taylor & Francis, an informa company.