Background Genuine uncertainty on superiority of one intervention over the other is called equipoise. Physician-investigators in randomized controlled trials need equipoise at least in studies with more than minimal risks. Ideally, this equipoise is also present in patient-participants. In pediatrics, data on equipoise are lacking. We hypothesize that 1) lack of equipoise at enrolment among parents may reduce recruitment; 2) lack of equipoise during participation may reduce retention in patients assigned to a less favoured treatment-strategy. Methods We compared preferences of (...) parents/patients at enrolment, documented by a questionnaire, with preferences developed during follow-up by an interview-study to investigate equipoise of child-participants and parents in the BeSt-for-Kids-study. This trial in new-onset Juvenile Idiopathic Arthritis-patients consists of three strategies. One strategy comprises initial treatment with a biological disease-modifying-antirheumatic-drug, currently not standard-of-care. Semi-structured interviews were conducted with 23 parents and 7 patients, median 11 months after enrolment. Results Initially most parents and children were not in equipoise. Parents/patients who refused participation, regularly declined due to specific preferences. Many participating families preferred the biological-first-strategy. They participated to have a chance for this initial treatment, and would even consider stopping trial-participation when not randomized for it. Their conviction of superiority of the biological-first strategy was based on knowledge from internet and close relations. According to four parents, the physician-investigator preferred the biological-first-strategy, but the majority stated that she had no preferred strategy. In phase 2, preferences tended to change to the treatment actually received. Conclusions Lack of equipoise during enrolment did not reduce study recruitment, mainly due to the fact that preferred treatment was only available within the study. Still, when developing a trial it is important to evaluate whether the physicians’ research question is in line with preferences of the patient-group. By exploring so-called ‘informed patient-group’-equipoise, successful recruitment may be enhanced and bias avoided. In our study, lack of equipoise during trial-participation did not reduce retention in those assigned to a less favoured option. We observed a change for preference towards treatment actually received, possibly explained by comparable outcomes in all three arms. (shrink)

We introduce the horizontal and vertical topologies on the product of topological spaces, and study their relationship with the standard product topology. We show that the modal logic of products of topological spaces with horizontal and vertical topologies is the fusion S4 ⊕ S4. We axiomatize the modal logic of products of spaces with horizontal, vertical, and standard product topologies.We prove that both of these logics are complete for the product of rational numbers ℚ × ℚ with the appropriate topologies.

The human blood coagulation system comprises a series of linked glycoproteins that upon activation induce the generation of downstream enzymes ultimately forming fibrin. This process is primarily important to arrest bleeding (hemostasis). Hemostasis is a typical example of a molecular machine, where the assembly of substrates, enzymes, protein cofactors and calcium ions on a phospholipid surface markedly accelerates the rate of coagulation. Excess, pathological, coagulation activity occurs in “thrombosis”, the formation of an intravascular clot, which in the most dramatic form (...) precipitates in the microvasculature as disseminated intravascular coagulation. Thrombosis occurs according to a biochemical machine model in the case of atherothrombosis on a ruptured atherosclerotic plaque, but may develop at a slower rate in venous thrombosis, illustrating that the coagulation machinery can act at different velocities. The separate coagulation enzymes are also important in other biological processes, including inflammation for which the rapid conversion of one coagulation factor by the other is not a prerequisite. The latter role of coagulation enzymes may be related to the old and probably maintained function of the coagulation machine in innate immunity. BioEssays 25:1220–1228, 2003. © 2003 Wiley Perioicals, Inc. (shrink)

We introduce the horizontal and vertical topologies on the product of topological spaces, and study their relationship with the standard product topology. We show that the modal logic of products of topological spaces with horizontal and vertical topologies is the fusion S4 ⊕ S4. We axiomatize the modal logic of products of spaces with horizontal, vertical, and standard product topologies.We prove that both of these logics are complete for the product of rational numbers ℚ × ℚ with the appropriate topologies.

We introduce the horizontal and vertical topologies on the product of topological spaces, and study their relationship with the standard product topology. We show that the modal logic of products of topological spaces with horizontal and vertical topologies is the fusion ${\bf S4}\oplus {\bf S4}$ . We axiomatize the modal logic of products of spaces with horizontal, vertical, and standard product topologies. We prove that both of these logics are complete for the product of rational numbers ${\Bbb Q}\times {\Bbb Q}$ (...) with the appropriate topologies. (shrink)

About one third of patients with epilepsy have seizures refractory to the medical treatment. Electrical stimulation mapping is the gold standard for the identification of “eloquent” areas prior to resection of epileptogenic tissue. However, it is time-consuming and may cause undesired side effects. Broadband gamma activity recorded with extraoperative electrocorticography during cognitive tasks may be an alternative to ESM but until now has not proven of definitive clinical value. Considering their role in cognition, the alpha and beta bands could further (...) improve the identification of eloquent cortex. We compared gamma, alpha and beta activity, and their combinations for the identification of eloquent cortical areas defined by ESM. Ten patients with intractable focal epilepsy participated in a delayed-match-to-sample task, where syllable sounds were compared to visually presented letters. We used a generalized linear model approach to find the optimal weighting of each band for predicting ESM-defined categories and estimated the diagnostic ability by calculating the area under the receiver operating characteristic curve. Gamma activity increased more in eloquent than in non-eloquent areas, whereas alpha and beta power decreased more in eloquent areas. Diagnostic ability of each band was close to 0.7 for all bands but depended on multiple factors including the time period of the cognitive task, the location of the electrodes and the patient’s degree of attention to the stimulus. We show that diagnostic ability can be increased by 3–5% by combining gamma and alpha and by 7.5–11% when gamma and beta were combined. We then show how ECoG power modulation from cognitive testing can be used to map the probability of eloquence in individual patients and how this probability map can be used in clinical settings to optimize ESM planning. We conclude that the combination of gamma and beta power modulation during cognitive testing can contribute to the identification of eloquent areas prior to ESM in patients with refractory focal epilepsy. (shrink)

The current COVID-19 pandemic has reactivated ancient metaphors but also initiated a new vocabulary: social distancing, lockdown, self-isolation, and sheltering in place. Terminology is not ethically neutral but reflects prevailing value systems. I will argue that there are two metaphorical vocabularies at work: an authoritarian one and a liberal one. Missing is an ecological vocabulary. It has been known for a long time that emerging infectious diseases are associated with the destruction of functioning ecosystems and biodiversity. Ebola and avian influenza (...) viruses have been significant warnings. Obviously, this pandemic will not be the last one. As the planet is our common home, the major metaphor to explore is sheltering at this home. (shrink)

The Database on Ethics Related Legislation and Guidelines was launched in March 2007 as the fourth database of the UNESCO Global Ethics Observatory system of databases in ethics of science and technology. The database offers a collection of legal instruments searchable by region, country, bioethical themes, legal categories and applicability to specific articles of the UNESCO Universal Declaration on Bioethics and Human Rights and International Declaration on Human Genetic Data. This paper discusses the background and rationale for the database and (...) its role as a consultative and comparative resource hub for the study of ethics related legal instruments across the world, with the purpose of informing and inspiring relevant stakeholders on the implementation of the principles contained within the UNESCO declarations on bioethics. (shrink)

Scholars have long been captivated by the parallels between birdsong and human speech and language. In this book, leading scholars draw on the latest research to explore what birdsong can tell us about the biology of human speech and language and the consequences for evolutionary biology. They examine the cognitive and neural similarities between birdsong learning and speech and language acquisition, considering vocal imitation, auditory learning, an early vocalization phase, the structural properties of birdsong and human language, and the striking (...) similarities between the neural organization of learning and vocal production in birdsong and human speech. After outlining the basic issues involved in the study of both language and evolution, the contributors compare birdsong and language in terms of acquisition, recursion, and core structural properties, and then examine the neurobiology of song and speech, genomic factors, and the emergence and evolution of language. Contributors: Hermann Ackermann, Gabriël J.L. Beckers, Robert C. Berwick, Johan J. Bolhuis, Noam Chomsky, Frank Eisner, Martin Everaert, Michale S. Fee, Olga Fehér, Simon E. Fisher, W. Tecumseh Fitch, Jonathan B. Fritz, Sharon M.H. Gobes, Riny Huijbregts, Eric Jarvis, Robert Lachlan, Ann Law, Michael A. Long, Gary F. Marcus, Carolyn McGettigan, Daniel Mietchen, Richard Mooney, Sanne Moorman, Kazuo Okanoya, Christophe Pallier, Irene M. Pepperberg, Jonathan F. Prather, Franck Ramus, Eric Reuland, Constance Scharff, Sophie K. Scott, Neil Smith, Ofer Tchernichovski, Carel ten Cate, Christopher K. Thompson, Frank Wijnen, Moira Yip, Wolfram Ziegler, Willem Zuidema. (shrink)

This contribution is a report of a two months' participant observation in a Dutch hospice. The goal of the observation was to gain an overview of moral decisions in a hospice in which euthanasia, a tolerated practice in the Netherlands, is not accepted as an option. In an introduction, the development of palliative care in the Netherlands will be briefly presented. Subsequently, various moral decisions that were taken during the participant observation are presented and analysed by means of case reports. (...) Attention is especially drawn to decisions that directly or indirectly relate to euthanasia. These moral decisions will be clarified in the light of the philosophy behind the concept of palliative care as it has evolved since the foundation of St Christopher's Hospice, London in 1967. (shrink)

Synthetic biology, as a research field, brings together molecular life scientists, computational biologists, and social scientists to engineer biological systems toward societally desired goals. Given the field’s broad multidisciplinarity and relatively young age, innovative educational methods are required to provide students with the needed background knowledge to push the field forward in the future. The international Genetically Engineered Machine competition is such an example where education and high-level research merge, providing the synthetic biology field with trained students, new ideas, and (...) novel results. In the 2021 edition alone, 343 teams from across the world completed the competition to tackle societal problems with synthetic biology. As Wageningen University & Research celebrates 10 years of participation in iGEM, we share our thoughts and experiences on supervising iGEM teams, which is especially relevant to organizers of current and new teams, and also others interested in the iGEM competition. (shrink)

Interactive technology assessment (iTA) provides an answer to the ethical problem of normative bias in evaluation research. This normative bias develops when relevant perspectives on the evaluand (the thing being evaluated) are neglected. In iTA this bias is overcome by incorporating different perspectives into the assessment. As a consequence, justification of decisions based on the assessment is provided by stakeholders having achieved agreement. In this article, agreement is identified with wide reflective equilibrium to show that it indeed has the potential (...) of justifying decisions. We work out several conditions for this agreement to be achievable and just. (shrink)

Solidarity belongs to the basic principles of Catholic Social Teaching (CST) and is part of the ethical repertoire of European moral traditions and European healthcare systems. This paper discusses how leaders of Catholic healthcare organizations (HCOs) can understand their institutional moral responsibility with regard to the preservation of solidarity. In dealing with this question, we make use of Taylor's philosophy of modern culture. We first argue that, just as all HCOs, Catholic ones also can embody and strengthen solidarity by just (...) doing their quintessential job, that is, to care for people with ill health. Second, we focus on the Catholic identity of these organizations and argue that this characteristic can empower a radical commitment to solidarity. Finally, we argue that CST provides a critical ethical framework for approaching solidarity from the perspective of the common good. (shrink)

OBJECTIVES: Cognitive and sensory difficulties frequently jeopardize informed consent of frail elderly patients This study is the first to test whether preliminary research experience could enhance geriatric patients' capacity to consent. DESIGN/SETTING: A step-wise consent procedure was introduced in a study on fluid balance in geriatric patients. Eligible patients providing verbal consent participated in a try-out of a week, during which bioelectrical impedance and weight measurements were performed daily. Afterwards, written informed consent was requested. Comprehension, risk and inconvenience scores (ranges: (...) 0-10) were obtained before and after the try-out by asking ten questions about the study's essentials and by asking for a risk and inconvenience assessment on a ten-points rating scale. SUBJECTS AND RESULTS: Seventy of the 78 eligible subjects started the try-out and 53 (68%) provided written consent. The comprehension score increased from 5.0 (+/- 2.3) to 7.0 (+/- 1.9) following the try-out (P < 0.001). The number of subjects capable of weighing risks and inconveniences increased from 32 to 48 (P < 0.001). CONCLUSIONS: Research experience improved the capacity to consent, still enabling an acceptable participation rate. Therefore, experienced consent seems a promising tool to optimize informed consent in frail elderly subjects. (shrink)

The growth of knowledge and its effects on the practice of medicine have been issues of philosophical and ethical interest for several decades and will remain so for many years to come. The outline of the present volume was conceived nearly three years ago. In 1987, a conference on this theme was held in Maastricht, the Netherlands, on the occasion of the founding of the European Society for Philosophy of Medicine and Health Care (ESPMH). Most of the chapters of this (...) book are derived from papers presented at that meeting, and for the purpose of editing the book Stuart Spicker, Ph. D., joined two founding members of ESPMH, Henk ten Have and Gerrit Kimsma. The three of them successfully brought together a number of interesting contribu tions to the theme, and ESPMH is grateful and proud to have initiated the production of this volume. The Society intends that annual meetings be held in different European countries on a rotating basis and to publish volumes related to these meetings whenever feasible. In 1988, the second conference was held in Aarhus, Denmark on "Values in Medical Decision Making and Resource Allocation in Health Care". In 1989, a meeting was held in Czestochowa, Poland, on "European Traditions in Philosophy of Medicine. From Brentano to Bieganski". It is hoped that these conferences and the books to be derived from them, will initiate a new European tradition, lasting well into the 21 st century! P. J. (shrink)

In this essay the authors provide arguments that teaching is an art and that teachers can learn much about their trade from a careful study of the performances of other artists. Artists and teachers have the same basic challenge: in order to be successful, both groups have to obtain and retain peoples’ attention. This also holds for popular music artists. Ten female student teachers specializing in the Pre-school and Foundation phases of schooling (four-to-six-year olds), and six lecturers from the Faculty (...) of Education at the University of the Free State, Bloemfontein, South Africa, participated in a workshop at a local game lodge. During the workshop, videos of ABBA songs and Mamma Mia! The Movie were analyzed and discussed. The theme of the workshop was “Being an Excellent Teacher: Appreciating ABBA.” The 4D-cycle of Appreciative Inquiry– Discover, Dream, Design and Destiny–was used as a methodological framework to identify numerous positive themes with possible classroom applications from the songs and the film. These themes were then connected to educational theory and embedded in the insights of Benny Andersson, Björn Ulvaeus, Judy Cramer and other people involved with ABBA. A reflective report by one student teacher about the impact the workshop had on her views of teaching and an excellent class that she presented is also included. (shrink)

Objective To evaluate the modes of death and treatment offered in the last 24 h of life to patients dying in 10 Brazilian intensive care units (ICUs) over a period of 2 years. Design and setting Cross-sectional, multicentre, retrospective study based on medical chart review. The medical records of all patients that died in seven paediatric and three adult ICUs belonging to university and tertiary hospitals over a period of 2 years were included. Deaths in the first 24 h of (...) admission to the ICU and brain death were excluded. Intervention Two intensive care fellows of each ICU were trained in fulfilling a standard protocol (κ=0.9) to record demographic data and all medical management provided in the last 48 h of life. The Student t test, Mann–Whitney U test, χ2 test and RR were used for data comparison. Measurements and main results 1053 medical charts were included (59.4% adult patients). Life support limitation was more frequent in the adult group (86% vs 43.5%; p<0.001). A ‘do not resuscitate’ order was the most common life support limitation in both groups (75% and 66%), whereas withholding/withdrawing were more frequent in the paediatric group (33.9% vs 24.9%; p=0.02). The life support limitation was rarely reported in the medical chart in both groups (52.6% and 33.7%) with scarce family involvement in the decision making process (23.0% vs 8.7%; p<0.001). Conclusion Life support limitation decision making in Brazilian ICUs is predominantly centred on the medical perspective with scarce participation of the family, and consequently several non-coherent medical interventions are observed in patients with life support limitation. (shrink)

These comments start, as they must, from the text of I. Hilberg in the Vienna corpus.1 This was the first properly critical edition of the Letters,and has not been superseded. It is, however, not without its limitations. In establishing his text Hilberg considered only a few MSS for each letter: for epist.1, seven, and for epist.107, six, in one of which the letter is represented twice, though in neither case is it complete.Hilberg promised a volume of prolegomena and indices to (...) accompany his text;2 but it seems that he died before it could appear, and we do not know how he assessed his MSS, or how many he consulted before making his choice.What we do know is that those on which he relied form a very small proportion of those which exist.B.Lambert′s catalogue of Jerome MSS3 lists 138 for epist.1 and 145 for epist.107, of which ten and thirteen respectively are dated ninth-to-tenth-century or earlier - and Lambert is well aware that his list cannot pretend to be exhaustive.4 Furthermore, there is some reason to doubt the accuracy of the collations which form the basis of Hilberg′s edition.5 It is evident that much work remains to be done before a definitive edition can be produced.Meanwhile Hilberg′s text is the best we have, and where I cite MSS I follow the readings of his apparatus criticus.6 The phrase ‘the MSS’ refers, in this article, only to those which Hilberg utilised. (shrink)

This volume is a comprehensive roadmap to the burgeoning area of affective sciences, which now spans several disciplines. The Handbook brings together, for the first time, the various strands of inquiry and latest research in the scientific study of the relationship between the mechanisms of the brain and the psychology of mind. In recent years, scientists have made considerable advances in understanding how brain processes shape emotions and are changed by human emotion. Drawing on a wide range of neuroimaging techniques, (...) neuropsychological assessment, and clinical research, scientists are beginning to understand the biological mechanisms for emotions. As a result, researchers are gaining insight into such compelling questions as: How do people experience life emotionally? Why do people respond so differently to the same experiences? What can the face tell us about internal states? How does emotion in significant social relationships influence health? Are there basic emotions common to all humans? This volume brings together the most eminent scholars in the field to present, in sixty original chapters, the latest research and theories in the field. The book is divided into ten sections: Neuroscience; Autonomic Psychophysiology; Genetics and Development; Expression; Components of Emotion; Personality; Emotion and Social Processes; Adaptation, Culture, and Evolution; Emotion and Psychopathology; and Emotion and Health. This major new volume will be an invaluable resource for researchers that will define affective sciences for the next decade. (shrink)

This book is an explication of a Westerner's understanding of Buddhism. Though the section headings, "Basic Buddhism," "Deeper Truths of Buddhism," and "Zen Buddhism" might suggest that the author is seeking to explain Buddhism on its own grounds, the author has not intended such. He is seeking to make Buddhism available to Westerners through explaining his own acceptance of the Buddhist way. Thus his book explains no particular school within Buddhism and is not very helpful as a key to Buddhism (...) as it is and was in Asia. Rather it is the culmination of a life's study of the subject and a personal confession of the author's own beliefs. The book is interspersed with ten poems written by the author called "Suffering," "Deck Chair, Brighton," "When I am Dead," "Youth in Age," "We Live in Boxes," "In Search of Nothing," "Rootless Thought," "Beyond," "Jijimuge," and "The Void is Full." The book is best suited for those whose interest in Buddhism is very light and who would prefer to read about a westerner's Buddhism.--P. J. H. (shrink)

Background: Islam and Muslims are underrepresented in the medical literature and the influence of physician’s cultural beliefs and religious values upon the clinical encounter has been understudied. Objective: To elicit the perceived influence of Islam upon the practice patterns of immigrant Muslim physicians in the USA. Design: Ten face-to-face, in-depth, semistructured interviews with Muslim physicians from various backgrounds and specialties trained outside the USA and practising within the the country. Data were analysed according to the conventions of qualitative research using (...) a modified grounded-theory approach. Results: There were a variety of views on the role of Islam in medical practice. Several themes emerged from our interviews: (1) a trend to view Islam as enhancing virtuous professional behaviour; (2) the perception of Islam as influencing the scope of medical practice through setting boundaries on career choices, defining acceptable medical procedures and shaping social interactions with physician peers; (3) a perceived need for Islamic religious experts within Islamic medical ethical deliberation. Limitations: This is a pilot study intended to yield themes and hypotheses for further investigation and is not meant to fully characterise Muslim physicians at large. Conclusions: Immigrant Muslim physicians practising within the USA perceive Islam to play a variable role within their clinical practice, from influencing interpersonal relations and character development to affecting specialty choice and procedures performed. Areas of ethical challenges identified include catering to populations with lifestyles at odds with Islamic teachings, end-of-life care and maintaining a faith identity within the culture of medicine. Further study of the interplay between Islam and Muslim medical practice and the manner and degree to which Islamic values and law inform ethical decision-making is needed. (shrink)

Neuroenhancement involves the use of neurotechnologies to improve cognitive, affective or behavioural functioning, where these are not judged to be clinically impaired. Questions about enhancement have become one of the key topics of neuroethics over the past decade. The current study draws on in-depth public engagement activities in ten European countries giving a bottom-up perspective on the ethics and desirability of enhancement. This informed the design of an online contrastive vignette experiment that was administered to representative samples of 1000 respondents (...) in the ten countries and the United States. The experiment investigated how the gender of the protagonist, his or her level of performance, the efficacy of the enhancer and the mode of enhancement affected support for neuroenhancement in both educational and employment contexts. Of these, higher efficacy and lower performance were found to increase willingness to support enhancement. A series of commonly articulated claims about the individual and societal dimensions of neuroenhancement were derived from the public engagement activities. Underlying these claims, multivariate analysis identified two social values. The Societal/protective highlights counter normative consequences and opposes the use enhancers. The Individual/proactionary highlights opportunities and supports use. For most respondents these values are not mutually exclusive. This suggests that for many neuroenhancement is viewed simultaneously as a source of both promise and concern. (shrink)