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)

The Declaration of Helsinki and the Council of the International Organization of Medical Sciences provide guidance on standards of care and prevention in clinical trials. In the current and increasingly challenging research environment, the ethical status of a trial design depends not only on protection of participants, but also on social value, feasibility, and scientific validity. Using the example of a study assessing efficacy of a vaccine to prevent human papilloma virus in HIV-1 infected adolescent girls in low resource countries (...) without access to the vaccine, we compare several trial designs which rank lower on some criteria and higher on others, giving rise to difficult trade-offs. This case demonstrates the need for developing more nuanced guidance documents to help researchers balance these often conflicting criteria. (shrink)

‘Mysticism means to isolate the eternal from the originated.’ This is not my definition of the word ‘mysticism’ but that of the founder of the ‘orthodox’ school of Muslim mysticism, Al-Junayd of Baghdad who flourished in the ninth century a.d . In actual fact it is not a definition of mysticism at all but of the Arabic word tawḥīd which means primarily ‘the affirmation of unity’; and that surely is an essential ingredient of any form of mysticism: it is the (...) affirmation through personal experience of unity either absolutely or in some qualified sense. (shrink)

As everyone knows, since the end of the Second World War there has been a sensational revival of interest in the non-Christian religions particularly in the United States and in this country. The revival has taken two forms, the one popular, the other academic. The first of these has turned almost exclusively to Hindu and Buddhist mysticism and can be seen as an energetic reaction against the dogmatic and until very recently rigid structure of institutionalised Christianity and a search for (...) a lived experience of the freedom of the spirit which is held to be the true content of mysticism, obscured in Christianity by the basic dogma of a transcendent God, the ‘wholly Other’ of Rudolf Otto and his numerous followers, but wholly untrammelled by any such concept in the higher reaches of Vedanta and Buddhism, particularly in its Zen manifestation. On the academic side the picture is less clear. There is, of course, the claim that the study of religion, like any other academic study, must be subjected to and controlled by the same principles of ‘scientific’ objectivity to which the other ‘arts’ subjects have been subjected, to their own undoing. But even here there would seem to be a bias in favour of the religions of India and the Far East as against Islam, largely, one supposes, in response to popular demand. (shrink)

The present commentary on it greatly contributes to the understanding of thisvery important work. In fact, it is a good expositary commentary, lucidly explaning the knotty points. It evinces deep study and understanding of Navya-Nyaya and its methodology.yhus, the sukhabodhika Tippanika represents a positive and distinctive contribution to the vast commercial literature on the Tattvacimtamani.

Hawthorne and Magidor's criticisms of the model of presupposition and assertion that I have used and defended are all based on a rejection of some transparency or introspection of assumptions about speaker presupposition. This response to those criticisms aims first to clarify, and then to defend, the required transparency assumptions. It is argued, first, that if the assumptions are properly understood, some prima facie problems for them do not apply, second, that rejecting the assumptions has intuitively implausible consequences, and third, (...) that the 'margin of error' argument against the principle of positive introspection has a false premiss. The paper concludes with a response to a criticism of what Hawthorne and Magidor call 'the uniformity principle' that is used in the model to explain some pragmatic phenomena. (shrink)

The aim of this study was to test red - green dichromats' ability to discriminate between illuminant and surface-reflectance changes in natural scenes. Stimuli were simulations of natural scenes presented on a colour monitor with 10-bit resolution per gun. The natural scenes were obtained with a fast hyperspectral imaging system. Six different scenes (including rocks, foliage, and buildings) were tested. In each trial, two images were presented in sequence, each for 1 s, with no interval. The images differed in the (...) phase of daylight on the scene: first with correlated colour temperature 25 000 K, then 6 700 K. The spectral reflectance of a region in the second image was changed randomly, consistent with a local change in daylight. The observer's task was to decide whether a particular surface in the successive images was the same (pure illuminant change) or different (illuminant change with a surface-reflectance change). The performance of four deuteranopes and five protanopes varied considerably across the scenes tested, with mean colour constancy indices (± 1 SEM) of 0.48 (± 0.13) and 0.19 (± 0.10), respectively (1.0 representing ideal performance). Deuteranopes seemed less disadvantaged than protanopes, performing close to normal with some scenes. (shrink)