_Covert treatment raises a number of ethical and practical issues in psychiatry. Viewpoints differ from the standpoint of psychiatrists, caregivers, ethicists, lawyers, neighbours, human rights activists and patients. There is little systematic research data on its use but it is quite certain that there is relatively widespread use. The veil of secrecy around the procedure is due to fear of professional censure. Whenever there is a veil of secrecy around anything, which is aided and abetted by vociferous opposition from some (...) sections of society, the result is one of two: 1) either the activity goes underground or 2) it is reluctantly discarded, although most of those who used it earlier knew it was needed. Covert treatment has the dubious distinction of suffering both such secrecy and disapproval. Covert treatment has a number of advantages and disadvantages in psychotic disorders. The advantages are that it helps solve practical clinical problems; prevents delays in starting treatment, which is associated with clinical risks and substantial costs; prevents risk of self-destructive behaviour and/or physical assault by patient; prevents relapse; and prevents demoralization of staff. The disadvantages are that it maybe used with malafide intent by caregivers with or without the complicity of psychiatrists; it may be used to force conformity in dissenters; and the clinician may land himself in legal tangles even with its legitimate use. In addition, it may prevent insight, encourage denial, promote unhealthy practices in the treating staff and prevent understanding of why noncompliance occurs in the first place. Some support its use in dementia and learning disorders but oppose it in schizophrenia. The main reason is that uncooperative patients of schizophrenia (and related psychoses) are considered to be those who refuse treatment but retain capacity; while in dementia and severe learning disorder, uncooperative patients are those who lack capacity. This paper disputes this contention by arguing that although uncooperative patients of schizophrenia (and related psychoses) apparently retain capacity, it is limited, in fact distorted, since they lack insight. It presents the concept of insight-unconsciousness in a patient of psychosis. Just as an unconscious patient has to be given covert medical/surgical treatment, similarly an insight-unconscious patient with one of the different psychoses (in the acute phase or otherwise) may also have to be given covert treatment till he regains at least partial insight. It helps control psychotic symptoms and assists the patient in regaining enough insight to realize he needs treatment. Another argument against covert treatment is that people with schizophrenia have the capacity to learn and therefore can learn that they are required to take medications, but if medications are given covertly it may well fuel their paranoia. However, it should be noted that the patient who has lack of insight cannot learn unless he regains that insight, and he may need covert treatment to facilitate this process. Covert treatment can fuel the paranoia, true, but it can also control the psychotic symptoms sufficiently so that regular treatment can be initiated. In a patient who refuses to accept that he is sick and when involuntary commitment is not an option to be considered, covert treatment is the only option, apart from physical restraint. Ultimately, a choice has to be made between a larger beneficence (control of symptoms and start of therapy) and a smaller malevolence (necessary therapy, but without the patient's knowledge and consent). A number of practical clinical scenarios are outlined wherein the psychiatrist should adopt covert treatment in the best interests of the patient. Ethical issues of autonomy, power, secrecy and malafide intent arise; each of these can be countered only by non-malfeasance (above all, do no harm) under the overarch of beneficence (even above that, dare to care). An advance directive with health care proxy that sanctions covert treatment is presented. Questions raised by the practical clinical scenarios are then answered. The conclusions are as follows: covert treatment, i.e, temporary treatment without knowledge and consent, is seldom needed or justified. But, where needed, it remains an essential weapon in the psychiatrist's armamentarium: to be used cautiously but without guilt or fear of censure. However, the psychiatrist must use it very judiciously, in the rarest of rare cases, provided: i) he is firmly convinced that it is needed for the welfare of the patient; ii) it is the only option available to tide over a crisis; iii) continuing efforts are made to try and get the patient into regular psychiatric care; iv) the psychiatrist makes it clear that its use is only as a stop-gap; v) he is always alert to the chances of malevolence inherent in such a process and keeps away from conniving or associating with anything even remotely suspicious; and vi) he takes due precautions to ensure that he does not land into legal tangles later. The need of the hour is to explore in greater detail the need and justification for covert treatment, to lay out clear and firm parameters for its legitimate use, follow it up with standard literature and, finally, to establish clinical practice guidelines by unconflicted authors. The term "covert treatment" is preferable to "surreptitious prescribing"; they should not be used synonymously, the latter term being reserved for those cases where there is malafide intent._. (shrink)

There is an alarming trend in the field of medicine, whose portents are ominous but do not seem to shake the complacency and merry making doing the rounds. The wants of the medical man have multiplied beyond imagination. The cost of organizing conferences is no longer possible on delegate fees. The bottom-line is: Crores for a Conference, Millions for a Mid-Term. However, the problem is that sponsors keep a discreet but careful tab on docs. All in all, costs of medicines (...) escalate, and quality medical care becomes a luxury. The whole brunt of this movement is borne by the patient. Companies like GlaxoSmithKline, Bayer, Pfizer, Bristol-Myers Squibb, AstraZeneca, Schering-Plough, Abbott Labs, TAP Pharmaceuticals, Wyeth and Merck have paid millions of dollars each as compensation in the last few years. The financial condition of many pharmaceutical majors is not buoyant either. Price deflation, increased Rand D spending, and litigation costs are the main reasons. In the future, the messy lawsuits situation would no longer be restricted to industry. It would involve academia and practising doctors as well. Indian pharma industry captains, who were busy raking in the profits at present, would also come under the scanner. If nothing else, it means industry and docs will have to sit down and do some soul searching. Both short and long-term measures will have to be put into place. Short-term measures involve reduction in i) pharma spending over junkets and trinkets; ii) hype over 'me too' drugs; iii) manipulation of drug trials; iv) getting pliant researchers into drug trials; iv) manipulation of Journal Editors to publish positive findings about their drug trials and launches; v) and for Indian Pharma, to conduct their own unbiased clinical trial of the latest drug projected as a blockbuster in the West, before pumping in their millions. The long-term measures are related to the way biomedical advance is to be charted. We have to decide whether medicine is to become a corporate enterprise or remain a patient welfare centered profession. A third approach involves an eclectic resolution of the two. Such amount of patient welfare as also ensures profit, and such amount of profit as also ensures patient welfare is to be forwarded. For, profit, without patient welfare, is blind. And patient welfare, without profit, is lame. According to this approach, medicine becomes a patient welfare centered professional enterprise. The various ramifications of each of these approaches are discussed in this monograph. (shrink)

The science of man, by A. Schaff.--The humanistic meaning of natural science, by R. Mukerjee.--The role of social sciences in the struggle for progress, by R. Schlesinger.--Scientific research in developing countries, by J. D. Bernal.--Problems of science and technology in underdeveloped countries by, D. D. Kosambi.--Priorities in scientific research for economic development, by J. Bognar.--Science and technology in underdeveloped countries, by S. H. Zaheer.--Science and scientific workers, by E. Olszewski.--Medical research in developing countries, by C. G. Pandit & N. P. (...) Gupta.--Changing society and crisis of enterprise, by Z. Tanic.--The university and society, by E. G. Edwards.--The intellectual and society, by V. B. Singh.--Indo-Soviet relations in retrospect, by K. P. S. Menon.--Fifteen years of cooperation between Indian and Soviet paediatricians, by I. N. Ussov. (shrink)

This article deals with detection and accommodation of sensor faults in longitudinal dynamics of an F8 aircraft model. Both the detection of the fault and reconfiguration of the failed sensor are done with the help of neural network-based models. Detection of a sensor fault is done with the help of knowledge-based neural network fault detection. Apart from KBNNFD, another neural network model is developed in this article for the reconfiguration of the failed sensor. A model-based approach of the neural network (...) is developed, which uses the radial basis function of the neural network. MBNN successfully does the task of providing analytical redundancy for the aircraft sensor. In this work, both detection and reconfiguration of a fault is done using neural networks. Hence, the control system becomes robust for handling sensor failures near steady state and reconfiguration is also faster. A generalized regression neural network, which is a type of radial basis network, is used for MBNN, which gives very efficient results for function approximation. An F8 aircraft model and C-Star controller, which improves its handling quality, are used for validation of the method involved. Models of F8 aircraft, C-Star controller, KBNNFD, and MBNN were developed using MATLAB/simulink. Successful implementation and simulation results are shown and discussed using Simulink. (shrink)

Throughout Christianity, its activities are in one way or another connected to the historical reality of its time. Usually, for different epochs, the strength of these bonds was different, but during the Middle Ages, they were significantly stronger than before and after. It is here that perhaps the most important moment was the rise of Christianity, which spread over a relatively short period of time almost throughout Europe. It was then - and never again in all its history - that (...) the Church was able to participate in the formation of all aspects of its contemporary life, in accordance with its spirit. When solving this task, it inevitably came in close contact with the "world" and the various forms in which it was represented. (shrink)

Millions of people in various parts of the world and within each country are presently surviving in categories described as “mere”, “miserable”, “idealistic”, “irresponsible”, and “acceptable”. The term “acceptable survival” is proposed as a bioethical goal of global survival, looking beyond the 21st century to the year 3000 and beyond. The frequently used alternative term is “sustainable development”, but in most contexts this is an economic concept and does not imply any moral or ethical constraints, except where these are spelled (...) out. Acceptable survival, broadly defined, means acceptable to a universal sense of what is morally right and good and what will continue in the long term. The expanding dominant, but irresponsible, world culture is not an acceptable type of development because it cannot survive in the long term. [M&GS 1995:185–191]. (shrink)

There Could Not Be A More Fundamental Approach To The Various Problems Of Education Than The One That The Learned Author, Who Is A Doyen In The Field Of ...

Study on Mānameyodaya of Nārāyaṇabhaṭṭapāda, treatise on Mimamsa philosophy.

The issues related to the multilingual situation in modern Bashkiria are discussed in the article, configuration of multilingualism is given on the basis of extensive and representative data of the latest census. Multilingual issues are discussed in the context of the social functions of philology, as well as a set of measures of a regulatory nature undertaken by the government and society to ensure social, ethno-cultural and inter-ethnic stability. The author believes that the language situation with multilingualism depends on a (...) number of sociolinguistic variables, but the invariant feature of all modifications of multilingualism in Bashkiria should be considered as a factor of the maximum level of language loyalty towards the Russian language. This factor provides a comprehensive and decisive impact on the conditions and status of multilingualism in the republic. (shrink)

This book challenges the widespread assumption of the incompatibility of evolution and the biological design argument. Kojonen analyzes the traditional arguments for incompatibility, and argues for salvaging the idea of design in a way that is fully compatible with evolutionary biology. Relating current views to their intellectual history, Kojonen steers a course that avoids common pitfalls such as the problems of the God of the gaps, the problem of natural evil, and the traditional Humean and Darwinian critiques. The resulting deconstruction (...) of the opposition between evolution and design has the potential to transform this important debate. (shrink)