Although tissue plasminogen activator (tPA) is the only medication approved by the United States Food and Drug Administration (FDA) for acute ischemic stroke, there is no consensus about the need for informed consent for its use. As a result, hospitals throughout the U.S. have varying requirements regarding obtaining informed consent from patients for the use of tPA, ranging from no requirement for informed consent to a requirement for verbal or written informed consent. We conducted a study to (1) determine current (...) beliefs about obtaining patients’ informed consent for tPA among a large group of stroke clinicians and (2) identify the ethical, clinical, and organizational factors that influence tPA consent practices. Semi-structured interviews were conducted by trained and experienced investigators and research staff to identify key barriers to implementing acute stroke services. Part of the interview explored current beliefs and practices around informed consent for tPA.This was a multicenter study that included 38 Veterans Health Administration (VHA) hospital locations. Participants were 68 stroke team clinicians, serving primarily on the neurology (35 percent) or emergency medicine (41 percent) service. We conducted thematic analysis based on principles of grounded theory to identify codes about consent for tPA. We used interpretive convergence to ensure consistency among the individual investigators’ codes and to ensure that all of the investigators agreed on coding and themes.We found that 38 percent of the stroke clinicians did not believe any form of consent was necessary for tPA, 47 percent thought that some form of consent was necessary, and 15 percent were unsure. Clinicians who believed tPA required informed consent were divided on whether consent should be written (40 percent) or verbal (60 percent). We identified three factors describing clinicians’ attitudes about consent: (1) legal and policy factors, (2) ethical factors, and (3) medical factors.The lack of consensus regarding consent for tPA creates the potential for delays in treatment, uneasiness among clinicians, and legal liability. The identified factors provide a potential framework to guide discussions about developing a standard of care for acquiring the informed consent of patients for the administration of tPA. (shrink)

The class $$\mathsf{TPA}$$ TPA of t rue p airing a lgebras is defined to be the class of relation algebras expanded with concrete set theoretical projection functions. The main results of the present paper is that neither the equational theory of $$\mathsf{TPA}$$ TPA nor the first order theory of $$\mathsf{TPA}$$ TPA are decidable. Moreover, we show that the set of all equations valid in $$\mathsf{TPA}$$ TPA is exactly on the $$\Pi ^1_1$$ Π 1 1 level. We consider the class $$\mathsf{TPA}^-$$ (...) TPA - of the relation algebra reducts of $$\mathsf{TPA}$$ TPA ’s, as well. We prove that the equational theory of $$\mathsf{TPA}^-$$ TPA - is much simpler, namely, it is recursively enumerable. We also give motivation for our results and some connections to related work. (shrink)

Tissue plasminogen activator (tPA) is administered to patients with suspected ischemic stroke to improve blood flow to the brain In rare cases, patients present with complaints of stroke symptoms that appear to be non-organic due to malingering, factitious disorder, or conversion disorder (psychogenic stroke mimics). Deciding whether or not to administer tPA to these patients can be challenging. The risk of hemorrhage after administration of tPA is low, but not zero. The ethical principles of beneficence and nonmaleficence need to be (...) weighed carefully in these situations. We present two cases of patients with suspected psychogenic stroke mimics to illustrate the ethical challenges faced in identifying and managing psychogenic stroke mimics. Further research is needed to demonstrate effective treatment strategies for patients with acute stroke symptoms of psychogenic etiology. (shrink)

My paper provides a preliminary work towards a theory of freedom and agency which I name "Theory of Procedural Agency (TPA)". Since TPA relies on intuitions which can not be settled into the metaphysical framework of contemporary approaches to freedom and agency, I focus on some reasons which explain why these intuitions should be preferred to the competing ones. My strategy is to argue for my view defending an embryonal version of TPA, that is Berkeley's considerations on free will, agency (...) and determinism. In the first section I deal with Berkeley's treatment of free will. My idea is that his arguments offer clear and evident reasons in support of the first intuition grounding a TPA like approach to freedom. In the second section I move some criticisms to Berkeley's theory of will, claiming that, in order to overcome these, the assumption of the constitution view concerning self-knowledge would help. In the third section I set forth a logical formulation for TPA, showing how Berkeley's consideration on agency provide grounding reasons for that. Finally, in the last section, I plan the work to be done to achieve a consistent and complete version of TPA. (shrink)

This article draws attention to an understudied phenomenon, transnational political alliances (TPA), which occur when multinational corporations cooperate with local companies to influence public policies of the host government. The article first explores the economic and political sources of TPAs, their structures, and the obstacles to their formation. It then examines TPAs in the context of China, a critical case because of the hostile political environment that discourages TPAs. However, the surprisingly common occurrence of TPAs in China indicates the power (...) of economic incentives for political cooperation yet also suggests the need for further studies of TPAs in a wide variety of economic and political settings. (shrink)

Alexander von Humboldt’s depictions of mountain vegetation are among the most iconic nineteenth century illustrations in the biological sciences. Here we analyse the contemporary context and empirical data for all these depictions, namely the _Tableau physique des Andes_ (1803, 1807), the _Geographiae plantarum lineamenta_ (1815), the _Tableau physique des Îles Canaries_ (1817), and the _Esquisse de la Géographie des plantes dans les Andes de Quito_ (1824/1825). We show that the Tableau physique des Andes does not reflect Humboldt and Bonpland’s field (...) data and presents a flawed depiction of plant occurrences and vertical succession of vegetation belts, arising from Humboldt’s misreading of La Condamine’s description (1751). Humboldt's 1815 depiction, by contrast, shows a distribution of high-vegetation belts that is consistent with La Condamine’s description, while the 1824 depiction drops innovations made in 1815 and returns to simply showing numerous species’ names, thus not applying Humboldt’s own earlier zonation framework. Our analysis of contemporary reactions to Humboldt’s TPA includes Francis Hall’s posthumously published 1834 illustration of Andean plant zonation near Quito and Humboldt’s reaction to Hall’s critique. Throughout his work on plant geography, Humboldt disregarded some of his own observations, or confused them. At stake was his reputation as an innovator in the field of plant geography and a discoverer of the sequence of high-elevation vegetation belts on the world’s mountains. (shrink)

Developing a national code for psychologists is a complex process that requires endurance and a proper understanding of not only contemporary needs but also cultural conditions. There are many issues to be considered carefully. It is better to look at code development beyond a text creation and rather as a process in which an ethics system may be created. In order not to merely repeat well-known codes, there are several steps that should be considered. This article intends to address the (...) conflict between suitability to the larger ethical systems and creating an innovative text. As a recent example, the development of the Turkish Psychological Association (TPA) ethics code is presented. (shrink)

BackgroundObtaining informed consent for intravenous thrombolysis in acute ischemic stroke can be challenging, and little is known about if and how the informed consent procedure is performed by neurologists in clinical practice. This study examines the procedure of informed consent for intravenous thrombolysis in acute ischemic stroke in high-volume stroke centers in the Netherlands.MethodsIn four high volume stroke centers, neurology residents and attending neurologists received an online questionnaire concerning informed consent for thrombolysis with tissue-type plasminogen activator (tPA). The respondents were (...) asked to report their usual informed consent practice for tPA treatment and their considerations on whether informed consent should be obtained.ResultsFrom the 203 invited clinicians, 50% (n = 101) completed the questionnaire. One-third of the neurology residents (n = 21) and 21% of the neurologists (n = 8) reported that they always obtain informed consent for tPA treatment. If a patient is not capable of providing informed consent, 30% of the residents (n = 19) reported that they start tPA treatment without informed consent. In these circumstances, 53% of the neurologists (n = 20) reported that the resident under their supervision would start tPA treatment without informed consent. Most neurologists (n = 21; 55%) and neurology residents (n = 45; 72%) obtained informed consent within one minute. None of the respondents used more than five minutes for informed consent. Important themes regarding obtaining informed consent for treatment were patients’ capacity, and medical, ethical and legal considerations.ConclusionThe current practice of informed consent for thrombolysis in acute ischemic stroke varies among neurologists and neurology residents. If informed consent is obtained, most clinicians stated to obtain informed consent within one minute. In the future, a shortened information provision process may be applied, making a shift from informed consent to informed refusal, while still considering the patient’s capacity, stroke severity, and possible treatment delays. (shrink)

We examine the impact of a government-initiated CSR project on corporate misconduct using the unique setting of China’s Targeted Poverty Alleviation (TPA) program. The difference-in-differences estimates show that firms participating in the TPA program engage in fewer misconduct activities than do their counterparts. This finding is robust to the parallel trends test, the placebo test, alternative regression specifications, alternative research designs, the reverse causality analysis, and the bivariate probit model with partial observability. Further analysis shows that TPA participation enhances the (...) ability of external financial professionals to monitor performance by stimulating the dissemination of TPA-related incremental information, thereby contributing to the decline in corporate misconduct. The cross-sectional heterogeneity analysis shows that the impact of TPA participation on corporate misconduct is more pronounced in firms with higher information asymmetry, with weaker political connections, and with weaker internal governance. Furthermore, we find evidence that TPA participation improves corporate financial performance but does not deteriorate information transparency. (shrink)

This is a translation from Russian to English of Nikolai Onufriyevich Lossky’s “Tpaнcцeндeнтaльнo-фeнoмeнoлoгичecкiй идeaлизмъ Гyccepля”, published in the émigré journal Пyть in 1939. In this article, Lossky presents and criticizes Husserl’s transcendental idealism. Like many successors of Husserl’s “Göttingen School,” Lossky interprets Husserl’s transcendental idealism as a Neo-Kantian idealism and he criticizes it on the ground that it leads to a form of solipsism. In light of his own epistemology and his metaphysical system, he also claims that, although Husserl is (...) more radical than Descartes in his methodological doubt, he is not radical enough, because his abstention from existential judgment with regard to the external world is itself an existential judgment. In this regard, Lossky affirms that his own critically-informed defense of naive realism is in fact more radical than Husserl’s transcendental idealism. (shrink)

This article draws attention to an understudied phenomenon, transnational political alliances (TPA), which occur when multinational corporations cooperate with local companies to influence public policies of the host government. The article first explores the economic and political sources of TPAs, their structures, and the obstacles to their formation. It then examines TPAs in the context of China, a critical case because of the hostile political environment that discourages TPAs. However, the surprisingly common occurrence of TPAs in China indicates the power (...) of economic incentives for political cooperation yet also suggests the need for further studies of TPAs in a wide variety of economic and political settings. (shrink)

Background:To date, most research on aggression in mental disorders focused on active-aggressive behavior and found self-directed and other-directed active aggression to be a symptom and risk-factor of psychopathology. On the other hand, passive-aggressive behavior has been investigated less frequently and only in research on psychodynamic defense mechanisms, personality disorders, and dysfunctional self-control processes. This small number of studies primarily reflects a lack of a reliable and valid clinical assessment of passive-aggressive behavior. To address this gap, we developed the Test of (...) Passive Aggression (TPA), a 24-item self-rating scale for the assessment of self-directed and other-directed passive-aggressive behavior.Method:Study 1 examined the internal consistency and factorial validity of the TPA in an inpatient sample (N= 307). Study 2 investigated the retest-reliability, internal consistency, and construct validity (active aggression, personality traits, impulsivity) of the TPA in a student sample (N= 180).Results:In line with our hypothesis, Exploratory Structural Equation Modeling revealed an acceptable to good fit of a bi-factorial structure of the TPA (Chi-square-df-ratio= 1.98;RMSR= 0.05, fit.off = 0.96). Both TPA scales showed good to excellent internal consistency (α= 0.83–0.90) and 4-week retest-reliability (rtt= 0.86). Correlations with well-established aggression scales, measures of personality, and impulsivity support discriminant and convergent validity of the TPA.Conclusions:The TPA is a reliable and valid instrument for the assessment of self-directed and other-directed passive-aggressive behavior. (shrink)

Robot-assisted retinal cannulation is an eye surgical procedure which can dissolve the obstruction by using robot to inject anticoagulant into occluded vessel. The current research on the critical parameters of cannulation for human is scarce because of the immature technology. Considering the influence of microneedle, this work investigated the effects of drug concentration, injection velocity, injection position, and size of clot on cannulation by theoretical analysis and finite element analysis. For finite element analysis, the multiphysics continuum model was established to (...) demonstrate species transport and reaction which simulates the entire lytic process of the occlusive clot, and four cell zones were established to describe the generation of plasmin with the addition of tissue-type plasminogen activator and fibrinolysis of clot by importing subroutines into each cell zone under the conditions of constant clot size and variable size, respectively. The results imply that the most efficient value of tPA concentration is 50 nM, injection velocity is 60 mm/s for clot length of 0.1 mm, and the best position to insert the cannula is 0.5 mm in front of the thrombus. For different clot lengths of 0.1 mm to 0.6 mm, the optimal range of tPA concentration and injection velocity is from 20 nM to 70 nM and from 40 mm/s to 60 mm/s, respectively, and explores the reasonable injection position of 0.3 mm to 0.5 mm in front of clot in a vein of 100 μm. This conclusion can be used to perform robot-assisted cannulation surgery to improve fibrinolytic efficiency. (shrink)