Background: Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. (...) Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges. (shrink)

Over the past decades, mood enhancement effects of various drugs and neuromodulation technologies have been proclaimed. If one day highly effective methods for significantly altering and elevating one’s mood are available, it is conceivable that the demand for them will be considerable. One urgent concern will then be what role physicians should play in providing such services. The concern can be extended from literature on controversial demands for aesthetic surgery. According to Margaret Little, physicians should be aware that certain aesthetic (...) enhancement requests reflect immoral social norms and ideals. By granting such requests, she argues, doctors render themselves complicit to a collective ‘evil’. In this paper, we wish to question the extent to which physicians, psychiatrists and/or neurosurgeons should play a role as ‘moral gatekeepers’ in dealing with suspect demands and norms underlying potential desires to alter one’s mood or character. We investigate and discuss the nature and limits of physician responsibilities in reference to various hypothetical and intuitively problematic mood enhancement requests. (shrink)

Case Reports Int J Psychoanal -/- . 1989:70 ( Pt 3):461-79. Negative hallucinations, other irretrievable experiences and two functions of consciousness L W Brakel -/- PMID: 2793325 -/- Abstract -/- After providing a psychodynamic exploration of negative hallucinations in four clinical cases, the focus of this paper was broadened in an attempt to understand the mechanism of negative hallucination. To this end, after defining the term 'irretrievable experiences', two other examples--preconscious perceptions and infantile amnesia, both analogues to negative hallucination--were examined. (...) A discussion followed concerning two types of 'consciousness': 'consciousness' as a synonym for 'awareness' and 'consciousness' as a distinct psychological state. Next, the role of different functions of each sort of consciousness in the processes of conferring, fixing and retrieving mental contents within particular categories of experience was taken up. Finally, integrating developmental aspects of these same functions, explanations were offered regarding the mechanisms involved in preconscious perception, infantile amnesia and negative hallucinations. -/- PubMed. (shrink)

The level of medical care to patients and the success of the implementation of the national project "Health" depend on the health status and doctor's professionalism. Modern healthcare reform is being implemented by optimizing costs, merging medical organizations, closing ineffective hospitals, expanding the use of high-tech care and informatization of the doctor's activities. All this makes it necessary to assess the health of doctors. Scientists have studied the quality of life and identified the professional burnout of doctors in children's clinics (...) in different age groups. Primary care pediatricians have a higher quality of life score when compared to the standard [1]. However, all groups have a high level of professional burnout. The pre-retirement group of doctors has more unfavorable profile. They are highly professional specialists but may experience emotional discomfort because the pension system has been reformed. This situation requires the introduction of preventive work with doctors of this age as a group with great potential and capable of professional longevity. (shrink)

Introduction: Schools have become a primary setting for providing mental health care to youths in the U.S. School-based interventions have proliferated, but their effects on mental health and academic outcomes remain understudied. In this study we will implement and evaluate the effects of a flexible multidiagnostic treatment called Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems on students' mental health and academic outcomes.Methods and Analysis: This is an assessor-blind randomized controlled effectiveness trial conducted across five (...) school districts. School clinicians are randomized to either MATCH or usual care treatment conditions. The target sample includes 168 youths referred for mental health services and presenting with elevated symptoms of anxiety, depression, trauma, and/or conduct problems. Clinicians randomly assigned to MATCH or UC treat the youths who are assigned to them through normal school referral procedures. The project will evaluate the effectiveness of MATCH compared to UC on youths' mental health and school related outcomes and assess whether changes in school outcomes are mediated by changes in youth mental health.Ethics and Dissemination: This study was approved by the Harvard University Institutional Review Board. We plan to publish the findings in peer-reviewed journals and present them at academic conferences.Clinical Trial Registration:ClinicalTrials.gov ID: NCT02877875. Registered on August 24, 2016. (shrink)

Dandruff is a common scalp condition, which frequently causes psychological distress in those affected. Dandruff is considered to be caused by an interplay of several factors. However, the pathogenesis of dandruff remains under‐investigated, especially with respect to the contribution of the hair follicle. As the hair follicle exhibits unique immune‐modulatory properties, including the creation of an immunoinhibitory, immune‐privileged milieu, we propose a novel hypothesis taking into account the role of the hair follicle. We hypothesize that the changes and imbalance of (...) yeast and bacterial species, along with increasing proinflammatory sebum by‐products, leads to the activation of immune response and inflammation. Hair follicle keratinocytes may then detect these changes in scalp microbiota resulting in the recruitment of leukocytes to the inflammation site. These changes in the scalp skin immune‐microenvironment may impact hair follicle immune privilege status, which opens new avenues into exploring the role of the hair follicle in dandruff pathogenesis. Also see the video abstract here: https://youtu.be/mEZEznCYtNs. (shrink)

The South African government announced the much-discussed stay-at-home order between March 27 and April 30, 2020, during what was known as lockdown level 5, which meant that citizens were not allowed to leave their homes. The objective of this study is to assess the stay-at-home order against the global principles of the UDBHR. It is deducible that, in reference to the UDBHR, the government possessed the right to curtail individual liberty, thereby not infringing on Article 5 of the UDBHR and (...) therefore, in this context, passes the test of the UDBHR. However, it remains uncertain at present whether the limitation of freedom imposed by the South African stay-at-home order was successful in controlling the spread of COVID-19 and protecting individuals from harm. Initial investigations also indicate that individuals who are particularly vulnerable may not have received equitable treatment in accordance with the principle outlined in Article 10, therefore, it can be cautiously and modestly argued that the stay-at-home order does not withstand scrutiny when assessed against the UDBHR. Given the continued discussion about the efficacy of limiting freedom to control the spread of COVID-19, and the growing conviction that the advancement of justice is being called into question, the notion of least restriction ought to be considered seriously. Ten Have (2022) is correct in asserting that global bioethics should also seriously consider other principles beyond an almost exclusive focus on limiting individual freedom. The preliminary conclusion is that the potential implementation of the stay-at-home order in the future must be seriously reconsidered. (shrink)

On a survalorisé l’influence des traités de rhétorique sur les théories de la représentation à la Renaissance et à l’Âge classique et on a minoré voire ignoré celle de la physiognomonie. Afin de rendre compte de son rôle méconnu, cet article entend mettre à jour les origines physiognomoniques de la pathognomonie, examiner l’imbrication de la physiognomonie et de la pathognomonie durant cette période charnière qui marque un changement de paradigme, en ouvrant sur le cas de la physio-pathognomonie de Charles Le (...) Brun. (shrink)

This paper examines the attitudes of circumcised women towards female circumcision in a community where the practice is in vogue. Also described are the type of circumcision performed, who usually performs the circumcision and complications. One hundred volunteers across the social strata were interviewed by means of a structured questionnaire. Data were analysed using frequency tables. The study revealed that 62% of respondents favoured the practice as an instrument for the control of female sexuality and maintenance of cultural pride. Circumcision (...) is mainly by excision of the clitoris and the labia minora performed mainly by traditional birth attendants. Complications include severe pain, difficulty with urination and excessive bleeding. Based on the findings, it is suggested that communities where femal genital mutilation is practised as a social norm should be involved in any eradication campaign, with the support of national and international organisations. Research is also essential to understand FGM in order to design effective reforms. (shrink)

The problem of representing a single localized particle has played a crucial role in the historical development of quantum theories. In particular, the failure to construct a relativistically invariant position eigenstate was a contributing factor in the demise of the so-called relativistic quantum mechanics, in favor of quantum field theories. Nevertheless, non-locality which stems from standard accounts of Single-particle localization still presents itself as a problem in the form of Gerhard Hegerfeldt's eponymous theorem of 1974. Accepting that a link may (...) be maintained between invariance and 'objectivity,' it is shown how Hegerfeldt's paradoxical result arises in relativistic theories from a failure of objectivity of localization-the so-called 'Jericho effect'. (shrink)

The Johns Hopkins-Fogarty African Bioethics Training Program (FABTP) has offered a fully-funded, one-year, non-degree training opportunity in research ethics to health professionals, ethics committee members, scholars, journalists and scientists from countries across sub-Saharan Africa. In the first 9 years of operation, 28 trainees from 13 African countries have trained with FABTP. Any capacity building investment requires periodic critical evaluation of the impact that training dollars produce. In this paper we describe and evaluate FABTP and the efforts of its trainees.Our data (...) show that since 2001, the 28 former FABTP trainees have authored or co-authored 105 new bioethics-related publications; were awarded 33 bioethics-related grants; played key roles on 78 bioethics-related research studies; and participated in 198 bioethics workshops or conferences. Over the past nine years, trainees have collectively taught 48 separate courses related to bioethics and have given 170 presentations on various topics in the field. Many former trainees have pursued and completed doctoral degrees in bioethics; some have become editorial board members for bioethics journals. Female trainees were, on average, less experienced at matriculation and produced fewer post-training outputs than their male counterparts. More comprehensive studies are needed to determine the relationships between age, sex, previous experience and training program outputs. (shrink)

Randomised clinical trials provide the most valid means of establishing the efficacy of clinical therapeutics. Ethical standards dictate that patients and clinicians should not consent to randomisation unless there is uncertainty about whether any of the treatment options is superior to the others ("equipoise"). However, true equipoise is rarely present; most randomised trials, therefore, present challenging ethical dilemmas. Minimising the tension between science and ethics is an obligation of investigators and clinicians. This article briefly reviews several techniques for addressing this (...) issue and suggests that unbalanced randomisation, a technique rarely employed in current clinical trial practice, may be useful for enhancing the ethical design of human experimentation. (shrink)

The present essay is intended to supply amplification, and where necessary correction, to my previous article on Anaxagoras' philosophy. Since its publication important essays on the same subject have been written by Mr. Cyril Bailey and by Mr. F. M. Cornford, and the present essay is also an attempt to examine some of the theories put forward in them. There are one or two points which may be stated at the outset. The conclusions which I put forward five years ago (...) I still believe to be valid. Some of the presentation of the evidence, however, I now see to be misleading and inadequate, notably the treatment of Aristotle's evidence, which I now hope to deal with more fully, and to show that it lends even stronger support to my thesis. I should also say that my former use of ‘Elements’ as a convenient collective term to refer to the four Empedoclean Elements has proved confusing, since it was never intended to suggest that these substances were elements in Anaxagoras' system. I now refer to them by their names in full. (shrink)

It is important to recognize that the problem dealt with by Plato in the central part of the Sophist is one which arises from the use of certain Greek phrases, and has no necessary or direct connexion with metaphysics. We tend to obscure this fact if we use English terms such as ‘Being’, ‘Reality’, ‘Existence’, etc., in discussing the dialogue, and indeed make it almost impossible to understand what Plato is trying to do. It is the way in which die (...) Greek terms ỗν and μή ỗν and other such terms are used by the ‘sophists’ which gives rise to the problem. (shrink)

Discussion of the concept of evil in Indian philosophy.

Исследование осуществлено на базе широкого спектра буддийских текстов на языке оригинала. Для философов, историков, буддологов, психологов и культурологов.