The success of the Human Genome Project has prompted interest in advancing the nascent field of exposomics. The exposome, which is dynamic and variable and changes over time, consists of all the internal and external exposures an individual has over a lifetime beginning with the prenatal period and early childhood. Efforts are underway to decipher the human epigenome by identifying the effects of all deleterious environmental exposures according to duration of exposure and time period. In this article, we argue that (...) the deciphering of the human exposome should be accompanied by sustained efforts to address the ethical, social and legal implications (ELSI) of exposomics. This will require financial investments from the National Institutes of Health (NIH), the European Union and other public and private funding agencies, analogous to support provided by NIH to address ELSI issues in genomics. (shrink)

This paper explores the notion of reciprocity in the context of active pulmonary and laryngeal tuberculosis treatment and related control policies and practices. We seek to do three things: First, we sketch the background to contemporary global TB care and suggest that poverty is a key feature when considering the treatment of TB patients. We use two examples from TB care to explore the role of reciprocity: isolation and the use of novel TB drugs. Second, we explore alternative means of (...) justifying the use of reciprocity through appeal to different moral and political theoretical traditions. We suggest that each theory can be used to provide reasons to take reciprocity seriously as an independent moral concept, despite any other differences. Third, we explore general meanings and uses of the concept of reciprocity, with the primary intention of demonstrating that it cannot be simply reduced to other more frequently invoked moral concepts such as beneficence or justice. We argue that reciprocity can function as a mid-level principle in public health, and generally, captures a core social obligation arising once an individual or group is burdened as a result of acting for the benefit of others. We conclude that while more needs to be explored in relation to the theoretical justification and application of reciprocity, sufficient arguments can be made for it to be taken more seriously as a key principle within public health ethics and bioethics more generally. (shrink)

Protection of human participants is a fundamental facet of biomedical research. We report the activities of a health service research study in which there were three institutional review boards (IRBs), three legal departments and one research administration department providing recommendations and mandating changes in the study methods. Complying with IRB requirements can be challenging, but can also adversely affect study outcomes. Multiple protocol changes mandated from multiple IRBs created a research method that was not reflective of how substance use screening (...) would be performed in a clinical setting. There was direct conflict between the IRBs' perceptions of participants' protection with the researchers' need to use research methodology that assures the clinical relevancy of results. (shrink)

There is widespread belief that connectionist networks are dramatically different from classical or symbolic models. However, connectionists rarely test this belief by interpreting the internal structure of their nets. A new approach to interpreting networks was recently introduced by Berkeley et al. (1995). The current paper examines two implications of applying this method: (1) that the internal structure of a connectionist network can have a very classical appearance, and (2) that this interpretation can provide a cognitive theory that cannot be (...) dismissed as a mere implementation. (shrink)

Recent policy in relation to clinical research proposals in the UK has distinguished between two types of review: scientific and ethical. This distinction has been formally enshrined in the recent changes to research ethics committee structure and operating procedures, introduced as the UK response to the EU Directive on clinical trials. Recent reviews and recommendations have confirmed the place of the distinction and the separate review processes. However, serious reservations can be mounted about the science/ethics distinction and the policy of (...) separate review that has been built upon it. We argue here that, first, the science/ethics distinction is incoherent, and, second, that RECs should not only be permitted to consider a study’s science, but that they have anobligation do so. (shrink)

Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)

The thesis of this article is that engagement and suffering are essential aspects of responsible caregiving. The sense of medical responsibility engendered by engaged caregiving is referred to herein as clinical phronesis, i.e. practical wisdom in health care, or, simply, practical health care wisdom. The idea of clinical phronesis calls to mind a relational or communicative sense of medical responsibility which can best be understood as a kind of virtue ethics, yet one that is informed by the exigencies of moral (...) discourse and dialogue, as well as by the technical rigors of formal reasoning. The ideal of clinical phronesis is not (necessarily) contrary to the more common understandings of medical responsibility as either beneficence or patient autonomy — except, of course, when these notions are taken in their disengaged form (reflecting the malaise of modern medicine). Clinical phronesis, which gives rise to a deeper, broader, and richer, yet also to a more complex, sense than these other notions connote, holds the promise both of expanding, correcting, and perhaps completing what it currently means to be a fully responsible health care provider. In engaged caregiving, providers appropriately suffer with the patient, that is, they suffer the exigencies of the patient's affliction (though not his or her actual loss) by consenting to its inescapability. In disengaged caregiving — that ruse Katz has described as the silent world of doctor and patient — provides may deny or refuse any given connection with the patient, especially the inevitability of the patient's affliction and suffering (and, by parody of reasoning, the inevitability of their own. When, however, responsibility is construed qualitatively as an evaluative feature of medical rationality, rather than quantitatively as a form of calculative reasoning only, responsibility can be viewed more broadly as not only a matter of science and will, but of language and communication as well — in particular, as the task of responsibly narrating and interpreting the patient's story of illness. In summary, the question is not whether phronesis can save the life of medical ethics — only responsible humans can do that! Instead, the question should be whether phronesis, as an ethical requirement of health care delivery, can prevent the death of medical ethics. (shrink)

Both the recent 'Warner' review of the UK research ethics committee (REC) system and the subsequent consultation document produced by the Central Office for Research Ethics Committees (COREC) emphasize the need to distinguish 'research' from what might be termed 'non-research'. This is to be determined through a process of filtering or 'triage', the intention being that RECs will avoid considering proposals with 'no material ethical issues'. In this paper we argue that trying to distinguish 'true' research from other projects is (...) counterproductive, misleading and potentially unethical. Our case is built around three assertions: (1) the distinction between research and non-research is imprecise; (2) both medical research and non-research can generate similar ethical issues; and (3) projects should be judged according to what they involve, not how they are labelled. (shrink)

If stem cell-based therapies are developed, we will likely confront a difficult problem of justice: for biological reasons alone, the new therapies might benefit only a limited range of patients. In fact, they might benefit primarily white Americans, thereby exacerbating long-standing differences in health and health care.

This case is about a study of burn patients that included a request to the IRB for a waiver of consent for perianal specimen collection–a request which ultimately was not approved by a reviewing IR...

The Report of the Ad Hoc Adivisory Group on the Operation of NHS Research Ethics Committees has resulted in a strange mixture of the timid, the revolutionary, and the bizarre.The Report of the Ad Hoc Advisory Group on the Operation of NHS Research Ethics Committees is a curious document.1 The remit of the review was focused on the workings and effectiveness of NHS research ethics committees and the multicentre committees ). The Group was primarily set up in response to a (...) series of complaints from medical researchers about the new research governance regime in the UK as a result of the Clinical Trials Directive2 and the Governance Arrangements for NHS Research Ethics Committees.3 The opportunity was also taken to consider the role of research ethics committees in a wider context, and take account of recent developments in relation to the ethics review of social care research,4 student projects,5 as well as recent legislation such as the Human Tissue Act,6 and the Mental Capacity Act.7 However, the resulting report is a strange mixture of the timid, the revolutionary, and the bizarre.A good example of the report’s timidity is its reluctance to propose fundamental change to the process of review or seriously limit the type of research that requires REC review. To its credit AHAG does suggest that some research ‘especially surveys and many studies on NHS staff, could normally be conducted safely without a requirement for REC review’ .1 This is, of course, to be welcomed. However, the report ultimately seems dismissive of the general complaint from researchers that the current process is inappropriately uniform. For example, in section 3.2, it is argued that the ‘common perception that the NHS REC system is dominated …. (shrink)

We report on the deliberations of an interdisciplinary group of experts in science, law, and philosophy who convened to discuss novel ethical and policy challenges in stem cell research. In this report we discuss the ethical and policy implications of safety concerns in the transition from basic laboratory research to clinical applications of cell-based therapies derived from stem cells. Although many features of this transition from lab to clinic are common to other therapies, three aspects of stem cell biology pose (...) unique challenges. First, tension regarding the use of human embryos may complicate the scientific development of safe and effective cell lines. Second, because human stem cells were not developed in the laboratory until 1998, few safety questions relating to human applications have been addressed in animal research. Third, preclinical and clinical testing of biologic agents, particularly those as inherently complex as mammalian cells, present formidable challenges, such as the need to develop suitable standardized assays and the difficulty of selecting appropriate patient populations for early phase trials. We recommend that scientists, policy makers, and the public discuss these issues responsibly, and further, that a national advisory committee to oversee human trials of cell therapies be established. **NB we did not reccommend a NAC, we think it might be appropriate**. (shrink)

Prominent tuberculosis (TB) actors are invoking solidarity to motivate and justify collective action to address TB, including through intensified development and implementation (D&I) of technologies such as drugs and diagnostics. We characterize the ethical challenges associated with D&I of new TB technologies by drawing on stakeholder perspectives from 23 key informant interviews and we articulate the ethical implications of solidarity for TB technology D&I. The fundamental ethical issue facing TB technological D&I is a failure within and beyond the TB community (...) to stand in solidarity with persons with TB in addressing the complex sociopolitical contexts of technological D&I. The failure in solidarity relates to two further ethical challenges raised by respondents: skewed power dynamics that hinder D&I and uncertainties around weighing risks and benefits associated with new technologies. Respondents identified advocacy and participatory research practices as necessary to address such challenges and to motivate sustained collective action to accelerate toward TB elimination. We present the first empirical examination of bioethical accounts of solidarity in public and global health. Our study suggests that solidarity allows us better to understand and address the ethical challenges that arrest the D&I of new TB technologies. Solidarity lends credence to policies and practices that address the relational nature of illness and health through collective action. (shrink)

We are printing in its entirety the discussion document which sets out a code of professional conduct for nurses published by the Royal College of Nursing in November 1976 together with commentaries by the Assistant Secretary of the British Medical Association, a professor of nursing studies, student nurses and a lawyer. The image of the nurse is still that of one of Florence Nightingale's young ladies or of a member of a religious order who is wholly dedicated to caring for (...) the sick. Today, as this document and the comments upon it show, 'dedication' is still part of the motive which leads a man or woman to become a nurse but in addition, and this is where the public may be ignorant or choose to be ignorant, nursing offers a career where intellectual achievement and the satisfaction of a demanding job bring their proper financial reward and place in the professional community. We are grateful to the Royal College of Nursing for permission to publish this document. (shrink)

Hollywood films partially construct how Americans think about education. Recent work on the representation of schools in American cinema has highlighted the role of class difference in shaping school film genres. It has also advanced the idea that a nuanced understanding of American individualism helps to explain why the different class genres are shaped as they are. This article attempts to refine this theoretical approach by focusing on the paradox of individualism, which suggests that individualism must always be dependent on (...) community. We examine 5 films (Rushmore 1988, The Breakfast Club 1985, Mona Lisa Smile 2003, School of Rock 2003, and Stand and Deliver 1988) and argue that, although the values of individualism are certainly celebrated, these films also show, perhaps unwittingly, that the achievements of individualism require robust student communities. We describe how student communities function in these films, what achievements they make possible, and what obstacles they face. (shrink)

As initially envisioned, Gödel's Collected Works were to include transcriptions of material from his mathematical workbooks. In the end that material, as well as some other manuscript items from Gödel's Nachlass, had to be left out. This note describes some of the unpublished items in the Nachlass that are likely to attract the notice of scholars and surveys the extent of shorthand transcription efforts undertaken hitherto. Some examples of sources outside Gödel's Nachlass that may be of interest to Gödel scholars (...) are also indicated. (shrink)

Volume 24, Issue 10, October 2024, Page 113-114.

The growing prevalence of obesity and related conditions such as Type II diabetes is held by many to be a major public health problem in developed countries, and increasingly in developing countries as well. If we wish to tackle this problem, it will be a major task. Individuals will have to change their consumption and exercise patterns, companies will have to improve the products they make and how they market them, nutrition experts and communities will have to redefine what is (...) acceptable and desirable in food practices and governments will have to lead and promote such societal-level changes in many different fields, including food policy, urban design, educational policies, agricultural subsidies and tax breaks, etc. This is all very difficult to achieve. In many people’s view, government action aiming at social change will be especially controversial and meet some resistance. New York …. (shrink)

This book provides a unique introduction for business leaders to the philosophical lexicon of classical and contemporary ideas—for and against—that are relevant to business and those destined to lead it. Rather than presenting the reader with a ‘philosophy of leadership’ the author uses his experiences in academia and as a leader in business to illustrate the practical application of philosophical ideas and methodologies covering the art and science of being a business leader: motivating stakeholders to deliver the initial phase of (...) a business plan for a new product or service; processing information (and risky ‘hidden-information’) that brings the company vision into reality; and ethically managing relationships to enhance the quality of decision-making and its outcomes. Creative aspiration, knowledge and ethical character are the three pillars of leadership. Within that construct, this book challenges leaders to seek their own path to self-development inspired by ideas that shape the ecology of capitalism and the opportunities it provides stakeholders to endow meaning and dignity to their lives through their participation in business. (shrink)

We question the role given to depiction in Clark and Fischer's account of interaction with social robots. Specifically, we argue that positing a unique cognitive process for handling depiction is evolutionarily implausible and empirically redundant because the phenomena it is intended to explain are not limited to depictive contexts and are better explained by reference to more general cognitive processes.

In a powerful and original contribution to the history of ideas, Hannah Dawson explores the intense preoccupation with language in early-modern philosophy, and presents a groundbreaking analysis of John Locke's critique of words. By examining a broad sweep of pedagogical and philosophical material from antiquity to the late seventeenth century, Dr Dawson explains why language caused anxiety in writers such as Montaigne, Bacon, Descartes, Hobbes, Gassendi, Nicole, Pufendorf, Boyle, Malebranche and Locke. Locke, Language and Early-Modern Philosophy demonstrates that (...) new developments in philosophy, in conjunction with weaknesses in linguistic theory, resulted in serious concerns about the capacity of words to refer to the world, the stability of meaning, and the duplicitous power of words themselves. Dr Dawson shows that language so fixated all manner of early-modern authors because it was seen as an obstacle to both knowledge and society. She thereby uncovers a novel story about the problem of language in philosophy, and in the process reshapes our understanding of early-modern epistemology, morality and politics. (shrink)

According to several commentators, Kurt Godel's incompleteness discoveries were assimilated promptly and almost without objection by his contemporaries - - a circumstance remarkable enough to call for explanation. Careful examination reveals, however, that there were doubters and critics, as well as defenders and rival claimants to priority. In particular, the reactions of Carnap, Bernays, Zermelo, Post, Finsler, and Russell, among others, are considered in detail. Documentary sources include unpublished correspondence from Godel's Nachlass.

Cultural interactions have been at the forefront of political strife in recent years as authoritarian regimes have come to power across the globe. This warrants investigation by social science researchers in the fields of social psychology, political psychology, and cognitive psychology. This study drew upon those three fields to explore the relationships between political orientation and (1) authoritarian traits, (2) attitudes towards intergroup relations and cross-cultural interactions (CCI), and (3) identity factors, largely through the lens of Social Identity Theory. Participants (...) comprised 2,582 undergraduates at a public university in the U.S. The Diverse Learning Environments survey assessed views on social identity, intergroup relations, political and religious ideology, and social and political issues. Correlational analysis and ANOVA were conducted to determine relationships between variables and differences between groups. Results indicated that the more strongly respondents rated their political orientation as conservative, the more authoritarian traits they tended to report, the less likely they were to engage in CCI, and the more likely they were to hold negative views of those from different backgrounds than themselves. The more respondents rated their political orientation as liberal, the more open they were to diversity and more likely they were to engage in CCI. Identity factors appeared to be more important to conservatives than to liberals in that strength of political ideology was related to common identity characteristics for conservatives but not for liberals. (shrink)

NThere are many problems with Levi and Green’s (2010) suggestion that a computer-based decision aid will overcome the major objections to advance directives (ADs). We focus on just two here. First, we argue that the key assumption underlying Levi and Green’s paper, that autonomy always ought to take priority over other values, is false. Second, we argue that the paper misses the point of the most telling objections to the use of ADs: they lack the relevant moral authority to determine (...) treatments. It is not that they are merely subject to a set of contingent problems related to capturing the wishes of individuals or being open to misinterpretation by others.We conclude that the plug should be pulled on Levi and Green’s computer-based proposal. (shrink)

PDP networks that use nonmonotonic activation functions often produce hidden unit regularities that permit the internal structure of these networks to be interpreted (Berkeley et al., 1995; McCaughan, 1997; Dawson, 1998). In particular, when the responses of hidden units to a set of patterns are graphed using jittered density plots, these plots organize themselves into a set of discrete stripes or bands. In some cases, each band is associated with a local interpretation. On the basis of these observations, Berkeley (...) (2000) has suggested that these bands are both subsymbolic and symbolic in nature, and has used the analysis of one network to support the claim that there are fewer differences between symbols and subsymbols than one might expect. We suggest below that this conclusion is premature. First, in many cases the local interpretation of each band is difficult to relate to the interpretation of a network's response; a more appropriate relationship only emerges when a band associated with one hidden unit is considered in the context of other bands associated with other hidden units (i.e., interpretations of distributed representations are more useful than interpretations of local representations). Second, the content that a band designates to an external observer (i.e., the interpretation assigned to a band by the researcher) can be quite different from the content that a band designates to the output units of the network itself.. We use two different network simulations – including the one described by Berkeley (2000) – to illustrate these points. We conclude that current evidence involving interpretations of nonmonotonic PDP networks actually illustrates the differences between symbolic and subsymbolic processing. (shrink)

In this article, I demonstrate that Friedrich Nietzsche offers us a unique form of hermeneutic critique. In particular, I contend that when reading Nietzsche’s perspectivism and will to power in light of each other, they provide us with the tools to overcome habits of interpretation through the concepts of genealogy and creative hermeneutics. I show this in three sections. In section one, I introduce Nietzsche’s perspectivism and situate it within his concept of the will to power. In doing so, I (...) demonstrate that interpretations exist amidst a complex field of agonistic, reciprocal relations in life’s constant production of meaning. In section two, I then analyze how certain interpretations sediment into habits, forming harmful blind spots in interpretive activity. Such habits, Nietzsche shows, when privileged as prima facie ‘True’ and left uncontested exclude different ways of interpreting and existing, stagnating the production of meaning and denying the agonistic conditions of life. In the final section, I argue that Nietzsche critiques such habits in the two directions of genealogy and creative hermeneutics. Through the backward approach of genealogy, Nietzsche problematizes the habit, excavates its lowly origin, and deconstructs its supposed universality. Through the forward approach of creative hermeneutics, he overcomes and reinterprets them out of their origins, experiments with difference and multiplicity, and engages in an ongoing critique to open up new perspectives. (shrink)

Tyler Paetkau, in his paper ‘Ladders and Stairs: how the intervention ladder focuses blame on individuals and obscures systemic failings and interventions’, adds to the growing body of academic literature raising questions about the appropriateness and usefulness of the Nuffield Council on Bioethics (NCB)’s intervention ladder (2007) as a tool for policymakers.1 2 Paetkau is critical of the intervention ladder because he holds that it focuses on individual choice and personal responsibility and pays insufficient attention to ‘systemic interventions’. He suggests (...) substituting the new metaphor of an ‘intervention stairway’ for that of the intervention ladder. I argue that his diagnosis of the problems does not go far enough and that his suggested alternative metaphor is more confusing than helpful. Paetkau’s critical analysis of the intervention ladder makes some good points. It is true that this metaphor assumes a narrow range of policy options, with a focus on changing individual behaviour, and a consequent emphasis on personal responsibility. This is the flip-side of the NCB’s focus on liberty as always being a positive value and restriction seen as intrinsically wrong. Paetkau points out that this means that much routine public health action directed at changing the more structural features that impact on health is missing from the story. I set this …. (shrink)

ABSTRACT Where Being and Event was a book of meta-ontology, demonstrating how things be, Alain Badiou tells us that Logics of Worlds is an objective phenomenology demonstrating how (and what) things do. As such, it should also be considered a book about power: how objects function in their worlds, how change is possible, and what the event does to worlds and the objects in them. Attending to this, this article shows two conflicting forms of power emerge in Logics of Worlds, (...) the power of appearance and the power of change. In this article, the author argues their incommensurability suggests an overall failure of a consistent account of power from Badiou. (shrink)

Wittgenstein's conception of infinity can be seen as continuing the tradition of the potential infinite that begins with Aristotle. Transfinite cardinals in set theory might seem to render the potential infinite defunct with the actual infinite now given mathematical legitimacy. But Wittgenstein's remarks on set theory argue that the philosophical notion of the actual infinite remains philosophical and is not given a mathematical status as a result of set theory. The philosophical notion of the actual infinite is not to be (...) found in the mathematics of set theory, only in a certain associated philosophy – what Wittgenstein calls a certain kind of “prose”. (shrink)

Background: Managing HIV treatment is a complex multi-dimensional task because of a combination of factors such as stigma and discrimination of some populations who frequently get infected with HIV. In addition, patient-provider encounters have become increasingly multicultural, making effective communication and provision of ethically sound care a challenge. Purpose: This article explores ethical issues that health service providers in the United States and Botswana encountered in their interaction with patients in HIV care. Research design: A descriptive qualitative design was used (...) to collect data from health service providers and patients using focused group discussions. This article is based on responses from health service providers only. Participants and context: This article is based on 11 focused group discussions with a total sample of 71 service providers in seven US sites and one Botswana site. Ethical considerations: Ethical review boards at all the study sites reviewed the study protocol and approved it. Ethical review boards of the study’s coordinating centers, Rutgers University and the University of California at San Francisco, also approved it. The study participants provided a written informed consent to participate. Findings: HIV service providers encountered ethical challenges in all the four Beauchamp and Childress’ biomedical ethics of respect for patients’ autonomy, beneficence, justice, and nonmaleficence. Discussion: The finding that HIV service providers encounter ethical challenges in their interaction with patients is supported by prior studies. The ethical challenges are particularly prominent in multicultural care and resource-constrained care environments. Conclusion: Provision of HIV care is fraught with ethical challenges that tend to pose different issues depending on a given care environment. It is important that strong partnerships are developed among key stakeholders in HIV care. In addition, health service providers need to be provided with resources so they can provide quality and ethically sound care. (shrink)

This paper argues that qualitative research is both useful and necessary, as it provides an essential means of gaining a richer understanding of patients' perceptions, social processes and meanings. In their paper in this edition of Clinical Ethics, Hallowell and Lawton raise many issues relating to the way that qualitative research is treated by RECs in the UK. In this paper I discuss just three key topics stimulated by their paper: the way that methodology relates to ethics, the experience and (...) character of the researcher, and the normative/descriptive distinction. I strongly support Hallowell and Lawton's appeal for greater communication between qualitative researchers and RECs. In other respects, I would argue that they do not go far enough. The recent review of research ethics structures and the review process provides an opportunity to move away from the present 'one size fits all' approach to ethical review. I would argue that this change could only benefit qualitative research and researchers. (shrink)

"Has any individual ever shaped his own civilization more thoroughly than Confucius? Certainly no other world figure has ever been presented as more of an exemplar to his countrymen. Yet what we know about the man himself is vague and shadowy, and the sayings attributed to him may seem obscure to the Westerner. Raymond Dawson addresses these paradoxes. Taking as a model the Chinese tradition of commentary on classical texts--in this case the Analects, the oldest and most reliable Confucian (...) text--he finds a body of thought whose expression does seem to reflect the views and aspirations of a recognizable person. He shows how the separate components of the Master's thought cohere into a distinct social, ethical, and intellectual system. Dawson elucidates the contemporary applicability of the sayings as well as the strength of their influence throughout the two and a half millennia of their currency, even in a China that has formally rejected them."-- provided by publisher. (shrink)

Researchers from diverse disciplines, including organismal and cellular physiology, sports science, human nutrition, evolution and ecology, have sought to understand the causes and consequences of the surprising variation in metabolic rate found among and within individual animals of the same species. Research in this area has been hampered by differences in approach, terminology and methodology, and the context in which measurements are made. Recent advances provide important opportunities to identify and address the key questions in the field. By bringing together (...) researchers from different areas of biology and biomedicine, we describe and evaluate these developments and the insights they could yield, highlighting the need for more standardisation across disciplines. We conclude with a list of important questions that can now be addressed by developing a common conceptual and methodological toolkit for studies on metabolic variation in animals. (shrink)

ObjectiveTo identify the ethical challenges associated with the development and implementation of new tuberculosis drugs and diagnostics.MethodsTwenty-three semi-structured qualitative interviews conducted between December 2015 and September 2016 with programme administrators, healthcare workers, advocates, policymakers, and funders based in the Americas, Europe, and Africa. Interviews were analysed using thematic analysis.ResultsDivergent interests and responsibilities, coupled with power imbalances, are a primary source of ethical challenges; the uncertain risk profiles of new drugs present an additional one. Although this challenge can be partially mitigated (...) through stringent pharmacovigilance, respondents highlighted that high-burden countries tend to lack the resources to facilitate safe implementation. Increased advocacy and community engagement are considered an ethical imperative for future TB development and implementation.ConclusionsThis project helps identify some of the ethical challenges of new TB technologies. It demonstrates that investigating ethical challenges through qualitative research is one way to apprehend the difficulty of implementing new TB technologies. Addressing this difficulty will require that those in positions of power reconsider their interests in relation to disempowered communities.Policy implicationsEfforts to build consensus regarding what values should underpin the global governance of TB research, prevention, and care are essential to facilitate the ethical implementation of new TB technologies. (shrink)

A colleague’s personal recollections of Jean van Heijenoort’s contributions to the editing of volumes I–III of Gödel’s Collected Works and of his interactions with the other editors.

We present a one per cent measurement of the cosmic distance scale from the detections of the baryon acoustic oscillations in the clustering of galaxies from the Baryon Oscillation Spectroscopic Survey, which is part of the Sloan Digital Sky Survey III. Our results come from the Data Release 11 sample, containing nearly one million galaxies and covering approximately 8500 square degrees and the redshift range 0.2 < z < 0.7. We also compare these results with those from the publicly released (...) DR9 and DR10 samples. Assuming a concordance Λ cold dark matter cosmological model, the DR11 sample covers a volume of 13 Gpc3 and is the largest region of the Universe ever surveyed at this density. We measure the correlation function and power spectrum, including density-field reconstruction of the BAO feature. The acoustic features are detected at a significance of over 7σ in both the correlation function and power spectrum. Fitting for the position of the acoustic features measures the distance relative to the sound horizon at the drag epoch, rd, which has a value of rd,fid = 149.28 Mpc in our fiducial cosmology. We find DV = at z = 0.32 and DV = at z = 0.57. At 1.0 per cent, this latter measure is the most precise distance constraint ever obtained from a galaxy survey. Separating the clustering along and transverse to the line of sight yields measurements at z = 0.57 of DA = and H =. Our measurements of the distance scale are in good agreement with previous BAO measurements and with the predictions from cosmic microwave background data for a spatially flat CDM model with a cosmological constant. © 2014 The Author Published by Oxford University Press on behalf of the Royal Astronomical Society. (shrink)

Emotion is closely associated with language, but we know very little about how children express emotion in their own writing. We used a large‐scale, cross‐sectional, and data‐driven approach to investigate emotional expression via writing in children of different ages, and whether it varies for boys and girls. We first used a lexicon‐based bag‐of‐words approach to identify emotional content in a large corpus of stories (N>100,000) written by 7‐ to 13‐year‐old children. Generalized Additive Models were then used to model changes in (...) sentiment across age and gender. Two other machine learning approaches (BERT and TextBlob) validated and extended these analyses, converging on the finding that positive sentiments in children's writing decrease with age. These findings echo reports from previous studies showing a decrease in mood and an increased use of negative emotion words with age. We also found that stories by girls contained more positive sentiments than stories by boys. Our study shows the utility of large‐scale data‐driven approaches to reveal the content and nature of children's writing. Future experimental work should build on these observations to understand the likely complex relationships between written language and emotion, and how these change over development. (shrink)

Essays and photographs describe the course of the Truckee River and the people who depend on the river's water.