We examined if cancer patients' health-related quality of life (HRQoL) scores on the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 are affected by the specific time point, before or during treatment, at which the questionnaire is completed, and whether this could bias the overall treatment comparison analyses. A 'completion-time window' variable was created on three closed EORTC randomised control trials in lung (non-small cell lung cancer, NSCLC) and colorectal cancer (CRC) to indicate when the QLQ-30 was completed (...) relative to chemotherapy cycle dates, defined as 'before', 'on' and 'after'. HRQoL mean scores were calculated using a linear mixed model. Statistically significant differences (P < 0.05) were observed on 6 and 5 scales for 'on' and 'after' comparisons in the NSCLC and two-group CRC trial, respectively. As for the three-group CRC trial, several statistical differences were observed in the 'before' to 'on' and the 'on' to 'after' comparisons. For all three trials, including the 'completion-time window' variable in the model resulted in a better fit, but no substantial changes in the treatment effects were noted. We showed that considering the exact timing of completion within specified windows resulted in statistical and potentially clinically significant differences, but it did not alter the conclusions of treatment comparison in these studies. (shrink)

Stanovich & West distinguish between evolutionary rationality and normative rationality, and System 1 and System 2 mental processes. They hold that the main function of System 2 has to do with normative and not evolutionary rationality. We ask how System 2 could then be an adaptation, especially given S&W's own work on individual differences.

Ubiquitous computing is a new kind of computing where devices enhance everyday artefacts and open up previously inaccessible situations for data capture. ‘Technology paternalism’ has been suggested by Spiekermann and Pallas (Poiesis & Praxis: Int J Technol Assess Ethics Sci 4(1):6–18, 2006) as a concept to gauge the social and ethical impact of these new technologies. In this article we explore this concept in the specific setting of UK road maintenance and construction. Drawing on examples from our qualitative fieldwork we (...) suggest that cultural logics such as those reflected in paternalistic health and safety discourse are central in legitimising the introduction of ubiquitous computing technologies. As such, there is little doubt that paternalism plays an essential role in people’s reasoning about ubiquitous computing in this setting. We argue, however, that since discourses such as health and safety are used by everyone (including both managers and workers) in the organisation to further their own aims, technologies transcend purely paternalistic conceptualisations and instead become a focal point for ongoing struggles for control between those deploying and using them. This means that the benefits and costs of such new technologies become harder to define from an ethical and social perspective. (shrink)

The practice of coercive measures in psychiatry is controversial. Although some have suggested that it may be acceptable if patients are a danger to others or to themselves, others committed themselves to eliminate it. Ethical, legal and clinical considerations become more complex when the mental incapacity is temporary and when the coercive measures serve to restore autonomy. We discuss these issues, addressing the conflict between autonomy and beneficence/non-maleficence, human dignity, the experiences of patients and the effects of coercive measures. We (...) argue that an appeal to respect autonomy and/or human dignity cannot be a sufficient reason to reject coercive measures. All together, these ethical aspects can be used both to support and to reject a non-seclusion approach. The total lack of controlled trials about the beneficial effects of coercive measures in different populations however, argues against the use of coercive measures. (shrink)

Infinite time Turing machines with only one tape are in many respects fully as powerful as their multi-tape cousins. In particular, the two models of machine give rise to the same class of decidable sets, the same degree structure and, at least for partial functions f : ℝ → ℕ, the same class of computable functions. Nevertheless, there are infinite time computable functions f : ℝ → ℝ that are not one-tape computable, and so the two models of infinitary computation (...) are not equivalent. Surprisingly, the class of one-tape computable functions is not closed under composition; but closing it under composition yields the full class of all infinite time computable functions. Finally, every ordinal that is clockable by an infinite time Turing machine is clockable by a one-tape machine, except certain isolated ordinals that end gaps in the clockable ordinals. (shrink)

of (from Oxford Uehiro Centre for Practical Ethics).

Background: Omalizumab, an anti-immunoglobulin E antibody, reduces exacerbations and symptoms in uncontrolled allergic asthma. The study objective was to estimate the costs and consequences of omalizumab compared to usual care from a US payer perspective. Methods: We estimated payer costs, quality-adjusted survival (QALYs), and the incremental cost-effectiveness ratio (ICER) of omalizumab compared to usual care using a state-transition simulation model that included sensitivity analyses. Every 2 weeks, patients could transition between chronic asthma and exacerbation health states. The best available evidence (...) informed the clinical and cost input estimates. Five years of omalizumab treatment followed by usual care was assumed to estimate a lifetime horizon. Omalizumab responders (60.5% of treated) were modeled as a separate scenario where nonresponders reverted back to usual care after 16 weeks of active treatment. Results: The mean lifetime discounted costs and QALYs were $83 400 and 13.87 for usual care and $174 500 and 14.19 for omalizumab plus usual care resulting in $287 200/QALY (95% interval: $219 300, $557 900). The ICER was $172 300/QALY when comparing omalizumab to usual care in the responder scenario. One-way sensitivity analyses indicated that the results were sensitive to the difference in treatment-specific utilities for the chronic state, exacerbation-associated mortality, omalizumab price, exacerbation rates, and response definition. Conclusions: The results suggest that adding omalizumab to usual care improves QALYs at an increase in direct medical costs. The cost-effectiveness of omalizumab is similar to other chronic disease biologics. The value increases when omalizumab response is used to guide long-term treatment. (shrink)