Current UK legislation is impacting upon the feasibility and cost-effectiveness of medical record-based research aimed at benefiting the NHS and the public heath. Whereas previous commentators have focused on the Data Protection Act 1998, the Health and Social Care Act 2001 is the key legislation for public health researchers wishing to access medical records without written consent. The Act requires researchers to apply to the Patient Information Advisory Group for permission to access medical records without written permission. We present a (...) case study of the work required to obtain the necessary permissions from PIAG in order to conduct a large scale public health research project. In our experience it took eight months to receive permission to access basic identifying information on individuals registered at general practices, and a decision on whether we could access clinical information in medical records without consent took 18 months. Such delays pose near insurmountable difficulties to grant funded research, and in our case £560 000 of public and charitable money was spent on research staff while a large part of their work was prohibited until the third year of a three year grant. We conclude by arguing that many of the current problems could be avoided by returning PIAG’s responsibilities to research ethics committees, and by allowing “opt-out” consent for many public health research projects. (shrink)

Current UK legislation is impacting upon the feasibility and cost-effectiveness of medical record-based research aimed at benefiting the NHS and the public heath. Whereas previous commentators have focused on the Data Protection Act 1998, the Health and Social Care Act 2001 is the key legislation for public health researchers wishing to access medical records without written consent. The Act requires researchers to apply to the Patient Information Advisory Group for permission to access medical records without written permission. We present a (...) case study of the work required to obtain the necessary permissions from PIAG in order to conduct a large scale public health research project. In our experience it took eight months to receive permission to access basic identifying information on individuals registered at general practices, and a decision on whether we could access clinical information in medical records without consent took 18 months. Such delays pose near insurmountable difficulties to grant funded research, and in our case £560 000 of public and charitable money was spent on research staff while a large part of their work was prohibited until the third year of a three year grant. We conclude by arguing that many of the current problems could be avoided by returning PIAG’s responsibilities to research ethics committees, and by allowing “opt-out” consent for many public health research projects. (shrink)

Prescriptive rules guide human behavior across various domains of community life, including law, morality, and etiquette. What, specifically, are rules in the eyes of their subjects, i.e., those who are expected to abide by them? Over the last sixty years, theorists in the philosophy of law have offered a useful framework with which to consider this question. Some, following H. L. A. Hart, argue that a rule’s text at least sometimes suffices to determine whether the rule itself covers a case. (...) Others, in the spirit of Lon Fuller, believe that there is no way to understand a rule without invoking its purpose — the benevolent ends which it is meant to advance. In this paper we ask whether people associate rules with their textual formulation or their underlying purpose. We find that both text and purpose guide people’s reasoning about the scope of a rule. Overall, a rule’s text more strongly contributed to rule infraction decisions than did its purpose. The balance of these considerations, however, varied across experimental conditions: In conditions favoring a spontaneous judgment, rule interpretation was affected by moral purposes, whereas analytic conditions resulted in a greater adherence to textual interpretations. In sum, our findings suggest that the philosophical debate between textualism and purposivism partly reflects two broader approaches to normative reasoning that vary within and across individuals. Keywords: , the concept of law, rules, legal psychology, Hart, Fuller. (shrink)

Alchemy is central to Jung's hypothesis of the collective unconscious. In this volume he begins with an outline of the process and aims of psychotherapy, and then moves on to work out the analogies between alchemy, Christian dogma and symbolism and his own understanding of the analytic process. Introducing the basic concepts of alchemy, Jung reminds us of the dual nature of alchemy, comprising both the chemical process and a parallel mystical component. He also discusses the seemingly deliberate mystification of (...) the alchemists. Finally, in using the alchemical process as providing insights into individuation, Jung emphasises the importance of alchemy in relating to us the transcendent nature of the psyche. (shrink)

Binge-purge eating disorders (BP-ED), such as bulimia nervosa and binge eating disorder, may share some neurobiological features. Electroencephalography (EEG) is a non-invasive measurement modality that may aid in research and diagnosis of BP-ED. We conducted a systematic review of the literature on EEG findings in BP-ED, seeking to summarize and analyze the current evidence, as well as identify shortcomings and gaps to inform new perspectives for future studies. Following PRISMA Statement recommendations, the PubMed, Embase, and Web of Science databases were (...) searched using terms related to “electroencephalography” and “binge-purge” eating disorders. Of 555 articles retrieved, 15 met predefined inclusion criteria and were included for full-text analysis. Eleven studies investigated EEG by means of event-related potentials (ERP) in BP-ED individuals: 7 using eating disorder-related stimuli (i.e., food, body image) and 4 using non-eating disorder-related stimuli (i.e., facial expressions or auditory clicks). These studies found significant differences in the N200, P200, P300, and LPP components in BP-ED participants compared to controls, indicating that this population exhibits impairments in selective attention, attentional allocation/processing, and allocation of motivational or emotion-based attention. Five studies investigated EEG using frequency analysis; reporting significant differences in beta activity in fronto-temporal and occipito-temporo-parietal areas in BP-ED individuals compared to controls, revealing a dysfunctional brain network. However, the small number of studies, the heterogeneity of samples, study paradigms, stimulus types, and the lack of an adequate assessment of neuropsychological parameters are some limitations of the current literature. Although some EEG data are promising and consistent with neuroimaging and neuropsychological findings in individuals with BP-ED, future studies need to overcome current methodological shortcomings. (shrink)

This book is a philosophical commentary on Schopenhauer's "Fourfold Root of the Principle of Sufficient Reason," dealing with each of Schopenhauer's principal ...

Narrative analysis is well established as a means of examining the subjective experience of those who suffer chronic illness and cancer. In a study of perceptions of the outcomes of treatment of cancer of the colon, we have been struck by the consistency with which patients record three particular observations of their subjective experience: the immediate impact of the cancer diagnosis and a persisting identification as a cancer patient, regardless of the time since treatment and of the presence or absence (...) of persistent or recurrent disease; a state of variable alienation from social familiars, expressed as an inability to communicate the nature of the experience of the illness, its diagnosis and treatment; and a persistent sense of boundedness, an awareness of limits to space, empowerment and available time. These subjectivities were experienced in varying degree by all patients in our study. Individual responses to these experiences were complex and variable. The experiences are best understood under the rubric of a category we call “liminality”. We believe that all cancer patients enter and experience liminality as a process which begins with the first manifestations of their malignancy. An initial acute phase of liminality is marked by disorientation, a sense of loss and of loss of control, and a sense of uncertainty. An adaptive, enduring phase of suspended liminality supervenes, in which each patient constructs and reconstructs meaning for their experience by means of narrative. This phase persists, probably for the rest of the cancer patient’s life. The experience of liminality is firmly grounded in the changing and experiencing body that houses both the disease and the self. Insights into the nature of the experience can be gained from the Existentialist philosophers and from the history of attitudes to death. Understanding liminality helps us to understand what it is that patients with cancer seek from the system to which they turn for help. Its explication should therefore be important for those who provide health care, those who educate health care workers and those concerned to study and use outcomes as administrative and policy making instruments. (shrink)

F. C. Copleston; XIV*—The Logical Empiricism of Nicholas of Autrecourt, Proceedings of the Aristotelian Society, Volume 74, Issue 1, 1 June 1974, Pages 249–262.