Background: More and more quantitative information is becoming available about the risks of complications arising from medical treatment. In everyday practice, this raises the question whether each and every risk, however low, should be disclosed to patients. What could be good reasons for doing or not doing so? This will increasingly become a dilemma for practitioners.Objective: To report doctors’ views on whether to disclose or withhold information on low risks of complications.Methods: In a qualitative study design, 37 respondents were included. (...) Focus group interviews were held with 22 respondents and individual in-depth interviews with 15.Results: Doctors have doubts about disclosing or withholding information on complication risk, especially in a risk range of 1 in 200 to 1 in 10 000. Their considerations on whether to disclose or to withhold information depend on a complicated mix of patient and doctor-associated reasons; on medical and personal considerations; and on the kind and purpose of intervention.Discussion: Even though the degree of a risk is important in a doctor’s considerations, the severity of the possible complications and patients’ wishes and competencies have an important role as well. Respondents said that low risks should always be communicated when there are alternatives for the intervention or when the patient may prevent or mitigate the risk. When the appropriateness of disclosing risks is doubtful, doctors should always tell their patients that no intervention is without risk, give them the opportunity to gather all the information they need or want, and enable them to detect a complication at an early stage. (shrink)

The proto-code of ethics and conduct for European nurse directors was developed as a strategic and dynamic document for nurse managers in Europe. It invites critical dialogue, reflective thinking about different situations, and the development of specific codes of ethics and conduct by nursing associations in different countries. The term proto-code is used for this document so that specifically country-orientated or organization-based and practical codes can be developed from it to guide professionals in more particular or situation-explicit reflection and values. (...) The proto-code of ethics and conduct for European nurse directors was designed and developed by the European Nurse Directors Association’s (ENDA) advisory team. This article gives short explanations of the code’ s preamble and two main parts: Nurse directors' ethical basis, and Principles of professional practice, which is divided into six specific points: competence, care, safety, staff, life-long learning and multi-sectorial working. (shrink)

The people and the value of their experience, by N. T. Pratt.--From kingship to democracy, by J. P. Harland.--Democracy at Athens, by G. M. Harper.--Athens and the Delian League, by B. D. Meritt.--Socialism at Sparta, by P. R. Coleman-Norton.--Tyranny, by M. Mac Laren.--Federal unions, by C. A. Robinson.--Alexander and the world state, by O. W. Reinmuth.--The Antigonids, by J. V. A. Fine.--Ptolemaic Egypt: a planned economy, by S. L. Wallace.--The Seleucids: the theory of monarchy, by G. Downey.--The political status of (...) the independent cities of Asia Minor in the Hellenistic period, by D. Magie.--The ideal states of Plato and Aristotle, by W. J. Oates.--Epilogue, by A. C. Johnson.--Bibliography (p. 225-233).--Index, by H. V. M. Dennis, III. (shrink)

Background: We were finding volunteers for functional magnetic resonance imaging studies with abnormalities requiring referral surprisingly frequently. The bioethics surrounding the incidental findings are not straightforward and every imaging institution will encounter this situation in their normal volunteers. Yet the implications for the individuals involved may be profound. Should all participants have review of their imaging by an expert and who should be informed? Methods: The normal volunteers that were imaged with magnetic resonance (MR) which were reviewed by a consultant (...) neuroradiologist. All participants completed a volunteer consent form in addition to a standard departmental MR safety screening form. The volunteer screening form requires the general practitioner details to be completed and asks the participant to consider closely the possibility and implications of finding an unexpected but potentially serious abnormality before signing. Results: 525 different individuals were scanned as normal volunteers, the mean age was 35-years and 330 were males. Of these 525, 46 had definite significant abnormalities (8.8%), mean age 50-years. Conclusion: We have found a high rate of incidental abnormalities amongst individuals participating in imaging studies at our institution. It is our current practice to inform the research study participant of the findings, counsel them and inform their primary care physician. We think that it is advisable for researchers utilising MR imaging of the brain to have access to trained neuroradiologists, a protocol in place to deal with this problem and take consent in a way that allows the participant to realise the possibility of an abnormal finding. (shrink)

Objective: To develop an approach for seeking informed consent to examine tissues retained from a previous study of sudden infant death syndrome as part of a study on asthma, and to document responses and participation rate.Design: Pilot open-ended approach to 10 volunteer SIDS parents, followed by staged approach to seek consent from the target SIDS families for the asthma study.Participants: Parents of SIDS infants known to SIDS and Kids Victoria and parents of SIDS infants from the 1991–2 SIDS in Victoria (...) case–control study.Main outcomes: Qualitative responses of the piloted parents and study parents, and participation rates.Results: The pilot group responses were used to refine the written material to be provided. Of the 72 families for which contact details were available, 45 gave verbal consent for contact by the Victorian Institute of Forensic Medicine regarding the asthma study, three refused and 24 did not respond to two letters. Thirty-three completed consent forms, all positive for participation in the asthma study, giving a positive response rate of 73% .Conclusions: The use of postmortem tissue for research is acceptable to the next of kin when an approach is sensitive to their concerns and needs and is made by experienced counsellors from a familiar organisation. Despite the painful memories evoked by the approach of the research group, the acceptance rate among those who could be contacted was high. (shrink)

Conference proceedings on Mongolian contributions to Buddhist knowledge.

This work is, in large part, a series of refutations; it is also the author's Ph.D. thesis. First to be refuted is Russell's vicious circle principle as a general remedy for the solution of the paradoxes. The author rejects the classification of paradoxes into syntactic and semantic, since in his view there are no purely syntactic paradoxes. The distinction in logic between the uninterpreted syntactical aspect of a system and the system when given a determinate interpretation is held to be (...) untenable. Tarski's distinction between object-language and meta-language and his concept of semantically closed language are considered irrelevant for the solution of the Liar paradox. The author claims that the usual versions of the Liar paradox have the same structure as the Barber paradox, viz., [S ↔ ~S]. The author solves the Liar paradox by pointing out that it does not have a proper reference. Cantor's diagonal argument for the indenumerability [[sic]] of the real numbers is labeled as unsatisfactory. Since the diagonal number is dependent upon the real numbers in the constructed list, the author claims that this makes the diagonal number to be of a different nature and status than the real numbers in the list; thus we have what the author calls the dependence fallacy. The author also refuses to accept Cantor's nested interval proof of the indenumerability [[sic]] of the real numbers. Within the proof, two infinite sequences are constructed, each of which converges to a limit. Because the proof does not give a "definite rule of convergence," the author is not satisfied that the infinite sequences converge. Also rejected is Cantor's theorem. Other paradoxes analyzed are the Berry, Richard, heterological, "Richardian", Russell, Cantor, and Burali-Forti paradoxes.--T. G. N. (shrink)

Two rotational bands have been identified and characterized in the proton-magic N = Z + 1 nucleus Ni-57. These bands complete the systematics of well-and superdeformed rotational bands in the light nickel isotopes starting from doubly magic Ni-56 to Ni-60. High-spin states in Ni-57 have been produced in the fusion-evaporation reaction Si-28(S-32, 2p1n)Ni-57 and studied with the gamma-ray detection array GAMMASPHERE operated in conjunction with detectors for evaporated light charged particles and neutrons. The features of the rotational bands in Ni-57 (...) are compared to those of neighbouring isotopes and interpreted by means of configuration-dependent cranked Nilsson-Strutinsky calculations. The two observed high-spin bands are considered signature partners and assigned to configurations with one 1g(9/2) proton and one 1g(9/2) neutron, resulting in an unambiguous understanding of the energetically favoured signature alpha = -1/2 band but a somewhat less satisfactory description of the signature alpha = +1/2 band. (shrink)

Ethical guidance for genomic research is increasingly sought and perceived to be necessary. Although there are pressing ethical issues in genomic research – concerning for example the recruitment of patients/participants; the process of taking consent; data sharing; and returning results to patients/participants – there is still limited useful guidance available for researchers/clinicians or for the research ethics committees who review such projects. This report outlines the ethical principles and guidance for genomic research co-produced with stakeholders during two workshops which took (...) place in the UK between November 2016 and May 2017. The stakeholders involved in these workshops included: healthcare professionals, genomic research teams, academics, patients, biobank managers, and representatives from the Health Research Authority, NHS Research Ethics Committees, patient support groups, pharmaceutical industry, and health policy think tanks. The co-produced principles and guidance are specifical... (shrink)

Spatial asymmetries are an intriguing feature of directed attention. Recent observations indicate an influence of temperament upon the direction of these asymmetries. It is unknown whether this influence generalises to visual orienting behaviour. The aim of the current study was therefore to explore the relationship between temperament and measures of spatial orienting as a function of target hemifield. An exogenous cueing task was administered to 92 healthy participants. Temperament was assessed using Carver and White's (1994) Behavioural Inhibition System and Behavioural (...) Activation System (BIS/BAS) scales. Individuals with high sensitivity to punishment and low sensitivity to reward showed a leftward asymmetry of directed attention when there was no informative spatial cue provided. This asymmetry was not present when targets were preceded by spatial cues that were either valid or invalid. The findings support the notion that individual variations in temperament influence spatial asymmetries in visual orienting, but only when lateral targets are preceded by a non-directional (neutral) cue. The results are discussed in terms of hemispheric asymmetries and dopamine activity. (shrink)

Alternative food networks are emerging in opposition to industrial food systems, but are criticized as being exclusive, since customers’ ability to patronize these market spaces is premised upon their ability to pay higher prices for what are considered the healthiest, freshest foods. In response, there is growing interest in widening the demographic profile given access to these alternative foods. This research asks: what barriers do alternative food businesses face in providing access and inclusion for low income consumers? Surveys and interviews (...) with 45 alternative food businesses in British Columbia, Canada uncovered five key barriers. The findings indicate that the barriers are symptomatic of structural issues in the Canadian food and social welfare systems. Although opportunities exist for business operators to widen access for low income shoppers, these alone cannot meaningfully ameliorate food-access inequality. Rather, these barriers underscore issues of income-disparity, poverty, and food-access inequality more broadly, and require structural and societal change to rectify. (shrink)

Sober (1992) has recently evaluated Brandon's (1982, 1990; see also 1985, 1988) use of Salmon's (1971) concept of screening-off in the philosophy of biology. He critiques three particular issues, each of which will be considered in this discussion.

Objectives: To report the attitudes and opinions of subjects in US clinical trials about whether or not, and why, they should receive post-trial access (PTA) to the trial drug, care and information. Design: Focus groups, short self-administered questionnaires. Setting: Boston, Dallas, Detroit, Oklahoma City. Participants: Current and recent subjects in clinical trials, primarily for chronic diseases. Results: 93 individuals participated in 10 focus groups. Many thought researchers, sponsors, health insurers and others share obligations to facilitate PTA to the trial drug, (...) if it benefited the subject, or to a therapeutic equivalent. Some thought PTA obligations include providing transition care (referrals to non-trial physicians or other trials, limited follow-up, short-term drug supply) or care for long-term adverse events. Others held, in contrast, that there are no PTA obligations regarding drugs or care. However, there was agreement that former subjects should receive information (drug name, dosage received, market approval date, long-term adverse effects, trial results). Participants frequently appealed to health need, cost, relationships, reciprocity, free choice and sponsor self-interest to support their views. Many of their reasons overlapped with those commonly discussed by bioethicists. Conclusion: Many participants in US trials for chronic conditions thought there are obligations to facilitate PTA to the trial drug at a “fair” price; these views were less demanding than those of non-US subjects in other studies. However, our participants’ views about informational obligations were broader than those of other subjects and many bioethicists. Our results suggest that the PTA debate should expand beyond the trial drug and aggregate results. (shrink)