OBJECTIVES: To compare the practices of local research ethics committees and the time they take to obtain ethical approval for a multi-centre study. DESIGN: A retrospective analysis of outcome of applications for a multi-centre study to local research ethics committees. SETTING: Thirty-six local research ethics committees covering 38 district health authorities in England. MAIN MEASURES: Response of chairmen and women, the time required to obtain approval, and questions asked in application forms. RESULTS: We received replies from all 36 chairmen contacted: (...) four (11%) granted their approval, and 32 (89%) required our proposal to be considered by their local research ethics committee. Three committees asked us to attend their meetings. The application was approved by all 36 local research ethics committees but the time to obtain ethical approval varied between six to 208 days. One third of the committees did not approve the project within three months, and three took longer than six months. There was considerable variation in the issues raised by local research ethics committees and none conformed exactly to the Royal College of Physicians' guidelines. CONCLUSION: Obtaining ethical approval for a multi-centre study is time-consuming. There is much diversity in the practice of local research ethics committees. Our data support the recommendation for a central or regional review body of multi-centre studies which will be acceptable to all local research ethics committees. (shrink)

Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and (...) participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses’ ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses’ own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner. (shrink)

The assertion by Simmons and Park that the dynamical map associated with the Bloch equations of nuclear magnetic resonance is not completely positive is wrong.

Even though since 1965 the Great Cultural Revolution was basically an internal struggle in Mainland China, it coincided with a high tide of criticism toward Russian revisionism and therefore constituted a struggle for defining the ideological line of the Chinese Communist Party. As an internal struggle, the Great Cultural Revolution subjected all phases of cultural activity and personnel to a severe political grinding down so that a more uniform political consciousness of Maoism was generated as the guiding principle of the (...) nation; as an attempt to repudiate Russian revisionism and to assert the ideological identity of Maoism, the Great Cultural Revolution has helped in practice to provide a model of continuing revolution for a genuinely pursued Marxist society. In his long article, Chou Yang, who himself later became a target and victim of the Great Cultural Revolution, spelled out the latter message and hinted at the former possibility. What is even more significant is that he stressed repeatedly the importance of the role philosophy workers and social science workers must play in waging an ideological struggle against both Marxist revisionism and capitalism, on the one hand, and the importance of political leadership in the studies and works of philosophy and the social sciences, on the other. (shrink)

This paper examines an issue that is becoming increasingly relevant as the pressures of a warming planet, changing climate and changing ecosystems ramp up. The broad context for the paper is the intragenerational, intergenerational, and interspecies equity implications of changing the climate and the value orientations of adapting to such change. In addition, the need to stabilize the planetary climate by urgent mitigation of change factors is a foundational ethical assumption. In order to avoid further animal and plant extinctions, or (...) at the very least, their increased vulnerability to becoming rare and endangered; the systematic assisted colonization of “at risk” species is being seriously considered by scientists and managers of biodiversity. The more practical aspects of assisted colonization have been covered in the conservation biology literature; however, the ethical implications of such actions have not been extensively examined. Our discussion of the value issues, using a novel case study approach, will rectify the limited ethical analysis of the issue of assisted colonization of species in the face of climate change pressures. Beyond sustainability ethics, both animal and environmental ethical approaches will be used and intrinsic versus instrumental value orientations in the literature shall form the basis of our discussion. After the application of all the ethical approaches to the case studies, we conclude that without mitigation and the prospect of a future stable climate, assisted colonization will be involved in an inherently unethical process and a “move and lose it” outcome. With mitigation, there is wide-ranging ethical support for assisted colonization. (shrink)

The effects of religion, population sub-division and geography on the prevalence of deaf-mutism were investigated using information collected in the 1921 Census of Punjab. The total sample size was 9·36 million, and comprised data on thirteen Hindu castes, seventeen Muslim biraderis and two Sikh castes. A two-way analysis of variance comparing males in Hindu castes in which consanguineous marriage was prohibited, with males in Muslim biraderis which favoured first cousin marriage, indicated major differences with respect to the patterns of deaf-mutism (...) within each religion. In the Muslim population 9·1% of the relative variation in the prevalence of deaf-mutism was inter-biraderi, 36·8% between geographical regions, and 48·8% an interaction between biraderi and region, whereas among Hindus 46·8% of the observed variation was inter-caste, 12·8% inter-region and 33·6% due to caste–region interaction. From a wider disease perspective the results obtained with the Hindu community indicate the significant genetic differentiation associated with caste endogamy. As the overwhelming majority of Hindu marriages continue to be within-caste, it can be predicted that similar levels of inter-caste differences in disease frequency currently exist. By comparison, the lower level of inter-biraderi variation among Muslims is probably indicative of the dissolution of pre-existing caste boundaries and the resultant gene pool mixing that followed the large-scale conversion of Hindus to Islam during Muslim rule in North India from the 13th to the 19th centuries. (shrink)

This is the first of three volumes which will contain all of Locke's extant philosophical writings relating to An Essay Concerning Human Understanding, not included in other Clarendon editions like the Correspondence. It contains the earliest known drafts of the Essay, Drafts A and B, both written in 1671, and provides for the first time an accurate version of Locke's text. Virtually all his changes are recorded in footnotes on each page. Peter Nidditch, whose highly acclaimed edition of An Essay (...) Concerning Human Understanding was published in this series in 1975, used pioneering editorial techniques in his compilation of Volume 1. Most of the work was completed before his tragically early death in 1983. Volumes 2 and 3, almost wholly the work of G. A. J. Rogers will contain the third extant draft of the Essay, the Epitome and the Conduct of the Understanding. They will also include a History of the Writing of the Essay, together with other shorter writings by Locke. (shrink)

Rapid developments in Artificial Intelligence are leading to an increasing human reliance on machine decision making. Even in collaborative efforts with Decision Support Systems (DSSs), where a human expert is expected to make the final decisions, it can be hard to keep the expert actively involved throughout the decision process. DSSs suggest their own solutions and thus invite passive decision making. To keep humans actively ‘on’ the decision-making loop and counter overreliance on machines, we propose a ‘reflection machine’ (RM). This (...) system asks users questions about their decision strategy and thereby prompts them to evaluate their own decisions critically. We discuss what forms RMs can take and present a proof-of-concept implementation of a RM that can produce feedback on users’ decisions in the medical and law domains. We show that the prototype requires very little domain knowledge to create reasonably intelligent critiquing questions. With this prototype, we demonstrate the technical feasibility to develop RMs and hope to pave the way for future research into their effectiveness and value. (shrink)

This is the first of three volumes which will contain all of John Locke's writings which relate to An Essay concerning Human Understanding. This volume contains an accurate version of the two earliest known drafts of the Essay. Virtually all of Locke's changes are recorded in footnotes. Volume I was largely completed by Peter Nidditch before his death in 1983. His pioneering editorial techniques won him acclaim for his edition of An Essay concerning Human Understanding in this series in 1975.

Dilemmas about resuscitation and life-prolonging treatment for severely compromised infants have become increasingly complex as skills in neonatal care have developed. Quality of life and resource issues necessarily influence management. Our Institute of Medical Ethics working party, on whose behalf this paper is written, recognises that the ultimate responsibility for the final decision rests with the doctor in clinical charge of the infant. However, we advocate a team approach to decision-making, emphasising the important role of parents and nurses in the (...) process. Assessing the relative burdens and benefits can be troubling, but doctors and parents need to retain a measure of discretion; legislation which would determine action in all cases is inappropriate. Caution should be exercised in involving committees in decision-making and, where they exist, their remit should remain to advise rather than to decide. Support for families who bear the consequences of their decisions is often inadequate, and facilitating access to such services is part of the wider responsibilities of the intensive care team. The authors believe that allowing death by withholding or withdrawing treatment is legitimate, where those closely involved in the care of the infant together deem the burdens to be unacceptable without compensating benefits for the infant. As part of the process accurate and careful recording is essential. (shrink)

Judges face difficult choices when the birth and genetic mothers of a child are separate people who dispute maternal access; the views of the general population may help them. Fifty women were asked whether, if they were infertile and could have only one child, they would prefer to be birth mothers (to carry a baby which was not genetically theirs) or genetic mothers (to have another woman carry their genetic baby). Similarly, fifty men were asked about their preference for a (...) partner's child. In both groups the strength of preferences was measured using a lottery technique. The direction and strength of preferences was similar between men and women, and approximately equally divided between birth and genetic motherhood. These attitudes should be taken into account by those adjudicating custody disputes between such mothers. (shrink)

All-encompassing text examines every aspect of coma from neurochemistry, monitoring, and treatments to prognostic factors.