BackgroundObtaining consent has become a standard way of respecting the patient’s rights and autonomy in clinical research. Ethical guidelines recommend that the child’s parent/s or authorised legal guardian provides informed consent for their child’s participation. However, obtaining informed consent in paediatric research is challenging. Parents become vulnerable because of stress related to their child’s illness. Understanding the views held by guardians and researchers about the consent process in Malawi, where there are limitations in health care access and research literacy will (...) assist in developing appropriate consent guidelines.MethodsWe conducted 20 in-depth interviews with guardians of children and research staff who had participated in paediatric clinical trial and observational studies in acute and non-acute settings in the Southern Region of Malawi. Interviews were audio-recorded, transcribed verbatim, and thematically analysed. Interviews were compared across studies and settings to identify differences and similarities in participants’ views about informed consent processes. Data analysis was facilitated by NVIVO 11 software.ResultsAll participants across study types and settings reported that they associated participating in research with therapeutic benefits. Substantial differences were noted in the decision-making process across study settings. Guardians from acute studies felt that the role of their spouses was neglected during consenting, while staff reported that they had problems obtaining consent from guardians when their partners were not present. Across all study types and settings, research staff reported that they emphasised the benefits more than the risks of the study to participants, due to pressure to recruit. Participants from non-acute settings were more likely to recall information shared during the consent process than participants in the acute setting.ConclusionThe health care context, culture and research process influenced participants’ understanding of study information across study types and settings. We advise research managers or principal investigators to define minimum requirements that would not compromise the consent process and conduct study specific training for staff. The use of one size fits all consent process may not be ideal. More guidance is needed on how these differences can be incorporated during the consent process to improve understanding and delivery of consent.Trial registration Not applicable. (shrink)

One of the core values to be applied by a body reviewing the ethics of human research is justice. The inclusion of justice as a requirement in the ethical review of human research is relatively recent and its utility had been largely unexamined until debates arose about the conduct of international biomedical research in the late 1990s. The subsequent amendment of authoritative documents in ways that appeared to shift the meaning of conceptions of justice generated a great deal of controversy. (...) Another difficulty has been that both the theory and the substance of justice that are applied by researchers or reviewers can be frequently seen to be subjective. Both the concept of justice — whether distributive or commutative — and what counts as a just distribution or exchange — are given different weight and meanings by different people.In this paper, the origins and more recent debates about the requirement to consider justice as a criterion in the ethical review of human research are traced, relevant conceptions of justice are distinguished, and the manner in which they can be applied meaningfully in the ethical review of all human research is identified.We also explain the way that these concepts are articulated in, and the intent and function of, specific paragraphs of the National Statementon Ethical Conduct in Human Research (2007). The National Statement identifies a number of issues that should be considered when a human research ethics committee is reviewing the justice aspects of an application. We provide guidance to researchers as to how they can show that there is a fair distribution of burdens and benefits in the participant experience and the research outcomes. We also provide practical guidance to researchers on how to think through issues of justice so that they can demonstrate that the design of their research projects meets this ethical requirement. (shrink)

Language anomalies and left-hemisphere dysfunction are commonly reported in schizophrenia. Additional evidence also suggests differences in the integration of information between the hemispheres. Bilateral gain is the increase in accuracy and decrease in latency that occurs when identical information is presented simultaneously to both hemispheres. This study measured bilateral gain in controls and individuals with schizophrenia using a lexical-decision task where word or non-word judgements were made to letter strings presented in the left visual field , right visual field or (...) bilaterally . Language was not abnormally lateralized in the schizophrenia group. Controls exhibited the expected decrease in latency when words were presented bilaterally. This effect was not observed in the schizophrenia group who were actually disadvantaged in this condition. The lack of bilateral gain in schizophrenia is discussed as arising from differences in the connections between areas in each hemisphere that mediate language. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Dr Ian Ramsey has made considerable use of the word ‘disclosure’ in what he has to say about religion and in his attempts to give an account of the meaning of religious language. He sometimes speaks of ‘discernment’ or ‘insight’ but ‘disclosure’ is the word he normally favours. In what follows I shall ask: what a disclosure is, to what extent Dr Ramsey's use of the notion leads to confusions, and what questions have to be faced in order to resolve (...) these confusions. (shrink)

Sexually‐selected exaggerated traits tend to be unusually reliable signals of individual condition, as their expression tends to be more sensitive to nutritional history and physiological circumstance than that of other phenotypes. As such, these traits are the foundation for many models of sexual selection and animal communication, such as “handicap” and “good genes” models. Exactly how expression of these traits is linked to the bearer's condition has been a central yet unresolved question, in part because the underlying physiological mechanisms regulating (...) their development have remained largely unknown. Recent discoveries across animals as diverse as deer, beetles, and flies now implicate the widely conserved insulin‐like signaling pathway, as a common physiological mechanism regulating condition‐sensitive structures with extreme growth. This raises the exciting possibility that one highly conserved pathway may underlie the evolution of trait exaggeration in a multitude of sexually‐selected signal traits across the animal kingdom. (shrink)

BackgroundExposure to early life stress is alarmingly prevalent and has been linked to the high rates of depression documented in adolescence. Researchers have theorized that ELS may increase adolescents’ vulnerability or reactivity to the effects of subsequent stressors, placing them at higher risk for developing symptoms of depression.MethodsWe tested this formulation in a longitudinal study by assessing levels of stress and depression during the COVID-19 pandemic in a sample of adolescents from the San Francisco Bay Area who had been characterized (...) 3–7 years earlier with respect to exposure to ELS and symptoms of depression.ResultsAs expected, severity of ELS predicted levels of depressive symptoms during the pandemic [r = 0.26, p = 0.006], which were higher in females than in males [t = −3.56, p < 0.001]. Importantly, the association between ELS and depression was mediated by adolescents’ reported levels of stress, even after controlling for demographic variables.ConclusionsThese findings underscore the importance of monitoring the mental health of vulnerable children and adolescents during this pandemic and targeting perceived stress in high-risk youth. (shrink)

A study is reported which focused on the problem-solving strategies employed by expert electronics engineers pursuing a real-world task: integrated-circuit design. Verbal protocol data were analysed so as to reveal aspects of the organisation and sequencing of ongoing design activity. These analyses indicated that the designers were implementing a highly systematic solution-development strategy which deviated only a small degree from a normatively optimal top-down and breadth-first method. Although some of the observed deviation could be described as opportunistic in nature, much (...) of it reflected the rapid depth-first exploration of tentative solution ideas. We argue that switches from a predominantly breadth-first mode of problem solving to depth-first or opportunistic modes may be an important aspect of the expert's strategic knowledge about how to conduct the design process effectively when faced with difficulties, uncertainties, and design impasses. (shrink)

This book brings together scholars from a variety of epistemological perspectives to explore the multiple ways in which sexuality does indeed matter in the arena of public education.

Epistemic relativists often appeal to an epistemic incommensurability thesis. One notable example is the position advanced by Wittgenstein in On certainty (1969). However, Ian Hacking’s radical denial of the possibility of objective epistemic reasons for belief poses, we suggest, an even more forceful challenge to mainstream meta-epistemology. Our central objective will be to develop a novel strategy for defusing Hacking’s line of argument. Specifically, we show that the epistemic incommensurability thesis can be resisted even if we grant the very insights (...) that lead Hacking to claim that epistemic reasons are always relative to a style of reasoning. Surprisingly, the key to defusing the argument is to be found in recent mainstream work on the epistemic state of objectual understanding. (shrink)

This paper explores the relationship between religion and history in the writings of R.G. Collingwood, Michael Oakeshott, and Clement C. J. Webb. Focussing principally on the early work of Collingwood and of Oakeshott and the later work of Webb, the paper shows that for all three philosophers the development of historical understanding in the late nineteenth and early twentieth centuries had important religious implications. While many of their British Idealist predecessors and contemporaries had responded to the 'higher criticism' of the (...) Bible by constructing speculative philosophies of history, Collingwood, Oakeshott and Webb understood history to be a genuine form of understanding that could not be so easily translated into other terms. Where Collingwood and Webb sought to integrate history with other expressions of mind, Oakeshott insisted on separating the various 'modes of experience'. The effect of this is to insulate religion from historical criticism but also, from the perspective of Collingwood and Webb, potentially undermine it by isolating it from ultimate truth. (shrink)

> Wealthy nations must do much more, much faster. The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference 26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature (...) and protect health. Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades.1 The science is unequivocal; a global increase of 1.5°C above the preindustrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse.2 3 Despite the world’s necessary preoccupation with COVID-19, we cannot wait for the pandemic to pass to rapidly reduce emissions. Reflecting the severity of the moment, this editorial appears in health journals across the world. We are united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory. The risks to health of increases above 1.5°C are now well established.2 Indeed, no temperature rise is ‘safe’. In the past 20 years, heat-related mortality among people aged over 65 has increased by more than 50%.4 Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality.5 6 Harms disproportionately affect the most vulnerable, including children, older populations, ethnic minorities, poorer communities and those with underlying health problems.2 4 Global heating is also contributing to the decline in …. (shrink)

We have all been very much influenced by philosophers whose revolutionary works have, in one way or another, contributed to our understanding of philosophical method; namely, G. E. Moore, who emphasized the effectiveness of ordinary language and common sense; Bertrand Russell, who has shown that logic can be a creative as well as an analytic instrument; Ludwig Wittgenstein, who dreamed of showing the structure of the world through the exhibition of logical form, and who then destroyed his own dream through (...) a grand exhibition of the multiplicity of uses—defying summation—to which language can be put; John Wisdom, who with an illuminating wit, has ironically written of the ironic power of philosophical discourse; A. J. Ayer, whose insistence on relating philosophical claims to sense experience has perpetuated the tough-minded pragmatism which Americans know through C. S. Peirce—these men, and many others. (shrink)

As Fragment 46 of the first book of Sallust's Histories Maurenbrecher prints: Magnis operibus perfectis obsidium cepit per L. Catilinam legatum. This he takes in effect to mean that Lucretius Ofella after the completion of great siege works received reinforcements brought by L. Catiline legate of Sulla. The interpretation depends largely upon his contention that the phrase obsidium cepit is to be taken as equivalent to subsidium cepit, for which he claims the authority, ultimately, of Verrius Flaccus as represented by (...) Festus p. 193M s.v. obsidium. Though opinions may occasionally have differed as to the precise event documented by the fragment, this central assumption seems to have gone unchallenged by historians. Yet it rests upon remarkably insecure foundations. The reading cepit has scant authority and the interpretation of obsidium as subsidium none at all. It is in fact the result of misunderstanding the passage of Festus in which the text is embedded. In Lindsay's edition the Festus entry which is here quoted in full runs as follows: Obsidium tamquam praesidium, subsidium recte dicitur, cuius etiam auctor C. Laelius pro se apud populum : ‘Ut in nobis terra marique simul obsidium facerent.’ Et Sallustius historiarum I : ‘Magnis operibus perfectis obsidium coepit per L. Catilinam legatum.’ Coepit is the reading of the manuscript F, which has been generally accepted, while cepit appears only in the Aldine edition where it may well be an emendation or even an error, there being no obvious independent source which might have provided it. For Maurenbrecher it was merely the ‘correction’ of Corte who produced the earliest roughly chronological arrangement of the fragments of Sallust's Histories. (shrink)

I have argued that without an adequate solution to the knower paradox Fitch's Proof is- or at least ought to be-ineffective against verificationism. Of course, in order to follow my suggestion verificationists must maintain that there is currently no adequate solution to the knower paradox, and that the paradox continues to provide prima facie evidence of inconsistent knowledge. By my lights, any glimpse at the literature on paradoxes offers strong support for the first thesis, and any honest, non-dogmatic reflection on (...) the knower paradox provides strong support for the second. Whether verificationists want to go the route I've suggested is not for me todecide. As in the previous section my aim has been that of defending the mere viability of verificationism in the face of what many, many philosophers have taken to be its death-knell, namely Fitch's Proof. But, as the final objection makes clear, showing that verificationism can live in the face of Fitch's Proof is one thing; showing that it should live is another project. If nothing else, I hope that this papershows that verificationists still have a project to pursue; Fitch's Proof, contrary to popular opinion, need not bury verificationism.13. (shrink)