Background: Medical tourism involves patients travelling internationally to receive medical services. This practice raises a range of ethical issues, including potential harms to the patient's home and destination country and risks to the patient's own health. Medical tourists often engage the services of a facilitator who may book travel and accommodation and link the patient with a hospital abroad. Facilitators have the potential to exacerbate or mitigate the ethical concerns associated with medical tourism, but their roles are poorly understood. -/- (...) Methods: 12 facilitators were interviewed from 10 Canadian medical tourism companies. -/- Results: Three themes were identified: facilitators' roles towards the patient, health system and medical tourism industry. Facilitators' roles towards the patient were typically described in terms of advocacy and the provision of information, but limited by facilitators' legal liability. Facilitators felt they played a positive role in the lives of their patients and the Canadian health system and served as catalysts for reform, although they noted an adversarial relationship with some Canadian physicians. Many facilitators described personally visiting medical tourism sites and forming personal relationships with surgeons abroad, but noted the need for greater regulation of their industry. -/- Conclusion: Facilitators play a substantial and evolving role in the practice of medical tourism and may be entering a period of professionalisation. Because of the key role of facilitators in determining the effects of medical tourism on patients and public health, this paper recommends a planned conversation between medical tourism stakeholders to define and shape facilitators' roles. (shrink)

Medical tourism is a practice, whereby individuals travel across national borders with the intention of receiving medical care. Medical tourists are motivated to travel abroad by a number of factors, including the affordability of care abroad, access to treatments not available at home, and wait times for care at home. In this article, we share the findings of interviews conducted with 32 Canadian medical tourists with the aim of developing a better understanding of medical tourism, the ethical issues it raises (...) for public health within Canada and other source countries for medical tourists, and to identify research gaps and policy responses to this practice. While patient and academic perspectives overlap in several regards, we suggest areas in which academic consideration of the ethical issues raised by medical tourism can be informed by patient perspectives. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 375 7he Westminster Dictionary of Christian Ethics. Edited by JAMES F. CHILDRESS and J mrn MACQUARRIE. Philadelphia: The Westminster Press, 1986. Pp. xvii + 678. $29.95. This is a second, revised edition of The Dictionary of Christian Ethics, prepared by John Macquarrie and published in 1967. This new edition follows Macquarrie's conception of a dictionary, but expands it. It includes several subject areas, basic ethical concepts, biblical (...) ethics, theological ethics, philosophical ethics, non-Cbistian ethics; psychological, 8ociological, political, and other relevant concepts; and articles on substantial issues such as war and abortion. The criterion for selection, as stated by the editor, was the importance of the topic for Christian ethical reflection. The aim was to indicate both what is agr.eed upon and what is controversial. About 40% of the entries from the first edition have been included. These are generally updated so as to include recent developments. The selection of subjects, the way in which they are treated and the list of contributors, reflect the ecumenical character of contemporary Christian ethics. The dictionary includes a host of valuable contributions. Readers who consults the work will no doubt evaluate the entries in terms of their particular purposes. This reviewer found most useful the entries which expla~ned particular basic concepts, for example Autonomy; those dealing with schools of thought, for example, Platonic Ethics, Marxist Ethics, or the contribution of particular traditions, for example, Jewish Ethics, Puritan Ethics, Official Roman Catholic Social Teaching, Eastern Orthodox Christian Ethics, and the many entries dealing with Biomedical Ethics and peace issues. 'rhere are a number of articles on topics which are most important, but for which it is often difficult to find a succinct and comprehensive treatment; such are the contributions on "Embodiment," and " Feminist Ethics." There are a number of useful entries on urg.ent contemporary questions such as Energy and Environmental Ethics. Practical questions such as the care of the aged and the ethics of counseling are also addressed. Each article has a short bibliography appended. Numerous cross-references to other relevant entries are most helpful in providing complementary information. There is a thorough index of names. The dictionary is not conceived as a compendium of the accepted or " official " ethical teachings of churches or religious traditions. Mention could be made, however, of the entry on " Official Roman Catholic Social Teaching." '¥here such teachings exist, they am usually indicated. There are some cases where the churches and/or traditions clearly differ. The approach which is most helpful to ethical debate is to acknowledge such differences clearly, with an appropriate statement of the relevant teaching. The editor himself (James F. Childress), in his own contributions, fol- 376 BOOK REVIEWS lows this p1'0cedure. Some Roman Catholic readers may find the articles on Abortion and Contraception, while excellent in other ways, less satisfactory in this respect. The general focus seems intended to be " middle of the road "; more conservative or radical groups may find their views insufficiently represented. No doubt some of the positions presented would be disputed by Christian ethicists. But the treatment of difficult points is balanced and fair. There are, unfortunately, some inaccuracies. The following examples deserve mention. In the article on Nullity, the Roman Catholic annulment is wrongly equated with papal dissolution of the marriage bond. In the article on Virtue, it is said that St. Thomas held that along with the infused supernatural virtues there are "infused natural virtues." St. Thomas spoke ratht>r of infused theological virtues and infused moral virtues (I. II, Q.63, 3.) In the article on deterrence, it is stated that the strategy of "mutual assured destruction ", dating from the 1960s, still provides the framework of American deterrence strategy. This point would be challenged by some representat.ives of the military, who claim that M.A.D. has not been policy for some years. The same article interprets the U.S. Bishops' Pastoral Letter, The Challenge of Peace. as basing its (conditional) acceptance of nuclear deterrence on the distinction between threatening to do an immoral aet without intending to do it, and threat coupled with the intent. That is, deterrence is aceepted as a "bluff." This is not a correct reading... (shrink)

This study investigated the performance of boys with psychopathic tendencies and comparison boys, aged 9 to 17 years, on two tasks believed to be sensitive to amygdala and orbitofrontal cortex func- tioning. Fifty-one boys were divided into two groups according to the Psychopathy Screening Device (PSD, P. J. Frick & R. D. Hare, in press) and presented with two tasks. The tasks were the gambling task (A. Bechara, A. R. Damasio, H. Damasio, & S. W. Anderson, 1994) and the Intradimensional/ (...) Extradimensional (ID/ED) shift task (R. Dias, T. W. Robbins, & A. C. Roberts, 1996). The boys with psychopathic tendencies showed impaired performance on the gambling task. However, there were no group differences on the ID/ED task either for response reversal or extradimensional set shifting. The implications of these results for models of psychopathy are discussed. (shrink)

This study investigates the ability of individuals with psychopathy to perform passive avoidance learning and whether this ability is modulated by level of reinforcement/punishment. Nineteen psychopathic and 21 comparison individuals, as defined by the Hare Psychopathy Checklist Revised (Hare, 1991), were given a passive avoidance task with a graded reinforcement schedule. Response to each rewarding number gained a point reward specific to that number (i.e., 1, 700, 1400 or 2000 points). Response to each punishing number lost a point punishment specific (...) to that number (i.e., the loss of 1, 700, 1400 or 2000 points). In line with predictions, individuals with psychopathy made more passive avoidance errors than the comparison individuals. In addition, while the performance of both groups was modulated by level of reward, only the performance of the comparison population was modulated by level of punishment. The results are interpreted with reference to a computational account of the emotional learning impairment in individuals with psychopathy. (shrink)

Background: The Declaration of Helsinki, the World Medical Association’s statement of ethical guidelines regarding medical research, is published in the three official languages of the WMA: English, French and Spanish.Methods: A detailed comparison of the three official language versions was carried out to determine ways in which they differed and ways in which the wording of the three versions might illuminate the interpretation of the document.Results: There were many minor linguistic differences between the three versions. However, in paragraphs 1, 6, (...) 29, 30 and in the note of clarification to paragraph 29, there were differences that could be considered potentially significant in their ethical relevance.Interpretation: Given the global status of the Declaration of Helsinki and the fact that it is translated from its official versions into many other languages for application to the ethical conduct of research, the differences identified are of concern. It would be best if such differences could be eliminated but, at the very least, a commentary to explain any differences that are unavoidable on the basis of language or culture should accompany the Declaration of Helsinki. This evidence further strengthens the case for international surveillance of medical research ethics as has been proposed by the WMA. (shrink)

It is human nature to try to recognize patterns and to make sense of that which we observe. Unfortunately, our intuition is often wrong, and so there is a need to impose some objectivity on the methods by which observations are converted into knowledge. One definition of biostatistics could be precisely this, the rigorous and objective conversion of medical and/or biological observations into knowledge. Both consumers of biostatistical principles and biostatisticians themselves vary in the extent to which they recognize the (...) need to continue the improvement. Some may not recognize the need for (some or all of) the methods that have already been developed; others may accept these as they find them completely sufficient; still others recognize both the value and the shortcomings of these methods, and seek to develop even better methods to ensure that future medical conclusions are less subject to biases than current ones are. (shrink)

During an Australian qualitative and empirical study looking at lesbian, gay, bisexual, and transgender client's experiences of counseling, and counselor's experiences of working with minority clients, a large body of unsolicited data emerged related to experiences of religious-based homophobia. Analysis of the data suggests that a lifelong process of posttraumatic recovery for many lesbian, gay, bisexual, and transgender people follows prior experiences of religious-based homophobia. This paper discusses the sociological debate related to how counselors find themselves at the crossroad between (...) a healthy lifestyle model of homosexuality based in well established contemporary professional ethics versus long standing religious-based attitudes and constraints toward homosexuality. This intersection of conflicting beliefs generates a controversial social and political environment in which counselors must make a basic decision to either support minority clients according to ethical guidelines or to side with socially conservative constructs that, rightly or wrongly, rely largely on Western religious traditions. (shrink)

At one time, A.J.Toynby regarded as civilizations of the "third generation" three civilizations that were formed during the transition from the Old City to the Middle Ages on the basis of the sociocultural, in particular, the religious, property of the ancient and Middle Eastern peoples: Western Christianity, Eastern Christianity, and Muslim. The first two, as is known, had two spiritual Christians, which resolutely differed only in the middle of the XI century. But at the civilization level, the distinction between the (...) East Christian and Western Christian worlds began with the final antiquity. (shrink)

This study investigates the performance of psychopathic individuals on tasks believed to be sensitive to dorsolateral prefrontal and orbitofrontal cortex (OFC) functioning. Psychopathic and non-psychopathic individuals, as defined by the Hare psychopathy checklist revised (PCL-R) [Hare, The Hare psychopathy checklist revised, Toronto, Ontario: Multi-Health Systems, 1991] completed a gambling task [Cognition 50 (1994) 7] and the intradimensional/extradimensional (ID/ED) shift task [Nature 380 (1996) 69]. On the gambling task, psychopathic participants showed a global tendency to choose disadvantageously. Specifically, they showed an (...) impaired ability to show learning over the course of the task. On the ID/ED task, the performance of psychopathic individuals was not significantly different from incarcerated controls on attentional set-shifting, but significant impairments were found on response reversal. These results are interpreted with reference to an OFC and amygdala dysfunction explanation of psychopathy. (shrink)

This paper reports a study of the roles of visuo-spatial and verbal working memory capacities in solving a planning task - the five-disc Tower of London (TOL) task. An individual differences approach was taken. Sixty adult participants were tested on 20 TOL tasks of varying difficulty. Total moves over the 20 TOL tasks was taken as a measure of performance. Participants were also assessed on measures of fluid intelligence (Raven's matrices), verbal short-term storage (Digit span), verbal working memory span (Silly (...) Sentence span), visuo-spatial short-term storage (Visual Pattern span and Corsi Block span), visuo-spatial working memory (Corsi Distance Estimation), visuo-spatial processing speed (Manikin test), and verbal speed (Rehearsal speed). Exploratory factor analysis using an oblique rotation method revealed three factors which were interpreted as (1) a visuo-spatial working memory factor, (2) an age-speed factor, and (3) a verbal working memory factor. The visuo-spatial and verbal factors were only moderately correlated. Performance on the TOL task loaded on the visuo-spatial factor but did not load on the other factors. It is concluded that the predominant goal-selection strategy adopted in solving the TOL relies on visuo-spatial working memory capacity and particularly involves the active ''inner scribe'' spatial rehearsal mechanism. These correlational analyses confirm and extend results previously obtained by use of dual task methods, (Phillips, Wynn, Gilhooly, Della Sala, & Logie, 1999). (shrink)

Professor Brian V. Johnstone, CSsR, has been quietly and unobtrusively contributing to the intellectual life of Catholicism, especially in the field of moral theology, for nearly four decades. Having published numerous theological articles on many topics, including biomedical ethics, peace and war, and fundamental moral theology, and directed many doctoral dissertations, it is no exaggeration to say that he has dedicated his entire life to teaching and writing theology. In honor of Johnstone's work, this felicitation volume covers a wide range (...) of themes in the Christian moral life with original articles written by internationally recognized theologians. In the spirit of Johnstone's thought and work, each article challenges the reader to reflect upon the present while contemplating the future of moral theology. (shrink)

This paper examines the impact that recent advances in clinical neurology, introspectionist psychology and neuroscience have upon the philosophical psycho?neural Identity Theory. Topics covered include (i) the nature and properties of phenomenal consciousness based on a study of the ?basic? visual field, i.e. that obtained in the complete dark, the Ganzfeld, and during recovery from occipital lobe injuries; (ii) the nature of the ?body?image? of neurology and its relation to the physical body; (iii) Descartes? error in choosing extension in space (...) as the criterion for distinguishing the physical and the mental; (iv) the technical distinction between sensing and perceiving; (v) why phenomenal Direct Realism is incorrect whereas epistemic DR and the representative theory are correct; (vi) the ontological and topological status of phenomenal space and physical space. This leads to considerations of the current ?binding problems? in neuroscience; the role of the brain mechanisms that construct the sensory fields of phenomenal consciousness; the ?homunculus? fallacy; the key difference between epistemic and non?epistemic perception as revealed by brain injury studies; and how the brain codes information, contrasting topological and vectorial coding, with particular reference to the binding problem. My conclusion is that the Identity Theory is incompatible with the scientific evidence from an integrated approach to modern introspectionist psychology, clinical neurology, and neuroscience. However, Cartesian Dualism is even more incompatible with the evidence. This leaves only two viable theories. The first is Bohr's theory of brain?consciousness complementarity. The second is the Broad?Price?Smythies theory of extension, which is a topological theory of the relation between phenomenal space and physical space. (shrink)

While outcomes for children with T-cell acute lymphoblastic leukemia have improved dramatically, survival rates for patients with relapsed/refractory disease remain dismal. Prior studies indicate that glucocorticoid resistance is more common than resistance to other chemotherapies at relapse. In addition, failure to clear peripheral blasts during a prednisone prophase correlates with an elevated risk of relapse in newly diagnosed patients. Here we show that intrinsic GC resistance is present at diagnosis in early thymic precursor T-ALLs as well as in a subset (...) of non-ETP T-ALLs. GC-resistant non-ETP T-ALLs are characterized by strong induction of JAK/STAT signaling in response to interleukin-7 stimulation. Removing IL7 or inhibiting JAK/STAT signaling sensitizes these T-ALLs, and a subset of ETP T-ALLs, to GCs. The combination of the GC dexamethasone and the JAK1/2 inhibitor ruxolitinib altered the balance between pro- and anti-apoptotic factors in samples with IL7-dependent GC resistance, but not in samples with IL7-independent GC resistance. Together, these data suggest that the addition of ruxolitinib or other inhibitors of IL7 receptor/JAK/STAT signaling may enhance the efficacy of GCs in a biologically defined subset of T-ALL.Leukemia advance online publication, 30 May 2017; doi:10.1038/leu.2017.136. (shrink)

A total of 1918 loci, detected by the hybridization of 938 expressed sequence tag unigenes from 26 Triticeae cDNA libraries, were mapped to wheat homoeologous group 4 chromosomes using a set of deletion, ditelosomic, and nulli-tetrasomic lines. The 1918 EST loci were not distributed uniformly among the three group 4 chromosomes; 41, 28, and 31% mapped to chromosomes 4A, 4B, and 4D, respectively. This pattern is in contrast to the cumulative results of EST mapping in all homoeologous groups, as reported (...) elsewhere, that found the highest proportion of loci mapped to the B genome. Sixty-five percent of these 1918 loci mapped to the long arms of homoeologous group 4 chromosomes, while 35% mapped to the short arms. The distal regions of chromosome arms showed higher numbers of loci than the proximal regions, with the exception of 4DL. This study confirmed the complex structure of chromosome 4A that contains two reciprocal translocations and two inversions, previously identified. An additional inversion in the centromeric region of 4A was revealed. A consensus map for homoeologous group 4 was developed from 119 ESTs unique to group 4. Forty-nine percent of these ESTs were found to be homoologous to sequences on rice chromosome 3, 12% had matches with sequences on other rice chromosomes, and 39% had no matches with rice sequences at all. Limited homology was found between wheat ESTs on homoeologous group 4 and the Arabidopsis genome. Forty-two percent of the homoeologous group 4 ESTs could be classified into functional categories on the basis of blastX searches against all protein databases. (shrink)

The rôle of mathematical models in growth studies is discussed and a distinction made between the structural and descriptive aspects of a mathematical formulation. A simple scheme is set up to represent in broad outline the simultaneous growth and interaction of larval and adult systems inMyrmica rubra and is matched against observed results.

On April 26, 1995, the United States Supreme Court limited the reach of the preemption provision of ERISA in New York State Conference of Blue Cross & Blue Shield Plans v. Tavelers Insurance Co. ). In Travelers, the Supreme Court upheld the validity of a New York statute requiring hospitals to collect surcharges from patients covered by commercial insurers and requiring health maintenance organizations to pay a surcharge to the state's general fund that varies depending on the number of Medicaid-eligible (...) HMO members enrolled. Neither patients insured by Blue Cross/Blue Shield plans nor the plans themselves are similarly charged under the statute. Several commercial insurers and HMOs claimed the surcharges should be preempted under ERISA because they are levied on patients whose insurance or HMO membership premiums are purchased by an ERISA plan.The ERISA preemption clause means that federal regulation, or lack thereof, supersedes state regulation that is related to employee pension and benefit plans. This preemption clause prevents states from changing health care and benefit law for a significant portion of state residents. (shrink)

Fourth-year medical students at the University of Colorado School of Medicine distributed cards to patients in the emergency department asking, "What Worries You Most?" The patients' responses provided insight about their most pressing concerns, often unrelated to their "chief complaints.".

Electrical resistivity and ac-calorimetric measurements reveal a complex magnetic phase diagram for single crystals of the ferromagnetic Kondo-lattice compound CeAgSb2 at high pressures up to 80 kbar. The ferromagnetic order at TC = 9.6 K at ambient pressure is completely suppressed at a critical pressure PC = 35 kbar. Another magnetic transition, possibly antiferromagnetic, found above 27 kbar, attains a maximum value TN 6 K at 44 kbar and then appears to be completely suppressed by 50 kbar. Thermodynamic and transport (...) measurements in the ferromagnetic state indicate an energy gap Δ 30 K in the spin-wave excitation spectrum at ambient pressure which decreases to Δ 10 K at P = 30 kbar. No superconductivity is observed at ambient pressure above T 0.1 K, under applied pressure in the ferromagnetic state (P = 28.5 kbar), nor in the antiferromagnetic state (P = 33 − 46 kbar) above 0.3 K. © 2003 The American Physical Society. (shrink)

A substantial body of evidence suggests that autobiographical recollection and simulation of future happenings activate a shared neural network. Many of the neural regions implicated in this network are affected in patients with bipolar disorder , showing altered metabolic functioning and/or structural volume abnormalities. Studies of autobiographical recall in BD reveal overgeneralization, where autobiographical memory comprises primarily factual or repeated information as opposed to details specific in time and in place and definitive of re-experiencing. To date, no study has examined (...) whether these deficits extend to future event simulation. We examined the ability of patients with BD and controls to imagine positive, negative and neutral future events using a modified version of the Autobiographical Interview that allowed for separation of episodic and non-episodic details. Patients were selectively impaired in imagining future positive, negative, and neutral episodic details; simulation of non-episodic details was equivalent across groups. (shrink)

This is the first book to offer the best essays, articles, and speeches on ethics and intelligence that demonstrate the complex moral dilemmas in intelligence collection, analysis, and operations. Some are recently declassified and never before published, and all are written by authors whose backgrounds are as varied as their insights, including Robert M. Gates, former Director of the Central Intelligence Agency; John P. Langan, the Joseph Cardinal Bernardin Professor of Catholic Social Thought at the Kennedy Institute of Ethics, Georgetown (...) University; and Loch K. Johnson, Regents Professor of Political Science at the University of Georgia and recipient of the Owens Award for contributions to the understanding of U.S. intelligence activities. Creating the foundation for the study of ethics and intelligence by filling in the gap between warfare and philosophy, this is a valuable collection of literature for building an ethical code that is not dependent on any specific agency, department, or country. (shrink)

The complex hexaploid wheat genome offers many challenges for genomics research. Expressed sequence tags facilitate the analysis of gene-coding regions and provide a rich source of molecular markers for mapping and comparison with model organisms. The objectives of this study were to construct a high-density EST chromosome bin map of wheat homoeologous group 2 chromosomes to determine the distribution of ESTs, construct a consensus map of group 2 ESTs, investigate synteny, examine patterns of duplication, and assess the colinearity with rice (...) of ESTs assigned to the group 2 consensus bin map. A total of 2600 loci generated from 1110 ESTs were mapped to group 2 chromosomes by Southern hybridization onto wheat aneuploid chromosome and deletion stocks. A consensus map was constructed of 552 ESTs mapping to more than one group 2 chromosome. Regions of high gene density in distal bins and low gene density in proximal bins were found. Two interstitial gene-rich islands flanked by relatively gene-poor regions on both the short and long arms and having good synteny with rice were discovered. The map locations of two ESTs indicated the possible presence of a small pericentric inversion on chromosome 2B. Wheat chromosome group 2 was shown to share syntenous blocks with rice chromosomes 4 and 7. (shrink)

Background: Issues concerning legislation and regulation with respect to the role of nurses in euthanasia and physician-assisted suicide gave the Minister for Health reason to commission a study of the role of nurses in medical end-of-life decisions in hospitals, home care and nursing homes.Aim: This paper reports the findings of a study of the role of nurses in euthanasia and physician-assisted suicide, conducted as part of a study of the role of nurses in medical end-of-life decisions. The findings for hospitals, (...) home care and nursing homes are described and compared.Method: A questionnaire was sent to 1509 nurses, employed in 73 hospitals, 55 home care organisations and 63 nursing homes. 1179 responses were suitable for analysis. The questionnaire was pilot-tested among 106 nurses, with a response rate of 85%.Results: In 37.0% of cases, the nurse was the first person with whom patients discussed their request for euthanasia or physician-assisted suicide. Consultation between physicians and nurses during the decision-making process took place quite often in hospitals and nursing homes and less frequently in home care situations . In some cases , nurses administered the euthanatics.Conclusions: The results show substantial differences between the intramural sector and the extramural sector , which are probably linked to the organisational structure of the institutions. Consultation between physicians and nurses during the decision-making process needs improvement, particularly in home care. Some nurses had administered euthanatics, although this task is by law exclusively reserved to physicians. (shrink)

D. Boulanger. Colloque Lamarck Paris, Vrin, 1980 EVOLUTION DU GROUPE DES NUMMULITES C'est en 1801 que Lamarck dans son Système des animaux sans vertèbres proposa le genre Nummulites qu'il considéra comme le 89e des ...

© 2016 Regents of the University of California.The Review summarizes much of particle physics and cosmology. Using data from previous editions, plus 3,062 new measurements from 721 papers, we list, evaluate, and average measured properties of gauge bosons and the recently discovered Higgs boson, leptons, quarks, mesons, and baryons. We summarize searches for hypothetical particles such as supersymmetric particles, heavy bosons, axions, dark photons, etc. All the particle properties and search limits are listed in Summary Tables. We also give numerous (...) tables, figures, formulae, and reviews of topics such as Higgs Boson Physics, Supersymmetry, Grand Unified Theories, Neutrino Mixing, Dark Energy, Dark Matter, Cosmology, Particle Detectors, Colliders, Probability and Statistics. Among the 117 reviews are many that are new or heavily revised, including those on Pentaquarks and Inflation. The complete Review is published online in a journal and on the website of the Particle Data Group. The printed PDG Book contains the Summary Tables and all review articles but no longer includes the detailed tables from the Particle Listings. A Booklet with the Summary Tables and abbreviated versions of some of the review articles is also available. (shrink)