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)

The epidemic of COVID-19 appears to be reshaping the world, separating before and after, present and past. Its perceived novelty raises the question of what role the past might play in the present epidemic and in responses to it. Taking the view that the past has not passed, but is present in is material and immaterial remains, and continuously emerging from these, we argue that it should not be studied as closed narration but through the array of its traces, which (...) constitute the texture of the present. To that end, and building on long-term ethnographic research on past and present epidemics in western Kenya, we assemble here some preliminary observations on the first weeks of COVID-19 in Kenya. We explore how the acute epidemic crisis currently unfolding is intertwined with layered fragments of earlier epidemic events, attending to material infrastructures, institutional practices, and ritual responses, to the presence of virally loaded bodies, pharmaceuticals, and their residues, and to the resurgence of often painful memories and emotions. People in this region have experienced a long century of epidemics and anti-epidemic measures of varying duration and intensity, from colonial and postcolonial sleeping sickness and smallpox to HIV/AIDS and more recently cancer, alongside actual or anticipated outbreaks of cholera and Ebola. This local perception of one long epidemic qualifies the notion of a radical temporal break that the COVID-19 pandemic is often associated with in European conversations. (shrink)

This article examines the origin of experiential organization, especially whether it is salient or selective. Aron Gurwitsch believes it is salient and William James that it is selective. I argue that Gurwitsch is right, and recount his argument and his critique of James, but I also pose my own critique and critical questions on the issue. -/- Gurwitsch's argument attempts to show that the organization of consciousness is not arbitrary or merely selected in some way by the subject. He claims (...) that when consciousness is organized it is found as already organized. -/- This is important for Gurwitsch's philosophical system because if he can establish that consciousness is always originally organized, then his famous claim that the theme, thematic-field, margin structure of consciousness is an invariant patterning impervious to the subject's whim, mood, or possible noetic training, is protected at the very start. (shrink)

Rule A: if it's metaphysically necessary that p, we may validly infer that no one is even partly morally responsible for the fact that p. Our principal aim in this article is to highlight the importance of this rule and to respond to two recent challenges to it. We argue that rule A is more important to contemporary theories of moral responsibility than has previously been recognized. We then consider two recent challenges to the rule and argue that neither challenge (...) successfully undermines the rule's initial appeal. (shrink)

The classic opening scene of 2001, A Space Odyssey shows an ape-man wreaking havoc with humanity's first invention--a bone used as a weapon to kill a rival. It's an image that fits well with popular notions of our species as inherently violent, with the idea that humans are--and always have been--warlike by nature. But as Douglas P. Fry convincingly argues in Beyond War , the facts show that our ancient ancestors were not innately warlike--and neither are we.

The author clarifies the existential philosophy that is implicit in Kurt Goldstein's philosophy of organism (Goldstein, 1963; 1995). Situated in response to the growing trend that psychological phenomena are reducible to the nervous system, the author argues for the reverse: that the significance of nervous system activity can only be understood by viewing it as background to foreground performances. Like the organization of perception into meaningful figure-- ground Gestalts, the existential modes of embodiment, sociality, temporality, spatiality, and attunement are organized (...) together to accomplish foreground performances. It is only within this context that the activity of the nervous system may be understood as significant or insignificant. Speech is given as an example. The article concludes with a commentary on how the trend of reducing psychological phenomena to neurological phenomena has impaired our understanding of brain disorders and psychological disorders. (shrink)

Background: According to the Declaration of Helsinki, patients who take part in a clinical trial must be adequately informed about the trial's aims, methods, expected benefits, and potential risks. The declaration does not, however, elaborate on what “adequately informed” might amount to, in practice. Medical researchers and Local Research Ethics Committees attempt to ensure that the information which potential participants are given is pitched at an appropriate level, but few studies have considered whether the patients who take part in such (...) trials feel they have been given adequate information, or whether they feel able to understand that information.Objectives: To explore trial participants' views on the amount of information provided, and of their own understanding of that information.Design: Structured interviews of patients participating in clinical trials for the treatment of chronic medical condition.Findings: Patients generally felt they were given an appropriate amount of information, and that they were able to understand all or most of it. They felt they were given adequate time to ask questions before agreeing to take part. In comparison with treatment given outwith the research setting, patients generally felt they received more information when participating in a clinical trial.Conclusions: Researchers sometimes complain that patients are given too much information during clinical trials, and have limited understanding of that information. The present study shows that this perception is not necessarily shared by patients. More research is needed in this area, particularly to gauge whether patient understanding is indeed accurate. (shrink)

In biology, and particularly in morphology, various types of explanation are found,e.g. causal, teleological, historical, etc.In this article an attempt has been made to analyse the relations between the various explanations to strive for an encompassing explanatory theory.The general structure of the explanatory theories appeared to be very similar, but the terms defining the phenomena and the types of the relations within the theories differ. To obtain a unifying theory it is necessary to develop methods to connect or transform the (...) different elements.An important aspect is that the definition of selected phenomena depends on the explanation pursued. (shrink)

We present in this article a new logical system inspired from linear logic. This system is designed in order to express causality and dynamism. The cut elimination theorem holds for this logic. Examples of applications are given.

(1) It remains to be seen if in the field of Psychiatry just as in that of Psychology the verbal output of a subject can be submitted to verification. Many statements of a highly emotional character being merely symptoms of certain dispositions have no direct communicative sense at all.(2) It being one of the characteristics of the mentally ill to loose contact and exchange of ideas with other people, the question naturally suggests itself if this symptom may be at the (...) bottom of the phenomenon of these persons taking refuge in logical and ideological terminologies, their talk being a kind of verbal autism. (shrink)