Although informed consent is important in clinical research, questions persist regarding when it is necessary, what it requires, and how it should be obtained. The standard view in research ethics is that the function of informed consent is to respect individual autonomy. However, consent processes are multidimensional and serve other ethical functions as well. These functions deserve particular attention when barriers to consent exist. We argue that consent serves seven ethically important and conceptually distinct functions. The first four functions pertain (...) principally to individual participants: (1) providing transparency; (2) allowing control and authorization; (3) promoting concordance with participants' values; and (4) protecting and promoting welfare interests. Three other functions are systemic or policy focused: (5) promoting trust; (6) satisfying regulatory requirements; and (7) promoting integrity in research. Reframing consent around these functions can guide approaches to consent that are context sensitive and that maximize achievable goals. (shrink)

The spatial dynamics of the optical emission from an array of 50 times 50 individual microcavity plasma devices is investigated. The array is operated in argon and argon-neon mixtures close to atmospheric pressure with an ac voltage. The optical emission is analysed with phase and space resolution. It has been found that the emission is not continuous over the entire ac period, but occurs once per half period. Each of the observed emission phases shows a self-pulsing of the discharge, with (...) several bursts of emission of fixed width and repetition rate. The number of emission bursts depends on applied voltage and frequency. Spatially resolved measurements prove that the emission bursts are formed by overlapping emission pulses from single discharge cavities. Intensity differences between positive and negative half-wave can be interpreted through spatially resolved measurements of single discharge cavities. (shrink)

By the time this essay is published, it will be a matter of weeks before doctors and nurse practitioners in Canada can legally end the lives (by medical assistance in dying, or MAID) of non-dying p...

Objective: To determine whether a moral reasoning exercise can improve response quality to surveys of healthcare priorities Methods: A randomised internet survey focussing on patient age in healthcare allocation was repeated twice. From 2574 internet panel members from the USA and Canada, 2020 (79%) completed the baseline survey and 1247 (62%) completed the follow-up. We elicited respondent preferences for age via five allocation scenarios. In each scenario, a hypothetical health planner made a decision to fund one of two programmes identical (...) except for average patient age (35 vs 65 years). Half of the respondents (intervention group) were randomly assigned to receive an additional moral reasoning exercise. Responses were elicited again 7 weeks later. Numerical scores ranging from –5 (strongest preference for younger patients) to +5 (strongest preference for older patients); 0 indicates no age preference. Response quality was assessed by propensity to choose extreme or neutral values, internal consistency, temporal stability and appeal to prejudicial factors. Results: With the exception of a scenario offering palliative care, respondents preferred offering scarce resources to younger patients in all clinical contexts. This preference for younger patients was weaker in the intervention group. Indicators of response quality favoured the intervention group. Conclusions: Although people generally prefer allocating scarce resources to young patients over older ones, these preferences are significantly reduced when participants are encouraged to reflect carefully on a wide range of moral principles. A moral reasoning exercise is a promising strategy to improve response quality to surveys of healthcare priorities. (shrink)

Background The use of lengthy, detailed, and complex informed consent forms is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in (...) biomedical research. Methods This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 to 5. Results Of the 2484 questionnaires distributed, 2113 were returned. The majority of respondents considered most elements required in the ICF to be ‘moderately important’ to ‘very important’ for their decision making. Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF. Conclusions Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF. (shrink)

A crisis continues to brew within the pharmaceutical research and development (R&D) enterprise: productivity continues declining as costs rise, despite ongoing, often dramatic scientific and technical advances. To reverse this trend, we offer various suggestions for both the expansion and broader adoption of modeling and simulation (M&S) methods. We suggest strategies and scenarios intended to enable new M&S use cases that directly engage R&D knowledge generation and build actionable mechanistic insight, thereby opening the door to enhanced productivity. What M&S requirements (...) must be satisfied to access and open the door, and begin reversing the productivity decline? Can current methods and tools fulfill the requirements, or are new methods necessary? We draw on the relevant, recent literature to provide and explore answers. In so doing, we identify essential, key roles for agent-based and other methods. We assemble a list of requirements necessary for M&S to meet the diverse needs distilled from a collection of research, review, and opinion articles. We argue that to realize its full potential, M&S should be actualized within a larger information technology framework—a dynamic knowledge repository—wherein models of various types execute, evolve, and increase in accuracy over time. We offer some details of the issues that must be addressed for such a repository to accrue the capabilities needed to reverse the productivity decline. (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)

Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid organ transplant, thirty-nine (...) (65.0 per cent) for candidates and twenty-one (35.0 per cent ) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent, p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often navigated communication challenges between transplant and non-transplant healthcare professionals and patients and families. (shrink)

Frederick Dretske′s views on the nature of seeing, the possibility of knowledge, the nature of content or non-natural meaning, the nature of behavior, and the role of content in teh causal explanation of behavior have been profoundly important. Dretske and His Critics contains original discussions of these issues by Joh Heil, Stuart Cohen, David H Sanford, Jaegwon Kim, Fred Adams, Daniel Dennett, Robert Cummins, Terence Horgan and Brian McLaughlin. Each chapter is responded to by Dretske himslef.

We show that for random bit strings, Up, with probability, image, the first order quantifier depth D) needed to distinguish non-isomorphic structures is Θ, with high probability. Further, we show that, with high probability, for random ordered graphs, G≤,p with edge probability image, D)=Θ, contrasting with the results for random graphs, Gp, given by Kim et al. [J.H. Kim, O. Pikhurko, J. Spencer, O. Verbitsky, How complex are random graphs in first order logic? Random Structures and Algorithms 26 119–145] of (...) D)=log1/pn+O. (shrink)

A scholarly edition of a work by David Hume. The edition presents an authoritative text, together with an introduction, commentary notes, and scholarly apparatus.

A numerical classification was performed on 69 elements with 54 chemicaland physicochemical properties. The elements fell into clusters in closeaccord with the electron shell s-, p- andd-blocks. The f-block elements were not included forlack of sufficiently complete data. The successive periods ofs- and p-block elements appeared in an ovalconfiguration, with d-block elements lying to one side. Morethan three axes were required to give good representation of thevariation, although the interpretation of the higher axes is difficult.Only 15 properties were scorable for (...) the noble gases, but despite thepaucity of properties reflecting chemical reactivity, analysis of the 69elements on these properties still showed the major features seen fromthe full set. (shrink)

This article explores the influence of Stoicism and religion on Adam Smith. While other commentators have argued either that the main influence on Smith was Stoicism or that it was religion, the two influences have not been explicitly linked. In this article I attempt to make such a link, arguing that Smith can be seen as belonging to the strand of Christian Stoicism chiefly associated with his teacher, Francis Hutcheson. Finally, some comments are made about the implications of this interpretation (...) for current understanding of the work of Adam Smith. (shrink)

Should the assessment of decision‐making capacity (DMC) be risk sensitive, that is, should the threshold for DMC vary with risk? The debate over this question is now nearly five decades old. To many, the idea that DMC assessments should be risk sensitive is intuitive and commonsense. To others, the idea is paternalistic or incoherent, or both; they argue that the riskiness of a given decision should increase the epistemic scrutiny in the evaluation of DMC, not increase the threshold for DMC. (...) We respond to the critics’ main concerns by providing a comprehensive account of how risk‐sensitive DMC is coherent, avoids paternalism, and best fulfills the epistemic goal of DMC evaluations. (shrink)

When do people say that they are moved, and does this experience constitute a unique emotion? We review theory and empirical research on being moved across psychology and philosophy. We examine feeling labels, elicitors, valence, bodily sensations, and motivations. We find that the English lexeme being moved typically (but not always) refers to a distinct and potent emotion that results in social bonding; often includes tears, piloerection, chills, or a warm feeling in the chest; and is often described as pleasurable, (...) though sometimes as a mixed emotion. While we conclude that it is a distinct emotion, we also recommend studying it in a more comprehensive emotion framework, instead of using the ambiguous vernacular term being moved as a scientific term. (shrink)

This collection of essays reflects the wide range of David Pingree's expertise in the scientific texts of Ancient Mesopotamia, Greece, India, Persia, and the medieval Arabic, Hebrew and Latin traditions. Both theoretical aspects and the practical applications of the exact sciences-in time keeping, prediction of the future, and the operation of magic-are dealt with. The book includes several critical editions and translations of hitherto unknown or understudied texts, and a particular emphasis is on the diffusion of scientific learning from one (...) culture to another, and through time. Above all, the essays show the variety and sophistication of the exact sciences in non-Western societies in pre-modern times. (shrink)

The basic notions of the theory of term rewriting are defined for terms that may involve function letters of infinite arity. A sufficient condition for completeness is derived, and its use demonstrated by the example of abstract clones over infinitary signatures.

The Medication Event Monitoring System (MEMS) is a relatively new device designed to overcome some of the disadvantages of traditional adherence-measuring techniques. MEMS has also been found useful in tracking adherence behaviour without the need to visit patients frequently. In this study each patient was given a pre-filled, labelled MEMS bottle and cap. Patients were monitored for 24 weeks. For patients specifically studied, there were periods when drug levels may have been low and some exhibited erratic medication-taking behaviour. It is (...) concluded that MEMS can measure adherence behaviour objectively, and so might be used to improve prescribing decisions, identify drug wastage and improve carer support. Further research is needed before the routine use of electronic medication monitoring can be recommended. (shrink)

Considering questions at the intersection of time and fiction deepens our understanding of fiction, introduces new questions for philosophy of time, and brings analytic philosophy in discussion with narratology. Philosophers debate whether fictional time can be tensed, whether fictional time can branch, repeat, pause, rewind, or skip and whether fictional time travel is possible. Much of the way we answer these questions will depend on our overall commitment to the nature of fiction. It’s also unclear what, if anything, we can (...) learn about the metaphysics of time from fiction. This chapter will introduce readers to discussions that are shaping the debates in this domain. (shrink)

Two doctors attempt to answer this question, one a specialist in geriatric medicine, the other a psychiatrist interested in the psychiatric problems of the elderly and the old. Both, however, come to the same general conclusion: attitudes of the doctors themselves and of society must be changed. These attitudes can determine not only whether an old person lives or dies but how he lives. Old people should not have to survive in mentally suspended animation with all objectives gone but should (...) be helped to achieve the goal of an independent life until death in their own homes. The third paper in this miniature symposium is provided by David Hobman, of Age Concern, who amplifies the specialist views of the first two writers in his discussion of attitudes to the elderly in modern society. He hints, however, that these may shortly change as the elderly become a sophisticated and powerful lobby which governments are forced to heed. (shrink)