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)

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Basic disagreements about what makes human life valuable hinder use of the concept of futility to decide whether it is appropriate to continue life support for one in a permanent state of unconsciousness, or to provide intensive medical care to one in the last stages of a terminal illness (the “paradigm cases”). Triage planning (the process of establishing criteria for health care prioritization) is an attractive alternative framework for addressing the paradigm cases. Triage planning permits society to see the cases (...) in the context of diverse moral perspectives, limited resources, and competing health care demands. Furthermore, at least one essential question posed by the paradigm cases is whether treatment is wasteful, and triage planning is a useful model for identifying and eliminating wasteful medical care. The authors describe how triage planning can be implemented to address the paradigm cases, and conclude that it offers one way of moving debate about these cases beyond futility. (shrink)

In this study, we investigate the effectiveness of a robust sampled-data H ∞ load frequency control scheme for power systems with randomly occurring time-varying delays. By using the input-delay technique, the sampled-data LFC model is reformulated as a continuous time-delay representation. Then, Bernoulli-distributed white noise sequences are used to describe randomly occurring time-varying delays in the sampled-data LFC model. Some less conservative conditions are achieved by utilizing the Lyapunov–Krasovskii functional and employing Jensen inequality and reciprocal convex combination lemma to ensure (...) the considered power system has mean-square asymptotic stability under the designed control scheme. The derived results are based on linear matrix inequalities that can readily be solved using the MATLAB LMI toolbox. The criteria obtained are used to analyze the upper bounds for time delays, and a comparison study to validate the efficacy of the presented method is presented. (shrink)

The article sets out aspects of locke's theory of personal identity which were seen by contemporaries to be not only fallacious but also to conflict with christian doctrine regarding the soul. A modified theory is then educed, From berkeley, Butler, William law and other divines, Which avoids these fallacies, Is epistemologically more rigorous and arguably expressed christian doctrine more accurately. This is seen as a forerunner of some central concerns of romantic theology.

The goal of this study was to determine whether it is possible to teach children with serious decoding problems four text comprehension strategies in listening contexts. The subjects were 9-11 year old students from special schools for children with learning disabilities. All the students were very poor at decoding; half of the group were also poor listeners, whereas the other half consisted of normal listeners. The experimental children were trained in strategies of clarifying, questioning, summarising and predicting through a combination (...) of reciprocal teaching and direct instruction. The results indicated significant programme effects on a strategic listening comprehension test. A transfer effect on general listening comprehension and general reading comprehension tests was not found. The poor listeners within the experimental group did not perform better than the normal listeners. (shrink)

Today's college students have more knowledge available to them than can be absorbed; mastery of a subject area creates siloes where nearly every course is tailored to comprehending subject matter that may be outdated before they graduate. But learning is more than subject-matter expertise. Our fast-paced environment requires instantaneous reactions to complex questions. Our instant-messaging age champions quick response over reflection or thought--even the president governs by Twitter. Yet the ethical dilemmas are no less complex than the subject matter; cyber (...) security, prison reform, labor rights, abortion, artificial intelligence, or gun laws are common table topics over lunch. Struggling through that complexity is central to understanding its implications for our culture. This book brings together some of the leading ethicists in the country to consider the rightful place of ethics in the university today. The authors make the case that higher education has a special duty to empower students to cultivate their character, ethically assess situations, and prepare them for an increasingly complex world. -- back cover. (shrink)