Demands by Patients or their Families for treatment thought to be inappropriate by health care providers constitute an important set of moral problems in clinical practice. A variety of approaches to such cases have been described in the literature, including medical futility, standard of care and negotiation. Medical futility fails because it confounds morally distinct cases: demand for an ineffective treatment and demand for an effective treatment that supports a controversial end (e.g., permanent unconsciousness). Medical futility is not necessary in (...) the first case and is harmful in the second. Ineffective treatment falls outside the standard of care, and thus health care workers have no obligation to provide it. Demands for treatment that supports controversial ends are difficult cases best addressed through open communication, negotiation and the use of conflict-resolution techniques. Institutions should ensure that fair and unambiguous procedures for dealing with such cases are laid out in policy statements. (shrink)

Background: Only data of published study results are available to the scientific community for further use such as informing future research and synthesis of available evidence. If study results are reported selectively, reporting bias and distortion of summarised estimates of effect or harm of treatments can occur. The publication and citation of results of clinical research conducted in Germany was studied.Methods: The protocols of clinical research projects submitted to the research ethics committee of the University of Freiburg in 2000 were (...) analysed. Published full articles in several databases were searched and investigators contacted. Data on study and publication characteristics were extracted from protocols and corresponding publications.Results: 299 study protocols were included. The most frequent study design was randomised controlled trial , followed by uncontrolled studies , laboratory studies and non-randomised studies . 182 were multicentre studies including 97 international collaborations. 152 of 299 had commercial funding and 46 non-commercial funding. 109 of the 225 completed protocols corresponded to at least one full publication ; the publication rate was 48%. 168 of 210 identified publications were cited in articles indexed in the ISI Web of Science. The median was 11 citations per publication .Conclusions: Results of German clinical research projects conducted are largely underreported. Barriers to successful publication need to be identified and appropriate measures taken. Close monitoring of projects until publication and adequate support provided to investigators may help remedy the prevailing underreporting of research. (shrink)

Background: The magnitude of bullying and harassment among psychiatrists is reportedly high, yet no peer-review published studies addressing this issue could be found. Therefore, it was decided to conduct a pilot study to assess the degree of the problem, the types of bullying/harassment and to provide some insights into the situation.Methods and Principal Findings: Following multiple focus group meetings, a yes/no response type questionnaire was developed to assess the degree and type of bullying and harassment experienced by psychiatrists. Over a (...) 3-month period the questionnaire was administered to a random sample of 60 psychiatrists. 57 out of the 60 psychiatrists reported harassment and bullying. Frequencies of the following response variables are presented in descending order: rumours 40% ; defamation 20% ; passing remarks 20% ; false accusations 15% ; threats 13.3% ; verbal abuse 13.3% ; unjustified complaints 13.3% ; promotion blocked 13.3% ; humiliation 13% ; bad reference given 10% ; credentials questioned 8.3% ; physical attacks 5% ; termination 5% ; derogatory remarks 1.7% and 1.7% were subjected to personal work. As a result of being subjected to harassment, 66.7% of the psychiatrists did not take any action, whereas 33.3% confronted the person they believed responsible. Asked whether the bullying and harassment caused distress, 18.3% of the psychiatrists did not report any effect, 30% reported mild distress, 40% moderate distress and severe distress was reported by 11.7%.Conclusions: It was concluded that the magnitude of bullying and harassment among psychiatrists may be quite high, as evidenced by this pilot study. There is a need for extensive systematic studies on this subject and to establish strategies to prevent and address this issue at a national and regulatory level. (shrink)

There has been much discussion about what, if any, legal and moral duties professionals have to disclose relevant genetic information to the family members of someone with an identified disease predisposing mutation. Here, we present a case report where dissemination of such a genetic test result did not take place within a family. In contrast to previous literature, there appeared to be no deliberate withholding of information, instead distant relatives were unable to communicate relevant information appropriately. When communication was facilitated (...) through the follow-up of a chance remark, the patient was able to avoid planned major surgery, with its attendant morbidity, and her high anxiety levels were much reduced. We believe this case highlights the need for an ongoing debate on how genetic services can best support patients and their families with disclosing relevant genetic information to other family members. (shrink)

This paper describes the topological aspect of a logic-based, artificial intelligence approach to formalising the qualitative description of spatial properties and relations, and reasoning about those properties and relations. This approach, known as RCC theory, has been under development for several years at the University of Leeds. The main rationale for this project is that qualitative descriptions of spatial properties and relationships, and qualitative spatial reasoning, are of fundamental importance in human thinking about the world: even where quantitative spatial data (...) are most important, they must be attached to the components of a perceived spatial structure if we are to make use of them. RCC theory covers other qualitative aspects of spatial description and reasoning, but the topological properties and relations of spatially extended entities are fundamental to our work. The topological formalisms used by mathematicians are, in general, not well suited to the task of formalising the kinds of ‘common-sense’ or ‘everyday’ qualitative spatial description and reasoning which are our primary interest. Nevertheless, we must come to grips with the concepts of topology as practised by mathematicians if we are not to risk constantly ‘reinventing wheels’. (shrink)

This three-volume history of England from before the Roman conquest through to the Glorious Revolution of 1688 was originally serialised in Charles Dickens' magazine Household Words between 1851 and 1853. The text was published in book form in the same period, although each volume was post-dated to the following year. Dickens dedicated the work to his own children, intending it to be a stepping stone to more substantial histories. The volumes were popular with readers for decades, and were (...) used in British schools well into the twentieth century. Dickens employs his signature style to bring events and personalities to life, making use of vivid similes, unabashedly partisan language and direct speech, as well as the occasional moral lesson. Volume 2 covers the period from the reign of Henry III through to the death in 1485 of the 'usurper and murderer' Richard III. (shrink)

Mitchell et al.'s claim, that their propositional theory is a single-process theory, is illusory because they relegate some learning to a secondary memory process. This renders the single-process theory untestable. The propositional account is not a process theory of learning, but rather, a heuristic that has led to interesting research.

On Roger Bacon's life and works, by A. G. Little.--Der einfluss des Robert Grosseteste auf die wissenschaftliche richtung des Roger Bacon, von Ludwig Baur.--La place de Roger Bacon parmi les philosophes du XIIIe siècle, par François Picavet.--Roger Bacon and the Latin vulgate, by Francis Aidan, cardinal Gasquet.--Roger Bacon and philology, by S. A. Hirsch.--The place of Roger Bacon in the history of mathematics, by David Eugene Smith.--Roger Bacon und seine verdienste um die optik, von Eilhard Wiedemann.--Roger Bacons lehre von der (...) sinnlichen spezies und vom seḣvorgange, von Sebastian Vogl.--Roger Bacons art des wissenschaftlichen arbeitens dargestellt nach seiner schrift De speculis, von J. Würschmidt.--Roger Bacon et l'horreur du vide, par Pierre Duhem.--Roger Bacon, his relations to alchemy and chemistry, by M. M. Pattison Muir.--Roger Bacon and gunpowder, by H. W. L. Hime.--Roger Bacon and medicine, by E. Withington. (shrink)