In vitro fertilization is now a well-established practice in the field of assisted reproduction. In 1995, over 41,000 IVF cycles were done in the United States, at a cost of more than $300 million. The overall success rate has risen to 22.8 deliveries per 100 egg-retrieval procedures. As the field has matured, the attention of policy-makers has shifted from questions about the ethical and legal status of human embryos to concerns about providing access and protecting consumers.Three such concerns have emerged. (...) One is the danger that IVF programs will disseminate misleading information about their success rates in order to attract patients. This problem, however, may be alleviated by the publication in late 1997 of the first of annual national and clinic specific reports, based on randomly audited data, by the Centers for Disease Control and Prevention, the American Society of Reproductive Medicine, the Society for Assisted Reproductive Technology, and RESOLVE, pursuant to the federal 1992 Fertility Clinic Success Rate and Laboratory Certification Act. (shrink)

Clinical ethical support services (CESS) represent a multifaceted field of aims, consultancy models, and methodologies. Nevertheless, the overall aim of CESS can be summed up as contributing to healthcare of high ethical standards by improving ethically competent decision-making in clinical healthcare. In order to support clinical care adequately, CESS must pay systematic attention to all real-life ethical issues, including those which do not fall within the ‘favourite’ ethical issues of the day. In this paper we attempt to capture a comprehensive (...) overview of categories of ethical tensions in clinical care. We present an analytical exposition of ethical structural features in judgement-based clinical care predicated on the assumption of the moral equality of human beings and the assessment of where healthcare contexts pose a challenge to achieving moral equality. The account and the emerging overview is worked out so that it can be easily contextualized with regards to national healthcare systems and specific branches of healthcare, as well as local healthcare institutions. By considering how the account and the overview can be applied to i) improve the ethical competence of healthcare personnel and consultants by broadening their sensitivity to ethical tensions, ii) identify neglected areas for ethical research, and iii) clarify the ethical responsibility of healthcare institutions' leadership, as well as specifying required institutionalized administration, we conclude that the proposed account should be considered useful for CESS. (shrink)

This article concerns the validity of six canonical rules that institutional review boards use to constrain the behavior of investigators. These rules require investigators to design their studies in a scientifically valid way, not pay their subjects to take risks, minimize risks to their subjects, secure for their subjects access to effective interventions post-trial, not pay their subjects too much and allow their subjects to withdraw from the study unconditionally. Enforcement of these rules is problematic because there are other relationships (...) that seem to be like the investigator-subject relationship in all ethically relevant respects, such as the employer-employee and volunteer organizer-volunteer relationships, to which we would not dream of applying these same rules. Applying these rules in one context but not the others is a violation of ethical consistency I label “exceptionalism.” We should conclude that it is time to reexamine the validity of the six rules. (shrink)

Extensive research has documented the harmful effects associated with working for a narcissistic supervisor. However, little effort has been made to investigate ways for victims to alleviate the burdens associated with exposure to such aversive persons. Building on the tenets of conservation of resources theory and the documented efficacy of functional assets to combat job-related stress, we hypothesized that subordinates’ resource management ability would buffer the detrimental impact of narcissistic supervisors on affective, cognitive, and behavioral work outcomes for subordinates. We (...) found support for our hypotheses across three independent samples of US workers. Specifically, higher levels of subordinate resource management ability attenuated the harmful effects of supervisor narcissism on employee-reported emotional exhaustion, job tension, depressed mood, task performance, and citizenship behavior. Conversely, these relationships further deteriorated for subordinates with lower levels of resource management ability. Overall, our research contributes to the literature that, although extensively documenting the harmful ramifications of narcissism in organizations, has neglected to investigate potentially mitigating factors. (shrink)

Background In Canadian jurisdictions without specific legislation pertaining to research consent, the onus is placed on researchers to determine whether a child is capable of independently consenting to participate in a research study. Little, however, is known about how child health researchers are approaching consent and capacity assessment in practice. The aim of this study was to explore and describe researchers' current practices. Methods The study used a qualitative descriptive design consisting of 14 face-to-face interviews with child health researchers and (...) research assistants in Southern Ontario. Transcribed interviews were analysed for common themes. Results Procedures for assessing capacity varied considerably from the use of age cutoffs to in-depth engagement with each child. Three key issues emerged from the accounts: (1) requirements that consent be provided by a single person thwarted researchers' abilities to support family decision-making; (2) little practical distinction was made between assessing if a child was capable, versus determining if study information had been adequately explained by the researcher; and (3) participants' perceived that review boards' requirements may conflict with what they considered ethical consent practices. Conclusion The results suggest that researchers' consent and capacity knowledge and skills vary considerably. Perceived discrepancies between ethical practice and ethics boards' requirements suggest the need for dialogue, education and possibly ethics board reforms. Furthermore we propose, where appropriate, a ‘family decision-making’ model that allows parents and their children to consent together, thereby shifting the focus from separate assent and consent procedures to approaches that appropriately engage the child and family. (shrink)

The rapid rise of international collaborative science has enabled access to genomic data. In this article, it is argued that to move beyond mapping genomic variation to understanding its role in complex disease aetiology and treatment will require extending data sharing for the purposes of clinical research translation and implementation.

The eleventh-century Byzantine compiler Cedrenus includes a unique story in the midst of his otherwise traditional and hagiographic material on the emperor Constantine. Mentioning the outbreak of war between the Roman and Persian empires, he describes the cause of the breakdown of peace somewhat as follows. A certain Metrodorus, who was of Persian origin, went to visit the Brahmins in India to study philosophy and won the reputation of being a holy man through his asceticism. He also built water mills (...) and baths, unknown to the Indians till that time. Having acquired this reputation, he entered the temples and took away many precious stones and pearls. He also received gifts from the king of the Indians. On his return to Byzantium he gave them to the emperor Constantine as being gifts of his own. When Constantine expressed his astonishment, Metrodorus said he had sent other gifts by the land route but that they had been detained by the Persians. Constantine then wrote a strong protest to Sapor demanding the gifts but received no reply; thus the peace was broken. This remarkable conte, more appropriate to the Arabian Nights than to sober history, is generally supposed to be referred to in a passage in Ammianus. Towards the end of a long section commenting on the personality and achievements of Julian, Ammianus turns briefly to the question of the ultimate responsibility for the Persian War which ended so disastrously for Julian and the Roman Empire: et quoniam eum obtrectatoribus novos bellorum tumultus ad perniciem rei communis insimulant concitasse, sciant docente veritate perspicue, non Iulianum sed Constantinum ardores Parthicos succendisse, cum Metrodori mendaciis avidius acquiescit, ut dudum rettulimus plane. (shrink)

The techniques of natural duality theory are applied to certain finitely generated varieties of Heyting algebras to obtain optimal dualities for these varieties, and thereby to address algebraic questions about them. In particular, a complete characterisation is given of the endodualisable finite subdirectly irreducible Heyting algebras. The procedures involved rely heavily on Priestley duality for Heyting algebras.

In this work I seek to explain the relationship between the substantially different characterizations of the public sphere made by Kant. In his writings on the Enlightenment, the productive component of this space is emphasized and the conditions that allow social and political progress to be fostered are identified. On the other hand, in the texts on the idea of a universal history, its antagonistic dynamics are rather emphasized. At first glance, the teleological history according to a plan of nature (...) seems to relegate the public sphere and the public use of reason to a secondary role. However, given the epistemic status of the philosophy of history, I will seek to highlight that, on the contrary, this regulative idea only has philosophical significance due to the effects of its public dissemination. Thus, what motivated the elaboration of a philosophy of history was rather the political potential of public thought, and, thus, the teleology of history is secondary to the conception of the public sphere. (shrink)

Both syntactic and semantic solutions are given for the entailment problem of duality theory. The test algebra theorem provides both a syntactic solution to the entailment problem in terms of primitive positive formulae and a new derivation of the corresponding result in clone theory, viz. the syntactic description of $\operatorname{Inv(Pol}(R))$ for a given set R of finitary relations on a finite set. The semantic solution to the entailment problem follows from the syntactic one, or can be given in the form (...) of an algorithm. It shows, in the special case of a purely relational type, that duality-theoretic entailment is describable in terms of five constructs, namely trivial relations, intersection, repetition removal, product, and retractive projection. All except the last are concrete, in the sense that they are described by a quantifier-free formula. It is proved that if the finite algebra $\underline{M}$ generates a congruence-distributive variety and all subalgebras of $\underline{M}$ are subdirectly irreducible, then concrete constructs suffice to describe entailment. The concept of entailment appropriate to strong dualities is also introduced, and described in terms of coordinate projections, restriction of domains, and composition of partial functions. (shrink)

I share Kulagin's bewilderment over the term "work-situation theme." There is something unnatural in dividing literature - the study of human beings - into topics and headings. How many kinds of prose we have heard of in recent years: working class, rural, urban, youth, military, intellectual, personal, industrial. The eruptions and outbursts occurring in literary life tend largely to eliminate these lines of demarcation, and then the arguments rage not so much upon themes as about language, creative style, characters, and (...) the degree to which the writer was successful in depicting the full richness and variety of life. (shrink)

Bradford C Bemiss, Chad A WittDepartment of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO, USA: Chronic rejection is a major cause of death after the first year following lung transplantation. Bronchiolitis obliterans is the most common pathologic finding on biopsy, characterized by fibrous granulation tissue, which obliterates the lumen of the bronchiole. Clinically, in the absence of tissue for pathology, BO syndrome refers to a progressive irreversible drop in the forced (...) expiratory volume in 1 second. Recently, a broader definition of chronic rejection, termed "chronic lung allograft dysfunction", has been used to encompass a more inclusive definition of posttransplant dysfunction. Recently, the lung transplant community has come to realize that chronic rejection may be the final common result after repetitive epithelial insults. Acute rejection, infection, and alloreactivity to mismatched HLA antigens are a few of these insults that damage the surface of the bronchioles. Recent evidence of autoimmunity to the normally hidden structural proteins collagen V and K-α1 tubulin have been correlated with a BO phenotype as well, perhaps correlating the epithelial damage with a mechanism for developing BO lesions. Many immunomodulatory medications and treatments have been studied for effectiveness for the treatment of chronic lung allograft dysfunction. New drugs, which more precisely target the immune system, are being developed and tested. Further study is required, but recent advances have improved our understanding of the pathogenesis and potential intervention for this common and deadly complication of lung transplantation.Keywords: lung transplant, bronchiolitis obliterans syndrome, rejection. (shrink)