© 2014 Taylor Francis. The Centers for Disease Control and Prevention recommends routine human immunodeficiency virus testing of every client presenting for services in venues where HIV prevalence is high. Because older adults have particularly poor prognosis if they receive their diagnosis late in the course of HIV disease, any screening provided to younger adults in these venues should also be provided to older adults. We examined aging-related disparities in recent and ever HIV testing in a probability sample of at-risk (...) adults seeking services in needle exchange sites, sexually transmitted disease clinics, and Latino community clinics that provide HIV testing. Using multiple logistic regression with generalized estimating equations, we estimated associations between age category and each HIV testing outcome. Even after controlling for covariates such as recent injection drug use, older adults had 40% lower odds than younger adults did of having tested in the past 12 months or ever. Aging-related disparities in HIV testing exist among clients of these high HIV prevalence venues and may contribute to known aging-related disparities in late diagnosis of HIV infection and poor long-term prognosis. (shrink)

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)

This book explores the universe and its subsystems from the three lenses of evolutionary (diversifying), developmental (converging), and complex (adaptive) processes at all scales. It draws from prolific experts within the academic disciplines of complexity science, physical science, information and computer science, theoretical and evo-devo biology, cosmology, astrobiology, evolutionary theory, developmental theory, and philosophy. The chapters come from a Satellite Meeting, "Evolution, Development and Complexity" (EDC) hosted at the Conference on Complex Systems, in Cancun, 2017. The contributions will be peer-reviewed (...) and contributors from outside the conference will be invited to submit chapters to ensure full coverage of the topics. This book explores many issues within the field of EDC such as the interaction of evolutionary stochasticity and developmental determinism in biological systems and what they might teach us about these twin processes in other complex systems. This text will appeal to students and researchers within the complex systems and EDC fields.. (shrink)

The aim of the present investigation was to describe and to classify significant ethical problems encountered by the members of the staff during the daily clinical work at a hospital medical department. A set of definitions was prepared for the purpose, including the definition of a 'significant ethical problem'. During a three month period 426 inpatients and 173 outpatients were admitted. Significant ethical problems were encountered during the management of 106 in-patients (25 per cent) and 9 out-patients (5 per cent). (...) No significant difference was found between the frequency of ethical problems in female and male patients, but a positive correlation was noted between the number of problems and the patients' age. The problem types were classified according to a problem list. The results of this investigation suggest that greater attention must be paid to discussions about ethical problems among doctors and other categories of health personnel and that, among others, medical students ought to be taught the analysis of ethical problems. (shrink)

At Moore’s time, the main-stream ethical theory is the doctrine that pleasure alone is good as an end as held by the hedonistic utilitarianism. Moore, however, asserts that good, not composed of any parts, is a simple notion and indefinable, and naturalistic ethical theories, in particular hedonistic utilitarianism, interpret intrinsic good as a property of a single natural object---pleasure, which is also the sole end of life, thus violates naturalistic fallacy. Moore seems to believe that there exist things other than (...) pleasure that are also intrinsically good and has searched for them. But Moore has not clearly stated what these things are, nor has he given any justification for why they are intrinsically good. This paper discusses Moore’s arguments and difficulties of utilitarianism. With the subjectivistic utilitarian theory of value, Unified Utilitarian Theory (UTT) discards the classification of value into intrinsic and instrumental and proves to be exempt of all theexisting difficulties with utilitarianism related to pleasure, including naturalistic fallacy, vagueness of pleasure and sole end of life, double counting, etc. (shrink)

Variant Creutzfeldt–Jakob disease is a fatal, transmissible, neurodegenerative disorder for which there is currently no effective treatment. vCJD arose from the zoonotic spread of bovine spongiform encephalopathy. There is now compelling evidence for human to human transmission through blood transfusions from presymptomatic carriers and experts are warning that the real epidemic may be yet to come. Imperatives exist for the development of reliable, non-invasive presymptomatic diagnostic tests. Research into such tests is well advanced. In this article the ethical implications of (...) the availability of these tests are elaborated and comparisons drawn with predictive genetic testing for Huntington’s disease and screening for HIV. Paramount to considerations is the issue of whom to test, weighing up respect for personal autonomy against obligations to benefit and protect society. A paradigm is proposed similar to that used for HIV screening but with unique features: compulsory testing of all blood/organ donors and individuals undergoing surgery or invasive procedures who have a significant risk of disease transmission. (shrink)

(Tye 2006) presents us with the following scenario: John and Jane are both stan- dard human visual perceivers (according to the Ishihara test or the Farnsworth test, for example) viewing the same surface of Munsell chip 527 in standard conditions of visual observation. The surface of the chip looks “true blue” to John (i.e., it looks blue not tinged with any other colour to John), and blue tinged with green to Jane.¹ Tye then in effect poses a multiple choice question.

An increasing number of research teams are investigating the efficacy of brain-computer interface (BCI)-mediated interventions for promoting motor recovery following stroke. A growing body of evidence suggests that of the various BCI designs, most effective are those that deliver functional electrical stimulation (FES) of upper extremity (UE) muscles contingent on movement intent. More specifically, BCI-FES interventions utilize algorithms that isolate motor signals—user-generated intent-to-move neural activity recorded from cerebral cortical motor areas—to drive electrical stimulation of individual muscles or muscle synergies. BCI-FES (...) interventions aim to recover sensorimotor function of an impaired extremity by facilitating and/or inducing long-term motor learning-related neuroplastic changes in appropriate control circuitry. We developed a non-invasive, electroencephalogram (EEG)-based BCI-FES system that delivers closed-loop neural activity-triggered electrical stimulation of targeted distal muscles while providing the user with multimodal sensory feedback. This BCI-FES system consists of three components: (1) EEG acquisition and signal processing to extract real-time volitional and task-dependent neural command signals from cerebral cortical motor areas, (2) FES of muscles of the impaired hand contingent on the motor cortical neural command signals, and (3) multimodal sensory feedback associated with performance of the behavioral task, including visual information, linked activation of somatosensory afferents through intact sensorimotor circuits, and electro-tactile stimulation of the tongue. In this report, we describe device parameters and intervention protocols of our BCI-FES system which, combined with standard physical rehabilitation approaches, has proven efficacious in treating UE motor impairment in stroke survivors, regardless of level of impairment and chronicity. (shrink)

SummaryP. Vardy asserts the thesis that the vicious circle principle has the same structure as Russell's paradox. But structure is not the thing itself. It is the thing objectivated from the wiewpoint of a mathematician. So this structure can be expressed in a mathematical formalism, e. g. the Λ‐calculus. Russell's paradox is understood as a result of the error of taking purely logical concepts, like negation, as lkiewise formalisable without change of meaning. The illusion of meaning in the liar's proposition: (...) Yl'am telling a lie can also be explained be the formalisable self‐referential structure of this proposition. Yet it remains an illusion because the logical intention cannot follow the structure.ResumeLe « Principe du cercle vicieux » a la même structure que le paradoxe de Russel: c'est une thèse de P. Várdy. Mais la structure n'est pas la chose même. Elle est la chose objectivée du point de vue du mathématicien et peut done être exprimée dans un formalisme mathématique, p. ex. le Λ‐calcul. L'erreur qui conduit au paradoxe de Russel, c'est de juger des concepts purement logique, p. ex. la négation, comme étant également exprimable dans un formalisme sans que leur sens ne change.L'illusion de sens que donne l'énoncé«je mens» dans le paradoxe du menteur peut aussi être expliquée par la structure formalisable d'autoréférence de cette proposition. Mais l'illusion persiste, parce que l'intention logique ne peut pas suivre la structure.ZusammenfassungRussells «Vicious circle principle» hat dieselbe Struktur wie die Russellsche Antinamie. So lautet die These P. Várdys. Aber die Struktur ist nicht die Sache selbst, sondern nur die vom mathematischen Standpunkte aus objektivierte Sache, die in einem Formalis‐onus ausgedrückt werden kann. Die Antinomie Russells wird Als Folge der irrigen Auffassung verstanden, rein logische Begriffe, wie z. B. die Negation, konnten formalisiert werden, ohne dass dabei ihr Sinn verwandelt würde. Die Sinnillusion des Satzes «Ich lüge» kann dann auch aus der selbstbezüglichen formalen Struktur des Satzes erklärt werden. Doch bleibt dies blosse Illusion, weil die logische Intention der Struktur nicht gerecht werden kann. (shrink)

High-spin states in the odd-odd N = Z nucleus Co-54 have been investigated by the fusion-evaporation reaction Si-28(S-32,1 alpha 1p1n)Co-54. Gamma-ray information gathered with the Ge detector array Gammasphere was correlated with evaporated particles detected in the charged particle detector system Microball and a 1 pi neutron detector array. A significantly extended excitation scheme of Co-54 is presented, which includes a candidate for the isospin T = 1, 6(+) state of the 1f(7/2)(-2) multiplet. The results are compared to large-scale shell-model (...) calculations in the fp shell. Effective interactions with and without isospin-breaking terms have been used to probe isospin symmetry and isospin mixing. A quest for deformed high-spin rotational cascades proved negative. This feature is discussed by means of cranking calculations. (shrink)