The current legal status and medical ethics of routine or religious penile circumcision of minors is a matter of ongoing controversy in many countries. We focus on the United Kingdom as an illustrative example, giving a detailed analysis of the most recent British Medical Association guidance from 2019. We argue that the guidance paints a confused and conflicting portrait of the law and ethics of the procedure in the UK context, reflecting deeper, unresolved moral and legal tensions surrounding child genital (...) cutting practices more generally. Of particular note is a lack of clarity around how to apply the “best interests” standard—ordinarily associated with time-sensitive proxy decision making regarding therapeutic options for a medically unwell patient—to a parental request for a medically unnecessary surgery to be carried out on the genitalia of a healthy child. Challenges arise in measuring and assigning weights to intended sociocultural or religious/spiritual benefits, and even to health-related prophylactic benefits, and in balancing these against potential physical, functional, and psychosexual risks or harms. Also of concern are apparently inconsistent safeguarding standards being applied to children based on their birth sex categorization or gender of rearing. We identify and discuss recent trends in British and international medical ethics and law, finding gradual movement toward a more unified standard for evaluating the permissibility of surgically modifying healthy children's genitals before they can meaningfully participate in the decision. (shrink)

Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)

Antimicrobial resistance (AMR) poses an increasing threat to patient care and population health and there is a growing need for novel therapies to tackle AMR. Bacteriophage (phage) therapy is a re-emerging antimicrobial strategy with the potential to transform how bacterial infections are treated in patients and populations. Currently, in the UK, phages can be used as unlicensed medicinal products on a ‘named-patient’ basis. We make an ethical case for why it is crucially important for the UK to invest in Good (...) Manufacturing Practice (GMP) for both ongoing unlicensed and future licensed phage therapy. Access to phages produced to GMP (GMP phages) will ensure effective patient care and better outcomes as well as health systems benefits. The UK also has the potential to become a global leader in the timely and cost-efficient manufacturing and supply of a therapy that meets internationally recognised standards. (shrink)

In a morally pluralist, or in Alasdair MacIntyre's terms “morally fragmented”, society it seems almost inevitable that people engaging with issues of bioethics should operate within something like John Rawls's idea of an “overlapping consensus”—the area in which there is broad agreement between people with different comprehensive worldviews, and in which they are able and willing to operate with the shared criteria of what Rawls calls “public reason”. There are, of course, those who are uneasy about this approach, usually because (...) they see moral fragmentation as being more pervasive and consensus more difficult to achieve, than the Rawlsians believe. From opposite wings Alasdair MacIntyre and Tristram Engelhardt join forces to question the viability of the liberal consensus. There are, of course, problems with an overlapping consensus. People with religious convictions often feel that …. (shrink)

Welcome to the Post-Truth era-- a time in which the art of the lie is shaking the very foundations of democracy and the world as we know it. The Brexit vote; Donald Trump's victory; the rejection of climate change science; the vilification of immigrants; all have been based on the power to evoke feelings and not facts. So what does it all mean and how can we champion truth in in a time of lies and 'alternative facts'? In this eye-opening (...) and timely book, Post-Truth is distinguished from a long tradition of political lies, exaggeration and spin. What is new is not the mendacity of politicians but the public's response to it and the ability of new technologies and social media to manipulate, polarise and entrench opinion. Where trust has evaporated, conspiracy theories thrive, the authority of the media wilt and emotions matter more than facts. Now, one of the UK's most respected political journalists, Matthew d'Ancona investigates how we got here, why quiet resignation is not an option and how we can and must fight back. (shrink)

Presently, there is a movement in the UK research governance framework towards what is referred to as proportional ethical review. Proportional ethical review is the notion that the level of ethical review and scrutiny given to a research project ought to reflect the level of ethical risk represented by that project. Relatively innocuous research should receive relatively minimal review and relatively risky research should receive intense scrutiny. Although conceptually attractive, the notion of proportional review depends on the possibility of effectively (...) identifying the risks and ethical issues posed by an application with some process other than a full review by a properly constituted research ethics committee. In this paper, it is argued that this cannot be achieved and that the only appropriate means of identifying risks and ethical issues is consideration by a full committee. This implies that the suggested changes to the National Health Service research ethics system presently being consulted on should be strenuously resisted. (shrink)

In an era where decolonizing architectural pedagogy is imperative, cities stand as the forefront of radical thought, acting as crucibles for ideological, activist, and spatial dynamics. These urban landscapes are not just breeding grounds for new paradigms, but also reflect significant shifts in political and social frameworks. This study adopts the concept of the “radical city” as a prism to understand how local events echo global political and sociocultural disturbances. This research takes an innovative approach by integrating mixed-method pedagogies, student-driven (...) inquiries, and diverse case studies, spanning continents from Asia to Latin America, Europe to Africa, and the US to the UK. The aim is to explore the deep-rooted changes in these cities and to promote a decolonized approach to architectural education, moving beyond traditional, Eurocentric narratives. The backbone of this research is the course “Visualizing Radical Urbanism,” offered at the Huckabee College of Architecture, Texas Tech University, in Fall 2022 and Fall 2023. Through this course, students engage in a pedagogical journey involving exploration, research, analysis, and introspection on their selected radical city. Their diverse methodologies and expressive mediums converge in a comprehensive portfolio, showcasing their intellectual growth and culminating in a reflective essay on their urban subject. By focusing on educational research and time investment in this course, the study highlights the importance of sustained, critical engagement with urban environments. This approach not only enriches architectural education but also contributes to the broader discourse on urban activism and decolonization, reinforcing the need for diverse, inclusive, and globally aware architectural pedagogies. (shrink)

Recently, commentators close to and within the UK government have claimed that patient choice can increase equity in the context of the National Health Service. This article critically examines the basis for this claim through analysis of recent speeches and publications authored by secretaries of state for health and their policy advisers. It is concluded that this claim has not developed prospectively from an analysis of the causes of healthcare inequity, or even with a consistent normative definition of equity. The (...) limited justification that is “framed in causal explanations” of inequity has suffered from an apparent disregard of the available evidence. (shrink)

Economic inequality has become a focus of prime interest for economic analysts and policy makers. This book provides an integrated approach to the topics of inequality and personal income distribution. It covers the practical and theoretical bases for inequality analysis, applications to real world problems and the foundations of theoretical approaches to income distribution. It also analyses models of the distribution of labour earnings and of income from wealth. The long-run development of income - and wealth - distribution over many (...) generations is also examined. Special attention is given to an assessment of the merits and weaknesses of standard economic models, to illustrating the implications of distributional mechanisms using real data and illustrative examples, and to providing graphical interpretation of formal arguments. Examples are drawn from US, UK and international sources. (shrink)

This book draws on case examples of contemporary black activism in South Manchester and contrasts them with events that surrounded C.L.R. James and his activism between 1935 and 1950. In doing so, the author considers what Brexit, the Labour Party and Theresa May's audit on racism in the UK have in common with the wartime decline of the British Empire, the rise and fall of the trade unions and the Italian invasion of Ethiopia. Clennon dialogues with James' theoretical frameworks around (...) capitalism, neoliberalism and post-colonialism, and uses this creative interplay of ideas to help make sense of contemporary events and issues of social justice from a UK ethnic minority perspective. Using Fanon, Gordon, Marx and Chakrabarty amongst others, the study explores James' take on dialectical materialism and uses this as an ongoing analytical tool throughout the volume with which he weaves an uneasy path between post-colonial and post-Marxist theories. The Polemics of C.L.R. James and Contemporary Black Activism will be of interest to students and scholars across a range of social science disciplines, including sociology, cultural studies, education and black studies. (shrink)

Medicine is unique among professions and trades, offering a 'product' which is unlike any other. The consequences for patients of being attracted by misleading information to an inappropriate doctor or service are such as to demand special restrictions on the advertising of doctors' services. Furthermore, health care in the UK is organised around the 'referral system', whereby general practitioners refer patients to specialists when necessary rather than have specialists accept patients on self-referral. But this need not inhibit the provision of (...) helpful factual information to those who need it. Recent policy changes by the General Medical Council considerably broaden the scope for general practitioners to make factual information of their services available to local people, while safeguarding the public against promotional activities which are designed to increase demand for certain kinds of specialist service by playing upon individuals' fears and lack of medical knowledge. (shrink)

New protocols have been developed for donors after circulatory death involving early assessment of donor status and premortem supporting treatment in appropriate cases where there is evidence that the patient wished to be an organ donor. These donors are now making an increasingly marked impact on overall deceased donor numbers in the UK. Donors after brainstem death, on the other hand, are much less buoyant yet require the same flexibility in approach in order to improve rates of donation and to (...) realize the wishes of potential deceased organ donors to the proper requisite extent. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hume Studies Volume XXIII, Number 2, November 1997, pp. 315-335 Reid: Conception, Representation and Innate Ideas ROGER D. GALLIE Section I of this paper begins with a presentation of Thomas Reid's doctrine of the signification of words, of what words signify or represent. That presentation serves to introduce a problem of interpretation, namely, what Reid thinks the connection is between conceiving something and grasping what a term for it (...) signifies. It is pointed out that even if Reid maintains that what a word signifies is conceived by both speaker and hearer when that word is understood, this is a far cry from the position that he takes the stronger view, whether for all or only for some things, that their being conceived involves the understanding of a term or terms. The position that he does indeed take this stronger, although moderate, view is defended in sections II, III and IV. In sections II and III it is argued that, in Reid's view, for an adequate conception of an individual, real or imaginary, a conception of its attributes is needed. In section IV it is argued that the possession of general conceptions (in distinction from their formation), without which conception of attributes is impossible, requires appropriate understanding of general terms. So since for the conception of an individual a conception of its attributes is needed, and since for the conception of attributes appropriate understanding of general terms is required, we arrive at a textually well-founded position: for the conception of most things, in Reid's view, understanding of terms is indispensable. Roger D. Gallie is at the Department of Philosophy, Nottingham University, University Park, Nottingham NG7 2RD UK. email: Roger.Gallie@nottingham.ac.uk 316 Roger D. Gallie The remainder of the paper considers the following question: to what extent, if any, Reid is committed to acceptance of nativist views on concept possession? To answer, in section V we consider to what extent Reid's moderate position on the possession of conceptions commits him to accepting Jerry Fodor's representational theory of mind (RTM) for propositional attitudes. It is clear that the view that a propositional attitude state such as belief involves some relation between a person and a representation such as a significant word, phrase or sentence of a natural language such as English can fairly be attributed to Reid. But it is also clear that Reid cannot be an adherent of the view that persons have a functional cum computational relation to Fodorean mental representations, so he cannot be an adherent of any nativism ex- plicitly contained in such a view. But it is to be noted that in his Inquiry, Chapter IV, Reid argues by a different route that in order to acquire a language such as English prior mastery of a system of significant signs is required. In section VI Keith Lehrer's argument in criticism of a reductionist interpretation of a position such as Fodor's is presented: that for a sign to signify something to someone presupposes that that person has a conception of what is signified. It is however pointed out that since there is a case for not viewing Fodor's position as reductionist overall Fodor can accept Lehrer's argument. Lehrer's innatist position, which he both claims to follow easily from this critical argument and to be a correct interpretation of Reid, is then presented: that we must presuppose an innate understanding of some signs to account for our learning the meaning of any signs. The objection that Reid too must accept the alleged innatist implications of Lehrer's critical argument in view of the implications of his moderate position on the possession of conceptions is considered and rebutted. In section VIII argue that while Lehrer makes a respectable case for innate principles of formation of conceptions such as that of hardness, something that Reid clearly endorses in his Inquiry, Chapter V, he does not succeed in making a case for there being any innate possession of conceptions. Finally, in section VIII, Reid's mature views in the Intellectual Powers, Essay VI, on how conceptions come to be possessed are expounded, and are fleshed out with some... (shrink)

This study examined the ethical issues experienced by nurses working in a small group of elderly persons’ care settings in the UK, using a survey questionnaire previously used in other countries for examining the cultural aspects of ethical issues. However ‘culture’ relates not only to ethnicity but also the organizational culture in which care is delivered. Nurses working in elderly persons’ care settings described a range of issues faced when caring for elderly terminally ill people, which illustrated the different needs (...) of patients, relatives, professionals and society. These issues related to the unique needs of elderly people (such as dementia sufferers) and could have an impact on patients’ quality of death. (shrink)

[kn. 1]. Without special title -- kn. 2. Obrazolohika systemy boh i Boh -- kn. 3. Katehorii︠a︡ obrazu.

The issue of safety culture is one of the most important in a modern medical facility because any problems during the provision of services may lead to irreversible consequences. Not only the patient may suffer, but the doctor who assisted. Unfortunately, very little attention to this issue is paid in Ukraine. Based on this, we can say that the topic is relevant and requires studying. -/- The purpose of writing this article is the analysis of the ways of forming professional (...) safety culture in clinical medicine. The methods by which we carried out scientific research are observation, analysis, evaluation, comparison, generalization. -/- The work examined interpretation of the term "safety culture", types of innovation in which it belongs and the main methods of its creation in the medical field. -/- Safety culture in the medical field involves the right of all health care workers to use measures to prevent actions that can harm a patient or a colleague. Different approaches were considered in the interpretation of the term "safety culture" and we proposed our own: safety culture is a system of values, objectives, knowledge and skills, rules and procedures, convictions shared by representatives of a certain medical profession and supported by patients, creating a favourable working climate, atmosphere of trust and becoming an efficient tool for achieving the goals of the organization. -/- The main components of the safety culture were defined: responsibilities of managers, communication, performance, resources of safety, trust, the degree of job satisfaction, etc. Based on several studies, it was found that no country has a perfect medical system. Every system should be improved. -/- We proposed measures to fix the situation with the safety culture in health care facilities. The correct management of safety can eliminate or fix many medical errors. That is why the need for a clear program of implementation, execution and control of SC in the medical establishment is necessary. -/- Scientific novelty of this work lies in the interpretation of the term "safety culture" at medical institutions and in determining major steps towards its creation. Practical value of the work is the opportunity to implement these steps in medical institutions for improvement of the safety culture and, therefore, to reduce the risk of bad accidents during treatment. -/- Further research can address safety culture management in medical institutions on the examples from the experience of countries with effective systems of health care. (shrink)

Extreme conditions like savantism, autism or synaesthesia, which have a neurological 2AH, UK basis, challenge the idea that other minds are similar to our own. In this paper we report a single case study of a man in whom all three of these conditions co-occur. We suggest, on the basis of this single case, that when savantism and synaesthesia co- occur, it is worthwhile testing for an undiagnosed Autism Spectrum Condition (ASC). This is because savantism has an established association with (...) ASC, and the combination of ASC with synaesthesia may increase the likelihood of savantism. The implications of these conditions for philosophy of mind are introduced. (shrink)

Under current UK law, an embryo cannot be transferred to a woman's uterus without the consent of both of its genetic parents, that is both of the people from whose gametes the embryo was created. This consent can be withdrawn at any time before the embryo transfer procedure. Withdrawal of consent by one genetic parent can result in the other genetic parent losing the opportunity to have their own genetic children. We argue that offering couples only one type of consent (...) agreement, as happens at present, is too restrictive. An alternative form of agreement, in which one genetic parent agrees to forego the right to future withdrawal of consent, should be available alongside the current form of agreement. Giving couples such a choice will better enable them to store embryos under a consent agreement that is appropriate for their circumstances. Allowing such a choice, with robust procedures in place to ensure the validity of consent, is the best way to respect patient autonomy. (shrink)

Recent years have witnessed the publication of numerous articles that draw a critical alignment between ethics and caring. In essence, this theme suggests that caring is a moral pursuit centred on the beneficent attention of one person shown to another. Yet, if such language is to have real poignancy, it must be geared towards an inclusive agenda that meets the needs of all within the community. Research evidence suggests that this is not always the case, especially in terms of the (...) care offered to members of minority ethnic groups. This article will focus on the findings of a qualitative research study that explored the expectations and perceived experiences of nursing care among members of the Pakistani community in Bradford, West Yorkshire, UK. The findings suggest that nurses should develop a more informed narrative that readily reflects the needs of the Pakistani community. (shrink)

Examination of the application of virtue ethics to business has only recently started to grapple with the measurement of virtue frameworks in a practical context. This paper furthers this agenda by measuring the impact of virtue at the level of the organisation and examining the extent to which organisational virtue impacts on moral attentiveness and the perceived role of ethics and social responsibility in creating organisational effectiveness. It is argued that people who operate in more virtuous organisational contexts will be (...) expected to be more attentive to ethical issues and in turn perceive a greater role for ethics and social responsibility in business. Analysis of results based on a sample of 137 HR professionals shows that where people report that their organisation provides meaningful work, they are more likely to display reflective MA and the belief that ethics and social responsibility are compatible with business objectives, suggesting that organisations who are interested in promoting an ethical culture should focus on their work structures and practices. More generally, OV is shown to have a more complex relationship with PRESOR than hypothesised pointing towards a more nuanced view of OV. The paper examines the implications of the results for organisations and research. (shrink)

In the UK and elsewhere suicide presents a major cause of death. In 2008 in the UK the topic of suicide rarely left the news. Controversy surrounding Daniel James and Debbie Purdy ensured that the problem of assisted suicide received frequent media discussion. This was fuelled also by reports of a higher than usual number of suicides by young people in South Wales. Attention attracted by cases such as that of Daniel James and Debbie Purdy can lead to a neglect (...) of the problem of how to respond to the vast majority of suicides, in which there is no obvious accompanying health problem. This paper seeks to redress that balance to some degree. Its focus is primarily on the provision of assisted suicide when the person seeking such assistance has no accompanying health problem. It is argued that a network of suicide centres (SCs) should be established, the purpose which in certain circumstances, will extend to assisting suicide in cases where a competent person has a definite, sustained intention to end their own life. Arguments in support of this proposal are provided, focusing on respect for autonomy, relief of suffering and respect for the ‘life-plan’ of a person. Considerations relating to reduction of harms to third parties are also recruited. Eight responses to the proposal are considered. But none is found compelling, nor are they found jointly compelling. (shrink)

The individual management of online identity, as part of a wider politics of personal information, privacy, and dataveillance, is an area where public policy is developing and where the public sector attempts to intervene. This paper attempts to understand the strategies and methods through which the UK government and public sector is engaging in online identity management. The analysis is framed by the analytics of government (Dean 2010 ) and governmentality (Miller and Rose 2008 ). This approach draws attention to (...) the wide assemblage of public and private actors with shared regimes of practice and fields of visibility, as well as to the extent to which individual actors are made responsible for their own identity management. The paper also uses communication and discursive research to examine the potential failings of engagement efforts. Communication theory suggested that the assumption of individual responsibility, alongside linguistic distortions created by this way of understanding the problematic of identity management, complicate and fundamentally limit engagement activity. (shrink)

This article attempts to locate the solicitor-advocacy reforms in the UK in the context of wider New Right led reforms of the welfare state and suggests that such reforms are part of a broader package aimed at weakening social democracy, encouraging the use of the market as an allocation mechanism and instilling 'efficiency' within and control over the professions. On the basis of interviews with organizational clients in Scotland, it is argued that the reforms may have a significant impact upon (...) the junior Bar and that while they may ultimately benefit corporate clients they are likely to bring further disadvantage to individual clients who are already weak within the professional-client relationship. (shrink)

Previously published as special issues of _The European Journal of the History of Economic Thought_ and _The Review of Political Economy_, this volume contains the papers devoted to the life and work of Piero Sraffa. Sraffa was a leading intellectual of the twentieth century. He was brought to Cambridge by John Maynard Keynes and had an important impact on the philosopher Ludwig Wittgenstein. He received the golden medal Söderström of the Swedish Academy of Sciences for his edition of David Ricardo's (...) _Works and Correspondence_ and he is the author of _Production of Commodities by Means of Commodities_, one of the most often cited book in economics. Using hitherto unpublished material from Sraffa's literary heritage kept at Trinity College, Cambridge, the papers throw new light on the intellectual development of the young Sraffa and correct several of the received views on him and his contribution. Themes covered concern his: objectivism rediscovery and reformulation of the classical theory of value and distribution criticism of Alfred Marshall's analysis relationship with his Cambridge colleagues and friends biography around the time when he left Italy for the UK friendship with Wittgenstein and his impact on the latter's thinking. (shrink)

For a patient to make an informed decision about participation in research, it is fundamental that they can understand what is involved. COREC has produced a model information sheet and consent form that researchers are encouraged and sometimes forced to use by LRECs. By applying readability statistics to these documents we have shown that the majority of the UK population would not be able to read this proposed text.

Since 1991, sperm donors in the UK have had the legal right to withdraw consent for the use of their sperm in fertility treatment. This has the potential to adversely affect patients. It may mean that previous recipients of a donor’s sperm cannot have further children who are full biological siblings to an existing child, and that embryos created from the donor’s sperm and a patient’s eggs must be destroyed.

Due to its concept and methodology, Graingers book on Frontinus is more fact-based fiction than biography. The reader gains an insight into how Frontinus' life and career might have unfolded, taking into account our knowledge of the Roman Empire in his time and the information about him that is confirmed by our sources. The author's assumptions are always plausibly substantiated. However, when reading the book, one learns far more about the Roman Empire, its provinces, its rulers and the political and (...) military conditions in the 1st century AD than about Frontinus. In this respect, this book is very exciting and informative, and it is also pleasant to read. (shrink)

This Article is made up of two parts. The first part reflects on the dominant functionalist approach to comparative consumer bankruptcy and suggests that this might be supplemented by a political economy analysis that addresses the role of national and international interest groups, including professionals, and ideology in understanding different national responses to overindebtedness in North America and Europe. The second part examines current reforms to consumer bankruptcy and responses to overindebtedness in the UK through this political economy lens and (...) concludes that competition among professional groups, the role and interests of the Insolvency Service, and the ideology of the Third Way in consumer policy will influence the ultimate structure adopted for addressing consumer insolvency. A study of the English experience suggests that there is also an element of national path dependency to consumer insolvency reform that may resist pressures towards convergence of approaches between countries in addressing issues of consumer insolvency. (shrink)

Kuznet︠s︡ov, I. V. Kategorii︠a︡ prichinnosti i ee poznavatelʹnoe znachenie.--Shali︠u︡tin, S. M. Ob otrazhenii kak obshchem svoĭstve materii.--I︠U︡rgelenas, D. I. Teorii︠a︡ otrazhenii︠a︡ i poni︠a︡tie informat︠s︡ii.--Korneeva, A. I. Vozrastai︠u︡shchai︠a︡ rolʹ logicheskogo myshlenii︠a︡ v poznanii mira.--Klimashevskiĭ, G. Teoretiko-poznavatelʹnai︠a︡ rolʹ myslennogo ėksperimenta v fizike.-- Podosetnik, V. M. Gnoseologicheskoe znachenie faktov v poznanii obshchestvennykh i︠a︡vleniĭ.

An association between age-related hearing loss and Alzheimer's Disease has been widely reported. However, the nature of this relationship remains poorly understood. Quantification of hearing loss as it relates to AD is imperative for the creation of reliable, hearing-related biomarkers for earlier diagnosis and development of ARHL treatments that may slow the progression of AD. Previous studies that have measured the association between peripheral hearing function and AD have yielded mixed results. Most of these studies have been small and underpowered (...) to reveal an association. Therefore, in the current report, we sought to estimate the degree to which AD patients have impaired hearing by performing a meta-analysis to increase statistical power. We reviewed 248 published studies that quantified peripheral hearing function using pure-tone audiometry for subjects with AD. Six studies, with a combined total of 171 subjects with AD compared to 222 age-matched controls, met inclusion criteria. We found a statistically significant increase in hearing threshold as measured by pure tone audiometry for subjects with AD compared to controls. For a three-frequency pure tone average calculated for air conduction thresholds at 500–1,000–2,000 Hz, an increase of 2.3 decibel hearing level was found in subjects with AD compared to controls. Likewise, for a four-frequency pure tone average calculated at 500–1,000–2,000–4,000, an increase of 4.5 dB HL was measured, and this increase was significantly greater than that seen for 0.5–2 kHz PTA. There was no difference in the average age of the control and AD subjects. These data confirm the presence of poorer hearing ability in AD subjects, provided a quantitative estimate of the magnitude of hearing loss, and suggest that the magnitude of the effect is greater at higher sound frequencies.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier: CRD42021288280. (shrink)

Objectives: To analyse legislation and medical professional positions concerning the doctor’s role in assisted dying in western Europe, and to discuss their implications for doctors.Method: This paper is based on country-specific reports by experts from European countries where assisted dying is legalised , or openly practiced , or where it is illegal .Results: Laws on assisted dying in The Netherlands and Belgium are restricted to doctors. In principle, assisted suicide is not illegal in either Germany or Switzerland, but a doctor’s (...) participation in Germany would violate the code of professional medical conduct and might contravene of a doctor’s legal duty to save life. The Assisted Dying for the Terminally Ill Bill proposed in the UK in 2005 focused on doctors, whereas the Proposal on Assisted Dying of the Norwegian Penal Code Commission minority in 2002 did not.Professional medical organisations in all these countries except The Netherlands maintain the position that medical assistance in dying conflicts with the basic role of doctors. However, in Belgium and Switzerland, and for a time in the UK, these organisations dropped their opposition to new legislation. Today, they regard the issue as primarily a matter for society and politics. This “neutral” stance differs from the official position of the Royal Dutch Medical Association which has played a key role in developing the Dutch practice of euthanasia as a “medical end-of-life decision” since the 1970s.Conclusion: A society moving towards an open approach to assisted dying should carefully identify tasks to assign exclusively to medical doctors, and distinguish those possibly better performed by other professions. (shrink)

The aim of UK-REACH (“The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers”) is to understand if, how, and why healthcare workers (HCWs) in the United Kingdom (UK) from ethnic minority groups are at increased risk of poor outcomes from COVID-19. In this article, we present findings from the ethical and legal stream of the study, which undertook qualitative research seeking to understand and address legal, ethical, and social acceptability issues around data protection, privacy, and information (...) governance associated with the linkage of HCWs’ registration data and healthcare data. We interviewed 22 key opinion leaders in healthcare and health research from across the UK in two-to-one semi-structured interviews. Transcripts were coded using qualitative thematic analysis. Participants told us that a significant aspect of Big Data research in public health is varying drivers of mistrust—of the research itself, research staff and funders, and broader concerns of mistrust within participant communities, particularly in the context of COVID-19 and those situated in more marginalised community settings. However, despite the challenges, participants also identified ways in which legally compliant and ethically informed approaches to research can be crafted to mitigate or overcome mistrust and establish greater confidence in Big Data public health research. Overall, our research indicates that a “Big Data Ethics by Design” approach to research in this area can help assure (1) that meaningful community and participant engagement is taking place and that extant challenges are addressed, and (2) that any new challenges or hitherto unknown unknowns can be rapidly and properly considered to ensure potential (but material) harms are identified and minimised where necessary. Our findings indicate such an approach, in turn, will help drive better scientific breakthroughs that translate into medical innovations and effective public health interventions, which benefit the publics studied, including those who are often marginalised in research. (shrink)

In the UK, the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a widely used process, designed to facilitate shared decision-making between a clinician and a patient or, if the patient lacks capacity to participate in the conversation, a person close to the patient. A key outcome of the ReSPECT process is a set of recommendations, recorded on the patient-held ReSPECT form, that reflect the conversation. In an emergency, these recommendations are intended to inform clinical decision-making, and thereby (...) enable the attending clinician—usually a general practitioner (GP) or paramedic—to act in the patient’s best interests. This study is the first to explore the extent to which ReSPECT recommendations realise their goal of informing best interests decision-making in community contexts. Using a modified framework analysis approach, we triangulate interviews with patients and their relatives, GPs and nurses and care home staff. Our findings show that inconsistent practices around recording patient wishes, diverging interpretations of the meaning and authority of recommendations and different situational contexts may affect the interpretation and enactment of ReSPECT recommendations. Enacting ReSPECT recommendations in an emergency can be fraught with complexity, particularly when attending clinicians need to interpret recommendations that did not anticipate the current emergency. This may lead to decision-making that compromises the patient’s best interests. We suggest that recording patients’ values and preferences in greater detail on ReSPECT forms may help overcome this challenge, in providing attending clinicians with richer contextual information through which to interpret treatment recommendations. (shrink)

Clinical ethics can be viewed as a practical discipline that provides a structured approach to assist healthcare practitioners in identifying, analysing and resolving ethical issues that arise in practice. Clinical ethics can therefore promote ethically sound clinical and organisational practices and decision-making, thereby contributing to health organisation and system quality improvement. In order to develop students’ decision-making skills, as well as prepare them for practice, we decided to introduce a clinical ethics strand within an undergraduate medical curriculum. We designed a (...) programme of clinical ethics activities for teaching and assessment purposes that involved using ethical frameworks to analyse hypothetical and real-life cases in uni- and inter- professional groups. In this paper, we draw on medical student feedback collected over 6 years to illustrate the appeal to students of learning clinical ethics. We also outline the range of benefits for students, healthcare organisations, and the field of clinical ethics arising from tomorrow’s doctors experiencing clinical ethics early in their training. We conclude by briefly reflecting on how including clinical ethics within tomorrow’s doctors curricular can secure and continue future engagement in clinical ethics support services in the UK, alongside the dangers of preparing students for organisational cultures that might not exist. We anticipate the findings presented in the paper will contribute to wider debates examining the impact of ethics teaching, and its ability to inform future doctors’ practice. (shrink)

A study was undertaken of the views of users of two genitourinary medicine (GUM) clinics in England on unlinked anonymous testing (UAT) for HIV. The UAT programme measures the prevalence of HIV in the population, including undiagnosed prevalence, by testing residual blood (from samples taken for clinical purposes) which is anonymised and irreversibly unlinked from the source. 424 clinic users completed an anonymous questionnaire about their knowledge of, and attitudes towards, UAT. Only 1/7 (14%) were aware that blood left over (...) from clinical testing may be tested anonymously for HIV. A large majority (89%) said they would agree to their blood being tested, although 74% wanted the opportunity to consent. These findings indicate broad support for UAT of blood in a group of patients whose samples are included in the HIV surveillance programme. The findings suggest the need for greater attention to be given to the provision of information and, if replicated in a larger survey, may justify a reappraisal of UK policy on UAT. (shrink)

How many words is a bilingual 2-year-old supposed to know or say in each of her languages? Speech and language therapists or researchers lack the tools to answer this question, because several factors have an impact on bilingual language skills: gender, amount of exposure, mode of acquisition, socio-economic status and the distance between L1 and L2. Unfortunately, these factors are usually studied separately, making it difficult to evaluate their weight on a unique measure of vocabulary. The present study measures the (...) contribution of the following factors to the vocabulary scores of bilingual toddlers: i) gender; ii) sibling ranking; iii) relative amount of exposure to each language; iv) mode of exposure; v) SES; vi) linguistic distance; vii) language spoken between parents. Close to the child’s second birthday, parents of 278 UK-based bilinguals completed successively: a 100-word version of the Oxford-CDI, the CDI in the child’s Additional Language, a family questionnaire, and the Language Exposure Questionnaire. Thirty-six British-English-AL pairs were considered, with languages contrasted on a second-language-learning scale : for example, Dutch and French are close to British-English, while Polish or Cantonese are more distant. Data from the corpus were included in two mixed-effect models, one with the English scores in comprehension as the dependent variable, and the other with production scores. The seven factors listed above were included as predictors. The amount of English exposure was the strongest predictor of comprehension scores = 9.35, p <.005, β = 0.02, t = 3.08, p <.005), followed by the language that parents speak between themselves = 14.94, p <.001, β = 1.37, t = 3.76, p <.0005), linguistic distance = 6.92, p <.01, β = -0.74, t = -2.66, p <.01) and age = 4.86, p <.05, β = 0.55, t = 2.17, p <.05). In production, gender = 13.57, p <.0005, β = -0.91, t = -03.72, p <.0005), amount of exposure to English = 13.57, p <.0005, β = -0.91, t = -03.72, p <.0005), the language that parents speak between themselves = 11.85, p <.005, β = 1.09, t = 3.41, p <.001), and the mother’s occupation = 4.51, p <.05, β = 0.63, t = 2.13, p <.05) were the significant predictors. The more English parents use to address one another, the more English words the child says and understands. This surprising result could be simply explained by the fact that parents who speak English together are also more likely to speak English to their child. The main results of this study is that linguistic distance is a powerful predictor of toddlers’ vocabulary in English, with children learning two close languages growing their vocabulary faster than those learning distant languages. (shrink)

When assessing Corporate Social Responsibility (CSR) and its impact on company performance there may be an informational asymmetry caused by differences in Familiarity with the firm assessed. This study uses participants' ratings of six large UK retailers to establish the direct relationships between the CSR components of Economic, Legal, Ethical, and Discretionary, and the firm performance dimensions of Reputation, Trust, and Customer Satisfaction, then explores whether Familiarity mediates the relationships between the CSR and the performance dimensions. The findings show CSR (...) Economic, Legal, and Discretionary are associated with firm Reputation and Trust, but not Customer Satisfaction, and that CSR Ethical is associated with Reputation, Trust, and Customer Satisfaction. Familiarity acts as a mediator between CSR Economic, Legal and Discretionary, and Trust and Customer Satisfaction. Familiarity also mediates the relationship between CSR Discretionary and Reputation. The link between CSR Economic and Legal, and Customer Satisfaction only emerges in mediation analysis. Managerial implications suggest increasing familiarity is vital through open and continuous communication about CSR programs is essential to keep customers aware. Methodological implications propose reevaluating the methods used to measure (CSR), taking into consideration its' multi‐faceted nature and the diverse impacts that different aspects have on familiarity and performance measures. (shrink)

The data produced by the scientific community impacts on academia, clinicians, and the general public; therefore, the scientific community and other regulatory bodies have been focussing on ethical codes of conduct. Despite the measures taken by several research councils, unethical research, publishing and/or reviewing behaviours still take place. This exploratory study considers some of the current unethical practices and the reasons behind them and explores the ways to discourage these within research and other professional disciplinary bodies. These interviews/discussions with PhD (...) students, technicians, and academics/principal investigators were conducted mostly in European higher education institutions including UK, Italy, Ireland, Portugal, Czech Republic and Netherlands.Through collegiate discussions, sharing experiences and by examining previously published/reported information, authors have identified several less reported behaviours. Some of these practices are mainly influenced either by the undue institutional expectations of research esteem or by changes in the journal review process. These malpractices can be divided in two categories relating to methodological malpractices including data management, and those that contravene publishing ethics. The former is mostly related to “committed bias”, by which the author selectively uses the data to suit their own hypothesis, methodological malpractice relates to selection of out-dated protocols that are not suited to the intended work. Although these are usually unintentional, incidences of intentional manipulations have been reported to authors of this study. For example, carrying out investigations without positive controls; but including these from a previous study. Other methodological malpractices include unfair repetitions to gain statistical significance, or retrospective ethical approvals. In contrast, the publication related malpractices such as authorship malpractices, ethical clearance irregularities have also been reported. The findings also suggest a globalised approach with clear punitive measures for offenders is needed to tackle this problem. (shrink)