Background: Clinical investigation is a growing field employing increasing numbers of nurses. This has created a new specialty practice defined by aspects unique to nursing in a clinical research context: the objectives (to implement research protocols and advance science), setting (research facilities), and nature of the nurse–participant relationship. The clinical research nurse role may give rise to feelings of ethical conflict between aspects of protocol implementation and the duty of patient advocacy, a primary nursing responsibility. Little is known about whether (...) research nurses experience unique ethical challenges distinct from those experienced by nurses in traditional patient-care settings. Research objectives: The purpose of the study was to describe the nature of ethical challenges experienced by clinical research nurses within the context of their practice. Research design: The study utilized a qualitative descriptive design with individual interviews. Participants and research context: Participating nurses (N = 12) self-identified as having experienced ethical challenges during screening. The majority were Caucasian (90%), female (83%), and worked in outpatient settings (67%). Approximately 50% had > 10 years of research experience. Ethical considerations: The human subjects review board approved the study. Written informed consent was obtained. Findings: Predominant themes were revealed: (1) the inability to provide a probable good, or/do no harm, and (2) dual obligations (identity as a nurse vs a research nurse). The following patterns and subthemes emerged: conflicted allegiances between protocol implementation, needs of the participant, desire to advance science, and tension between the nurse–patient therapeutic relationship versus the research relationship. Discussion: Participants described ethical challenges specific to the research role. The issues are central to the nurse–participant relationship, patient advocacy, the nurse’s role in implementing protocols, and/or advancing science. Conclusion: Ethical challenges related to the specialized role of clinical research nurses were identified. More research is warranted to fully understand their nature and frequency and to identify support systems for resolution. (shrink)

The centenary of the birth of Ludwig Wittgenstein (1889-1951) provided an opportunity for recovering some of the great Wittgensteinian subjects, for re-examining them and for discussing their implications and relevance. This volume is the result of the interchange that took place in Girona (Spain) among well-known scholars of Wittgenstein's work in different countries. The eleven contributions are organized into three main subjects: on Wittgenstein's method (B. McGuinness, E. Tugendhat and J.M. Terricabras), on knowledge and meaning (G.E.M. Anscombe, R. Bambrough, N. (...) Malcolm, and P.T. Geach), on language and use (D. Pears, E.v. Savigny, J. Bouveresse and J. Ferrater Mora). This volume is not only the result of the different and mature reflexions of its authors, but in two cases (Malcolm and Ferrater Mora) it has also unfortunately become their last contribution to the subject. (shrink)

About one third of patients with epilepsy have seizures refractory to the medical treatment. Electrical stimulation mapping is the gold standard for the identification of “eloquent” areas prior to resection of epileptogenic tissue. However, it is time-consuming and may cause undesired side effects. Broadband gamma activity recorded with extraoperative electrocorticography during cognitive tasks may be an alternative to ESM but until now has not proven of definitive clinical value. Considering their role in cognition, the alpha and beta bands could further (...) improve the identification of eloquent cortex. We compared gamma, alpha and beta activity, and their combinations for the identification of eloquent cortical areas defined by ESM. Ten patients with intractable focal epilepsy participated in a delayed-match-to-sample task, where syllable sounds were compared to visually presented letters. We used a generalized linear model approach to find the optimal weighting of each band for predicting ESM-defined categories and estimated the diagnostic ability by calculating the area under the receiver operating characteristic curve. Gamma activity increased more in eloquent than in non-eloquent areas, whereas alpha and beta power decreased more in eloquent areas. Diagnostic ability of each band was close to 0.7 for all bands but depended on multiple factors including the time period of the cognitive task, the location of the electrodes and the patient’s degree of attention to the stimulus. We show that diagnostic ability can be increased by 3–5% by combining gamma and alpha and by 7.5–11% when gamma and beta were combined. We then show how ECoG power modulation from cognitive testing can be used to map the probability of eloquence in individual patients and how this probability map can be used in clinical settings to optimize ESM planning. We conclude that the combination of gamma and beta power modulation during cognitive testing can contribute to the identification of eloquent areas prior to ESM in patients with refractory focal epilepsy. (shrink)

The American Journal of Bioethics, Volume 12, Issue 1, Page 16-18, January 2012.

Romanian born E.M. Cioran, who lived in Paris until his death in 1995, writes of politics, of history, and of the utopian dream. "Cioran has a claim to be regarded as among the handful of original minds... writing today".--NEW YORK TIMES.

_Zettel, _ an en face bilingual edition, collects fragments from Wittgenstein's work between 1929 and 1948 on issues of the mind, mathematics, and language.

The purpose of the article is to challenge widely accepted views of the relationship among rationality, morality, and prudence. It contends that we cannot understand either the rational or the moral enterprise without a correct philosophical view of the human self, and that such a view of the self is impossible without taking account of the rational and the moral enterprises themselves. The paper concludes that the moral point of view is anchored in the nature of selfhood so that one (...) can be neither rational and immoral nor prudent and immoral. (shrink)

Feldman has recently argued that leibniz never stated leibniz' law. This article seeks to rebut his arguments and makes a number of incidental points about the interpretation of the law.

Если вы налаживаете деловые и культурные связи со странами Востока, вам не обойтись без знания истоков культуры мусульман, их ценностных ориентиров, менталитета и правил поведения в самых разных ситуациях. Обо всем этом вы узнаете, прочитав книгу.

Interpretation of the classics in political theory seems to go in waves. For a while we had John Locke, the bourgeois thinker. Now we seem to be in a Locke-as-radical-democrat phase. Locke-the-bourgeois had problems of its own, but a radically democratic Locke -- not just the old Locke as liberal democrat but Locke as quasi-Leveller -- strains the interpretative imagination more than most; yet in recent years, several different kinds of argument have been advanced in support of it, both textual (...) and contextual. The most effective argument has proceeded by situating Locke in the context of radical Whig politics in the 1670s and '80s, the struggles over religious toleration and the royal succession, in particular the �Exclusion Crisis� of 1679-81. This contextual argument has been accompanied by various textual interpretations having to do with Locke's conceptions of property, consent, representation, the right of revolution and natural law. Among other things, these are supposed to show that while Locke had nothing explicit to say about the extent of the franchise, the weight of evidence suggests that he would have supported a fairly wide franchise, perhaps even something like the (almost) manhood suffrage advocated by the Levellers (at least according to some, and probably the most convincing, interpretations of their ideas). Most recently, in these pages, Martin Hughes, building on the work of James Tully and Richard Ashcraft in particular, has pushed the argument as far as it can probably go. His argument on taxation and suffrage has provided a motivation here for a wider exploration of Locke's views on representation, consent and the franchise. (shrink)