Obtaining prospective written consent from women to participate in trials when they are experiencing an obstetric emergency is challenging. Alternative consent pathways, such as gaining verbal consent at enrolment followed, later, by obtaining written consent, have been advocated by some clinicians and bioethicists but have received little empirical attention. We explored women’s and staff views about the consent procedures used during the internal pilot of a trial, where the protocol permitted staff to gain verbal consent at recruitment. Interviews with staff (...) and participating women. Data were analysed thematically and interviews were cross-compared to identify differences and similarities in participants’ views about the consent procedures used. Women and some staff highlighted benefits to obtaining verbal consent at trial enrolment, including expediting recruitment and reducing the burden on those left exhausted by their births. However, most staff with direct responsibility for taking consent expressed extreme reluctance to proceed with enrolment until they had obtained written consent, despite being comfortable using verbal procedures in their clinical practice. To account for this resistance, staff drew a strong distinction between research and clinical care and suggested that a higher level of consent was needed when recruiting into trials. In doing so, staff emphasised the need to engage women in reflexive decision-making and highlighted the role that completing the consent form could play in enabling and evidencing this process. While most staff cited their ethical responsibilities to women, they also voiced concerns that the absence of a signed consent form at recruitment could expose them to greater risk of litigation were an individual to experience a complication during the trial. Inexperience of recruiting into peripartum trials and limited availability of staff trained to take consent also reinforced preferences for obtaining written consent at recruitment. While alternative consent pathways have an important role to play in advancing emergency medicine research, and may be appreciated by potential recruits, they may give rise to unintended ethical and logistical challenges for staff. Staff would benefit from training and support to increase their confidence and willingness to recruit into trials using alternative consent pathways. This qualitative research was undertaken as part of the GOT-IT Trial. Date of registration 26/03/2014. (shrink)

Binge-purge eating disorders (BP-ED), such as bulimia nervosa and binge eating disorder, may share some neurobiological features. Electroencephalography (EEG) is a non-invasive measurement modality that may aid in research and diagnosis of BP-ED. We conducted a systematic review of the literature on EEG findings in BP-ED, seeking to summarize and analyze the current evidence, as well as identify shortcomings and gaps to inform new perspectives for future studies. Following PRISMA Statement recommendations, the PubMed, Embase, and Web of Science databases were (...) searched using terms related to “electroencephalography” and “binge-purge” eating disorders. Of 555 articles retrieved, 15 met predefined inclusion criteria and were included for full-text analysis. Eleven studies investigated EEG by means of event-related potentials (ERP) in BP-ED individuals: 7 using eating disorder-related stimuli (i.e., food, body image) and 4 using non-eating disorder-related stimuli (i.e., facial expressions or auditory clicks). These studies found significant differences in the N200, P200, P300, and LPP components in BP-ED participants compared to controls, indicating that this population exhibits impairments in selective attention, attentional allocation/processing, and allocation of motivational or emotion-based attention. Five studies investigated EEG using frequency analysis; reporting significant differences in beta activity in fronto-temporal and occipito-temporo-parietal areas in BP-ED individuals compared to controls, revealing a dysfunctional brain network. However, the small number of studies, the heterogeneity of samples, study paradigms, stimulus types, and the lack of an adequate assessment of neuropsychological parameters are some limitations of the current literature. Although some EEG data are promising and consistent with neuroimaging and neuropsychological findings in individuals with BP-ED, future studies need to overcome current methodological shortcomings. (shrink)

In an essay on pantheism Schopenhauer observes that his chief objection against it is that it says nothing, that it simply enriches language with a superfluous synonym of the word “world.” It can hardly be denied that by this remark the great pessimist, who was himself an atheist, scored a real point. For if a philosopher starts off with the physical world and proceeds to call it God, he has not added anything to the world except a label, a label (...) which, if we take into account the ordinary significance of the word “God,” might well appear unnecessary and superfluous: one might just as pertinently say that the world is the world as that the world is God. Neither the Jew nor the Christian nor the Moslem understand by “God” the physical world, so that, if someone calls the physical world God, he cannot be taken to mean that the world is God according to the Jewish or Christian or Moslem understanding of God. Does he mean any more than that the physical world is ultimately self-explanatory, that no Cause external to the world, no transcendent Being is requisite or admissible, i.e. that there is no God? If that were all there is in pantheism, the latter would indeed be indistinguishable from atheism, and those who called Spinoza an atheist would be fully justified. (shrink)

This is a book about the philosophy of Henri Bergson which shows how relevant Bergson is to much contemporary philosophy. The book takes as its point of departure Bergson's insistence on precision in philosophy. It then discusses a variety of topics including laughter, the nature of time as experienced, how intelligence and language should be construed as a pragmatic product of evolution, and the antinomies of reason represented by magic and religion. This is not just another exposition of Bergson's work. (...) It offers an account of why Bergson commanded such a massive reading public in his own day and why he deserves to be read now. Written in a terse and clear style, this book will prove appealing to teachers and students of philosophy, cognitive science, psychology, religious studies and literature. (shrink)