Background: Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. (...) Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges. (shrink)

This is a fascinating book. It uses tuberculosis to look at the balance between individual liberty and the public good: the tensions created between personal liberty and social responsibility, a strong theme in all work in public health. The context is New York in the 1990s, but as Coker states, “This book uses the lens of tuberculosis control, and in particular the detention of non-infectious individuals, to examine America's response to its most vulnerable and marginalised citizens, and asks the question: (...) `is detention of non-infectious, non-compliant individuals right from ethical, legal, and public health perspectives'”. The book is divided into nine chapters. It …. (shrink)

This book explains the notational system NUSAP (Numeral, Unit, Spread, Assessment, Pedigree) and applies it to several examples from the environmental sciences.

Philosophical hermeneutics provides a model of interreligious dialogue that acknowledges the interpretive variability of truth claims while maintaining their relation to a preinterpretive reality. The dialectic and tensive structure of philosophical hermeneutics directly parallels the tension between the diversity of belief and the ultimacy of the sacred. By placing philosophers like Gadamer, Ricoeur, Peirce, and Whitehead in conversation, J. R. Hustwit describes religious truth claims as coconstituted by the planes of linguistic convention and uninterpreted otherness. Only when we recognize that (...) religious claims emerge from a dalliance back and forth across the limits of the understanding can we appreciate the engagement between religions. In terms of dialogue, this approach treats religious truth claims as tentative hypotheses, but hypotheses that are frequently commensurable and rationally contestable. Interreligious dialogue goes beyond facilitating bonhomie or negotiating tolerance; dialogue can and should be a disciplined space for rationally adjudicating claims about what lies beyond the limits of human understanding. (shrink)

It is human nature to try to recognize patterns and to make sense of that which we observe. Unfortunately, our intuition is often wrong, and so there is a need to impose some objectivity on the methods by which observations are converted into knowledge. One definition of biostatistics could be precisely this, the rigorous and objective conversion of medical and/or biological observations into knowledge. Both consumers of biostatistical principles and biostatisticians themselves vary in the extent to which they recognize the (...) need to continue the improvement. Some may not recognize the need for (some or all of) the methods that have already been developed; others may accept these as they find them completely sufficient; still others recognize both the value and the shortcomings of these methods, and seek to develop even better methods to ensure that future medical conclusions are less subject to biases than current ones are. (shrink)

Purpose: Physicians are often reluctant to discuss “Do Not Resuscitate” orders with patients. Although perceived self-efficacy is a known prerequisite for behavioural change, little is understood about the confidence of physicians regarding DNR discussions.Subjects and methods: A survey of 217 internal medicine attendings and 132 housestaff at two teaching hospitals about their attitudes and confidence regarding DNR discussions.Results: Participants were significantly less confident about their ability to discuss DNR orders than to discuss consent for medical procedures , and this was (...) true for both attendings and housestaff . In a multivariate logistic model of confidence regarding DNR discussions, women were less confident than men ; house officers were less confident than attendings , those who were less confident of their ability to discuss medical procedures were less confident discussing DNR , and those who found talking to patients about DNR orders very difficult reported less confidence than those who did not .Conclusion: We conclude that physicians’ confidence regarding DNR discussions is low compared with their confidence regarding other medical discussions and that confidence varies by sex and perceived difficulty of the task. Efforts to improve DNR discussions should explore the need to tailor educational interventions to fit these characteristics. (shrink)

XLRI, in association with a few Tata Group companies, established the XLRI-JRD Tata Foundation in Business Ethics in 1991 to mark their long-standing commitment and contribution to business ethics in India. The foundation seeks to address this by publicly affirming the urgent need for ethics in business and the need to bring about a conducive culture in which it can thrive.

This volume of selections provides a fresh translation of some of the major philosophical and literary achievements of the beleaguered editor of the Encyclopedie. For the most part, the selections follow a chronological sequence with each selection given a brief explanation in which the reader is referred to the 1875 Assezat and Tourneux edition of Diderot's works. The main thrust of Diderot's philosophical materialism is embodied in D'Alembert's Dream, in which the author argues that the mechanized-physical view gives coherent unity (...) to cosmological, biological, and moral speculation. Yet, if Diderot is to be a materialist, he is to be a humanistic one, for in his Refutation of Helvetius he rails against the latter's view of man as a mere sensory-bound animal devoid of real moral feelings. Thus there is in Diderot a vacillation between a heartfelt desire for moral values which beg to be grounded on reason, and a reason that cannot accept the basis for the values of his day since experience seems to contradict such a basis. Diderot expresses this dichotomy well in Rameau's Nephew. In the mastery of his dialogue form, Diderot plays the man of moral stability while the nephew represents the moral nihilist. It is interesting to note that Hegel saw in the nephew a cultural alienation or self-estrangement which gradually produced the characteristic cleavage between faith and reason in the age of the French Enlightenment. Since he bore this inner tension within himself, and since it is men who make up "ages," one can say that Diderot was the French Enlightenment.—J. J. R. (shrink)

This reconstruction of Empedocles' thought for the most part depends upon how the notions of rest and movement are related to the elements. Many traditional interpretations have both the love and strife forces of Empedocles as moving causes which combine and separate the elements respectively. O'Brien claims, however, that there is really only one moving cause: strife; and therefore there is only one time of rest in the cosmos, when love unites the elements into the Sphere. Strife is seen as (...) Empedocles' explanation of diversity in the world, and love as his explanation of unity. O'Brien's reconstruction, then, would rank Empedocles as a serious metaphysician coping with the problem of the one and the many; rather than as a naive pre-scientist explaining the genesis of animals by the combining of "separated limbs." O'Brien suggests that Empedocles is attempting to save the Parmenidean notion of unity without relegating movement to the realm of illusion. In this way, Empedocles also appears to anticipate Plato's attempt to explain the spatial and temporal world in terms of what is non-spatial and timeless. Roughly speaking, as Plato's Forms are to the physical world, so love and strife are to the elements. O'Brien's reconstruction project is carefully done with a rather thorough analysis of all the sources. Appended to the work is a 61-page bibliography which includes every book and article exclusively on Empedocles written from 1806 to 1965.--J. J. R. (shrink)

Scabini's doctoral thesis from the Università Cattolica del Sacro Cuore in Milan focuses primarily on the philosophical methodology pervading Tillich's three volume Systematic Theology, although the author demonstrates a solid familiarity with all of Tillich's writing. The study has two major divisions. Part one summarizes Tillich's existential dialectic, method of correlation, his concept of reason and revelation and his treatment of ontology. Part two explores Tillich's theology of culture with particular emphasis on his concept of history. Tillich's development of existence (...) and the Christ, the New Being, receives only passing attention, although Scabini has certainly grasped the significance of the New Being in Tillich's comprehensive system. While the author's summation of Tillich's philosophical structures affords a precise and competent overview, some of her critical reflections appear too modest and beg further development and clarification. Scabini's most dominant criticism is that Tillich failed to articulate a rigorous metaphysics and thus succumbed to imprecision and ambiguity. The author also contends that Tillich, even if he would deny the charge, has produced a natural theology in his treatment of Being and God. Given the Tillichian distinction and dilemma between controlling knowledge and receiving knowledge, Scabini asks on what rational principle Tillich opts for receiving knowledge and its openness to revelation since both types of knowledge are equally acceptable. Since Tillich views the existential situation of man as offering only partial meaning to life's ambiguities, Scabini asks on what metaphysical grounds partial meaning demands ultimacy in meaning. The author presents a thorough bibliography on Tillich. Scabini deserves honest commendation for her engaging study and becomes the first scholar to present the systematic thought of Paul Tillich to an Italian audience.--J. R. (shrink)

Aristotle had accused the Presocratic philosophers of constantly turning up the wrong set of principles as explanations of physical reality. To speak of the archai as if they were physical entities was, according to Aristotle, to confuse the notion of archai with that of stoicheia. This volume by Sinnige, however, traces the notion of "matter" through Presocratic thought and reveals a non-tangible, indeterminate view of matter that is sometimes identified with that of infinity. The author shows how Anaximander carried over (...) the mythical concept of Chronos as the ruling power of the universe into a more rational notion of apeiron. Sinnige's conclusion here is that "matter" for Anaximander is not a sensible substance at all, but rather the infinite and divine expanse of the universe. Each of the Presocratic views on matter and infinity is considered in its turn. Sinnige maintains that with the Pythagoreans the notion of the apeiron became more fully identified with that of instability and indeterminateness. The author also takes issue with the traditional interpretations of the doxographers who make Zeno's paradoxes nothing more than arguments against the reliability of sensory knowledge. Rather, Sinnige claims, Zeno's view of infinity marks a turning point in which mathematical dimensions are irrevocably associated with that term. Basically the author shows that early notions of matter and infinity vacillate between corpuscular theories on the one hand and mathematical views on the other.--J. J. R. (shrink)

Students of politico-philosophical thought should welcome this attempt to understand present-day Soviet philosophy in the light of its historical background. What is there in Soviet thought today that echoes the classical Marxist theory? In what way has the contemporary ideology broken with the past or at least revamped the classic view? The historical view can best approach these questions, and beginning with the Young Hegelian, Hegelian, and Feuerbachian influence on Marx, the author follows history's path through Leninism, Stalinism and finally (...) into the contemporary scene. The limited size of the text necessarily restricts discussion, but an annotated bibliography of some secondary works will aid the student's further research.—J. J. R. (shrink)

“Towards a Theory of Taxation” is a proper theme for an Englishman to take when giving a paper in America. After all it was from the absence of such a theory that the United States derived its existence. The Colonists felt strongly that there should be no taxation without representation, and George III was unable to explain to them convincingly why they should contribute to the cost of their defense. Since that time, understanding has not advanced much. In Britain we (...) still maintain the fiction that taxes are a voluntary gift to the Crown, and taxing statutes are given the Royal Assent with the special formula, “La Reine remercie ses bons sujets, accepte leur benevolence, et ainsi le veult” instead of the simple “La Reine le veult,” and in the United States taxes have regularly been levied on residents of the District of Columbia who until recently had no representation in Congress, and by the State of New York on those who worked but did not reside in the State, and so did not have a vote. Taxes are regularly levied, in America as elsewhere, on those who have no say on whether they should be levied or how they should be spent. I am taxed by the Federal Government on my American earnings and by state governments on my American spending, but I should be hard put to it to make out that it was unjust. Florida is wondering whether to follow California in taxing multinational corporations on their world-wide earnings. (shrink)

This article traces the multiple enactments of sex in clinical practices of transgender medicine to argue against the presumed singularity of ‘transexuality’. Using autoethnography to analyse my own experience as a trans patient, I describe my clinical encounters with doctors, psychiatrists and surgeons in order to theorise sex as multiple. Following recent developments in science and technology studies (STS) that advance the work of Judith Butler on sex as performatively reproduced, I use a praxiographic approach to argue that treatment practices (...) produce particular iterations of what sex (and transexuality) ‘is’ and how these processes limit and foreclose other trans possibilities. I consider the ethical, political and material-discursive implications of treatment practices and offer a series of reflections about the effects and effectiveness of current clinical practices and the possibilities for intervening in such processes in order that, following Annemarie Mol, we might (re)make sex (and transexuality) differently. (shrink)

_Reading Science_ looks at the distinctive language of science and technology and the role it plays in building up scientific understandings of the world. It brings together discourse analysis and critical theory for the first time in a single volume. This edited collection examines science discourse from a number of perspectives, drawing on new rhetoric, functional linguistics and critical theory. It explores this language in research and industrial contexts as well as in educational settings and in popular science writing and (...) science fiction. The papers also include consideration of the role of images in science writing and the importance of reading science discourse as multi-modal text. The internationally renowned contributors include M. A. K. Halliday, Charles Bazerman and Jay Lemke. (shrink)

We extend the theory of “Fine structure and iteration trees” to models having more than one Woodin cardinal.