Background Biobank participants often do not understand much of the information they are provided as part of the informed consent process, despite numerous attempts at simplifying consent forms and improving their readability. We report the first assessment of biobank enrollees’ comprehension under an "integrated consent” process, where patients were asked to enroll in a research biobank as part of their normal healthcare experience. A number of healthcare systems have implemented similar integrated consent processes for biobanking, but it is unknown how (...) much patients understand after enrolling under these conditions. Methods: We recruited patients who enrolled in a biobank while in a healthcare setting when receiving ordinary care. We assessed knowledge of consent materials using 11 true/false questions drawn from a well-known biobank knowledge test. After reviewing the results from 114 participants, we revised the consent form and repeated the knowledge assessment with 144 different participants. Results: Participants scored poorly on the knowledge test in both rounds, with no significant differences in overall scores or individual items between the rounds. In Phase 1, participants answered 53% of the questions correctly, 25% incorrectly, and 22% “I don’t know.” In Phase 2, participants answered 53% of questions correctly, 24% incorrectly, and 23% “I don’t know.” Participants scored particularly poorly on questions about data sharing and accessing medical records. Conclusions: Enrollees under an integrated consent model had significant misunderstandings that persisted despite an attempt to improve information specifically about those topics in a consent form. These results raise challenges for current approaches that attribute misunderstanding to overly complex consent forms. They also suggest that the pressures of the clinic may compound other problems with patient understanding of biobank consent. As health systems increasingly blend research and care, they may need to rethink their approach to educating patients about participation in a biobank. (shrink)

It has been widely argued that words are analogous to species such that words, like species, are natural kinds. In this paper, I consider the metaphysics of word-kinds. After arguing against an essentialist approach, I argue that word-kinds are homeostatic property clusters, in line with the dominant approach to other biological and psychological kinds.

Kaplan ([1990]. “Words.” Proceedings of the Aristotelian Society 64: 93–119; [2011]. “Words on Words.” The Journal of Philosophy 108 (9): 504–529) argues that there are no unspoken words. Hawthorne and Lepore ([2011]. “On Words.” The Journal of Philosophy 108 (9): 447–485) put forward examples that purport to show that there can be such words. Here, I argue that Kaplan is correct, if we grant him a minor variation. While Hawthorne and Lepore might be right that there can be unspoken words, (...) I will argue that they fail to show that there can be uninstantiated words. (shrink)

The 2010 Nagoya Protocol is an international framework for access and benefit sharing (ABS) of the use of genetic and biological resources, with particular focus on indigenous communities. This is especially important in Africa, where local communities have a close reliance on environmental resources and ecosystems. However, national legislation and policies commonly lag behind international agreements, and this poses challenges for legal compliance as well as practical applications. This study reviews the academic literature on the Nagoya Protocol and ABS applications, (...) and then considers the implications of this analysis for research in Africa. Results show that there is uneven engagement with the principles of the Nagoya Protocol across different academic disciplines; local communities are sometimes sidelined in these studies; and only 8% of researchers in the literature analysed are located in Africa. Future developments should focus on ensuring national compliance with the Nagoya Protocol, and that researchers and industry work in partnership with local African communities on ABS issues. (shrink)

The natural name theory, recently discussed by Johnson (2018), is proposed as an explanation of pure quotation where the quoted term(s) refers to a linguistic object such as in the sentence ‘In the above, ‘bank’ is ambiguous’. After outlining the theory, I raise a problem for the natural name theory. I argue that positing a resemblance relation between the name and the linguistic object it names does not allow us to rule out cases where the natural name fails to resemble (...) the linguistic object it names. I argue that to avoid this problem, we can combine the natural name theory with a type-realist metaphysics of language, and hold that the name is natural because the name is an instance of the kind that it names. I conclude by reflecting on the importance of the metaphysics of language for questions in the philosophy of language. (shrink)

Johanna Knapstein,1 Daniel Grimm,1 Marcus A Wörns,1 Peter R Galle,1 Hauke Lang,2 Tim Zimmermann111st Department of Internal Medicine, Johannes Gutenberg-University, Mainz, Germany; 2Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg-University, Mainz, GermanyIntroduction: Hepatitis C virus reinfection occurs universally after liver transplantation, with accelerated cirrhosis rates of up to 30% within 5 years after liver transplantation. Dual antiviral therapy with pegylated interferon-2a and ribavirin only reaches sustained virological response rates of ~30% after liver transplantation. With the approval of viral NS3/4A (...) protease inhibitors telaprevir, boceprevir, and simeprevir and the NS5B polymerase inhibitor sofosbuvir, combination therapy offers new therapeutic options for HCV-infected patients, resulting in considerably higher sustained virological response rates in the nontransplant setting. Case presentation: We report three cases of TVR-based triple antiviral therapy in HCV genotype 1 reinfected patients after liver transplantation, of whom a 57-year-old Caucasian female and a 43-year-old Caucasian male were therapy naïve, and a 49-year-old Caucasian male patient was pretreated ineffectively. After 4 weeks of therapy, viral load decreased one to three log10 and became negative in weeks 6 to 8 in the therapy naïve patients. The pretreated patient showed a negative viral load in week 4. TVR was administered over 12 weeks, 750 mg thrice daily. Doses of immunosuppression with cyclosporine were reduced four to six fold. Initial peg-IFN and RBV doses ranged from 135–180 µg/week and 800–1,200 mg/day, according to the patient's body weight. Doses of peg-IFN and RBV were adapted to 90–135 µg/week and 400–800 mg/day after 2 to 12 weeks of protease inhibitor therapy. Dual therapy was continued for 36 weeks with total treatment duration of 48 weeks in the therapy naïve patients leading to a sustained virological response 12 weeks after the end of therapy. In the pretreated patient a breakthrough was detected in week 24 and therapy was discontinued. Overall, antiviral therapy was well tolerated. Side effects included dysgeusia and anemia leading to erythropoietin application and blood transfusions. Conclusion: This case series emphasizes that triple therapy with TVR is an efficient treatment for therapy naïve HCV genotype 1 reinfected patients after liver transplantation. But therapeutic options for pretreated patients require improvement. Keyword: cyclosporine, interferon, ribavirin, hepatitis C, protease inhibitor. (shrink)

Intentional mental states have causes and effects. Davidson has shown that this fact alone does not entail the existence of psycho‐physical laws, but his anomalism makes the connection between the content and causation of intentional states utterly mysterious. By defining intentional states in terms of their causes and effects, functionalism promises to explain this connection. If intentional states have their causes and effects in virtue of their contents, then there must be intrinsic states (of the people who have them) which (...) are ‘local causal surrogates’ for the propositions believed, desired, or whatever. We can define these intrinsic states in terms of the laws that govern them, but these laws alone are not sufficient to account for intentional content. To do that we need to invoke laws which link these intrinsic states with their contents. Such a ‘wide’ functional account is sketched; it combines a suggestion of Ramsey's about truth conditions with a ‘feedback’ account of the content of desires. (shrink)

Evolutionary adaptation. An essay on the concept of adaptation, seen from an evolutionary point of view. The conclusion is that adaptation in this sense is the historical narrative of evolution. The mechanism of the process is selection, the scientific argumentation of the explanation is based on a phylogenetic analysis.