Introduction Future HIV vaccine efficacy trials with adolescents will need to ensure that participants comprehend study concepts in order to confer true informed assent. A Hepatitis B vaccine trial with adolescents offers valuable opportunity to test youth understanding of vaccine trial requirements in general. Methods Youth reviewed a simplified assent form with study investigators and then completed a comprehension questionnaire. Once enrolled, all youth were tested for HIV and confirmed to be HIV-negative. Results 123 youth completed the questionnaire (mean age=15 (...) years; 63% male; 70% Hispanic). Overall, only 69 (56%) youth answered all six questions correctly. Conclusions Youth enrolled in a Hepatitis B vaccine trial demonstrated variable comprehension of the study design and various methodological concepts, such as treatment group masking. (shrink)

Judgment aggregation theory, which concerns the translation of individual judgments on logical propositions into consistent group judgments, has shown that group consistency generally cannot be guaranteed if each proposition is treated independently from the others. Developing the right method of abandoning independence is thus a high-priority goal. However, little work has been done in this area outside of a few simple approaches. To fill the gap, we compare four methods based on distance metrics between judgment sets. The methods generalize the (...) premise-based and sequential priority approaches to judgment aggregation, as well as distance-based preference aggregation. They each guarantee group consistency and implement a range of distinct functions with different properties, broadening the available tools for social choice. A central result is that only one of these methods (not previously considered in the literature) satisfies three attractive properties for all reasonable metrics. (shrink)

Merab Konstantinovich [Mamardashvili] met with me immediately, as soon as I requested it, although he forewarned me that he could only dimly remember much of that distant past in which I was most interested. But evidently that past still perturbed him as well, since he agreed to speak with me even though he had not yet completely recovered from his illness, and hence his voice was feeble, at times subsiding to a whisper; he would pronounce his words indistinctly, constantly sticking (...) one onto another; on top of that, for technical reasons the dictaphone was situated a bit away from him. It was therefore very difficult to transcribe the text, and I raised many questions with the idea of asking Merab Konstantinovich about them at our next meeting and clearing up some things. But alas, there was no next meeting … Hence I am permitting myself now to publish only some of the most clearly enunciated fragments of my conversation with him, one of the four "forefathers" of the Moscow Methodological Circle, whose name for us, today's participants (and hence neophytes) in the methodological movement, is enveloped by legends handed down by word of mouth. I kept my questions to a minimum. Mamardashvili's reminiscences, arguments, and reflections will seem contentious to many. But no matter, one can dispute points of substance even with those who have passed on. (shrink)

Background One of the objectives of medicine is to relieve patients' suffering. As a consequence, it is important to understand patients' perspectives of suffering and their ability to cope. However, there is poor insight into what determines their suffering and their ability to bear it. Purpose To explore the constituent elements of suffering of patients who explicitly request euthanasia or physician-assisted suicide (EAS) and to better understand unbearable suffering from the patients' perspective. Patients and methods A qualitative study using in-depth (...) face-to-face interviews was conducted with 31 patients who had requested EAS. The grounded theory approach was used to analyse the data. Results Medical, psycho-emotional, socio-environmental and existential themes contributed to suffering. Especially fatigue, pain, decline, negative feelings, loss of self, fear of future suffering, dependency, loss of autonomy, being worn out, being a burden, loneliness, loss of all that makes life worth living, hopelessness, pointlessness and being tired of living were constituent elements of unbearable suffering. Only patients with a psychiatric (co)diagnosis suffered unbearably all the time. Conclusions Unbearable suffering is the outcome of an intensive process that originates in the symptoms of illness and/or ageing. According to patients, hopelessness is an essential element of unbearable suffering. Medical and social elements may cause suffering, but especially when accompanied by psycho-emotional and existential problems suffering will become ‘unbearable’. Personality characteristics and biographical aspects greatly influence the burden of suffering. Unbearable suffering can only be understood in the continuum of the patients' perspectives of the past, the present and expectations of the future. (shrink)

Causal understanding is a defining characteristic of human cognition. Like many animals, human children learn to control their bodily movements and act effectively in the environment. Like a smaller subset of animals, children intervene: they learn to change the environment in targeted ways. Unlike other animals, children grow into adults with the causal reasoning skills to develop abstract theories, invent sophisticated technologies and imagine alternate pasts, distant futures and fictional worlds. In this Review, we explore the development of human-unique causal (...) learning and reasoning from evolutionary and ontogenetic perspectives. We frame our discussion using an ‘interventionist’ approach. First, we situate causal understanding in relation to cognitive abilities shared with non-human animals. We argue that human causal understanding is distinguished by its depersonalized (objective) and decontextualized (general) representations. Using this framework, we next review empirical findings on early human causal learning and reasoning and consider the naturalistic contexts that support its development. Then we explore connections to related abilities. We conclude with suggestions for ongoing collaboration between developmental, cross-cultural, computational, neural and evolutionary approaches to causal understanding. (shrink)

In St. Francis Regional Medical Center v. Blue Cross & Blue Shield of Kansas ), the United States Court of Appeals for the Tenth Circuit upheld Blue Cross/Blue Shield of Kansas's anti-assignment requirement, on the grounds that the Employee Retirement Income Security Act preempted a hospital's claim against Blue Cross. The court also held that public policy supported anti-assignment requirements in health plans not covered under ERISA.When drafting ERISA, Congress did not explicitly address assignability of health care benefits. According to (...) the court of appeals, congressional silence constituted an intent to allow the parties to negotiate freely the assignment of health care benefits. Examining non-ERISA health plans, the court adopted a balancing test to determine the validity of anti-assignment clauses; it found that anti-assignment requirements promote freedom of contract and may include medical costs. (shrink)

The roots of much of Western medicine lie in the Christian monastic tradition and its commitment to nonstigmatizing compassionate care throughout the life cycle and to the ideal of empathic personal connection between physicians, patients, and the communities and relationships in which both of these are embedded. In the modern West, these Christianly informed aspects of medicine are increasingly being undercut as medical care becomes ever more specialized, technologized, and depersonalized. At the same time, there exist a variety of efforts (...) to counter these tendencies and to foster a practice of medicine that is more sensitive to the personal, relational, familial, and narrative dimensions of health, illness, and medical care. There are, in particular, considerable numbers of physicians, psychologists, and psychotherapists working at the intersections of biomedical and psychosocial care, of care for individuals and care for families, and of the body and the mind. Given the natural affinity that Christian bioethicists might be expected to have to communitarian, narrative, and family-oriented approaches to health care, it is thus remarkable that there appears to be no work of Christian bioethics that interacts in any discernible way with this psychotherapeutic literature concerning health, illness, families, and the mind-body interface. Instead, Christian bioethicists appear to endorse a narrowly reductionistic biomedical view of health and illness while either ignoring the psychosocial, integrative, and collaborative literature, or actively blaming and shaming those pastors or lay Christians who might have anything to do with psychotherapy or psychosocial care. This is unbecoming and unhelpful. In the fragmented, complex, and potentially dehumanizing world that is modern medical care, those who would think Christianly about the care of the sick cannot afford to despise psychology and psychosocial care. On the contrary, the church needs psychotherapy. In this article, I will thus consider, first, what the state of the conversation is where Christian bioethics and psychosocial and psychotherapeutic care are concerned. I will then turn to some of the principal landmarks in the professional literature concerning psychotherapeutic work with the sick, the disabled, the dying, and the bereaved, particularly as these are considered in contexts that include families and lay and professional caregivers. I will then identify a few opportunities for practical and theological reflection that present themselves in this literature, and will conclude with a few comments on the substance and relationship of salvation and health. (shrink)

In Prior’s [4], Appendix A §4 and §5, and Chapter IV, and more explicitly in Bull’s [2], we find sequences of tense-logical systems which place increasingly more restrictive conditions on the temporal relation “… is before …”. We give here a simple, diagrammatic account of the way in which the successive postulates for temporal order place these conditions on the temporal relation: we do not provide any essentially new semantics for these systems, nor do we prove any rigorous metatheorems. We (...) do, however, quite often assume the completeness results of Lemmon, Bull and others without explicit mention. (shrink)

Are values and social priorities universal, or do they vary across geography, culture, and time? This question is very relevant to Asia’s emerging economies that are increasingly looking at Western models for answers to their own outmoded health care systems that are in dire need of reform. But is it safe for them to do so without sufficient regard to their own social, political, and philosophical moorings? This article argues that historical and cultural legacies influence prevailing social values with regard (...) to health care financing and resource allocation, and that the Confucian dimension provides a helpful entry point for a deeper understanding of ongoing health care reforms in East Asia – as exemplified by the unique case of Singapore. (shrink)

Hegel raises many real problems on the basis of the phenomenology of spirit: logico-ontological, gnoseological, and philosophico-historical problems. But in all spheres, levels, and forms of consciousness, Hegel investigates particularly the formation of the socially developed and historically oriented universal subject of thought, will, and action in the context of the forms of the manifest spirit, forms that in reality assume the status of being. It is precisely this investigation that constitutes the real problematic of Hegel's Phenomenology of Spirit.

The notion of a Sasaki projectionon an orthomodular lattice is generalized to a mapping Φ: E × E → E, where E is an effect algebra. If E is lattice ordered and Φ is symmetric, then E is called a Φ-symmetric effect algebra.This paper launches a study of such effect algebras. In particular, it is shown that every interval effect algebra with a lattice-ordered ambient group is Φ-symmetric, and its group is the one constructed by Ravindran in his proof that (...) every effect algebra that has the Riesz decomposition property is an interval algebra. It is shown that the doubling construction introduced in the paper is connected to the conditional event algebrasof Goodman, Nguyen, and Walker. (shrink)

In the article three tragedies: ‘The Battle of Arminius‘ by Christian Dietrich Grabbe, ‘Nibelungs‘ by Friedrich Hebbel, ‘The Ring of the Nibelung‘ by Richard Wagner are considered. The aim of this paper is to investigate how history reception and mythological material correlates with the idea of national identity. The comparative-historical, typological and historical-genetic methods are applied in this publication. The genres of historical, philosophical and mythological tragedy became the most popular genres in the socio-political conditions in the 30s of the (...) 19th century in Germany. Grabbe underlines the idea of the presence of the ‘local‘ regional history within the framework of the ‘big‘ and significant one. Grabbe paid attention to the historical process and historical figures, not to any particular historical event. In his last work, tragedy ‘The Battle of Arminius‘, Grabbe showed his understanding of the country’s historical origins and the creation of a national myth. F. Hebbel and R. Wagner comprehend the images and motifs of Norse mythology as a universal model of human existence. While interpreting the story of Nibelungs, F. Hebbel notes not only its national roots but its universal source; he models the image of the world through the prism of the microcosm of Burgundians/Nibelungs. Wagner’s tetralogy is not so much an interpretation as a creation of the ‘new myth‘. The images of Arminius and Siegfried have the features of the archaic primal forefather, ‘cultural hero‘ of the nation, who intimately related with Nature and home ground. Myth and mythological history are not only the tools of attainment of national identity but the means of reversion the modern man to the lost harmony of the Universe, which pertains to the mythological mind. (shrink)