BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Given any collection F of computable functions over the reals, we show that there exists an algorithm that, given any sentence A containing only bounded quantifiers and functions in F, and any positive rational number delta, decides either “A is true”, or “a delta-strengthening of A is false”. Moreover, if F can be computed in complexity class C, then under mild assumptions, this “delta-decision problem” for bounded Sigma k-sentences resides in Sigma k. The results stand in sharp contrast to the (...) well-known undecidability of the general first-order theories with these functions, and serve as a theoretical basis for the use of numerical methods in decision procedures for formulas over the reals. (shrink)

Many people who have never read the works of Nietzsche possess some vague notion of what he taught. For them the philosophy of Nietzsche is represented by a few floating ideas—“Superman,” “Will to Power,” and even perhaps “blond beast.” Others again have learnt a little more about Nietzsche and perhaps read something of what he actually said; yet the net result is an impression of a passionate and destructive thinker, who launched his attacks on this side and on that, without (...) any regard for consistency. For them there can be no philosophy of Nietzsche: they know that he often wrote in the form of aphorism and they picture his thought in general as a series of detached utterances, many of which are mutually exclusive. It may then be of use to some, if we attempt to set forth the guiding inspiration and leading ideas of Nietzsche, for when these have been grasped, it will be seen that it is by no means absurd to speak of a philosophy of Nietzsche. It may well be impossible to reconcile all his utterances, at least so far as the words are concerned—though Nietzsche is of course not the only philosopher who betrays inconsistency in his thought—but it should be remembered that Nietzsche was not given to standing still: his thought developed. Moreover, he often spoke in an exaggerated form, so that some of the apparent inconsistencies may be ascribed to over-emphasis. In any case, even granting the presence of irreconcilable inconsistencies in his thought, Nietzsche's various theories not only may, but must, be seen as a whole, if they are seen in the light of his guiding ideas and inspiration. (shrink)

Liebe Frau Henry! Soeben bekomme ich Ihren Brief, Die Freude, die mir Ihre Ankündigung macht, veranlaßt mich, Ihnen sofort zu antworten. Sie wissen wohl, daß ich seit Jahren wünsche, Sie möchten Ihre philosophischen Arbeiten fortsetzen und möchten die dafür notwendige Muße finden. Ich weiß nicht, ob Sie wissen, daß ich Sie mehrfach für philosophische Lehrstühle, über deren Besetzung ich unter dem Gesichtspunkt der Naturphilosophie gefragt worden bin, vorgeschlagen habe.

Curio’s six lictors with laureled fasces (Cic. Att. 10.4.9) are best explained by his holding command in 49 BC not as Caesar’s legatus, but pro praetore with imperium nominally in his own right, granted (‘extra-constitutionally’) by Caesar directly, without vote of Senate and People.

It is generally believed that Polybios mistook L. Iunius Pullus (cos. 249) for one of the consuls of 248 B. C. The internal evidence of Polybios’ narrative shows clearly that he knew the correct year of Iunius’ consulship, and inadvertently created a false impression of the date by structuring his account so as to tell the story of the Roman siege of Lilybaeum without interruption, from its inception in 250 to Claudius Pulcher’s defeat at Drepana in the following year. This (...) narrative objective led him to postpone the paragraph (1.52.4-5) detailing the Roman reaction to the disastrous siege operations of 250 and the consular elections for 249 until after his account of Drepana, without considering how such an arrangement could mislead readers two millenia hence. (shrink)

There are an infinite variety of attitudes to euthanasia, each individual response to the concept being influenced by many factors. Consequently there is a literature on the subject ranging from the popular article to papers in specialized journals. This study, however, has taken a well defined sample of people, inviting them to answer a questionnaire which was designed to elicit their attitudes to euthanasia in a way which could be analysed statistically. Nor surprisingly attitudes appeared to 'harden' as those answering (...) the questionnaire grew more experienced in dealing with patients and also more professionally established. Thus it was found that of the seven groups questioned practising physicians showed more positive attitudes to euthanasia and their responses did not differ significantly from those of senior medical students. It is these groups which actually or potentially have to resolve the clinical dilemma posed by the dying patient. (shrink)