Objectives The objectives of the study are to understand the current practice of informed consent in medical research in public hospitals in Shanghai, and to share our views with other countries, especially developing countries. Methods In the study, 145 consent forms (CFs) of the selected research projects in eight public hospitals with ethics committees in Shanghai were audited, and the principle investigators (PIs) of these research projects and 40 student subjects who had participated in clinical drug tests were surveyed by (...) questionnaires. Results The CFs of medical researches in public hospitals with ethics committees in Shanghai were generally acceptable. However, there were some defects in the CFs. Although most of the surveyed PIs had correct recognition of informed consent, some processes of informed consent were not in accordance with generally accepted requirements. A large number of the PIs considered the greatest difficulty with informal consent was lack of correct recognition of subjects or legally authorised representatives on medical research. Discussion Informed consent in medical research should consider the research ethics, the background of potential subjects, the local resources and culture of medical research. In addition, special protection is needed for student subjects in informed consent as well as efforts for building and restoring the public's trust in biomedical research. Conclusion The informed consent in Shanghai's public hospitals with ethics committees was generally acceptable and the achievement of adequate informed consent is influenced by many factors. (shrink)

This paper expands upon the work by Wang (Proceedings of TARK, pp. 493–512, 2017) who proposes a new framework based on quantifier-free predicate language extended by a new bundled modality \(\exists x\Box \) and axiomatizes the logic over S5 frames. This paper first gives complete axiomatizations of the logics over K, D, T, 4, S4 frames with increasing domains and constant domains, respectively. The systems w.r.t. constant domains feature infinitely many additional rules defined inductively than systems w.r.t. increasing domains. (...) In the second part of the paper, we show that these rules are admissible in the systems without them by providing a general strategy for proving completeness theorems for the logics without these rules over constant domain models (also increasing domain models). (shrink)

Recent years witnessed a growing interest in non-standard epistemic logics of knowing whether, knowing how, knowing what, knowing why and so on. The new epistemic modalities introduced in those logics all share, in their semantics, the general schema of ∃x◻φ, e.g., knowing how to achieve φ roughly means that there exists a way such that you know that it is a way to ensure that φ. Moreover, the resulting logics are decidable. Inspired by those particular logics, in this work, we (...) propose a very general and powerful framework based on quantifier-free predicate language extended by a new modality, which packs exactly ∃x◻ together. We show that the resulting language, though much more expressive, shares many good properties of the basic propositional modal logic over arbitrary models, such as finite-tree-model property and van Benthem-like characterization w.r.t.\ first-order modal logic. We axiomatize the logic over S5 frames with intuitive axioms to capture the interaction between the new modality and know-that operator in an epistemic setting. (shrink)

Let ≤r and ≤sbe two binary relations on 2ℕ which are meant as reducibilities. Let both relations be closed under finite variation and consider the uniform distribution on 2ℕ, which is obtained by choosing elements of 2ℕ by independent tosses of a fair coin.Then we might ask for the probability that the lower ≤r-cone of a randomly chosen set X, that is, the class of all sets A with A ≤rX, differs from the lower ≤s-cone of X. By c osure (...) under finite variation, the Kolmogorov 0-1 aw yields immediately that this probability is either 0 or 1; in case it is 1, the relations are said to be separable by random oracles.Again by closure under finite variation, for every given set A, the probability that a randomly chosen set X is in the upper ≤r-cone of A is either 0 or 1; let Almostr be the class of sets for which the upper ≤r-cone has measure 1. In the following, results about separations by random oracles and about Almost classes are obtained in the context of generalized reducibilities, that is, for binary relations on 2ℕ which can be defined by a countable set of total continuous functionals on 2ℕ in the same way as the usual resource-bounded reducibilities are defined by an enumeration of appropriate oracle Turing machines. The concept of generalized reducibility comprises a natura resource-bounded reducibilities, but is more general; in particular, it does not involve any kind of specific machine model or even effectivity. The results on generalized reducibilities yield corollaries about specific resource-bounded reducibilities, including several results which have been shown previously in the setting of time or space bounded Turing machine computations. (shrink)

Lachlan observed that the infimum of two r.e. degrees considered in the r.e. degrees coincides with the one considered in the ${\Delta_2^0}$ degrees. It is not true anymore for the d.r.e. degrees. Kaddah proved in (Ann Pure Appl Log 62(3):207–263, 1993) that there are d.r.e. degrees a, b, c and a 3-r.e. degree x such that a is the infimum of b, c in the d.r.e. degrees, but not in the 3-r.e. degrees, as a < x < b, c. In (...) this paper, we extend Kaddah’s result by showing that such a structural difference occurs densely in the r.e. degrees. Our result immediately implies that the isolated 3-r.e. degrees are dense in the r.e. degrees, which was first proved by LaForte. (shrink)

The paper expands upon the work by Wang [4], who proposes a new framework based on quantifier-free predicate language extended by a new modality ∃x□\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\exists x\Box $$\end{document} and axiomatizes the logic over S5 frames. This paper gives the logics over K, D, T, 4, S4 frames with increasing and constant domains. And we provide a general strategy for proving completeness theorems for logics w.r.t. the increasing domain and logics w.r.t. the (...) constant domain respectively. (shrink)

In order to solve the problem of unsmooth and inefficient human-computer interaction process in the information age, a method for human-computer interaction intention prediction based on electroencephalograph signals and eye movement signals is proposed. This approach is different from previous methods where researchers predict using data from human-computer interaction and a single physiological signal. This method uses the eye movements and EEG signals that clearly characterized the interaction intention as the prediction basis. In addition, this approach is not only tested (...) with multiple human-computer interaction intentions, but also takes into account the operator in different cognitive states. The experimental results show that this method has some advantages over the methods proposed by other researchers. In Experiment 1, using the eye movement signal fixation point abscissa Position X, fixation point ordinate Position Y, and saccade amplitude to judge the interaction intention, the accuracy reached 92%, In experiment 2, only relying on the pupil diameter, pupil size and fixed time, fixed time of eye movement signals can not achieve higher accuracy of the operator’s cognitive state, so EEG signals are added. The cognitive state was identified separately by combining the screened EEG parameters Rα/β with the eye movement signal pupil diameter and fixation time, with an accuracy of 91.67%. The experimental combination of eye movement and EEG signal features can be used to predict the operator’s interaction intention and cognitive state. (shrink)

In March 1996, the General Accounting Office (GAO) issued the reportScientific Research: Continued Vigilance Critical to Protecting Human Subjects.It stated that “an inherent conflict of interest exists when physician-researchers include their patients in research protocols. If the physicians do not clearly distinguish between research and treatment in their attempt to inform subjects, the possible benefits of a study can be overemphasized and the risks minimized.” The report also acknowledged that “the line between research and treatment is not always cleartoclinicians. Controversy (...) exists regarding whether certain medical procedures should be categorized as research.”This problem currently plagues gene transfer research. A few months prior to the GAO report, an ad hoc committee appointed by National Institutes of Health (NIH) Director Harold Varmus expressed similar concerns in its assessment of NIH investment in research on gene therapy. (shrink)

A striking feature of human female sexual reproduction is the high level of gametes that exhibit an aberrant number of chromosomes (aneuploidy). A high baseline observed in women of prime reproductive age is followed by a dramatic increase in older women. Proper chromosome segregation requires one or more DNA crossovers (COs) between homologous maternal and paternal chromosomes, in combination with cohesion between sister chromatid arms. In human females, CO designations occur normally, according to the dictates of CO interference, giving early (...) CO-fated intermediates. However, ≈25% of these intermediates fail to mature to final CO products. This effect explains the high baseline of aneuploidy and is predicted to synergize with age-dependent cohesion loss to explain the maternal age effect. Here, modern advances in the understanding of crossing over and CO interference are reviewed, the implications of human female CO maturation inefficiency are further discussed, and areas of interest for future studies are suggested. (shrink)

In this timely, thoughtful book, which goes to the heart of feminist concerns in the context of larger social, ecological, and theological issues, Nancy R. Howell proposes an ecofeminist worldview based on the organic-relational philosophy of Alfred North Whitehead. In particular, the book explores the ways in which Whitehead's philosophy can help to establish interrelationships among various women's communities, the relationship between humanity and nature, and the theological process of relating the world to God. Howell strives to develop principles (...) that are compatible with the wide spectrum of women's voices from different racial backgrounds and social strata. Specifically, she moves beyond mere acknowledgment of differing perspectives within the woman's movement and seriously engages criticisms of race-privileged white feminism by African American and Latin American activists. A Feminist Cosmology calls for a self-critical reformation of feminist thought based on a more inclusive framework, one that takes into account the diversity of relationships among women, the deep interdependence of humanity and the ecosystem, and ultimately the variety of theological perspectives relating the world to God. (shrink)

Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such (...) framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion. (shrink)

Accession Number: ATLA0001713221; Hosting Book Page Citation: p 945-961.; Language(s): English; General Note: Bibliography: p 961.; Issued by ATLA: 20130825; Publication Type: Essay.

This study adapts the theory of reasoned action (Ajzen and Fishbein, 1980) to the behavior of fraudulent reporting on financial statements so as to examine the effects of moral reasoning and self-monitoring on intention to report fraudulently, using structural equation modeling. The paper seeks to investigate two of the red flags for financial statement fraud identified in Loebbecke et al.'s (1989) paper: client management displays a significant lack of moral fiber and client personnel exhibit strong personality anomalies. As expected, high (...) moral reasoners are more influenced than low moral reasoners by their own attitude towards the behavior. Contrary to prior research, low self-monitors are found to be more influenced than high self-monitors by subjective norms. Future research is recommended to investigate the counter-intuitive results for self-monitors, to consider the implications of group decision making as regards the promulgation of fraudulent financial statements, and to examine additional red flags for financial statement fraud. (shrink)

A study of visual culture in the teaching of the life sciences.

The purpose of this article is to provide a critical examination of two aspects of culture and biomedicine that have helped to shape the meaning and practice of genetic testing for breast cancer. These are: (1) the cultural construction of fear of breast cancer, which has been fuelled in part by (2) the predominance of a ‘risk’ paradigm in contemporary biomedicine. The increasing elaboration and delineation of risk factors and risk numbers are in part intended to help women to contend (...) with their fear of breast cancer. However, because there is no known cure or foolproof prevention for breast cancer, risk designations bring with them recommendations for vigilant surveillance strategies and screening guidelines. We argue that these in effect exacerbate women’s fears of breast cancer itself. The volatile combination of discourses of fear, risk and surveillance have significant ethical and social consequences for women’s lives and well-being. Genetic testing decisions are made within this context; if nurses understand this context they can play an important role in helping women to cope with the anxiety and fear of breast cancer risk. (shrink)

Our aims are to set forth a multiprinciple system for selecting among clinical trials competing for limited space in an immunotherapy production facility that supplies products under investigation by scientific investigators; defend this system by appealing to justice principles; and illustrate our proposal by showing how it might be implemented. Our overarching aim is to assist manufacturers of immunotherapeutic products and other potentially breakthrough experimental therapies with the ethical task of prioritizing requests from scientific investigators when production capacity is limited.

In the past ten years, there has been growing interest in and concern about protecting the privacy of personal medical information. Insofar as medical records increasingly are stored electronically, and electronic information can be shared easily and widely, there have been legislative efforts as well as scholarly analyses calling for greater privacy protections to ensure that patients can feel safe disclosing personal information to their health-care providers. At the same time, the volume of biomedical research conducted in this country continues (...) to grow. The budget of the National Institutes of Health, for example, was $20,298 million in 2001, having more than doubled from a budget of $9,218 million 10 years before. This growing body of research includes increased efforts to use stored medical records as a source of data for health services, epidemiologic, and clinical studies. (shrink)

A theoretical approach relying on quantum computation in microtubules within neurons can potentially resolve the enigmatic features of visual consciousness, but raises other questions. For example, how can delicate quantum states, which in the technological realm demand extreme cold and isolation to avoid environmental ‘decoherence’, manage to survive in the warm, wet brain? And if such states could survive within neuronal cell interiors, how could quantum states grow to encompass the whole brain? We present a physiological model for visual consciousness (...) that can accommodate brain-wide quantum computation according to the Penrose–Hameroff ‘Orch OR’ model. In this view, visual consciousness occurs as a series of several-hundred-millisecond epochs, each comprising ‘crescendo sequences’ of quantum computations occurring at ∼40 Hz. (shrink)

Problem: Medical student mistreatment, as well as patient and staff mistreatment by all levels of medical trainees and faculty, is still prevalent in U.S. clinical training. Largely missing in interventions to reduce mistreatment is acknowledgement of the abuse of power produced by the hierarchical structure in which medicine is practiced. Approach: Beginning in 2001, Yale School of Medicine has held annual “Power Day” workshops for third year medical students and advanced practice nursing students, to define and analyse power dynamics within (...) the medical hierarchy and hidden curriculum using literature, guest speakers, and small groups. During rotations, medical students write narratives about the use of power witnessed in the wards. In response to student and small group leader feedback, workshop organizers have developed additional activities related to examining and changing the use of power in clinical teams. Outcome: Emerging narrative themes included the potential impact of small acts and students feeling “mute” and “complicit” in morally distressing situations. Small groups provided safe spaces for advice, support, and professional identity formation. By 2005, students recognized residents that used power positively with Power Day awards and alumni served as keynote speakers on the use of power in medicine. By 2010, departments including OB/GYN, surgery, psychiatry, and paediatrics, had added weekly team Power Hour discussions. Next Steps: The authors highlight barriers, benefits, and lessons learned. Barriers include the notion of clinical irrelevance and resistance to the word “power” due to perceived accusation of abuse. Benefits include promoting open dialogue about power, fostering inter-professional collaboration, rewarding positive role modelling by residents and faculty, and creating a network of trainee empowerment and leadership. Furthermore, faculty have started to ask that issues of power be addressed in a more transparent way at their level of the hierarchy as well. (shrink)

Participants in clinical research sometimes view participation as therapy or exaggerate potential benefits, especially in phase I or phase II trials. We conducted this study to discover what methods might improve cancer patients’ understanding of early-phase clinical trials. We randomly assigned 130 cancer patients from three U.S. medical centers who were considering enrollment in a phase I or phase II cancer trial to receive either a multimedia intervention or a National Cancer Institute pamphlet explaining the trial and its purpose. Intervention (...) participants were 32 times more likely to believe that the trial’s purpose was to examine safety and 60 % less likely to believe they would experience long-term benefit or cure. There was no difference in enrollment decision. However, while patients’ understanding of the trial’s purpose improved and expectations of long-term benefit diminished, half the respondents still believed they would experience long-term benefit or cure from participation. Therefore, we conclude that multimedia interventions such as this one may help oncologists to explain the risks and benefits of early-phase cancer trials in a way that patients can more easily understand, helping them to make more informed decisions about participation. But further research into other factors that influence patients’ beliefs about the outcome of enrollment is needed, both to modify the interventions and to determine how malleable patient beliefs are. (shrink)

The three important target articles make a strong case for regarding racism as a public health crisis. Each calls for advocacy by the bi...