No consensus yet exists on how to handle incidental fnd-ings in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are fndings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers (...) have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed. (shrink)

Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.

L'auteur compare des extraits de deux comptes-rendus divergeants de l'attitude de Jean II Comnène dans le conflit contre les Hongrois entre 1127 et 1129, par Jean Cinnamus et Nicetas Choniates, afin de tenter d'apporter quelques lumières sur sa carrière.

Accession Number: ATLA0001712129; Hosting Book Page Citation: p 207-225.; Language(s): English; General Note: Bibliography: p 222-225.; Issued by ATLA: 20130825; Publication Type: Essay.

Returning genomic research results to family members raises complex questions. Genomic research on life-limiting conditions such as cancer, and research involving storage and reanalysis of data and specimens long into the future, makes these questions pressing. This author group, funded by an NIH grant, published consensus recommendations presenting a framework. This follow-up paper offers concrete guidance and tools for implementation. The group collected and analyzed relevant documents and guidance, including tools from the Clinical Sequencing Exploratory Research Consortium. The authors then (...) negotiated a consensus toolkit of processes and documents. That toolkit offers sample consent and notification documents plus decision flow-charts to address return of results to family of living and deceased participants, in adult and pediatric research. Core concerns are eliciting participant preferences on sharing results with family and on choice of a representative to make decisions about sharing after participant death. (shrink)

Continuing the debate over whether consciousness causes behaviour or plays no functional role in it, leading scholars discuss the question in terms of neuroscience, philosophy, law, and public policy.

Evolutionary theory assumed that mutations occur constantly, gradually, and randomly over time. This formulation from the “modern synthesis” of the 1930s was embraced decades before molecular understanding of genes or mutations. Since then, our labs and others have elucidated mutation mechanisms activated by stress responses. Stress‐induced mutation mechanisms produce mutations, potentially accelerating evolution, specifically when cells are maladapted to their environment, that is, when they are stressed. The mechanisms of stress‐induced mutation that are being revealed experimentally in laboratory settings provide (...) compelling models for mutagenesis that propels pathogen–host adaptation, antibiotic resistance, cancer progression and resistance, and perhaps much of evolution generally. We discuss double‐strand‐break‐dependent stress‐induced mutation in Escherichia coli. Recent results illustrate how a stress response activates mutagenesis and demonstrate this mechanism's generality and importance to spontaneous mutation. New data also suggest a possible harmony between previous, apparently opposed, models for the molecular mechanism. They additionally strengthen the case for anti‐evolvability therapeutics for infectious disease and cancer. (shrink)

Early embryogenesis of Caenorhabditis elegans provides a striking example of the generation of polarity and the partitioning of cytoplasmic factors according to this polarity. Microfilaments (MFs) appear to play a critical role in these processes. By visualizing the distribution of MFs and by studying the consequences of disrupting MFs for short, defined periods during zygote development, we have generated some new ideas about when and how microfilaments function in the zygote.

oise Baylis, 1234 Le Marchant Street, Halifax, Nova Scotia, Canada B3H 3P7. Tel.: (902)-494–2873; Fax: (902)-494-2924; Email: francoise.baylis{at}dal.ca ' + u + '@' + d + ' '//--> . Abstract Recently, there has been a growing interest in public health and public health ethics. Much of this interest has been tied to efforts to draw up national and international plans to deal with a global pandemic. It is common for these plans to state the importance of drawing upon a well-developed (...) ethics framework and we argue that this framework should reflect the values and insights of feminist relational theory. More specifically, we argue that pandemic planning must be squarely situated in the larger realm of public health and that an ethics framework for public health will be one that recognizes the need to pay particular attention to the vulnerability of subpopulations lacking in social and economic power. We propose an ethics framework for public health that builds on the notions of relational personhood (including relational autonomy and social justice) and relational solidarity. In this way, we aim for a public health ethics that, as appropriate, promotes the public interest and the common good. CiteULike Connotea Del.icio.us What's this? (shrink)

Successful preimplantation genetic diagnosis to avoid creating a child affected by a genetically-based disorder was reported in 1989. Since then PGD has been used to biopsy and analyze embryos created through in viuo fertilization to avoid transferring to the mother’s uterus an embryo affected by a mutation or chromosomal abnormality associated with serious illness. PGD to avoid serious and early-onset illness in the child-to-be is widely accepted. PGD prevents gestation of an affected embryo and reduces the chance that the parents (...) will be faced with a difficult decision of whether to terminate the pregnancy. More controversial have been PGD to select the sex of the child-to-be for “family balancing”, PGD for mere susceptibility to disease and for late-onset disorders such as Alzheimer diseas, and most controversially, PGD to create a donor child who is Human Leukocyte Antigen (HLA-matched with a preexisting sibling in need of stem cell transplant. (shrink)

In this paper I use a feminist relational approach to critically examine contemporary mainstream assumptions in the field of development concerning the relationship between poverty and prosperity....

Genetic testing poses fundamental questions for insurance. Testing can predict a low probability of future illness and disability, which can help promote the insurability of individuals with a family history of genetic risk, but it can also invite insurers to reject applicants, increase premiums, exclude people with certain illnesses and disabilities, and otherwise adjust the underwriting processes for individuals with certain genotypes. In the workplace, these issues may cause employers who offer or pay for insurance to alter their hiring behavior, (...) either by selecting those with desirable genetic makeup or rejecting, dismissing, or reassigning those who carry an unwanted risk, ultimately threatening employability and the safety net that insurance is intended to provide. (shrink)

In this paper we aim to shed light on the dynamics of regional identity construction and deconstruction. We will argue that four forms of identity can be identified that are linked through various processes of change. To that end, we will theoretically conceptualise 'identity' by discussing historical and current scholarly debates on identity in a variety of scientific disciplines. Then, we will argue that the mutual contradiction of the current theories is a paradox if seen from the angle of regional (...) identity construction and deconstruction. Building upon elements from the various theoretical approaches, we propose a heuristic model describing the dynamics of identity construction and deconstruction, which will be explored by means of the example of the Green Heart region, a spatial planning concept in western Holland. (shrink)

The interface between genetic research results and clinical practice occurs when patients present them- selves to physicians. When patients ask their doctors about the potential impact of a family disease on themselves, their children, and their grandchildren, physicians have an opportunity to be helpful. Unfortunately, the scientific discoveries are occurring faster than most physicians can read about them in their speciality journals and hence adjust their practice. Meanwhile, the press and media are proclaiming the latest scientific breakthroughs, creating a preventive (...) and curative expectation that physicians cannot fulfill.In this time of health system reorganization and consolidation, many people do not know who their primary caregiver is, no less which insurer is likely to cover which visit or genetic test. (shrink)

Holding life and death in their hands -- Is this for me? -- The intensive care unit. Personnel ; Rhythms ; Economics -- Actors. Patients ; Friends, family, and significant others ; Health care professionals -- Decisions. Informed consent ; Venues ; Affect ; Conflict -- Prognosis. Evidence ; Timing ; Mixed messages ; Negotiation ; Accuracy ; Prognostic framing -- Decision-making scripts. The legal script ; Cognitive scripts ; Conflicts of interest ; Law at the bedside -- Improvisation: decisions (...) in the real world. The patient should decide ; Reprising patient instructions ; Standing in the patient's shoes ; Beneficence ; It's God's decision ; What we want ; Denial, opting out -- Making a difference? The role of physicians ; Opting for a trajectory ; Outcomes ; I thought the law would take care of this ; Does any of this matter? -- The end. Implications ; Before it's too late ; When it's too late ; When "this" happens to me. (shrink)

Nanomedicine is yielding new and improved treatments and diagnostics for a range of diseases and disorders. Nanomedicine applications incorporate materials and components with nanoscale dimensions where novel physiochemical properties emerge as a result of size-dependent phenomena and high surface-to-mass ratio. Nanotherapeutics and in vivo nanodiagnostics are a subset of nanomedicine products that enter the human body. These include drugs, biological products, implantable medical devices, and combination products that are designed to function in the body in ways unachievable at larger scales. (...) Nanotherapeutics andin vivonanodiagnostics incorporate materials that are engineered at the nanoscale to express novel properties that are medicinally useful. These nanomedicine applications can also contain nanomaterials that are biologically active, producing interactions that depend on biological triggers. Examples include nanoscale formulations of insoluble drugs to improve bioavailability and pharmacokinetics, drugs encapsulated in hollow nanoparticles with the ability to target and cross cellular and tissue membranes and to release their payload at a specific time or location, imaging agents that demonstrate novel optical properties to aid in locating micrometastases, and antimicrobial and drug-eluting components or coatings of implantable medical devices such as stents. (shrink)

This paper investigated the effects, ramifications and limitations of categorising and labelling Directors and Boards when measuring or evaluating performance. According to Weiner (1982) labelling can have a profound impact on a person's life, leading to stigmas, reputation bias, prejudice or discrimination which can adversely impact Director and Board performance. Labelling Directors' behavioural traits can lead to the exaggeration of behaviours and lead fellow Directors or shareholders to have preconceived expectations about Directors. This study hypothesised that measurement of Directors and (...) Boards should be measured on a continuum and remain fluid. Fluid measurement takes into account all aspects of a Directors behaviour, circumstances and situational impacts, without categorisation or judgement. Results suggest Directors feel more confident in their ability to perform as Directors and evidence a greater state of preparedness and readiness for change. Findings are discussed in terms of the impacts for Directors, decision-making ability and Board performance. (shrink)

Celebrates a half century of television history, from "The Howdy Doody Show" and "I Love Lucy" to "The Simpsons" and "The Sopranos," and the personalities, shows, and landmark events that changed entertainment history.

This monograph opens with an examination of the aid industry and the claims of leading practitioners that the industry is experiencing a crisis of confidence due to an absence of clear moral guidelines. The book then undertakes a critical review of the leading philosophical accounts of the duty to aid, including the narrow, instructive accounts in the writings of John Rawls and Peter Singer, and broad, disruptive accounts in the writings of Onora O’Neill and Amartya Sen. Through an elaboration of (...) the elements of interconnection, responsible action, inclusive engagement, and accumulative duties, the comparative approach developed in the book has the potential to overcome the philosophical tensions between the accounts and provide guidance to aid practitioners, donors and recipients in the complex contemporary circumstances of assistance. Informed by real world examples, this book grapples with complex and multi-dimensional questions concerning practices and the ethics of aid. The author judiciously guides us through the debate between deontological and consequentialist moral theories to arrive at a sophisticated consequentialist account that does justice to the complexity of the problems and facilitates our deliberation in discharging our duty to aid, without yielding, as it should not, a determinate answer for each specific situation. Researchers, students, and practitioners of international aid will all find this book rewarding. Win-chiat Lee, Professor and Chair, Department of Philosophy, Wake Forest University Susan Murphy’s book offers us a sophisticated exploration of the philosophical basis for aid. It is grounded in a full understanding of the complexities and pitfalls of the aid industry, but its particular strength lies, mainly through an extensive discussion of Singer, Rawls, O’Neill and Sen, in a comparison of consequentialist and duty-based approaches, eventually endorsing a broad non-idealised, situated consequentialist account in what she calls an interconnected ethical approach to the practice of assistance. For anyone wanting to think carefully about why we should give aid, this book has much to offer. Dr Nigel Dower Honorary Senior Lecturer, University of Aberdeen Author of World Ethics – the New Agenda. (shrink)

Recently, Hosmer (1994a) proposed a model linking right, just, and fair treatment of extended stakeholders with trust and innovation in organizations. The current study tests this model by using Victor and Cullen''s (1988) ethical work climate instrument to measure the perceptions of the right, just, and fair treatment of employee stakeholders.In addition, this study extends Hosmer''s model to include the effect of right, just, and fair treatment on employee communication, also believed to be an underlying dynamic of trust.More specifically, the (...) current study used a survey of 111 managers to test (1) whether right, just, and fair treatment influences trust, both directly as well as indirectly via communication, and (2) whether trust influences perceptions of commitment and innovation. Strong support for the study''s hypotheses and Hosmer''s (1994a) model was found. Such findings support those who argue that moral management may be good management. (shrink)

The Physician Orders for Life-Sustaining Treatment Paradigm is designed to improve end-of-life care by converting patients’ treatment preferences into medical orders that are transferable throughout the health care system. It was initially developed in Oregon, but is now implemented in multiple states with many others considering its use. Accordingly, an observational study was conducted in order to identify potential legal barriers to the implementation of a POLST Paradigm. Information was obtained from experts at state emergency medical services and long-term care (...) organizations/agencies in combination with a review of relevant state law. Legal analysis of survey responses and existing laws identified several potential state legal barriers to a POLST Paradigm implementation. The most potentially problematic barriers are detailed statutory specifications for out-of-hospital DNR protocols. Other potential barriers include limitations on the authority to consent to forgo life-sustaining treatments, medical preconditions, and witnessing requirements for out-of-hospital DNR protocols. (shrink)

Introduction JOHN HORTON AND SUSAN MENDUS The essays in this volume are concerned with the theoretical and conceptual issues involved in the idea of ...

While researchers have examined the types of ethical issues that arise in long-term care, few studies have explored long-term care nurses’ experiences of moral distress and fewer still have examined responses to initial moral distress. Using an interpretive description approach, 15 nurses working in long-term care settings within one city in Canada were interviewed about their responses to experiences of initial moral distress, resources or supports they identified as helpful or potentially helpful in dealing with these situations, and factors that (...) hindered nurses in their responses. Using a thematic analysis process, three major themes were identified from the nurses’ experiences: (i) the context of the situation matters; (ii) the value of coming together as a team; and (iii) looking for outside direction. The work of responding to initial moral distress was more fruitful if opportunities existed to discuss conflicts with other team members and if managers supported nurses in moving their concerns forward through meetings or conversations with the team, physician, or family. Access to objective others and opportunities for education about ethics were also identified as important for dealing with value conflicts. (shrink)