Julia Tinland, Oussama Haddadi, Marie-Pierre Aimée Dann
Abstract Background The diagnosis of chronic lymphocytic leukaemia (CLL) is often fortuitous. Stage A patients do not experience severe symptoms and therefore do not require initial treatment. Instead, they are placed under active surveillance in order to track disease deterioration over time. Around half of these patients will never need treatment. Diagnostic disclosure of Stage A CLL thus leads to a great deal of uncertainty. Accordingly, stage A patients’ lives are sometimes more impacted by their diagnosis than by the disease itself. This study aimed to outline the ethical issues surrounding the diagnosis of potentially indolent CLL in stage A patients under active surveillance in France by investigating their experiences, needs, expectations and self-perceptions. Methods We co-constructed an online questionnaire with the French leukaemia and lymphomas patient association ELLyE. Comprising 46 closed, semi-closed and semi-open questions, it focused on stage A patients’ experiences regarding their diagnosis and active surveillance, their encounters with medical professionals, as well as the support they received from family members, friends, non-medical healthcare professionals, and patient associations. We conducted a descriptive analysis to examine the results. Results Of the 235 participants included in the study, 46% were women. Mean age was 66 years old. All had been diagnosed between 1982 and 2021 (median year of diagnosis was 2013). Almost three-quarters (72.8%) of the sample did not consider themselves as sick. Two-thirds (66.8%) reported feeling uncertain about their disease progression and the feeling of a constant threat hanging over them. Patients recently diagnosed (i.e., < 5 years) were more likely to experience anxiety, anguish and powerlessness related to this uncertainty than patients diagnosed more than ten years previously. Many participants did not wish for more frequent or longer follow-up consultations with hospital-based specialists. Moreover, some wished to distance themselves as much as possible from anything related to cancer care and to live their lives as normally as possible. Conclusions Our study highlights that the difficulties patients with stage A CLL encounter tend to remain invisible because of limited interactions with medical professionals. Greater acknowledgment and understanding of these difficulties by these professionals are needed in order to adequately address different needs.
Ken O. Buesseler, Daniele Bianchi, Fei Chai
et al.
There are many potential approaches to marine carbon dioxide removal (mCDR), of which ocean iron fertilization (OIF) has the longest history of study. However, OIF studies to date were not primarily designed to quantify the durability of carbon (C) storage, nor how wise OIF might be as an mCDR approach. To quantify C sequestration, we introduce a metric called the “centennial tonne,” defined as 1,000 kg of C isolated from atmospheric contact for on average at least 100 years. We present the activities needed to assess OIF from a scientific and technological perspective, and additionally, how it might be responsibly studied and potentially deployed. The five activities include: field studies in the Northeast Pacific; improved modeling for field studies, data assimilation and predictions at larger scales; improvements in monitoring, reporting and verification (MRV) for C, and also MRV for tracking ecological and environmental impacts; and developing new iron sources and their delivery, to increase efficiencies and reduce costs. The fifth activity is to understand whether public and community support exists for OIF, and what governance structures might support further research and possible deployment of OIF. This article is written by a multidisciplinary experts group called Exploring Ocean Iron Solutions (ExOIS) that is organized around a responsible code of conduct. Of the mCDR approaches, OIF has the potential to be low cost, scalable, and rapidly deployable. Reducing CO2 emissions must lead the way, but there is also an urgency to decide under what conditions and whether OIF might be deployed or not.
This study investigated the role of cognitive control in moral decision-making, focusing on conflicts between financial temptations and the integrity of honesty. We employed a perceptual task by asking participants to identify which side of the diagonal contained more red dots within a square to provoke both honest and dishonest behaviors, tracking their reaction times (RTs). Participants encountered situations with no conflict, ambiguous conflict, and clear conflict. Their behaviors in the clear conflict condition categorized them as either “honest” or “dishonest.” Our findings suggested that, in ambiguous conflict situations, honest individuals had significantly longer RTs and fewer self-interest responses than their dishonest counterparts, suggesting a greater need for cognitive control to resolve conflicts and a lesser tendency toward self-interest. Moreover, a negative correlation was found between participants’ number of self-interest responses and RTs in ambiguous conflict situations (r = −0.27 in study 1 and r = −0.66 in study 2), and a positive correlation with cheating numbers in clear conflict situations (r = 0.36 in study 1 and r = 0.82 in study 2). This suggests less cognitive control was required for self-interest and cheating responses, bolstering the “Will” hypothesis. We also found that a person’s self-interest tendency could predict their dishonest behavior. These insights extend our understanding of the role of cognitive control plays in honesty and dishonesty, with potential applications in education, policy-making, and business ethics.
New “clinical pearls” about medical practice are presented (phrases that, in relatively few words, in a brief, concise and coherent manner, include knowledge or useful advice about the profession), transmitted from “experts” to students and young colleagues “in a “master-apprentice”. These “clinical pearls”, generally, are the result of careful observation and the well-used experience of colleagues, which synthesize knowledge that is passed from generation to generation empirically, just as popular knowledge is transmitted through saying, aphorisms, proverbs, etc. The “original” clinical pearls are transmitted “orally”, from person to person regarding various situations that arise during the exercise of the profession in different scenarios, especially healthcare. Although some clinical pearls could serve as starting points for future full-fledged researches, it must be remembered that in medicine not everything is knowledge, it is also art and ethics. After reflecting again on the role in medical education of these “drops of knowledge”, so in line with the fast times that we live in and with the possibility of having rescued a few more clinical pearls, in this work more than 40 “new” ones are presented, classified as clinical, therapeutic and public health and medical ethics, which are expected to be of practical use in our professionals practice and for the benefit of our citizens.
Pavithran Keechilat, Gopalakrishna Iyer N, Rajalakshmi Geetha
et al.
Background: Tongue tumors show intra and inter-tumoral heterogenicity with high incidence, relapse and mortality rates necessitating further research. Recurrence/metastasis that occurs after surgical resection of primary cancer is often the reason for poor survival in these patients. Lymph nodes are the most common site of metastasis in tongue tumors. Therefore, premetastatic molecular changes can be best evaluated in lymph nodes which may epitomize the earliest events in the metastasis cascades. The presence of circulating tumor cells(CTCs) in the absence of nodal disease (N0) may represent tumor aggressiveness, suggesting an immune escape which may have high metastatic potential. This trial was developed to investigate the earliest pre-metastatic changes which may regulate tumor dormancy and predict metastasis. A better understanding of organotropism or pre-metastatic changes can help in theragnostic, thereby preventing the outbreak of overt metastasis. Methods: A single-institutional prospective observational cohort study. This trial will be conducted at a tertiary care Centre (Amrita Institute of Medical Sciences Kochi). Eligible patients will be enrolled after obtaining informed consent. The dissected lymph nodes will be subjected to histopathological and immunohistochemical analyses for premetastatic niche (PMN) formation. In addition, circulating tumor cells will be evaluated before treatment and 6 months after treatment. The patients will be followed up for a period of two years to correlate the findings with the recurrence-free survival. Expected results: The pre-metastatic changes, if detected will be a predictive biomarker. It may help to define future drug targets for metastasis chemoprevention . CTCs may define the tumor aggressiveness ,there by prognostication and helps in better disease management. Ethics and dissemination: The study has received the following approval: Ethics Committee of Amrita School of Medicine (ECASM-AIMS-2022-048).Trial Registered Prospectively( CTRI/2022/03/041256 ) on 22/03/2022 under Clinical Trial Registry of India
AbstractAI Ethicsis a burgeoning and relatively new field that has emerged in response to growing concerns about the impact of artificial intelligence (AI) on human individuals and their social institutions. In turn, AI ethics is a part of the broader field of digital ethics, which addresses similar concerns generated by the development and deployment of new digital technologies. Here, we tackle the important worry that digital ethics in general, and AI ethics in particular, lack adequate philosophical foundations. In direct response to that worry, we formulate and rationally justify some basic concepts and principles for digital ethics/AI ethics, all drawn from a broadly Kantian theory of human dignity. Our argument, which is designed to be relatively compact and easily accessible, is presented in ten distinct steps: (1) what “digital ethics” and “AI ethics” mean, (2) refuting the dignity-skeptic, (3) the metaphysics of human dignity, (4) human happiness or flourishing, true human needs, and human dignity, (5) our moral obligations with respect to all human real persons, (6) what a natural automaton or natural machine is, (7) why human real persons are not natural automata/natural machines: because consciousness is a form of life, (8) our moral obligations with respect to the design and use of artificial automata or artificial machines, aka computers, and digital technology more generally, (9) what privacy is, why invasions of digital privacy are morally impermissible, whereas consensual entrances into digital privacy are either morally permissible or even obligatory, and finally (10) dignitarian morality versus legality, and digital ethics/AI ethics. We conclude by asserting our strongly-held belief that a well-founded and generally-accepted dignitarian digital ethics/AI ethics is of global existential importance for humanity.
Matthew B. Goss, MS, N. Thao N. Galván, MD, MPH, Joseph D. Geha, DDS
et al.
Background. Successful liver transplantation is dependent on restoration of hepatic arterial (HA) flow. Although uncommon, some native recipient HAs are not suitable or inadequate for anastomosis, thereby necessitating extra-anatomic HA reconstruction. Splenic artery transposition (SAT) is 1 method of HA reconstruction, in which the recipient splenic artery is transposed to reestablish perfusion of the donor liver. Due to the rarity of the technique, literature describing outcomes is limited. In the current report, we describe 3 patients (2 adults, 1 pediatric) who underwent complex upper abdominal surgery before whole-organ deceased donor liver transplantation with SAT.
Methods. The demographic and patient care information was collected prospectively and subsequently reviewed retrospectively. Given the de-identified nature of the data included, this study was exempt from approval from an ethics board.
Results. Recipient splenic arteries were dissected from their origin at the celiac trunk, for approximately 3–5 cm to ensure a gentle anterior-cranial curve toward the right upper quadrant, allowing anastomosis to the donor celiac trunk in an end-to-end fashion. Postoperatively, all 3 patients had rapid normalization of liver function tests and brisk HA flow demonstrated by Doppler ultrasound. Longer-term follow-up, ranging from 1 to 3 years, reveals continued patency of the reconstructed HAs and liver function tests within normal limits.
Conclusions. Our experience points to SAT as a safe and effective technique for extra-anatomic HA reconstruction.
Following ethnographic studies of Danish companies, this article examines how small- and medium-sized companies are implementing cobots into their manufacturing systems and considers how this is changing the practices of technicians and operators alike. It considers how this changes human values and has ethical consequences for the companies involved. By presenting a range of dilemmas arising during emergent processes, it raises questions about the extent to which ethics can be regulated and predetermined in processes of robot implementation and the resulting reconfiguration of work.
What are the political implications of hospitality in the context of colonial domination? What are the issues involved in determining the identity of the other as part of institutional politics? This article poses these questions, relying on the aporetic dimension intrinsic to the notion of Derridian hospitality. It questions the colonial perspective of welcome. Derrida's thinking on hospitality is therefore, above all, an enquiry into the very concept of hospitality, which is always placed on the side of the one with the «strongest or dominating reason». The author questions even the most generous welcome, highlighting the ambiguity that is established between hospitality and power. This aporia establishes an offer of hospitality that is inescapably linked to the point of view of the dominant, i.e. the colonizer. The one who, imposes his views on the other when it comes to the concept of «I welcome you into my home» or rather hospitality, due to the unequal or asymmetrical distribution of power.
Leah Quinlivan, Rebecca Nowland, Sarah Steeg
et al.
BackgroundComplex challenges may arise when patients present to emergency services with an advance decision to refuse life-saving treatment following suicidal behaviour.AimsTo investigate the use of advance decisions to refuse treatment in the context of suicidal behaviour from the perspective of clinicians and people with lived experience of self-harm and/or psychiatric services.MethodForty-one participants aged 18 or over from hospital services (emergency departments, liaison psychiatry and ambulance services) and groups of individuals with experience of psychiatric services and/or self-harm were recruited to six focus groups in a multisite study in England. Data were collected in 2016 using a structured topic guide and included a fictional vignette. They were analysed using thematic framework analysis.ResultsAdvance decisions to refuse treatment for suicidal behaviour were contentious across groups. Three main themes emerged from the data: (a) they may enhance patient autonomy and aid clarity in acute emergencies, but also create legal and ethical uncertainty over treatment following self-harm; (b) they are anxiety provoking for clinicians; and (c) in practice, there are challenges in validation (for example, validating the patient’s mental capacity at the time of writing), time constraints and significant legal/ethical complexities.ConclusionsThe potential for patients to refuse life-saving treatment following suicidal behaviour in a legal document was challenging and anxiety provoking for participants. Clinicians should act with caution given the potential for recovery and fluctuations in suicidal ideation. Currently, advance decisions to refuse treatment have questionable use in the context of suicidal behaviour given the challenges in validation. Discussion and further patient research are needed in this area.Declaration of interestD.G., K.H. and N.K. are members of the Department of Health's (England) National Suicide Prevention Advisory Group. N.K. chaired the National Institute for Health and Care Excellence (NICE) guideline development group for the longer-term management of self-harm and the NICE Topic Expert Group (which developed the quality standards for self-harm services). He is currently chair of the updated NICE guideline for Depression. K.H. and D.G. are NIHR Senior Investigators. K.H. is also supported by the Oxford Health NHS Foundation Trust and N.K. by the Greater Manchester Mental Health NHS Foundation Trust.
Introduction It is accepted that although patients may initiate a visit to a healthcare provider, follow-up visits are often based on recommendations from providers. This suggests that follow-up care, since not initiated by patients, may not reflect patients’ perception of a need for care. However, few studies have examined the burden of regular follow-up care and patients’ perceived value of such care. For parents of children with type 1 diabetes (T1D), follow-up visits are scheduled regardless of how well controlled the diabetes is. Our study examines how benefits and burden from the parents’ perspective could affect their preferences in regard to the frequency of regular follow-up care.Methods We aim to develop an online patient survey to be distributed to parents of children living with T1D in the province of Quebec, Canada. The survey will be available in French and English, and distributed through diabetes clinics, on social media groups and forums for parents of children with T1D. The survey will be developed in collaboration with parents of children with T1D to ensure that it appropriately reflects the services in regular follow-up care and that the language is understandable and clear.Ethics and dissemination All participants will be informed of the requirements and objectives of the survey at the beginning of the questionnaire and that the data collected will remain anonymous and confidential. Ethics approval for the study was obtained from the research ethics committee of the CHU de Québec-Université Laval. Results of the study will be shared with relevant stakeholders with the aim of improving practices and better meeting patients’ and families’ needs.
<p>The United Nations proclaimed a decade of marine science for sustainable
development (2021–2030) to develop a common framework that will ensure that
ocean science can fully support countries in achieving the goal of
sustainable development. Marine scientific understanding is fundamental to
managing human activities that affect this environment, and
ocean observations have a particularly important role in enhancing the knowledge base of
our oceans. With this important task, scientists have the responsibility to
act in an ethical way and apply all the fundamental principles described in
the Cape Town statement: (a) ethical values, (b) social values and (c) cultural
values (Peppoloni and Di Capua, 2017).</p><p>This article is a fist attempt to highlight the core values applicable to
ocean observation, which can then be improved and adopted as part of
geoethics and the stewardship of the Earth system. It opens up avenues for
reflection on geoethical implications in the field of ocean observation
and suggests nine key principles that marine scientists could follow in
their innovative research regarding open access to data, effectiveness,
compliance with laws, environmental respect and nature conservation,
reciprocal relation and cultural respect, equity and fairness, knowledge
transfer, governance adapted to socio-ecological systems, and the use of animals
in research.</p>
Antonio J. Salazar, Nicolás Useche, Manuel Granja
et al.
Objective. The aim of this study was to evaluate the equivalence of brain CT interpretations performed using a diagnostic workstation and a mobile tablet computer, in a telestroke service. Materials and Methods. The ethics committee of our institution approved this retrospective study. A factorial design with 1452 interpretations was used. The assessed variables were the type of stroke classification, the presence of contraindications to the tPA administration, the presence of a hyperdense intracranial artery sign (HMCA), and the Alberta Stroke Program Early CT Score (ASPECTS) score. These variables were evaluated to determine the effect that the reading system had on their magnitudes. Results. The achieved distribution of observed lesions using both the reading systems was not statistically different. The differences between the two reading systems to claim equivalence were 1.6% for hemorrhagic lesions, 4.5% for cases without lesion, and 5.2 for overall ischemic lesion. Equivalence was achieved at 2.1% for ASPECTS ≤ 6, 6.5% for the presence of imaging contraindication to the tPA administration, and 7.2% for the presence of HMCA. Conclusion. The diagnostic performance for detecting acute stroke is likely equivalent whether a tablet computer or a diagnostic workstation is used or not.