Background Informed consent is an integral component of good medical practice. Many researchers have investigated measures to improve the quality of informed consent, but it is not clear which techniques work best and why. To address this problem, we propose developing a core outcome set to evaluate interventions designed to improve the consent process for surgery in adult patients with capacity. Part of this process involves reviewing existing research that has reported what is important to patients and doctors in the (...) informed consent process. Methods This qualitative synthesis comprises four phases: identification of published papers and determining their relevance; appraisal of the quality of the papers; identification and summary of the key findings from each paper while determining the definitiveness of each finding against the primary data; comparison of key themes between papers such that findings are linked across studies. Results Searches of bibliographic databases returned 11,073 titles. Of these, 16 studies met the inclusion criteria. Studies were published between 1996 and 2016 and included a total of 367 patients and 74 health care providers. Thirteen studies collected data using in-depth interviews and constant comparison was the most common means of qualitative analysis. A total of 94 findings were extracted from the primary papers and divided into 17 categories and ultimately 6 synthesised findings related to: patient characteristics, knowledge, communication, the model patient, trust and decision making. Conclusions This qualitative meta-aggregation is the first to examine the issue of informed consent for surgery. It has revealed several outcomes deemed important to capture by patients and clinicians when evaluating the quality of a consent process. Some of these outcomes have not been examined previously in research comparing methods for informed consent. This review is an important step in the development of a COS to evaluate interventions designed to improve the consent process for surgery. Registration The study protocol was registered on the international prospective register for systematic reviews. (shrink)

Although living conditions have improved throughout history, protest, at least in the last few decades, seems to have increased to the point of becoming a normal phenomenon in modern societies. Contributors to this volume examine how and why this is the case and argue that although problems such as poverty, hunger, and violations of democratic rights may have been reduced in advanced Western societies, a variety of other problems and opportunities have emerged and multiplied the reasons and possibilities for protest.

High-spin states have been studied in Pr-135(59), populated through the Cd-116(Na-23,4n) reaction at 115 MeV, using the Gammasphere gamma-ray spectrometer. The negative-parity yrast band has been significantly extended to spin similar to 45 (h) over bar and excitation energy 21.5 MeV, showing evidence for several rotational alignments. The positive-parity yrast band of Ce-135(58), populated through the p4n channel of this reaction, was also populated to spin similar to 38 (h) over bar and excitation energy 18 MeV. Cranking calculations indicate that (...) these nuclei are soft with respect to the triaxiality parameter gamma and that several competing nuclear shapes occur at high spin. (shrink)

Hypnagogic and hypnopompic experiences (HHEs) accompanying sleep paralysis (SP) are often cited as sources of accounts of supernatural nocturnal assaults and paranormal experiences. Descriptions of such experiences are remarkably consistent across time and cultures and consistent also with known mechanisms of REM states. A three-factor structural model of HHEs based on their relations both to cultural narratives and REM neurophysiology is developed and tested with several large samples. One factor, labeled Intruder, consisting of sensed presence, fear, and auditory and visual (...) hallucinations, is conjectured to originate in a hypervigilant state initiated in the midbrain. Another factor, Incubus, comprising pressure on the chest, breathing difficulties, and pain, is attributed to effects of hyperpolarization of motoneurons on perceptions of respiration. These two factors have in common an implied alien ''other'' consistent with occult narratives identified in numerous contemporary and historical cultures. A third factor, labeled Unusual Bodily Experiences, consisting of floating/flying sensations, out-of-body experiences, and feelings of bliss, is related to physically impossible experiences generated by conflicts of endogenous and exogenous activation related to body position, orientation, and movement. Implications of this last factor for understanding of orientational primacy in self-consciousness are considered. Central features of the model developed here are consistent with recent work on hallucinations associated with hypnosis and schizophrenia. (shrink)

High-spin states in the odd-odd N = Z nucleus Co-54 have been investigated by the fusion-evaporation reaction Si-28(S-32,1 alpha 1p1n)Co-54. Gamma-ray information gathered with the Ge detector array Gammasphere was correlated with evaporated particles detected in the charged particle detector system Microball and a 1 pi neutron detector array. A significantly extended excitation scheme of Co-54 is presented, which includes a candidate for the isospin T = 1, 6(+) state of the 1f(7/2)(-2) multiplet. The results are compared to large-scale shell-model (...) calculations in the fp shell. Effective interactions with and without isospin-breaking terms have been used to probe isospin symmetry and isospin mixing. A quest for deformed high-spin rotational cascades proved negative. This feature is discussed by means of cranking calculations. (shrink)

Two rotational bands have been identified and characterized in the proton-magic N = Z + 1 nucleus Ni-57. These bands complete the systematics of well-and superdeformed rotational bands in the light nickel isotopes starting from doubly magic Ni-56 to Ni-60. High-spin states in Ni-57 have been produced in the fusion-evaporation reaction Si-28(S-32, 2p1n)Ni-57 and studied with the gamma-ray detection array GAMMASPHERE operated in conjunction with detectors for evaporated light charged particles and neutrons. The features of the rotational bands in Ni-57 (...) are compared to those of neighbouring isotopes and interpreted by means of configuration-dependent cranked Nilsson-Strutinsky calculations. The two observed high-spin bands are considered signature partners and assigned to configurations with one 1g(9/2) proton and one 1g(9/2) neutron, resulting in an unambiguous understanding of the energetically favoured signature alpha = -1/2 band but a somewhat less satisfactory description of the signature alpha = +1/2 band. (shrink)

In this paper, we discuss the macroscopic quantum behavior of simple superconducting circuits. Starting from a Lagrangian for electromagnetic field with broken gauge symmetry, we construct a quantum circuit model for a superconducting weak link (SQUID) ring, together with the appropriate canonical commutation relations. We demonstrate that this model can be used to describe macroscopic excitations of the superconducting condensate and the localized charge states found in some ultrasmall-capacitance weak-link devices.

The statistical properties of a single quantum object and an ensemble of independent such objects are considered in detail for two-level systems. Computer simulations of dynamic zero-point quantum fluctuations for a single quantum object are reported and compared with analytic solutions for the ensemble case.

Debate on free will with Christian List, Gregg Caruso, and Cory Clark. The exchange is focused on Christian List's book Why Free Will Is Real.

Environmental concerns and the complex issues and dilemmas raised by animal rights pose fundamental questions for philosophers. The essays in this welcome collection put environmental thinking into the broader context of philosophical thought. Distinguished contributions from key thinkers, including Mary Midgley, Stephen Clark, J.Baird Callicott, Holmes Rolston, Dale Jamieson and John Haldane, focus on our attitudes to animals and the environment as critically determined by deeper philosophical concerns. Timothy Chappell's useful introduction provides a guide to the issues and dilemmas (...) and links the diverse arguments and themes. Examining whaling, animal captivity, and specicism amongst other topics, this book adds substantially to the contemporary debate in environmental philosophy. (shrink)

Medium- and high-spin states of Pr-134 were populated using the Cd-116(Na-23, 5n) reaction and studied with the GAMMASPHERE spectrometer. Several new bands have been found in this nucleus, one of them being linked to the previously observed chiral-candidate twin-band structure. The ground state of Pr-134 could be determined through establishing a level structure that connects the two previously known long-lived isomeric states. Unambiguous spin-parity assignments for the excited states could be performed based on the known 2(-) spin-parity of the ground (...) state combined with the present experimental data. Intrinsic single-particle configurations have been assigned to the newly observed bands on the basis of the measured B(M1)/B(E2) ratios, alignments, band-crossing frequencies, bandhead spins, the observed single-particle configurations in the neighboring nuclei, and taking into account the predictions of total Routhian surface and tilted-axis cranking calculations. (shrink)

Tomasello argues in the target article that a sense of moral obligation emerges from the creation of a collaborative “we” motivating us to fulfill our cooperative duties. We suggest that “we” takes many forms, entailing different obligations, depending on the type of the relationship in question. We sketch a framework of such types, functions, and obligations to guide future research in our commentary.

J.C.D. Clark demythologizes the history of Thomas Paine, understanding the impact he has had on modern human rights, democracy, and internationalism.

The contest between “Lockeian liberalism” and “classical republicanism” as explanatory frameworks for the intellectual history of the American Revolution, and therefore of the present-day United States, has been one of the longest running and most distinguished in recent U.S. historiography. It also has major implications for the history of political thought in the North Atlantic Anglophone world more widely. Yet this debate was merely suspended when it was held to have ended in an ill-defined compromise. Although some U.S. historians expressed (...) doubts and qualifications, attention in U.S. historiography moved on to other themes while leaving the initial problem unsolved. This article reopens the question; it suggests that a historicization of both these two categories is now both possible and necessary, and that their supersession will advance understanding of the Revolution. It seeks to help solve this problem by the same means that the debate began: that is, by re-establishing a link between U.S. and U.K. historiographies. (shrink)

"Written in clear language, this book offers a seasoned historian's effective response to postmodernism's challenge to culture and history.

Most, perhaps all, states have “myths of origin”: those semi-historical, semi-propagandistic accounts of their founding and (what are termed) essential purposes. There is nothing unusual in the Uni...

Objectives: To analyse legislation and medical professional positions concerning the doctor’s role in assisted dying in western Europe, and to discuss their implications for doctors.Method: This paper is based on country-specific reports by experts from European countries where assisted dying is legalised , or openly practiced , or where it is illegal .Results: Laws on assisted dying in The Netherlands and Belgium are restricted to doctors. In principle, assisted suicide is not illegal in either Germany or Switzerland, but a doctor’s (...) participation in Germany would violate the code of professional medical conduct and might contravene of a doctor’s legal duty to save life. The Assisted Dying for the Terminally Ill Bill proposed in the UK in 2005 focused on doctors, whereas the Proposal on Assisted Dying of the Norwegian Penal Code Commission minority in 2002 did not.Professional medical organisations in all these countries except The Netherlands maintain the position that medical assistance in dying conflicts with the basic role of doctors. However, in Belgium and Switzerland, and for a time in the UK, these organisations dropped their opposition to new legislation. Today, they regard the issue as primarily a matter for society and politics. This “neutral” stance differs from the official position of the Royal Dutch Medical Association which has played a key role in developing the Dutch practice of euthanasia as a “medical end-of-life decision” since the 1970s.Conclusion: A society moving towards an open approach to assisted dying should carefully identify tasks to assign exclusively to medical doctors, and distinguish those possibly better performed by other professions. (shrink)

Research into the work of UK estate agents reveals a love‐hate attitude on the part of the public and profound ethical ambivalences. Dr Clarke is a member of the Department of Sociology, Social Policy and Social Work Studies, The University of Liverpool, POB 147, Liverpool L69 3BX. This article draws on his study Slippery Customers: Estate Agents, The Public and Regulation, Blackstone Press 1994, co‐authored with D. Smith and M. McConville.

Recently, Rueger and Sharp (1996) and Koperski (1998) have been concerned to show that certain procedural accounts of model confirmation are compromised by non-linear dynamics. We suggest that the issues raised are better approached by considering whether chaotic data analysis methods allow for reliable inference from data. We provide a framework and an example of this approach.

sirIn a scholarly and thought-provoking paper, Clarke sets out to debunk the concept of “rational suicide” as nonsensical.1 His motivation in this is to undermine any support that the notion of rational suicide might give to a “categorical right to suicide”. If his enterprise were successful, however, it would go far beyond the “rights issue” and would have a profound impact on all arguments raised in support of euthanasia or physician-assisted suicide.Clarke's major thrust might be termed the argument from posthumous (...) ignorance. He begins with a claim that the process of making a rational decision involves the process of “gaining all possible facts and `imagining' all possible consequences”. He goes on to say that making a rational decision “in the consideration of life or death . . . would seem to be impossible”. It is “impossible” …. (shrink)