Canada has a marked shortfall between the supply and demand for kidneys for transplantation. Median wait times for deceased donor kidney transplantation vary from 5.8 years in British Columbia, 5.2 years in Manitoba and 4.5 years in Ontario to a little over 2 years in Quebec and Nova Scotia. Living donation provides a viable option for some, but not all people. Consequently, a small number of people travel abroad to undergo kidney transplantation by commercial means. The extent to which they (...) are aware of the potential risks to their health and the health of the kidney vendors is unclear. Travel abroad to obtain a kidney commercially i.e. transplant tourism (TT), raises ethical issues which include the exploitation of the poor, uncertainty of donor informed consent to nephrectomy, poor clinical care and lack of follow up for the donor, commodification of the body and inequity of access to medical care for donors. Also, TT widens socioeconomic disparities in access to transplantation, differing from the Canadian system of universal coverage for healthcare. The Canadian transplant community has discussed how to respond to patients who plan to travel abroad for TT or return with a purchased kidney. Unease rests in the tension between the duty to care for legitimate Canadian residents and the unwillingness to enable TT. This paper discusses three anonymized cases and the Canadian responses to TT as recorded in academic literature and a formal statement by relevant professional bodies. (shrink)

We estimate that 208,000 deep brain stimulation (DBS) devices have been implanted to address neurological and neuropsychiatric disorders worldwide. DBS Think Tank presenters pooled data and determined that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. The DBS Think Tank was founded in 2012 providing a space where clinicians, engineers, researchers from industry and academia discuss current and emerging DBS technologies and logistical and ethical issues facing the field. (...) The emphasis is on cutting edge research and collaboration aimed to advance the DBS field. The Eighth Annual DBS Think Tank was held virtually on September 1 and 2, 2020 (Zoom Video Communications) due to restrictions related to the COVID-19 pandemic. The meeting focused on advances in: (1) optogenetics as a tool for comprehending neurobiology of diseases and on optogenetically-inspired DBS, (2) cutting edge of emerging DBS technologies, (3) ethical issues affecting DBS research and access to care, (4) neuromodulatory approaches for depression, (5) advancing novel hardware, software and imaging methodologies, (6) use of neurophysiological signals in adaptive neurostimulation, and (7) use of more advanced technologies to improve DBS clinical outcomes. There were 178 attendees who participated in a DBS Think Tank survey, which revealed the expansion of DBS into several indications such as obesity, post-traumatic stress disorder, addiction and Alzheimer’s disease. This proceedings summarizes the advances discussed at the Eighth Annual DBS Think Tank. (shrink)

DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers can freely discuss current and emerging deep brain stimulation technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in (...) its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year’s meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury. (shrink)

Spin gauge models use a real Clifford algebraic structure Rp,q associated with a real manifold of dimension p + q to describe the fundamental interactions of elementary particles. This review provides a comparison between those models and the standard model, indicating their similarities and differences. By contrast with the standard model, the spin gauge model based on R3,8 generates intermediate boson mass terms without the need to use the Higgs-Kibble mechanism and produces a precise prediction for the mass of the (...) top quark. The potential of this model to account for exactly three families of fermions is considered. (shrink)

Speaker recognition under mismatched conditions is a challenging task. Speech signal is nonlinear and nonstationary, and therefore, difficult to analyze under realistic conditions. Also, in real conditions, the nature of the noise present in speech data is not known a priori. In such cases, the performance of speaker identification or speaker verification degrades considerably under realistic conditions. Any SR system uses a voice activity detector as the front-end subsystem of the whole system. The performance of most VADs deteriorates at the (...) front end of the SR task or system under degraded conditions or in realistic conditions where noise plays a major role. Recently, speech data analysis and processing using Norden E. Huang’s empirical mode decomposition combined with Hilbert transform, commonly referred to as Hilbert–Huang transform, has become an emerging trend. EMD is an a posteriori, adaptive, data analysis tool used in time domain that is widely accepted by the research community. Recently, speech data analysis and speech data processing for speech recognition and SR tasks using EMD have been increasing. EMD-based VAD has become an important adaptive subsystem of the SR system that mostly mitigates the effect of mismatch between the training and the testing phase. Recently, we have developed a VAD algorithm using a zero-frequency filter-assisted peaking resonator and EMD. In this article, the efficacy of an EMD-based VAD algorithm is studied at the front end of a text-independent language-independent SI task for the speaker’s data collected in three languages at five different places, such as home, street, laboratory, college campus, and restaurant, under realistic conditions using EDIROL-R09 HR, a 24-bit wav/mp3 recorder. The performance of this proposed SI task is compared against the traditional energy-based VAD in terms of percentage identification rate. In both cases, widely accepted Mel frequency cepstral coefficients are computed by employing frame processing from the extracted voiced speech regions using the respective VAD techniques from the realistic speech utterances, and are used as a feature vector for speaker modeling using popular Gaussian mixture models. The experimental results showed that the proposed SI task with the VAD algorithm using ZFFPR and EMD at its front end performs better than the SI task with short-term energy-based VAD when used at its front end, and is somewhat encouraging. (shrink)

The performance of most of the state-of-the-art speaker recognition systems deteriorates under degraded conditions, owing to mismatch between the training and testing sessions. This study focuses on the front end of the speaker verification system to reduce the mismatch between training and testing. An adaptive voice activity detection algorithm using zero-frequency filter assisted peaking resonator was integrated into the front end of the SV system. The performance of this proposed SV system was studied under degraded conditions with 50 selected speakers (...) from the NIST 2003 database. The degraded condition was simulated by adding different types of noises to the original speech utterances. The different types of noises were chosen from the NOISEX-92 database to simulate degraded conditions at signal-to-noise ratio levels from 0 to 20 dB. In this study, widely used 39-dimension Mel frequency cepstral coefficient features were used, and Gaussian mixture model–universal background model was used for speaker modeling. The proposed system’s performance was studied against the energy-based VAD used as the front end of the SV system. The proposed SV system showed some encouraging results when EMD-based VAD was used at its front end. (shrink)

In this article, a new adaptive data-driven strategy for voice activity detection using empirical mode decomposition is proposed. Speech data are decomposed using an a posteriori, adaptive, data-driven EMD in the time domain to yield a set of physically meaningful intrinsic mode functions. Each IMF preserves the nonlinear and nonstationary property of the speech utterance. Among a set of IMFs, the IMF that contains source information dominantly called characteristic IMF can be identified and extracted by designing a zero-frequency filter-assisted peaking (...) resonator. The detected CIMF is used to compute energy using short-term processing. Choosing proper threshold, voiced regions in speech utterances are detected using frame energy. The proposed framework has been studied on both clean speech utterance and noisy speech utterance. The proposed method is used for voice activity detection in the presence of white noise and shows encouraging result in the presence of white noise up to 0 dB. (shrink)

The tension between public duty and private conscience is a central theme of English history in the seventeenth century, when established authorities were questioned and violently disrupted. It has also been an important theme in the work of one of the foremost historians of the period, G.E. Aylmer. It makes, therefore, an especially appropriate subject for this volume. The contributors are leading historians, whose topics range from contemporary writings on conscience and duty to the particular problems faced by individuals and (...) groups, both Puritan and Royalist, at the center and in the localities. These scholarly and original studies throw new light on the innumberable dilemmas of conscience of seventeenth-century men and women, and together make a distinguished contribution to seventeenth-century history. (shrink)

arbitrary flowchart programs by introducing a new recursive function for each tag point. In the above example, one obtains: int = int1, p..... 1 h ), w...., y2r )_.

The rapid emergence and exploding usage of online social networking forums, which are frequented by millions, present clinicians with new ethical and professional challenges. Particularly among a younger generation of physicians and patients, the use of online social networking forums has become widespread. In this article, we discuss ethical challenges facing the patient–doctor relationship as a result of the growing use of online social networking forums. We draw upon one heavily used and highly trafficked forum, Facebook, to illustrate the elements (...) of these online environments and the ethical challenges peculiar to their novel form of exchange. Finally, we present guidelines for clinicians to negotiate responsibly and professionally their possible uses of these social forums. (shrink)

There is usually great concern over the use of psychiatric patients for clinical research, as it raises the ethical and legal issues of human dignity and autonomy. In this paper the authors describe and evaluate a follow-up neurobiological study of patients who had been discharged from a psychiatric research ward at least ten months earlier. It is pointed out that such studies are rare and that the writers were provided with the unique opportunity to examine attitudinal and motivational dimensions involved (...) in the patients' agreement to participate in the study. (shrink)

This paper discusses the views of 17 healthcare practitioners involved with transplantation on the ethics of live liver donations . Donations between emotionally related donor and recipients increased the acceptability of an LLD compared with those between strangers. Most healthcare professionals disapproved of altruistic stranger donations, considering them to entail an unacceptable degree of risk taking. Participants tended to emphasise the need to balance the harms of proceeding against those of not proceeding, rather than calculating the harm-to-benefits ratio of donor (...) versus recipient. Participants’ views suggested that a complex process of negotiation is required, which respects the autonomy of donor, recipient and HCP. Although they considered that, of the three, donor autonomy is of primary importance, they also placed considerable weight on their own autonomy. Our participants suggest that their opinions about acceptable risk taking were more objective than those of the recipient or donor and were therefore given greater weight. However, it was clear that more subjective values were also influential. Processes used in live kidney donation were thought to be a good model for LLD, but our participants stressed that there is a danger that patients may underestimate the risks involved in LLD if it is too closely associated with LKD. (shrink)