After long arguments between positivism and falsificationism, the verification of universal hypotheses was replaced with the confirmation of uncertain major premises. Unfortunately, Hemple proposed the Raven Paradox. Then, Carnap used the increment of logical probability as the confirmation measure. So far, many confirmation measures have been proposed. Measure F proposed by Kemeny and Oppenheim among them possesses symmetries and asymmetries proposed by Elles and Fitelson, monotonicity proposed by Greco et al., and normalizing property suggested by many researchers. Based on the (...) semantic information theory, a measure b* similar to F is derived from the medical test. Like the likelihood ratio, measures b* and F can only indicate the quality of channels or the testing means instead of the quality of probability predictions. Furthermore, it is still not easy to use b*, F, or another measure to clarify the Raven Paradox. For this reason, measure c* similar to the correct rate is derived. Measure c* supports the Nicod Criterion and undermines the Equivalence Condition, and hence, can be used to eliminate the Raven Paradox. An example indicates that measures F and b* are helpful for diagnosing the infection of Novel Coronavirus, whereas most popular confirmation measures are not. Another example reveals that all popular confirmation measures cannot be used to explain that a black raven can confirm “Ravens are black” more strongly than a piece of chalk. Measures F, b*, and c* indicate that the existence of fewer counterexamples is more important than more positive examples’ existence, and hence, are compatible with Popper’s falsification thought. (shrink)

When militaries mention loyalty as a value they mean loyalty to colleagues and the organisation. Loyalty to principle, the type of loyalty that has a wider scope, plays hardly a role in the ethics of most armed forces. Where military codes, oaths and values are about the organisation and colleagues, medical ethics is about providing patient care impartially. Being subject to two diverging professional ethics can leave military medical personnel torn between the wish to act loyally towards colleagues, (...) and the demands of a more outward looking ethic. This tension constitutes a test of integrity, not a moral dilemma. (shrink)

Qualitative evidence concerning the relationship between QoL and a wide range of disabilities suggests that subjective judgments regarding other people’s QoL are wrong more often than not and that such judgments by medical practitioners in particular can be biased. Guided by their desire to do good and avoid harm, surgeons often rely on "the eyeball test" to decide whether a patient will or will not benefit from surgery. But the eyeball test can easily harbor a range of (...) implicit judgments and biases against patients with disabilities, including erroneous assumptions about QoL. We critique the use of the "eyeball" test and offer suggestions to reduce bias and ensure that patients’ values are more consistently prioritized in surgical decision-making. (shrink)

The phenomenon of medical overtesting in general, and specifically in the emergency room, is well-known and regarded as harmful to both the patient and the healthcare system. Although the implications of this problem raise myriad ethical concerns, this paper explores the extent to which overtesting might mitigate race-based health inequalities. Given that medical malpractice and error greatly increase when the patients belong to a racial minority, it is no surprise that the mortality rate similarly increases in proportion to (...) white patients. For these populations, an environment that emphasizes medical overtesting may well be the desirable medical environment until care evens out among races and ethnicities; additionally, efforts to lower overtesting in conjunction with a high rate of racist medical mythology may cause harm by lower testing when it is actually warranted. Furthermore, medical overtesting may help to assuage racial distrust. This paper ultimately concludes that an environment of medical overtesting may be less pernicious than the alternative. (shrink)

Reprinted with modification and permission from Kennedy Institute of Ethics Journal. The phenomenon of medical overtesting in general, and specifically in the emergency room, is well-known and regarded as harmful to both the patient and the healthcare system. Although the implications of this problem raise myriad ethical concerns, this chapter explores the extent to which overtesting might mitigate race-based health inequalities. Given that medical malpractice and error greatly increase when the patients belong to a racial minority, it is (...) no surprise that the mortality rate similarly increases in proportion to white patients. For these populations, an environment that emphasizes medical overtesting may well be the desirable medical environment until care evens out among races and ethnicities; additionally, efforts to lower overtesting in conjunction with a high rate of racist medical mythology may cause harm by lower testing when it is actually warranted. Furthermore, medical overtesting may help to assuage racial distrust. This paper ultimately concludes that an environment of medical overtesting may be less pernicious than the alternative. (shrink)

This book examines the moral luck paradox, relating it to Kantian, consequentialist and virtue-based approaches to ethics. It also applies the paradox to areas in medical ethics, including allocation of scarce medical resources, informed consent to treatment, withholding life-sustaining treatment, psychiatry, reproductive ethics, genetic testing and medical research. If risk and luck are taken seriously, it might seem to follow that we cannot develop any definite moral standards, that we are doomed to moral relativism. However, Dickenson offers (...) strong counter-arguments to this view that enable us to think in terms of universal standards. (shrink)

The objective of this research programme is to contribute to the establishment of the emerging science of Formal Ontology in Information Systems via a collaborative project involving researchers from a range of disciplines including philosophy, logic, computer science, linguistics, and the medical sciences. The re­searchers will work together on the construction of a unified formal ontology, which means: a general framework for the construction of ontological theories in specific domains. The framework will be constructed using the axiomatic-deductive method of (...) modern formal ontology. It will be tested via a series of applications relating to on-going work in Leipzig on medical taxonomies and data dictionaries in the context of clinical trials. This will lead to the production of a domain-specific ontology which is designed to serve as a basis for applications in the medical field. (shrink)

Purpose: The objective of this study is to determine the importance of supplementary medical ethics course for resident physicians. In this study, we assessed the current state of their knowledge of medical ethics and aimed to improve and deepen their understanding of clinical scenarios to increase their awareness of the link between the practice of medicine and ethical issues. Methods: The course was held for groups of 10-12 people for 3 days a week for a total of 6 (...) hours. Tests given prior to and following completion of the course were used to assess the effectiveness of a medical ethics training course in which 120 resident physicians completed. The evaluation was made on the basis of the same pre-and post-tests (14 scenarios) and direct observation of participants. Result and Discussion: The average age was 28.23 ± 4.08 and 25% were female and 75% were male. Of the participants, 68.3% were training to be internists, 24.2% were training to be surgeons, and 7.5% were training in laboratory medicine. There was a significant statistical difference between the mean total scores of both tests (p=0.00). After completing the course, residents took into account the medical ethical principles while discussing ethical decisions. Conclusion: After finishing the course, participants defended their responses in regard to issues of medical ethics more carefully and articulated their thoughts more clearly. Our experience demonstrated that the trainees benefited from a structured curriculum in medical ethics. We believe that the development and implementation of our course may serve as a case study for training resident physicians in medical ethics. (shrink)

Mehlman and Li offer a framework for approaching the bioethical issues raised by the military use of genomics that is compellingly grounded in both the contemporary civilian and military ethics of medical research, arguing that military commanders must be bound by the two principles of paternal- ism and proportionality. I agree fully. But I argue here that this is a much higher bar than we may fully realize. Just as the principle of proportionality relies upon a thorough assessment of (...) harms caused and military advantage gained, the use of genomic research, on Mehlman and Li’s view, will require an accurate understanding of the connection between genotypes and phenotypes – accurate enough to ameliorate the risk undertaken by our armed forces in being subject to such research. Recent conceptual work in evolutionary theory and the philosophy of biology, however, renders it doubtful that such knowledge is forthcoming. The complexity of the relationship between genotypic factors and realized traits (the so-called ‘G→P map’) makes the estimation of potential military advantage, as well as potential harm to our troops, incredibly challenging. Such fundamental conceptual challenges call into question our ability to ever satisfactorily satisfy the demands of a sufficiently rigorous ethical standard. (shrink)

I defend an empirically-oriented approach to the analysis and remediation of social injustice. My springboard for this argument is a debate—principally represented here between Tommie Shelby and Elizabeth Anderson, but with much deeper historical roots and many flowering branches—about whether racial-justice advocacy should prioritize integration (bringing different groups together) or community development (building wealth and political power within the black community). Although I incline toward something closer to Shelby’s “egalitarian pluralist” approach over Anderson’s single-minded emphasis on integration, many of Shelby’s (...) criticisms of integrationism are misguided, and his handling of the empirical literature is profoundly unbalanced. In fact, while both Shelby and Anderson defend the importance of social science to their projects, I’ll argue that each takes a decidedly unempirical approach, which ultimately obscures the full extent of our ignorance about what we can and ought to do going forward. A more authentically empirical tack would be more epistemically humble, more holistic, and less organized around what I’ll call prematurely formulated “Grand Unified Theories of Social Change.” I defend a more “diversified experimentalist” approach, which rigorously tests an array of smaller-scale interventions before trying to replicate and scale up the most promising results. (shrink)

The medical and social model of disability is discussed and debated among researchers, scholars, activists, and people in general. It is common to hold a mixed view and believe that some disabled people suffer more from social obstacles and others more from medical problems inherent in their bodies or minds. Rachel Cooper discusses possible ‘test environments’, making explicit an idea which likely plays an implicit part in many disability discussions. We place or imagine placing the disabled person (...) in a range of different environments. If there is a relevant test environment in which they do fine, their problem was societal/external; if there is not, it was medical/internal. Cooper admits that deciding on the appropriate range of test environments is an ethical and political question. In this chapter, I argue that we often ought to widen our scope when discussing psychiatric disabilities. (shrink)

The Deaf culture in the United States is a unique culture that is not widely understood. To members of the Deaf community in the United States, deafness is not viewed as a disease or pathology to be treated or cured; instead it is seen as a difference in human experience. Members of this community do not hide their deafness; instead they take great pride in their Deaf identity. The Deaf culture in the United States is very communitarian not individualistic. Mary (...) Beth and Dominic are a married couple in their late 20s who are genetically deaf. They are active members in the Deaf community and work as advocates for individuals who are deaf, family members of Deaf people and sign language interpreters who identify with the Deaf culture. Mary Beth and Dominic approach the fertility clinic with a request that they only want a child with the genetic gene for deafness. They would want the embryos that do not have the gene to be destroyed. This would entail creating a child who would have the gene for deafness. Medically and ethically, should the fertility clinic agree to the couple’s request? The authors argue that the couple's request should be denied and provide reasons for it from the perspectives of foundational and clinical ethics. (shrink)

Abstract: In this research, the Artificial Neural Network (ANN) model was developed and tested to predict the rate of treatment expenditure on an individual or family in a country. A number of factors have been identified that may affect treatment expenses. Factors such as age, grade level such as primary, preparatory, secondary or college, sex, size of disability, social status, and annual medical expenses in fixed dollars excluding dental and outpatient clinics among others, as input variables for the ANN (...) model. A model based on the multi-layer Perceptron topology was developed and trained using data on 5574 cases. The evaluation of the test data shows that the ANN model is capable of predicting correctly Medical Expenses. (shrink)

Routine testing is a practice whereby medical professionals ask all patients whether they would like an HIV test, regardless of whether there is anything unique to a given patient that suggests the presence of HIV. In three respects I aim to offer a fresh perspective on the debate about whether a developing country with a high rate of HIV infection morally ought to adopt routine testing. First, I present a neat framework that organises the moral issues at stake, (...) bringing out the basic principles involved and exhibiting their logical relationships. Second, appealing to the Kantian principle of respect for the dignity of persons, I offer a thorough justification for routine testing when it serves as a gateway to anti-retroviral treatment (ART). Third, I present a respect-based defence of the controversial and novel thesis that routine testing is morally justified even if ART is unaffordable or otherwise unavailable. (shrink)

This article explores the Nuffield Council on Bioethics’ recent report about non-invasive prenatal testing. Given that such testing is likely to become the norm, it is important to question whether there should be some ethical parameters regarding its use. The article engages with the viewpoints of Jeff McMahan, Julian Savulescu, Stephen Wilkinson and other commentators on prenatal ethics. The authors argue that there are a variety of moral considerations that legitimately play a significant role with regard to (prospective) parental decision-making (...) in the context of NIPT, for example, views on the morality of abortion and understandings of the impact of disability on quality of life. The variable nature of such considerations, both singularly and combined, suggests that any approach to NIPT should be sensitive to and understanding of similarly variable parental assessments and decisions. The implications of the approach developed for current and future policies in this area are explored, along with the impact of such arguments on ideas about procreative beneficence. (shrink)

In Vayena’s article, ‘direct-to-consumer (DTC) genomics on the scales of autonomy’, she claims that there may be a strong autonomy-based argument for permitting DTC genomic services. In this response, I point out how the diminishment of one’s genetic privacy can cause a relevant autonomy-related harm which must be balanced against the autonomy-related gains DTC services provide. By drawing on conceptual connections between privacy and the Razian conception of autonomy, I show that DTC genetic testing may decrease the range of valuable (...) options individuals possess, which impacts the extent to which would-be consumers can exercise their autonomy. (shrink)

As a response to the opioid epidemic in the United States, the Centers for Disease Control and Prevention (CDC) published the CDC Guideline for Prescribing Opioids for Chronic Pain in 2016. This document served as a means to reduce risks and address harms of opioid use by recommending that clinicians conduct periodic urine drug testing for patients on chronic opioid therapy. As an unintended result of this recommendation, providers began using unexpected urine drug test results as a reason to (...) dismiss patients from practice, both out of concern for their patients’ wellbeing as well as their own legal risks. Using Husserl’s and Heidegger’s phenomenology, we argue that this science-based, black-and-white practice does not heed the patient as a whole person. Instead, we recommend a more contextual, patient-centered approach that can help us to better understand and manage patient needs in such contexts. (shrink)

Education on authorship was delivered and evaluated by pre test and post test questionnairen on 30 post graduate medical students at the Department of Anestheology, Dhaka Medical College, Bangladesh between January and June 2019 to understand the knowledge, skill and attitude of post graduate medical students on authorship. Result: Before intervention, majority (60%) of the students felt that who perform the research work should be the author of the article. But 40% students were divided and (...) felt that who advised the design of the research (20%), who provided the grants (10%) and Chief/Head of the division (10%) should be the author of the article respectively. Maximum (70%) respondents did not know the order of authorship. Of 40% respondent felt that the PI should be always the first author and 40% don’t know the answer. Half of the students (50%) felt that keeping honorary author increased the opportunity of acceptance of publication. Of 36.7% and 13.3% of students felt that keeping honorary author increased the article’s value and made good relation to them to get some extra facility from them respectively. Of 20% participants were pressurized by lab head/head of department for inclusion of their name as an author. Half of the (56.7 %) respondents felt that the author’s contribution should be stated in the article. Only few 4 (13.3%) respondents said that their institute had guideline for authorship. However, after education 100% of students felt that who perform the research work should be only the author of the article. All (100%) respondents understood the order of authorship. Most of the students (86%) felt that PI should be always the first author. Of 100% respondent felt supervisor of the research should be the last author. All students (100%) felt author’s contribution should be mentioned in the article. All (100%) students did not want to include as author those who help in research design and secured grant; and they did not like to keep honorary author in their article. All (100%) students expressed that their institute had no guideline for authorship. After intervention, three groups of students were asked to write one page of article on Anesthesiology. Interestingly, they did not include any name in the author by line who were not participate or had any contribution in the writing. Conclusion: The comparative data between pre- and post-text have highlighted a general lack of understanding of the basic concept of authorship ethics which significantly improved after the intervention. The results also indicate that the education on authorship improved the awareness of postgraduate medical students in a particular centre. (shrink)

This article investigates the ability of mental incapacity tests to account for problems of control, through a study of the approach to alcohol dependence and a comparison with the approach to anorexia nervosa, in England and Wales. The focus is on two areas of law where questions of legal and mental capacity arise for people who are alcohol dependent: decisions about treatment for alcohol dependence and diminished responsibility for a killing. The mental incapacity tests used in these legal contexts are (...) importantly different—one involves a ‘cognitive’ test, while the other includes an explicit impaired-control limb—and the comparison provides insight into a longstanding debate about the virtues of one type of test over the other. It is shown that both kinds of test can take control problems into account, but also that both can be interpreted in narrow and wide ways that significantly influence the outcome of the assessment. It is therefore argued that to a large extent, it is not the kind of mental incapacity test that matters, but how the test is interpreted. It is further proposed that value judgements are playing an unrecognised and inappropriate role in shaping this interpretation. This raises concerns about the current approach to assessing the impact of alcohol dependency on the capacity to make decisions about alcohol use or treatment, as well as broader concerns about flexibility within incapacity tests. (shrink)

What should we do about children and young people who want to be tested for incurable, adult onset, genetic disorders? In particular, what should a general practitioner do if he or she believes the young person is competent to decide, but the regional genetics unit refuses to test anyone under 18? In this article I discuss such a case (drawn from actual practice, but anonymised), and consider the arguments for and against allowing the young person to be tested in (...) terms of good practice, case and statute law, empirical evidence, and ethics. (shrink)

Logical Probability (LP) is strictly distinguished from Statistical Probability (SP). To measure semantic information or confirm hypotheses, we need to use sampling distribution (conditional SP function) to test or confirm fuzzy truth function (conditional LP function). The Semantic Information Measure (SIM) proposed is compatible with Shannon’s information theory and Fisher’s likelihood method. It can ensure that the less the LP of a predicate is and the larger the true value of the proposition is, the more information there is. So (...) the SIM can be used as Popper's information criterion for falsification or test. The SIM also allows us to optimize the true-value of counterexamples or degrees of disbelief in a hypothesis to get the optimized degree of belief, i. e. Degree of Confirmation (DOC). To explain confirmation, this paper 1) provides the calculation method of the DOC of universal hypotheses; 2) discusses how to resolve Raven Paradox with new DOC and its increment; 3) derives the DOC of rapid HIV tests: DOC of “+” =1-(1-specificity)/sensitivity, which is similar to Likelihood Ratio (=sensitivity/(1-specificity)) but has the upper limit 1; 4) discusses negative DOC for excessive affirmations, wrong hypotheses, or lies; and 5) discusses the DOC of general hypotheses with GPS as example. (shrink)

Advanced medical imaging, such as CT, fMRI and PET, has undergone enormous progress in recent years, both in accuracy and utilization. Such techniques often bring with them an illusion of immediacy, the idea that the body and its diseases can be directly inspected. In this paper we target this illusion and address the issue of the reliability of advanced imaging tests as knowledge procedures, taking positron emission tomography in oncology as paradigmatic case study. After individuating a suitable notion of (...) reliability, we argue that PET is a highly theory-laden and non-immediate knowledge procedure, in spite of the photographic-like quality of the images it delivers; the diagnostic conclusions based on the interpretation of PET images are population-dependent; PET images require interpretation, which is inherently observer-dependent and therefore variable. We conclude with a three-step methodological proposal for enhancing the reliability of advanced medical imaging. (shrink)

The double subjectivity of conscience and the need to test conscientious objections -/- Abstract In spite of the collapse of the traditional objective concept of conscience and the subsequent subjectivation of conscience, conscientious objections are still often considered as a valid ground for exemption from legal and professional obligations. Conscientious objections are seen as more serious than ordinary moral objections. It is not evident why this is so. I argue, with Niklas Luhmann, that the function of conscience is to (...) protect the moral core of a person’s identity. Overruling conscientious objections threatens this core. Claims of conscience are usually founded on the right of freedom of conscience. This right is not absolute. I discuss the view of Richard Arneson who rejects the right of freedom of conscience and defends the right against conscience. I agree with Arneson that, at the one hand, conscientious objectors may constitute a threat to the social and legal order when their objections are not recognised and, at the other hand, too easy giving in to conscientious objections may also threaten the viability of social and legal order. That is why it is needed to determine when conscientious objections cannot be taken at face value, but should be subjected to a series of tests. The aim of these tests is to contain the number of objectors. I discuss 6 criteria for determining whether conscientious objections ground an exemption to legal and professional obligations. At the end of the article I discuss the conscientious objections of medical doctors. (shrink)

The debate about direct-to-consumer genetic testing has centred on whether consumers are the best judges of their own clinical care. Inthis article, I also examine whether the science of personalized medicine is really as advanced as its proponents claim, and how the availability of genetic markers affects decisions on who gets and does not get medical treatment.

We have begun work on two separate but related ontologies for the study of neurological diseases. The first, the Neurological Disease Ontology (ND), is intended to provide a set of controlled, logically connected classes to describe the range of neurological diseases and their associated signs and symptoms, assessments, diagnoses, and interventions that are encountered in the course of clinical practice. ND is built as an extension of the Ontology for General Medical Sciences — a high-level candidate OBO Foundry ontology (...) that provides a set of general classes that can be used to describe general aspects of medical science. ND is being built with classes utilizing both textual and axiomatized definitions that describe and formalize the relations between instances of other classes within the ontology itself as well as to external ontologies such as the Gene Ontology, Cell Ontology, Protein Ontology, and Chemical Entities of Biological Interest. In addition, references to similar or associated terms in external ontologies, vocabularies and terminologies are included when possible. Initial work on ND is focused on the areas of Alzheimer’s and other diseases associated with dementia, multiple sclerosis, and stroke and cerebrovascular disease. Extensions to additional groups of neurological diseases are planned. The second ontology, the Neuro-Psychological Testing Ontology (NPT), is intended to provide a set of classes for the annotation of neuropsychological testing data. The intention of this ontology is to allow for the integration of results from a variety of neuropsychological tests that assay similar measures of cognitive functioning. Neuro-psychological testing is an important component in developing the clinical picture used in the diagnosis of patients with a range of neurological diseases, such as Alzheimer’s disease and multiple sclerosis, and following stroke or traumatic brain injury. NPT is being developed as an extension to the Ontology for Biomedical Investigations. (shrink)

Military doctors and nurses, employees with a compound professional identity as they are neither purely soldiers nor simply doctors or nurses, face a role conflict between the clinical professional duties to a patient and obligations, express or implied, real or perceived, to the interests of a third party such as an employer, an insurer, the state, or in this context, military command (London et al. 2006). In the context of military medical ethics this is commonly called dual loyalty (or, (...) less commonly, mixed agency). Although other professionals in the military, for instance counsellors or lawyers, might experience similar problems of dual loyalties, it seems that the dual loyalties experienced by military medical personnel are particularly testing. (shrink)

: This article critically examines the constitution of impairment in prenatal testing and screening practices and various discourses that surround these technologies. While technologies to test and screen prenatally are claimed to enhance women's capacity to be self-determining, make informed reproductive choices, and, in effect, wrest control of their bodies from a patriarchal medical establishment, I contend that this emerging relation between pregnant women and reproductive technologies is a new strategy of a form of power that began to (...) emerge in the late eighteenth century. Indeed, my argument is that the constitution of prenatal impairment, by and through these practices and procedures, is a widening form of modern government that increasingly limits the field of possible conduct in response to pregnancy. Hence, the government of impairment in utero is inextricably intertwined with the government of the maternal body. (shrink)

Definitive diagnosis of malaria requires the demonstration through laboratory tests of the presence within the patient of malaria parasites or their components. Since malaria parasites can be present even in the absence of malaria manifestations, and since symptoms of malaria can be manifested even in the absence of malaria parasites, malaria diagnosis raises important issues for the adequate understanding of disease, etiology and diagnosis. One approach to the resolution of these issues adopts a realist view, according to which the needed (...) clarifications will be derived from a careful representation of the entities on the side of the patient which form the ultimate truthmakers for clinical statements. We here address a challenge to this realist approach relating to the diagnosis of malaria, and show how this challenge can be resolved by appeal to Basic Formal Ontology (BFO) and to the Ontology for General Medical Science (OGMS) constructed in its terms. (shrink)

This paper has a dual character, combining a philosophical ontological exploration with a conceptual modeling approach in systems and software engineering. Such duality is already practiced in software engineering, in which the current dominant modeling thesis is object orientation. This work embraces an anti-thesis that centers solely on the process rather than emphasizing the object. The approach is called occurrence-only modeling, in which an occurrence means an event or process where a process is defined as an orchestrated net of events (...) that form a semantical whole. In contrast to object orientation, in this occurrence-only modeling objects are nothing more than long events. We apply this paradigm to (1) a UML/BPMN inventory system in simulation engineering and (2) an event-based system that represents medical occurrences that occur on a timeline. The aim of such a venture is to enhance the field of conceptual modeling by adding yet a new alternative methodology and clarifying differences among approaches. Conceptual modeling’s importance has been recognized in many research areas. An active research community in simulation engineering demonstrates the growing interest in conceptual modeling. In the clinical domains, temporal information elucidates the occurrence of medical events (e.g., visits, laboratory tests). These applications give an opportunity to propose a new approach that includes (a) a Stoic ontology that has two types of being, existence and subsistence; (b) Thinging machines that limit activities to five generic actions; and (c) Lupascian logic, which handles negative events. With such a study, we aim to substantiate the assertion that the “occurrence only” approach is a genuine philosophical base for conceptual modeling. The results in this paper seem to support such a claim. (shrink)

We raise a problem of applicability of RCTs to validate nuclear diagnostic imaging tests. In spite of the wide application of PET and other similar techniques that use radiopharmaceuticals for diagnostic purposes, RCT-based evidence on their validity is sparse. We claim that this is due to a general conceptual problem that we call Prevalence of Treatment, which arises in connection with designing RCTs for testing any diagnostic procedure in the present context of medical research, and is particularly apparent in (...) this case. We also identify three practical reasons why RCTs do not qualify as the best option for PET validation, which have to do with specific characteristics of nuclear diagnostic imaging, and of radiopharmaceuticals. The paper is meant to contribute both to the philosophical discussion on the EBM hierarchy of evidence, and on the specific debate on radiopharmaceuticals in nuclear medicine. (shrink)

Aim: To elicit preferences for prognostic information, attitudes towards withdrawal of life-sustaining treatment (WLST) and perspectives on acceptable quality of life after post-anoxic coma within the adult general population of Germany, Italy, the Netherlands and the United States of America. Methods: A web-based survey, consisting of questions on respondent characteristics, perspectives on quality of life, communication of prognostic information, and withdrawal of life-sustaining treatment, was taken by adult respondents recruited from four countries. Statistical analysis included descriptive analysis and chi2-tests for (...) dierences between countries. Results: In total, 2012 respondents completed the survey. In each country, at least 84% indicated they would prefer to receive early prognostic information. If a poor outcome was predicted with some uncertainty, 37-54% of the respondents indicated that WLST was not to be allowed. A conscious state with severe physical and cognitive impairments was perceived as acceptable quality of life by 17–44% of the respondents. Clear differences between countries exist, including respondents from the U.S. being more likely to allow WLST than respondents from Germany (OR = 1.99, p < 0.001) or the Netherlands (OR = 1.74, p < 0.001) and preferring to stay alive in a conscious state with severe physical and cognitive impairments more than respondents from Italy (OR = 3.76, p < 0.001), Germany (OR = 2.21, p < 0.001), or the Netherlands (OR = 2.39, p < 0.001). Conclusions: Over one-third of the respondents considered WLST unacceptable when there is any remaining prognostic uncertainty. Respondents had a more positive perspective on acceptable quality of life after coma than what is currently considered acceptable in medical literature. This indicates a need for a closer look at the practice of WLST based on prognostic information, to ensure responsible use of novel prognostic tests. (shrink)

Harms of medical interventions are systematically underestimated in clinical research. Numerous factors—conceptual, methodological, and social—contribute to this underestimation. I articulate the depth of such underestimation by describing these factors at the various stages of clinical research. Before any evidence is gathered, the ways harms are operationalized in clinical research contributes to their underestimation. Medical interventions are first tested in phase 1 ‘first in human’ trials, but evidence from these trials is rarely published, despite the fact that such trials (...) provide the foundation for assessing the harm profile of medical interventions. If a medical intervention is deemed safe in a phase 1 trial, it is tested in larger phase 2 and 3 clinical trials. One way to think about the problem of underestimating harms is in terms of the statistical ‘power’ of a clinical trial—the ability of a trial to detect a difference of a certain effect size between the experimental group and the control group. Power is normally thought to be pertinent to detecting benefits of medical interventions. It is important, though, to distinguish between the ability of a trial to detect benefits and the ability of a trial to detect harms. I refer to the former as power-B and the latter as power-H. I identify several factors that maximize power-B by sacrificing powerH in phase 3 clinical trials. If a medical intervention is approved for general use, it is evaluated by phase 4 post-market surveillance. Phase 4 surveillance of harms further contributes to underestimating the harm profile of medical interventions. At every stage of clinical research the hunt for harms is shrouded in secrecy, which further contributes to the underestimation of the harm profiles of medical interventions. (shrink)

This paper is a preliminary step towards the assessment of an alarming widespread belief that victims of the novel coronavirus SARS-CoV-2 include the quality and accuracy of scientific publications about it. Our initial results suggest that this belief cannot be readily ignored, denied, dismissed or refuted, since some genuine supporting evidence can be forwarded for it. This evidence includes an obvious increase in retractions of papers published about the COVID-19 pandemic plus an extra-ordinary phenomenon of inconsistency that we report herein. (...) In fact, we provide a novel method for validating any purported set of the four most prominent indicators of diagnostic testing (Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value), by observing that these indicators constitute three rather than four independent quantities. This observation has virtually been unheard of in the open medical literature, and hence researchers have not taken it into consideration. We define two functions, which serve as consistency criteria, since each of them checks consistency for any set of four numerical values (naturally belonging to the interval [0.0,1.0]) claimed to be the four basic diagnostic indicators. Most of the data we came across in various international journals met our criteria for consistency, but in a few cases, there were obvious unexplained blunders. We explored the same consistency problem for some diagnostic data published in 2020 concerning the ongoing COVID-19 pandemic and observed that the afore-mentioned unexplained blunders tended to be on the rise. A systematic extensive statistical assessment of this presumed tendency is warranted. (shrink)

The present article is a primary introduction to the semi-structured interviewing method SMILE_PH, an acronym for Sense-Making Interviews Looking at Elements of Philosophical Health. Beyond grounding this new methodology theoretically (a work that is started here but will in the future necessitate several developments), the main motivation here is pragmatic: to provide the recent philosophical health movement with a testable method and show that philosophically-oriented interviews are possible in a manner that can be reproduced, compared, tested and used systematically with (...) a population that has received no training in philosophy. The SMILE_PH approach was conceived by the author during an ethically approved pilot study focused on the philosophy of life of persons living with spinal cord injury (SCI), with the intention of rectifying the epistemic obstacles generated by rationalist, Socratic or unstructured ways of in-depth interviewing. The six-step structure of the method is also inspired by hundreds of individual dialogue sessions with philosophical counselees, led by the author between 2018 and 2022: the SMILE_PH method progressively gathers phenomenological data about 1 – our bodily sense, 2 – our sense of self, 3 – our sense of belonging, 4 – our sense of the possible, 5 – our sense of purpose and 6 – our philosophical sense. (shrink)

There is a middle ground of imperfect knowledge in fields like medicine and the social sciences. It stands between our day-to-day relatively certain knowledge obtained from ordinary basic observation of regularities in our world and our knowledge from well-validated theories in the physical sciences. -/- The latter enable reliable prediction a great deal of the time of the happening of events never before experienced. The former enable prediction only of what has happened before and beyond that of educated guesses which (...) may sometimes prove right and others not when we test them. -/- The imperfection of our knowledge between those limits is a consequence of complexity. -/- Reductionist empiricism fails when faced with complexity but we all still have to live in a complex world where reductionist science cannot help us devise reliable theories from which we can predict the behaviour of the world around us. We cannot predict reliably. We can only monitor actively and manage actively the world around us if we want to try to control our environment. We have a limited prediction horizon. -/- Science and empiricism work well if we want to send Voyager I and II over 3 billion miles away but not for most other things. -/- In medicine how and when to apply probabilistic, conjectural, incomplete medical theories and explanations requires professional expertise, intuition and judgement (non scientific knowledge) which is essential. Medical diagnosis is a skill of predicting from knowledge of what has happened before that the past will recur in the current patient applying expertise and intuition from knowledge and experience of prior cases and probabilistic medical research and theory. The physician is left to an educated guess as to how the future will develop for the particular individual patient the focus of his or her current attention. (shrink)

Eyal Shahar’s essay review [1] of James Penston’s remarkable book [2] seems more inspired playful academic provocation than review or essay, expressing dramatic views of impossible validity. The account given of modern biostatistical causation reveals the slide from science into the intellectual confusion and non-science RCTs have created: “…. the purpose of medical research is to estimate the magnitude of the effect of a causal contrast, for example the probability ratio of a binary outcome …” But Shahar’s world is (...) simultaneously not probabilistic, but of absolute uncertainty: “We should have no confidence in any type of evidence ….. We should have no confidence at all”. Shahar’s "Causal contrast" is attractive. It seems to make sense, but bypasses in two words the means of establishing causation by the scientific method. This phrase assumes a numeric statistically significant “contrast” is causal rather than a potential correlation requiring further investigation. The concept of “causal contrast” is a slippery slope from sense into biostatistical non-science. This can be illustrated with an hypothetical RCT where 100% of interventions exhibit a posited treatment effect and 0% of placebo controls. Internal validity is seemingly quite reasonably assumed satisfied (common-sense dictating the likelihood of an awesome magnificent fraud, bias or plain error of the magnitude required is infinitesimal). Scientific method appears satisfied. The RCT demonstrates: (1) strict regularity of outcome in the presence of posited cause; (2) the absence of outcome in its absence and (3) an intervention (experiment) showing the direction of causation is from posited cause to posited effect. Now travel further down the slope from science. Assume 50% of interventions and 0% of controls are positive. We compromise scientific method, but justify this by assuming a large subgroup which we say surely must on these figures be exhibiting the posited treatment effect. But what of 10% of interventions and 9% of placebo controls exhibiting the posited treatment effect? Our biostatistician says the 1% “causal contrast” is statistically significant. But we have: (1) minimal evidence of regularity; (2) the posited outcome irrespective of presence of posited cause and (3) our intervention is at the highest equivocal in demonstrating any form of causation. This is not science. It is, however, where biostatistics has unthinkingly taken us, as Penston has shown comprehensively [2]. We, the audience of published medical research, are now for the 10% / 9% example well down the slope from science. An unattractive hypothesis results requiring numerous assumptions similar to these:- "There is a 'contrast' which is ‘causal’, albeit the method employed is not scientific. An effect of the intervention has been observed in a very small subgroup. This subgroup is susceptible to treatment. The similar number of placebo controls exhibiting the outcome sought is irrelevant, because the 1% difference between intervention and controls is statistically significant. The statistical analysis is valid and reliable. The RCT’s internal validity is sufficiently satisfied. No funding or bias or fraud has affected the results or their analysis.” As Penston notes: “Confirming and refuting the results of research is crucial to science …. But … there’s no way of testing the results of any particular large-scale RCT or epidemiological study. Each study … is left hanging in the air, unsupported.” It gets worse. To identify a rare serious adverse reaction of a frequency of 1:10,000 can require a trial of 200,000 or larger split between controls and interventions. This is not done. But for every 100 who prospectively benefit from the intervention, 9,900 also receive it. And for every 100 benefiting one person (who likely gains no benefit) will suffer a serious unidentified adverse reaction. This is also without taking account of more common adverse reactions whether serious or otherwise. References [1] Shahar, E. (2011) Research and medicine: human conjectures at every turn. International Journal of Person Centered Medicine 1 (2), 250-253. [2] Penston, J. (2010). stats.con: How we’ve been fooled by statistics-based research in medicine. London: The London Press, UK. (shrink)

If each of the subtypes of autism is defined simply as constituted by a set of symptoms, then the criteria for its observation are straightforward, although, of course, some of those symptoms themselves might be hard to observe definitively. Compare with telling whether or not someone is bleeding: while it might be hard to tell if someone is bleeding internally, we know what it takes to find out, and when we have the right access and instruments we can settle the (...) issue. But matters are not so simple for the autism subtypes. For one thing, how do we settle which symptoms to group together under one heading? One key difference between “autism disorder” and “Asperger’s disorder” is that the former exhibit language delays (sometimes extreme), whereas the latter do not. But is that a sign of genuinely distinct conditions or is that an artifact of the distinct groups of subjects that Leo Kanner and Hans Asperger worked with? And in general, although there are certainly types of behavior that are taken to be indicative of autism, none by itself is taken by diagnosticians to be either necessary or sufficient for a definitive diagnosis for any of the autism subtypes. What is the diagnostician to do? This is not merely an academic issue, as many parents can attest. Are we in a situation, then, that each practitioner has his or her own “pet” signs that are the “real keys” to the diagnosis? That would suggest that the term “autistic” might meet the fate of the outdated term “neurotic,” which turned out to be a pseudo-scientific term for an inexact clumping together of unrelated phenomena. The assumption amongst specialists seems to be that we will reach the point with "autism" that we have with "water": there will be a root essence to autism whose presence or absence settles a diagnosis. If that is to be the case, however, we have to settle the level of application of the concept. Does the term apply to people who exhibit particular behaviors? Or is it possible to exhibit “autistic” behaviors without actually being autistic, because autism is instead a particular feature of the mind (as, for example, in Baron-Cohen’s “impaired theory of mind module” theory, discussed below) which usually but not necessarily has behavioral effects? Or is autism located instead in the brain, perhaps in damage to key areas, which in turn would typically have an effect on modules of the mind? Or perhaps autism is located in genetics or biology, so that some people with damage to the brain caused by accidents so that they exhibit autistic symptoms would not actually be autistic. Conversely, supposing one had an “autistic brain” but showed none of (or not a sufficient number of) the symptoms, would one not be autistic? The assumption is that the genotypes and phenotypes will line up neatly, but if they do not, what happens to the concept “autistic?” (There is an analogy in the philosophy of sex and gender: androgen insensitive individuals tend to self-identify as female and have outward female traits, but have XY chromosomes—should we go with chromosomes or self-identity in assigning sex category?) Finally, the implications for these complications for diagnosis and categorization, with the attendant social and medical implications is discussed. The typical assumption of the medical profession is that autism cannot be “cured.” That assumes that autism is not simply the symptoms. However, at the same time, the tests used to diagnose ASDs work simply from the symptoms (for example, Baron-Cohen’s Sally/Anne test, which ASD children of a certain age almost all fail, but which practically no ASD adult fails). This implies an inherent confusion over the status of the concept. I conclude that attempts to make sense of some true or accurate summary of what it is to be autistic (such as one would find in the DSM) are almost certainly misguided and will vanish into history along with “neurotic.” But as with racial terms, which are similarly shifting and perverse, the term has already passed into the public sphere and will have a lasting and dangerous influence beyond its short scientific shelf-life. (shrink)

Legal theorists have characterized physical evidence of brain dysfunction as a double-edged sword, wherein the very quality that reduces the defendant’s responsibility for his transgression could simultaneously increase motivations to punish him by virtue of his apparently increased dangerousness. However, empirical evidence of this pattern has been elusive, perhaps owing to a heavy reliance on singular measures that fail to distinguish between plural, often competing internal motivations for punishment. The present study employed a test of the theorized double-edge pattern (...) using a novel approach designed to separate such motivations. We asked a large sample of participants (N = 330) to render criminal sentencing judgments under varying conditions of the defendant’s mental health status (Healthy, Neurobiological Disorder, Psychological Disorder) and the disorder’s treatability (Treatable, Untreatable). As predicted, neurobiological evidence simultaneously elicited shorter prison sentences (i.e., mitigating) and longer terms of involuntary hospitalization (i.e., aggravating) than equivalent psychological evidence. However, these effects were not well explained by motivations to restore treatable defendants to health or to protect society from dangerous persons but instead by deontological motivations pertaining to the defendant’s level of deservingness and possible obligation to provide medical care. This is the first study of its kind to quantitatively demonstrate the paradoxical effect of neuroscientific trial evidence and raises implications for how such evidence is presented and evaluated. (shrink)

In this paper an Artificial Neural Network (ANN) model, for predicting the category of a tumor was developed and tested. Taking patients’ tests, a number of information gained that influence the classification of the tumor. Such information as age, sex, histologic-type, degree-of-diffe, status of bone, bone-marrow, lung, pleura, peritoneum, liver, brain, skin, neck, supraclavicular, axillar, mediastinum, and abdominal. They were used as input variables for the ANN model. A model based on the Multilayer Perceptron Topology was established and trained using (...) data set which its title is “primary tumor” and was obtained from the University Medical Centre, Institute of Oncology, Ljubljana, Yugoslavia Test data evaluation shows that the ANN model is able to correctly predict the tumor category with 76.67 % accuracy. (shrink)

I argue that if minds supervene on the intrinsic physical properties of things like brains, then typical human brains host many minds at once. Support comes from science-nonfiction realities that, unlike split-brain cases, have received little direct attention from philosophers. One of these realities is that some patients are functioning (albeit impaired) and phenomenally conscious by all medical and commonsense accounts despite the fact that they have undergone a hemispherectomy: an entire brain hemisphere has been fully detached. Another is (...) the Wada test, in which a patient has each hemisphere anesthetized, one after the other, while the other hemisphere is awake and functioning—again, phenomenally conscious by any standard. I will argue that hemispherectomies, Wada tests, and related procedures each present cases in which the minds that exist after the detachment (or anesthetization) of a hemisphere are surviving minds which must be associated with the surviving (or un-anesthetized) hemisphere. I will argue that such surviving minds existed before the medical procedure, instantiated by the then-intact hemisphere that was due to survive the loss of its complementary hemisphere. If so, then the typical subject has at least three minds: a “left hemisphere mind”, a “right hemisphere mind”, and a “whole brain mind”. But the argument generalizes to cases in which smaller portions of the brain are lost, yielding a great number of additional minds, some overlapping. Some important ethical implications are raised and briefly examined. (shrink)

Nos meses de Junho/Julho - 2019, houve relatos de vazamento de patógenos do Fort Detrick, instalação do Comando Médico do Exército dos EUA, conhecido por desenvolver armas biológicas e que abriga um dos muitos laboratórios BSL-4 do país. Em agosto de 2019, a instalação foi fechada para investigação e a imprensa não teve acesso a informações detalhadas. -/- Em setembro de 2019, um vírus mortal começou a se espalhar nos EUA infectando 26 milhões de pessoas naquele outono, com pelo menos (...) 250.000 hospitalizadas e 20.000 mortes. Posteriormente o Dr. Robert Redfield, diretor do Centro de Controle e Prevenção de Doenças dos EUA, reconheceu perante o Comitê do Congresso, que algumas mortes por influenza foram mais tarde diagnosticadas como de Covid-19. -/- Em 18 de outubro de 2019, dia do início dos Jogos Mundiais Militares em Wuhan, que contou com a presença de militares americanos, a Fundação Bill & Melinda Gates e o Johns Hopkins Center for Health Security em parceria com o Fórum Econômico Mundial, promovem uma simulação de pandemia de coronavírus em Nova York, reunindo líderes empresariais e agentes do governo. -/- Em novembro de 2019, o prefeito de Belleville, Nova Jersey, Michael Melham, passou mal e seu diagnóstico foi uma grave pneumonia posteriormente confirmado como sendo Covid-19. Falei com Michael sobre a veracidade dos fatos e ele me confirmou o diagnóstico. Disse que possui dois testes de anticorpos positivos para a Covid-19. -/- Em janeiro de 2019 a revista Science publicou um artigo questionando a teoria oficial de que o vírus havia sido transmitido de um animal para um ser humano no mercado de Wuhan e outro estudo publicado na revista The Lancet, concluiu que 13 das primeiras 41 pessoas diagnosticadas com Covid-19 não tiveram nenhum contato com o mercado de Wuhan, além disso, o Dr. Daniel Lucey, professor de doenças infecciosas da Georgetown University Medical Center, disse baseado em evidências, que o "paciente zero", foi infectado antes de dezembro de 2019, mais precisamente entre outubro e início de novembro de 2019, mas o diagnóstico era de pneumonia e assim o vírus começou a se espalhar por Wuhan. -/- Agora, não é porque o novo coronavírus surgiu na China, que sua origem seja o laboratório de Wuhan, a gripe espanhola por exemplo, se disseminou no mundo a partir da Europa matando 50 milhões de pessoas e sua origem estava no Fort Riley, em Kansas, EUA. (shrink)

PURPOSE: The conventional wisdom in dental and medical education is that dental and medical students experience "ethical erosion" over the duration of dental and medical school. There is some evidence for this claim, but in the case of dental education this evidence consists entirely of survey research, which doesn't measure behavior. The purpose of this study was to measure the altruistic behavior of dental students, in order to fill the significant gap in knowledge of how students are (...) disposed to behave, rather than how they are disposed to think. -/- METHODS: To test the altruistic behavior of dental students, we conducted a field experiment using the Ultimatum Game, which is a game commonly used in economics to observe social behavior. Students from each of the four years of dental school played the game in standardized conditions with real money. -/- RESULTS: Students exhibited greater levels of altruism than the general population typically does. Students' altruism peaked in year four. Students' altruism was associated with the socioeconomic status of responder. -/- CONCLUSION: The results suggest that that dental students are more altruistic than the population average and that altruism increases during their education. Thus, if a decreasing ability to behave altruistically is observed during dental school, it is not likely due to a general disposition of students, but rather some factor specific to the educational environment in which the decrease is observed. (shrink)

Even in the increasingly individualized American medical system, advocates of 'personalized medicine' claim that healthcare isn't individualized enough. With the additional glamour of new biotechnologies such as genetic testing and pharmacogenetics behind it, 'Me Medicine'-- personalized or stratified medicine-- appears to its advocates as the inevitable and desirable way of the future. Drawing on an extensive evidence base, this book examines whether these claims are justified. It goes on to examine an alternative tradition rooted in communitarian ideals, that of (...) the common good as a goal in medicine. (shrink)

Animal research has long been a source of biomedical aspirations and moral concern. Examples of both hope and concern are abundant today. In recent months, as is common practice, monkeys have served as test subjects in promising preclinical trials for an Ebola vaccine or treatment 1 , 2 , 3 and in controversial maternal deprivation studies. 4 The unresolved tension between the noble aspirations of animal research and the ethical controversies it often generates motivates the present issue of the (...) Cambridge Quarterly of Healthcare Ethics. As editors of this special section, we hope that these original and timely articles will push the professional discussion of animal research ethics in a positive direction that will benefi t research scientists and others interested in moral problems in animal research. We also look forward to a day when animal research will genuinely meet both appropriate scientifi c and appropriate ethical criteria—criteria that themselves can be improved by critical scrutiny. Animal research—that is, the use of live animals as experimental subjects in biomedical and behavioral fi elds of learning—has been deeply entrenched for well over half a century. One signal development was the enactment in the late 1930s of federal product safety legislation in the United States and other nations that required animal testing of food, drugs, and medical devices prior to use by human subjects or consumers. 5 Another development was the publication of codes of research ethics that called for animal research prior to human research. The Nuremberg Code, published by an American military tribunal in 1947–48 after scrutiny of Nazi medical atrocities, stated that experiments involving the use of human subjects should be " based on the results of animal experimentation. " 6 The Declaration of Helsinki, fi rst published in 1964, reaffi rmed this assumption and added, rather imprecisely, that " the welfare of animals used for research must be respected. " 7 Against the background of such statements, the institutionalization and widespread acceptance of animal research in the twentieth century rested on two basic assumptions, one factual and one moral. The factual assumption was that animal research is suffi ciently reliable as a basis for predicting the effects of drugs, products, and other materials on human beings that animal trials can be expected to yield signifi cant scientifi c conclusions and medical benefi ts to humanity. (shrink)

The internet of things is increasingly spreading into the domain of medical and social care. Internet-enabled devices for monitoring and managing the health and well-being of users outside of traditional medical institutions have rapidly become common tools to support healthcare. Health-related internet of things (H-IoT) technologies increasingly play a key role in health management, for purposes including disease prevention, real-time tele-monitoring of patient’s functions, testing of treatments, fitness and well-being monitoring, medication dispensation, and health research data collection. H-IoT (...) promises many benefits for health and healthcare. However, it also raises a host of ethical problems stemming from the inherent risks of Internet enabled devices, the sensitivity of health-related data, and their impact on the delivery of healthcare. This paper maps the main ethical problems that have been identified by the relevant literature and identifies key themes in the on-going debate on ethical problems concerning H-IoT. (shrink)

One of the most challenging issues in medical ethics is a permission or prohibition of euthanasia. Is a patient with an incurable disease who has lots of pain permitted to kill oneself or ask others to do that? The main reason advanced by the opponents is the absolute prohibition of murder. Accordingly, the meaning of murder plays a key role in determining the moral judgment of euthanasia. The aim of this paper is to confirm the role of intention in (...) moral judgment of euthanasia and eliminate the name of unjust murder from voluntary euthanasia. The Intention of an agent determines the name of the act and whether it is right or wrong. An important point that dose not taken into account in the definitions of murder, killing as well as their ethical judgment is considering the attributes of being unjust and forcible. Killing a human being is neither intrinsically good nor bad, but its ethical judgment depends on the way that happens, i.e. just or unjust. Every killing is neither bad nor unethical except unjust one which is both bad and unethical. The attribute of “unjust” has been mentioned in the definition of murder in Islamic jurisprudence, law, traditions, and Quran. Owing to this argument, on one hand, it is true to state that voluntary euthanasia is not unjust and forcible murder (the test of correct negation), and on the other hand, it is not true to say that voluntary euthanasia is unjust and forcible murder (the test of incorrect predication). It can be concluded that voluntary euthanasia is an independent title other than unjust murder and does not have its judgment. (shrink)

This study analyzed the monitoring and evaluation of HIV/AIDS prevention programs in Southern Senatorial District of Cross River State, Nigeria. The study considered different levels of care/support and tested for locational variations in the monitoring/evaluation of HIV/AIDs prevention programs. A descriptive survey research design was utilized. This study covered 596 public health employees (doctors, nurses, pharmacists, and laboratory employees) in the study area. A sample of 239 respondents was chosen using the proportional stratified random sampling procedure. Data was collected using (...) a questionnaire constructed by the researchers and validated by specialists. Data gathered were analyzed using descriptive and inferential statistics. Results indicated that HIV/AIDs programs have been successfully monitored/evaluated to a high extent. High rates of success in the monitoring/evaluation of HIV/AIDs prevention programs are attributable to high rates of care/support provided to people living with HIV/AIDs. There was a significant variation in the monitoring/evaluation of HIV/AIDs prevention programs based on the location of health facilities, with higher rates recorded for urban areas. Based on the findings, it was concluded that the monitoring/evaluation of HIV/AIDs prevention programs in the Southern Senatorial District of Cross River State had recorded a significant level of success. The study recommended, among others, that there should be even distribution of medical facilities, resources and personnel to both urban and rural areas to promote equity and access to materials needed to contain or mitigate the spread of the pandemic across all locations. (shrink)

In this paper we present applications of the ACGT Master Ontology (MO) which is a new terminology resource for a transnational network providing data exchange in oncology, emphasizing the integration of both clinical and molecular data. The development of a new ontology was necessary due to problems with existing biomedical ontologies in oncology. The ACGT MO is a test case for the application of best practices in ontology development. This paper provides an overview of the application of the ontology (...) within the ACGT project thus far. (shrink)

Background: Obstetrics and gynaecology are many and common, where a woman suffers from problems related to pregnancy or her reproductive organs. Any part of her body may be affected due to some symptoms that are completely related to the reproductive organs when she is in a critical period for her, whether in her menstrual cycle, pregnancy, or disease conditions. The bulk of cases of diseases related to women and childbirth are dealt with great care and special care, as all diseases (...) related to women are considered very sensitive diseases due to the presence of the disease in sensitive and not simple places. A gynaecologist is a specialist in all diseases and problems related to the female sexual organs. They perform regular preventive medical exams, such as cervical smear tests and breast exams. It also provides consultations for women of all ages about the problems of contraception, infertility and menopause. Objectives: The objective of this expert system is to help and facilitate women in diagnosing diseases related to their obstetrics and gynaecology, a simple expert system has been designed consisting of ten various common diseases that affect women whether During or without pregnancy, Methods: In this system, the system consists of a list of some common symptoms, the correct diagnosis adopted for these diseases, and how to treat diseases in the correct way with the help of a consultant obstetrician and gynaecologist, Dr. Fathi Muhammad Al-Habibi, and these diseases are: uterine cancer, cervical cancer, Infertility, double uterus, ectopic pregnancy, endometrial cancer, female sexual dysfunction, endometriosis, faecal incontinence, female infertility, CLIPS Expert System language was used to design and implement the proposed expert system. Results: The proposed ten obstetrics and gynaecology diagnostic expert system was evaluated by medical students and they were satisfied with its performance. Conclusions: The proposed expert system is very useful for obstetricians and gynaecologists, patients with reproductive system problems, and recent graduates. (shrink)

Background: The most common hematological abnormality among people infected with Human Immunodeficiency Virus (HIV) is anemia. This is also related to high mortality risk among patients receiving Antiretroviral Therapy (ART). Purpose: This study aimed to identify predictors of anemia among HIV patients taking ART using a regimen of the single-tablet drug contain tenofovir, lamivudine, and efavirenz in Jayapura, Papua. Methods: This was a cross-sectional study conducted at Jayapura regional hospital from June to September 2017. A total of 80 HIV patients (...) were eligible for analysis. Data collection was conducted through an interview, medical record, measurement, and laboratory assay. The significance of differences among categorical variables was analyzed using Fisher’s exact test. The variables with p < 0.25 were then analyzed using binary logistic regression to determine predictors associated with anemia. A threshold of p < 0.05 indicates statistical significance. Results: This study showed that Body Mass Index (BMI) <18.50 (p = 0.01; OR = 5.63; 95% CI = 1.43 < OR < 22.19), length on ART ≤12 months (p = 0.00; OR = 4.90; 95% CI = 1.65 < OR < 14.53), and Cluster of Differentiation 4 (CD4+) percentage out of normal (p = 0.02; OR = 0.19; 95% CI = 0.05 < OR <0.77) had a significant association with anemia. Conclusion: BMI, length on ART, and CD4+ percentage were predictors of anemia among HIV patients taking antiretroviral therapy containing tenofovir, lamivudine, and efavirenz regimen in Jayapura. (shrink)