Treatment over objection: minds, bodies and beneficence

“The only freedom which deserves the name is that of pursuing our own good in our own way, so long as we do not attempt to deprive others of theirs or impede their efforts to obtain it. Each is the proper guardian of his own health, whether bodily or mental and spiritual”John Stuart Mill – On Liberty1This quote from Mill highlights an important distinction for medical ethics: a distinction between bodily and mental health. In this paper, we want to look at the ways that ethics and law have addressed this distinction, especially in relation to involuntary treatment. We will claim that both philosophy and case law appear to address involuntary treatment for physical disorders in very different ways to involuntary treatment for mental disorders; and will relate these differences in analysis to different approaches to understanding the capacity to make autonomous decisions

Cosmological constraints from CMB distortion

We examine bounds on adiabatic and isocurvature density fluctuations from $\mu$-type spectral distortions of the cosmic microwave background (CMB). Studies of such distortion are complementary to CMB measurements of the spectral index and its running, and will help to constrain these parameters on significantly smaller scales. We show that a detection on the order of $\mu \sim 10^{-7}$ would strongly be at odds with the standard cosmological model of a nearly scale-invariant spectrum of adiabatic perturbations. Further, we find that given the current CMB constraints on the isocurvature mode amplitude, a nearly scale-invariant isocurvature mode (common in many curvaton models) cannot produce significant $\mu$-distortion. Finally, we show that future experiments will strongly constrain the amplitude of the isocurvature modes with a highly blue spectrum as predicted by certain axion models.Comment: 6 pages, 4 figures, version 3 contains a new figure showing the contribution to \mu_k as a function of k, and a clarification regarding the acoustic wave energy, accompanied by a related acknowledgement and referenc

Neutrinos and Future Concordance Cosmologies

We review the free parameters in the concordance cosmology, and those which might be added to this set as the quality of astrophysical data improves. Most concordance parameters encode information about otherwise unexplored aspects of high energy physics, up to the GUT scale via the "inflationary sector," and possibly even the Planck scale in the case of dark energy. We explain how neutrino properties may be constrained by future astrophysical measurements. Conversely, future neutrino physics experiments which directly measure these parameters will remove uncertainty from fits to astrophysical data, and improve our ability to determine the global properties of our universe.Comment: Proceedings of paper given at Neutrino 2008 meeting (by RE

Reionization and the large-scale 21 cm-cosmic microwave background cross correlation

Of the many probes of reionization, the 21 cm line and the cosmic microwave background (CMB) are among the most effective. We examine how the cross-correlation of the 21 cm brightness and the CMB Doppler fluctuations on large angular scales can be used to study this epoch. We employ a new model of the growth of large scale fluctuations of the ionized fraction as reionization proceeds. We take into account the peculiar velocity field of baryons and show that its effect on the cross correlation can be interpreted as a mixing of Fourier modes. We find that the cross-correlation signal is strongly peaked toward the end of reionization and that the sign of the correlation should be positive because of the inhomogeneity inherent to reionization. The signal peaks at degree scales (l~100) and comes almost entirely from large physical scales (k~0.01 Mpc). Since many of the foregrounds and noise that plague low frequency radio observations will not correlate with CMB measurements, the cross correlation might appear to provide a robust diagnostic of the cosmological origin of the 21 cm radiation around the epoch of reionization. Unfortunately, we show that these signals are actually only weakly correlated and that cosmic variance dominates the error budget of any attempted detection. We conclude that the detection of a cross-correlation peak at degree-size angular scales is unlikely even with ideal experiments.Comment: 15 pages, 4 figures, submitted to MNRA

Constraining the Inflationary Equation of State

We explore possible constraints on the inflationary equation state: p=w\rho. While w must be close to -1 for those modes that contribute to the observed power spectrum, for those modes currently out of experimental reach, the constraints on w are much weaker, with only w<-1/3 as an a priori requirement. We find, however, that limits on the reheat temperature and the inflationary energy scale constrain w further, though there is still ample parameter space for a vastly different (accelerating) equation of state between the end of quasi-de Sitter inflation and the beginning of the radiation-dominated era. In the event that such an epoch of acceleration could be observed, we review the consequences for the primordial power spectrum.Comment: 12 pages, 2 figur

Constraining holographic inflation with WMAP

In a class of recently proposed models, the early universe is strongly coupled and described holographically by a three-dimensional, weakly coupled, super-renormalizable quantum field theory. This scenario leads to a power spectrum of scalar perturbations that differs from the usual empirical LCDM form and the predictions of generic models of single field, slow roll inflation. This spectrum is characterized by two parameters: an amplitude, and a parameter g related to the coupling constant of the dual theory. We estimate these parameters, using WMAP and other astrophysical data. We compute Bayesian evidence for both the holographic model and standard LCDM and find that their difference is not significant, although LCDM provides a somewhat better fit to the data. However, it appears that Planck will permit a definitive test of this holographic scenario.Comment: 24 pages, 9 figs, published versio

Inflation and the Scale Dependent Spectral Index: Prospects and Strategies

We consider the running of the spectral index as a probe of both inflation itself, and of the overall evolution of the very early universe. Surveying a collection of simple single field inflationary models, we confirm that the magnitude of the running is relatively consistent, unlike the tensor amplitude, which varies by orders of magnitude. Given this target, we confirm that the running is potentially detectable by future large scale structure or 21 cm observations, but that only the most futuristic measurements can distinguish between these models on the basis of their running. For any specified inflationary scenario, the combination of the running index and unknown post-inflationary expansion history induces a theoretical uncertainty in the predicted value of the spectral index. This effect can easily dominate the statistical uncertainty with which Planck and its successors are expected to measure the spectral index. More positively, upcoming cosmological experiments thus provide an intriguing probe of physics between TeV and GUT scales by constraining the reheating history associated with any specified inflationary model, opening a window into the "primordial dark age" that follows the end of inflation.Comment: 32 pages. v2 and v3 Minor reference updates /clarification

Male frequent attenders of general practice and their help seeking preferences

Background: Low rates of health service usage by men are commonly linked to masculine values and traditional male gender roles. However, not all men conform to these stereotypical notions of masculinity, with some men choosing to attend health services on a frequent basis, for a variety of different reasons. This study draws upon the accounts of male frequent attenders of the General Practitioner's (GP) surgery, examining their help-seeking preferences and their reasons for choosing services within general practice over other sources of support. Methods: The study extends thematic analysis of interview data from the Self Care in Primary Care study (SCinPC), a large scale multi-method evaluation study of a self care programme delivered to frequent attenders of general practice. Data were collected from 34 semi-structured interviews conducted with men prior to their exposure to the intervention. Results: The ages of interviewed men ranged from 16 to 72 years, and 91% of the sample (n= 31) stated that they had a current health condition. The thematic analysis exposed diverse perspectives within male help-seeking preferences and the decision-making behind men's choice of services. The study also draws attention to the large variation in men's knowledge of available health services, particularly alternatives to general practice. Furthermore, the data revealed some men's lack of confidence in existing alternatives to general practice. Conclusions: The study highlights the complex nature of male help-seeking preferences, and provides evidence that there should be no 'one size fits all' approach to male service provision. It also provides impetus for conducting further studies into this under researched area of interest. © 2011 WPMH GmbH