Limited health literacy is a pervasive and independent risk factor for poor health outcomes. Despite decades of reports exhibiting that the healthcare system is overly complex, unneeded complexity remains commonplace and endangers the lives of patients, especially those with limited health literacy. In this article, we define health literacy and describe the empirical evidence associating health literacy and poor health outcomes. We recast the issue of poor health literacy from within the ethical perspective of the least well-off and argue that (...) poor health outcomes deriving from limited health literacy ought to be understood as a fundamental injustice of the healthcare system. We offer three proposals that attempt to rectify this injustice, including: universal precautions that presume limited health literacy for all healthcare users; expanded use of technology supported communication; and clinical incentives that account for limited health literacy. (shrink)

Background:An ethical, informed consent process requires that potential participants understand the study, their rights, and the risks and benefits. Yet, despite strategies to improve communication, many participants still lack understanding of potential risks and benefits. Investigating attitudes and practices of research nurses can identify ways to improve the informed consent process.Research question:What are the attitudes, practices, and preparedness of nurses involved in the informed consent process regarding communication of risks and benefits?Research design:A survey was developed and administered online to a (...) national purposive sample of 107 research nurses with experience obtaining informed consent for clinical trials. Survey responses stratified by selected work-related characteristics were analyzed.Ethical considerations:Participants were instructed they need not answer each question and could stop at any time. They consented by clicking “accept” on the email which linked to the survey. The study was approved by the Northeastern University Institutional Review Board, Boston, Massachusetts.Findings:Most research nurses used a teach-back method to assess participant comprehension, while 72% relied on their intuition. About one-third did not feel prepared to communicate related statistics. About 20% did not feel prepared to tailor information, and half did not feel competent using supplemental materials to enhance risks and benefits comprehension. Only 70% had received training in the informed consent process which included in-person training, case studies, online courses, feedback during practice sessions, and simulation, such as role playing and viewing videos. Perceived preparedness was significantly associated with greater informed consent experience and training.Conclusion:Research nurses may have inadequate training to encourage, support, and reinforce communication of risks and benefits during the informed consent process. Relevant purposeful education and training should help to improve and standardize the ethical informed consent process. (shrink)

Background One of the objectives of medicine is to relieve patients' suffering. As a consequence, it is important to understand patients' perspectives of suffering and their ability to cope. However, there is poor insight into what determines their suffering and their ability to bear it. Purpose To explore the constituent elements of suffering of patients who explicitly request euthanasia or physician-assisted suicide (EAS) and to better understand unbearable suffering from the patients' perspective. Patients and methods A qualitative study using in-depth (...) face-to-face interviews was conducted with 31 patients who had requested EAS. The grounded theory approach was used to analyse the data. Results Medical, psycho-emotional, socio-environmental and existential themes contributed to suffering. Especially fatigue, pain, decline, negative feelings, loss of self, fear of future suffering, dependency, loss of autonomy, being worn out, being a burden, loneliness, loss of all that makes life worth living, hopelessness, pointlessness and being tired of living were constituent elements of unbearable suffering. Only patients with a psychiatric (co)diagnosis suffered unbearably all the time. Conclusions Unbearable suffering is the outcome of an intensive process that originates in the symptoms of illness and/or ageing. According to patients, hopelessness is an essential element of unbearable suffering. Medical and social elements may cause suffering, but especially when accompanied by psycho-emotional and existential problems suffering will become ‘unbearable’. Personality characteristics and biographical aspects greatly influence the burden of suffering. Unbearable suffering can only be understood in the continuum of the patients' perspectives of the past, the present and expectations of the future. (shrink)

There is no doubt that custard apple diseases are among the important reasons that destroy the Custard Apple plant and its agricultural crops. This leads to obvious damage to these plants and they become inedible. Discovering these diseases is a good step to provide the appropriate and correct treatment. Determining the treatment with high accuracy depends on the method used to correctly diagnose the disease, expert systems can greatly help in avoiding damage to these plants. The expert system correctly diagnoses (...) Custard Apple disease to make it easier for farmers to find the right treatment based on the appropriate diagnosis. Objectives: A specialized syllable language system was established for the diagnosis of Custard Apple plant disease. (shrink)

Judgment aggregation theory, which concerns the translation of individual judgments on logical propositions into consistent group judgments, has shown that group consistency generally cannot be guaranteed if each proposition is treated independently from the others. Developing the right method of abandoning independence is thus a high-priority goal. However, little work has been done in this area outside of a few simple approaches. To fill the gap, we compare four methods based on distance metrics between judgment sets. The methods generalize the (...) premise-based and sequential priority approaches to judgment aggregation, as well as distance-based preference aggregation. They each guarantee group consistency and implement a range of distinct functions with different properties, broadening the available tools for social choice. A central result is that only one of these methods (not previously considered in the literature) satisfies three attractive properties for all reasonable metrics. (shrink)

The notion of a Sasaki projectionon an orthomodular lattice is generalized to a mapping Φ: E × E → E, where E is an effect algebra. If E is lattice ordered and Φ is symmetric, then E is called a Φ-symmetric effect algebra.This paper launches a study of such effect algebras. In particular, it is shown that every interval effect algebra with a lattice-ordered ambient group is Φ-symmetric, and its group is the one constructed by Ravindran in his proof that (...) every effect algebra that has the Riesz decomposition property is an interval algebra. It is shown that the doubling construction introduced in the paper is connected to the conditional event algebrasof Goodman, Nguyen, and Walker. (shrink)

Background: Hospital nurses are frequently the first care givers to receive a patient’s request for euthanasia or physician-assisted suicide (PAS). In France, there is no consensus over which medical practices should be considered euthanasia, and this lack of consensus blurred the debate about euthanasia and PAS legalisation. This study aimed to investigate French hospital nurses’ opinions towards both legalisations, including personal conceptions of euthanasia and working conditions and organisation. Methods: A phone survey conducted among a random national sample of 1502 (...) French hospital nurses. We studied factors associated with opinions towards euthanasia and PAS, including contextual factors related to hospital units with random-effects logistic models. Results: Overall, 48% of nurses supported legalisation of euthanasia and 29%, of PAS. Religiosity, training in pallative care/pain management and feeling competent in end-of-life care were negatively correlated with support for legalisation of both euthanasia and PAS, while nurses working at night were more prone to support legalisation of both. The support for legalisation of euthanasia and PAS was also weaker in pain treatment/palliative care and intensive care units, and it was stronger in units not benefiting from interventions of charity/religious workers and in units with more nurses. Conclusions: Many French hospital nurses uphold the legalisation of euthanasia and PAS, but these nurses may be the least likely to perform what proponents of legalisation call “good” euthanasia. Improving professional knowledge of palliative care could improve the management of end-of-life situations and help to clarify the debate over euthanasia. (shrink)

Are values and social priorities universal, or do they vary across geography, culture, and time? This question is very relevant to Asia’s emerging economies that are increasingly looking at Western models for answers to their own outmoded health care systems that are in dire need of reform. But is it safe for them to do so without sufficient regard to their own social, political, and philosophical moorings? This article argues that historical and cultural legacies influence prevailing social values with regard (...) to health care financing and resource allocation, and that the Confucian dimension provides a helpful entry point for a deeper understanding of ongoing health care reforms in East Asia – as exemplified by the unique case of Singapore. (shrink)

Non-fiction graphic novels about illness and death created by patients and their loved ones have much to teach all readers. However, the bond of empathy made possible in the comic form may have special lessons for healthcare providers who read these texts and are open to the insights they provide.

Merab Konstantinovich [Mamardashvili] met with me immediately, as soon as I requested it, although he forewarned me that he could only dimly remember much of that distant past in which I was most interested. But evidently that past still perturbed him as well, since he agreed to speak with me even though he had not yet completely recovered from his illness, and hence his voice was feeble, at times subsiding to a whisper; he would pronounce his words indistinctly, constantly sticking (...) one onto another; on top of that, for technical reasons the dictaphone was situated a bit away from him. It was therefore very difficult to transcribe the text, and I raised many questions with the idea of asking Merab Konstantinovich about them at our next meeting and clearing up some things. But alas, there was no next meeting … Hence I am permitting myself now to publish only some of the most clearly enunciated fragments of my conversation with him, one of the four "forefathers" of the Moscow Methodological Circle, whose name for us, today's participants (and hence neophytes) in the methodological movement, is enveloped by legends handed down by word of mouth. I kept my questions to a minimum. Mamardashvili's reminiscences, arguments, and reflections will seem contentious to many. But no matter, one can dispute points of substance even with those who have passed on. (shrink)

Using the mathematical notion of an entity to represent states in quantum and classical mechanics, we show that, in a strict sense, proper superpositions are possible in classical mechanics.

This paper inquires into the nature of intertheoretic relations between psychology and neuroscience. This relationship has been characterized by some as one in which psychological explanations eventually will fall away as otiose, overthrown completely by neurobiological ones. Against this view it will be argued that it squares poorly with scientific practices and empirical developments in the cognitive neurosciences. We analyse a case from research on visual perception, which suggests a much more subtle and complex interplay between psychology and neuroscience than (...) a complete take-over of the former by the latter. In the case of vision, cross-theory influences between psychology and neuroscience go back and forth, resulting in refinement in both disciplines. We interpret this case study as showing that: (1) Mutual co-evolution of psychological and neurobiological theories, exemplifying persisting top-down influences from psychology, is a more empirically adequate way to describe psychoneural theory relations than a view on co-evolution, favoured by reductionists, which regards the cross-theory contributions from psychology as merely heuristically useful with no enduring influence on neurobiological theorizing; (2) In research on vision, discovering (or hypothesizing) the neural basis of functions vindicates psychological approaches, it does not eliminate them; (3) Current work on vision shows that many perceptual phenomena must be understood in terms of dynamical interactions between an observer and his/her environment. Therefore, we argue that internalist characterizations of the visual system must be supplemented with externalist accounts that address these reciprocal observer-environment interactions involved in vision. Such processes seem quite different from (internal) cellular and molecular ones, and as such seem to lie outside the scope of neuroscientific inquiry. We conclude that psychoneural reduction or elimination is implausible as a meta-theoretical prediction of theory choice in empirical work. Instead, this case study of vision shows that both psychology and neuroscience contribute to, and complement one another in the study of visual perception. (shrink)

The description Ausonius has given us of his family and of the teachers and professors of Bordeaux in the mid-fourth century is exceptional among our sources because of its detail and completeness. There is no reason to suppose that the picture he gives is untypical of life in the provinces and it makes a welcome change from the histories of aristocratic politics at Rome or Constantinople. It provides an excellent opportunity for a pilot study in which we may see how (...) the conflicting elements of social status were in practice reconciled and applied. In the traditional, and still prevalent view, the society of the Later Roman Empire was ‘crushed … in the iron clamp of castes separated from one another by barriers which could not be passed’. The evidence of Ausonius suggests that this judgement should be qualified. The society of the fourth century may have been stable. It was not static. (shrink)

In Prior’s [4], Appendix A §4 and §5, and Chapter IV, and more explicitly in Bull’s [2], we find sequences of tense-logical systems which place increasingly more restrictive conditions on the temporal relation “… is before …”. We give here a simple, diagrammatic account of the way in which the successive postulates for temporal order place these conditions on the temporal relation: we do not provide any essentially new semantics for these systems, nor do we prove any rigorous metatheorems. We (...) do, however, quite often assume the completeness results of Lemmon, Bull and others without explicit mention. (shrink)