Introduction: The decision of “do not attempt resuscitation” in the event of cardiopulmonary arrest is usually made when the patients are critically ill and cannot make an informed choice. Although, various professional bodies have published guidelines, little is know about the patients’ own views regarding DNAR discussion.Aim: The aim of this study was to determine patients’ attitudes regarding discussing DNAR before they are critically ill.Methods: A prospective study was performed in a general out patients department. A questionnaire was distributed to (...) consecutive outpatients along with an explanatory leaflet in the adult outpatient clinic.Results: 364 patients completed the questionnaire . 90% of respondents wanted all patients to be asked regarding DNAR decision at some point during a hospital admission. The majority would not find a DNAR discussion distressing. Only 10% would find it upsetting, however, 48% of these still wanted a discussion. 37% of respondents wanted to discuss DNAR decisions on admission; 32% in outpatients; 17% at consent for surgery, 14% when they are critically ill. 87% of respondents would not object to their relatives being involved in making decisions about their resuscitation status. However, only 12% of the subjects in the study had been involved in discussing the resuscitation status of a relative and 21% would not be comfortable to discuss a relative’s resuscitation status. Although 33% of patients preferred their resuscitation status to simply be documented within their clinical notes, 77% wanted it to be more easily accessible.Conclusions: This study suggests that contrary to current practice most patients want to discuss their DNAR status prior to becoming critically ill. This includes half of the small number that find it distressing to discuss. Although most patients are comfortable with relatives being involved in discussing DNAR, a significant proportion do not want their relatives to be asked. Furthermore, once a decision has been made, the majority of patients want it to be more accessible than current practice allows. (shrink)

Introduction: The decision of “do not attempt resuscitation” in the event of cardiopulmonary arrest is usually made when the patients are critically ill and cannot make an informed choice. Although, various professional bodies have published guidelines, little is know about the patients’ own views regarding DNAR discussion.Aim: The aim of this study was to determine patients’ attitudes regarding discussing DNAR before they are critically ill.Methods: A prospective study was performed in a general out patients department. A questionnaire was distributed to (...) consecutive outpatients along with an explanatory leaflet in the adult outpatient clinic.Results: 364 patients completed the questionnaire . 90% of respondents wanted all patients to be asked regarding DNAR decision at some point during a hospital admission. The majority would not find a DNAR discussion distressing. Only 10% would find it upsetting, however, 48% of these still wanted a discussion. 37% of respondents wanted to discuss DNAR decisions on admission; 32% in outpatients; 17% at consent for surgery, 14% when they are critically ill. 87% of respondents would not object to their relatives being involved in making decisions about their resuscitation status. However, only 12% of the subjects in the study had been involved in discussing the resuscitation status of a relative and 21% would not be comfortable to discuss a relative’s resuscitation status. Although 33% of patients preferred their resuscitation status to simply be documented within their clinical notes, 77% wanted it to be more easily accessible.Conclusions: This study suggests that contrary to current practice most patients want to discuss their DNAR status prior to becoming critically ill. This includes half of the small number that find it distressing to discuss. Although most patients are comfortable with relatives being involved in discussing DNAR, a significant proportion do not want their relatives to be asked. Furthermore, once a decision has been made, the majority of patients want it to be more accessible than current practice allows. (shrink)

The paper addresses the use of heterogeneous ensembles of intelligent unmanned vehicles in such a perspective field of innovations as an unmanned fishery. The issues of joint activity of unmanned vehicles of different types in fishing operations based on intelligent technologies are investigated. The “smart fishing” approach based on the joint fishing operation model is proposed. The operational framework that includes missions, roles, and activity scenarios embedded in the discretized spatial model is presented. The scenario activities are considered as the (...) sequences of pentad that determine executing specific functions concerning the specified waypoint, timepoints, and the states of vehicles. The definition of the plan as the scenario prototype that needs adjusting to the conditions of the situational context is proposed. The coordination problem regarding the joint activities of the unmanned vehicles and their scenarios is defined and the coordination framework based on the distributed common board model and coordination primitives is presented. The prototype of the intelligent scenario-based system including the implementation of both operational and coordination frameworks developed for the control of unmanned vehicles is described. This system makes unmanned vehicles capable to absorb all the latest advances in intelligent technologies to perform smart fishing operations jointly in a large heterogeneous group. The proposed approach to smart fishing using intelligent technologies makes it possible to detach fishermen from the fishing activities dangerous to their life and health, to reduce significantly poaching and illegal fishing, to increase the overall efficiency of fishing operations, and even to save the marine ecosystem. (shrink)

Mathematical modeling is a convenient way for characterization of complex ecosystems. This approach was applied to study the dynamics of zooplankton in Lake Sevan (Armenia) at different stages of anthropogenic eutrophication with the use of a novel method called discrete modeling of dynamical systems with feedback (DMDS). Simulation demonstrated that the application of this method helps in characterization of inter- and intra-component relationships in a natural ecosystem. This method describes all possible pairwise inter-component relationships like “plus–plus,” “minus–minus,” “plus–minus,” “plus–zero,” “minus–zero,” (...) and “zero–zero” that occur in most ecosystems. Based on the results, a working hypothesis was formulated. It was found that the sensitivity to weak external influence in zooplanktons was the greatest during the mid period of eutrophication in Lake Sevan, whereas in the final stages of eutrophication, an outbreak in the biomass production of cyanobacteria was evident. To support this approach, a weak external disturbance in the form of magnetic storm was used to see its effect on species Daphnia longispina sevanica. A statistically significant correlation between the frequency of magnetic storms and the number of this species was revealed and an increase in the number of toxic cyanobacteria species as a consequence of eutrophication. This paper, for the first time, suggests a DMDS method, to diagnose impact of anthropogenic eutrophication on environment. (shrink)

The level of development of advertising and sponsorship activities in Russia is still significantly inferior to Western countries, but every year we see tremendous development in this area. Sponsorship is not mostly considered as an investment and marketing communication yet, but rather as a charity. This approach, according to the authors, is more consistent with philanthropy. In this regard, the article defines the concepts of "sponsorship" and "philanthropy", shows the difference between them. Examples of interaction between sports organizations and sponsors (...) are considered. The role of advertising in this interaction is analyzed. According to the authors, Russia has a good legal framework for regulating the relations of sponsors, patrons, athletes and fans, but the system of ethical control of such relations is poorly developed. (shrink)

Издание содержит: Теоретические аспекты проблемы; Внехудожественная эстетика в искусстве; Приложение.

Neonatal extracorporeal membrane oxygenation (ECMO), a technology for the treatment of respiratory failure in newborns, is used as a case study to examine statistical and ethical aspects of clinical trials and to illustrate a proposed 'ethics of evidence', an approach to medical uncertainty within the context of contemporary biomedical ethics. Discussion includes the twofold aim of the ethics of evidence: to clarify the role of uncertainty and scientific evidence in medical decision-making, and to call attention to the need to confront (...) the irreducible nature of uncertainty. (shrink)

The concept of quality of life is the basis for a new paradigm of clinical medicine. Its assessment is considered to be an important instrument in determining disease severity and effectiveness of different treatment modalities. Our studies are devoted to the problem of diabetes complications especially anemia in patients with diabetic kidney disease. Anemia in subjects with diabetic nephropathy may result from various pathogenic factors including erythropoietin deficiency, iron deficiency, vitamin B12 and/or folate deficiencies, the effects of proinflammatory cytokines etc. (...) Diabetic patients with anemia are at increased risk of cardiovascular accidents and death. The aim of this study was to assess the influence of anemia on the quality of life of patients with early stages of diabetic nephropathy. We investigated 127 patients with type 2 diabetes mellitus and early diabetic nephropathy. Anemia was defined according to the World Health Organization criteria. Anemic patients were divided into three groups according to the stage of chronic kidney disease. Patients’ quality of life was assessed with SF-36 health survey. Anemic patients had lower scores of physical role functioning and emotional role functioning as compared to the patients with normal hemoglobin level, irrespective of the stage of chronic kidney disease. Patients with anemia and chronic kidney disease stage 3 had lower scores of general health perceptions, physical functioning, bodily pain, vitality and mental health than patients in the non-anemic group. Social role functioning was similar in anemic and non-anemic patients. The possible mechanisms and implications of the above mentioned findings are discussed with a medical and humanitarian perspective. The directions of further studies are proposed. (shrink)

Protection of human participants is a fundamental facet of biomedical research. We report the activities of a health service research study in which there were three institutional review boards (IRBs), three legal departments and one research administration department providing recommendations and mandating changes in the study methods. Complying with IRB requirements can be challenging, but can also adversely affect study outcomes. Multiple protocol changes mandated from multiple IRBs created a research method that was not reflective of how substance use screening (...) would be performed in a clinical setting. There was direct conflict between the IRBs' perceptions of participants' protection with the researchers' need to use research methodology that assures the clinical relevancy of results. (shrink)

The article is devoted to the memory of Vyacheslav Semenovich Stepin and Nikita Nikolaevich Moiseev, whose multifaceted work was integrally focused on philosophical, interdisciplinary and transdisciplinary research of the key ideas and principles of universal human-dimensional evolutionism. Other remarkable Russian scientists V.I. Vernadsky, S.P. Kurdyumov, S.P. Kapitsa, D.S. Chernavsky worked in the same tradition of universal evolutionism. While V.I. Vernadsky and N.N. Moiseev had been the originators of that scientific approach, V.S. Stepin provided philosophical foundations for the ideas of those (...) remarkable scientists and thinkers. The scientific legacy of V.S. Stepin and N.N. Moiseev maintained the formation of a new quality of research into the philosophy of science and technology as well as into the philosophy of culture. This new quality is multidimensional and it is difficult to define unambiguously, but we presume the formation of those areas of philosophical knowledge as constructively oriented languages of interdisciplinary and transdisciplinary co-participation of philosophy in the convergent-evolutionary development of scientific knowledge in general. In this regard, attention is paid to V.S. Stepin’s affirmations about non-classical nature of modern social and humanitarian knowledge. Quantum mechanics teaches us that the reality revealed through it is a hybrid construct, or symbiosis, of both mean and object of cognition. Therefore, the very act of cognitive observation constructs quantum reality. Thus, it is very close to the process of cognition in modern sociology and psychology. V.S. Stepin insisted that these principles are applicable to all complex selfdeveloping systems, and such are all “human-dimensional” objects of modern humanities. In all the phases of homeostasis changes, or crises, there is necessarily a share of chaos, instability, uncertainty in the selection process of future development scenarios, which is ineliminably affected by our observation. Therefore, a cognitive observer in the humanities should be considered as a concept of post-non-classical rationality, that is as an observer of complexity. (shrink)

Книга включает материал, охватывающий основной курс проблем философии науки, социологии и истории знания, научного творчества, являющихся сферой интересов Г. Ф. Миронова. В качестве специального раздела представлены работы молодых исследователей.

The state-of-art research in the field of life’s organization confronts the need to investigate a number of interacting components, their properties and conditions of sustainable behaviour within a natural system. In biology, ecology and life sciences, the performance of such stable system is usually related to homeostasis, a property of the system to actively regulate its state within a certain allowable limits. In our previous work, we proposed a deterministic model for systems’ homeostasis. The model was based on dynamical system’s (...) theory and pairwise relationships of competition, amensalism and antagonism taken from theoretical biology and ecology. However, the present paper proposes a different dimension to our previous results based on the same model. In this paper, we introduce the influence of inter-component relationships in a system, wherein the impact is characterized by direction (neutral, positive, or negative) as well as its (absolute) value, or strength. This makes the model stochastic which, in our opinion, is more consistent with real-world elements affected by various random factors. The case study includes two examples from areas of hydrobiology and medicine. The models acquired for these cases enabled us to propose a convincing explanation for corresponding phenomena identified by different types of natural systems. (shrink)

In May 2011, the clinical ethics group of the Center for Ethics at Washington Hospital Center launched a 40-hour, three and one-half day Clinical Ethics Immersion Course. Created to address gaps in training in the practice of clinical ethics, the course is for those who now practice clinical ethics and for those who teach bioethics but who do not, or who rarely, have the opportunity to be in a clinical setting. “Immersion” refers to a high-intensity clinical ethics experience in a (...) busy, urban, acute care hospital. During the Immersion Course, participants join clinical ethicists on working rounds in intensive care units and trauma service. Participants engage in a videotaped role-play conversation with an actor. Each simulated session reflects a practical, realistic clinical ethics case consultation scenario. Participants also review patients’ charts, and have small group discussions on selected clinical ethics topics. As ethics consultation requests come into the center, Immersion Course participants accompany clinical ethicists on consultations. Specific to this pilot, because participants’ evaluations and course faculty impressions were positive, the Center for Ethics will conduct the course twice each year. We look forward to improving the pilot and establishing the Immersion Course as one step towards addressing the gap in training opportunities in clinical ethics. (shrink)