RationaleSurrogates of critically ill patients often have inaccurate expectations about prognosis. Yet there is little research on how intensive care unit clinicians should discuss prognosis, and existing expert opinion-based recommendations give only general guidance that has not been validated with surrogate decision makers.ObjectiveTo determine the perspectives of key stakeholders regarding how prognostic information should be conveyed in critical illness.MethodsThis was a multicenter study at three academic medical centers in California, Pennsylvania, and Washington. One hundred eighteen key stakeholders completed in-depth semistructured (...) interviews. Participants included 47 surrogates of adult patients with acute respiratory distress syndrome; 45 clinicians working in study ICUs, including physicians, nurses, social workers, and spiritual care providers; and 26 experts in health communication, decision science, ethics, family-centered care, geriatrics, healthcare disparities, palliative care, psychology, psychiatry, and critical care.Measurements and main resultsThere was broad support among surrogates for existing expert recommendations, including truthful prognostic disclosure, emotional support, tailoring the disclosure strategy to each family's needs, and checking for understanding. In addition, stakeholders offered suggestions that add specificity to existing recommendations, including: In addition to conveying prognostic estimates, clinicians should help families "see the prognosis for themselves" by showing families radiographic images and explaining the clinical significance of physical manifestations of severe disease at the bedside. Many physicians did not support using numeric estimates to convey prognosis to families, whereas many surrogates, clinicians from other disciplines, and experts believed numbers could be helpful. Clinicians should conceptualize prognostic communication as an iterative process that begins with a preliminary mention of the possibility of death early in the ICU stay and becomes more detailed as the clinical situation develops. Although prognostic information should be initially disclosed by physicians, other members of the multidisciplinary team-nurses, social workers, and spiritual care providers-should be given explicit role responsibilities to reinforce physicians' prognostications and help families process a poor prognosis emotionally.ConclusionsFamily members, clinicians, and experts identified specific communication behaviors that clinicians should use to discuss prognosis in the critical care setting. These findings extend existing opinion-based recommendations and should guide interventions to improve communication about prognosis in ICUs. (shrink)

ObjectiveTo prospectively study the cingulate cortex for the localization and role of the grasping action in humans during electrical stimulation of depth electrodes.MethodsAll the patients with intractable focal epilepsy and a depth electrode stereotactically placed in the cingulate cortex, as part of their pre-surgical epilepsy evaluation from 2015 to 2017, were included. Cortical stimulation was performed and examined for grasping actions. Post-implantation volumetric T1 MRIs were co-registered to determine the exact electrode position.ResultsFive patients exhibited contralateral grasping actions during electrical stimulation. (...) All patients had electrodes implanted in the ventral bank of the right cingulate sulcus adjacent to the vertical anterior commissure line. Stimulation of other electrodes in adjacent regions did not elicit grasping.ConclusionGrasping action elicited from a localized region in the mid-cingulate cortex directly supports the concept of the cingulate cortex being crucially involved in the grasping network. This opens an opportunity to explore this region with deep brain stimulation as a motor neuromodulation target for treatment in specific movement disorders or neurorehabilitation. (shrink)

Volume 28, Issue 1, January 2020, Page 209-212.

Volume 28, Issue 1, January 2020, Page 209-212.

British Journal for the History of Philosophy, Volume 19, Issue 5, Page 1012-1015, September 2011.

It became customary in the eighteenth century to praise Longinus in ways that mimicked one of his own favorite turns of thought—to identify enthusiastically two elements that would more commonly be thought of as quite distinct. To say, with Boileau and Pope, that Longinus “is himself the great Sublime he draws,” or to profess to doubt, as Gibbon did, “which is the most sublime, Homer’s Battle of the Gods or Longinus’ apostrophe…upon it,” is knowingly to override certain conventional lines of (...) demarcation—between writers and their subject matter, between text and interpretation—very much in the manner of Longinus overriding the distinction between Homer and his heroes, between sublime language and its author , or between sublime poet and his audience .1 Longinus’ admirers, struck by the force of the treatise, are usually willing to release him from the strictures of theoretical discourse and allow him the license of a poet; they are likely to appreciate his transgressions of conventional limits without ever calling them into question. It has been left to more skeptical readers, wary of Longinus’ “transports,” to draw attention to his odd movements of thought: W. K. Wimsatt, for example, is unsympathetic but acute when he accuses Longinus of “sliding” from one theoretical distinction to another, a slide “which seems to harbor a certain duplicity and invalidity.”2 Wimsatt is right: something one might want to call a “slide” is observable again and again in the treatise, and not merely from one theoretical distinction to another. One finds in the treatise a rhetorician’s argument conducted with great intelligence and energy, but one also discovers that it is remarkably easy to lose one’s way, to forget which rhetorical topic is under consideration at a particular point, to find oneself attending to a quotation, a fragment of analysis, a metaphor—some interestingly resonant bit of language that draws one into quite another system of relationships. I want to attempt to follow that movement here, to hold it in mind and to question its implications. I will look closely at a number of passages in which Longinus interweaves language of his own with that of the authors he admires—for it is here, out of the play of text with quotation and of quotations with one another, that the most interesting meanings as well as the peculiar power of the treatise are generated.1. ‘Longinus’ On Sublimity, trans. D. A. Russell , 9. 2, 7. 2; all further references to this work will appear in text, though I have changed a word or two of Russell’s translation in the interests of a more literal rendering of the Greek. I am indebted to another recent translation, G. M. A. Grube’s Longinus On Great Writing , and more particularly to the ample and intelligent introduction and notes accompanying Russell’s edition of the Greek text, ‘Longinus’ On the Sublime .2. W. K. Wimsatt, Jr., and Cleanth Brooks, Literary Criticism: A Short History , p.101. (shrink)

This collection of essays, published to coincide with Tony Honore's sixty-fifth birthday, focuses on the areas where Honore's thought has made the most significant contribution: Roman law and jurisprudence. Included are essays by P.S. Atiyah, Zenon Bankowski, John Bell, Peter Birks, John W. Cairs, Hugh Collins, David Daube, W. M. Gordon, J. W. Harris Nicola Lacey, A. D. E. Lewis, Detlef Liebs, G. D. MacCormack, Neil MacCormick, G. Maher, Pieter Norr, Alan Rodger, and Peter Stein.

The focus here will be on the tension between architecture’s symbolic role and its function as a space to house and present art. ‘Symbolic’ refers both to a building as an aesthetic or sculptural form and secondly to its role in expressing civic identity. ‘Function’ refers to the intended purpose or practical use apart from its role as a form of art. As an art form, it serves important symbolic purposes; its practical purposes are linked to serving individual and community (...) functions requiring the delineation of space. In the present context of museum architecture, certain museum buildings are more likely to be seen as a sculptural object than as functioning buildings. The reasons for this development derive in part from unresolved issues pertaining to the respective roles of symbolic and practicalfunction as is seen in the analysis of architecture provided by G. W. F. Hegel, Rudolf Arnheim and Nelson Goodman. The vocabularies of contemporary architects such Frank Gehry and Santiago Calatrava do not follow the abstract geometrical patterns of Le Corbusier or Louis Kahn who envisioned a universal vocabulary of architectural forms derived from industrial technical forms that underscored Modernist conventions in architecture.By looking at this issue in the contexts provided by the theoretical discussions of Hegel, Arnheim and Goodman, it is possible to see more clearly the importance of examining with a critical eye the relative place of symbolism and function in museum architecture, and to question whether current museum practice has gone astray in allowing the sculptural symbolism to become the dominant element. When either its symbolic or its practical aspects are out of balance the result is sure to be unsatisfactory architecture. If the past is a reliable guide, it works best when the symbolic (sculptural) and the practical in architecture are worked out in harmony with each other. (shrink)

Descartes is not simply our iconic modern philosopher, mathematician or scientist. He stands as the cultural symbol for modernity itself. This title offers insights into the relationship between Descartes and the Modern, and the very meaning and status of Modernity itself.

A non-partisan introduction to the ideas of the controversial political philosopher and classicist.