Little is known about the consequences of moral distress. The purpose of this study was to identify clinical situations that caused nurses to experience moral distress, to understand the consequences of those situations, and to determine whether nurses would change their practice based on their experiences. The investigation used a descriptive approach. Open-ended surveys were distributed to a convenience sample of 204 critical care nurses employed at a university medical center. The analysis of participants’ responses used an inductive approach and (...) a thematic analysis. Each line of the data was reviewed and coded, and the codes were collapsed into themes. Methodological rigor was established. Forty-nine nurses responded to the survey. The majority of nurses had experienced moral distress, and the majority of situations that caused nurses to experience moral distress were related to end of life. The nurses described negative consequences for themselves, patients, and families. (shrink)

The history of the National Health Service research ethics system in the UK and some of the key drivers for its change into the present system are described. It is suggested that the key drivers were the unnecessary delay of research, the complexity of the array of processes and contradictions between research ethics committee (REC) decisions. It is then argued that the primary drivers for this change are and will be replicated by the systems of research ethics review being put (...) in place at UK universities in response to the Economic and Social Research Council research ethics framework. It is argued that this is particularly problematic for multi-centre review and for researchers who switch institutions. Finally, some potential solutions to this problem and their feasibility are discussed. (shrink)

David Blank presents a new translation into clear modern English of a key treatise by one of the greatest of ancient philosophers, together with the first ever commentary on this work. Sextus Empiricus' Against the Grammarians is a polemical attack on ancient Greek ideas about grammar, and provides one of the best examples of sustained Sceptical reasoning.

Objectives—To assess whether UK and US health care professionals share the views of medical ethicists about medical futility, withdrawing/withholding treatment, ordinary/extraordinary interventions, and the doctrine of double effectDesign, subjects and setting–A 138-item attitudinal questionnaire completed by 469 UK nurses studying the Open University course on “Death and Dying” was compared with a similar questionnaire administered to 759 US nurses and 687 US doctors taking the Hastings Center course on “Decisions near the End of Life”.Results–Practitioners accept the relevance of concepts widely (...) disparaged by bioethicists: double effect, medical futility, and the distinctions between heroic/ordinary interventions and withholding/ withdrawing treatment. Within the UK nurses' group a “rationalist” axis of respondents who describe themselves as having “no religion” are closer to the bioethics consensus on withholding and withdrawing treatment.Conclusions—Professionals' beliefs differ substantially from the recommendations of their professional bodies and from majority opinion in bioethics. Bioethicists should be cautious about assuming that their opinions will be readily accepted by practitioners. (shrink)

Purpose. The research is devoted to the analysis of the urgent problem of the information society: the overload of a person with information and, as a result, the impossibility of adequate formation and development of the personality; as well as the problem of "digitization" of human existence and the formation of a new reality of dataism. Theoretical basis. A lot of modern scientific works are devoted to the analysis of the information society, its problems and features. The information society is (...) a logical continuation of the scientific and technological revolution, which led to the rapid growth of scientific knowledge and the technology development. In the 20th century, technologies have touched the sphere of knowledge and information, as a result of which the formation and development of the information society, or "knowledge society", takes place. Information becomes the main resource in it, and, one way or another, a person’s life is inextricably connected with the information space. With the information society formation, the problem of information search and processing becomes one of the most urgent. It turns out that despite the abundance and availability of information, it is very difficult to determine its relevance. A lot of effort is spent on developing information retrieval algorithms. Another problem is related to the person’s inability to process large amounts of data. This situation begins to influence not only the education process and professional activity, but also the formation of a person’s personality. A person is "lost" in the information space and gradually loses his/her "I". Algorithms for data analysis come to the rescue, but gradually, instead of giving a person material for thought, they begin to make decisions on their own, and therefore, live life instead of a person. With the advent of Big Data processing algorithms, a new ideological paradigm appears – dataism, which predicts the merger of a person with the general data flow. Originality. The authors make assumptions that the dataistic future is "natural". A lot of works, including in the framework of philosophy, are focused on the problem of "dissolving" a person in the information space and finding ways to overcome it. But, in our opinion, this process is a completely logical continuation of human evolution. Conclusions. Existence of a person as a data flow is not a problem and a threat, but a new dimension of his/her being, and, therefore, requires a careful study and formulation of the main principles of this form of existence. (shrink)

The nature of the Plague described by Thucydides in Book 2, chapter 49, has long been discussed both by medical and by classical scholars. Of numerous suggested identifications none has found general approval; and it is doubtful whether any opinion is more prevalent today than that the problem is insoluble. The classical scholar is handicapped by his ignorance of medical science; his medical colleague has often been led astray by translations deficient in exactitude if not disfigured by error. The difficulties (...) are great enough: but there is one indispensable preliminary task which can be undertaken with some prospect of success. If Thucydides' description is to be compared with modern records, it is necessary first to determine what the Greek words mean; and that can only be done by determining how far the Greek is expressed in the technical terms of contemporary medical science. It is obvious that Thucydides required a special vocabulary for this part of his work; and in fact over forty words in chapters 49 and 50 are unexampled elsewhere in his History, and a dozen more are used in meanings unexampled elsewhere. It is certain that a number of medical treatises were in circulation in Thucydides' lifetime, and that a more or less standard vocabulary had been or was being established. Now if it can be shown that the great majority of the terms employed by Thucydides in ch. 49 recur, apparently with the same meanings, as standard terms in the contemporary doctors, our second task—the comparison of Thucydides' description with modern records—will become a more rational undertaking than it was before, no longer the doubtful speculation which many of the modern doctors suppose it to be, thinking as they do that they have to deal with a layman's generalities expressed in literary language. (shrink)

Many analogies exist between the process of evolution by natural selection and of learning by reinforcement and punishment. A full extension of the evolutionary analogy to learning to include analogues of the fitness, genotype, development, environmental influences, and phenotype concepts makes possible a single theory of the learning process able to encompass all of the elementary procedures known to yield learning.

The contents of Scala Graduum Caloris are described, supplemented by unpublished material. Both temperature measurements by his linseed oil thermometer and those based upon his law of cooling are shown to be reasonably accurate to 300°C, but above that value they are much too low. The apparent agreement and the deviation are explained by the differences between the assumptions that Newton made in deriving his law of cooling and the conditions in which he used it. Newton's attempts to link terrestrial (...) and celestial science in applications in the Principia are shown to fail from his confounding the concepts of temperature, heat and radiant intensity and his ignorance of most factors affecting the temperature rise of irradiated materials. Other comments on varied aspects of heat, mainly published in the Queries, are set out and analysed. His originality is assessed. (shrink)

The interaction of the organism with the environment requires not only reactive, but also active behavior which helps subject to meet the challenge of the uncertainty of the environment. A positive feedback between active behavior and immune system makes the selection process effective.

Hull et al.'s analysis of operant behavior in terms of interaction and replication does not seem consistent with a genuine selection model. The putative replicators do not replicate, and the overall process is more reminiscent of directed mutation than of natural selection. General analogies between natural selection and operant reinforcement are too superficial to be of much scientific use.

In their account of learning and behavior, the authors define an interactor as emitted behavior that operates on the environment, which excludes Pavlovian learning. A unified neural-network account of the operant-Pavlovian dichotomy favors interpreting neurons as interactors and synaptic efficacies as replicators. The latter interpretation implies that single-synapse change is inherently Lamarckian.

Activity anorexia illustrates selection of behavior at the biological, behavioral, and neural levels. Based on evolutionary history, food depletion increases the reinforcement value of physical activity that, in turn, decreases the reinforcement effectiveness of eating – resulting in activity anorexia. Neural opiates participate in the selection of physical activity during periods of food depletion.

Seeking parallels among disciplines can have both risks and benefits. Finding parallels may be a vacuous exercise in categorization, generating no new insights. And pointing to analogous functions may cause us to treat them as homologous. Hull et al. have provided a basis for the generation of insights in different selectionist areas, without confusing analogy with homology.

Traditional theists are, with few exceptions, global semantic realists about the interpretation of external world statement. Realism of this kind is treated by many as a shibboleth of traditional Christianity, a sine qua non of theological orthodoxy. Yet, this love affair between theists and semantic realism is a poor match. I suggest that everyone (theist or no) has compelling evidence drawn from everyday linguistic practice to reject a realist interpretation of most external world statements. But theists have further reason to (...) forswear this view, because those who insist on global semantic realism open themselves to the charge of hubris of a theologically inappropriate kind. If the arguments in this paper are sound, then neither God nor any of us have reason to apply a realist interpretation to all or even most statements about the external world. (shrink)

The working situation prevailing in theoretical and experimental physics today is held to be inseparable from the interpretation of quantum theory, and constitutes an embodiment of its implicit difficulties. Such an understanding of the present situation in fundamental physics provides a quite different basis for ideas than the formulation of alternative courses of action (experiments) or alternative forms of knowledge (theories), which proceeds from the belief in a full separation of theory from experiment in this field. It is argued that (...) this underlying belief is not well founded. One must therefore consider the technical details of the field together with its foundations, and thus especially the situation produced by fundamental physics, including, in particular, the growth of high-energy technology, which exerts a determining influence on the further course of the subject. (shrink)