It is evident, in the face of the COVID-19 pandemic that has physicians confronting death and dying at unprecedented levels along with growing data suggesting that physicians who care for dying patients face complex emotional, psychological and behavioural effects, that there is a need for their better understanding and the implementation of supportive measures. Taking into account data positing that effects of caring for dying patients may impact a physician’s concept of personhood, or “what makes you, ‘you’”, we adopt Radha (...) Krishna’s Ring Theory of Personhood (RToP) to scrutinise the experiences of physicians working in intensive care units (ICU) using a fictional scenario that was inspired by real events. The impact of death and dying, its catalysts, internal constituents, external factors, dyssynchrony, and buffers, specific to ICU physicians, were identified and explored. Such a framework allows for ramifications to be considered holistically and facilitates the curation of strategies for conflict resolution. This evaluation of the RToP acknowledges the experience and wide-ranging effects it has on ICU physicians. As such, our findings provide insight into their specific needs and highlight the importance of support on a personal and organisational level. Although further research needs to be conducted, the RToP could serve as the basis for a longitudinal assessment tool supported by the use of portfolios or mentorship due to their provision of personalised, appropriate, specific, timely, accessible and long-term support. (shrink)

This article reports the results of a survey, by mailed questionnaire, of the attitudes, values and practices of doctors in Singapore with respect to the doctor-patient relationship. Questionnaires were sent to a random sample of 475 doctors (261 general practitioners and 214 medical specialists), out of which 249 (52.4%) valid responses were completed and returned. The survey is the first of its kind in Singapore. Questions were framed around issues of medical paternalism, consent and patient autonomy. As the doctors were (...) exposed to Western ethical concepts in their training, we were not surprised to find that they would mostly allow patients some say in decision-making and keep patients reasonably informed. In respecting patient autonomy, they would usually seek to influence patient choice by persuasion. However, the residual "Asian-ness" of doctors in Singapore gives rise to some inconsistencies between values and practices. Many doctors still believe that a number of their patients are incapable of rational choice. There is some lack of openness in telling patients the whole truth. When patients choose to refuse treatment, many doctors are prepared to involve family members in making a consensus decision. Doctors were also asked how they made ethical judgements in the face of dilemmas, and how they would like disputes with patients to be resolved. By and large, the doctors prefer to make their own judgements rather than to rely on rules. They also wish to keep the law courts out of disputes with patients, preferring less public ways of settling disputes. (shrink)

Neste artigo, interrogamos os funcionamentos do conceito de platô em "Mil Platôs" (1980), a obra-prima de Deleuze e Guattari. Essa pesquisa esclarece, de forma concreta, duas linhas de pensamento, que são a epistemológica, por um lado, e a ética, por outro, enfocando os parágrafos nos quais Deleuze e Guattari usam efetivamente esse conceito. Do ponto de vista epistemológico, o conceito de platô permite praticar uma maneira de escrita rizomática e a explicação antiteleológica. Do ponto de vista ético, esse conceito, tirado (...) de Gregory Bateson, nos convida a formar a alegria contínua e global, ou a gaieté em termos espinosistas. In this paper, we question the workings of the concept of plateau in "A Thousand Plateaus" (1980), Deleuze and Guattari's chef-d'oeuvre. This research specifically clarifies two lines of thought, which are epistemological on the one hand, and ethics on the other hand, focusing on the paragraphs where Deleuze and Guattari actually employ this concept. From the epistemological point of view, the concept of plateau allows practicing a way of rhizomatic writing and anti-teleological explanation. From the point of view of ethics, this concept borrowed from Gregory Bateson invites us to form the continuous and global joy, or gaiety in Spinoza's terms. (shrink)

Projects that challenge students to practice service leadership for civic improvement can address the aim of developing civic-mindedness in undergraduates. We conducted two qualitative studies. First, we investigated the learning experiences of four teams of undergraduate business students, who undertook semester-long course-embedded service-learning projects in partnership with four Hong Kong-based social enterprises. The students described five modes of civic engagement as project purposes, mentioned applying six types of service leadership practice for civic improvement, and described eight types of developmental outcome (...) within the domain of civic-mindedness. Comparisons suggested that besides relational support through training and guidance, empowering infrastructure, opportunities to exercise autonomy, and opportunities to demonstrate competence, three project-related features that varied between projects were important in fostering civic-mindedness. These were direct contact with grassroots-based beneficiaries; the experience of making a tangible difference; and linking the campus with the wider community. A second qualitative study indicated that course-embedded team projects with these features that were undertaken in mixed teams that included freshman and senior year business students fostered civic-mindedness for both categories of student. (shrink)

The Deaf culture in the United States is a unique culture that is not widely understood. To members of the Deaf community in the United States, deafness is not viewed as a disease or pathology to be treated or cured; instead it is seen as a difference in human experience. Members of this community do not hide their deafness; instead they take great pride in their Deaf identity. The Deaf culture in the United States is very communitarian not individualistic. Mary (...) Beth and Dominic are a married couple in their late 20s who are genetically deaf. They are active members in the Deaf community and work as advocates for individuals who are deaf, family members of Deaf people and sign language interpreters who identify with the Deaf culture. Mary Beth and Dominic approach the fertility clinic with a request that they only want a child with the genetic gene for deafness. They would want the embryos that do not have the gene to be destroyed. This would entail creating a child who would have the gene for deafness. Medically and ethically, should the fertility clinic agree to the couple’s request? The authors argue that the couple's request should be denied and provide reasons for it from the perspectives of foundational and clinical ethics. (shrink)

Modern philosophy is divided, apparently. The two apparent divisions are commonly referred to as “Analytic” and “Continental” (Prado). The former division is often seen as Kantian, ahistoricist, scientific, and logical; the latter division is often seen as Hegelian, historicist, conversational, and rhetorical (Rorty). In this paper, we attempt to use the principles of experimental philosophy and comparative computational techniques against a corpus of self-identified “analytic” and “continental” texts in order to test various hypotheses about the analytic/continental divide from the philosophical (...) literature: some hypotheses are supported, some opposed, and others left open to further research. This project was funded by the 2022 University of Houston MD Anderson Library Digital Research Commons Special Projects Grant. (shrink)

In Singapore’s multicultural society, a sizable proportion of the population subscribes to complementary and alternative medicine. In this article, we discuss the impact this has on medical practice in the context of the four principles of medical ethics. To uphold the principle of autonomy, we propose a non-judgmental approach towards patients who use CAM. Nevertheless, in order to promote health and prevent harm, the safety profiles of CAM must be studied through systematic research. In addition, the principle of justice is (...) one concerned with the fair distribution of scarce healthcare resources, while granting equal access to healthcare regardless of beliefs. Understanding CAM from an ethical perspective allows for the provision of safe, holistic, and culturally relevant care. (shrink)

Thesis (Ph.D.)--University of Hawaii at Manoa, 2008.

© 2014 Zou et al. Nrf2, a central regulator of the cellular defense against oxidative stress and inflammation, participates in modulating hepatocyte proliferation during liver regeneration. It is not clear, however, whether Nrf2 regulates hepatocyte growth, an important cellular mechanism to regain the lost liver mass after partial hepatectomy. To determine this, various analyses were performed in wild-type and Nrf2-null mice following PH. We found that, at 60 h post-PH, the vast majority of hepatocytes lacking Nrf2 reduced their sizes, activated (...) hepatic progenitor markers, depleted HNF4α protein, and downregulated the expression of a group of genes critical for their functions. Thus, the identity of hepatocytes deficient in Nrf2 was transiently but massively impaired in response to liver mass loss. This event was associated with the coupling of protein depletion of hepatic HNF4α, a master regulator of hepatocyte differentiation, and concomitant inactivation of hepatic Akt1 and p70S6K, critical hepatocyte growth signaling molecules. We conclude that Nrf2 participates in maintaining newly regenerated hepatocytes in a fully differentiated state by ensuring proper regulation of HNF4α, Akt1, and p70S6K during liver regeneration. (shrink)

Liver transplantation (LT) activities during the COVID-19 pandemic have been curtailed in many countries. The impact of various policies restricting LT on outcomes of potential LT candidates is unclear. We studied all patients on the nationwide LT waitlists in Hong Kong and Singapore between January 2016 and May 2020. We used continuous time Markov chains to model the effects of different scenarios and varying durations of disruption on LT candidates.

ObjectivesWorking-age cancer patients face barriers to resuming work after treatment completion. Those resuming work contend with reduced productivity arising from persisting residual symptoms. Existing studies of return to work after cancer diagnosis were done predominantly in Western countries. Given that employment and RTW in cancer survivors likely vary regionally due to healthcare provision and social security differences, we documented rates and correlates of RTW, work productivity, and activity impairment among Chinese cancer survivors in Hong Kong at one-year post-treatment.MethodsOf 1,106 cancer (...) patients assessed at six-months post-cancer treatment, 593 previously worked; detailed work status, psychological distress, physical symptom distress, supportive care needs, health-related quality of life, and illness perception were assessed. Six months later, work productivity and activity impairment were assessed. Descriptive analyses examined RTW rate. Fully adjusted regressions determined RTW, work productivity, and activity impairment predictors.ResultsAt baseline, 39% were working, 26% on sick leave, and 35% were unemployed. Compared to patients returning to work, unemployed participants were older, likely manual/service-oriented workers, and had lower family income, chemotherapy, fewer unmet health system and information needs, poorer physical functioning, and negative illness perceptions. Sick leave participants were likely service-oriented workers, who had head and neck cancer, chemotherapy, and poor physical functioning. At FU, baseline depressive symptoms, physical symptom distress, and negative illness perceptions predicted presenteeism and work productivity loss; gynecological cancer, fewer unmet health system and information needs, and greater unmet sexuality needs predicted absenteeism; physical symptom distress, negative illness perception, and poor physical functioning predicted activity impairment.ConclusionCancer survivors who had more physically demanding jobs and poorer physical functioning delayed RTW. Unmanaged physical symptom and psychological distress hindered work productivity. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Background: Frailty is a natural consequence of the aging process. With the increasing aging population in Mainland China, the quality of life and end-of-life care for frail older people need to be taken into consideration. Advance Care Planning has also been used worldwide in long-term facilities, hospitals and communities to improve the quality of end-of-life care, increase patient and family satisfaction, and reduce healthcare costs and hospital admissions in Western countries. However, it has not been practiced in China. Research objective: (...) This study aimed to evaluate the effectiveness of a modified Advance Care Planning intervention in certainty of end-of-life care, preferences for end-of-life care, quality of life concerns, and healthcare utilization among frail older people. Research design: This study used a quasi-experimental design, with a single-blind, control group, pretest and repeated posttest approach. Participants and research context: A convenience sample of 74 participates met the eligibility criteria in each nursing home. A total of 148 frail older people were recruited in two nursing homes in Zhejiang Province, China. Ethical considerations: The study received ethical approval from the Clinical Research Ethics Committee, the Faculty of Medicine, and The Chinese University of Hong Kong, CREC Ref. No: 2016.059. Findings: The results indicated the Advance Care Planning programme was effective at increasing autonomy in decision making on end-of-life care issues, decreasing decision-making conflicts over end-of-life care issues, and increasing their expression about end-of-life care. Discussion: This study promoted the participants’ autonomy and broke through the inherent custom of avoiding talking about death in China. Conclusion: The modified Advance Care Planning intervention is effective and recommended to support the frail older people in their end-of-life care decision in Chinese society. (shrink)

The counseling process involves attention, emotional perception, cognitive appraisal, and decision-making. This study aimed to investigate cognitive appraisal and the associated emotional processes when reading short therapists' statements of motivational interviewing (MI). Thirty participants with work injuries were classified into the pre-contemplation (PC,n= 15) or readiness stage of the change group (RD,n= 15). The participants viewed MI congruent (MI-C), MI incongruent (MI-INC), or control phrases during which their electroencephalograms were captured. The results indicated significant Group × Condition effects in the (...) frontally oriented late positive complex (P600/LPC). The P600/LPC's amplitudes were more positive-going in the PC than in the RD group for the MI congruent statements. Within the PC group, the amplitudes of the N400 were significantly correlated (r= 0.607–0.649) with the participants' level of negative affect. Our findings suggest that the brief contents of MI statements alone can elicit late cognitive and emotional appraisal processes beyond semantic processing. (shrink)

Monoterpenes are the main components of essential oils and are possible precursors for many commodity chemicals and high energy density fuels. Monoterpenes are synthesized from geranyl diphosphate, which is also the precursor for the biosynthesis of farnesyl diphosphate. FPP biosynthesis diverts the carbon flux from monoterpene production to C15 products and quinone biosynthesis. In this study, we tested a chromosomal mutation of E. coli's native FPP synthase to improve GPP availability for the production of monoterpenes using a heterologous mevalonate pathway. (...) Monoterpene production at high levels required not only optimization of GPP production but also a basal level of FPP to maintain growth. The optimized strains produced two jet fuel precursor monoterpenoids 1,8-cineole and linalool at the titer of 653 mg/L and 505 mg/L, respectively, in batch cultures with 1% glucose. The engineered strains developed in this work provide useful resources for the production of high-value monoterpenes. This article is protected by copyright. All rights reserved. (shrink)

The crystal structures of three new intermetallic ternary compounds in the LnNiSb 3 family have been characterized by single crystal X-ray diffraction. PrNiSb 3, NdNiSb 3 and SmNiSb 3 all crystallize in an orthorhombic space group, Pbcm, Z=12, with a=12.5700Å, b=6.2010Å, c=18.670Å, and V=1431.64Å3; a=12.5090Å, b=6.1940Å, c=18.3350Å, and V=1420.61Å3; and a=12.3900Å, b=6.1760Å, c=18.2650Å, and V=1397.65Å3, for Ln=Pr, Nd and Sm, respectively. These compounds consist of rare-earth atoms located above and below layers of nearly square, buckled Sb nets, along with layers (...) of highly distorted edge- and face-sharing NiSb 6 octahedra. Resistivity data indicate metallic behavior for all three compounds. Magnetization measurements show antiferromagnetic behavior with TN=4.5K, 4.6 K, and 2.9 K. Effective moments of 3.62 μ B, 3.90 μ B and 0.80 μ B are found for PrNiSb 3, NdNiSb 3 and SmNiSb 3, respectively, and are consistent with Pr 3+, Nd 3+, and Sm 3+. Structure of PrNiSb 3 viewed down the b-axis containing Pr atoms located between layers of nearly square Sb nets and highly distorted Ni-centered octahedra. © 2004 Elsevier Inc. All rights reserved. (shrink)

© 2015 American Chemical Society.Near-infrared dye-sensitized upconversion nanoparticles can broaden the absorption range and boost upconversion efficiency of UCNPs. Here, we achieved significantly enhanced upconversion luminescence in dye-sensitized core/active shell UCNPs via the doping of ytterbium ions in the UCNP shell, which bridged the energy transfer from the dye to the UCNP core. As a result, we synergized the two most practical upconversion booster effectors to amplify upconversion efficiency. We demonstrated two biomedical applications using these UCNPs. By using dye-sensitized core/active (...) shell UCNP embedded poly polymer implantable systems, we successfully shifted the optogenetic neuron excitation window to a biocompatible and deep tissue penetrable 800 nm wavelength. Furthermore, UCNPs were water-solubilized with Pluronic F127 with high upconversion efficiency and can be imaged in a mouse model. (shrink)

Although separated in time and place, is a dialogue possible between Lee Yulgok and Heinrich Ott? This is what this study will attempt to find out. Ours will be an attempt to bridge the diachronical and diatopical gap through a creative hermeneutics. Our attempt to establish a dialogue between Yulgok and Ott should not be based simply on a few 'concepts' drawn from Yulgok and Ott. Instead, we have to take the entire thought-systems of Yulgok and Ott in order to (...) open a possibility of a cross-cultural dialogue. ;For both Yulgok and Ott, the non-dualistic approach is essential to the formulation of their thoughts. In his formulation and interpretations of Bonhoeffer's theology, Ott's attempt to establish a non-dualistic approach poses a possible solution to the conflict between the theologies of K. Barth and R. Bultmann. ;In comparison, Yulgok tried in his own way to contribute a non-dualistic way of thinking for the Confucian tradition through his own creative and critical interpretation of Chu Hsi. ;In order to be engaged in a fruitful dialogue between Yulgok and Ott, we need to establish a 'point of contact' through which the dialogue between Confucian philosophy and Christian theology may take place. This 'point of contact', in the case of the dialogue between Yulgok and Ott, is 'sincerity' and 'reality'. (shrink)