ObjectiveTo assess the impact of the closure of group-based cardiac rehabilitation training during the first COVID-19 lockdown in spring 2020 on patients’ physical activity, cardiorespiratory fitness, and cardiovascular risk, and to describe the patient experience of lockdown and home-based exercise training during lockdown.DesignMixed methods study. Prospectively collected post-lockdown measurements were compared to pre-lockdown medical record data. Quantitative measurements were supplemented with qualitative interviews about the patient experience during lockdown.SettingOutpatient CR centre in Salzburg, Austria.ParticipantsTwenty-seven patients [six female, mean age (...) 69 years] who attended weekly CR training sessions until the first COVID-19 lockdown in March 2020.Outcome MeasureQuantitative: exercise capacity, cardiovascular risk. Qualitative: individual semi-structured interviews.ResultsExercise capacity had significantly reduced from pre- to post-lockdown: mean power in maximal ergometry 165 vs. 151, p < 0.001; submaximal ergometer training 99 vs. 97, p = 0.038. There was no significant difference in Framingham risk score and other cardiovascular risk factors. Qualitative data showed that almost all patients had kept physically active during lockdown, but 17 said they had been unable to maintain their exercise levels, and 15 felt their cardiorespiratory fitness had deteriorated. Many patients missed the weekly CR training and the motivation and sense of community from training together with others. Several patients stated that without professional supervision they had felt less confident to carry out home-based exercise training at high intensity.ConclusionThis study highlights the importance of group-based supervised exercise training for patients who engage well in such a setting, and the detrimental impact of disruption to this type of CR service on physical activity levels and exercise capacity. Additionally, learning from the COVID-19 pandemic may inform the development and implementation of remote CR modalities going forward. (shrink)

Exercise-based rehabilitation forms a key part of the UK National Health Service patient-care pathway for cardiac rehabilitation (CR). Only around half of all eligible patients attend core CR, however, with social inequalities affecting participation. Few qualitative studies have explored in-depth the key factors influencing engagement with CR, specifically from a sociological theoretical, and ethnographic perspective. Utilising an ethnographic approach allowed us to get a sense of the embodied experiences of 10 participants attending or declining core CR, together (...) with a further seven family members/significant others. This provided in-depth appreciation of participants’ lifeworld contexts as key influences on CR participation. The article draws on these qualitative data and focuses on 1) participants’ initial thoughts about CR; and 2) navigating the field of CR, analysed via thematic analysis. We utilise a Bourdieusian theoretical perspective to theorise the findings, including salient socio-cultural factors influencing attendance/non-attendance and (non)adherence. The article findings highlight how perceptions of CR and the ability to navigate the field are strongly influenced by habitus and capital, and how personal biographies and socio-material conditions affect adherence to CR programmes. The study provides original insights into embodied experiences of exercise-based CR, and novel understandings of the reasons for drop-out/poor adherence, theorised from a Bourdieusian perspective. (shrink)

Complex adaptive systems and nursingThere have been numerous references to complexity theory and complex systems in the recent healthcare literature, including nursing. However, exaggerated claims have (in my view) been made about how they can be applied to health service delivery, and there is a widespread tendency to misunderstand some of the concepts associated with complexity thinking (usually justified by describing the misconception as a metaphor). These conceptscanbe extended to systems and structures in healthcare organisations but, at this stage in (...) the development of complexity science, only in a modest and very cautious way. In this paper I first outline some of the key ideas in the theory of complex adaptive systems, and then suggest that they have been distorted by a series of influential articles in the medical literature. I go on to present a simple case study of my own and undertake a complexity analysis of it. In the conclusion I suggest that we should beware of some outdated ideas being trotted out in the guise of complexity — an exciting and diverse area of enquiry that those old ideas do not, in fact, resemble. (shrink)

Infertile couples have come to take assisted reproductive technologies (ART) for granted. An increasing number of single women and lesbian couples also desire to have children and turn to ART, especially donor insemination, to fulfill this desire. While most married couples find that access to ART is limited primarily by the ability to pay, for single women and lesbian couples, the story may be much different. In the United States, they may find that doctors and infertility clinics view their desires (...) as immoral and refuse to accept them as patients, although other doctors and clinics readily accept them. In most other countries, however, it is against the law for single women and lesbian couples to make use of ART, including donor insemination. In this paper I will argue that marital status and sexual orientation should not serve as a barrier to accessing the world of reproductive medicine. I will base this conclusion on two arguments. First, that justice requires that we treat like cases alike. Just as we would not accept or reject patients for cardiac rehabilitation programs based on factors such as a history of poor eating habits, so too we should not look at nonmedical factors such as marital status when deciding whether to treat infertility. For the second justification for the conclusion of equal access to ART, I will examine the concept of the family. I will argue that it is morally acceptable for single women and lesbian couples to have children and to head families. (shrink)

This study is a continuation of the work of Professor Kazimierz Wrześniewski. It concerns the role of curiositytrait in the dynamics of changes in coping and quality of life after a heart attack. The study was attended by 222 people after a heart attack, of whom 140 participated in the three stages of the study: at the beginning and at the end of cardiac rehabilitation and a year after leaving the resort. The participants aged 24-64 years. Curiosity-trait was (...) measured by Spielberger and Wrześniewski’s STPI questionnaire. To assess coping strategies a modified version of the COPE by Carver et al., was used. The specific and general quality of life were measured by the Polish adaptations of MacNew and NHP questionnaires. The level of curiosity-trait significantly differentiated changes in the dynamics of positive reinterpretation, problem solving and resignation, but did not affect the change in quality of life within the year after a heart attack. (shrink)

Infertile couples have come to take assisted reproductive technologies (ART) for granted. An increasing number of single women and lesbian couples also desire to have children and turn to ART, especially donor insemination, to fulfill this desire. While most married couples find that access to ART is limited primarily by the ability to pay, for single women and lesbian couples, the story may be much different. In the United States, they may find that doctors and infertility clinics view their desires (...) as immoral and refuse to accept them as patients, although other doctors and clinics readily accept them. In most other countries, however, it is against the law for single women and lesbian couples to make use of ART, including donor insemination.In this paper I will argue that marital status and sexual orientation should not serve as a barrier to accessing the world of reproductive medicine. I will base this conclusion on two arguments. First, that justice requires that we treat like cases alike. Just as we would not accept or reject patients for cardiac rehabilitation programs based on factors such as a history of poor eating habits, so too we should not look at nonmedical factors such as marital status when deciding whether to treat infertility. For the second justification for the conclusion of equal access to ART, I will examine the concept of the family. I will argue that it is morally acceptable for single women and lesbian couples to have children and to head families. (shrink)

Previous studies suggest in line with dual process models that interoceptive skills affect controlled decisions via automatic or implicit processing. The “framing effect” is considered to capture implicit effects of task-irrelevant emotional stimuli on decision-making. We hypothesized that cardiac awareness, as a measure of interoceptive skills, is positively associated with susceptibility to the framing effect. Forty volunteers performed a risky-choice framing task in which the effect of loss versus gain frames on decisions based on identical information was assessed. The (...) results show a positive association between cardiac awareness and the framing effect, accounting for 24% of the variance in the framing effect. These findings demonstrate that good interoceptive skills are linked to poorer performance in risky choices based on ambivalent information when implicit bias is induced by task-irrelevant emotional information. These findings support a dual process perspective on decision-making and suggest that interoceptive skills mediate effects of implicit bias on decisions. (shrink)

According to a number of influential views in penal theory, 1 one of the primary goals of the criminal justice system is to rehabilitate offenders. Rehabilitativemeasures are commonly included as a part of a criminal sentence. For example, in some jurisdictions judges may order violent offenders to attend anger management classes or to undergo cognitive behavioural therapy as a part of their sentences. In a limited number of cases, neurointerventions — interventions that exert a direct biological effect on the brain (...) — have been used as aids to rehabilitation, typically being imposed as part of criminal sentences, separate treatment orders, or conditions of parole. Examples of such interventions include medications intended to attenuate addictive desires in substance-abusing offenders and agents intended to suppress libido in sex offenders.This chapter reviews some of the ethical issues raised by the use of neurointerventions as aids to rehabilitation. (shrink)

Cardiac disease is the leading cause of death worldwide. Cardiovascular diseases can be prevented if an effective diagnostic is made at the initial stages. The ECG test is referred to as the diagnostic assistant tool for screening of cardiac disorder. The research purposes of a cardiac disorder detection system from 12-lead-based ECG Images. The healthcare institutes used various ECG equipment that present results in nonuniform formats of ECG images. The research study proposes a generalized methodology to process (...) all formats of ECG. Single Shoot Detection MobileNet v2-based Deep Neural Network architecture was used to detect cardiovascular disease detection. The study focused on detecting the four major cardiac abnormalities with 98% accuracy results were calculated. The work is relatively rare based on their dataset; a collection of 11,148 standard 12-lead-based ECG images used in this study were manually collected from health care institutes and annotated by the domain experts. The study achieved high accuracy results to differentiate and detect four major cardiac abnormalities. Several cardiologists manually verified the proposed system’s accuracy result and recommended that the proposed system can be used to screen for a cardiac disorder. (shrink)

The purpose of this study was to explore the challenges met by nursing staff in a rehabilitation ward. The overall design was qualitative: data were derived from focus interviews with groups of nurses and analyzed from a phenomenological-hermeneutic perspective. The main finding was that challenges emerge on two levels of ethics and rationality: an economic/administrative level and a level of care. An increase in work-load and the changing potential for patient rehabilitation influence the care that nurses can provide (...) in rehabilitating patients, and therefore also affect patients’ feelings of self-worth and dignity. Some patients wish to maintain their independence and autonomy, whereas others seem to ‘lose themselves’. Independence and autonomy are associated with dignity, but their lack is contrary to it. (shrink)

Hannah Arendt a un problème avec la philosophie. Si elle en joue et provoque, le trait s’avère constant, tout au long de sa vie, publique comme privée. Jamais elle ne cacha son peu d’appétence pour les « diseur[s] professionnel[s] de vérité »1. Elle poussa même le vice jusqu’à déclarer, en réponse à Günther Gauss qui, lors d’une célèbre entrevue datant de 1964 et tel le frais cabri qui, avec candeur et bonheur, se dirige guilleret, primesautier, vers la surprise party que (...) donne le loup en son... (shrink)

Criminal offenders are sometimes required, by the institutions of criminal justice, to undergo medical interventions intended to promote rehabilitation. Ethical debate regarding this practice has largely proceeded on the assumption that medical interventions may only permissibly be administered to criminal offenders with their consent. In this article I challenge this assumption by suggesting that committing a crime might render one morally liable to certain forms of medical intervention. I then consider whether it is possible to respond persuasively to this (...) challenge by invoking the right to bodily integrity. I argue that it is not. (shrink)

Criminal offenders may be offered to participate in voluntary rehabilitation programs aiming at correcting undesirable behaviour, as a condition of early release. Behavioural treatment may include direct intervention into the central nervous system (CNS). This article discusses under which circumstances voluntary rehabilitation by CNS intervention is justified. It is argued that although the context of voluntary rehabilitation is a coercive circumstance, consent may still be effective, in the sense that it can meet formal criteria for informed consent. (...) Further, for a consent to be normatively valid (“take the wronging out of the act”) under a coercive circumstance, the subject to be treated must (1) have the sovereign authority to consent, and (2) the offer-giver must be in the right normative position to make the offer. While I argue that subjects do have the sovereign authority to consent to treatment, I also argue that inappropriate offers yield invalid consents. Considerations on inappropriate offers should therefore inform which kinds of CNS intervention-based rehabilitation schemes the state may propose as part of the criminal justice system. Yet as I conclude in this paper, while there are some intrinsic constraints on voluntary rehabilitation programs, the main constraints on voluntary rehabilitation are likely to be contingent overriders. However, CNS intervention is not ruled out as such in the context of voluntary rehabilitation. (shrink)

Interoception in the broader sense refers to the perception of internal states, including the perception of the actual state of the internal organs and the motor system. Dimensions of interoception include interoceptive accuracy, i.e., the ability to sense internal changes assessed with behavioral tests, confidence rating with respect to perceived performance in an actual behavioral test, and interoceptive sensibility, i.e., the self-reported generalized ability to perceive body changes. The relationship between dimension of cardioceptive and proprioceptive modalities and their association with (...) affect are scarcely studied. In the present study, undergraduate students filled out questionnaires assessing positive and negative affect, interoceptive sensibility, and body competence. Following this, they completed a behavioral task assessing cardioceptive accuracy and two tasks assessing proprioceptive accuracy with respect to the tension of arm flexor muscles and the angular position of the elbow joint. Confidence ratings were measured with visual analog scales after the tasks. With the exception of a weak association between cardioceptive accuracy and the respective confidence rating, no associations between and within modalities were found with respect to various dimensions of interoception. Further, the interoceptive dimensions were not associated with state and trait positive and negative affect and perceived body competence. In summary, interoceptive accuracy scores do not substantially contribute to conscious representations of cardioceptive and proprioceptive ability. Within our data, non-pathological affective states are not associated with the major dimensions of interoception for the cardiac and proprioceptive modalities. (shrink)

Recently, the practice of deciding legal cases on purely statistical evidence has been widely criticised. Many feel uncomfortable with finding someone guilty on the basis of bare probabilities, even though the chance of error might be stupendously small. This is an important issue: with the rise of DNA profiling, courts are increasingly faced with purely statistical evidence. A prominent line of argument—endorsed by Blome-Tillmann 2017; Smith 2018; and Littlejohn 2018—rejects the use of such evidence by appealing to epistemic norms that (...) apply to individual inquirers. My aim in this paper is to rehabilitate purely statistical evidence by arguing that, given the broader aims of legal systems, there are scenarios in which relying on such evidence is appropriate. Along the way I explain why popular arguments appealing to individual epistemic norms to reject legal reliance on bare statistics are unconvincing, by showing that courts and individuals face different epistemic predicaments (in short, individuals can hedge when confronted with statistical evidence, whilst legal tribunals cannot). I also correct some misconceptions about legal practice that have found their way into the recent literature. (shrink)

Certain organoid subtypes are particularly sensitive. We explore whether moral intuitions about the heartbeat warrant unique moral consideration for newly advanced contracting cardiac organoids. Despite the heartbeat’s moral significance in organ procurement and abortion discussions, we argue that this significance should not translate into moral implications for cardiac organoids.

The implications for the substantivalist–relationalist controversy of Barbour and Bertotti's successful implementation of a Machian approach to dynamics are investigated. It is argued that in the context of Newtonian mechanics, the Machian framework provides a genuinely relational interpretation of dynamics and that it is more explanatory than the conventional, substantival interpretation. In a companion paper (Pooley [2002a]), the viability of the Machian framework as an interpretation of relativistic physics is explored. 1 Introduction 2 Newton versus Leibniz 3 Absolute space versus (...) an affine connection 4 Anti-relationalist arguments 5 Rehabilitating relationalism 6 Dynamics on the relative configuration space 7 Intrinsic particle dynamics 8 Conclusion. (shrink)

A 68-year-old patient who suffered from gastric cancer diagnosed 8 months earlier presented with multiple peritoneal and hepatic metastasis, despite several rounds of chemo- and radiotherapy. After admission to hospital, his general condition quickly became severely compromised. He was nearly emaciated, despite being on partial parenteral feeding. Four years earlier, due to a cardiac arrhythmia that was refractory to medication, the patient had a cardiac pacemaker implanted, regulated to go off at frequencies of below 70 beats per minute. (...) Given the patient's terminal situation, the team started developing some doubts about the pacemaker's effects during his dying process. The patient had mentioned his intention to donate his pacemaker after his death, but had not asked for its deactivation. The specialists were not sure about the effect of the pacemaker in unnecessarily prolonging the patient's final hour. Nevertheless, they opposed deactivation, which they considered ethically uncertain. The family, who had been initially for the deactivation, decided against it. The patient's condition was progressively deteriorating, as he was falling into a state of sopor and, later, into a coma. (shrink)

This article explores the rehabilitation of the ethical dimension of human interactions with nature, using cross-cultural perspectives in Africa. Cross-cultural comparison of indigenous concepts of the relationship between people and nature with contemporary environmental and scientific issues facilitate the rehabilitation, renewal and validation of indigenous environmental ethics. Although increasing attention is being given to the environmental concerns of non-western traditions, most of the related research has centered on Asia, Native American Indians and Australian Aborigines with little attention being (...) paid to Africa. However, this study has confirmed that, like other multi-cultural traditions, African indigenous traditions contain symbolic and ethical messages that are passed from generation to generation in order to ensure respect and compassion for other living creatures. The article shows, however, that not all indigenous knowledge is environmentally friendly. Indigenous and modern environmental ethics alike have something to teach as well as something to learn. (shrink)

This article responds to Janet Kourany’s proposal, in Philosophy of Science after Feminism, that scientific practices be held to the ideal of ‘socially responsible science’, to produce results that are not only cognitively sound, but also significant in the light of values ‘that can be morally justified’. Kourany also urges the development of ‘contextualized philosophy of science’—of which feminist philosophy of science is exemplary—that is ‘politically engaged’ and ‘activist’, ‘informed by analyses of the actual ways in which science interacts with (...) the wider society in which it occurs, the ways in which science is shaped by and in turn shapes society’, and that can contribute to understanding both the cognitive and social dimensions of science. Although I share Kourany’s commitment to contextualized philosophy of science, I question her proposed ideal of ‘socially responsible science’ and the grounds she provides for adopting it. My argument leads me to defend rehabilitating the traditional ideal of the ‘neutrality’ of science, which I reinterpret as the ideal of ‘inclusiveness and evenhandedness’. (shrink)

In this short article, we articulate a position that organ recovery from uncontrolled DCD — primarily patients who have suffered a cardiac arrest — is unlikely to result in a significant number of organs, and this small gain must be balanced against significant risk of unduly influencing resuscitation provider decision-making, and jeopardizing public trust in the propriety of organ donation and transplantation.

The lack of clarity of religious values in rehabilitation program conducted for prisoners in jails has been the cause of a failure of the rehabilitation process of prisoners. This research aims to examine the implementation of the prisoner rehabilitation program and offer relevant components of humanist values for rehabilitation in prisons. The research method used a naturalistic qualitative approach and an analytical descriptive data analysis technique, and revealed in detail the prisoner rehabilitation program through the (...) developing of religious values for behavioral change. This research showed that the prisoner rehabilitation programs in prisons is a very significant effort to bring behavioral change in prisoners. Despite this, the evaluation undertaken of the rehabilitation program shows sub-optimal results. It was found that application of humanist values can replace prohibitions and punishment which are applied on prisoners. The research has implications for positive changes in prisoner behavior which tend to be more grounded in consciousness than fear of prohibition and punishment. This research provides further evidence as to the effectiveness of the humanist approach in prisoner religious rehabilitation. (shrink)

: When may a physician legitimately offer enrollment in a randomized clinical trial (RCT) to her patient? Two answers to this question have had a profound impact on the research ethics literature. Equipoise, as originated by Charles Fried, which we term Fried's equipoise (FE), stipulates that a physician may offer trial enrollment to her patient only when the physician is genuinely uncertain as to the preferred treatment. Clinical equipoise (CE), originated by Benjamin Freedman, requires that there exist a state of (...) honest, professional disagreement in the community of expert practitioners as to the preferred treatment. FE and CE are widely understood as competing concepts. We argue that FE and CE offer separable and, in themselves, incomplete justifications for the conduct of clinical trials. FE articulates conditions under which the fiduciary duties of physician to patient may be upheld in the conduct of research. CE sets out a standard for the social approval of research by institutional review boards. Viewed in this way, FE and CE are not necessarily competing notions, but rather address complementary moral concerns. (shrink)

Rehabilitation For Traumatic Brain Injury (TBI) is a state-of-the-science review of the effectiveness of rehabilitation interventions.

The point Sesardic (Biol Philos 25: 143–162, 2010) makes about the possibility of distinguishing groups for which there is a lot of within-group variation is not sufficient to rehabilitate a biological concept of race. In this note, I sketch a number of issues that quickly arise once we delve more deeply into the relevant scientific knowledge, concepts, methods, and questions for inquiry.

: The feminist ethic of care has often been criticized for its inability to address four problems--the problem of exploitation as it threatens care givers, the problem of sustaining care-giver integrity, the dangers of conceiving the mother-child dyad normatively as a paradigm for human relationships, and the problem of securing social justice on a broad scale among relative strangers. We argue that there are resources within the ethic of care for addressing each of these problems, and we sketch strategies for (...) developing the ethic more fully. (shrink)

In his Kritik der reinen Vernunft, Kant asserts that laws of nature “carry with them an expression of necessity”. There is, however, widespread interpretive disagreement regarding the nature and source of the necessity of empirical laws of natural sciences in Kant's system. It is especially unclear how chemistry—a science without a clear, straightforward connection to the a priori principles of the understanding—could contain such genuine, empirical laws. Existing accounts of the necessity of causal laws unfortunately fail to illuminate the possibility (...) of non-physical laws. In this paper, I develop an alternative, ‘ideational’ account of natural laws, according to which ideas of reason necessitate the laws of some non-physical sciences. Chemical laws, for instance, are grounded on ideas of the elements, and the chemist aims to reduce her phenomena to these elements via experimentation. Although such ideas are beyond the possibility of experience, their postulation is necessary for the achievement of reason's theoretical ends: the unification and explanation of the cognitions of science. (shrink)

In Psychoanalysis, its image and its public Moscovici introduced the theory of social representations and took further the project of rehabilitating common sense. In this paper I examine this project through a consideration of the problem of cognitive polyphasia, and the continuity and discontinuity between different systems of knowing. Focusing on the relations between science and common sense. I ask why, despite considerable evidence to the contrary, the scientific imagination tends to deny its relation to common sense and believe that (...) can displace it. I argue that the psychosocial dynamic between common sense and science is revealing of how heavily they are entangled in, and indeed indebted to each other. Even more, this dynamic allows for a full appreciation of what the theory of social representations calls states of cognitive polyphasia. Different systems of thinking and knowing do not displace each other but live side by side, co-existing in a variety of ways, fulfilling different functions and answering different needs in social life. (shrink)

The management of children born with trisomy 18 is controversial, and both providers and parents often have differing opinions. Many parents choose to terminate the pregnancy while others go forward, making decisions based on their beliefs, understanding, and physician recommendations. Physicians are similarly divided regarding treatment of these children, as some feel that aggressive treatments are futile while others defer to the parents' wishes.Interrupted aortic arch with ventricular septal defect in children with trisomy 18 presents an ethical dilemma that highlights (...) the kinds of controversies in medical decision making facing physicians on a daily basis. Repair of interrupted aortic arch with ventricular septal defect poses a high risk to newborns with or without trisomy 18. Therefore, the option for surgery should be treated as with any routine informed consent process. Parents should be counseled about the risks, benefits, alternatives, and the likelihood of success both short and long term and be should offered a choice between surgery and palliative care. (shrink)