Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year survival of less than 50% who had advanced gastrointestinal or lung cancer or amyotrophic lateral sclerosis were interviewed. Each patient’s medical record was reviewed at enrollment and at 3 months for evidence of the discussion of patient wishes concerning (...) ventilator support, artificial nutrition and hydration , resuscitation and hospice care. A Kaplan–Meier analysis was also performed and 2-year survival calculated.Results: 60 cancer and 32 ALS patients were enrolled. ALS patients were more likely than cancer patients to have evidence of discussion about their wishes for ventilator support , ANH , DNR and hospice care . At 6 months, 91% of ALS patients were alive compared with 62% of cancer patients; at 2 years, 63% of ALS patients were alive compared with 23% of cancer patients .Conclusions: Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making. (shrink)

This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are dealing with professional boundary (...) issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. (shrink)

Ormerod and Chronicle reported that optimal solutions to traveling salesperson problems were judged to be aesthetically more pleasing than poorer solutions and that solutions with more convex hull nodes were rated as better figures. To test these conclusions, solution regularity and the number of potential intersections were held constant, whereas solution optimality, the number of internal nodes, and the number of nearest neighbors in each solution were varied factorially. The results did not support the view that the convex hull is (...) an important determinant of figural attractiveness. Also, in contrast to the findings of Ormerod and Chronicle, there were consistent individual differences. Participants appeared to be divided as to whether the most attractive figure enclosed a given area within a perimeter of minimum or maximum length. It is concluded that future research in this area cannot afford to focus exclusively on group performance measures. (shrink)

Under the careful editorship of R. A. Markus, this book appears to be one of the very finest anthologies of critical essays dedicated to the elucidation of the thought of St. Augustine. Those familiar with Markus’ contribution to The Cambridge History of Later Greek and Early Medieval Philosophy will readily attest to the depth as well as to the breadth of understanding which Markus brings to Augustine scholarship. Three of the essays appear for the first time: "Action and Contemplation," by (...) Robert J. O’Connell; "Si Fallor, Sum," by Gareth B. Matthews; "On Augustine’s Concept of a Person," by A. C. Boyd. The remaining articles have appeared either as separate pieces or as journal articles: "St. Augustine and Christian Platonism," by A. H. Armstrong; "St. Augustine on Signs," by R. A. Markus; "The Theory of Signs of St. Augustine’s De Doctrina Christiana," by B. Darrell Jackson; "Augustine on Speaking from Memory" and "The Inner Man," by Gareth B. Matthews; "Augustine on Foreknowledge and Free Will," by William L. Rowe; "Augustine on Free Will and Predestination," by John M. Rist; "Time and Contingency in St. Augustine," by Robert Jordan; "Empiricism and Augustine’s Problems about Time," by Hugh M. Lacey; "Political Society," by P. R. L. Brown; "The Development of Augustine’s Ideas on Society before the Donatist Controversy" and "De Civitate Dei, XV, 2, and Augustine’s Idea of the Christian Society," The essays display scholarly depth as well as concern for contemporary philosophical problems. It is an excellent addition to Augustine scholarship and to contemporary philosophizing. This book is part of the Doubleday Anchor Modern Studies in Philosophy Series, under the general editorship of Amelie O. Rorty.—D. A. C. (shrink)

Increasingly the body is a possession that does not belong to us. It is bought and sold, bartered and stolen, marketed wholesale or in parts. The professions - especially reproductive medicine, transplant surgery, and bioethics but also journalism and other cultural specialists - have been pliant partners in this accelerating commodification of live and dead human organisms. Under the guise of healing or research, they have contributed to a new 'ethic of parts' for which the divisible body is severed from (...) the self, torn from the social fabric, and thrust into commercial transactions -- as organs, secretions, reproductive capacities, and tissues -- responding to the dictates of an incipiently global marketplace. Breaking with established approaches which prioritize the body as 'text', the chapters in this book examine not only images of the body-turned-merchandise but actually existing organisms considered at once as material entities, semi-magical tokens, symbolic vectors and founts of lived experience. The topics covered range from the cultural disposal and media treatment of corpses, the biopolitics of cells, sperm banks and eugenics, to the international trafficking of kidneys, the development of 'transplant tourism', to the idioms of corporeal exploitation among prizefighters as a limiting case of fleshly commodity. This insightful and arresting volume combines perspectives from anthropology, law, medicine, and sociology to offer compelling analyses of the concrete ways in which the body is made into a commodity and how its marketization in turn remakes social relations and cultural meanings. (shrink)

The syllabus presented here is designed for use in the training of researchers and research ethics committee members throughout the European Union and beyond. It is intended to be accessible to scientific and lay readers, including those with no previous experience of ethical theory and analysis. The syllabus will cover key issues in the ethics of research involving human participants, including the ethical issues associated with new technologies.

This paper examines the issue of global child labor. The treatment is grounded in the classical economics of Adam smith and the more recent writings of human capital theorists. Using this framework, the universal problem of child labor in newly industrializing countries is investigated. Child labor is placed in its historical context with a brief review of practices in the United States and Great Britain at the time those countries were industrializing. Then, child labor is examined in its contemporary global (...) context. We argue that, as countries industrialize, they tend to follow predictable patterns of development – including use of and eventual abandonment of child labor. We argue that this convergence under the logic of industrial capitalism supports a universalist approach to human rights (that would condemn child labor) over a more tolerant cultural relativist approach. (shrink)

What can textual combinations, format, and size tell us about the worldviews of the donors, scribes, and readers of medieval Chinese Buddhist manuscripts? How can material sources inform us about the ways adherents both perceived and actively shaped their traditions? This essay offers answers to these questions through analysis of several manuscripts of the Scripture on the Cause and Effects of Wholesome and Unwholesome Acts (Shan’e yinguo jing 善惡因果經, T no. 2881), discovered in the Dunhuang Library Cave. The text was (...) likely composed in Chinese, and it first appears in Buddhist catalogs in the year 695 ce. Extant manuscripts of Cause and Effects appear in both scroll and booklet formats and number at least fifty-two in total, a significant number that attests to the popularity of the text. This essay analyzes the textual content and literary techniques, relating both to physical aspects of the manuscripts. It examines the textual and the material together through the mediating concept of practice—in this case, medieval Chinese reading practices. (shrink)

The Necessary Maximality Principle for c. c. c. forcing with real parameters is equiconsistent with the existence of a weakly compact cardinal. (© 2005 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim).

ABSTRACT Digital mental health interventions have emerged as a promising means of expanding access to mental healthcare. Prospective participants reporting severe symptoms or suicidal ideation are often excluded from DMHI trials and may struggle to access alternative treatments. However, evidence suggests that DMHIs are efficacious for people reporting these characteristics. We suggest that there are risks to both including and excluding people from DMHI trials, and we urge researchers to ensure that their eligibility criteria are designed in an evidence-based and (...) ethically conscious manner. We also make specific recommendations for those working in various other capacities within the academic community. (shrink)

This study contributes simultaneously to research on women board members and competitive dynamics by investigating two unresolved research questions: What is the effect of female directors on the firm’s competitive repertoire? Under what conditions is this effect more pronounced? Leveraging the “Awareness-Motivation-Capability” (AMC) framework, we predict that having women on the board of directors should impact the complexity, heterogeneity, and volume of the firm’s competitive moves. Relying upon a sample of U.S. pharmaceutical firms for the years 2000 to 2017, we (...) find that adding female directors on the board positively affects the complexity and volume of a firm’s competitive moves, but negatively impacts the heterogeneity of competitive actions. In addition, the presence of a female CEO moderates these effects, leading to more complex competitive actions and increased volume. Thus, our study lends a greater understanding of how female board members influence competitive dynamics and shape the strategic direction of the firm. (shrink)

Measuring neuronal activity with electrophysiological methods may be useful in detecting neurological dysfunctions, such as mild traumatic brain injury (mTBI). This approach may be particularly valuable for rapid detection in at-risk populations including military service members and athletes. Electrophysiological methods, such as quantitative electroencephalography (qEEG) and recording event-related potentials (ERPs) may be promising; however, the field is nascent and significant controversy exists on the efficacy and accuracy of the approaches as diagnostic tools. For example, the specific measures derived from an (...) electroencephalogram (EEG) that are most suitable as markers of dysfunction have not been clearly established. A study was conducted to summarize and evaluate the statistical rigor of evidence on the overall utility of qEEG as an mTBI detection tool. The analysis evaluated qEEG measures/parameters that may be most suitable as fieldable diagnostic tools, identified other types of EEG measures and analysis methods of promise, recommended specific measures and analysis methods for further development as mTBI detection tools, identified research gaps in the field, and recommended future research and development thrust areas. The qEEG study group formed the following conclusions: 1. Individual qEEG measures provide limited diagnostic utility for mTBI. However, many measures can be important features of qEEG discriminant functions, which do show significant promise as mTBI detection tools. 2. ERPs offer utility in mTBI detection. In fact, evidence indicates that ERPs can identify abnormalities in cases where EEGs alone are nondisclosing. 3. The standard mathematical procedures used in the characterization of mTBI EEGs should be expanded to incorporate newer methods of analysis including nonlinear dynamical analysis, complexity measures, analysis of causal interactions, graph theory and information dynamics. 4. and 5. are too long to include here. (shrink)

At the end of his life of Aratus Plutarch recounts the death of the Achaean statesman in 213 BC, the subsequent transport of his body — after a consultation of the Delphic oracle — from Aigion to his native Sicyon, his burial inside of the city, and the annual festival established in his honor. Although Plutarch’s account of the retrieval of the body is for several reasons highly suspect historically, his description of the festival rings true and appears to derive (...) — not directly, I argue, but indirectly through an intermediate source — from an inscription. Most of the content and language finds close parallels in surviving inscriptions concerned with the conduct of sacrifices and, especially, with the large, organized processions that very often preceded them. I use material from these inscriptions to supplement and shed light on Plutarch’s brief account and to offer a tentative reconstruction of the festival and its procession, in the context of what is known of the topography of Hellenistic Sicyon. I also make a suggestion, again tentative, of the identity of Plutarch’s source for the passage. (shrink)

Extending a normal 24 hours day by four hours is unexpectedly highly disruptive to daily rhythms in gene expression in the blood. Using a paradigm in which human subjects were exposed to a 28 hours day, Archer and colleagues show how this sleep‐altering forced desynchrony protocol caused complex disruption to daily rhythms in distinct groups of genes. Such perturbations in the temporal organisation of the blood transcriptome arise quickly, and point to the fragile nature of coordinated genomic activity. Chronic disruption (...) of the daily and circadian rhythms in sleep compromise health and well‐being and this study reveals potential new molecular targets to combat the disruptive effects of shift work and jetlag. (shrink)

John Kinsella’s poetry returns again and again to the landscape of the Western Australian wheatbelt. The wheatbelt is a region that was suddenly and violently re-made by capital in the service of cereal and fibre production during the course of the twentieth century. Despite this radical repurposing of land and the wholesale eradication of an ancient biome, the new farming zone quickly took on the halo of a natural landscape within state and nationalist ideologies. Against the backdrop of this event, (...) Kinsella’s wheatbelt can be viewed as a comprehensive deconstruction of the forces that have led the wheatbelt to where it is now and which still provide the material conditions of its existence. In this essay, Kinsella’s Divine Comedy: Journeys Through a Regional Geography is considered as exemplary of his wheatbelt poetry. The essay explores the basic conceits that animate Kinsella’s poetics of critique. It argues that Kinsella’s poetry offers a strategic intervention into the claims of “capitalist realism,” which is Mark Fisher’s term for the foreclosure of alternatives to profit-driven patterns of production and consumption. Capitalist realism, in the context of the wheatbelt, asserts that whether we like it or not, one cannot argue against the basic entitlement that productive imperatives have to use land as they see fit. This essay attempts to detail the kinds of ways that Kinsella’s poetry tries to fracture this claim to common sense that capitalist production monopolises. What it finds, somewhat counter-intuitively, is that Kinsella’s poetry draws together two things which are traditionally regarded as antinomies – the machine and the organism. In this respect, Kinsella’s poetry is distinctly different from conventional ecopoetry, which tends to uphold the distinction between an authentic nature and a corrupting technology. Kinsella’s Divine Comedy makes use of the tripartite layering of Dante’s eschatology to evolve new topologies of being in the wheatbelt, and indeed, being in the world. Further still, the essay makes the claim that Kinsella delivers us a “cybernetic wheatbelt,” which refigures nature as a communicative machine. (shrink)

During the nineteen years of her play-writing career, Aphra Behn had far more new plays staged than anyone else. This book is the first to examine all her theatrical work. It explains her often dominant place in the complex theatrical culture of Charles II's reign, her divided political sympathies, and her interests as a free-thinking intellectual. It also reveals her as a brilliant theatrical practitioner, who used the seen as richly and significantly as the spoken.

Le présent article propose une approche sémiotique du concept rhétorique d'éthos, et analyse de ce point de vue les portraits des candidats à l'élection présidentielle de 2002 en France, en première page de leurs prospectus électoraux.

The coronavirus disease-2019 (COVID-19) has caused shortages of life-sustaining medical resources, and future waves of the virus may cause further scarcity. The Yale New Haven Health System developed a triage protocol to allocate scarce medical resources during the COVID-19 pandemic, with the primary goal of saving the most lives possible, and a secondary goal of making triage assessments and decisions consistent, transparent, and fair. We outline the process of developing the protocol, summarize the protocol, and discuss the major ethical challenges (...) encountered, along with our answers to the challenges. These challenges include (1) the role of age and chronic comorbidities; (2) evaluating children and pregnant patients; (3) racial, ethnic, and socioeconomic disparities in health; (4) prioritization of healthcare workers; and (5) balancing clinical judgment versus protocolized assessments.We conclude with a review of the limitations of our protocol and the lessons learned. We hope that a robust public discussion of such protocols and the ethical challenges they raise will result in the fairest possible processes, less need for triage, and more lives saved during future waves of the pandemic and similar public health emergencies. (shrink)

This essay was written for the 1984 General Motors Intercollegiate Business Understanding Program. It consists of three sections, each responding to a separate issue posed by General Motors. The opinions expressed are not those of the General Motors management.The first section attempts to document, through the use of Harvard Business Review articles, a shift in the notion of managerial responsibility from a narrowly focused role responsibility to a more widely focused moral responsibility.

Hugh V. Mclachlan Cet article est une réponse à la critique de Saunders de ma proposition de politique non conséquentialiste publiée précédemment concernant l’utilisation d’une loterie pour la distribution de vaccins rares par l’État face à une pandémie de grippe. J’y ai soutenu que, pour des raisons de justice, l’État devrait distribuer une partie du vaccin rare qu’il pourrait détenir à certains de ses employés de la santé et le reste aux citoyens de manière aléatoire et égale sur le principe (...) d’une loterie. Au coeur de la critique de Saunders se trouve l’affirmation selon laquelle j’ai omis à tort de prendre en compte les différences moralement pertinentes dans les besoins et la capacité de production entre les receveurs potentiels du vaccin. Le point central de ma réponse ici est que le fait que le besoin et la capacité de production soient ou non des facteurs moralement pertinents dépend de qui ou de quoi distribue le vaccin, à qui ils le distribuent et pourquoi ils le font. Par exemple, la discrimination entre les personnes dans la distribution de vaccins publics distribués à titre prophylactique sur la base de leur âge est injuste, qu’elle soit ou non moralement justifiable pour d’autres motifs. (shrink)

Successful interactions between people are dependent on rapid recognition of social cues. We investigated whether head direction – a powerful social signal – is processed in the absence of conscious awareness. We used continuous flash interocular suppression to render stimuli invisible and compared the reaction time for face detection when faces were turned towards the viewer and turned slightly away. We found that faces turned towards the viewer break through suppression faster than faces that are turned away, regardless of eye (...) direction. Our results suggest that detection of a face with attention directed at the viewer occurs even in the absence of awareness of that face. While previous work has demonstrated that stimuli that signal threat are processed without awareness, our data suggest that the social relevance of a face, defined more broadly, is evaluated in the absence of awareness. (shrink)

Les dépenses en médicaments augmentent plus rapidement que les ressources disponibles. Les facteurs qui jouent sur l’augmentation des dépenses en médicaments au Canada sont essentiellement associés au volume d’utilisation et à l’arrivée de nouveaux médicaments. Parmi ceux-ci, certains sont extrêmement onéreux et apportent peu de bénéfices par rapport à leur coût. Les évaluateurs sont amenés à s’interroger sur l’opportunité de les inscrire sur la liste des produits couverts par le régime public. L’un des problèmes les plus persistants pour les agences (...) d’évaluations est celui de justifier le refus de rembourser un médicament sur la base de son coût élevé. Nous croyons que le rationnement de médicaments très chers peut s’appuyer sur une justification transparente qui comprend, outre des données probantes, des principes et des valeurs éthiques. Dans cet article, nous entreprenons d’établir et d’analyser les critères et principes pharmaco-économiques et éthiques à considérer lorsqu’il s’agit de limiter équitablement l’accès à des médicaments onéreux. (shrink)

This paper consists of commentaries about and the reprint of an autobiographical essay authored by Italian medium Eusapia Palladino and published in 1910. The details of the essay are discussed in terms of the writings of other individuals about the life and performances of the medium. The essay conveys a view of Palladino as a person who has suffered much in life and has a mission to help scientific research into mediumship. Typical of the positive emphasis in autobiographies in general, (...) the medium did not discuss negative aspects of her performances. Due to the fact that the essay appeared during Palladino's visit to New York City in which many authors branded her as a fraud, it may be speculated that the purpose of this autobiography was to elicit sympathy from the American public. While some of the statements that Palladino made about phenomena are consistent with the statements of other authors who have written about her, there are several statements that show alternate or incomplete versions of particular events in her life. The differences suggests that Palladino's essay and other discussions about the medium's life are not reliable when it comes to specific details and to biographical accuracy. (shrink)

Résumé: Cet article discute de façon générale les cas dans lesquels les symboles peuvent être utilisés de façon avantageuse dans le raisonnement logique et mathématique, et aspire, par un examen des symboles déjà existants, à déterminer quelques règles ou principes, d’abord, quant à l’opportunité d’introduire de nouveaux symboles, puis, quant au types de symboles qui doivent être sélectionnés. Cet article contient aussi une brève histoire du développement graduel de la méthode symbolique propre à l’auteur, telle qu’elle a été présentée et (...) expliquée par l’auteur dans ses articles publiés dans les Proceedings of the London Mathematical Society, le Educational Times, le Philosophical Magazine, et Mind. (shrink)

Résumé: Cet article discute de façon générale les cas dans lesquels les symboles peuvent être utilisés de façon avantageuse dans le raisonnement logique et mathématique, et aspire, par un examen des symboles déjà existants, à déterminer quelques règles ou principes, d’abord, quant à l’opportunité d’introduire de nouveaux symboles, puis, quant au types de symboles qui doivent être sélectionnés. Cet article contient aussi une brève histoire du développement graduel de la méthode symbolique propre à l’auteur, telle qu’elle a été présentée et (...) expliquée par l’auteur dans ses articles publiés dans les Proceedings of the London Mathematical Society, le Educational Times, le Philosophical Magazine, et Mind. (shrink)

The gelsolin gene family encodes a number of higher eukaryotic actin-binding proteins that are thought to function in the cytoplasm by severing, capping, nucleating or bundling actin filaments. Recent evidence, however, suggests that several members of the gelsolin family may have adopted unexpected nuclear functions including a role in regulating transcription. In particular, flightless I, supervillin and gelsolin itself have roles as coactivators for nuclear receptors, despite the fact that their divergence appears to predate the evolutionary appearance of nuclear receptors. (...) Flightless I has been shown to bind both actin and the actin-related BAF53a protein, which are subunits of SWI/SNF-like chromatin remodelling complexes. The primary sequences of some actin-related proteins such as BAF53a exhibit conservation of residues that, in actin itself, are known to interact with gelsolin-related proteins. In summary, there is a growing body of evidence supporting a biological role in the nucleus for actin, Arps and actin-binding proteins and, in particular, the gelsolin family of actin-binding proteins. (c) 2005 Wiley Periodicals, Inc. (shrink)