Aim: To improve clinical and ethical understanding of patient preferences for information and involvement in decision making.Objectives: To develop and evaluate a clinical tool to elicit these preferences and to consider the ethical issues raised.Design: A before and after study.Setting: Three UK hospices.Participants: Patients with advanced life-threatening illnesses and their doctors.Intervention: Questionnaire on information and decision-making preferences.Main outcome measures: Patient-based outcome measures were satisfaction with the amount of information given, with the way information was given, with family or carer information, (...) and confidence about future decision making. Doctor-based outcome measures were confidence in matching information to patient preference, matching family or carer communication to patient preference, knowing patient preferences and matching future decision making with patient preference.Results: Of 336 admissions, 101 patients completed the study . Patient satisfaction with the way information was given and family communication improved after introduction of the tool. Doctor confidence improved across all outcome measures .Conclusions: Patient satisfaction and doctor confidence were improved by administering the questionnaire, but complex ethical issues were raised by implementing and applying this research. The balance of ethical considerations were changed by advanced life-threatening illness, because there is increased risk of harm through delivery of information discordant with the patient’s own preferences. The importance of truly understanding patient preferences towards the end of life is highlighted by this study. (shrink)

In his preface, Hunter explains that this volume is intended to provide for non-mathematicians an introduction to the most important results of modern mathematical logic. The reader will find here the work of Post, Skolem, Gödel, Church, Henkin, and others, presented in a terse and closely-knit style. Though acknowledging the trend toward natural deduction systems, Hunter sticks to more classical axiomatic systems on the grounds that the proofs of metatheorems are simplified by that choice. He begins with a formal system (...) of propositional logic, for which he develops proofs of completeness, consistency, and decidability. Systems of first order predicate logic are then dealt with, and Church's and Gödel's results on undecidability and incompleteness are presented. There is a brief, useful discussion indicating what parts of first order predicate logic are decidable. It is assumed that the reader has some familiarity with elementary formal logic: Hunter develops the set-theoretical results he requires. The compactness of the presentation is facilitated by the use of earlier results for propositional logic to obtain certain results for predicate logic. Especially helpful is Hunter's technique of prefacing each of the longer and more difficult proofs with a section explaining the key ideas and the general method of proof; summaries are also often provided in conclusion. Because of the orientation of the book, a more extensive discussion of the significance of the results obtained and the philosophical issues which have been raised concerning some of them, would have been welcome. Nonetheless, this is a good, concise introduction for those who are not yet prepared to tackle the more technical literature. A bibliography is provided for those interested in pursuing the subject in greater detail.--E. M. F. (shrink)

A partir de una encuesta por correo electrónico a estudiantes de Ingeniería en el SAI de la UAMA en un contexto de enseñanza remota forzado por la pandemia, se caracteriza la gestión de la docencia, desde la visión de los estudiantes, se realiza un diagnóstico de los aspectos relacionados. Es un estudio transversal con un análisis cualitativo y descriptivo de las respuestas. La gestión docente se ve afectada por factores inherentes al proceso, así como también por factores externos. Los resultados (...) obtenidos muestran que fue impactada fuertemente al realizarse el proceso totalmente vía remota especialmente, la comunicación e interacción alumno-profesor. (shrink)

An eminent psychologist and a gerontologist explain how to cope with the problems of aging and how to get the most out of one's later years.

In the past few years an increasing number of colleges and universities have added courses in biomedical ethics to their curricula. To some extent, these additions serve to satisfy student demands for "relevance. " But it is also true that such changes reflect a deepening desire on the part of the academic community to deal effectively with a host of problems which must be solved if we are to have a health-care delivery system which is efficient, humane, and just. To (...) a large degree, these problems are the unique result of both rapidly changing moral values and dramatic advances in biomedical technology. The past decade has witnessed sudden and conspicuous controversy over the morality and legality of new practices relating to abortion, therapy for the mentally ill, experimentation using human subjects, forms of genetic interven tion, suicide, and euthanasia. Malpractice suits abound and astronomical fees for malpractice insurance threaten the very possibility of medical and health-care practice. Without the backing of a clear moral consensus, the law is frequently forced into resolving these conflicts only to see the moral issues involved still hotly debated and the validity of existing law further questioned. In the case of abortion, for example, the laws have changed radically, and the widely pub licized recent conviction of Dr. Edelin in Boston has done little to foster a moral consensus or even render the exact status of the law beyond reasonable question. (shrink)

Despite their diversity and ecological importance, many areas of the SAR—Stramenopila, Alveolata, and Rhizaria—clade are poorly understood as the majority of SAR species lack molecular data and only 5% of species are from well-sampled families. Here, we review and summarize the state of knowledge about the three major clades of SAR, describing the diversity within each clade and identifying synapomorphies when possible. We also assess the “dark area” of SAR: the morphologically described species that are missing molecular data. The majority (...) of molecular data for SAR lineages are characterized from marine samples and vertebrate hosts, highlighting the need for additional research effort in areas such as freshwater and terrestrial habitats and “non-vertebrate” hosts. We also describe the paucity of data on the biogeography of SAR species, and point to opportunities to illuminate diversity in this major eukaryotic clade. See also the video abstract here: https://youtu.be/_VUXqaX19Rw. Despite their diversity, abundance, and importance, fewer than 10% of the species within the SAR—Stramenopila, Alveolata, and Rhizaria—clade have been assessed using molecular tools. Only a small percentage of the molecular records contain information on ecology or have associate location data, indicating a tremendous dark area. (shrink)