The problem of psychological pain caused by discussions of do not resuscitate status with patients is addressed. Case histories of patients with such distress are given. We propose that not all patients should be informed of their do not resuscitate status, that the information about such status be given incrementally, and that the giving of further information be guided by the patient's reaction to earlier information. While some affirm the duty of the physician always to inform the patient about his (...) or her do not resuscitate status, we affirm the duty of the physician to determine whether the patient wishes to enter into this discussion. (shrink)

To localize wheat ESTs on chromosomes, 882 homoeologous group 6-specific ESTs were identified by physically mapping 7965 singletons from 37 cDNA libraries on 146 chromosome, arm, and sub-arm aneuploid and deletion stocks. The 882 ESTs were physically mapped to 25 regions flanked by 23 deletion breakpoints. Of the 5154 restriction fragments detected by 882 ESTs, 2043 were localized to group 6 chromosomes and 806 were mapped on other chromosome groups. The number of loci mapped was greatest on chromosome 6B and (...) least on 6D. The 264 ESTs that detected orthologous loci on all three homoeologs using one restriction enzyme were used to construct a consensus physical map. The physical distribution of ESTs was uneven on chromosomes with a tendency toward higher densities in the distal halves of chromosome arms. About 43% of the wheat group 6 ESTs identified rice homologs upon comparisons of genome sequences. Fifty-eight percent of these ESTs were present on rice chromosome 2 and the remaining were on other rice chromosomes. Even within the group 6 bins, rice chromosomal blocks identified by 1-6 wheat ESTs were homologous to up to 11 rice chromosomes. These rice-block contigs were used to resolve the order of wheat ESTs within each bin. (shrink)

The sequencing of the human genome and decreasing costs of sequencing technology have led to the notion of ‘personalized medicine’. This has been taken by some authors to indicate that personalized medicine will provide individualized treatments solely based on one’s DNA sequence. We argue this is overly optimistic and misconstrues the notion of personalization. Such interpretations fail to account for economic, policy and structural constraints on the delivery of healthcare. Furthermore, notions of individualization based on genomic data potentially take us (...) down the road of genetic reductionism obscuring the role of environmental factors in disease and ill health. We propose that one should see personalized medicine as a way of using personal genomic information to stratify individuals into subpopulations and suggest that personalized medicine be seen within a broader idea of personalized healthcare, reflecting healthcare that integrates personal genomic data into cultural, environmental and personal contexts. (shrink)

In this work, the significance of combining the evidence from multitaper mel-frequency cepstral coefficients, linear prediction residual, and linear prediction residual phase features for multilingual speaker identification with the constraint of limited data condition is demonstrated. The LPR is derived from linear prediction analysis, and LPRP is obtained by dividing the LPR using its Hilbert envelope. The sine-weighted cepstrum estimators with six tapers are considered for multitaper MFCC feature extraction. The Gaussian mixture model–universal background model is used for modeling each (...) speaker for different evidence. The evidence is then combined at scoring level to improve the performance. The monolingual, crosslingual, and multilingual speaker identification studies were conducted using 30 randomly selected speakers from the IITG multivariability speaker recognition database. The experimental results show that the combined evidence improves the performance by nearly 8–10% compared with individual evidence. (shrink)

Are restrictive measures and duties to care ethically reasonably acceptable to faith-based organizations? This study describes the perceptions of individually interviewed spiritual leaders of the disease control measures used during the recent SARS outbreak in Toronto. Four central themes were identified: the relationship between religious obligation and civic responsibilities; the role of faith-based organizations in supporting public health restrictive measures; the reciprocal obligations of public health and religious communities during restrictions; and justifiable limits to duties to care. We conclude that, (...) within certain constraints, spiritual leaders find restrictive measures ethically reasonable and that spiritual leaders can play an important role during pandemic and epidemic control planning. Public health officials should therefore include them in the early and ongoing deliberations of the criteria and logistics for implementation during public health emergencies. (shrink)

The effects of religion, population sub-division and geography on the prevalence of deaf-mutism were investigated using information collected in the 1921 Census of Punjab. The total sample size was 9·36 million, and comprised data on thirteen Hindu castes, seventeen Muslim biraderis and two Sikh castes. A two-way analysis of variance comparing males in Hindu castes in which consanguineous marriage was prohibited, with males in Muslim biraderis which favoured first cousin marriage, indicated major differences with respect to the patterns of deaf-mutism (...) within each religion. In the Muslim population 9·1% of the relative variation in the prevalence of deaf-mutism was inter-biraderi, 36·8% between geographical regions, and 48·8% an interaction between biraderi and region, whereas among Hindus 46·8% of the observed variation was inter-caste, 12·8% inter-region and 33·6% due to caste–region interaction. From a wider disease perspective the results obtained with the Hindu community indicate the significant genetic differentiation associated with caste endogamy. As the overwhelming majority of Hindu marriages continue to be within-caste, it can be predicted that similar levels of inter-caste differences in disease frequency currently exist. By comparison, the lower level of inter-biraderi variation among Muslims is probably indicative of the dissolution of pre-existing caste boundaries and the resultant gene pool mixing that followed the large-scale conversion of Hindus to Islam during Muslim rule in North India from the 13th to the 19th centuries. (shrink)

The advances in treatment of HIV and the introduction of polymerase chain reaction assay for the virus now make it acceptable for HIV discordant couples where the male partner is seropositive to attempt to conceive through artificial insemination by husband (AIH) or via in vitro fertilisation. With undetectable viral load and washed sperm, there is minimal risk of transmission of HIV to the female partner, children, other patients, or staff. We describe the development of a programme of AIH for HIV (...) discordant couples and the reasoning behind offering such a programme. (shrink)

The aim of this article is to give more insight into what ethical challenges clinicians in mental healthcare experience and discuss with a Clinical Ethics Committee in psychiatry in the Region of Southern Denmark. Ethical considerations are an important part of the daily decision-making processes and thereby for the quality of care in mental healthcare. However, such ethical challenges have been given little systematic attention – both in research and in practices. A qualitative content analysis of 55 written case-reports from (...) the Clinical Ethics Committee. The Committee offers clinicians in mental healthcare structured ethical analyses of ethical challenges and makes a thorough written case-report. The ethical challenges are grouped into three overarching topics: 1. Clinicians and their relation to patients and relatives. 2. Clinicians and institutional aspects of mental healthcare 3. Clinicians and mental healthcare in a wider social context. Through presentation of illustrative examples the complexity of daily clinical life in mental healthcare becomes evident, as well as typical interests, values and arguments. This qualitative study indicates that difficult ethical challenges are an inherent part of mental healthcare that requires time, space and competence to be dealt with adequately. (shrink)

H.B.G. Casimir's life, interests and works are intertwined with the important developments that have taken place in physics during this century. This book was compiled by his friends and admirers in honour of his 80th birthday and concentrates mainly on Casimir's achievements in the field of physics, though without ignoring the peripheral areas of the history and philosophy of physics in which he was greatly interested. The book is divided into four parts. Part I describes Casimir's teachers, Ehrenfest, Bohr and (...) Pauli, and will be of general interest due to the key role which these physicists played in modern developments. The articles do give new facts and provide new insights into the history of modern physics. Part II consists of essays on recent developments in various areas of physics in which Casimir has taken an active interest, such as the modern concept of time, statistical foundations of electrodynamic theory and field theory. The subjects covered in Part III have been selected because of Casimir's efforts in the industrial research area of physics. They cover past, present and future expectations in research. (shrink)

As the title indicates, Faith and Knowledge deals with the relation between religious faith and cognitive beliefs, between the truth of religion and the truths of philosophy and science. Hegel is guided by his understanding of the historical situation: the individual alienated from God, nature, and community; and he is influenced by the new philosophy of Schelling, the Spinozistic Philosophy of Identity with its superb vision of the inner unity of God, nature, and rational man. Through a brilliant discussion of (...) the philosophies of Kant, Fichte, and other luminaries of the period, Hegel shows that the time has finally come to give philosophy the authentic shape it has always been trying to reach, a shape in which philosophy’s old conflicts with religion on the one hand and with the sciences on the other are suspended once for all. This is the first English translation of this important essay. Professor H. S. Harris offers a historical and analytic commentary to the text and Professor Cerf offers an introduction to the general reader which focuses on the concept of intellectual intuition and on the difference between authentic and inauthentic philosophy. (shrink)

Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and (...) participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses’ ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses’ own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner. (shrink)

As the title indicates, Faith and Knowledge deals with the relation between religious faith and cognitive beliefs, between the truth of religion and the truths of philosophy and science. Hegel is guided by his understanding of the historical situation: the individual alienated from God, nature, and community; and he is influenced by the new philosophy of Schelling, the Spinozistic Philosophy of Identity with its superb vision of the inner unity of God, nature, and rational man. Through a brilliant discussion of (...) the philosophies of Kant, Fichte, and other luminaries of the period, Hegel shows that the time has finally come to give philosophy the authentic shape it has always been trying to reach, a shape in which philosophy’s old conflicts with religion on the one hand and with the sciences on the other are suspended once for all. This is the first English translation of this important essay. Professor H. S. Harris offers a historical and analytic commentary to the text and Professor Cerf offers an introduction to the general reader which focuses on the concept of intellectual intuition and on the difference between authentic and inauthentic philosophy. (shrink)

Background Residual dried blood spots (rDBS) from newborn screening programmes represent a valuable resource for medical research, from basic sciences, through clinical to public health. In Hong Kong, there is no legislation for biobanking. Parents’ view on the retention and use of residual newborn blood samples could be cultural-specific and is important to consider for biobanking of rDBS. Objective To study the views and concerns on long-term storage and secondary use of rDBS from newborn screening programmes among Hong Kong Chinese (...) parents. Methods A mixed-method approach was used to study the views and concerns on long-term storage and secondary use of rDBS from newborn screening programmes among Hong Kong Chinese parents of children 0–3 years or expecting parents through focus groups (8 groups; 33 participants) and a survey (n = 1012, 85% mothers) designed with insights obtained from the focus groups. We used framework analysis to summarise the themes as supportive factors, concerns and critical arguments for retention and secondary use of rDBS from focus group discussion. We used multiple logistic regression to assess factors associated with support for retention and secondary use of rDBS in the survey. Results Both in focus groups and survey, majority of parents were not aware of the potential secondary use of rDBS. Overall secondary use of rDBS in medical research was well accepted by a large proportion of Hong Kong parents, even if all potential future research could not be specified in a broad consent. However parents were concerned about potential risks of biobanking rDBS including leaking of data and mis-use of genetic information. Parents wanted to be asked for permission before rDBS are stored and mainly did not accept an “opt-out” approach. The survey showed that parents born in mainland China, compared to Hong Kong born parents, had lower awareness of newborn screening but higher support in biobanking rDBS. Higher education was associated with support in rDBS biobanking only among fathers. Conclusion Long-term storage and secondary use of rDBS from newborn screening for biomedical research and a broad consent for biobanking of rDBS are generally acceptable to Hong Kong parents given their autonomy is respected and their privacy is protected, highlighting the importance of an accountable governance and a transparent access policy for rDBS biobanks. (shrink)