Provider claims to conscientious objection have generated a great deal of heated debate in recent years. However, the conflicts that arise when providers make claims to the "conscience" are only a subset of the more fundamental challenges that arise in health care practice when patients and providers come into conflict. In this piece, the author provides an account of patient-provider conflict from within the moral tradition of St. Thomas Aquinas. He argues that the practice of health care providers should be (...) understood as a form of practical reasoning and that this practical reasoning must necessarily incorporate both "moral" and "professional" commitments. In order to understand how the practical reasoning of provider should account for the needs and commitments of the patient and vice versa, he explores the account of dependence provided by Alasdair MacIntyre in his book Dependent Rational Animals. MacIntyre argues that St. Thomas’ account of practical reasoning should be extended and adapted to account for the embodied vulnerability of all humans. In light of this insight, providers must view patients not only as the subjects of their moral reflection but also as fellow humans upon whom the provider depends for feedback on the effectiveness and relevance of her practical reasoning. The author argues that this account precludes responsive providers from adopting either moral or professional conclusions on the appropriateness of interventions outside the individual circumstances that arise in particular situations. The adoption of this orientation toward patients will neither eradicate provider-patient conflict nor compel providers to perform interventions to which they object. But this account does require that providers attend meaningfully to the suffering of patients and seek feedback on whether their intervention has effectively addressed that suffering. (shrink)
BackgroundSystems medicine is the name for an assemblage of scientific strategies and practices that include bioinformatics approaches to human biology ; “big data” statistical analysis; and medical informatics tools. Whereas personalized and precision medicine involve similar analytical methods applied to genomic and medical record data, systems medicine draws on these as well as other sources of data. Given this distinction, the clinical translation of systems medicine poses a number of important ethical and epistemological challenges for researchers working to generate systems (...) medicine knowledge and clinicians working to apply it.DiscussionThis article focuses on three key challenges: First, we will discuss the conflicts in decision-making that can arise when healthcare providers committed to principles of experimental medicine or evidence-based medicine encounter individualized recommendations derived from computer algorithms. We will explore in particular whether controlled experiments, such as comparative effectiveness trials, should mediate the translation of systems medicine, or if instead individualized findings generated through “big data” approaches can be applied directly in clinical decision-making. Second, we will examine the case of the Riyadh Intensive Care Program Mortality Prediction Algorithm, pejoratively referred to as the “death computer,” to demonstrate the ethical challenges that can arise when big-data-driven scoring systems are applied in clinical contexts. We argue that the uncritical use of predictive clinical algorithms, including those envisioned for systems medicine, challenge basic understandings of the doctor-patient relationship. Third, we will build on the recent discourse on secondary findings in genomics and imaging to draw attention to the important implications of secondary findings derived from the joint analysis of data from diverse sources, including data recorded by patients in an attempt to realize their “quantified self.”SummaryThis paper examines possible ethical challenges that are likely to be raised as systems medicine to be translated into clinical medicine. These include the epistemological challenges for clinical decision-making, the use of scoring systems optimized by big data techniques and the risk that incidental and secondary findings will significantly increase. While some ethical implications remain still hypothetical we should use the opportunity to prospectively identify challenges to avoid making foreseeable mistakes when systems medicine inevitably arrives in routine care. (shrink)
Branching fraction measurements using B-meson decays to Ks0π+π- are presented. These measurements were obtained by analyzing a data sample of 88.9 × 106 Υ → BB̄ decays collected with the BABAR detector at the SLAC PEP-II asymmetric-energy B factory. Using a maximum likelihood fit, the following branching fraction results were obtained: B = × 10 -6, B × 10-6, and Bπ+) = × 10-6. The CP violating charge asymmetry AK*π for the decay B0 → K*+π- was measured to be AK*π (...) = 0.23 ± 0.18-0.06+0.09. For all these measurements the first error is statistical and the second is systematic. (shrink)
We have investigated the exclusive, radiative B meson decays to K 2* in 89 × 106 BB̄ events with the BABAR detector at the PEP-II storage ring. We measure the branching fractions B0γ) = × 10-5 and B+γ) = × 10-5, where the first error is statistical and the second systematic. In addition, we measure the CP-violating asymmetry A CP[B0 → K2* 0γ] = -0.08 ± 0.15 ± 0.01.
In  it is proved the categorical isomorphism of two varieties: bounded commutative BCK-algebras and MV -algebras. The class of MV -algebras is the algebraic counterpart of the infinite valued propositional calculus L of Lukasiewicz . The main objective of the present paper is to study that isomorphism from the perspective of logic. The B-C-K logic is algebraizable and the quasivariety of BCKalgebras is the equivalent algebraic semantics for that logic . We call commutative B-C-K logic, briefly cBCK, to the (...) extension of B-C-K logic associated to the variety of commutative BCK–algebras. Moreover, we present the extension Boc of cBCK obtained by adding the axiom of “boundness”. We prove that the deductive system Boc is equivalent to L. We observe that cBCK admits two interesting extensions: the logic Boc, treated in this paper, which is equivalent to the system L of Lukasiewicz, and the logic Co that is naturally associated to the system Balo of `-groups . This constructions establish a link between L and Balo , that would be a logical approach to the categorical relationship between MV–algebras and `-groups. (shrink)
Born in 1918 in New York, awarded a doctorate in analytical chemistry (1944), Leonard K. Nash enjoyed a distinguished career at Harvard, holding a chair of chemistry from 1959 to 1986. Conducting research in thermodynamics and statistical mechanics, Nash authored successful textbooks, some of which remain in print (e.g. Elements of Chemical Thermodynamics, and Elements of Statistical Thermodynamics).This essay describes the theory of science that Nash developed in a book he published in 1963, The Nature of the Natural Sciences. The (...) present author is of the view that Nash's neglected theory is worth retrieving, as one that is likely to kindle the interest of historians of metascience on several counts. Part of .. (shrink)