BackgroundAs moral case deliberations (MCDs) have increasingly been implemented in health care institutions as a form of ethics support, it is relevant to know whether and how MCDs actually contribute to positive changes in care. Insight is needed on what actually happens in daily care practice following MCD sessions. This study aimed at investigating the impact of MCD and exploring how ‘impact of MCD’ should be conceptualized for future research.MethodsA multiple-case study was conducted in a care organization for people with (...) intellectual disabilities and/or acquired brain injury, by observing MCD sessions as ‘cases’, followed by interviews with health care professionals concerning the follow-up to these cases, and a focus group with involved MCD facilitators. A conceptual scheme concerning the possible impact formed the basis for analysis: (1) individual moral awareness; (2) the actions of health care professionals; (3) collaboration among health care professionals; (4) the concrete situation of the client; (5) the client’s quality of care and life; (6) the organizational and policy level.ResultsAccording to interviewees, their moral awareness and their collaboration, both among colleagues and with clients’ relatives, improved after MCD. Perceived impact on client situation, quality of care/life and the organizational level varied among interviewees or was difficult to define or link to MCD. Three aspects were added to the conceptual scheme concerning the impact of MCD: (a) preparations and expectations prior to the MCD session; (b) a translational step between the conclusions of the MCD session and practical events in the following period, and (c) collaboration with clients’ relatives. A negative impact of MCD was also found on misunderstandings among participants and disappointment about lack of follow-up.ConclusionsConcretizing and conceptualizing the ‘impact’ of MCD is complicated as many factors play a role either before or during the transition from MCD to practice. It is important to consider ‘impact’ in a broad sense and to relate it to the goals and context of the MCD in question. Future studies in this field should pay additional attention to the preparations, content and process involved in ethics support, including clients’ and relatives’ experiences. (shrink)

I explore some of the ways that assumptions about the nature of substance shape metaphysical debates about the structure of Reality. Assumptions about the priority of substance play a role in an argument for monism, are embedded in certain pluralist metaphysical treatments of laws of nature, and are central to discussions of substantivalism and relationalism. I will then argue that we should reject such assumptions and collapse the categorical distinction between substance and property.

This study is based on the 1983 Rural Health Survey of Ethiopia. Patterns and levels of child morbidity by age, sex, geographic region, and sanitary facilities are examined. Morbidity levels peak in the second year of life. Diarrhoeal diseases are of major importance, especially among infants and toddlers. Parasitic diseases, and respiratory diseases other than pneumonia, become increasingly important with age.There are no significant sex differentials in morbidity except for higher rates of diarrhoeal diseases among female children. Geographic differentials are (...) quite marked with particularly high morbidity levels from all disease types in the western mountainous regions of Ethiopia. Access to high quality drinking water, a latrine, and garbage disposal, are strongly related to reduced overall morbidity levels, though not necessarily to reduced diarrhoeal disease levels. (shrink)

jild-i 1. Āzādī va marzʹhāyash -- jild-i 2. Istiqlāl (farhangī).

To begin with, can we possibly call esthetic activity a cognitive function , that is, do the products of esthetic activity possess, along with their other characteristics, a certain cognitive value?

Causation is at once familiar and mysterious. Neither common sense nor extensive philosophical debate has led us to anything like agreement on the correct analysis of the concept of causation, or an account of the metaphysical nature of the causal relation. Causation: A User's Guide cuts a clear path through this confusing but vital landscape. L. A. Paul and Ned Hall guide the reader through the most important philosophical treatments of causation, negotiating the terrain by taking a set of examples (...) as landmarks. They clarify the central themes of the debate about causation, and cover questions about causation involving omissions or absences, preemption and other species of redundant causation, and the possibility that causation is not transitive. Along the way, Paul and Hall examine several contemporary proposals for analyzing the nature of causation and assess their merits and overall methodological cogency.The book is designed to be of value both to trained specialists and those coming to the problem of causation for the first time. It provides the reader with a broad and sophisticated view of the metaphysics of the causal relation. (shrink)

The past two decades have seen a dramatic increase in the use of telemedicine while the information technology revolution has contributed significantly to its popularity. In addition, there has been a recent increase in the use of telemedicine in the intensive care unit (ICU), partially driven by a critical shortage of intensivists. However, the ethical questions raised by the implementation of tele-ICUs have not been adequately considered. In this essay, we will discuss the development of tele-ICUs from the perspective of (...) autonomy, beneficence/non-malificence, justice and professionalism. (shrink)

Quantified modal logic and propositional attitudes have long been regarded as sites susceptible to referential opacity — that curious affliction first diagnosed by Quine. In this paper I suggest a way of alleviating the symptoms of referential opacity as they manifest themselves in fictional contexts, contexts in which we are confronted by discourse about fiction. Indeed, a case might be made against Quine that it is fictional, rather than quotational, contexts which are the referentially opaque contexts par excellence. For whether (...) we take a Fregean line on the matter and consider the obliquity of fictional terms as due to shift of reference, or a Quinean line and consider their opacity as due to failure of reference, their non-standard occurrence is clear and avowed. Moreover, as the non-standardness or non-vulgarity of terms in fictional contexts is by design and not due to some mere accident of orthography, they seem in many ways to be both more interesting and potentially more revealing. (shrink)

Objective: To determine cryopreservation-induced alterations in the cytoskeleton of metaphase II mouse oocytes and the implications of these alterations in functionality of the cytoskeleton and polyploidy after fertilization.Design: Comparative study.Setting: Clinical and academic research environment at a medical school teaching hospital.Intervention : Oocytes were frozen using a slow-cooling and slow-thawing protocol in 1.5 M dimethyl sulfoxide and 0.2 M sucrose and were analyzed before and after fertilization.Main Outcome Measure : Cytoskeletal alterations, fertilization, and polyploidy rates.Result : When analyzed immediately after (...) thawing, the oocytes displayed dramatic cytoskeletal alterations. Only slight recovery was observed upon removal of the cryoprotectants. However, incubation after thawing of 1 hour at 37oC completely reestablished a normal microfilament and microtubule pattern while partially restoring normal spindle morphology and chromosome alignment. Accordingly, insemination immediately after removal of cryoprotectants resulted in a significantly decreased fertilization rate and aberrant dynamics of cytoskeleton-dependent events, whereas oocytes inseminated after the post-thaw incubation displayed fertilization rates and cytoskeletal dynamics comparable to those in controls. Cryopreservation did not increase polyspermy but significantly increased digyny when the oocytes were inseminated after the post-thaw incubation. All digynic eggs displayed an abnormal spindle remnant in comparison with diploid or polyspermic eggs.Conclusion : A brief period of incubation after thawing allows recovery and positively affects fertilization and cytoskeletal dynamics. Cryopreservation does not impair the functionality of microfilaments and cytoplasmic microtubules during postfertilization events. Our findings suggest that the increased rate of digyny in cryopreserved oocytes may be related to the spindle disorganization, leading to failure in segregation of the chromosomes, rather than to direct malfunction of the microfilaments in polar body formation. (shrink)

The text is taken from Georg Luck's edition . I have also consulted P. Burman , S. G. Owen's editio maior , A. L. Wheeler's Loeb edition in the 2nd edition revised by G. P. Goold , and Georg Luck's commentary . I have also had a preview of J. B. Hall's forthcoming Teubner edition and I have used his apparatus, in which the traditional sigla for the principal manuscripts are retained.

The contemporary operating environment for deployed United States military operations largely focuses on deployments to predominantly Islamic countries. The differences in cultural values between d...