Decisions about cardiopulmonary resuscitation may be based on medical prognosis, quality of life and patients' choices. Low survival rates indicate its overuse. Although the concept of medical futility has limitations, several strong predictors of non-survival have been identified and prognostic indices developed. Early results indicate that consideration of resuscitation in the elderly should be very selective, and support "opt-in" policies. In this minority of patients, quality of life is the principal issue. This is subjective and best assessed by the individual (...) in question. Patients' attitudes cannot be predicted reliably and surrogate decision-making is inadequate. Lay knowledge is poor. However, patients can use prognostic information to make rational choices. The majority welcome discussion of resuscitation and prefer this to be initiated by their doctors; many wish to decide for themselves. There is little evidence that this causes distress. The views of such patients, if competent, should be sought actively. (shrink)

OBJECTIVES: To study the resuscitation preferences, choice of decision-maker, views on the seeking of patients' wishes and determinants of these of elderly hospital in-patients. DESIGN: Questionnaire administered on admission and prior to discharge. SETTING: Two acute geriatric medicine units (Southampton and Poole). PARTICIPANTS: Two hundred and fourteen consecutive consenting mentally competent patients admitted to hospital as emergencies. RESULTS: Resuscitation was wanted by 60%, particularly married and functionally independent patients and those who had not already considered it. Not wanted resuscitation was (...) associated with lack of social contacts. Sixty-seven per cent welcomed enquiry about their preferences and 78% wanted participation in decision, 43% as sole decision-maker. Wishing to choose oneself was associated with not wanting resuscitation, prior knowledge of it, and lack of a spouse. Patients' opinions remained stable during their admission. CONCLUSIONS: Discussion of resuscitation is practical on hospital admission without causing distress and the views expressed endure through the period of hospitalisation. Elderly patients' attitudes depend partly on personal health and social circumstances. This may assist doctors when patients are unable to participate themselves. (shrink)

Upshot: We seek to address several questions and statements made in the commentaries by elaborating on the four main aspects of the M-N-L framework. Before doing so, we discuss the issue of constructivist teaching in the context of schools. We conclude by hypothesizing on what would be lost in the M-N-L framework by taking constructivism out of the picture.

Context: Constructivist teachers who find themselves working within an educational system that adopts a realist epistemology, may find themselves at odds with their own beliefs when they catch themselves paying closer attention to the knowledge authorities intend them to teach rather than the knowledge being constructed by their learners. Method: In the preliminary analysis of the mathematical learning of six low-performing Year 7 boys in a Maltese secondary school, whom one of us taught during the scholastic year 2014-15, we constructed (...) a conceptual framework which would help us analyze the extent to which he managed to be sensitive to constructivism in a typical classroom setting. We describe the development of the framework M-N-L as a viable analytical tool to search for significant moments in the lessons in which the teacher appeared to engage in what we define as “constructivist teaching” during mathematics lessons. The development of M-N-L is part of a research program investigating the way low-performing students make mathematical sense of new notation with the help of the software Grid Algebra. Results: M-N-L was found to be an effective instrument which helped to determine the extent to which the teacher was sensitive to his own constructivist beliefs while trying to negotiate a balance between the mathematical concepts he was expected to teach and the conceptual constructions of his students. Implications: One major implication is that it is indeed possible for mathematics teachers to be sensitive to the individual constructions of their learners without losing sight of the concepts that society, represented by curriculum planners, deems necessary for students to learn. The other is that researchers in the field of education may find M-N-L a helpful tool to analyze CT during typical didactical situations established in classroom settings. (shrink)

Schistosomes are parasitic blood flukes, responsible for significant human disease in tropical and developing nations. Here we review information on the organization of the cytoskeleton and associated motor proteins of schistosomes, with particular reference to the organization of the syncytial tegument, a unique cellular adaptation of these and other neodermatan flatworms. Extensive EST databases show that the molecular constituents of the cytoskeleton and associated molecular systems are likely to be similar to those of other eukaryotes, although there are potentially some (...) molecules unique to schistosomes and platyhelminths. The biology of some components, particular those contributing to host–parasite interactions as well as chemotherapy and immunotherapy are discussed. Unresolved questions in relation to the structure and function of the tegument relate to dynamic organization of the syncytial layer. BioEssays 26:752–765, 2004. © 2004 Wiley Periodicals, Inc. (shrink)

A better understanding of how schistosomes exploit host nutrients, neuro‐endocrine hormones and signalling pathways for growth, development and maturation may provide new insights for improved interventions in the control of schistosomiasis. This paper describes recent advances in the identification and characterisation of schistosome tyrosine kinase and signalling pathways. It discusses the potential intervention value of insulin signalling, which may play an important role in glucose uptake and carbohydrate metabolism in schistosomes, providing the nutrients essential for parasite growth, development and, notably, (...) female fecundity. Significant progress has also been made in the characterisation of other schistosome growth factor receptors, such as transforming growth factor beta receptor and epidermal growth factor receptor, and in our understanding of their roles in the host‐parasite molecular dialogue and parasite development. The use of parasite signal transduction components as novel vaccine or drug targets may prove invaluable in prevention, treatment and control strategies to combat schistosomiasis. (shrink)

In the same year, 1961, Peter D. Mitchell and Robert R.J.P. Williams both put forward hypotheses for the mechanism of oxidative phosphorylation in mitochondria and photophosphorylation in chloroplasts. Mitchell's proposal was ultimately adopted and became known as the chemiosmotic theory. Both hypotheses were based on protons and differed markedly from the then prevailing chemical theory originally proposed by E.C. Slater in 1953, which by 1961 was failing to account for a number of experimental observations. Immediately following the publication of Williams's (...) hypothesis and before his own was published, Mitchell initiated a correspondence. Examination of the letters shows the development of a dispute based on the validity of the proposals, who should have priority and particularly whether Mitchell had drawn on Williams's work without acknowledgement. We have concluded that Mitchell's proposals were original although it is evident that prior to the correspondence Williams had considered and rejected a proposition similar to Mitchell's theory. However, a major cause of the dispute was the difference in disciplinary backgrounds of Mitchell, a microbial biochemist and Williams, a chemist. (shrink)

Objectives To investigate risk perception relating to living kidney donation, to compare the risk donors would accept with current practice and identify influential factors. Design An observational study consisting of questionnaires completed by previous living donors and the general public. Participants selected the risk they would accept from a list of options, in various scenarios. Risk communication was investigated by randomly dividing the sample and presenting risk differently. Setting Primary care (two centres) and secondary care (one centre), London. Participants 175 (...) questionnaires were sent to patients who had previously undergone living-donor nephrectomy and to members of the public consulting a general practitioner. The living-donor sample comprised 77 consecutive donors at Guy's Hospital from May 2003 to January 2005. The general-public sample was recruited from two London healthcare centres. Of the eventual 151 participants, 61 were living donors and 90 were from the general public. Main outcome measure The amount of risk a participant would accept to donate a kidney. Results 74% of participants were willing to accept a risk of death higher than 1/3000. The most commonly accepted risk was 1/2 (29%). Those presented with a ‘chance of survival’ accepted higher risks than those presented with a ‘risk of death’ (p<0.01). Greater risks were accepted when the recipient was closely related and, for some, when the recipient's prognosis was worse. No difference was observed between the living-donor and general-public groups. Conclusions Kidney donors will accept a higher risk of death than is currently quoted, especially if risks are presented in terms of chance of survival. (shrink)

This book taps the best American thinkers to answer the essential American question: How do we sustain our experiment in government of, by, and for the people? Authored by an extraordinary and politically diverse roster of public officials, scholars, and educators, these chapters describe our nation's civic education problem, assess its causes, offer an agenda for reform, and explain the high stakes at risk if we fail.

In the same year, 1961, Peter D. Mitchell and Robert R.J.P. Williams both put forward hypotheses for the mechanism of oxidative phosphorylation in mitochondria and photophosphorylation in chloroplasts. Mitchell's proposal was ultimately adopted and became known as the chemiosmotic theory. Both hypotheses were based on protons and differed markedly from the then prevailing chemical theory originally proposed by E.C. Slater in 1953, which by 1961 was failing to account for a number of experimental observations. Immediately following the publication of Williams (...) 's hypothesis and before his own was published, Mitchell initiated a correspondence. Examination of the letters shows the development of a dispute based on the validity of the proposals, who should have priority and particularly whether Mitchell had drawn on Williams 's work without acknowledgement. We have concluded that Mitchell's proposals were original although it is evident that prior to the correspondence Williams had considered and rejected a proposition similar to Mitchell's theory. However, a major cause of the dispute was the difference in disciplinary backgrounds of Mitchell, a microbial biochemist and Williams, a chemist. (shrink)

Recognising and responding appropriately to emotions is critical to adaptive psychological functioning. Psychopathic traits (e.g. callous, manipulative, impulsive, antisocial) are related to differences in recognition and response when emotion is conveyed through facial expressions and language. Use of emotional music stimuli represents a promising approach to improve our understanding of the specific emotion processing difficulties underlying psychopathic traits because it decouples recognition of emotion from cues directly conveyed by other people (e.g. facial signals). In Experiment 1, participants listened to clips (...) of emotional music and identified the emotional content (Sample 1, N = 196) or reported on their feelings elicited by the music (Sample 2, N = 197). Participants accurately recognised (t(195) = 32.78, p <.001, d = 4.69) and reported feelings consistent with (t(196) = 7.84, p <.001, d = 1.12) the emotion conveyed in the music. However, psychopathic traits were associated with reduced emotion recognition accuracy (F(1, 191) = 19.39, p <.001) and reduced likelihood of feeling the emotion (F(1, 193) = 35.45, p <.001), particularly for fearful music. In Experiment 2, we replicated findings for broad difficulties with emotion recognition (Sample 3, N = 179) and emotional resonance (Sample 4, N = 199) associated with psychopathic traits. Results offer new insight into emotion recognition and response difficulties that are associated with psychopathic traits. (shrink)

This paper deals mainly with generalizations of results in finitary combinatorics to infinite ordinals. It is well-known that for finite ordinals ∑bT<αβ is the number of 2-element subsets of an α-element set. It is shown here that for any well-ordered set of arbitrary infinite order type α, ∑bT<αβ is the ordinal of the set M of 2-element subsets, where M is ordered in some natural way. The result is then extended to evaluating the ordinal of the set of all n-element (...) subsets for each natural number n ≥ 2. Moreover, series ∑β<αf are investigated and evaluated, where α is a limit ordinal and the function f belongs to a certain class of functions containing polynomials with natural number coefficients. The tools developed for this result can be extended to cover all infinite α, but the case of finite α appears to be quite problematic. (shrink)

The aim of this exploratory study was to examine client demographics and expectations, reasons for use, sensations during treatment, and perceived outcomes of Pranic Healing, an energy healing system lacking in scientific documentation but whose use in the general population is becoming more widespread internationally. This study consisted of a cross-sectional survey of adults (18+ years of age) receiving care from 12 Pranic Healing practices in four different states in the U.S. (N = 179) completing online questionnaires. Closed-ended response sets (...) were analyzed descriptively, while qualitative data were analyzed using content analysis. Reasons to use the therapy included physical, mental/emotional, and metaphysical issues, dissatisfaction with conventional care, and overall well-being. Expectations of care included enhanced abilities, cure or relief, or unsure. Respondents were more likely to cite a specific problem from which they needed alleviation than to cite overall health or wellness as their goal. Sensations experienced were reported to be of a relaxing nature and not, as was hypothesized, of an energizing nature. Results show that those who use Pranic Healing fit the sociodemographic profile of CAM (complementary and alternative medicine) users in the United States, that their reasons for use are not homogeneous, and that preliminary descriptive data from a selective subsample of respondents indicated that some respondents are experiencing positive outcomes attributed to this modality. (shrink)

This text has already been published in Studies in Philosophy and Education, Feb. 2018, n° 37, p.103–107. As we all know it, writing and reading takes time. In the contemporary social and academic context, often shaped by a destabilizing sense of acceleration and urgency, protecting the moments required for such ‘time-consuming' activities is not something that can be taken for granted anymore. The way we commit to a specific task expresses as much about the meaning it may carry that what (...) we - Débats. (shrink)

We say that a ring admits elimination of quantifiers, if in the language of rings, {0, 1, +, ·}, the complete theory of R admits elimination of quantifiers. Theorem 1. Let D be a division ring. Then D admits elimination of quantifiers if and only if D is an algebraically closed or finite field. A ring is prime if it satisfies the sentence: ∀ x ∀ y ∃ z (x = 0 ∨ y = 0 ∨ xzy ≠ 0). Theorem (...) 2. If R is a prime ring with an infinite center and R admits elimination of quantifiers, then R is an algebraically closed field. Let A be the class of finite fields. Let B be the class of 2 × 2 matrix rings over a field with a prime number of elements. Let C be the class of rings of the form $GF(p^n) \bigoplus GF(p^k)$ such that either n = k or g.c.d. (n, k) = 1. Let D be the set of ordered pairs (f, Q) where Q is a finite set of primes and f: Q → A ∪ B ∪ C such that the characteristic of the ring f(q) is q. Finally, let E be the class of rings of the form $\bigoplus_{q \in Q}f(q)$ for some (f, Q) in D. Theorem 3. Let R be a finite ring without nonzero trivial ideals. Then R admits elimination of quantifiers if and only if R belongs to E. Theorem 4. Let R be a ring with the descending chain condition of left ideals and without nonzero trivial ideals. Then R admits elimination of quantifiers if and only if R is an algebraically closed field or R belongs to E. In contrast to Theorems 2 and 4, we have Theorem 5. If R is an atomless p-ring, then R is finite, commutative, has no nonzero trivial ideals and admits elimination of quantifiers, but is not prime and does not have the descending chain condition. We also generalize Theorems 1, 2 and 4 to alternative rings. (shrink)

What is the relationship between biotechnology employees’ beliefs about the moral outcomes of a controversial transgenic research project and their attitudes of acceptance towards the project? To answer this question, employees (n=466) of a New Zealand company, AgResearch Ltd., were surveyed regarding a project to create transgenic cattle containing a synthetic copy of the human myelin basic protein gene (hMBP). Although diversity existed amongst employees’ attitudes of acceptance, they were generally: in favor of the project, believed that it should be (...) allowed to proceed to completion, and that it is acceptable to use transgenic cattle to produce medicines for humans. These three items were aggregated to form a project acceptance score. Scales were developed to measure respondents’ beliefs about the moral outcomes of the project for identified stakeholders in terms of the four principles of common morality (benefit, non-harm, justice, and autonomy). These data were statistically aggregated into an Ethical Valence Matrix for the project. The respondents’ project Ethical Valence Scores correlated significantly with their project acceptance scores (r=0.64, p<0.001), accounting for 41% of the variance in respondents’ acceptance attitudes. Of the four principles, non-harm had the strongest correlation with attitude to the project (r=0.59), followed by benefit and justice (both r=0.54), then autonomy (r=0.44). These results indicate that beliefs about the moral outcomes of a research project, in terms of the four principles approach, are strongly related to, and may be significant determinants of, attitudes to the research project. This suggests that, for employees of a biotechnology organization, ethical reasoning could be a central mechanism for the evaluation of the acceptability of a project. We propose that the Ethical Valence Matrix may be used as a tool to measure ethical attitudes towards controversial issues, providing a metric for comparison of perceived ethical consequences for multiple stakeholder groups and for the evaluation and comparison of the ethical consequences of competing alternative issues or projects. The tool could be used to measure both public and special interest groups’ ethical attitudes and results used for the development of socially responsible policy or by science organizations as a democratizing decision aid to selection amongst projects competing for scarce research funds. (shrink)

Keith Thomas: Gerald Edward Aylmer, 1926-2000 Adrian Hollis: William Spencer Barrett, 1914-2001 Bruce Williams: Charles Frederick Carter, 1919-2002 Malcolm Mackintosh: John Erickson, 1929-2002 J. H .R. Davis: Raymond William Firth, 1901-2002 F. M. L. Thompson: Hrothgar John Habakkuk, 1915-2002 A. W. Price: Richard Mervyn Hare, 1919-2002 Hugh Lloyd-Jones: Geoffrey Stephen Kirk, 1921-2003 Michael Lapidge and Peter Matthews: Vivien Anne Law, 1954-2002 Ann Moss: John Lough, 1913-2000 Terence Cave: Ian Dalrymple McFarlane, 1915-2002 Ludwig Paul: David Neil MacKenzie, 1926-2001 Peter (...) Birks: John Kieran Barry Moylan Nicholas, 1919-2002 Jonathan Shepard: Dimitri Dimitrievich Obolensky, 1918-2001 David Cannadine: John Harold Plumb, 1911-2001 Daniel Waley: Nicolai Rubinstein, 1911-2002 Ian Wood: John Michael Wallace-Hadrill, 1916-1985 R. G. M. Nisbet: William Smith Watt, 1913-2002 G. W. Bernard: Richard Bruce Wernham, 1906-1999. (shrink)

BackgroundThe ARRIVE (Animal Research: Reporting of In Vivo Experiments) guidelines are widely endorsed but compliance is limited. We sought to determine whether journal-requested completion of an ARRIVE checklist improves full compliance with the guidelines.MethodsIn a randomised controlled trial, manuscripts reporting in vivo animal research submitted to PLOS ONE (March–June 2015) were randomly allocated to either requested completion of an ARRIVE checklist or current standard practice. Authors, academic editors, and peer reviewers were blinded to group allocation. Trained reviewers performed outcome adjudication (...) in duplicate by assessing manuscripts against an operationalised version of the ARRIVE guidelines that consists 108 items. Our primary outcome was the between-group differences in the proportion of manuscripts meeting all ARRIVE guideline checklist subitems.ResultsWe randomised 1689 manuscripts (control: n = 844, intervention: n = 845), of which 1269 were sent for peer review and 762 (control: n = 340; intervention: n = 332) accepted for publication. No manuscript in either group achieved full compliance with the ARRIVE checklist. Details of animal husbandry (ARRIVE subitem 9b) was the only subitem to show improvements in reporting, with the proportion of compliant manuscripts rising from 52.1 to 74.1% (X2 = 34.0, df = 1, p = 2.1 × 10−7) in the control and intervention groups, respectively.ConclusionsThese results suggest that altering the editorial process to include requests for a completed ARRIVE checklist is not enough to improve compliance with the ARRIVE guidelines. Other approaches, such as more stringent editorial policies or a targeted approach on key quality items, may promote improvements in reporting. (shrink)

Background and PurposeMany critically ill patients in intensive care units (ICUs) are unable to communicate their wishes about goals of care, particularly about the use of life-sustaining treatments. Surrogates and clinicians struggle with medical decisions because of a lack of clarity regarding patients’ preferences, leading to prolonged hospitalizations and increased costs. This project focused on the development and implementation of a tool to facilitate a better communication process by (1) assuring the early identification of a surrogate if indicated on admission (...) and (2) clarifying the decision-making standards that the surrogate was to use when participating in decision making. Before introducing the tool into the admissions routine, the staff were educated about its use and value to the decision-making process.Project and MethodsThe study was to determine if early use of a simple method of identifying a patient’s surrogate and treatment preferences might impact length of stay (LOS) and total hospital charges. A pre- and post-intervention study design was used. Nurses completed the surrogacy information tool for all patients upon admission to the neuroscience ICU. Subjects (total N=203) were critically ill patients who had been on a mechanical ventilator for 96 hours or longer, or in the ICU for seven days or longer. The project included staff education on biomedical ethics, critical communication skills, early identification of families and staff in crisis, and use of a simple tool to document patients’ surrogates and previously expressed care wishes. Data on hospital LOS and hospital charges were collected through a retrospective review of medical records for similar four-month time frames pre- and post-implementation of the assessment tool.ResultsSignificant differences were found between pre- and post-groups in terms of hospital LOS (F=6.39, p=.01) and total hospital charges (F=7.03, p=.009).ConclusionsProject findings indicate that the use of a simple admission assessment tool, supported by staff education about its completion, use, and available resources, can decrease LOS and lower total hospital charges. The reasons for the difference between the pre- and post-intervention groups remain unclear. Further research is needed to evaluate if the quality of communications between patients, their legally authorized representatives, and clinicians—as suggested in the literature—may have played a role in decreasing LOS and total hospital charges. (shrink)

I argue that quantum optical experiments that purport to refute Bohr’s principle of complementarity fail in their aim. Some of these experiments try to refute complementarity by refuting the so called particle–wave duality relations, which evolved from the Wootters–Zurek reformulation of BPC. I therefore consider it important for my forgoing arguments to first recall the essential tenets of BPC, and to clearly separate BPC from WZPC, which I will argue is a direct contradiction of BPC. This leads to a need (...) to consider the meaning of particle–wave duality relations and to question their fundamental status. I further argue that particle and wave complementary concepts are on a different footing than other pairs of complementary concepts. (shrink)

Galen's æuvre presents a remarkably varied body of texts–varied in subject matter, style, and didactic purpose. Logical tracts sit alongside tomes of drug–lore; handbooks of dietetics alongside anatomical investigations; treatises of physiology alongside ethical opuscula. These differences in type have received some, though as yet insufficient, scholarly attention. Mario Vegetti demonstrated the coexistence of two ‘profili’ or images of the art of medicine: Galen presents the art as an Aristotelian deductive science, on the one hand, and as a technician's craft, (...) on the other. The former image, offering an ambitious elevation of the doctor's cultural status, has medicine as a philosophical episteme analogous to the mathematical sciences, exercised above all to provide causal accounts and logical demonstrations, and centred on the knowledge of anatomy. The second image is that of the clinician, concerned with the body in its pathological manifestations and using as its prime model the ‘pre-anatomical’ theory of the humours. And the content of the treatises shifts in relation to this dual image: ‘profilo alto’ and ‘profilo basso’ are reflected in different types of work. Polemical writings such as the Protrepticus, as well as the great treatises of anatomy and physiology, De usu partium and De naturalibus facultatibus, present medicine in the former light, while works like De temperamentis or Quod animi mores base themselves on humoral pathology and accord with the earlier, artisan-like image. (shrink)