While valuable work has been done addressing clinical ethics within established healthcare systems, we anticipate that the projected growth in acquisitions of community hospitals and facilities by large tertiary hospitals will impact the field of clinical ethics and the day-to-day responsibilities of clinical ethicists in ways that have yet to be explored. Toward the goal of providing clinical ethicists guidance on a range of issues that they may encounter in the systematization process, we discuss key considerations and potential challenges in (...) implementing system-wide ethics consultation services. Specifically, we identify four models for organizing, developing, and enhancing ethics consultation activities within a system created through acquisitions: train-the-trainer, local capacity-building, circuit-riding, and consolidated accountability. We note each model’s benefits and challenges. To our knowledge, this is the first paper to consider the broader landscape of issues affected by consolidation. We anticipate that clinical ethicists, volunteer consultants, and hospital administrators will benefit from our recommendations. (shrink)

America's research universities, approximately 125 in number,play important roles in the nation's research system, and help toset the tone for all institutions of research and higherlearning. As the research universities have formed closer linkswith industry, new problems have arisen that have precipitated amajor debate. The academic medical centres and related lifescience departments present some of the most challenging newissues, which are analysed in this paper within the framework ofthe biomedical research system that has evolved in the UnitedStates since the Second (...) World War. (shrink)

The clinical ethicist met with Ms. H to clarify what information she wants and does not want to know. First, she wants to receive any treatment that could prolong her life, regardless of how the treatment affects her ability to engage in activities of daily living. Second, she wants to be included in the decision‐making process as much as possible, as long as clinicians use only “positive” language. Ms. H considers the words “dying,” “chemotherapy,” “radiation,” and “cancer” to be “bad (...) words.” For conversations in which these words cannot be avoided, she wants her clinicians to talk to her son. Her desired engagement includes hearing about risks, benefits, and alternatives to treatments if clinicians use only “positive” language. Finally, she says that she rarely sees doctors and that she is “very scared” of hospitals, despite exhibiting a comfortable demeanor.Should clinicians honor Ms. H's waiver of specified information and, if so, to what degree? (shrink)

Developing a care plan in a critical care context can be challenging when the therapeutic alliance between clinicians and families is compromised by anger. When these cases occur, clinicians often turn to clinical ethics consultants to assist them with repairing this alliance before further damage can occur. This paper describes five different reasons family members may feel and express anger and offers concrete strategies for clinical ethics consultants to use when working with angry families acting as surrogate decision makers for (...) critical care patients. We reviewed records of consults using thematic analysis between January 2015 and June 2016. Each case was coded to identify whether the case involved a negative encounter with an angry family. In our review, we selected 11 cases with at least one of the following concerns or reasons for anger: perceived or actual medical error, concerns about the medical team’s competence, miscommunication, perceived conflict of interest or commitment, or loss of control. To successfully implement these strategies, clinical ethics consultants, members of the medical team, and family members should share responsibility for creating a mutually respectful relationship. (shrink)

Schools of Faith represents a diversity of essays from scholars in several continents. The contributors, all leading theologians and ethicists, offer reflections on historical and contemporary themes which are significant for wider debates in theological education and church life in today's world. The range of contributor and content provides a fitting tribute to the work of Iain R. Torrance over many years. Amid the numerous subjects discussed, the authors focus on liturgy, textual criticism, public theology, the ethics of war, Christian (...) doctrine, divine action, ecumenism, inter-faith dialogue, spiritual formation, the office of the minister, and the interface between religion and literature. The multi-faceted nature of this collection signifies its importance for historical, systematic and practical theology. (shrink)

© 2017. The American Astronomical Society. All rights reserved.We present new observations of the low-mass companion to HD 984 taken with the Gemini Planet Imager as a part of the GPI Exoplanet Survey campaign. Images of HD 984 B were obtained in the J and H bands. Combined with archival epochs from 2012 and 2014, we fit the first orbit to the companion to find an 18 au orbit with a 68% confidence interval between 14 and 28 au, an eccentricity (...) of 0.18 with a 68% confidence interval between 0.05 and 0.47, and an inclination of 119°with a 68% confidence interval between 114°and 125°. To address the considerable spectral covariance in both spectra, we present a method of splitting the spectra into low and high frequencies to analyze the spectral structure at different spatial frequencies with the proper spectral noise correlation. Using the split spectra, we compare them to known spectral types using field brown dwarf and low-mass star spectra and find a best-fit match of a field gravity M6.5 ±1.5 spectral type with a corresponding temperature of K. Photometry of the companion yields a luminosity of log=2.88 ± 0.07 dex with DUSTY models. Mass estimates, again from DUSTY models, find an age-dependent mass of 34 ±1 to 95 ±4 M Jup. These results are consistent with previous measurements of the object. (shrink)

First, I consider J.L. Mackie's deductive argument from evil, noting that required modifications to his premises, especially those dealing with what it is to be a good person and omnipotence, do not entail that God would be required to eliminate evil completely. Hence, no contradiction exists between God's existence, possession of certain properties, and the existence of evil. Second I evaluate McCloskey's arguments against reasons for evil often suggested by the theist: that evil is a means to achieving the good, (...) that evil is a by-product of securing the good, and that certain goods are logically dependent on the existence of certain evils. I argue that in none of these objections is McCloskey successful. (shrink)

The authors of this article are previous or current members of the Clinical Ethics Consultation Affairs (CECA) Committee, a standing committee of the American Society for Bioethics and Humanities (ASBH). The committee is composed of seasoned healthcare ethics consultants (HCECs), and it is charged with developing and disseminating education materials for HCECs and ethics committees. The purpose of this article is to describe the educational research and development processes behind our teaching materials, which culminated in a case studies book called (...) A Case-Based Study Guide for Addressing Patient-Centered Ethical Issues in Health Care (hereafter, the Study Guide). In this article, we also enumerate how the Study Guide could be used in teaching and learning, and we identify areas that are ripe for future work. (shrink)

This text, serving as an introduction to Aristotelian, symbolic, inductive, and practical logic, presents the techniques of these approaches to logic, some of the philosophical problems of logic, and some of the attempts to solve philosophical problems by means of various logical techniques. It discusses the problem of universals and null classes; briefly introduces the theory of types; and presents Lukasiewicz's formalization of Aristotelian syllogistic logic as an example of a formal system. Classical logic and propositional logic are carefully and (...) fully presented. The text, however, is weak in its presentation of quantificational logic. After a correct, but brief and very inadequate introduction to quantificational logic, the readers are referred to Quine, Methods of Logic, or to Copi, Symbolic Logic, for a more adequate development. The chapter on inductive logic discusses the uses and dangers of generalizations and introduces the probability calculus; the chapter on informal logic discusses criteria of rationality and presents the usual informal fallacies. There are problems and exercises after many of the sections, and answers in the back of the book.—R. L. S. (shrink)

The expository material in this book is ninety-nine pages long and covers very sketchily the philosophy of language, classical logic, symbolic logic, informal fallacies, the philosophy of science, and probability theory. To supplement the text material, the authors have included 142 pages of exercises, which may be removed from the book by tearing along the perforations. The authors have deliberately written a brief text so that the instructor "will be left free to elaborate according to his own judgment as his (...) classroom situation warrants." Eight pages are devoted to quantificational logic. The high price of this paperback text does not seem to be warranted by either the brief expository material, the removable pages of exercises, or the uniqueness of this approach.—R. L. S. (shrink)

Many religious people are alarmed about features of the current age - violence in the media, a pervasive hedonism, a marginalization of religion, and widespread abortion. These concerns influence politics, but just as there should be a separation between church and state, so should there be a balance between religious commitments and secular arguments calling for social reforms. Robert Audi offers a principle of secular rationale, which does not exclude religious grounds for action but which rules out restricting freedom except (...) on grounds that any rational citizen would accept. The book describes the essential commitments of free democracy, explains how religious and secular moral considerations can be integrated to facilitate co-operation in a world of religious pluralism, and proposes ideals of civic virtue that express the mutual respect on which democracy depends. Audi offers a balanced and sophisticated treatment of the relations between religion and politics in a modern, secular society. (shrink)

CHAPTER ONE INTRODUCTION S 1.1: THE AIMS OF THIS BOOK ... God has not been so sparing to men to make them barely two- legged creatures, and left it to ...

The genome is a stable repository of vastly intricate genetic information developed over eons of evolution; this information is replicated at the highest fidelity and expressed within each cell at the highest selectivity. Non‐leukemia cancers break this standard; the intricate genetic information qualitatively and progressively deteriorates, resulting in a somatic Darwinian free‐for‐all. In a process lasting several years, a genomically heterogeneous population replicates from a single cell that originally lost the ability to preserve its genomic integrity. Cells selected for their (...) abilities to proliferate and spread, while evading host defenses, inexorably expand their numbers. The clinical consequences of this become severe, as the genomically diverse cell population that evolves contains members that can evade most therapeutic approaches aimed at “the tumor cell”. BioEssays 23:1037–1046, 2001. © 2001 John Wiley & Sons, Inc. (shrink)

Atherosclerosis is the major cause of death in the industrialised world. Though much work on the pathogenesis of atherosclerosis points to 'oxidised' low density lipoprotein (LDL) as a key aetiological feature in the generation of the atherosclerotic plaque, the nature of this 'oxidised' LDL in vivo remains an enigma. We argue here that glycated LDL shows many of the characteristics attributed to 'oxidised LDL' and may be the source of the latter in vivo. These include the increased uptake and impaired (...) degradation of glycated LDL by macrophages and the stimulation of transendothelial chemotaxis of monocytes, cytokine secretion and platelet aggregation. We hypothesise that the covalent binding of glycated LDL to the endothelial cell wall may result in the formation of the early atherosclerotic lesion of the fatty streak and that apolipoprotein E may mediate the physiological clearance of glycated moieties. The proposed role of glycation in the pathogenesis of atherosclerosis would explain its high incidence among diabetics and the contentious epidemiological and experimental correlations between dietary sugar and atherosclerosis. (shrink)

Copyright © 2015 by the Society of Criti. Objective: Global lung stress varies considerably with low tidal volume ventilation for acute respiratory distress syndrome. High stress despite low tidal volumes may worsen lung injury and increase risk of death. No widely available parameter exists to assess global lung stress. We aimed to determine whether the volume delivered during a recruitment maneuver is inversely associated with lung stress and mortality in acute respiratory distress syndrome. Design: Substudy of an acute respiratory distress (...) syndrome clinical trial on esophageal pressure-guided positive end-expiratory pressure titration. Setting: U.S. academic medical center. Patients: Forty-two patients with acute respiratory distress syndrome in whom airflow, airway pressure, and esophageal pressure were recorded during the recruitment maneuver. Interventions: A single recruitment maneuver was performed before initiating protocol-directed ventilator management. Recruitment maneuvers consisted of a 30-second breath hold at 40 cm H2O airway pressure under heavy sedation or paralysis. VRM was calculated by integrating the flow-time waveform during the maneuver. End-inspiratory stress was defined as the transpulmonary pressure during end-inspiratory pause of a tidal breath and tidal stress as the transpulmonary pressure difference between end-inspiratory and end-expiratory pauses. Measurements and Main Results: VRM ranged between 7.4 and 34.7 mL/kg predicted body weight. Lower VRM predicted high end-inspiratory and tidal lung stress. After adjusting for Pao2/Fio2 and either driving pressure, tidal volume, or plateau pressure and positive end-expiratory pressure, VRM remained independently associated with both end-inspiratory and tidal stress. In unadjusted analysis, low VRM predicted increased risk of death. VRM remained significantly associated with mortality after adjusting for study arm. Conclusions: Low VRM independently predicts high lung stress and may predict risk of death in patients with acute respiratory distress syndrome. (shrink)

Explains the intersubjective nature of the self and the function of role taking in the development of the personal level of intersubjectivity out of primordial, pre-personal sociality or corporeal intersubjectivity of the lived body. Pragmatic philosophy of George Herbert Mead; Existential-phenomenology of Maurice Merleau-Ponty; Fundamental and pervasive rapport; More.

This report describes the rationale, approaches, organization, and resource development leading to a large-scale deletion bin map of the hexaploid wheat genome. Accompanying reports in this issue detail results from chromosome bin-mapping of expressed sequence tags representing genes onto the seven homoeologous chromosome groups and a global analysis of the entire mapped wheat EST data set. Among the resources developed were the first extensive public wheat EST collection. Described are protocols for sequencing, sequence processing, EST nomenclature, and the assembly of (...) ESTs into contigs. These contigs plus singletons were used for selection of distinct sequence motif unigenes. Selected ESTs were rearrayed, validated by 5′ and 3′ sequencing, and amplified for probing a series of wheat aneuploid and deletion stocks. Images and data for all Southern hybridizations were deposited in databases and were used by the coordinators for each of the seven homoeologous chromosome groups to validate the mapping results. Results from this project have established the foundation for future developments in wheat genomics. (shrink)

Continuous recordings of brain electrical activity were obtained from a group of 176 patients throughout surgical procedures using general anesthesia. Artifact-free data from the 19 electrodes of the International 10/20 System were subjected to quantitative analysis of the electroencephalogram (QEEG). Induction was variously accomplished with etomidate, propofol or thiopental. Anesthesia was maintained throughout the procedures by isoflurane, desflurane or sevoflurane (N = 68), total intravenous anesthesia using propofol (N = 49), or nitrous oxide plus narcotics (N = 59). A set (...) of QEEG measures were found which reversibly displayed high heterogeneity of variance between four states as follows: (1) during induction; (2) just after loss of consciousness (LOC); (3) just before return of consciousness (ROC); (4) just after ROC. Homogeneity of variance across all agents within states was found. Topographic statistical probability images were compared between states. At LOC, power increased in all frequency bands in the power spectrum with the exception of a decrease in gamma activity, and there was a marked anteriorization of power. Additionally, a significant change occurred in hemispheric relationships, with prefrontal and frontal regions of each hemisphere becoming more closely coupled, and anterior and posterior regions on each hemisphere, as well as homologous regions between the two hemispheres, uncoupling. All of these changes reversed upon ROC. Variable resolution electromagnetic tomography (VARETA) was performed to localize salient features of power anteriorization in three dimensions. A common set of neuroanatomical regions appeared to be the locus of the most probable generators of the observed EEG changes. (shrink)