Physicians have developed a number of implicit and explicit approaches to complex medical decisions. Decision analysis is an explicit, quantitative method of clinical decision making that involves the separation of the probabilities of events from their relative values, or utilities. Its use can help physicians make difficult choices in a manner that promotes true patient participation. Decision analysis also provides a framework for the incorporation of data from multiple sources and for the assessment of the impact of uncertain data on (...) the final decision. Although this approach is imperfect, it represents a significant advance in clinical decision making. (shrink)

Primordial emotions are the subjective element of the instincts which are the genetically programmed behaviour patterns which contrive homeostasis. They include thirst, hunger for air, hunger for food, pain and hunger for specific minerals etc.There are two constituents of a primordial emotion—the specific sensation which when severe may be imperious, and the compelling intention for gratification by a consummatory act. They may dominate the stream of consciousness, and can have plenipotentiary power over behaviour.It is hypothesized that early in animal evolution (...) complex reflex mechanisms in the basal brain subserving homeostatic responses, in concert with elements of the reticular activating system subserving arousal, melded functionally with regions embodied in the progressive rostral development of the telencephalon. This included the emergent limbic and paralimbic areas, and the insula. This phylogenetically ancient organization subserved the origin of consciousness as the primordial emotion, which signalled that the organisms existence was immediately threatened. Neuroimaging confirms major activations in regions of the basal brain during primordial emotions in humans. The behaviour of decorticate humans and animals is discussed in relation to the possible existence of primitive awareness.Neuroimaging of the primordial emotions reveals that rapid gratification of intention by a consummatory act such as ingestion causes precipitate decline of both the initiating sensation and the intention. There is contemporaneous rapid disappearance of particular regions of brain activation which suggests they may be part of the jointly sufficient and severally necessary activations and deactivations which correlate with consciousness [Crick, F. & Koch, C. . A framework for consciousness. NatureNeuroscience,6, 119–126]. (shrink)

A Lasting tradition among the ancients marked Sicily as the birthplace and Tisias and Corax as inventors of the art of rhetoric: and in this tradition, legendary though it became, there is a stricter truth than in most of the stories related about the foundation of invented arts. We, with more elaborate historical views, shall still say of rhetoric that it was created at a certain epoch; and can still point to the Sicilians Tisias and Corax as its authors. Oratory, (...) to be sure, has existed almost as long as speech. Its beginnings are prehistoric, and must in any case be imperceptible; and if by rhetorician we meant no more than one who uses speech with more than common effect, we might set the origin of rhetoric as far back as we chose, and could hardly bring it lower than the beginning of recorded literature. Indeed we are told that under the Antonine Emperors the eminent scholar Telephus of Pergamum wrote a book on Rhetoric in Homer, in which he illustrated from the Poet the whole contemporary system of the art down to the thirteen constitutions of Minucian; and in the same spirit the Venerable Bede, resenting the claim of the Greeks to have invented tropes and figures of speech, wrote a short work to show that they could all be found in Holy Scripture. But such inquiries, even when conducted less foolishly than by Telephus and less incompetently than by Bede, are irrelevant to the proper history of rhetoric. Let the practice of oratory have begun when it may, the first attempts known to us in Classical Antiquity to formulate a series of principles for the art of speech were made in the fifth century before Christ. These earliest systems were naturally very imperfect: they could not immediately be either comprehensive or well organized. But they were something that had not existed at all before: methodical principles for speaking. At the moment when these were first set out the art of rhetoric began. (shrink)

The early handbooks of rhetoric compiled by Tisias and Corax and their successors seem to have been directed entirely at successful speaking in courts of law. This was the art that Strepsiades set out to learn in the Philosopher's Thinking-shop; this, Isocrates complains, was the only object of technical writers on rhetoric before his time; and Aristotle, when he wrote the chapter that stands first in hisRhetoric, made just the same complaint: τς ατς oσμς μεθδoυ περι τ δημηγoρικτ και δικανικ (...) και καλλιoνoς και πoλιτικωτραςτς δημηγoρικς πραγματειας oςηρ oσης τς περι τ ςυναλλγματα, πει μν κεινης oδν λγoυγι, περι δικξεσθαι πντες πειρνται τεχνoλoγειν. The art as the Sophists practised it was by no means so limited in its application: many of them were accustomed to playing the parts of statesmen and diplomats as well as of educators; and the most notorious field for their powers of oratory was of course the lecture or πιδειξις. But the systems of rhetoric that they devised and taught did not cover their own practice; and forensic oratory, as well as seeming the most commonly necessary kind at that time, was also, it must be said, the easiest to reduce to rule. Gorgias, it is true, professed to teach a rhetoric of more extended application, by means of which his pupils would be able to produce conviction in any public assembly;* but we must conclude that this wider field was at least very imperfectly treated in all the technical systems of the time. Plato shortly describes the position thus:μλιστα μν πως περι τς δικας λγεται τε και γρφεται τχν, λγεται δ και περι δημηγoριας π ι πλo≠ δ oκκoα. (shrink)

Live donor kidney transplantation is the best treatment option for most patients with late-stage chronic kidney disease; however, the rate of living kidney donation has declined in the United States. A consensus conference was held June 5-6, 2014 to identify best practices and knowledge gaps pertaining to live donor kidney transplantation and living kidney donation. Transplant professionals, patients, and other key stakeholders discussed processes for educating transplant candidates and potential living donors about living kidney donation; efficiencies in the living donor (...) evaluation process; disparities in living donation; and financial and systemic barriers to living donation. We summarize the consensus recommendations for best practices in these educational and clinical domains, future research priorities, and possible public policy initiatives to remove barriers to living kidney donation. (shrink)

The purpose of this qualitative study was to analyse nurses’ professional dignity in their everyday working lives. We explored the factors that affect nursing professional dignity in practice that emerge in relationships with health professionals, among clinical nurses working in hospitals and in community settings in central Italy. The main themes identified were: (i) nursing professional dignity perceived as an achievement; (ii) recognition of dignity beyond professional roles. These two concepts are interconnected. This study provides insights into professional dignity in (...) nursing being perceived as an achievement linked to the intrinsic dignity of every human being. The ‘nursing professional dignity perceived as an achievement’ was perceived as having declined in different social factors. Some factors of nursing professional dignity perceived as an achievement were attained more easily in community settings. ‘Recognition of dignity beyond professional roles’ underpins the intrinsic dignity as an expression of humanity, embedded in persons regardless of any profession, and values, such as: respect, moral integrity, humility, working conscientiously and kindness. (shrink)

The proto-code of ethics and conduct for European nurse directors was developed as a strategic and dynamic document for nurse managers in Europe. It invites critical dialogue, reflective thinking about different situations, and the development of specific codes of ethics and conduct by nursing associations in different countries. The term proto-code is used for this document so that specifically country-orientated or organization-based and practical codes can be developed from it to guide professionals in more particular or situation-explicit reflection and values. (...) The proto-code of ethics and conduct for European nurse directors was designed and developed by the European Nurse Directors Association’s (ENDA) advisory team. This article gives short explanations of the code’ s preamble and two main parts: Nurse directors' ethical basis, and Principles of professional practice, which is divided into six specific points: competence, care, safety, staff, life-long learning and multi-sectorial working. (shrink)

This well organized and interesting anthology concerns the image of the self-directed individual as replaced by a deterministic model of his behavior. Since legal, personal-social, and religious institutions still see man as self-controlled and therefore responsible, Mr. Klausner views this replacement as particularly troublesome. The first third of the book is predominantly historical and draws from an extremely tolerant range of sources including yoga, philosophy, psychology, hypnosis and self-help publications. The remainder of the volume is psychological and sociological, with emphasis (...) on the individual acting under stress, and with the traditional philosophical problems completely ignored. While the thematic problem is not obviously tackled there is fruitful examination of significant concepts with detailed and well-researched relationships of these concepts with a manifold of phenomena. There are several extensive bibliographies accompanying the readings. Not including introductory contributions the book includes: "Self-Control in the Perspective of History": Klausner, B. Nelson, Moses Hadas; "Self-Control in a Sociological Perspective": S. M. Dornbusch, M. K. Opler, Guy E. Swanson; "Self-Control in Psychological Perspective": I. L. Janis, S. J. Korchin, H. Liddel; "Self-Control in Psychiatric Perspective": M. T. Orne, O. McK, Rioch, K. Goldstein; and "Scientific Hermeneutics": Klausner.—D. A. G. (shrink)

Each volume of this series of Companions to major philosophers contains specially-commissioned essays by an international team of scholars, together with a substantial bibliography, and will serve as a reference work for students and non-specialists. The contributors to this Companion probe the full depth of Kierkegaard's thought revealing its distinctive subtlety. The topics covered include Kierkegaard's views on art and religion, ethics and psychology, theology and politics, and knowledge and virtue. Much attention is devoted to the pervasive influence of Kierkegaard (...) in twentieth-century philosophy. New readers will find this the a convenient and accessible guide to Kierkegaard. Advanced students and specialists will find a conspectus of recent developments in the interpretation of Kierkegaard. (shrink)

The aim of this study was to analyze the association between physical activity and eating habits during the COVID-19 pandemic among Brazilian adults. A sample of 1,929 participants answered an online survey, however 1,874 were included in the analysis. The impact of the COVID-19 pandemic on eating habits was assessed inquiring about participants' intake of fruits, vegetables, fried foods, and sweets during the pandemic. Physical activity was assessed by asking participants about their weekly frequency, intensity and number of minutes/hours engaging (...) in structured physical activities per week. Participants were then stratified into categories based on moderate-to-vigorous intensity and into active or inactive. Increased sweets consumption was the most commonly reported change to eating habits, followed by an increase in the consumption of vegetables, fruits, and fried foods. Physical activity practice was related to lower consumption of fried foods and sweets. A cluster analysis revealed subjects with higher the level of physical activity was more likely to follow a healthy diet. Thus, physical activity was positively associated with healthier eating habits. Health authorities must recommend regular physical as a strategy to improve overall health during the COVID-19 pandemic. Future studies should address the physical activity interventions to improve health status during a pandemic. (shrink)

This book might be better entitled "Objectivity in Science" since topics traditionally associated with the given title are not focused on until the last chapter. The majority of the work is devoted to broader themes in science. The stated purpose of the work is "to combat the position of anti-objectivism" and to provide "a convenient map for finding one’s way about in the tangle of issues surrounding the question of objectivity in social science." Chapter One begins with a discussion of (...) what objectivism is not and what it is not committed to. (shrink)

ObjectivesThe present study explores the effect of visual art training on people with dementia, utilizing a randomized control trial design, in order to investigate the effects of an 8-week visual art training program on cognition. In particular, the study examines overall cognition, delayed recall, and working memory, which show deficits in people with dementia.MethodFifty-three individuals with dementia were randomly assigned into either an art training or usual-activity waitlist control group. Overall cognition and delayed recall were assessed with the Montreal Cognitive (...) Assessment, and working memory was assessed with the Backward Digit Span task.ResultsThere were no group differences in overall cognition, or working memory, while a difference in delayed recall was undetermined, based on post-test—pre-test difference scores. Groups were comparable at baseline on all measures.ConclusionThe measures of cognition, delayed recall, and working memory used in this study were not affected by an 8-week visual art training program.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NCT03175822. (shrink)

This very short and less than solemn volume deals with approximately fifty aspects of eleven broad philosophical problems. The questions chosen are believed by the author to be capable of further resolution and among these we find: "What is Philosophy?," "What do we know?," and also, "What is God like?," "How does God Operate?," "Who is my neighbor?," and "What is life?" Little attention is paid to the questions themselves, that is to their understanding or clarification, but Mr. Keleher directly (...) proceeds to answer them, a move which at times, as in his discussion of natural law, leaves much wanting. On the whole, the issues are handled in a glib and oversimplified fashion which is perhaps all that can be expected of an edition which devotes two pages to the question "What is logic?," one and a half pages to the refutation of the theory of evolution, one to the categorical imperative and one-half to "The market... of Western Civilization." Where there is insightful comment—as in some of the epistemological discussions—it is all too brief in a way that is neither introductory nor satisfying.—D. A. G. (shrink)

Originally published in different form this is a commentary on "modern man" that is not, and does not pretend to be, a sociological or psychological study. It does claim to be philosophical, but if it is, it is surely not in the Anglo-American analytic tradition. It is concerned with such thinkers as Marcel, Proust, Nietzsche, Sartre, Buber, Dostoyevsky, Kierkegaard, Kafka, Marx and Heidegger, although there is often gross over-simplification of their views and a frequent tendency to confuse the lives of (...) the philosophers with the content of their works. Through the framework of the tale of the Sleeping Beauty and by way of commentary Mr. Harper examines such notions as poetic justice, hope, longing, mystery, promise, waiting, nostalgia and "presence": "something that moves one." The text is ridden with highly dubious and at times unintelligible assertions. But only a minimum of sensitivity is needed to understand that dramatic emphasis is being placed upon certain aspects of the experience of those who may be seriously concerned with the lack of God in the world, those who are shaken, disturbed, and homesick, who turn toward the past to complete a hungry and hollow present. Mr. Harper believes there are few who do not.—D. A. G. (shrink)

This article featuring India constitutes one of five articles in a collection of essays on local capacity-building in research ethics by graduates from the University of Toronto’s Joint Centre for Bioethics MHSc in Bioethics, International Stream program funded by the Fogarty International Center for Advanced Study in the Health Sciences. Research ethics is a growing area of work and interest in India. Ethics review remains the weakest component in the mechanism of good clinical practice, and there is a severe dearth (...) of professionals trained in ethics who can provide leadership. Although the Indian Good Clinical Practice Guidelines, the Indian Medical Council Act, and the Drugs and Cosmetics Act require that the Indian Council of Medical Research’s ethical guidelines be followed as a mandatory requirement for physicians who conduct research, there is a pervasive lack of awareness of basic requirements guiding the ethical conduct of research. There is a great need to strengthen India’s research ethics capacity and regulatory framework for research. (shrink)

SummaryExtremism in the environment‐versus innateness controversy in the behavioural sciences and in human sociobiology is being examined. Genetic effects can be severely modified or overruled by environmental factors, but may, nevertheless, be important. Dawkins' view that we are survival machines programmed to subserve selfish genes seems untenable and is a root of racialism. It is also argued that morality is compatible with mixed genetic and environmental control of brains via existing biological machinery.