Patient-reported outcomes are frequently used for medical decision making, at the levels of both individual patient care and healthcare policy. Evidence increasingly shows that PROs may be influenced by patients’ response shifts and dispositions. We identify how response shifts and dispositions may influence medical decisions on both the levels of individual patient care and health policy. We provide examples of these influences and analyse the consequences from the perspectives of ethical principles and theories of just distribution. If influences of response (...) shift and disposition on PROs and consequently medical decision making are not considered, patients may not receive optimal treatment and health insurance packages may include treatments that are not the most effective or cost-effective. We call on healthcare practitioners, researchers, policy makers, health insurers, and other stakeholders to critically reflect on why and how such patient reports are used. (shrink)

We prove linear and polynomial growth properties of sets and functions that are existentially definable in the ordered group of integers with divisibility. We determine the laws of addition with order and divisibility.

We prove linear and polynomial growth properties of sets and functions that are existentially definable in the ordered group of integers with divisibility. We determine the laws of addition with order and divisibility.

Van den Dries, L. and J. Holly, Quantifier elimination for modules with scalar variables, Annals of Pure and Applied Logic 57 161–179. We consider modules as two-sorted structures with scalar variables ranging over the ring. We show that each formula in which all scalar variables are free is equivalent to a formula of a very simple form, uniformly and effectively for all torsion-free modules over gcd domains . For the case of Presburger arithmetic with scalar variables the result takes (...) a still simpler form, and we derive in this way the polynomial-time decidability of the sets defined by such formulas. (shrink)

We apply an online optimization process based on machine learning to the production of Bose-Einstein condensates. BEC is typically created with an exponential evaporation ramp that is optimal for ergodic dynamics with two-body s-wave interactions and no other loss rates, but likely sub-optimal for real experiments. Through repeated machine-controlled scientific experimentation and observations our ’learner’ discovers an optimal evaporation ramp for BEC production. In contrast to previous work, our learner uses a Gaussian process to develop a statistical model of the (...) relationship between the parameters it controls and the quality of the BEC produced. We demonstrate that the Gaussian process machine learner is able to discover a ramp that produces high quality BECs in 10 times fewer iterations than a previously used online optimization technique. Furthermore, we show the internal model developed can be used to determine which parameters are essential in BEC creation and which are unimportant, providing insight into the optimization process of the system. (shrink)

Dans l'oeuvre d'Edith Stein, l'alterite apparait comme constitutive de la personne humaine. D'un point de vue proprement subjectif, l'alterite renvoie... l'alter ego,... la dimension communautaire et, dans une perspective croyante, au Tout-Autre. D'un point de vue objectif, elle designe les valeurs, qui faconnent la personnalite, et la foi, qui vient au secours de la raison humaine. Un parcours des oeuvres principales de l'auteur permet de prendre la mesure... la fois de la continuite et de l'evolution de sa pensee. A partir (...) de l..., l'etude entreprend de mettre en evidence, d'une part, l'originalite de la pensee d'Edith Stein par rapport... celle de Husserl et, d'autre part, comment Edith Stein se situe par rapport... la pensee de Thomas d'Aquin. L'influence de l'oeuvre de Jean de la Croix est egalement abordee. Enfin, en dialogue avec des auteurs comme Ricoeur, Levinas ou Ladriere, la troisieme partie du livre aborde de maniere critique la question de l'alterite comme fondement de la personne et cela selon trois parcours, l'un lie... la phenomenologie d'Edith Stein, l'autre... sa philosophie chretienne, et le dernier... son attrait pour la mystique. (shrink)

BackgroundObtaining informed consent for intravenous thrombolysis in acute ischemic stroke can be challenging, and little is known about if and how the informed consent procedure is performed by neurologists in clinical practice. This study examines the procedure of informed consent for intravenous thrombolysis in acute ischemic stroke in high-volume stroke centers in the Netherlands.MethodsIn four high volume stroke centers, neurology residents and attending neurologists received an online questionnaire concerning informed consent for thrombolysis with tissue-type plasminogen activator (tPA). The respondents were (...) asked to report their usual informed consent practice for tPA treatment and their considerations on whether informed consent should be obtained.ResultsFrom the 203 invited clinicians, 50% (n = 101) completed the questionnaire. One-third of the neurology residents (n = 21) and 21% of the neurologists (n = 8) reported that they always obtain informed consent for tPA treatment. If a patient is not capable of providing informed consent, 30% of the residents (n = 19) reported that they start tPA treatment without informed consent. In these circumstances, 53% of the neurologists (n = 20) reported that the resident under their supervision would start tPA treatment without informed consent. Most neurologists (n = 21; 55%) and neurology residents (n = 45; 72%) obtained informed consent within one minute. None of the respondents used more than five minutes for informed consent. Important themes regarding obtaining informed consent for treatment were patients’ capacity, and medical, ethical and legal considerations.ConclusionThe current practice of informed consent for thrombolysis in acute ischemic stroke varies among neurologists and neurology residents. If informed consent is obtained, most clinicians stated to obtain informed consent within one minute. In the future, a shortened information provision process may be applied, making a shift from informed consent to informed refusal, while still considering the patient’s capacity, stroke severity, and possible treatment delays. (shrink)

Chervenak and McCullough, authors of the most acknowledged ethical framework for maternal–fetal surgery, rely on the ‘ethical–obstetrical’ concept of the fetus as a patient in order to determine what is morally owed to fetuses by both physicians and the women who gestate them in the context of prenatal surgery. In this article, we reconstruct the argumentative structure of their framework and present an internal criticism. First, we analyse the justificatory arguments put forward by the authors regarding the moral status of (...) the fetus qua patient. Second, we discuss the internal coherence and consistency of the moral obligations those authors derive from that concept. We claim that some of the dilemmas their approach is purported to avoid, such as the debate about the independent moral status of the fetus, and the foundation of the moral obligations of pregnant women (towards the fetuses they gestate) are not, all things considered, avoided. Chervenak and McCullough construct the obligations of physicians as obligations towards entities with equal moral status. But, at the same time, they assume that the woman has an independent moral status while the moral status of the fetus is dependent on the decision of the woman to present it to a physician for care. According to the logic of their own argumentation, Chervenak and McCullough implicitly admit a different moral status of the woman and the fetus, which will lead to different ascription of duties of the physician than those they ascribed. (shrink)

This article focuses on maternal-fetal surgery (MFS) and on the concept of clinical equipoise that is a widely accepted requirement for conducting randomized controlled trials (RCT). There are at least three reasons why equipoise is unsuitable for MFS. First, the concept is based on a misconception about the nature of clinical research and the status of research subjects. Second, given that it is not clear who the research subject/s in MFS is/are, if clinical equipoise is to be used as a (...) criterion to test the ethical appropriateness of RCT, its meaning should be unambiguous. Third, because of the multidisciplinary character of MFS, it is not clear who should be in equipoise. As a result, we lack an adequate criterion for the ethical review of MFS protocols. In our account, which is based on Chervenak and McCullough's seminal work in the field of obstetric ethics, equipoise is abandoned. and RCT involving MFS can be ethically initiated when a multidisciplinary ethics review board (ERB), having an evidence-based assessment of the risks involved, is convinced that the value of answering the research hypothesis, for the sake of the health interests of future pregnant women carrying fetuses with certain congenital birth defects, justifies the actual risks research participants might suffer within a set limit of low/manageable. (shrink)

Libraries provide access to large amounts of library metadata. Unfortunately, many libraries only offer textual interfaces for searching and browsing their holdings. Visualizations provide simpler, faster, and more efficient ways to navigate, search and study large quantities of metadata. This paper presents GlamMap, a visualization tool that displays library metadata on an interactive, computer-generated geographic map. We provide detailed discussion of how GlamMap benefits the work of librarians and researchers. We show how geographic representations help librarians to perform tasks such (...) as collection assessment and how geographic information helps researchers to identify important scientific resources. (shrink)

BackgroundReducing the number of animals used in experiments has become a priority for the governments of many countries. For these reductions to occur, animal-free alternatives must be made more available and, crucially, must be embraced by researchers.MethodsWe conducted an international online survey for academics in the field of animal science (N = 367) to explore researchers’ attitudes towards the implementation of animal-free innovations. Through this survey, we address three key questions. The first question is whether scientists who use animals in (...) their research consider governmental goals for animal-free innovations achievable and whether they would support such goals. Secondly, responders were asked to rank the importance of ten roadblocks that could hamper the implementation of animal-free innovations. Finally, responders were asked whether they would migrate (either themselves or their research) if increased animal research regulations in their country of residence restricted their research.ResultsWhile nearly half (40%) of the responders support governmental goals, the majority (71%) of researchers did not consider such goals achievable in their field within the near future. In terms of roadblocks for implementation of animal-free methods, ~ 80% of the responders considered ‘reliability’ as important, making it the most highly ranked roadblock. However, all other roadblocks were reported by most responders as somewhat important, suggesting that they must also be considered when addressing animal-free innovations. Importantly, a majority reported that they would consider migration to another country in response to a restrictive animal research policy. Thus, governments must consider the risk of researchers migrating to other institutes, states or countries, leading to a ‘brain-drain’ if policies are too strict or suitable animal-free alternatives are not available.ConclusionOur findings suggest that development and implementation of animal-free innovations are hampered by multiple factors. We outline three pillars concerning education, governmental influence and data sharing, the implementation of which may help to overcome these roadblocks to animal-free innovations. (shrink)

Experimental evidence strongly supports the view that the subdivision of organ anlagen into smaller structural units is an autonomous process. Dalcq &Pasteels' hypothesis which says that the boundaries between the different areas into which a morphogenetic field differentiates are determined by “Threshold values” in the “potential” of the field in question, is inconsistent with our present knowledge of biochemical reaction systems. Threshold values may only be used indescribing the spatial differentiation of a morphogenetic field. It is suggested that the latter (...) concept be replaced by the concept of “optimal values” in the intensity of a morphogenetic field-specific for the various chemo-differentiations characterizing the different regions into which a morphogenetic field will split up-and that each optimal value isdeterminative for the appearance of one particular differentiation within the morphogenetic field, each differentiation being formed within a certain range of intensity of the field. On the basis of the hypothesis formulated above a “virginal” morphogenetic field will necessarily differentiate into a number of smaller fields of second order, which in their turn will split up into fields of third order, etc. ” Pattern formation” may be defined as the differentiation of a morphogenetic field into an increasing number of smaller fields of higher order of qualitative different chemical and structural composition. Since differentiation of a morphogenetic field proceeds autonomously, the capacity for pattern formation is an intrinsic property of a morphogenetic field. In the light of these considerations it is suggested that a morphogenetic field action is responsible for the first differentiation of the developing embryo into regions with predominantly ectodermal, mesodermal or endodermal differentiation tendencies. The present knowledge about the characteristic pattern formation taking place in the axial mesoderm as well as in the overlying neural plate seems to be in good agreement with the implications of the present morphogenetic field concept. It is emphasized, however, that if the present morphogenetic field concept cannot be characterized further biochemically and biophysically, it will have to be replaced by another concept which can be defined more sharply and is more easily accessible to experimental analysis. Les preuves expérimentales confirment que la subdivision des ébauches des organes en unités structurelles plus petites est un processus autonome. L'hypothèse deDalcq &Pasteels disant que les bornes entre les différents domaines formées par la différenciation d'un champ morphogénétique sont déterminées par des „valeurs seuil” dans le „potentiel” du champ en question, n'est pas en harmonie avec notre connaissance actuelle des systèmes biochimiques. Des “valeurs seuil” ne peuvent être employés qu'en décrivant la différenciation spatiale d'un champ morphogénétique. On prend en considération de remplacer le concept des “valeurs seuil” par le concept des “valeurs optimales” dans l'intensité d'un champ morphogénétique. Ce seraient les valeurs spécifiques aux différenciations chimiques diverses qui caractérisent les différents domaines dans lesquels un champ morphogénétique se différencie. En outre, chaque valeur optimale serait déterminative à la formation d'une différenciation spéciale dans le champ morphogénétique, chaque différentiation se formant dans un certain trajet de l'intensité du champ. Par suite de l'hypothèse formulée ci-dessus un champ morphogénétique “virginal” va nécessairement se différencier en un nombre de champs plus petits de deuxième ordre, qui à leur tour se divisent en champs d'ordre troisième, etc. ... La régionalisation peut être définie comme la différenciation d'un champ morphogénétique dans un nombre de plus en plus élevé de champs plus petits d'ordre supérieur de composition chimique et structurelle qualitativement différente. Parce que la différenciation d'un champ morphogénétique se produit de façon autonome, le pouvoir de régionalisation est une propriété intrinsique d'un champ morphogénétique. Ces considérations nous mènent à proposer que l'action d'un champ morphogénétique est responsable de la première différenciation de l'embryon en régions qui possèdent des tendences de différenciation principalement ectodermiques, mésodermiques, ou bien endodermiques. La connaissance actuelle concernant la régionalisation caractéristique qui se produit dans le mésoderme axial ainsi que dans la plaque neurale superposée paraît se conformer aux conséquences du concept de champ morphogénétique. Cependant on souligne le fait que dans le cas òu le concept actuel du champ morphogénétique ne pourra pas être plus amplement caractérisé de façon biochimique et biophysique, il faudra le remplacer par un autre concept qui puit être défini plus nettement et qui est mieux accessible à l'analyse expérimentale. Die Auffassung, dass die Aufteilung von Organanlagen in kleineren Struktureinheiten ein selbständiger Prozess ist, findet Bestätigung in den experimentellen Ergebnissen. Die Hypothese vonDalcq &Pasteels , dass die Grenzen zwischen den unterschiedenen Gebieten, in denen ein morphogenetisches Feld sich differenziert, durch “Schwellenwerte” im “Potential” des genannten Feldes bestimmt werden, ist unvereinbar mit unserem heutigen Wissen über biochemischen Reaktionssystemen. Der Gebrauch des Begriffs “Schwellenwert” ist nur gestattet bei der Beschreibung der räumlichen Differenzierung eines morphogenetischen Feldes. Statt dieses Begriffs wird der Begriff “Optimaler Wert” vorgeschlagen; Werte also in der Intensität eines morphogenetischen Feldes, optimal und spezifisch für die verschiedene Chemodifferenzierungen, welche die Gebiete kennzeichnen, in denen ein morphogenetisches Feld sich differenzieren wird. Jeder optimaler Wert soll dann das Erscheinen einer bestimmten Differenzierung innerhalb des morphogenetischen Feldes veranlassen, welche Differenzierung sich bildet innerhalb eines bestimmten Bereichs der Feldintensität. Auf Grund der obigen Hypothese wird ein “virginelles” morphogenetisches Feld zwangsläufig sich differenzieren in eine Anzahl kleinerer Feldern zweiten Grades; diese in Felder dritten Grades, usw. Musterbildung könnte definiert werden als die Differenzierung eines morphogenetischen Feldes in eine zunehmende Anzahl kleinerer Felder höheren Grades von qualitativ verschiedener chemischen und strukturellen Zusammensetzung, Weil diese Differenzierung autonom vor sich geht, ist das Vermögen zur Musterbildung eine innewohnende Eigenschaft eines morphogenetischen Feldes. Im Lichte dieser Betrachtungen ist es naheliegend anzunehmen dass eine morphogenetische Feldwirkung verantwortlich ist für die erste Differenzierung des sich entwickelnden Embryos in Gebiete überwiegend ektodermalen, mesodermalen oder entodermalen Differenzierungstendenzen. Die heutigen Kenntnisse über die charakteristische Musterbildung im axialen Teil des Mesoderms und in der überliegenden Neuralplatte scheinen in guter Übereinstimmung zu sein mit den des morphogenetischen Feldbegriffs. Dennoch wird benachdruckt, dass, falls das gegenwärtige morphogenetische Feldbegriff nicht weiter biochemisch und biophysisch gekennzeichnet werden kann, anstatt dessen ein anderer Begriff entwickelt werden muß, der schärfer definiert werden kann und besser zugänglich ist für experimentelle Analyse. (shrink)

Background: Debates over legalisation of physician-assisted suicide or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period.Methods: The data from Oregon comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands comprised all four (...) government-commissioned nationwide studies of end-of-life decision making and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought.Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured , people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups.Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. (shrink)

Cet article examine les opinions des néoplatoniciens tardifs sur le phénomène social de la philotimia (« amours des honneurs » ; « ambition »). Sur la base du Commentaire de l’Alcibiade de Proclus, on montre que la philotimia est une émotion qui résulte d’une compréhension imparfaite de la vraie nature de l’honneur et du pouvoir. La mauvaise philotimia pousse les ambitieux à poursuivre une carrière politique en quête de pouvoir mondain et de prestige au prix de l’étude de la philosophie. (...) La bonne philotimia, au contraire, peut les pousser à rechercher ce qui est véritablement bien et donc les mettre sur la voie de la philosophie. L’histoire fournit maints exemples de bonne et de mauvaise philotimia. Damascius, dans sa Vie d’Isidore, mobilise des théories de la bonne et de la mauvaise philotimia pour éloigner ses lecteurs de l’arène politique et les conduire vers la poursuite de la philosophie. (shrink)

Si l’on retient surtout de l’œuvre de Claudel une certaine conception de l’espérance, de la joie et du triomphe religieux, on oublie, par contre, assez souvent qu’il y a chez cet écrivain toute une réflexion concernant le mystère et le problème du mal. C’est pourquoi, afin de mettre en relief cet aspect, l’A. a choisi de comparer la première œuvre de Claudel, Tête d’or , avec le livre de Job. Il suit ainsi pas à pas la structure du livre biblique (...) pour mieux dégager ensuite l’importance des thèmes jobiens dans la pièce de Claudel. Plus largement encore, cet article vise à montrer combien l’auteur, dans la rédaction de Tête d’or, s’est imprégné d’un certain ton biblique, particulièrement représenté par l’Ecclésiaste. (shrink)