IntroductionThe objectives of this study are to assess and compare differences in the intensity, frequency, and overall severity of moral distress among a diverse group of healthcare professionals.MethodsParticipants from within Baylor Health Care System completed an online seven-point Likert scale (range, 0 to 6) moral distress survey containing nine core clinical scenarios and additional scenarios specific to each participant’s discipline. Higher scores reflected greater intensity and/or frequency of moral distress.ResultsMore than 2,700 healthcare professionals responded to the survey (response rate 18.14 (...) percent); survey respondents represented multiple healthcare disciplines across a variety of settings in a single healthcare system. Intensity of moral distress was high in all disciplines, although the causes of highest intensity varied by discipline. Mean moral distress intensity for the nine core scenarios was higher among physicians than nurses, but the mean moral distress frequency was higher among nurses. Taking into account both intensity and frequency, the difference in mean moral distress score was statistically significant among the various disciplines. Using post hoc analysis, differences were greatest between nurses and therapists.ConclusionsMoral distress has previously been described as a phenomenon predominantly among nursing professionals. This first-of-its-kind multidisciplinary study of moral distress suggests the phenomenon is significant across multiple professional healthcare disciplines. Healthcare professionals should be sensitive to situations that create moral distress for colleagues from other disciplines. Policy makers and administrators should explore options to lessen moral distress and professional burnout that frequently accompanies it. (shrink)

We study the groups Gal L and Gal KP, and the associated equivalence relations EL and EKP, attached to a first order theory T. An example is given where EL≠ EKP. It is proved that EKP is the composition of EL and the closure of EL. Other examples are given showing this is best possible.

La evaluación constituye un elemento curricular decisivo para mejorar el aprendizaje del alumnado, siempre que se utilice de modo continuo y con carácter formativo. La evaluación formativa evalúa procesos, ofreciendo datos permanentes acerca de cómo se produce paso a paso ese aprendizaje, permitiendo así detectar las dificultades que se presentan y los talentos del alumnado y adoptar las medidas adecuadas de modo inmediato. Este planteamiento favorece la personalización de la evaluación y, con ello, la atención a cada estudiante en función (...) de sus peculiaridades, garantizando la inclusión educativa de calidad para todos. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

In this paper, we describe the use of legal ontologies as a basis to improve IT support for professional judges. As opposed to most legal ontologies designed so far, which are mostly based on dogmatic and normative knowledge, we emphasize the importance of professional knowledge and experience as an important pillar for constructing the ontology. We describe an intelligent FAQ system for junior judges that intensively use the ontology.

A Steiner triple system (STS) is a set S together with a collection B of subsets of S of size 3 such that any two elements of S belong to exactly one element of B. It is well known that the class of finite STS has a Fraïssé limit M_F. Here, we show that the theory T of M_F is the model completion of the theory of STSs. We also prove that T is not small and it has quantifier elimination, (...) TP2, NSOP1, elimination of hyperimaginaries and weak elimination of imaginaries. (shrink)

A model $M$ of countable similarity type and cardinality $\kappa$ is expandable if every consistent extension $T_{1}$ of its complete theory with $|T_{1}|\leq \kappa$ is satisfiable in $M$ and it is compactly expandable if every such extension which additionally is finitely satisfiable in $M$ is satisfiable in $M$ . In the countable case and in the case of a model of cardinality $\geq 2^{\omega}$ of a superstable theory without the finite cover property the notions of saturation, expandability and compactness for (...) expandability agree. The question of the existence of compactly expandable models which are not expandable is open. Here we present a test which serves to prove that a compactly expandable model of cardinality $\geq 2^{\omega}$ of a superstable theory is expandable. It is stated in terms of the existence of a certain elementary submodel whose corresponding theory of pairs of models satisfies a weak elimination of Ramsey quantifiers. (shrink)

One of the most dramatic advances in the physical sciences during the nineteenth century was the emergence of spectroscopy. It rapidly became an invaluable experimental technique for chemists and astronomers, while for physicists it opened a window upon the world of sub-atomic phenomena. Sir John Herschel played an important part, the value of which has sometimes been underestimated, in the early development of spectroscopy. This paper examines his contribution to the subject during the period 1819–61 in the light of his (...) publications and of certain manuscript material preserved in the Royal Society's Library. Herschel corresponded with most of the scientists who did important work in spectroscopy during his lifetime, and he expressed definite opinions on most of the practical and theoretical problems that arose in it; however, the present study cannot pretend to offer a complete discussion of all aspects of the early history of spectroscopy. (shrink)

This book analyzes for the first time in English the ethical theory that underpins Qur’anic legislation by providing a classification of specific verses in which Islam’s holy book discusses moral issues. The principal purpose of this book is to demonstrate the ways in which the Qur’an theoretically and practically provides the moral code to which Muslims around the world adhere. The author divides his analysis into a survey of Qur’anic attitudes towards the basic ethical issues of obligation and responsibility, issues (...) of moral psychology such as motivation and intention, as well as matters of social ethics such as the function of law in society. He then explores the meanings of individual morality, morality within the family and civil society, and the relationship of morality to the idea of the state. (shrink)

The expertise defense is the best-known response by armchair philosophers to the challenge posed by experimental philosophers regarding the trustworthiness of intuitions. In a series of recent experiments, Experimental philosophers have recently focused on professional philosophers, claiming that, contrary to what the expertise defense assumes, philosophers’ intuitions are no less susceptible to the influence of irrelevant factors (the direct strategy). Additionally, drawing from literature on expertise, they contend that, unlike other domains of expertise, practice does not improve philosophers’ intuitions (the (...) indirect strategy). In this paper, adopting a skill-based perspective on expertise, my primary objective is to defend the expertise defense against both direct and indirect strategies. Based on the skill-based account, I present three arguments against the direct strategy by challenging its power, scope and methodology. Furthermore, borrowing empirical findings from recent literature on expertise, I argue against the indirect strategy that four skills that constitute philosophical expertise regarding thought experiments can be improved through various forms of practice, including deliberate practice. However, my moderate defense departs from typical versions of the expertise defense since I argue that while recent experiments by experimental philosophers cannot undermine the expertise defense, they provide valuable insights into philosophical expertise. (shrink)

In this paper, I plan to show that the use of a specific population concept—Millstein’s Causal Interactionist Population Concept (CIPC)—has interesting and counter-intuitive ramifications for discussions of the reality of biological race in human beings. These peculiar ramifications apply to human beings writ large and to individuals. While this in and of itself may not be problematic, I plan to show that the ramifications that follow from applying Millstein’s CIPC to human beings complicates specific biological racial realist accounts—naïve or otherwise. (...) I conclude with the notion that even if biological races do exist—by fulfilling all of the criteria needed for Millstein’s population concept (which, given particular worries raised by Gannett (Synthese 177:363–385, 2010), and Winther and Kaplan (Theoria 60:54–80, 2013) may not)—the lower-bound limit for the scope of biological racial realism is at the level of populations, and as such they cannot say anything about whether or not individual organisms themselves have races. (shrink)

This text explores how human beings construe experience: experience as a resource, as a potential for understanding, representing and acting on reality.

Recognized in his day as a man of letters equaling Rousseau and Voltaire in France and rivaling Samuel Johnson, David Hume passed from favor in the Victorian age--his work, it seemed, did not pursue Truth but rather indulged in popularization. Although Hume is once more considered as one of the greatest British philosophers, scholars now tend to focus on his thought rather than his writing. To round out our understanding of Hume, M. A. Box in this book charts the interrelated (...) development of Hume's literary ambitions, theories of style, and compositional practice from his Treatise in 1739 through the Enquiries. In so doing, Box makes the case for Hume's career-long concern with the presentational modes of reaching an audience for his philosophical writings. Hume reacted to the popular failure of his masterpiece, A Treatise of Human Nature, Box suggests, by self-consciously exploring strategies in his subsequent works for agreeably bringing his readership to participate in the act of philosophizing. Combining a sensitive grasp of the ways Restoration period and eighteenth-century writers conceived the relations between rhetoric and philosophy with sound readings of particular texts, Box shows how Hume's literary concerns went beyond matters of style to involve persona, structure, and doctrine. While this book helps explain long-standing ambiguities surrounding Hume, especially by pointing out the tension between his created persona and his own voice, it also serves as an excellent introduction to his philosophy. (shrink)

Metabolism is a criterion of life. Three senses are distinguished. The weakest allows strong A-Life: virtual creatures having physical existence in computer electronics, but not bodies, are classes as 'alive'. The second excludes strong A-Life but allows that some non-biochemical A-Life robots could be classed as alive. The third, which stresses the body's self-production by energy budgeting and self-equilibrating energy exchanges of some (necessary) complexity, excludes both strong A-Life and living non-biochemical robots.

The study presents the broad outlines for a relationalist interpretation of the Indian epistemological doctrine svataḥ prāmāṇya. Due to the inadequacy of the main western interpretations thereof, the paper’s approach can be considered an inference to the best explanation. Its main part is devoted to the typologization of various epistemological doctrines based on the svataḥ prāmāṇya principle in terms of strong and weak disjunctivism. Three paradigm cases of strong disjunctivism and a special variety of weak disjunctivism have thus been identified (...) in Indian epistemology, which allowed to draw a conclusion that strong disjunctivism constituted one of its general paradigms. (shrink)

Since its publication in 1974, scholars throughout the humanities have adopted G M A Grube's masterful translation of the Republic as the edition of choice for their study and teaching of Plato's most influential work. In this brilliant revision, C D C Reeve furthers Grube's success both in preserving the subtlety of Plato's philosophical argument and in rendering the dialogue in lively, fluent English, that remains faithful to the original Greek. This revision includes a new introduction, index, and bibliography by (...) Reeve. (shrink)