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)

If necessity is a generic notion, then, like any generic notion, it becomes specified not by a criterion as such but by a differentia. The differentia of logical necessity is that the denial of a logically necessary proposition is self-contradictory; one of our best criteria of logical necessity is that after careful consideration we see that the denial of the proposition is self-contradictory.

2. Thesis 2 I accept insofar as it asserts the relation of possibility to actuality to be a fundamental aspect of things. This relation is sui generis.

This work has been selected by scholars as being culturally important and is part of the knowledge base of civilization as we know it. This work is in the public domain in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. Scholars believe, and we concur, that this work is important enough to be (...) preserved, reproduced, and made generally available to the public. To ensure a quality reading experience, this work has been proofread and republished using a format that seamlessly blends the original graphical elements with text in an easy-to-read typeface. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

Buddhism originated and developed in an Indian cultural context that featured many first-person practices for producing and exploring states of consciousness through the systematic training of attention. In contrast, the dominant methods of investigating the mind in Western cognitive science have emphasized third-person observation of the brain and behavior. In this chapter, we explore how these two different projects might prove mutually beneficial. We lay the groundwork for a cross-cultural cognitive science by using one traditional Buddhist model of the mind (...) – that of the five aggregates – as a lens for examining contemporary cognitive science conceptions of consciousness. (shrink)

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Bishop is a professor of nursing; Scudder is a professor of philosophy.

Sally Gadow influenced our work when we first began exploring the meaning of nursing philosophically. In this article, we discuss two major themes of Gadow's work that have influenced us: existential advocacy and treating the body objectively without reducing the patient to the moral status of an object. Our treatment of these issues is appreciative but not uncritical. We argue that existential advocacy makes an important contribution to the meaning of nursing but that it cannot be its essential meaning. We (...) contend that Gadow, by making self‐direction the essence of care, tends to diminish the intersubjective nature of care. Then we show how Gadow recovers the intersubjective nature of care by disclosing how nurses and patients both become subjects in personal relationships, even when tending to the body objectively. We show how hermeneutic phenomenology, which we favour, can contribute to Gadow's existential phenomenology by using examples from nursing practice to disclose the meaning of nursing. Gadow's major contribution to our work has been in the ways her work has evoked creative thought from us concerning the meaning of nursing. (shrink)

This volume identifies, discusses and addresses the wide array of ethical issues that have emerged for engineers due to the rise of a global economy. To date, there has been no systematic treatment of the particular challenges globalization poses for engineering ethics standards and education. This volume concentrates on precisely this challenge. Scholars and practitioners from diverse national and professional backgrounds discuss the ethical issues emerging from the inherent symbiotic relationship between the engineering profession and globalization. Through their discussions a (...) deeper and more complete understanding of the precise ways in which globalization impacts the formulation and justification of ethical standards in engineering as well as the curriculum and pedagogy of engineering ethics education emerges. (shrink)