Background: Since the passage of the Patient Self-Determination Act, numerous policy mandates and institutional measures have been implemented. It is unknown to what extent those measures have affected end-of-life care, particularly with regard to the do-not-resuscitate order.Methods: Retrospective cohort study to assess associations of the frequency and timing of DNR orders with advance directive status, patient demographics, physician’s specialty and extent of documentation of discussion on end-of-life care.Results: DNR orders were more frequent for patients on a medical service than on (...) a surgical service and were made earlier in the hospital stay for medicine than for surgical patients . 22.18% of all patients had some form of an advance directive in their chart, yet this variable had no impact on the frequency or timing of DNR ordering. Documentation of DNR discussion was significantly associated with the frequency of DNR orders and the time from DNR to death .Conclusions: The physician’s specialty continues to have a significant impact on the frequency and timing of DNR orders, while advance directive status still has no measurable impact. Additionally, documentation of end-of-life discussions is significantly associated with varying DNR ordering rates and timing. (shrink)

BackgroundHospitalized older adults frequently have impaired cognition and must rely on surrogates to make major medical decisions. Ethical standards for surrogate decision making are well delineated, but little is known about what factors surrogates actually consider when making decisions.ObjectivesTo determine factors surrogate decision makers consider when making major medical decisions for hospitalized older adults, and whether or not they adhere to established ethical standards.DesignSemi-structured interview study of the experience and process of decision making.SettingA public safety-net hospital and a tertiary referral (...) hospital in a large city in the Midwest United States.ParticipantsThe study included 35 surrogates with a recent decision-making experience for an inpatient aged 65 or older.MeasurementsThe key factors that surrogates considered when making decisions. Interview transcripts were coded and analyzed using the grounded theory method of qualitative analysis.ResultsSurrogates considered patient-centered factors and surrogate-centered factors. Patient-centered factors included: respecting the patient’s input, using past knowledge of the patient to infer the patient’s wishes, and consider ing what is in the patient’s best interests. Some surrogates expressed a desire for more information about the patient’s prior wishes. Surrogate-centered factors included: surrogate’s wishes as a guide, surrogate’s religious beliefs and/or spirituality, surrogate’s interests, and family consensus.ConclusionOur study indicates that surrogate decision making is more complex than the standard ethical models, which are limited to considerations of the patient’s autonomy and beneficence. Because surrogates also imagine what they would want under the circumstances and consider their own needs and preferences, models of surrogate decision making must account for these additional considerations. Surrogates’ desire for more information about patients’ preferences suggests a need for greater advance care planning. (shrink)

According to the causal interpretation of quantum mechanics, one can precisely define the state of an individual particle in a many-body system by its position, momentum, and spin. It is shown in the EPR spin experiment that the quantum torque brings about an instantaneous change in the state of one of the particles when the other undergoes a local interaction, but that such a transfer of “information” cannot be extracted by any experiment subject to the laws of quantum mechanics.

India has produced several drafts of data policies. In this work, they are referred to [1] JBNSCR 2018, [2] DPDPR 2018, [3] NSAI 2018, [4] RAITF 2018, [5] PDPB 2019, [6] PRAI 2021, [7] JPCR 2021, [8] IDAUP 2022, [9] IDABNUP 2022. All of them consider Artificial Intelligence (AI) a social problem solver at the societal level, let alone an incentive for economic growth. However, these policy drafts warn of the social disruptions caused by algorithms and encourage the careful use (...) of computational technologies in various social contexts. Hence, the emerging data society and its implications in India's social contexts demand immense social science attention, which needs to be improved in the policy drafts, primarily because they are creations of industry stakeholders, technocrats, bureaucrats, and experts from tech schools. In the larger social milieu of digital infrastructure emerging, the fundamental question is whether India's national philosophy envisioned in the Indian constitution is reflected in the policy papers. The paper enquires whether the national data policy upholds the core values dispersed through the philosophy of the Indian constitution, which, among other things, is not confined only to inclusion, diversity, rights, liberty, justice and equality. By focusing on constitutional values, the paper seeks to offer a broader and more critical understanding of India's approach to AI policy by bringing together analyses of a wide array of policy documents available in the public realm. (shrink)

The concept of joint action is at the core of numerous diverse research topics, including philosophical explorations of social action, studies of human dialogue, human-computer interaction, computer-supported collaborative work, multiagent systems, distributed artificial intelligence, distributed simulation, and contract law. It is therefore remarkable that so central a concept has received so little detailed analysis, in comparison with studies of individuals. However, in recent years, the study of joint action has begun to undergo more intense scrutiny, primarily from philosophers and researchers (...) in artificial intelligence. These two disciplines often address similar topics but with different motivations, methodologies, tools, and criteria for success. Although this paper is inspired by philosophical work, it is squarely motivated by the concerns of building intelligent systems that are capable of collaborative behavior, either with a user, or with other such systems. Still, we hope that the paper sheds light on philosophical issues, and treats the subject of joint action at a sufficiently precise level to be illuminating of problems that any philosophical account needs to confront. (shrink)

It was shown by de Broglie and Bohm that the concept of a deterministic particle trajectory is compatible with quantum mechanics. It is demonstrated by explicit construction that there exists another more general deterministic trajectory interpretation. The method exploits an internal angular degree of freedom that is implicit in the Schrödinger equation, in addition to the particle position. The de Broglie-Bohm model is recovered when the new theory is averaged over the internal freedom. The model exhibits a strong form of (...) entanglement which implies a primary role for the wavefunction of the Universe. The conditions of autonomy are examined, and the viability of the theory is established by application to the measurement problem. (shrink)

The Upanishads reveal that in the beginning, nothing existed: “This was but non-existence in the beginning. That became existence. That became ready to be manifest”. (Chandogya Upanishad 3.15.1) The creation began from this state of non-existence or nonduality, a state comparable to (0). One can add any number of zeros to (0), but there will be nothing except a big (0) because (0) is a neutral number. If we take (0) as Nirguna Brahman (God without any form and attributes), then (...) from where and how did the universe come into existence? -/- The neutral power (0) cannot produce anything without having an element of duality in it. Although Nirguna Brahman is neutral, it has a positive, negative, and neutral pole, constituting its Prakriti or nature. Prakriti has three latent Gunas (modes or qualities): Satva, Rajas, and Tamas. They are related to Gyana Shakti (the power of knowledge) Sankalpa Shakti (the power of ideation), and Kriya Shakti (the power of action). Science says that Atom is the basic element from which the universe evolved. The Atom has three nuclei- electron, pluton, and neutron. The Satva, Rajas, and Tamas in Indian spirituality are nothing but the mystical names for the nuclei of an atom. -/- According to Bhagavata Purana, Prakriti is also constituted of the elements of Time, Karma (action/destiny) and Swabhava (innate nature). Time disturbs the equilibrium of Gunas. From the aspect of Karma is produced an entity called Mahat, in the form of intelligence. Mahat is dominated by Satva and Rajas. From Mahat manifests the next evolute dominated by Tamas with three predominant qualities – Dravya (substance), Kriya (action), as well as intelligence. It forms to become the Ego principle (Ahamkara). -/- Ahamkara has three modes – Satvic, Rajasic and Tamasic. Satvic is Jnana oriented, Rajasic action-oriented and Tamasic Dravya (substance) oriented. From the Tamasic Ahankara, five gross elements are produced (ether, air, fire, water, and earth - Akash, Vayu, Agni, Jal and Prithvi). From the Satvic Ahamkara, guardian deities (the sun and moon, deities of sense organs, and organs of action) and from Rajasic Ahamkara, ten senses (Indriyas), five senses of perception, five organs of action, the faculties of intellect and Prana (life breath) are produced. -/- Bhagavata says that since these energies, elements, and faculties remained disassociated, they were combined to form a Cosmic Egg. The egg floats in the primal waters for a thousand years. Then God enters this Cosmic Egg and manifests himself as the Cosmic Purusha. He is the first nucleus, the God particle equivalent to the number (1) which is the embodiment of everything in the universe. The concept of creation and dissolution in Hinduism can be compared to the waves in an ocean that appear and disappear incessantly. The Manvantaras are such successive episodes of creation emerging from the Cosmic Person, the Manu who is embodied God-Consciousness, God himself. These episodes of creation are measured in Hinduism in terms of Manvantaras, the epochs of Manus. -/- Manu is the ‘First-Born’ (1) of God, the Cosmic Purusha from whom the world has originated. This Cosmic Person (Purusha) has been described as having fourteen biospheres (heavens) that are inhabited by various life forms in the order of evolution of consciousness. If we begin from the human biosphere (Bhuloka), there are ten astral biospheres that a man must transcend to attain liberation or Mukti from the cycle of births and deaths. -/- The number (1) produces the primary numbers up to (9) through the transmutation of the creational energies and qualities. The process can be related to the descent and cyclical evolution of (1) through ten spiritual stages, finally merging with the nondual (0). The number (10) marks the merger of (1) with (0). The Hindu worldview is that all life forms in an episode of creation must evolve to become one with the non-dual state (0) to attain liberation from the cycle of births and deaths in a cyclical process. -/- . (shrink)

Background: According to the Declaration of Helsinki, patients who take part in a clinical trial must be adequately informed about the trial's aims, methods, expected benefits, and potential risks. The declaration does not, however, elaborate on what “adequately informed” might amount to, in practice. Medical researchers and Local Research Ethics Committees attempt to ensure that the information which potential participants are given is pitched at an appropriate level, but few studies have considered whether the patients who take part in such (...) trials feel they have been given adequate information, or whether they feel able to understand that information.Objectives: To explore trial participants' views on the amount of information provided, and of their own understanding of that information.Design: Structured interviews of patients participating in clinical trials for the treatment of chronic medical condition.Findings: Patients generally felt they were given an appropriate amount of information, and that they were able to understand all or most of it. They felt they were given adequate time to ask questions before agreeing to take part. In comparison with treatment given outwith the research setting, patients generally felt they received more information when participating in a clinical trial.Conclusions: Researchers sometimes complain that patients are given too much information during clinical trials, and have limited understanding of that information. The present study shows that this perception is not necessarily shared by patients. More research is needed in this area, particularly to gauge whether patient understanding is indeed accurate. (shrink)

Pease ad loc.: ‘Roman writers often use axis… in a figurative sense… for the caelum as a whole, and in our passage, while the force is applied by Atlas to the axis of the sphere, yet the whole sphere is apparently in mind, as the phrase stellis ardentibus aptum indicates.’ It is lexicographical commonplace that axis is used, especially in the poets, as a synonym for the sky, yet the oddity of the synecdoche by which a scientific, or pseudoscientific, term (...) for the axis of the universe is transferred to mean the heavens in general has been little commented on; unanalytic recognition of the semantic fact is the norm . I believe that a more precise account of this transference can be given, and in particular I will argue that Virgilian usage in the Aeneid is central to the history of this process. (shrink)