A Síndrome de Kabuki é um distúrbio bastante raro, com múltiplas anomalias congênitas. O objetivo do estudo foi descrever características comportamentais, cognitivas e sociais de uma criança com seis anos de idade com Síndrome de Kabuki, e suas implicações no processo escolar. Como resultados, verif..

Abstract Context: Established in 1997, Summa Health System’s Medical Ethics Committee (EC) serves as an educational, supportive, and consultative resource to patients/families and providers, and serves to analyze, clarify, and ameliorate dilemmas in clinical care. In 2009 the EC conducted its 100th consult. In 2002 a Palliative Care Consult Service (PCCS) was established to provide supportive services for patients/families facing advanced illness; enhance clinical decision-making during crisis; and improve pain/symptom management. How these services affect one another has thus far been (...) unclear. Objectives: This study describes EC consults: types, reasons, recommendations and utilization, and investigates the impact the PCCS may have on EC consult requests or recommendations. Methods: Retrospective reviews of 100 EC records explored trends and changes in types of consults, reasons for consults, and EC recommendations and utilization. Results: There were 50 EC consults each in the 6 years pre- and post-PCCS. Differences found include: (1) a decrease in number of reasons for consult requests (133–62); (2) changes in top two reasons for EC consult requests from ‘Family opposed to withdrawing life-sustaining treatment (LST)’ and ‘Patient capacity in question’ to ‘Futility’ and ‘Physician opposed to providing LST’; (3) changes in top two recommendations given by the EC from ‘Emotional Support for Patient/Family’ and ‘Initiate DNR Order’ to ‘Comfort Care’ and ‘Withdraw Treatment.’ Overall, 88% of recommendations were followed. Conclusion: PCCS availability and growth throughout the hospital may have influenced EC consult requests. EC consults regarding family opposition to withdrawing LST and EC recommendations for patient/family support declined. Content Type Journal Article Pages 1-16 DOI 10.1007/s10730-011-9170-9 Authors Jessica Richmond Moeller, Department of Psychiatry and Behavioral Sciences, Akron General Medical Center, 400 Wabash Ave, Akron, OH 44307, USA Teresa H. Albanese, Health Services Research and Education Institute, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Kimberly Garchar, Kent State University, 6000 Frank Ave., N.W, North Canton, OH 44720, USA Julie M. Aultman, Department of Family and Community Medicine, Northeast Ohio Medical University, P.O. Box 95, Rootstown, OH 44272, USA Steven Radwany, Palliative Care and Hospice Services, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Dean Frate, Internal Medicine, Palliative Care and Hospice Services, Summa Health System and Northeast Ohio Medical University, 55 Arch St., Suite 1A, Akron, OH 44304, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)

Introduction: Ethical conflict is a phenomenon that has been under study over the last three decades, especially the types moral dilemma and moral distress in the field of nursing care. However, ethical problems and their idiosyncrasies need to be further explored. Aim: The objectives of this study were, first, to obtain a transcultural Portuguese-language adaptation and validation of the Ethical Conflict Nursing Questionnaire–Critical Care Version and, second, to analyse Portuguese critical care nurses’ level of exposure to ethical conflict and its (...) characteristics. Methods: A cross-cultural validation and descriptive, prospective and correlational study. The sample was made for 184 critical care nurses in 2016. Ethical Considerations: The study was authorised by Bioethics Commission of the University of Barcelona, the Associaçâo de Apoio ao Serviço de Cuidados Intensivos do Centro Hospitalar do Porto and the Sociedade Portuguesa de Enfermagem de Saúde Mental. Findings: The Portuguese version of the Ethical Conflict Nursing Questionnaire–Critical Care Version was a valid and reliable instrument to measure exposure to conflict. Moral outrage was the most common type of conflict. The most problematic situations were the ineffectiveness of analgesic treatments, the administration of treatments considered futile and the mismanagement of resources. (shrink)

We investigate expressiveness and definability issues with respect to minimal models, particularly in the scope of Circumscription. First, we give a proof of the failure of the Löwenheim-Skolem Theorem for Circumscription. Then we show that, if the class of P; Z-minimal models of a first-order sentence is Δ-elementary, then it is elementary. That is, whenever the circumscription of a first-order sentence is equivalent to a first-order theory, then it is equivalent to a finitely axiomatizable one. This means that classes of (...) models of circumscribed theories are either elementary or not Δ-elementary. Finally, using the previous result, we prove that, whenever a relation Pi is defined in the class of P; Z-minimal models of a first-order sentence Φ and whenever such class of P; Z-minimal models is Δ-elementary, then there is an explicit definition ψ for Pi such that the class of P; Z-minimal models of Φ is the class of models of Φ ∧ ψ. In order words, the circumscription of P in Φ with Z varied can be replaced by Φ plus this explicit definition ψ for Pi. (shrink)

We investigate some logics which use the concept of minimal models in their definition. Minimal objects are widely used in Logic and Computer Science. They are applied in the context of Inductive Definitions, Logic Programming and Artificial Intelligence. An example of logic which uses this concept is the MIN logic due to van Benthem [20]. He shows that MIN is equivalent to the Least Fixed Point logic in expressive power. In [6], we extended MIN to the MIN Logic and proved (...) it is equivalent to second-order logic in expressive power. Here, we exhibit a fragment of MIN, the MINΔ logic, which is more expressive than LFP, less expressive than MIN and closed under boolean connectives and first-order quantification. In order to do this, in the Section 2, we prove that the Downward Löwenheim-Skolem Theorem holds for arbitrary countable sets of LFP-formulas by showing that every infinite structure has a countable LFP-substructure. The method may be used to generalize this theorem to any set of LFP-formulas. We also analyse the expressive power of the Nested Abnormality Theories of Lifschitz, another formalism based on minimal models used in Artificial Intelligence, and we demonstrate that for each second-order theory Γ there is a NAT which is a conservative extension of Γ. We give a translation from second-order sentences into such NATs which is linear in the size of the sentence in prenex normal form. Finally, we establish a hierarchy of expressiveness of these logics that deal with the concept of minimal models. (shrink)

Young children, like adults, understand that human agents can flexibly choose different actions in different contexts, and they evaluate these agents based on such choices. However, little is known about children's tendencies to attribute the capacity to choose to robots, despite increased contact with robotic agents. In this paper, we compare 5‐ to 7‐year‐old children's and adults’ attributions of free choice to a robot and to a human child by using a series of tasks measuring agency attribution, action prediction, and (...) choice attribution. In morally neutral scenarios, children ascribed similar levels of free choice to the robot and the human, while adults were more likely to ascribe free choice to the human. For morally relevant scenarios, however, both age groups considered the robot's actions to be more constrained than the human's actions. These findings demonstrate that children and adults hold a nuanced understanding of free choice that is sensitive to both the agent type and constraints within a given scenario. (shrink)

This article summarizes the recent evidence on global poverty and inequality, including both developed and developing countries. Section 1 discusses poverty and inequality data and presents evidence on levels and recent trends in poverty and inequality around the world. Section 2 turns to the issues involved in aggregating inequality indices across countries, in order to construct a meaningful measure of global inequality. Section 3 discusses the empirical relationship between economic growth, poverty, and inequality dynamics. Section 4 turns to the likely (...) economic determinants of poverty and inequality changes. Section 5 offers some conclusions, and points to some promising research themes within this general topic. (shrink)

A community's abilities to promote health and maximize its response to public health threats require fulfillment of one of the four elements of public health legal preparedness, the capacity to effectively coordinate law-based efforts across different governmental jurisdictions, as well as across multiple sectors and disciplines. Government jurisdictions can be viewed “vertically” in that response efforts may entail coordination in the application of laws across multiple levels, including local, state, tribal, and federal governments, and even with international organizations. Coordination of (...) legal responses to public health emergencies also may involve a horizontal dimension comprising numerous and diverse sectors, such as public health, public and private health care, emergency management, education, law enforcement, the judiciary, and the military.Although responses to many acute health threats can implicate multiple jurisdictions and sectors, the jurisdictional and sectoral dimensions of legal preparedness are complex and may vary substantially by the nature of a threat, its geographic and geopolitical extent, and the operational response demanded. (shrink)

A community's abilities to promote health and maximize its response to public health threats require fulfillment of one of the four elements of public health legal preparedness, the capacity to effectively coordinate law-based efforts across different governmental jurisdictions, as well as across multiple sectors and disciplines. Government jurisdictions can be viewed “vertically” in that response efforts may entail coordination in the application of laws across multiple levels, including local, state, tribal, and federal governments, and even with international organizations. Coordination of (...) legal responses to public health emergencies also may involve a horizontal dimension comprising numerous and diverse sectors, such as public health, public and private health care, emergency management, education, law enforcement, the judiciary, and the military.Although responses to many acute health threats can implicate multiple jurisdictions and sectors, the jurisdictional and sectoral dimensions of legal preparedness are complex and may vary substantially by the nature of a threat, its geographic and geopolitical extent, and the operational response demanded. (shrink)

The thymus gland, which plays a key role in the maturation and functioning of the lymphoid system, is implicated in the acquired immune deficiency syndrome (AIDS). The observation that the thymic hormone, thymosin α1, is elevated in individuals at risk for AIDS (as opposed to being depressed in other immunodeficient states) has provided the first direct evidence that the thymus is malfunctioning early in the course of this deadly disease. These observations have been valuable in screening for the syndrome with (...) a rapid radioimmunoassay and in the initiation of the first clinical trials with thymosin in high risk homosexuals and hemophiliacs. If the progressive immune paralysis in AIDS is due to a dying thymus, the early identification of asymptomatic carriers of AIDS or individuals with modest AIDS‐related dysfunction may lead to therapy with thymosin or other thymomimetic agents that can restore immune function and prevent the onset of frank AIDS. (shrink)

Moral distress (MD) is well-documented within the nursing literature and occurs when constraints prevent a correct course of action from being implemented. The measured frequency of MD has increased among nurses over recent years, especially since the COVID-19 Pandemic. MD is less understood among nurse leaders than other populations of nurses. A qualitative systematic review was conducted with the aim to synthesize the experiences of MD among nurse leaders. This review involved a search of three databases (Medline, CINAHL, and APA (...) PsychINFO) which resulted in the retrieval of 303 articles. PRISMA review criteria guided authors during the article review and selection process. Following the review, six articles were identified meeting review criteria and quality was assessed using the Critical Appraisal Skills Programme (CASP) Checklist for qualitative studies. No ethical review was required for this systematic review. The six studies included in this review originated from the United States, Brazil, Turkey, and Iran. Leadership roles ranged from unit-based leadership to executive leadership. Assigned quality scores based upon CASP criteria ranged from 6 to 9 (moderate to high quality). Three analytical themes emerged from the synthesis: (1) moral distress is consuming; (2) constrained by the system; and (3) adapt to overcome. The unique contributors of MD among nurse leaders include the leadership role itself and challenges navigating moral situations as they arise. The nurse leader perspective should be considered in the development of future MD interventions. (shrink)

Human faces are one of the most prominent stimuli in the visual environment of young infants and convey critical information for the development of social cognition. During the COVID-19 pandemic, mask wearing has become a common practice outside the home environment. With masks covering nose and mouth regions, the facial cues available to the infant are impoverished. The impact of these changes on development is unknown but is critical to debates around mask mandates in early childhood settings. As infants grow, (...) they increasingly interact with a broader range of familiar and unfamiliar people outside the home; in these settings, mask wearing could possibly influence social development. In order to generate hypotheses about the effects of mask wearing on infant social development, in the present work, we systematically review N = 129 studies selected based on the most recent PRISMA guidelines providing a state-of-the-art framework of behavioral studies investigating face processing in early infancy. We focused on identifying sensitive periods during which being exposed to specific facial features or to the entire face configuration has been found to be important for the development of perceptive and socio-communicative skills. For perceptive skills, infants gradually learn to analyze the eyes or the gaze direction within the context of the entire face configuration. This contributes to identity recognition as well as emotional expression discrimination. For socio-communicative skills, direct gaze and emotional facial expressions are crucial for attention engagement while eye-gaze cuing is important for joint attention. Moreover, attention to the mouth is particularly relevant for speech learning. We discuss possible implications of the exposure to masked faces for developmental needs and functions. Providing groundwork for further research, we encourage the investigation of the consequences of mask wearing for infants’ perceptive and socio-communicative development, suggesting new directions within the research field. (shrink)

Recently, individualized or personalized medicine (PM) has become a buzz word in the academic as well as public debate surrounding health care. However, PM lacks a clear definition and is open to interpretation. This conceptual vagueness complicates public discourse on chances, risks and limits of PM. Furthermore, stakeholders might use it to further their respective interests and preferences. For these reasons it is important to have a shared understanding of PM. In this paper, we present a sufficiently precise as well (...) as adequate definition of PM with the potential of wide acceptance. (shrink)

In this article, I discuss Otto Neurath’s philosophy in the context of Vienna Circle modernism. Following recent scholarship, the discussion considers as a starting point Neurath’s participation at the fourth International Congress of Modern Architecture (CIAM IV). However, the image of Neurath’s modernism that results from this perspective is incomplete because it tends to overlook the importance of scientific utopianism in Neurath’s thought. Scientific utopianism is a methodology proposed by Neurath for the social sciences in technological contexts, in which scientists (...) elaborate and develop plans (utopias) for the transformation of society, thus contributing to an informed societal debate. Decisions are nevertheless kept outside the domain of scientific activity. I claim that recognizing the centrality of scientific utopianism in Neurath’s philosophy is fundamental to understand Neurath’s modernism. This interpretation highlights the affinities of Neurath’s philosophy of the social sciences with the modern utopianism of H. G. Wells. Both authors consider that there can be no ultimate solution to social problems but that a plural and constant debate of proposals is fundamental for the improvement of society. Therefore, Neurath’s modernism connects his philosophy of science to the literary utopian tradition. (shrink)

Apresentam-se os resultados clínicos principais de uma primeira investigação efectuada a familiares de doentes sob tratamento paliativo no domicílio da área de Lisboa, com o instrumento de medida da satisfação SERVQUAL Modificado. Dos 58 familiares/doentes que responderam ao questionário apenas uma minona estava insatisfeita (uma classe de 5 indivíduos mostra-se francamente insatisfeita), uma classe de 15 estava moderadamente satisfeita, havendo 38 individuos fortemente satisfeitos com a qualidade e prontidäo dos serviços prestados. Porém urna percentagem elevada de doentes, segundo a opinião (...) retrospectiva dos cuidadores, faleceu com sintomatologia agravada, nomeadamente dores (60%), obstipação (67%) e depressão/ansiedade (43%). Discute-se a consistência e validade do questionáno SERVQUAL Modificado, contextualizam-se os resultados no que é o standard da prática da MCP e integram-se na promoção da dignidade humana no fim da vida. We present the main clinical findings of research on palliative home care, carried out among relatives of patients in the Lisbon area. An adapted version of SERVQUAL was used. Of a total of 58 carers surveyed only a small number (5) was unsatisfied 15 were only moderately satisfied. 38 family carers were strongly satisfied with the services. Yet, a high percentage of patients, as viewed in retrospect by their relatives died with some aggravated symptoms: 60% with more pain, 67% constipation, and 43% anxiety/depression. We discuss the consistency and validity of this adapted SERVQUAL tool and the main results are contextualized beanng in mind the standard practice of palliative medicine and the pursuit of human dignity in death. (shrink)

Apresentamos um resumo do desenvolvimento e do contexto institucional do Projecto Humanização dos Cuidados Paliativos em Contexto Domiciliário, aprovado e financiado pela Fundação Calouste Gulbenkian. Utilizam-se largamente os próprios documentos que o justificaram e os relatórios oficiais para dar uma imagem vivida, realista e técnica das dificuldades da profissionalização e reforma dos Cuidados Paliativos, mesmo quando integrada em acções de formação num serviço de um Centro de Tratamento Compreensivo do Cancro. We put forward a synopsis of the development and institutional (...) context of the Project Humanização dos Cuidados Paliativos em Contexto Domiciliário, approved and financed by the Calouste Gulbenkian Foundation. The groundwork documents are widely used as well as official reports so as to convey a lively, realistic and technical image arising from professionalizing and reforming Palliative Medicine even when it is based on in-service training programmes in an Comprehensive Cancer Center. (shrink)

Phillip Ferreira - Perfectionism and the Common Good: Themes in the Philosophy of T.H. Green - Journal of the History of Philosophy 43:3 Journal of the History of Philosophy 43.3 369-370 David O. Brink. Perfectionism and the Common Good: Themes in the Philosophy of T. H. Green. Oxford: Clarendon Press, 2003. Pp. xiv + 139. Cloth, $27.50. The British idealists have not fared well during the past century. Still, there has been in recent years a renewed interest in the (...) movement's principal figures: F. H. Bradley and T. H. Green. And, while Bradley's polemical style has found a wider audience, Green's work—especially his Principles of Political Obligation—appears to have had the steadier following. Lesser known than Green's political writing, though, is his longer and more difficult Prolegomena to Ethics. And David O. .. (shrink)

The article analyzes the possibility of reconciling skepticism with moral theories and the idea that moral philosophy is the supreme arbiter of all moral justification. We cannot take universally valid maxims as descriptive rules nor can we fall into an individualistic relativism. H. Putnam seeks to deconstruct Habermas' separation of values and norms, and, in doing so, he shows the need for such a reconciliation.

Este artigo apresenta a biografia e o percurso profissional de Pedro Ferreira, impressor activo em Lisboa no século XVIII, e descreve algumas das marcas tipográficas utilizadas nas suas impressões.

É muitas vezes aceite que certas categorias, tipicamente as de género, raça, orientação sexual ou doença mental, são construções sociais e não divisões naturais no mundo. A distinção entre categorias naturais e categorias sociais, como pretende ser a distinção entre o sexo e o género, tem servido no âmbito da crítica e ciência social para advogar a abolição de certas normas sociais, e para a implementação de políticas mais equitativas. Contudo, há aspectos centrais do construtivismo que são pouco claros. O (...) que é que se nega ao rejeitar que as categorias construídas socialmente são naturais? E o que significa dizer que essas categorias são construções sociais? E será de todo verdade que certas categorias, como o género, são sociais e não naturais? Não tenho a pretensão de responder a todas estas complexas questões neste artigo, mas espero pelo menos iluminar parte do debate contemporâneo sobre estes problemas. Por uma questão de espaço, concentrar-me-ei na noção de género. (shrink)

En este artículo se inquiere acerca de las razones que llevaron a Ḥ. Naṣṣār, en su edición del dīwān de Ŷamīl b. Ma‛mar al-‛Uḏrī, a unir en un solo poema lo que en las fuentes árabes se presentaba como dos poemas independientes, aunque con el mismo verso inicial. Sin embargo, esa coincidencia se explica fácilmente si se tienen en cuenta las técnicas de composición oral, con su uso de fórmulas y expresiones formulaicas, que se detectan en la poesía árabe antigua, (...) modo de composición que siguió vigente a lo largo de casi todo el período omeya, mientras no se generalizó el uso de la escritura. (shrink)

Fifty years after the death of Edmund Husserl, the main founder of the phenomenological current of thought, we present to the public a four book collection showing in an unprecedented way how Husserl's aspiration to inspire the entire universe of knowledge and scholarship has now been realized. These volumes display for the first time the astounding expansion of phenomenological philosophy throughout the world and the enormous wealth and variety of ideas, insights, and approaches it has inspired. The basic commitment to (...) phenomenological concerns found in all this variety makes this collection a most signifi cant historical document. This second volume of the collection bears witness to a deliberate shift of attention from the earlier to the later phase of Husserl's reflections. We see how his issues - intersubjectivity, ethics, human encounter, the societal world, empathy, the sphere of the self, and the surpassing of dichotomies (bodylpsyche, etc.) - are now at the center of attention in the human sciences. Among the authors are H. Tellenbach, A. Rigobello, C. Balzer, C. Bjurvill, V. Molchanov, E. Syristova, O. Balaban, R. Boehm, M. Sancipriano, O. M. Anwar, Y. Okamoto, B. Holyst, T. Sodeika, and M. De Negri. The studies were gathered at the programs held by The World Institute for Advanced Phenomenological Research and Learning in the commemorative year 1988/1989, chiefly at the First World Congress of Phenomenology at Santiago de Compos tela, Spain, with the aim of assessing the current state of phenomenology. A-T. T. (shrink)

A partir del comentario hecho por José L. L. Aranguren sobre «puede» y «debe» en ética, aquí se plantea el significado de los principios de ética en la situación de retroceso democrático del siglo XXI. Ha sido analizada por la filosofía y la teoría política recientes. En los años sesenta, las críticas de D. Sternberger al modelo de polis, de política cívica en las obras de H. Arendt, se apoyaban en la imagen de la ciudad hundida. Pero las preguntas sobre (...) el alcance del realismo («puede») y el lugar de los principios («debe») siguen abiertas. ¿Ultra posse nemo obligatur? Aquella imagen de la polis puede ser reemplazada por otra algo distinta, la ciudad sumergida. Se encuentra en la literatura, sería también la metáfora de la necesaria reconstrucción de las políticas democráticas, con el «deber ser» como núcleo de la cultura cívica. Los principios éticos y, en especial, justicia como equidad será aquí la referencia en dos situaciones: (1) la política de salud pública, (2) los procesos de paz. En conclusión, el marco normativo cuenta o ha de contar, tanto en la paz como en la guerra. Decir «nunca más» es también una forma de recordar el papel crucial de los principios. (shrink)

Bringing allegory into the light from the neglect into which it fell means focusing on the wondrous heights of the human spirit in its significance for culture. Contemporary philosophies and literary theories, which give pre-eminence to primary linguistics forms (symbol and metaphor), seem to favor just that which makes intelligible communication possible. But they fall short in accounting for the deepest subliminal founts that prompt the mind to exalt in beauty, virtue, transcending aspiration. The present, rich collection shows how allegory, (...) incorporating the soaring of the spirit, offers highlights for culture, with its fluctuations and transformation. This collective effort, rich in ideas and intuitions and covering a vast range of cultural manifestations, is a pioneering work, retrieving the vision of the exalted human spirit, bringing together literature, theatre, music and painting in a variety of revealing perspectives. The authors include: M. Kronegger, Ch. Raffini, J. Smith, J.B. Williamson, H. Ross, M.F. Wagner, F. Divorne, L. Oppenheim, D.K. Heckerl, N. Campi de Castro, P. Saurez Pascual, M. Alfaro Amieiro, H. Fletcher Thompson, R.J. Wilson III, and A. Stensaas. For specialists, students and workers in philosophy, comparative literature, aesthetic phenomenologists and historians of art. (shrink)

At more than five-hundred pages, this volume — the first in a set of five — is neither a short nor an easy read. Most will, I suspect, treat the book as a reference work, consulting only those sections relevant to their study. But its materials are sometimes demanding; and in several chapters readers will encounter considerable interpretive difficulties. I shall have more to say about these difficulties further down. First, though, a few comments on the book’s contents.