RATIONALE AND AIMS: Total hip and knee replacements, usually, have long waiting lists. There are several prioritization tools for these kind of patients. A new tool should undergo a standardized validation process. The aim of the present study was to validate a new prioritization tool for primary hip and knee replacements. METHODS: We carried out a prospective study. Consecutive patients placed on the waiting list were eligible for the study. Patients included were mailed a questionnaire which included, (...) among other questions, the seven items of the priority tool and the Western Ontario and McMasters Universities Arthritis Index (WOMAC) specific questionnaire. The priority tool gives a score from 0 to 100 points, and three categories (urgent, preferent and ordinary). We studied the content and construct validity. We used Student's t-test or one-way analysis of variance. Correlational analysis was used to evaluate convergent and discriminate validity. RESULTS: The sample consisted of 838 patients (62.3% were female), with mean age of 70.2 years (SD 8.4). A total of 55.5% patients underwent knee replacement. Given that the tool was elaborated by patients and orthopaedic surgeons, it shows a good content validity. The priority score was statistically different (P < 0.001) among the three urgency categories created. The scores of the three WOMAC dimensions showed differences (P < 0.001) by the three urgency categories created. The correlations between the priority score and WOMAC dimensions were 0.79 (function), 0.69 (pain) and 0.51 (stiffness). The correlations between WOMAC items and items from priority tool were greater (0.47-0.69) between items measuring similar constructs than those measuring different constructs (0.27-0.49). These data are similar in both joints. CONCLUSIONS: Results support the validity of the prioritization tool to be used with patients waiting for hip or knee replacement. (shrink)

The Centers for Medicare & Medicaid Services has initiated bundled payments for hip and knee total joint replacement in an effort to decrease healthcare costs and increase quality of care. The ethical implications of this program have not been studied. This article considers the ethics of patient selection to improve outcomes; specifically, screening patients by body mass index to determine eligibility for total joint replacement. I argue that this type of screening is not ethically defensible, (...) and that the bundled payment program as structured is likely to lead to unfair restrictions on who receives total joint replacements. (shrink)

Total knee arthroplasty (TKA) is a commonly implemented elective surgical treatment for end-stage osteoarthritis of the knee, demonstrating high success rates when assessed by objective medical outcomes. However, a considerable proportion of TKA patients report significant dissatisfaction postoperatively, related to enduring pain, functional limitations, and diminished quality of life. In this conceptual analysis, we highlight the importance of assessing patient-centred outcomes routinely in clinical practice, as these measures provide important information regarding whether surgery and postoperative rehabilitation interventions (...) have effectively remediated patients’ real-world “quality of life” experiences. We propose a novel precision medicine approach to improving patient-centred TKA outcomes through the development of a multivariate machine-learning model. The primary aim of this model is to predict individual postoperative recovery trajectories. Uniquely, this model will be developed using an interdisciplinary methodology involving non-linear analysis of the unique contributions of a range of preoperative risk and resilience factors to patient-centred TKA outcomes. Of particular importance to the model’s predictive power is the inclusion of a comprehensive assessment of modifiable psychological risk and resilience factors that have demonstrated relationships with TKA and other conditions in some studies. Despite the potential for patient psychological factors to limit recovery, they are typically not routinely assessed preoperatively in this patient group, and thus can be overlooked in rehabilitative referral and intervention decision-making. This represents a research-to-practice gap that may contribute to adverse patient-centred outcomes. Incorporating psychological risk and resilience factors into a multivariate prediction model could improve the detection of patients at risk of sub-optimal outcomes following TKA. This could provide surgeons and rehabilitation providers with a simplified tool to inform postoperative referral and intervention decision-making related to a range of interdisciplinary domains outside their usual purview. The proposed approach could facilitate the development and provision of more targeted rehabilitative interventions on the basis of identified individual needs. The roles of several modifiable psychological risk and resilience factors in recovery are summarised, and intervention options are briefly presented. While focusing on rehabilitation following TKA, we advocate for the broader utilisation of multivariate prediction models to inform individually-tailored interventions targeting a range of health conditions. (shrink)

Medical paternalism has long been a common medical practice. However, patient autonomy in healthcare has been recently adopted by doctors and patients alike. This study explored whether doctors and patients in a tertiary care hospital in Saudi Arabia preferred autonomy or paternalism in shared decision‐making. A total of 118 participants (51 patients requiring total knee replacement, owing to stages 3–4 of osteoarthritis, and 67 doctors) from the Eastern province, Saudi Arabia. responded to a 17‐question category‐based questionnaire (...) involving four scales of autonomy. Descriptive statistics and chi‐square test results revealed that in this hospital, patients preferred a paternalistic approach toward their medical care along with a full disclosure of the risks related to surgical procedures. We recommend health education regarding the specific autonomy subscales (doctor knows best, patient should decide, right to non‐participation, and obligatory risk information), and the implementation of protocols that protect patients' rights and enhance personal autonomy. (shrink)

Background: Gait analysis after total ankle replacement and ankle arthrodesis is usually measured barefoot. However, this does not reflect reality. The purpose of this study was to compare patients barefoot and with footwear. Methods: We compared 126 patients (total ankle replacement 28, ankle arthrodesis 57, and tibiotalocalcaneal arthrodesis 41) with 35 healthy controls in three conditions (barefoot, standardized running, and rocker bottom shoes). Minimum follow-up was 2 years. We used dynamic pedobarography and a light gate. Main (...) outcome measures: relative midfoot index, forefoot maximal force, walking speed. Findings: The relative midfoot index decreased in all groups from barefoot to running shoes and again to rocker bottom shoes (p < 0.001). The forefoot maximal force increased wearing shoes (p < 0.001), but there was no difference between running and rocker bottom shoes. Walking speed increased by 0.06 m/s with footwear (p < 0.001). Total ankle replacement and ankle arthrodesis were equal in running shoes but both deviated from healthy controls (total ankle replacement/ankle arthrodesis smaller RMI p = 0.07/0.017; increased forefoot maximal force p = 0.757/0.862; slower walking speed p < 0.001). In rocker bottom shoes, this ranking remained the same except the relative midfoot index merged to similar values. Tibiotalocalcaneal arthrodesis were inferior in both shoes. Interpretation: Runners are beneficial and the benefit is greater for fusions and replacements. Rocker bottom shoes have little added benefit. Total ankle replacement and ankle arthrodesis were equal but inferior to healthy controls. Tibiotalocalcaneal arthrodesis has an inferior outcome. (shrink)

ObjectivesThe purpose of this study was to identify risk factors for delirium after total joint arthroplasty and provide theoretical guidance for reducing the incidence of delirium after TJA.MethodsThe protocol for this meta-analysis is registered with PROSPERO. We searched PubMed, the Cochrane Library and Embase for observational studies on risk factors for delirium after TJA. Review Manager 5.3 was used to calculate the relative risk or standard mean difference of potential risk factors related to TJA. STATA 14.0 was used for (...) quantitative publication bias evaluation.ResultsIn total, 25 studies including 3,767,761 patients from 9 countries were included. Old age has been widely recognized as a risk factor for delirium. Our results showed that the main risk factors for delirium after TJA were patient factors, comorbidities, surgical factors and drug factors.ConclusionsMultiple risk factors were associated with delirium after TJA. These results may help doctors predict the occurrence of delirium after surgery and determine the correct treatment.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42020170031. (shrink)

Abstract:Should the process of ecological restoration be considered a type of moral reparation? In a recent issue of this journal, Ben Almassi (2017) has argued that ecological restoration should be understood as a moral repair, i.e., as "a model for rebuilding the moral conditions of relationships" (20). Ideas of restorative justice and moral repair are appropriate to address human injustice and wrongdoing. But these concepts are vacuous and lose their meaning when addressing the ethics of human activities regarding the natural (...) world because of the essential character of the restoration process: the replacement or substitution of new entities for pre-existing entities in an attempt to reverse the irreversible. At best, the idea of moral reparations to nature is a weak metaphor with no practical efficacy; at worst, it totally misconceives the relationship between human activity and the natural environment in the process of ecological restoration and provides yet another dangerous and disingenuous justification of human arrogance and domination of the natural world. In the guise of the act of moral reparations, humans are instead attempting to assume the powers of God, to control the natural and human world. My previous criticisms of the ethics and meaning of ecological restorations—especially regarding the substitution of new individuals and the artifactual nature of restorations—can be used to undermine Almassi's thesis of moral repair as a goal of ecological restoration practice. In addition an analysis of the Book of Job in the Old Testament demonstrates that not even God—much less humans—can restore and replace what has been destroyed. (shrink)

In this essay I argue that Kant remained committed to the necessity and fundamental importance of education throughout his career. Like Johann Bernhard Basedow (1724–90), Kant holds that a ‘total transformation’ of schools is necessary, and he holds this view not only in the 1770s but in his later years as well. In building my case I try to refute two recent opposing interpretations – Reinhard Brandt’s position that Kant’s early ‘education enthusiasm’ was later replaced by a politics enthusiasm, (...) and Manfred Kuehn’s view that the increasing importance of autonomy in Kant’s mature ethics leads him to de-emphasize education. (shrink)

Animal replaceability is supposed to be a feature of some consequentialist theories, like Utilitarianism. Roughly, an animal is replaceable if it is permissible to kill it because the disvalue thereby caused will be compensated by the value of a new animal’s life. This is specially troubling since the conditions for such compensation seem easily attainable by improved forms of raising and killing animals. Thus, grounding a strong moral status of animals in such theories is somewhat compromised. As is, consequently, their (...) position as an alternative to rights-based theories in animal ethics. Recognising this, some utilitarians tried to disassociate utilitarianism and replaceability. I will here add my voice to this project. However, instead of seeing the culprit in the usual suspects (hedonism, maximisation or the total view), I advance a new proposal. After identifying that the compensating value for a disvaluable action has to be its consequence, I present a restriction on consequences: consequences of sequences of actions cannot be consequences of the isolated actions in the sequences. Given this, the main argument is simple: killing an animal is permissible only if the the value of the new animal’s life is a consequence of the killing; but this value is a consequence of a sequence of actions which involves the killing plus some additional actions; therefore, since, via the restriction, such value is not a consequence of the killing, it is irrelevant to its normative status. I then present two further motivations for the restriction: firstly, it prevents the value of conditional actions from trivially influencing the value of the actions on which they are conditional; secondly, it is useful – even if not a complete solution – to reply other objections to consequentialism: the accordion effect of action and the cluelessness problem. I finally consider a couple of objections. (shrink)

Objective: Stand-to-sit task is an important daily function, but there is a lack of research evidence on whether knee osteoarthritis affects the postural balance during the task. This study aimed to compare individuals with knee OA and asymptomatic controls in postural balance and identify kinematic and lower extremity muscle activity characteristics in individuals with knee OA during the stand-to-sit task.Methods: In total, 30 individuals with knee OA and 30 age-matched asymptomatic controls performed the 30-s Chair (...) Stand Test at self-selected speeds. Motion analysis data and surface electromyography were collected while participants performed the 30sCST. To quantify postural balance, the displacement of the center of mass and the peak instantaneous velocity of the CoM were calculated. The kinematic data included forward lean angles of the trunk and pelvic, range of motion of the hip, knee, and ankle joints in the sagittal plane. The averaged activation levels of gluteus maximus, vastus lateralis, vastus medialis, rectus femoris, biceps femoris, tibialis anterior, and medial head of gastrocnemius muscles were indicated by the normalized root mean square amplitudes.Results: Compared with the asymptomatic control group, the knee OA group prolonged the duration of the stand-to-sit task, demonstrated significantly larger CoM displacement and peak instantaneous CoM velocity in the anterior-posterior direction, reduced ankle dorsiflexion RoM, greater anterior pelvic tilt RoM, and lower quadriceps femoris and muscles activation level coupled with higher BF muscle activation level during the stand-to-sit task.Conclusion: This study indicates that individuals with knee OA adopt greater pelvic forward lean RoM and higher BF muscle activation level during the stand-to-sit task. However, these individuals exist greater CoM excursion in the anterior-posterior direction and take more time to complete the task. This daily functional activity should be added to the rehabilitation goals for individuals with knee OA. The knee OA group performs reduced ankle dorsiflexion RoM, quadriceps femoris, and TA activation deficit. In the future, the rehabilitation programs targeting these impairments could be beneficial for restoring the functional transfer in individuals with knee OA. (shrink)

It seems to be a widespread opinion that increasing the length of existing happy lives is better than creating new happy lives and that it may be better even when the total welfare is lower in the outcome with extended lives. The chapter discusses two interesting suggestions that seem to support this idea. The first is critical level utilitarianism (CLU) and the other is view comparativism. The chapter describes the pure case of life extension versus life replacement and (...) then presents some different views about the value of life extension, indicating some of the arguments in favor and against life extension fail. Then, it turns to the implications of critical level utilitarianism and comparativism in regards to life extension versus replacement, the main topic of this chapter. A case is presented to explain that there is a conflict between intuitions regarding life extension and comparativism. (shrink)

It has been claimed that increasing the length of existing lives with positive welfare is better than creating new lives with positive welfare although the total sum of well-being is the same in both cases, or less in the outcome with extended lives. I shall discuss an interesting suggestion --- that it makes an outcome worse if people are worse off than they otherwise could have been --- that seem to support this idea. I call this view Comparativism.

It seems to be a widespread opinion that increasing the length of existing happy lives is better than creating new happy lives although the total welfare is the same in both cases, and that it may be better even when the total welfare is lower in the outcome with extended lives. I shall discuss two interesting suggestions that seem to support this idea. Firstly, the idea there is a positive level of well-being above which a life has to (...) reach to have positive contributive value to a population. This view is usually called critical level utilitarianism. Secondly, the viewthat it makes an outcome worse if people are worse off than they otherwise could have been. I shall call this view comparativism. Firstly, I shall describe what I call the pure case of life extension versus replacement. Then I shall very briefly describe some different views about the value of life extension and indicate why I think some of the arguments in favor and against life extension fail. I shall then turn to the implications of critical level utilitarianism and comparativism in regards to life extension versus replacement, which is the main topic of this chapter. (shrink)

It seems to be a widespread opinion that increasing the length of existing happy lives is better than creating new happy lives although the total welfare is the same in both cases, and that it may be better even when the total welfare is lower in the outcome with extended lives. I shall discuss two interesting suggestion that seems to support this idea, or so it has been argued. Firstly, the idea there is a positive level of wellbeing (...) above which a life has to reach to have positive contributive value to a population, so-called Critical Level Utilitarianism. Secondly, the view that it makes an outcome worse if people are worse off than they otherwise could have been, a view I call Comparativism. I shall show that although these theories do capture some of our intuitions about the value of longevity, they have such counterintuitive implications in other cases that we ultimately have to reject them. (shrink)

Automation does not always replace human labour altogether: there is an intermediate stage of human co-existence with machines, including robots, in a production process. Cobots are robots designed to participate at close quarters with humans in such a process. I shall discuss the possible role of cobots in facilitating the eventual total elimination of human operators from production in which co-bots are initially involved. This issue is complicated by another: cobots are often introduced to workplaces with the message (from (...) managers) that they will not replace human operators but will rather assist human operators and make their jobs more interesting and responsible. If, in the process of learning to assist human operators, robots acquire the skills of human operators, then the promise of avoiding replacement can turn out to be false, and if a human operator loses his job, he has been harmed twice over: once by unemployment and once by deception. I shall suggest that this moral risk attends some cobots more than others. (shrink)

ABSTRACT: This article attempts to define the status of the political order in Pascal's thought by examining the coherence of the fragments on custom, imagination, force and justice in the Pensées. Situating this order between divine Justice and unjust human justice, Pascal offers a contribution to the Augustinian account of the relationship between moral and political existence by his description of the experience of temporal authority and of the spiritual skill which that experience requires.

Ces contributions tentent de dégager les enjeux littéraires, philosophiques, politiques et psychologiques des "Dialogues", oeuvre méconnue de Rousseau, afin de cerner sa signification dans le parcours de l'écrivain.

Abstract In this paper an algebraic method is presented to derive a 4 × 4 Hermitian Schrödinger equation from with and . The latter operator replacement is a common procedure in a quantum description of the total energy. In the derivation we don’t make use of Dirac’s method of four vectors. Moreover, the root operator isn’t squared either. Instead, use is made of the algebra of operators to derive a Hermitian matrix Schrödinger equation. We believe that new physics (...) can be obtained from an alternative quantization of the relativistic total energy. Note e.g. the pion physics behind the Klein–Gordon equation and the antimatter behind the Dirac quantization of the total relativistic energy. In this paper, for the sake of clarity, a time-only dependence of the electromagnetic potential vector is assumed. It is also demonstrated that a “latent” Lorentz invariance exists related to a derived expression for amplitude and phase. (shrink)