Until recently, cardiotoxicity in the setting of a malignant disease was attributed solely to the detrimental effects of chemo‐ and/or radio‐therapy to the heart. On this account, the focus was on the evaluation of well‐established cardiac biomarkers for the early detection of myocardial damage. Currently, this view has been revised. Cardiotoxicity is not restricted to a single organ but instead affects the endothelium as a whole. Indeed, it has come into light that not only cancer therapy but also malignant cells (...) per se can impair the cardiovascular system, through a paracrine and endocrine mode of action. Even more intriguingly, a clear interplay between molecular pathways involved in cancer and cardiovascular disease has become prevalent, suggesting a common nominator that governs the pathophysiology of these two entities. Taken together, our strategy in the quest of novel biomarkers in the emerging field of cardio‐oncology should be critically reshaped. (shrink)

(1941). A survey of the growth of knowledge about certain parts of the foetal cardio-vascular apparatus, and about the foetal circulation, in Man and some other mammals. Part I: Galen to Harvey. Annals of Science: Vol. 5, No. 1, pp. 57-89.

Upshot: Thanks to the commentaries we have been able to further clarify the situation of generative first-person analysis in the general framework of neurophenomenology and more specifically of cardio-phenomenology as its extension and reformulation. We have also provided more detailed information about the way phenomenology as transcendental philosophy is genuinely operating as a practice in cardio-phenomenology and has a central function regarding the creation of categories and their suspensive questioning thanks to the epoché method. We have also drawn (...) great benefits from the questions about how micro-phenomenology allows a refinement of descriptive categories and the way new categories are generated, and we have been able to provide some answers about different scales of newness in the generative process. (shrink)

This study concerns the problem of late complications of antineo-plastic therapy. Reduced parameters of the cardiorespiratory system in childhood may have a tremendous impact on health. In order to assess the selected parameters, to evaluate physical endurance, and compare the results with those obtained for healthy children, a test was carried out on a treadmill, until 80% of maximum pulse rate was reached. To compare the differences between the treatment group and the control group, three approaches were used. The first (...) one was the classical statistical inference, the second consisted in forming a multidimensional normal model and also involved modelling of the correlation between variables. The unstructured type of the working correlation matrix was chosen to obtain the results and correct standard errors. In the last approach, logistic regression was used to model the relationship between binary outcome and covariates, and to differentiate between the groups of patients on the basis of their cardiovascular parameters. (shrink)

Background:Cardio-pulmonary resuscitation is the default procedure during cardio-pulmonary arrest. If a patient does not want cardio-pulmonary resuscitation, then a do not attempt resuscitation order must be documented. Often, this order is not given; even if thought to be appropriate. This situation can lead to a slow code, defined as an ineffective resuscitation, where all resuscitation procedures are not performed or done slowly.Research objectives:To describe the perceptions of nurses working on internal medicine wards of slow codes, including the (...) factors associated with its implementation.Research design:This was a cross-sectional, descriptive study. Participants completed a personal characteristics questionnaire and the Perceptions and Factors of Slow Codes questionnaire designed for this study.Participants and research context:The sample was a convenience sample of nurses working on internal medicine wards in two Israeli hospitals.Ethical considerations:The study received ethical approval from both institutions, where data were collected and stored according to institutional policy.Findings:Most reported that resuscitations were conducted according to protocol. Some took their time calling the code, or waited by the bedside and did not perform cardio-pulmonary resuscitation. Factors most associated with slow codes were poor patient prognosis and a low chance of patient survival. Two-thirds reported that slow codes were done on their unit and the majority perceived slow codes as ethical.Discussion:This study confirms that slow codes are part of medical care on internal medicine wards, where most nurses perceive them as an ethical alternative. These perceptions are in contrast to most legal and ethical opinions expressed in the literature.Conclusion:Nurses should be educated about the legal and ethical implications of slow codes, and qualitative and quantitative studies should be conducted that further investigate its implementation. (shrink)

Background Decisions regarding Cardio-Pulmonary Resuscitation (CPR) and Do Not Attempt Resuscitation (DNAR) orders remain demanding, as does including patients in the process. Objectives To explore physicians’ justification for CPR/DNAR orders and decisions regarding patient inclusion, as well as their reports of how they initiated discussions with patients. Methods We administered a face-to-face survey to residents in charge of 206 patients including DNAR and CPR orders, with or without patient inclusion. Results Justifications were provided for 59% of DNAR orders and (...) included severe comorbidity, patients and families’ resuscitation preferences, patients’ age, or poor prognosis or quality of life. Reasons to include patients in CPR/DNAR decisions were provided in 96% and 84% of cases, and were based on respect for autonomy, clinical assessment of the situation as not too severe, and the view that such inclusion was required. Reasons for not including patients were offered in 84% of cases for CPR and in 70% for DNAR. They included absent decision-making capacity, a clinical situation viewed as good (CPR) or offering little hope of recovery (DNAR), barriers to communication, or concern that discussions could be emotionally difficult or superfluous. Decisions made earlier in the patient's management were infrequently viewed as requiring revision. Residents reported a variety of introductions to discussions with patients. Conclusions These results provide better understanding of reasons for CPR/DNAR decisions, reasons for patient inclusion or lack thereof, and ways in which such inclusion is initiated. They also point to potential side-effects of implementing CPR/DNAR recommendations without in-depth and practical training. This should be part of a regular audit and follow-up process for such recommendations. (shrink)

Context: The use of first-person micro-phenomenological interviews and their productive interaction with third-person physiological data is a challenging and pressing issue in order to offer an effective and fruitful application of Varela’s neurophenomenological hypothesis. Problem: We aim at offering a generative method of analysis of first-person micro-phenomenological interviews using third-person physiological data. Our challenge is to describe this generative first-person analysis with the third-person physiological framework rather than put Varela’s hypothesis into practice in a generative way (as we did in (...) another paper. Method: The present contribution is a first pioneering study as far as the exposition of such an interactive generative methodology is concerned. It is also a new issue insofar as it deals with a case study, surprise in depression, that has not been thoroughly dealt with so far, either in philosophy or in psychopathology. Results: We show that the analysis of first-person data is an intrinsic generative one, insofar as new refined categories and multifarious circular micro- and macro-processes were discovered in the very process of analyzing. They provide the initial structural generic third-person description of surprise inherited both from philosophical phenomenological a priori categories and from the experimental startle setting with a refined micro-segmentation of the dynamic of the experience. Implications: Our article could be of interest to neurophenomenologists looking for an effective application and to researchers in quest of a method of analysis of first-person data. The present limitations are due to the still preliminary data-results we need to complete. Constructivist content: The article is directly linked to Varela’s neurophenomenological program and aims at extending and reforming it with a cardio-phenomenological approach. Keywords: First-person micro-phenomenological interviews, surprise, generative analysis of first-person data, depression, cardio-phenomenology, generative categories. (shrink)

Cardiophenomenology aims at refining the neuro-phenomenological approach created by F. Varela as a new paradigm, jointly based on Husserl’s a priori dynamics of the living present and an experiment on anticipatory time-dynamics of visual motor perception. In order to do so, we will situate the paradigm of neurophenomenology at the cardio-vascular level, focusing on the emotional dynamics of lived experience and thus refining the dialogue, more precisely, the generative mutual constraints between first- and third-person analysis. In this article we (...) present the theoretical hypothesis of cardiophenomenology, which places the bodily-emotional heartsystem at its core, as an intrinsic part of the cognitive system. The latter therefore needs to be enlarged in order to include an enactive embodied cardiac-affective dimension. Here we present five main arguments for the necessary inclusion of the bodily-emotional heartsystem in the cognitive system: first, two pragmatic operational arguments, then three theoretical ones. A direct methodological-pragmatic consequence is the actual operativity of the generative mutual constraints based on an experiential -experimental continuity of the embodied cardiac-affective fold inherent in the subject. (shrink)

While there are numerous doubts, controversies and lack of consensus on alternative definitions of human death, it is argued that it is more ethical to allow people to choose either cessation of cardio-respiratory function or loss of entire brain function as the definition of death based on their own views. This paper presents the law of organ transplantation in Japan, which allows people to decide whether brain death can be used to determine their death in agreement with their family. (...) Arguably, Japan could become a unique example of individual choice in the definition of death if the law is revised to allow individuals choose definition of death independently of their family. It suggests that such an approach is one of the reasonable policy options a country can adopt for legislation on issues related to the definition of death. (shrink)

The gap between the number of organs available for transplant and the number of individuals who need transplanted organs continues to increase. At the same time, thousands of transplantable organs are needlessly overlooked every year for the single reason that they come from individuals who were declared dead according to cardio pulmonary criteria. Expanding the donor population to individuals who die uncontrolled cardiac deaths will reduce this disparity, but only if organ preservation efforts are utilized. Concern about potential legal (...) liability for temporary preservation of organs pending a search for family members appears to be one of the impediments to wider use of donation in cases of uncontrolled cardiac death in states without statutes explicitly authorizing such action. However, we think that the risk of liability for organ preservation under these circumstances is de minimis, and that concerns about legal impediments to preservation should yield to the ethical imperative of undertaking it. (shrink)

The definition of death was clearer one hundred years ago than it is today. People were declared dead if diagnosed with permanent cessation of both cardio‐circulatory function and respiratory function. But the definition has been muddled by the development of new technologies and interventions—first by cardiopulmonary resuscitation and ventilators, which were introduced in the mid‐twentieth century, and now by extracorporeal membrane oxygenation, which creates the ability to keep oxygenated blood circulating, with or without a beating heart or functioning lungs. (...) In Defining Death: The Case for Choice, Robert Veatch and I argue that the definition of death should focus on “what change in a human being is so fundamental that we can say the individual is no longer with us as a member of the human community bearing rights such as the right not to be killed.” We assert that this decision is a normative issue about which different stakeholders may believe that different changes are fundamental, and we therefore propose that the optimal policy solution may be to allow stakeholders to choose their own definition within a reasonable range of options. There are three caveats that need to be highlighted regarding this approach. (shrink)

Traditionally, people were recognized as being dead using cardio-respiratory criteria: individuals who had permanently stopped breathing and whose heart had permanently stopped beating were dead. Technological developments in the middle of the twentieth century and the advent of the intensive care unit made it possible to sustain cardio-respiratory and other functions in patients with severe brain injury who previously would have lost such functions permanently shortly after sustaining a brain injury. What could and should physicians caring for such (...) patients do? Significant advances in human organ transplantation also played direct and indirect roles in discussions regarding the care of such patients. Because successful transplantation requires that organs be removed from cadavers shortly after death to avoid organ damage due to loss of oxygen, there has been keen interest in knowing precisely when people are dead so that organs could be removed. Criteria for declaring death using neurological criteria developed, and today a whole brain definition of death is widely used and recognized by all 50 states in the United States as an acceptable way to determine death. We explore the ongoing debate over definitions of death, particularly over brain death or death determined using neurological criteria, and the relationship between definitions of death and organ transplantation. (shrink)

People with mental illnesses have higher prevalence and mortality rates with regard to common somatic diseases and causes of death, such as cardio-vascular conditions or cancer. One factor contributing to this excess morbidity and mortality is the sub-standard level of physical healthcare offered to the mentally ill. In particular, they are often subject to diagnostic overshadowing: a tendency to attribute physical symptoms to a pre-existing diagnosis of mental illness. This might be seen as an unfortunate instance of epistemic bad (...) luck, where particular features of a group of patients make a timely and correct diagnosis unlikely. While this can explain some cases of diagnostic overshadowing, I argue that in other cases, epistemic injustice is involved. Analyzing the case of diagnostic overshadowing, I distinguish two kinds of testimonial injustice. For one, there are classic cases of transactional testimonial injustice resulting from prejudices against the mentally ill. In addition, there are cases of structural testimonial injustice resulting from features of health care systems. To overcome diagnostic overshadowing, remedies on the individual as well as structural level are thus needed. (shrink)

The 1981 Uniform Determination of Death Act (UDDA) established the validity of both cardio-respiratory and neurological criteria of death. However, many religious traditions including most forms of Haredi Judaism (ultra-orthodox) and many varieties of Buddhism strongly disagree with death by neurological criteria (DNC). Only one state in the U.S., New Jersey, allows for both religious exemptions to DNC and provides continuation of health insurance coverage when an exception is invoked in its 1991 Declaration of Death Act (NJDDA). There is (...) yet no quantitative or qualitative data on the frequencies of religious exemptions in New Jersey. This study gathered information about the frequency of religious exemptions and policy in New Jersey that was created out of respect for religious beliefs. Literature and internet searches on topics related to religious objections to DNC were conducted. Fifty-three chaplains and heads of bioethics committees in New Jersey hospitals were contacted by phone or email requesting a research interview. Respondents answered a set of questions about religious exemptions to DNC at the hospital where they worked that explored the frequency of such religious exemptions in the past five years, the religious tradition indicated, and whether any request for a religious exemption had been denied. This study was approved by the Northeastern University Institutional Review Board (IRB #: 16–03-15). Eighteen chaplains and bioethics committee members participated in a full research interview. Of these, five reported instances of religious exemptions to DNC occurring at the hospital at which they worked for a total of approximately 30–36 known exemptions in the past five years. Families sought religious exemptions because of faith in an Orthodox Judaism tradition and nonreligious reasons. No failed attempts to obtain an exemption were reported. Religious exemptions to DNC in New Jersey do occur, although very infrequently. Prior to this study, there was no information on their frequency. Considering religious exemptions do occur, there is a need for national or state policies that addresses both religious objections to DNC and hospital resources. More information is needed to better understand the impact of granting religious exemptions before new policy can be established. (shrink)

ABSTRACT In keeping with the pre‐eminent status accorded autonomy within Australia, Europe, and the United States, medical practice requires that patients authorize do‐not‐resuscitate (DNR) orders, intended to countermand the default practice in hospitals of instituting cardiopulmonary‐resuscitation (CPR) on all patients experiencing cardio‐pulmonary arrest. As patients typically do not make these decisions proactively, however, family members are often asked to act as surrogate decision‐makers and decide on the patient's behalf. Although the appropriateness of patients or their families having to decide (...) about the provision of CPR has been challenged, there has been little examination of how patients and their families talk about and negotiate such decisions, particularly in the context of the patient's imminent death. In this article, part of a larger study analysing interviews with 28 patients (13 female) with cancer within weeks of their death, and 20 others (predominantly family) attending, we argue that a common assumption underpinning participants' talk about the DNR decision (i.e. forgoing CPR) is that it requires a choice between life and death. Using illustrative examples, we demonstrate that in making decisions about CPR, patients and their families are implicitly required to make moral judgements about the value of the patient's life, including their relationships with significant others. We identify some implications of these empirical observations for the development of ethically appropriate policies and practices regarding patient autonomy and surrogacy at the end of life. (shrink)

A recent paper in this journal (1) suggests that involving terminally ill patients in choices concerned with Cardio-Pulmonary Resuscitation (CPR) produces 'psychological pain' and therefore is ill-advised. Such a claim rests on anecdotal observations made by the authors. In this paper I suggest that drawing conclusions in ethics, no less than in science, requires a rigorous framework and cannot be relegated to personal observation of a few cases. The paper concludes by suggesting that patients, if we acknowledge their valid (...) interest in making their own choices, must themselves be allowed to make a prior choice about choosing. Those who may not wish to choose may properly be relieved of this burden and may allow another to choose for them. Routinely allowing others to make choices for competent adults, however, is likely to decrease communication with the dying patient and to introduce an atmosphere of suspicion and fear and to exclude the competent patient from his/her rightful place in the community. (shrink)

Despite that it is commonly accepted that migraine is a disorder of the nervous system with a prominent genetic basis, it is comorbid with a plethora of medical conditions. Several studies have found bidirectional comorbidity between migraine and different disorders including neurological, psychiatric, cardio- and cerebrovascular, gastrointestinal, metaboloendocrine, and immunological conditions. Each of these has its own genetic load and shares some common characteristics with migraine. The bidirectional mechanisms that are likely to underlie this extensive comorbidity between migraine and (...) other diseases are manifold. Comorbid pathologies can induce and promote thalamocortical network dysexcitability, multi-organ transient or persistent pro-inflammatory state, and disproportionate energetic needs in a variable combination, which in turn may be causative mechanisms of the activation of an ample defensive system with includes the trigeminovascular system in conjunction with the neuroendocrine hypothalamic system. This strategy is designed to maintain brain homeostasis by regulating homeostatic needs, such as normal subcortico-cortical excitability, energy balance, osmoregulation, and emotional response. In this light, the treatment of migraine should always involves a multidisciplinary approach, aimed at identifying and, if necessary, eliminating possible risk and comorbidity factors. (shrink)

High levels of somatic symptom distress represent a core component of both mental and physical illness. The exact aetiology and pathogenesis of this transdiagnostic phenomenon remain largely unknown. The Affective Picture Paradigm (APP) represents an innovative experimental paradigm to study somatic symptom distress. Based on the HiTOP framework and a population-based sampling approach, associations between facets of somatic symptom distress and symptoms induced by the APP were explored in two studies (N1 = 201; N2 = 254) using structural equation bi-factor (...) models. Results showed that the APP effect was significantly positively correlated with general somatic symptom distress (PHQ-15, HiTOP), cardio-respiratory symptoms (PHQ-15), as well as difficulties identifying feelings. In conclusion, negative affective cues in the APP can elicit somatic symptoms, particularly in people with higher levels of somatic symptom distress. Difficulties identifying feelings might contribute to this phenomenon. Results are compatible with a predictive processing account of somatic symptom perception. (shrink)

Adopting the perspective of another person is an important aspect of social cognition and has been shown to depend on multisensory signals from one’s own body. Recent work suggests that interoceptive signals not only contribute to own-body perception and self-consciousness, but also to empathy. Here we investigated if social cognition – in particular adopting the perspective of another person – can be altered by a systematic manipulation of interoceptive cues and further, if this effect depends on empathic ability. The own-body (...) transformation task – wherein participants are instructed to imagine taking the perspective and position of a virtual body presented on a computer screen – offers an effective way to measure reaction time differences linked to the mental effort of taking an other’s perspective. Here, we adapted the OBT with the flashing of a silhouette surrounding the virtual body, either synchronously or asynchronously with the timing of participants’ heartbeats. We evaluated the impact of this cardio-visual synchrony on reaction times and accuracy rates in the OBT. Empathy was assessed with the empathy quotient questionnaire. Based on previous work using the cardio-visual paradigm, we predicted that synchronous cardio-visual stimulation would increase self-identification with the virtual body and facilitate participants’ ability to adopt the virtual body’s perspective, thereby enhancing performance on the task, particularly in participants with higher empathy scores. We report that participants with high empathy showed significantly better performance during the OBT task during synchronous versus asynchronous cardio-visual stimulation. Moreover, we found a significant positive correlation between empathic ability and the synchrony effect. We conclude that synchronous cardio-visual stimulation between the participant’s body and a virtual body during an OBT task makes it easier to adopt the virtual body’s perspective, presumably based on multisensory integration processes. However, this effect depended on empathic ability, suggesting that empathy, interoception and social perspective taking are inherently linked. (shrink)

Résumé Les missions et transmissions qui s’engagent dans les liens sociaux et familiaux ont prise sur le corps, ici défini dans sa double composition de corps biologique et de corps érotique. Les messages du sexuel inconscient infiltrent l’architecture psychosomatique et subvertissent les relations familiales, sociales, intersubjectives. Après quelques rappels théoriques, l’article aborde plusieurs situations cliniques prises dans la littérature psychanalytique (cas de Dora pour Freud) et dans la pratique clinique récente avec des patients présentant des pathologies somatiques diverses : pelade (...) totale décalvante, infarctus du myocarde, suivi post-greffe cardio-pulmonaire. (shrink)

Résumé Les missions et transmissions qui s’engagent dans les liens sociaux et familiaux ont prise sur le corps, ici défini dans sa double composition de corps biologique et de corps érotique. Les messages du sexuel inconscient infiltrent l’architecture psychosomatique et subvertissent les relations familiales, sociales, intersubjectives. Après quelques rappels théoriques, l’article aborde plusieurs situations cliniques prises dans la littérature psychanalytique (cas de Dora pour Freud) et dans la pratique clinique récente avec des patients présentant des pathologies somatiques diverses : pelade (...) totale décalvante, infarctus du myocarde, suivi post-greffe cardio-pulmonaire. (shrink)

I met Ernie in 1965 on the wrestling mats of our high school in North Bergen, New Jersey, a township on top of the plateau overlooking Hoboken and across the Hudson River from Manhattan. Hoboken then was still the Hoboken of Elia Kazan’s “On the Waterfront” (1954).1 Even though the Hudson was less than a mile across at that point, it was a wide spiritual divide. We were Jersey boys, not New Yorkers. Ernie was as ambitious as I was about (...) wrestling, and, so, after the season was over, we used to take a bus to Journal Square in Jersey City, and then walk about eight city blocks to a gym to lift weights. In those days, high schools didn’t have weight rooms; and gyms were scarce, men only, quite filthy, and entirely devoid of cardio equipment and Nautilus machines. They were all sweat, grunts, groans, and clanking iron. By 1968, on Tuesdays and Thursdays, after a grueling wrestling practice at the high school, we would take a bus to New York City (it took about a half hour to get into “the City” by bus, less if the Lincoln Tunnel was not crowded), and then a short subway ride up to the New York Athletic Club on 59th street, across from Central Park, to spend a couple of hours working out with former university wrestling stars—guys in their mid-twenties from places like Oklahoma, Nebraska, and Iowa—who were training to make the Olympic team. Even with all of this wrestling time, we were frustrated by the fact that there was nowhere to work out on Sundays. We investigated and found out that the Jersey City YMCA had a wrestling mat and was open on Sundays. We then spent our Sunday afternoons working out there, so as not to miss a day of wrestling. Wrestling was our savior: a healthy way to get out anger.2 But it wasn’t all wrestling. We did something else too: We talked. We spent many hours together introspecting out loud, and just trying to make sense of things. Ernie has mentioned in print one early topic of discussion: “We spent years trying to solve various logical conundra like how on earth the Virgin Mary could have been a virgin.... (shrink)

BackgroundThis research explores how the COVID-19 pandemic has changed the ways doctors make end-of-life decisions, particularly around Do Not Attempt Cardio-Pulmonary Resuscitation (DNACPR), treatment escalation and doctors’ views on the legalisation of euthanasia and physician-assisted suicide.MethodsThe research was conducted between May and August 2021, during which COVID-19 hospital cases were relatively low and pressures on NHS resources were near normal levels. Data were collected via online survey sent to doctors of all levels and specialties, who have worked in the (...) NHS during the pandemic.Results231 participants completed the survey. The research found that over half of participants reported making more patients DNACPR than prepandemic, and this was due, at least in part, to an increased focus on factors including patient age, Clinical Frailty Scores and resource limitations. In addition, a sizeable minority of participants reported that they now had a higher threshold for escalating patients to ITU and a lower threshold for palliating patients, with many attributing these changes to formative experiences gained during the pandemic. Finally, our study found that there has not been a statistically significant change in the views of clinicians on the legalisation of euthanasia or physician-assisted suicide since the start of the pandemic.ConclusionThe COVID-19 pandemic appears to have altered several aspects of end-of-life decision making, and many of these changes have remained even as COVID-19 hospital cases have declined. (shrink)

On 10 July 1973, Laurens, our second son, was born in the same Dutch hospital where I worked as an intensive care physician. Two weeks after we brought him. home from the hospital, my wife heard him crying at about 5:45 A.M. Rather than going to him, she decided to wait until his scheduled feeding time. At about 6:10 when she went to Laurens's room to feed him, she saw him. face down in the corner of his crib. He appeared (...) dead. She screamed for me. I ran from upstairs to Laurens's room on the ground floor. I initiated cardio-pulmonary resuscitation and continued the CPR while my wife called our general practitioner. He arrived in about 10 minutes and the ambulance arrived a minute later. (shrink)

After many years of reflection and debate, there is a clear international trend, indeed a near consensus, to endorse as a matter of ethics and law the modern biomedical conception of brain death as an alternative to the traditional conception of death. Alireza Bagheri has surveyed the current state of the law governing organ donation in eight Asian countries. His research shows that for the purpose of facilitating organ donation, the following countries have adopted the biomedical standard of brain death: (...) Turkey , Saudi Arabia , Singapore , Philippines , India , Japan , Korea , and Iran . In addition, there is an active and ongoing movement in China to also enact a brain death legal standard. On the other hand, the new definition of brain death always has been controversial. It is worthwhile to pause and survey the arguments for and the objections to the now popular conception of human death as brain-death. In light of the arguments over the definition of death and also of a survey of the different legal constraints on organ donation in different countries, the key elements of a model policy that incorporates the best of all of these different approaches will be defended. This model policy incorporates a pluralist standard of death, which allows individuals to choose a cardio-respiratory, whole brain, or higher brain conception of death. It also includes what I call a donor-recipient priority principle that gives priority to organ donors as recipient of organ transplants. Rather than requiring an organ donor card, a model policy should be based on a principle of presumed consent for organ transplant and a principle of surrogate consent. Finally, although a principle requiring family consent is too restrictive, family consultation in these important decisions should be encouraged by physicians and public policy. (shrink)

The so-called uncontrolled donation after circulatory determination of death (uDCDD) have been implemented in several countries, including Spain and France, to increase the availability of organs for transplantation. These protocols allow obtaining kidneys, livers and lungs of patients who do not survive cardio-pulmonary resuscitation performed in out-of-hospital settings. Simultaneously with the development and recent proliferation of these protocols, some emergency teams have begun to employ unconventional methods of CPR, with still uncertain but promising results. The coexistence of these two (...) possibilities raises some questions: At what point should attempts to save a patient with circulatory arrest be abandoned so that this individual can begin to be considered as a potential organ donor? How to manage potential conflicts of loyalties that may arise within emergency and procurement teams? How should the information to the families of those patients and potential organ donors be managed? This article gathers the conclusions of a workshop in which an interdisciplinary working group addressed these and other questions related to DCDD and non-conventional CPR. (shrink)

This paper sketches a comprehensive methodology to analyse the elementary structures of prehistoric art. A formal analysis of art is proposed through the distinction between pictograms, ideograms and psychograms. The dynamic between these elements and the thematic contents of the represented scenes is related to the four main types of social organization: early hunters, early gatherers, late hunters, pastoralists and complex economy societies. Cultural patterns of these societies and formal elements of art may appear as sharing the same elementary structures.

There are around 94 000 000 obese people in the US alone, where 30% of the population is classified as obese.1 In industrialised countries, cardio-vascular diseases, associated with obesity and lack of physical activity, are the leading causes of death.Many millions of people affected by obesity expose themselves to stroke, heart attack, atherosclerosis, type-2 diabetes, osteoarthritis and other joint problems, sleeping problems , cancer, and psychological illnesses such as depression.While both in the United States and in the United ….

Few clinical situations arouse more emotion and drama and lead to more conflict in decision-making than cardio-pulmonary resuscitation . The procedure was described as potentially beneficial more than 40 years ago. However, its efficacy and place in the care of the frail elderly have taken a long time to be established. In the world of secular medical practice, there are many situations when CPR may be provided to elderly, frail and cognitively compromised individuals for whom its clinical benefit is (...) questionable. In those patients suffering from dementia, surrogates are responsible for decision-making, which complicates the process. When the clinical uncertainty is coupled with strong cultural and religious influences, as within Orthodox Judaism, the development of an acceptable approach to cardiac arrest is more challenging. A clinically sound, ethically defensible and religiously sensitive approach to CPR requires a deep understanding of all the factors involved in the decision-making process and may require periodic re-evaluation not only by clinicians but by religious scholars and leaders. (shrink)

The neurological criteria for the determination of death remain controversial within secular and Catholic circles, even though they are widely accepted within the medical community. In Determining Death by Neurological Criteria, Matthew Hanley offers both a practical and a philosophical defense. Hanley shows that the criteria are often misapplied in clinical settings, leading to cases where persons declared dead apparently spontaneously revive. These instances are often connected to a rushed decision to retrieve donated organs, thus undermining the trust of the (...) public in organ donation. Hanley calls on health care institutions to take seriously their obligation to establish strict protocols for the determination of death, including who may conduct the examinations. From a broader perspective, Hanley considers how the criteria rely on a philosophical conception of the person as a living organism whose unity disintegrates at death. This view, he notes, corresponds to the Catholic conviction that the soul is the life-principle of the body, which departs at death, bringing about the destruction of the body-soul composite. The Vatican, recognizing that death is a medical judgment, has generally given its approval to the criteria. Hanley also reviews the many and various objections offered by detractors, including against the use of the apnea test, which is faulted as a practice that sometimes hastens death. The problem of the continued presence of certain vital functions within the deceased body of the brain dead is explored in detail, with reference to particular cases and to solutions proposed by leading physicians and bioethicists. Hanley likewise addresses the dilemma of having two separate standards for death, one neurological and the other cardiopulmonary. Given the possibility of resuscitation following loss of the cardio-circulatory system, he concludes that the neurological criteria must be the true standard. Stoppage of the heart leads swiftly to the final necrosis of the brain. -- Provided by publisher. (shrink)

The main topic of this article is Otto Frank's forgotten notion of the pressure-volume diagram of the cardiac ventricle as a means to assess the external mechanical work of the heart. Developed by Frank at the end of the 19th century, this idea was reenvisioned as pressure-volume area about 70 to 80 years later by Hiroyuki Suga. This notion now serves as a perspective for defining cardiac contractility and thus enabling the controlled clinical application of cardiac assist devices. We begin (...) our discussion, however, with the work of Ernest H. Starling, whose dominant influence on the thinking of cardio-physiologists led to a neglect of some of the fundamental insights of Frank's... (shrink)

Context and AimsAlthough some exercise-based interventions have been associated with lower levels of pain and performance-related musculoskeletal disorders among musicians, the evidence is still mixed. Furthermore, little is known about musicians’ general engagement in physical activity, their knowledge of PA guidelines, or the relevant training they receive on pain prevention and the sources of such training. Similarly, little is known about the relationship between PA and PRMDs and other risk factors for PRMDs.MethodsFollowing a cross-sectional correlational study design, both standardized andad (...) hocmeasurements were used to investigate self-reported PA [International Physical Activity Questionnaire – Short Form ], knowledge of PA guidelines, and barriers to engaging in PA [Centers for Disease Control ; Determinants of Physical Activity Questionnaire ]; sedentary behavior [Sedentary Behavior Questionnaire ]; pain [36-Item Short Form Survey Instrument ] and PRMDs ; reported physical exertion ; anxiety [Hospital Anxiety and Depression Scale ]; practice behaviors ; and relevant training among conservatoire students in the United Kingdom. The entire set of questionnaires was administered both online and via hard copies between June 2017 and April 2018.ResultsDemographic information was obtained from 111 respondents, mostly undergraduate students from seven conservatoires. They reported high levels of engagement in PA, despite poor knowledge of PA guidelines. Teachers were the most frequently mentioned source of pain prevention information, and 62% agreed that they had received advice on why they should engage in cardio PA. Sedentary behavior was comparable to normative data. Levels of bodily pain and PRMDs were low, but 43% showed “abnormal” clinical anxiety and found playing their instruments “somewhat hard” on average. Bodily pain interfering with practice and performance was positively correlated with frequency and severity of PRMDs, anxiety, and RPE. Frequency and severity of PRMDs were also associated with sedentary behavior at the weekend. Anxiety was associated with RPE. No association was found between PA and PRMDs.ConclusionThe relationship between PA and PRMDs and pain remains unclear and needs further investigation. While health education needs to be improved, other pathways may need to be taken. Given the high levels of anxiety, the ideology of Western classical music itself may need to be challenged. (shrink)

Open peer commentary on the article “A First-Person Analysis Using Third Person-Data as a Generative Method: A Case Study of Surprise in Depression” by Natalie Depraz, Maria Gyemant & Thomas Desmidt. Upshot: The generative method outlined in the target article produces some interesting results, demonstrating the value of cardio-phenomenology. The proposed division of categories reflecting the structure of experience into sub-categories suggests that prior theoretical commitments may have influenced the process of analysis in ways the authors might not have (...) foreseen or intended. This commentary discusses potential areas for future work, proposing that some modifications to the methodology might lessen possibly unforeseen influences on the central process of classification. (shrink)

BackgroundHealth decisions occur in a context with omnipresent social influences. Information concerning what other patients decide may present certain interventions as more desirable than others.ObjectivesTo explore how physicians refer to what other people decide in conversations about the relevancy of cardio-pulmonary resuscitation or do-not-attempt-resuscitation orders.MethodsWe recorded forty-three physician–patient admission interviews taking place in a hospital in French-speaking Switzerland, during which CPR is discussed. Data was analysed with conversation analysis.ResultsReference to what other people decide in regards to CPR is used (...) five times, through reported speech. The reference is generic, and employed as a resource to deal with trouble encountered with the patient’s preference, either because it is absent or potentially incompatible with the medical recommendation. In our data, it is a way for physicians to present decisional paths and to steer towards the relevancy of DNAR orders. By calling out to a sense of membership, it builds towards the patient embracing norms that are associated with a desirable or relevant social group.ConclusionsIntroducing DNAR decisions in terms of what other people opt for is a way for physicians to bring up the eventuality of allowing natural death in a less overt way. Formulating treatment choices in terms of what other people do has implications in terms of supporting autonomous and informed decision making, since it nudges patients towards conformity with what is presented as the most preferable choice on the basis of social norms. (shrink)

Philosophers have simplified brain death issues by drawing two distinctions--that between dead persons and dead bodies or organisms, and that between the concept of definition of death and the criteria for determining when and that death has occurred. The result has been protracted debates as to whether the death of patients is the death of persons or the death of organisms, and whether physicians should use cardio-respiratory criteria, whole brain criteria, or higher brain criteria. Advocates of the death of (...) persons prefer higher brain criteria; advocates of the death of organisms prefer cardiovascular criteria; but both will compromise, for different reasons, on the whole brain criteria that most legislators have come to accept. Advocates of person -death regard whole brain criteria as unnecessarily demanding and woefully wasteful of transplantable organs and nursing care. Nonetheless, they accept current whole-brain based legislation as a first neurological step away from traditional cardio-respiratory. (shrink)