With the aging of the general population and the ability of intensivists to support patients using ventilator support, tracheostomy has become a vital tool in the medical management of critically ill patients. While much of the medical literature on tracheostomy has focused on the optimal timing of and indications for performing this procedure, little is written on the ethical tensions that can revolve around decisions by patients, surrogates, and physicians on its use. This article will elucidate the ethical dilemmas that (...) can arise surrounding the use of tracheostomy in critically ill patients and how ethics consultants and committees can approach these cases to allow resolution. (shrink)

In intensive care, disputes sometimes arise when patients or surrogates strongly desire treatment, yet health professionals regard it as potentially inappropriate. While professional guidelines confirm that physicians are not always obliged to provide requested treatment, determining when treatment would be inappropriate is extremely challenging. One potential reason for refusing to provide a desired and potentially beneficial treatment is because (within the setting of limited resources) this would harm other patients. Elsewhere in public health systems, cost effectiveness analysis is sometimes used (...) to decide between different priorities for funding. In this paper, we explore whether cost-effectiveness could be used to determine the appropriateness of providing intensive care. We explore a set of treatment thresholds: the probability threshold (a minimum probability of survival for providing treatment), the cost threshold (a maximum cost of treatment), the duration threshold (the maximum duration of intensive care), and the quality threshold (a minimum quality of life). One common objection to cost-effectiveness analysis is that it might lead to rationing of life-saving treatment. The analysis in this paper might be used to inform debate about the implications of applying cost-effectiveness thresholds to clinical decisions around potentially inappropriate treatment. (shrink)

Climate change has caused serious threats to global economic development and human well-being, and green finance is a new way to achieve ecological, economic, and social sustainable development, and it also has important theoretical significance and policy value. This study firstly aims to study the impact of green finance on regional carbon intensity. Then, it aims to determine the moderating effect of capital stock per capita on the relationship between green finance and carbon intensity based on moderating effect (...) model as well as to investigate the threshold effect of capital stock per capita on the relationship between green finance and carbon intensity based on threshold effect model. The main conclusions are as follows: Every 1% increase in green finance will lead to a 2% decrease in carbon intensity, and the inhibition of green finance on carbon intensity is most obvious in northeast and east China. The capital stock per capita has a significant moderating effect, which could enhance the restraining effect of green financial development on carbon intensity, and this moderating effect is most obvious in northeast China. The capital stock per capita has a threshold effect in the process of green finance development to suppress carbon intensity. The higher the capital stock per capita, the stronger the inhibition effect of green finance development on carbon intensity. Therefore, in the process of capital accumulation, attention should be paid to improve the relevant legal system and policy guarantee, optimization of financial structure, and stimulation of the capital allocation effect of green finance. Simultaneously, in order to strengthen the inhibitory effect of green finance on carbon intensity, differentiated green finance development policies should be formulated based on factor endowment structure and comparative advantages of different regions. (shrink)

When is it permissible to allow a newborn infant to die on the basis of their future quality of life? The prevailing official view is that treatment may be withdrawn only if the burdens in an infant's future life outweigh the benefits. In this paper I outline and defend an alternative view. On the Threshold View, treatment may be withdrawn from infants if their future well-being is below a threshold that is close to, but above the zero-point of (...) well-being. I present four arguments in favor of the Threshold View, and identify and respond to several counterarguments. I conclude that it is justifiable in some circumstances for parents and doctors to decide to allow an infant to die even though the infant's life would be worth living. The Threshold View provides a justification for treatment decisions that is more consistent, more robust, and potentially more practical than the standard view. (shrink)

The Helen of Gorgias is designed to provoke the aspiring speaker to consider his relationship with society as a whole. The speech's extreme claims regarding the power of logos reflect simplistic ideas about speaker-audience relations current among Gorgias' target audience, ideas reflected in an interpretive stance towards model speeches that privileges method over truth. The Helen pretends to encourage this conception of logos and interpretive stance in order to expose the intense desire and naïve credulity that drive a coolly technical (...) appraisal of model speeches. The Helen thus manifests, with a playfulness suited to its liminal position, a concern for the ethical and social formation of those who might accept the invitation to study logos. (shrink)

Transcranial magnetic stimulation studies have demonstrated increased cortical facilitation and reduced inhibition following aerobic exercise, even when examining motor regions separate to the exercised muscle group. These changes in brain physiology following exercise may create favorable conditions for adaptive plasticity and motor learning. One candidate mechanism behind these benefits is the increase in brain-derived neurotropic factor observed following exercise, which can be quantified from a venous blood draw. The aim of this study was to investigate changes in motor cortex excitability (...) and inhibition of the upper limb, and circulating BDNF, following high-intensity interval training on a stationary bicycle. Nineteen sedentary adults participated in a randomized crossover design study involving a single bout of high-intensity interval cycling for 20 min or seated rest. Venous blood samples were collected, and transcranial magnetic stimulation was used to stimulate the extensor carpi radialis, where motor evoked potentials were recorded pre- and post-condition. Following exercise, there was a significant increase in corticospinal excitability measured at 120% of resting motor threshold and a reduction in short-interval cortical inhibition. There was a non-significant 23.6% increase in BDNF levels. Collectively, these results reflect a net reduction in gamma aminobutyric acid ergic synaptic transmission and increased glutamatergic facilitation, resulting in increased corticospinal excitability. This study supports the notion that acute high-intensity exercise provides a potent stimulus for inducing cortical neuroplasticity, which may support enhanced motor learning. (shrink)

Ethical analyses, professional guidelines and legal decisions support the equivalence thesis for life-sustaining treatment: if it is ethical to withhold treatment, it would be ethical to withdraw the same treatment. In this paper we explore reasons why the majority of medical professionals disagree with the conclusions of ethical analysis. Resource allocation is considered by clinicians to be a legitimate reason to withhold but not to withdraw intensive care treatment. We analyse five arguments in favour of non-equivalence, and find only relatively (...) weak reasons to restrict rationing to withholding treatment. On the contrary, resource allocation provides a strong argument in favour of equivalence: non-equivalence causes preventable death in critically ill patients. We outline two proposals for increasing equivalence in practice: (1) reduction of the mortality threshold for treatment withdrawal, (2) time-limited trials of intensive care. These strategies would help to move practice towards more rational treatment limitation decisions. (shrink)

Predictable somatosensory feedback leads to a reduction in tactile sensitivity. This phenomenon, called tactile suppression, relies on a mechanism that uses an efference copy of motor commands to help select relevant aspects of incoming sensory signals. We investigated whether tactile suppression is modulated by the task-relevancy of the predicted consequences of movement and the intensity of related somatosensory feedback signals. Participants reached to a target region in the air in front of a screen; visual or tactile feedback indicated the (...) reach was successful. Furthermore, tactile feedback intensity varied across two groups of participants. We measured tactile suppression by comparing detection thresholds for a probing vibration applied to the finger either early or late during reach and at rest. As expected, we found an overall decrease in late-reach suppression, as no touch was involved at the end of the reach. We observed an increase in the degree of tactile suppression when strong tactile feedback was given at the end of the reach, compared to when weak tactile feedback or visual feedback was given. Our results suggest that the extent of tactile suppression can be adapted to different demands of somatosensory processing. Downregulation of this mechanism is invoked only when the consequences of missing a weak movement sequence are severe for the task. The decisive factor for the presence of tactile suppression seems not to be the predicted action effect as such, but the need to detect and process anticipated feedback signals occurring during movement. (shrink)

ABSTRACTPrior research has found a relationship between perceived facial attractiveness and perceived personal trustworthiness. We examined the time course of attractiveness relative to trustworthiness evaluation of emotional and neutral faces. This served to explore whether attractiveness might be used as an easily accessible cue and a quick shortcut for judging trustworthiness. Detection thresholds and judgment latencies as a function of expressive intensity were measured. Significant correlations between attractiveness and trustworthiness consistently held for six emotional expressions at four intensities, and (...) neutral faces. Importantly, perceived attractiveness preceded perceived trustworthiness, with lower detection thresholds and shorter decision latencies. This reveals a time course advantage for attractiveness, and suggests that earlier attractiveness impressions could bias trustworthiness inferences. A heuristic cognitive mechanism is hypothesised to ease processing demands by relying on simple a... (shrink)

Publication date: 16 April 2018 Source: Author: Parto Fazli, Ebrahim Abbasi The objective of the study is to test experimentally the Kuznets curve of energy intensity in selected developing countries with the focus of D-8 countries during 1990-2014. According to the results, and by using the static and dynamic estimators and the Panel- ARDL model, the Kuznets curve was accepted for energy intensity and the per capita income threshold was estimated $3931.25. The urbanization rate and the degree (...) of industrialization have a positive and significant effect on the GDP of consuming energy of D-8 countries in the long term. The most important policy recommendations were discussed for policy-makers and researchers. (shrink)

RESUMEN En este artículo se analiza la caracterización de la obra de arte como un mapa de intensidad que propone Gilles Deleuze en su ensayo intitulado Lo que dicen los niños, recogido en el libro Crítica y clínica. El aspecto cartográfico del arte se vincula con el concepto de desterritorialización y el Cuerpo sin Órganos que desarrolla el filósofo, junto con Félix Guattarí, en Mil Mesetas. Así, el arte-cartografía representa el devenir-mundo del sujeto que transita el Cuerpo sin Órganos y (...) las diferencias intensivas que pueblan el desierto de la multiplicidad. Cada trayecto recorrido es descrito por un mapa artístico donde se plasman las haecceidades y los umbrales de paso de los flujos que penetran los cuerpos desorganizados. El mapa de intensidad sería la representación cartográfica del trayecto que recorre un sujeto inmerso en un espacio hodológico, siendo cada línea del mapa un viaje en un espacio intensivo. ABSTRACT In this paper the characterization of the work of art as a map of intensity, as proposed by Gilles Deleuze in his essay What the children say (gathered in Critique et clinique), will be analyzed. Art's cartographic aspect is linked to the concept of deterritorialization and the Body without Organs that the philosopher, along with Félix Guattarí, develops in Thousand Plateaus. Thus, the art-cartography represents the becoming-world of the subject that transits the Body-without-organs and the intensive differences that populate the desert of multiplicity. Each way travelled is descripted by an artistic map where the haecceities and the thresholds of flows that pierce through the disorganized bodies are portrayed. The map of intensity would be the cartographic representation of the haul travelled by a subject immersed in a hodologic space, being every line of the map a journey within an intensive space. (shrink)

Background: The intrauterine hearing experience differs from the extrauterine hearing exposure within a neonatal intensive care unit (NICU) setting. Also, the listening experience of a neonate drastically differs from that of an adult. Several studies have documented that the sound level within a NICU exceeds the recommended threshold by far, possibly related to hearing loss thereafter. The aim of this study was, firstly, to precisely define the dynamics of sounds within an incubator and, secondly, to give clinicians and caregivers (...) an idea about what can be heard “inside the box.” Methods: Audio recordings within an incubator were conducted at the Pediatric Simulation Center of the Medical University Vienna. They contained recorded music, speech and synthesized sounds. To understand the dynamics of sounds around and within the incubator the following stimuli were used: broadband noise with decreasing sound level in ten steps of 6 dB, sine waves (62.5, 125, 250, 500, 1000, 2000, 4000, 8000 and 16000 Hz), logarithmic sweep (Chirp) over the frequency band 20 Hz to 21 kHz, singing male voice, singing and whispering female voice. Results: Our results confirm a protective effect of the incubator from noises above 500 Hz in conditions of “no-flow” and show almost no protective effect of an incubator cover. We, furthermore, observed a strong boost of low frequencies below 125 Hz within the incubator, as well as a notable increase of higher frequency noises with open access doors, a significant resonant effect of the incubator, and a considerable masking effect of the respiratory support against any other source of noise or sound stimulation even for “low-flow” conditions. Conclusion: Our study reveals high noise levels of air supply at high flow rates and the boost of low frequencies within the incubator. Education of medical staff and family members as well as modifications of the physical environment should aim at reducing noise exposure of preterm infants in the incubator. Audiovisual material is provided as supplementary material. (shrink)

Falls are a leading cause of serious injury and restricted participation among persons with stroke (PwS). Reactive balance control is essential for fall prevention, however, only a few studies have explored the effects of lesion characteristics (location and extent) on balance control in PwS. We aimed to assess the impact of lesion characteristics on reactive and anticipatory balance capacity, gait, and hemiparetic lower limb function, in PwS. Forty-six subacute PwS were exposed to forward, backward, right and left unannounced horizontal surface (...) translations in 6 increasing intensities, while standing. Fall threshold (i.e., perturbation intensity that results in a fall into the harness system) was measured. In addition, the Berg Balance Scale (BBS), 6 Minute Walk Test (6MWT) and Lower Extremity Fugl-Meyer (LEFM) were measured. Lesion effects were analyzed separately for left- and right-hemisphere damaged (LHD, RHD) patients, using voxel-based lesion-symptom mapping (VLSM). Our results show that voxel clusters where damage exerted a significant impact on balance, gait and lower-limb function were found in the corticospinal tract, in its passage in the corona radiata and in the posterior limb of the internal capsule. Additional significant impact was found to lesions affecting the putamen and the external capsule. Balance, gait, and hemiparetic lower limb function showed much overlap of the corresponding ‘significant’ voxel clusters. Test scores of RHD and LHD patients were affected largely by damage to homologous regions, with the LHD group showing a wider distribution of ‘significant’ voxels. The study corroborates and extends previous findings by demonstrating that balance control, gait, and lower limb function are all affected mainly by damage to essentially the same brain structures, namely - the corticospinal tract and adjacent structures in the capsular-putaminal region. (shrink)

Introduction: The present study aimed to investigate the effects of two high-intensity interval training shuttle-run-based models, over ten weeks on aerobic, anaerobic, and neuromuscular parameters, and the association of the training load and heart rate variability with the change in the measures in young futsal players. Methods: Eleven young male futsal players participated in this study. This pre-post study design was performed during a typical 10 weeks training period. HIIT sessions were conducted at 86% and 100% of peak speed (...) of the FIET. Additionally, friendly and official matches, technical-tactical and strength-power training sessions were performed. Before and after the training period, all players performed the FIET, treadmill incremental, repeated sprint ability, sprint 15-m, and vertical jump tests, and the HRV was measured. Training load was monitored using the session rating of perceived effort. Data analysis was carried out using Bayesian inference methods. Results: The HIIT86 model showed clear improvements for the peak oxygen uptake, peak speed in the treadmill incremental test, first and second ventilatory thresholds, RSA best and mean times, CMJ, and SJ. The HIIT100 model presented distinct advances in VO2peak, peak speed in the treadmill incremental test, RSA mean time, and CMJ. Between HIIT models comparisons showed more favorable probabilities of improvement for HIIT86 than HIIT100 model in all parameters. TL data and HIIT models strongly explained the changes in the RSA mean and best times, as well as HRV changes, and HIIT models explained positively VO2peak changes. All other changes in the parameters were low to moderately explained. Conclusion: The HIIT86 proved to be more effective for improving aerobic, RSA, and neuromuscular parameters than HIIT100 during a typical 10-week futsal training period. So, strength and conditioning specialists prescribing shuttle-run intermittent exercises at submaximal intensities can manage the individual acceleration load imposed on athlete increasing or decreasing either the set duration or the frequency of change of direction during HIIT programming. (shrink)

We present an instrument developed to explain to students the concept of the personal ethical threshold (PET). The PET represents an individual’s susceptibility to situational pressure in his or her organization that makes moral behavior more personally difficult. Further, the PET varies according to the moral intensity of the issue at hand, such that individuals are less vulnerable to situational pressure for issues of high moral intensity, i.e., those with greater consequences for others. A higher PET reflects (...) an individual’s greater likelihood of adhering to the morally correct path, even in the face of high situational pressures (personal costs) and low moral intensity (collective importance). PET questionnaires were completed by 506 students representing eight business schools throughout the United States. Relationships between respondents’ PET and their gender, age, and major field of study, as well as the geographical location of their school, are explored. Results indicate that older students have higher PETs and that students attending schools in the northeastern part of the United States have lower PETs. These findings are discussed. It is argued that the PET instrument can be used to help students identify organizational pressures and intrapersonal processes that can impede their moral behavior in organizations. (shrink)

What is the function of pain? A popular view in contemporary philosophy is that the pain system is a bodily disturbance detector: pain states track/detect and represent bodily disturbances and the phenomenal character of the (sensory dimension of) pain supervenes on this representational content. The view can accommodate paradigmatic pain cases, e.g., when pain follows from stepping on a nail. Once we consider more complex pain phenomena, however, it has seemingly little to offer. In this paper, I discuss dissociation between (...) pains and bodily disturbances, variation in pain thresholds, the effects of repeated stimulation on experienced pain intensity, and the modulation of pain experience by cognitive and emotional states. I argue that these phenomena suggest that the pain system is not a bodily disturbance detector, but a sophisticated security system. (shrink)

Focusing with special intensity on scenes that feature still photographs in the Italian films Blow-Up, Three Brothers, and The One Hundred Steps, this paper traces a progressive return to the neorealist call for a cinema of truth-telling on the threshold on the new millennium.

In 2017, a Philadelphia research team revealed the closest thing to an artificial womb the world had ever seen. The ‘biobag’, if as successful as early animal testing suggests, will change the face of neonatal intensive care. At present, premature neonates born earlier than 22 weeks have no hope of survival. For some time, there have been no significant improvements in mortality rates or incidences of long-term complications for preterms at the viability threshold. Artificial womb technology, that might change (...) these odds, is eagerly anticipated for clinical application. We need to understand whether AWT is an extension of current intensive care or something entirely new. This question is central to determining when and how the biobag should be used on human subjects. This paper examines the science behind AWT and advances two principal claims. First, AWT is conceptually different from conventional intensive care. Identifying why AWT should be understood as distinct demonstrates how it raises different ethico-legal questions. Second, these questions should be formulated without the ‘human being growing in the AW’ being described with inherently value laden terminology. The ‘human being in an AW’ is neither a fetus nor a baby, and the ethical tethers associated with these terms could perpetuate misunderstanding and confusion. Thus, the term ‘gestateling’ should be adopted to refer to this new product of human reproduction: a developing human being gestating ex utero. While this paper does not attempt to solve all the ethical problems associated with AWT, it makes important clarifications that will enable better formulation of relevant ethical questions for future exploration. (shrink)

When consciousness is examined using subjective ratings, the extent to which processing is conscious or unconscious is often estimated by calculating task performance at the subjective threshold or by calculating the correlation between accuracy and awareness. However, both these methods have certain limitations. In the present article, we propose describing task accuracy and awareness as functions of stimulus intensity as suggested by Koch and Preuschoff . The estimated lag between the curves describes how much stimulus intensity must (...) increase for awareness to change proportionally as much as accuracy and the slopes of the curves are used to assess how fast accuracy and awareness increases and whether awareness is dichotomous. The method is successfully employed to assess consciousness characteristics on data from four different awareness scales. (shrink)

Through the examination of the lives of several immortal beings, this paper defends a version of Moritz Schlick’s claim that the meaning of life is play. More precisely: a person’s life has meaning to the extent it there are things in it that the person values intrinsically rather than merely instrumentally and above a certain threshold of intensity. This is a subjectivist account of meaning in life. I defend subjectivism about meaning in life from common objections by understanding (...) statements about life’s meaning in quasi-realist terms. (shrink)

Although the thesis that the moral better than relation is transitive seems obviously true, there is a growing literature according to which Parfit’s repugnant conclusion and related puzzles reveal that this thesis is false or problematic. This paper begins by presenting several such puzzles and explaining how they can be used in arguments for the intransitivity of better than. It then proposes and defends a plausible alternative picture of the behavior of better than that both resolves the repugnant conclusion and (...) preserves transitivity. On the threshold-based model of lexicality defended here, hedonic episodes whose intensity is above a certain point are lexically greater than those whose intensity is below it. The final sections argue that this model is independently plausible and can be defended from several important objections. (shrink)

Digital pictures can be type-identical in respect of colours, shapes and sizes (allographic), but they are not tokens of notational systems, because the types under which they are identical have vague limits and do not meet the requirements for notational characters. Digital display devices are designed to instantiate only limited ranges of objective properties (light intensities, sizes and shapes). Those ranges keep differences in objective magnitudes below sensory discrimination thresholds, and thus define objective conditions sufficient, but not necessary, for the (...) phenomenal type-identity of pictures. The fact that digital pictures are types shows that pictures are not necessarily autographic. Moreover, the reasons why digital pictures are allographic (essentially, the consistent manipulation of sub-phenomenal information) could in principle also be made to apply to non-digital pictures. (shrink)

The question of the animal is one of the most intensely debated in the contemporary philosophical arena. The present article makes the case that Husserl’s phenomenological approach offers a stimulating and open-ended perspective on this discussion. The animal, indeed, is an instance of extreme otherness, which pushes phenomenology to its limits. The paper opens with an outline of the methodological issues raised by the question of the animal. It then examines what the animal—at this point, taken as a whole—and the (...) human being have in common and what Husserl sees as the main differences between them. A critical aspect here is the question of personhood. Finally, Sect. 3 traces Husserl’s progression from a general concept of animality to detailed and nuanced phenomenological descriptions of different animals and their intra- and inter-specific relationships. Husserl understands that the threshold that joins and divides human beings and animals is difficult to pin down, because there is more than one threshold: it is plural. (shrink)

Orgasm is one of the most intense pleasures attainable to an organism, yet its underlying mechanisms remain poorly understood. On the basis of existing literatures, this article introduces a novel mechanistic model of sexual stimulation and orgasm. In doing so, it characterizes the neurophenomenology of sexual trance and climax, describes parallels in dynamics between orgasms and seizures, speculates on possible evolutionary origins of sex differences in orgasmic responding, and proposes avenues for future experimentation. Here, a model is introduced wherein sexual (...) stimulation induces entrainment of coupling mechanical and neuronal oscillatory systems, thus creating synchronized functional networks within which multiple positive feedback processes intersect synergistically to contribute to sexual experience. These processes generate states of deepening sensory absorption and trance, potentially culminating in climax if critical thresholds are surpassed. The centrality of rhythmic stimulation (and its modu... (shrink)

ABSTRACT: Simon Baron-Cohen has argued that autism and related developmental disorders (sometimes called “autism spectrum conditions” or “autism spectrum disorders”) can be usefully thought of as the condition of possessing an “extreme male brain.” The impetus for regarding autism spectrum disorders (ASD) this way has been the accepted science regarding the etiology of autism, as developed over that past several decades. Three important features of this etiology ground the Extreme Male Brain theory. First, ASD is disproportionately male (approximately 10:1 in (...) the case of Asperger’s Syndrome or high-functioning autism (HFA) and approximately 4:1 in the case of autistic disorder). Second, ASD is not psychogenic but biological in origin, and hence is not the product of sexist conditioning or childrearing practices, although these may affect the development of the disorder. Third, ASD is regarded as a spectrum developmental disorder, unlike other disorders such as Down Syndrome that are diagnosed by a (nearly) binary criterion. Down Syndrome, for example, is diagnosed by the presence in all or most cells within a given individual of an extra copy of Chromosome 21. Autism, on the other hand, is diagnosed by the presence of a set of symptoms that vary in their intensity and in their milder forms seem to conform to purported sex differences in cognitive, emotional, and social functioning. -/- In this paper, I do not challenge accepted science regarding the etiology of autism, and I do not challenge the idea of ASD as a disorder. Nor do I wish to offer an alternative account of what autism is. Instead, I focus on the usefulness of thinking of a disorder as an extreme version of ordinary sex differences. Does it follow from the fact that a disorder is more often found in men that we should think of it as an extreme form of maleness? If not, what other conditions must be met in order to warrant this way of thinking about ASD? What does it mean to say that ASD is a form of “extreme male brain”? Feminists are rightly skeptical of theories that make claims about male and female brains, so how should we respond to the clear evidence that the differences between typical and ASD individuals are not caused by childrearing practices? I explain what I take to be Baron-Cohen’s central argument that autism should be seen as the extreme male brain, and critique that argument. I conclude that there is no good argument that autistic symptoms should be regarded as an extreme form of male mental traits, and that Baron-Cohen’s claim does not help us to understand autism, women, or men. His claim is a speculative thesis that is readily mobilized for sexist practices. As such it requires a higher threshold for evidentiary support and rigorous argumentation—support and argumentation that does not exist. -/- KEYWORDS: autism, brain, gender, neuroscience, feminism, male . (shrink)

We present an instrument developed to explain to students the concept of the personal ethical threshold. The PET represents an individual's susceptibility to situational pressure in his or her organization that makes moral behavior more personally difficult. Further, the PET varies according to the moral intensity of the issue at hand, such that individuals are less vulnerable to situational pressure for issues of high moral intensity, i.e., those with greater consequences for others. A higher PET reflects an (...) individual's greater likelihood of adhering to the morally correct path, even in the face of high situational pressures and low moral intensity. PET questionnaires were completed by 506 students representing eight business schools throughout the United States. Relationships between respondents' PET and their gender, age, and major field of study, as well as the geographical location of their school, are explored. Results indicate that older students have higher PETs and that students attending schools in the northeastern part of the United States have lower PETs. These findings are discussed. It is argued that the PET instrument can be used to help students identify organizational pressures and intrapersonal processes that can impede their moral behavior in organizations. (shrink)

Background:Neonatal nurse practitioners have become the frontline staff exposed to a myriad of ethical issues that arise in the day-to-day environment of the neonatal intensive care unit. However, ethics competency at the time of graduation and after years of practice has not been described.Research aim:To examine the ethics knowledge base of neonatal nurse practitioners as this knowledge relates to decision making in the neonatal intensive care unit and to determine whether this knowledge is reflected in attitudes toward ethical dilemmas in (...) the neonatal intensive care unit.Research design:This was a prospective cohort study that examined decision making at the threshold of viability, life-sustaining therapies for sick neonates, and a ranking of the five most impactful ethical issues.Participants and research context:All 47 neonatal nurse practitioners who had an active license in the State of Mississippi were contacted via e-mail. Surveys were completed online using Survey Monkey software.Ethical considerations:The study was approved by the University of Mississippi Medical Center Institutional Review Board (IRB; #2015-0189).Findings:Of the neonatal nurse practitioners who completed the survey, 87.5% stated that their religious practices affected their ethical decision making and 76% felt that decisions regarding life-sustaining treatment for a neonate should not involve consultation with the hospital’s legal team or risk management. Only 11% indicated that the consent process involved patient understanding of possible procedures. Participating in the continuation or escalation of care for infants at the threshold of viability was the top ethical issue encountered by neonatal nurse practitioners.Discussion:Our findings reflect deficiencies in the neonatal nurse practitioner knowledge base concerning ethical decision making, informed consent/permission, and the continuation/escalation of care.Conclusion:In addition to continuing education highlighting ethics concepts, exploring the influence of religion in making decisions and knowing the most prominent dilemmas faced by neonatal nurse practitioners in the neonatal intensive care unit may lead to insights into potential solutions. (shrink)