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

Although there is a growing recognition that older adults and those with extensive comorbid conditions undergo cancer screening too frequently, there is little information about patients’ perceptions regarding cessation of cancer screening. Information on older adults’ views of screening cessation would be helpful both for clinicians and for those designing interventions to reduce overscreening.

Although tissue plasminogen activator (tPA) is the only medication approved by the United States Food and Drug Administration (FDA) for acute ischemic stroke, there is no consensus about the need for informed consent for its use. As a result, hospitals throughout the U.S. have varying requirements regarding obtaining informed consent from patients for the use of tPA, ranging from no requirement for informed consent to a requirement for verbal or written informed consent. We conducted a study to (1) determine current (...) beliefs about obtaining patients’ informed consent for tPA among a large group of stroke clinicians and (2) identify the ethical, clinical, and organizational factors that influence tPA consent practices. Semi-structured interviews were conducted by trained and experienced investigators and research staff to identify key barriers to implementing acute stroke services. Part of the interview explored current beliefs and practices around informed consent for tPA.This was a multicenter study that included 38 Veterans Health Administration (VHA) hospital locations. Participants were 68 stroke team clinicians, serving primarily on the neurology (35 percent) or emergency medicine (41 percent) service. We conducted thematic analysis based on principles of grounded theory to identify codes about consent for tPA. We used interpretive convergence to ensure consistency among the individual investigators’ codes and to ensure that all of the investigators agreed on coding and themes.We found that 38 percent of the stroke clinicians did not believe any form of consent was necessary for tPA, 47 percent thought that some form of consent was necessary, and 15 percent were unsure. Clinicians who believed tPA required informed consent were divided on whether consent should be written (40 percent) or verbal (60 percent). We identified three factors describing clinicians’ attitudes about consent: (1) legal and policy factors, (2) ethical factors, and (3) medical factors.The lack of consensus regarding consent for tPA creates the potential for delays in treatment, uneasiness among clinicians, and legal liability. The identified factors provide a potential framework to guide discussions about developing a standard of care for acquiring the informed consent of patients for the administration of tPA. (shrink)

The primary objective was to review pediatric ethics consultations at a large academic health center over a nine year period, assessing demographics, ethical issues, and consultant intervention. The secondary objective was to describe the evolution of PECs at our institution. This was a retrospective review of Consultation Summary Sheets compiled for PECs at our Academic Health Center between January 2008 and April 2017. There were 165 PECs reviewed during the study period. Most consult requests came from the inpatient setting, with (...) the Pediatric and Neonatal Intensive Care Units being the highest utilizers. Consultation utilization increased over the study period. The most common patient age was less than one year. Physicians were most likely to request consultation. Patient Best Interest, Withholding/Withdrawing of Life Sustaining Therapy, and Provider Moral Distress were ethical issues most commonly identified by the consultants. Making recommendations was the most common consultant intervention. The ethics consultation process evolved over time from informal provider discussions, to a hospital infant care review committee, to a pediatric only consultation service, to a combined adult/pediatric consultation service, with variable levels of salary support for consultants. Ethics consultation requests are growing at our institution. Similarities in identified ethical issues exist between our findings and existing literature, however meaningful comparisons remains elusive secondary to variability in approaches to investigation and reporting. A combined paid/volunteer/trainee ethics consultation service model appears sustainable and real time ethics consultation is feasible using this approach. (shrink)

Although hope is a pervasive concept in cancer treatment, we know little about how ambulatory patients with cancer define or experience hope. We explored hope through semistructured interviews with ten patients with advanced (some curable, some incurable) colon cancer at one Midwestern, university–based cancer center. We conducted a thematic analysis to identify key concepts related to patient perceptions of hope. Although we did ask specifically about hope, patients also often revealed their hopes in response to indirect questions or by telling (...) stories about their cancer experience. We identified four major themes related to hope: 1) hope is essential, 2) a change in perspective, 3) the content of hope, and 4) communicating about hope. The third theme, the content of hope, included three subthemes: a) the desire for normalcy, b) future plans, and c) hope for a cure. We conclude that hope is an essential concept for patients undergoing treatment for cancer as it pertains to their psychological well–being and quality of life, and hope for a cure is not and should not be the only consideration. In a clinical context, the exploration of patients’ hopes and aspirations in light of their cancer diagnosis is important because it provides a frame for understanding their goals for treatment. Exploration of the content of patients’ hope can not only help to illuminate misunderstandings but also clarify how potential treatments may or may not contribute to achieving patients’ goals. (shrink)

The nature of quantum computation is discussed. It is argued that, in terms of the amount of information manipulated in a given time, quantum and classical computation are equally efficient. Quantum superposition does not permit quantum computers to ''perform many computations simultaneously'' except in a highly qualified and to some extent misleading sense. Quantum computation is therefore not well described by interpretations of quantum mechanics which invoke the concept of vast numbers of parallel universes. Rather, entanglement makes available types of (...) computation processes which, while not exponentially larger than classical ones, are unavailable to classical systems. The essence of quantum computation is that it uses entanglement to generate and manipulate a physical representation of the correlations between logical entities, without the need to completely represent the logical entities themselves. (shrink)

Purpose. To consider the uniqueness of Descartes’ way of interpreting poetry as a type of philosophizing that makes it possible to comprehend the metaphysical nature of man. Its implementation involves the consistent solution of the following tasks: a) understanding methodological changes in the philosophy of the 20th century in the process of actualization of anthropological interest; b) argumentation of the importance of poetic thinking for early Descartes in the process of addressing modern historians of philosophy and the thinker’s texts. Theoretical (...) basis. I rely on the conceptual positions of phenomenology, existentialism and hermeneutics. Originality. Finding of the study is that poetic thinking is the most authentic way of meaningful comprehension of the metaphysicity of man. The paper outlines the nature of the expression of this correlation in the philosophizing of the 20th-21th centuries and substantiates the thesis about the importance of the poetic principle for understanding the phenomenon of man in early works by Descartes. Conclusions. The paper examined the methodological shifts in anthropologically oriented philosophizing of the 20th-21th centuries and focused on the manifestations of related moments in the philosophical legacy of Descartes. The latter demonstrates the existence of a still underestimated version of interpreting the metaphysical foundations of human existence, the form of understanding of which is poetic thinking. It is a form of caring for the humane in man. (shrink)

Whether it is fair to use personal responsibility of patients for their own health as a rationing criterion in healthcare is a controversial matter. A host of difficulties are associated with the concept of personal responsibility in the field of medicine. These include, in particular, theoretical considerations of justice and such practical issues as multiple causal factors in medicine and freedom of health behaviour. In the article, personal responsibility is evaluated from the perspective of several theories of justice. It is (...) argued that in a healthcare system based on both equality of opportunity and solidarity, responsible health behaviour can—in principle—be justifiably expected. While the practical problems associated with personal responsibility are important, they do not warrant the common knee-jerk refusal to think more deeply about responsibility for health as a means of allocating healthcare resources. In conclusion, the possibility of introducing personal responsibility as a fair rationing criterion is briefly sketched. (shrink)

In this paper, the authors have detected a new effect in the area of geomagnetism, related to the behavior of a magnetic dipole freely floating on water surface. An experiment is described in the present paper in which a magnetic dipole fixed upon a float placed on non- magnetized water surface undergoes displacement along with reorientation caused by fine structure of the earth's magnetic field. This fact can probably be explained by secular decrease of the earth's major dipole moment. Further, (...) a detailed study of the phenomenon may create interesting premises for its practical use, particularly for the analysis of fine structure of geomagnetic field and its time-dependent anomalies. A strange behavior of some sea fish species prior to strong earthquakes may be explained if the fish are assumed as 'live magnetic dipoles'. (shrink)

Over his philosophical career, David Wiggins has produced a body of work that, though varied and wide-ranging, stands as a coherent and carefully integrated whole. In this book Ferner examines Wiggins’ conceptualist-realism, his sortal theory ‘D’ and his human being theory in order to assess how far these elements of his systematic metaphysics connect. In addition to rectifying misinterpretations and analysing the relations between Wiggins’ works, Ferner reveals the importance of the philosophy of biology to Wiggins’ approach. This book elucidates (...) the biological anti-reductionism present in Wiggins’ work and highlights how this stance stands as a productive alternative to emergentism. With an analysis of Wiggins’ construal of substances, specifically organisms, the book goes on to discuss how Wiggins brings together the concept of a person with the concept of a natural substance, or human being. An extensive introduction to the work of David Wiggins, as well as a contribution to the dialogue between personal identity theorists and philosophers of biology, this book will appeal to students and scholars working in the areas of philosophy, biology and the history of Anglophone metaphysics. (shrink)

The study aims to identify the efficiency of the university education performance from the perspective of postgraduate and undergraduate students in international and Palestinian universities. The analytical descriptive approach was used for this purpose and the questionnaire was used as a main tool for data collection. The study community consists of: post graduate students, (23850) graduate students and (146355) undergraduate students. The sample of the study was 378 graduate students and 383 undergraduate students. The random stratified sample was used. The (...) Statistical Package of Social Sciences (SPSS) was also used for data analysis. The study reached a number of results, the most important of which are: The level of efficiency of educational performance in Palestinian and international universities from the point of view of postgraduate and undergraduate students was high. And that there are significant differences between the average views of the sample of the study on the efficiency of educational performance in Palestinian and international universities attributed to the University and to the benefit of international universities. The study concluded many recommendations, the most important of which is the necessity of continuing to develop e-learning strategies that affect the efficiency of educational performance and research commensurate with the university's position in the local and international community, which puts it on the best classification between local and international universities through e-learning. (shrink)

The study aimed to identify the role of administrative procedures and systems in enhancing the performance of the educational institutions in the Islamic University in Gaza. To achieve the research objectives, the researchers used the analytical descriptive approach to collect information. The researchers used the questionnaire distributed to three categories of employees at the Islamic University (senior management, faculty members, their assistants and members of the administrative board). A random sample of 314 employees was selected and 276 questionnaires were retrieved (...) with a recovery rate of 88.1%. The Statistical Analysis Program (SPSS) was used to enter process and analyze data. The results of the research showed a positive role for the administrative procedures and systems in enhancing the performance of the Islamic University from the point of view of the members (senior management, teaching staff and their assistants and the administrative body), where the relative weight of all the paragraphs (73.728%). The analysis of the results revealed that the administrative procedures at the Islamic University in Gaza are used to an acceptable degree. The relative weight of all the paragraphs is 70%. This indicates a relationship between administrative procedures and regulations and the performance of the Islamic University in the Gaza Strip. The study found that there was a good degree of approval from the sample regarding the administrative procedures and their relationship to the job performance. There exist a sufficient degree of powers to the deans and department managers to carry out their tasks, with the use of plans as control tools. And that there are rules and procedures provided for decision-making in the University Council. It also has full powers to manage the university to improve the teaching and learning environment. The researchers also recommended a number of recommendations, including the need to follow up on the procedures and systems of management and update them continuously in the light of changes that may occur and to ensure the existence of a strong system of electronic information systems within the university. There is a need to provide mechanisms for obtaining information about the surrounding external environment, and effective mechanisms to provide managers with the necessary information in a timely manner. The importance of providing channels of communication that enables staff to communicate information about any violations and breaches. The study also recommended the follow-up, review, procedures and administrative systems, and work to modify them in line with the mission of the university and the objectives that the university seeks to reach. (shrink)

L'ouvrage ici presente appartient peut-etre a la derniere periode de la production d'Avicenne. Le Livre des directives et remarques supplee les parties perdues de La philosophie orientale, dernier grand projet avicennien, en ce sens qu'il tend a rearticuler science divine et science universelle, par raport a l'entreprise philosophique du Shifa'. Neanmoins les Directives ne sont aucunement un traite, mais plutot un recueil de notes sur des points controverses. Les liens entre les chapitres sont souvent tenus, parfois meme arbitraires, mais il (...) ressort pourtant de la des modifications importantes par rapport aux philosophes grecs. Les theories d'Avicenne sont ainsi toutes en faveur d'une pensee rationaliste et scientifique. L'avance scientifique des orientaux a, pour lui, ouvert a l'intelligence des voies nouvelles; les methodes grecques de pensee demeurent fondamentales, mais des exigences inconnues de leur temps demandent qu'elles soient depassees. (shrink)

This article introduces the three-valuedweakly-intuitionistic logicI 1 as a counterpart of theparaconsistent calculusP 1 studied in [11].I 1 is shown to be complete with respect to certainthree-valued matrices. We also show that in the sense that any proper extension ofI 1 collapses to classical logic.The second part shows thatI 1 is algebraizable in the sense of Block and Pigozzi (cf. [2]) in a way very similar to the algebraization ofP 1 given in [8].

The problem of antimicrobial resistance is so dire that people are predicting that the era of antibiotics may be coming to an end, ushering in a ‘post-antibiotic’ era. A comprehensive policy response is therefore urgently needed. A part of this response will require framing the problem in such a way that adequately reflects its nature as well as encompassing an approach that has the best prospect of success. This paper considers framing the problem as a slowly emerging disaster, including its (...) potential benefits and difficulties, from a conceptual and policy perspective. (shrink)

The universe, of which our domicile the planet Earth forms but a minuscule part, has an architecture that changes and has been changing in time. In other words, it has a history of evolution. Lack of experimental evidence denies us the knowledge of what the universe was like “at the time of its origin,” as discussed by Hubert Reeves in the preceding chapter. Neither do we know much about its geometry, simply because our observatories are concentrated, for all practical purposes, (...) vanishingly close to a single point in an immensity whose size can only be measured by the billions of years required by light to go from one extremity to another! (shrink)

The Lord of the Fourteen worlds is manifest here. Questioner: For whom is the title 'Dada Bhagwan' used? Dadashri: For 'Dada Bhagwan.' Not for me. I am a 'Gnani Purush A. M. Patel.' 'Dada Bhagwan' is the Lord of the fourteen worlds. He dwells within you also, but He has not awakened yet, he remains unmanifested. Here within me, He is fully awakened and manifest. He is capable of awakening the Lord within you.