Objectives: To quantify the use of do-not-resuscitate orders in a tertiary-care children’s hospital and to characterise the circumstances in which such orders are written.Design: Retrospective study conducted in a 500-bed children’s hospital in Taiwan.Patients: The course of 101 patients who died between January 2002 and December 2005 was reviewed. The following data were collected: age at death, gender, disease and its status, place of death and survival. There were 59 males and 42 females with a median age of 103 months (...) . 50 children had leukaemias, and 51 had malignancies other than leukaemia. The t test and the χ2 test were applied as appropriate.Results: The study found that 44% of patient deaths occurred in the paediatric oncology ward; 29% of patient deaths occurred in the intensive care unit; and 28% of patients died in their home or at another hospital. Other findings included the following: 46 of 101 patients died after attempted cardiopulmonary resuscitation and 55 died with a DNR order in effect. The mean age at death was 9.8 years in both groups with or without DNR orders.Conclusions: From the study of patient deaths in this tertiary-care children’s hospital, it was concluded that an explicit DNR order is now the rule rather than the exception, with more DNR orders being written for patients who have been ill longer, who have solid tumours, who are not in remission and who are in the ward. (shrink)

Studies exploring how students learn and understand science processes such as diffusion and natural selection typically find that students provide misconceived explanations of how the patterns of such processes arise (such as why giraffes’ necks get longer over generations, or how ink dropped into water appears to “flow”). Instead of explaining the patterns of these processes as emerging from the collective interactions of all the agents (e.g., both the water and the ink molecules), students often explain the pattern as being (...) caused by controlling agents with intentional goals, as well as express a variety of many other misconceived notions. In this article, we provide a hypothesis for what constitutes a misconceived explanation; why misconceived explanations are so prevalent, robust, and resistant to instruction; and offer one approach of how they may be overcome. In particular, we hypothesize that students misunderstand many science processes because they rely on a generalized version of narrative schemas and scripts (referred to here as a Direct-causal Schema) to interpret them. For science processes that are sequential and stage-like, such as cycles of moon, circulation of blood, stages of mitosis, and photosynthesis, a Direct-causal Schema is adequate for correct understanding. However, for science processes that are non-sequential (or emergent), such as diffusion, natural selection, osmosis, and heat flow, using a Direct Schema to understand these processes will lead to robust misconceptions. Instead, a different type of general schema may be required to interpret non-sequential processes, which we refer to as an Emergent-causal Schema. We propose that students lack this Emergent Schema and teaching it to them may help them learn and understand emergent kinds of science processes such as diffusion. Our study found that directly teaching students this Emergent Schema led to increased learning of the process of diffusion. This article presents a fine-grained characterization of each type of Schema, our instructional intervention, the successes we have achieved, and the lessons we have learned. (shrink)

The practice of respecting patients’ autonomy is rooted in the healthcare professionals’ empathy for patients’ situations, without which appropriate supports to the patients during the informed consent process may be remarkably moderated. The purpose of this study was to explore elective surgery patients’ experiences during their decision-making process. This research was conducted using a phenomenological approach, and the data analysis was guided by Colaizzi’s method. A total of 17 participants were recruited from a hospital in southern Taiwan. Two major themes (...) emerged from the analyses: (a) a voluntary yet necessary alternative—to undergo a surgery and (b) alternatives compelled by the unalterable decision—the surgery. It was concluded that unless healthcare professionals can empathize with the distressed situation of their patients who are facing elective surgery, the practice of informed consent may become merely a routine. Nurses can be the best advocates for patients and facilitators to enhance communication between patients and healthcare personnel. (shrink)

Biologically motivated computing seeks to transfer ideas from the biosciences to computer science. In seeking to make transfers it is helpful to be able to appreciate the metaphors which people use. This is because metaphors provide the context through which analogies and similes are made and by which many scientific models are constructed. As such, it is important for any rapidly evolving domain of knowledge to have developments accounted for in these terms. This paper seeks to provide one overview of (...) the process of modelling and shows how it can be used to account for a variety of biologically motivated computational models. Certain key ideas are identified in the subsequent analysis of biological sources, notably, systemic metaphors. Three important aspects of biological thinking are then considered in the light of computer science applications: biological organization, the cell, and models of evolution. The analysis throughout the paper is descriptive rather than formalized so that a large variety of potential applications may be considered. (shrink)

Advances in transplantation have extended the life and relieved the suffering of thousands of individuals. The prospect of being able to use tissues from embryos, as well as from anencephalic newborns, offers the promise of further relief of suffering. However, these possibilities raise significant moral and public policy issues. The question arises of the extent to which those who disapprove of abortion may make use of tissues derived from abortion in order to treat serious diseases. This essay argues that, with (...) proper safeguards, such tissue can be used without cooperating in abortion. That is, even those who oppose abortion can benefit from the use of tissue procured during abortion. Questions also arise regarding the probity of maintaining a pregnancy in order to produce an anencephalic newborn whose biological existence will be maintained so as better to secure organs once death is declared. It is argued that, since no harm can be done to a being that has neither a sense of self or the capacity to feel pain, and since women have a right to forego abortions, there is no legitimate ground for opposing women's seeking meaning in their pregnancy through maximizing the opportunity of others to use the organs of their anencephalic newborn once death has been declared. Finally, it is argued that, since the capacities for sentience, a minimal condition for personhood, are never realized by an anencephalic, the entity has never been alive as a person. Therefore, there should be no opposition in principle to aborting anencephalics nor, after proper declaration, to making their organs available as one would after whole-brain death, despite the continued functioning of the brain stem. (shrink)

Background Ethically, informed consent regarding randomised controlled trials (RCTs) should be understandable to patients. The patients can then give free consent or decline to participate in a RCT. Little is known about what patients really understand in consultations about RCTs. Methods Cancer patients who were asked to participate in a randomised trial were surveyed using a semi-standardised interview developed by the authors. The interview addresses understanding, satisfaction and needs of the patients. The sample included eight patients who participated in a (...) trial and two who declined. The data were analysed on the basis of Mayring's qualitative analysis. Results Patients' understanding of informed consent was less developed than anticipated, especially concerning key elements such as randomisation, content and procedure of RCTs. Analysing the result about satisfaction of the patients, most of the patients described their consultations as hectic and without advance notice. Health limitations due to cancer played a decisive role. However, most of the patients perceived their physician to be sympathetic. Analysing the needs of patients, they ask for a clear informed consent consultation with enough time and adequate advance notice. Conclusion This study fills an important empirical research gap of what is ethically demanded in an RCT consultation and what is really understood by patients. The qualitative approach enabled us to obtain new results about cancer patients' understanding of informed consent, to clarify patients' needs and to develop new ideas to optimise the informed consent. (shrink)

The US neutrino community gathered at the Workshop on the Intermediate Neutrino Program at Brookhaven National Laboratory February 4-6, 2015 to explore opportunities in neutrino physics over the next five to ten years. Scientists from particle, astroparticle and nuclear physics participated in the workshop. The workshop examined promising opportunities for neutrino physics in the intermediate term, including possible new small to mid-scale experiments, US contributions to large experiments, upgrades to existing experiments, R&D plans and theory. The workshop was organized into (...) two sets of parallel working group sessions, divided by physics topics and technology. Physics working groups covered topics on Sterile Neutrinos, Neutrino Mixing, Neutrino Interactions, Neutrino Properties and Astrophysical Neutrinos. Technology sessions were organized into Theory, Short-Baseline Accelerator Neutrinos, Reactor Neutrinos, Detector R&D and Source, Cyclotron and Meson Decay at Rest sessions.This report summarizes discussion and conclusions from the workshop. (shrink)

In recent times, daily, ordinary medical practices have incontrovertibly been developing under the condition of complexity. Complexity jeopardizes the moral core of practicing medicine: helping people, with their illnesses and suffering, in a medically competent way. Practical wisdom has been proposed as part of the solution to navigate complexity, aiming at the provision of morally good care. Practical wisdom should help practitioners to maneuver in complexity, where the presupposed linear ways of operating prove to be insufficient. However, this solution is (...) unsatisfactory, because the proposed versions of practical wisdom are too individualistic of nature, while physicians are continuously operating in varying teams, and dealing with complicated technologies and pressing structures. A second point of critique is, that these versions are theory based, and thus insufficiently attuned to the actual context of everyday medical practices. Now, our proposal is to use an approach of practical wisdom that enables medical practices to counter the complexity issue and to re-invent the moral core of medical practicing as well. This implies a practice oriented approach, as thematized by practice theory, qualitative empirical research from the inside, and abduction from actual performed practical wisdom towards an apt understanding of phronèsis. (shrink)

This chapter describes the potential far‐reaching consequences of contemplative higher education for the fields of science and medicine.

Background and objective: Code status discussions may fail to address patients’ treatment-related goals and their knowledge of cardiopulmonary resuscitation (CPR). This study aimed to investigate patients’ resuscitation preferences, knowledge of CPR and goals of care. Design, setting, patients and measurements: 135 adults were interviewed within 48 h of admission to a general medical service in an academic medical centre, querying code status preferences, knowledge about CPR and its outcome probabilities and goals of care. Medical records were reviewed for clinical information (...) and code status documentation. Results: 41 (30.4%) patients had discussed CPR with their doctor, 116 (85.9%) patients preferred full code status and 11 (8.1%) patients expressed code status preferences different from the code status documented in their medical record. When queried about seven possible goals of care, patients affirmed an average of 4.9 goals; their single most important goals were broadly distributed, ranging from being cured (n = 36; 26.7%) to being comfortable (n = 8; 5.9%). Patients’ mean estimate of survival to discharge after CPR was 60.4%. Most patients believed it was helpful to discuss goals of care (n = 95; 70.4%) and the chances of surviving inhospital CPR (n = 112; 83.0%). Some patients expressed a desire to change their code status after receiving information about survival following inhospital CPR (n = 11; 8.1%) or after discussing goals of care (n = 2; 1.5%). Conclusions: Doctors need to address patients’ knowledge about CPR and take steps to avoid discrepancies between treatment orders and patients’ preferences. Addressing CPR outcome probabilities and goals of care during code status discussions may improve patients’ knowledge and influence their preferences. (shrink)

PurposeTo explore the mindfulness practice, its long-term effects, facilitators and barriers, in clinical clerkship students 2 years after participation in an 8-week mindfulness-based stress reduction training.MethodA qualitative study was performed by semi-structured in-depth interviews with 16 clinical clerkship students selected by purposive sampling. Students had participated in a MBSR training 2 years before and were asked about their current mindfulness practice, and the long-term effects of the MBSR training. Thematic analysis was conducted using the constant comparison method. Data saturation was (...) reached after 16 interviews.ResultsMost interviewees were still engaged in regular, predominantly informal, mindfulness practice, although some discontinued mindfulness practice and reported an “unchanged lifestyle.” Three main themes came forward; “focused attention and open awareness” during daily activities as core elements of long-term mindfulness practice; “changes in behavior and coping” that resulted from taking a pause, reflecting, recognizing automatic behavioral patterns and making space for a conscious response; “integration in personal and professional life” by enhanced enjoyment of daily activities, improved work-life-balance and making different career choices. Barriers and facilitators in starting and maintaining mindfulness practice were understanding and intention as “pre-conditions”; practical, personal, and professional factors of students in maintaining practice.ConclusionTwo years after participation in a MBSR training, many interviewees were still engaged in mindfulness practice contributing to both personal and professional changes. In light of the high clerkship demands, MBSR training could be a valuable addition to medical curricula, supporting medical students in developing necessary competencies to become well-balanced professionals. (shrink)

Weismann's famous test of inheritance assumes that inherited traits will persist in the absence of the environment that first produced them; while, on the other hand, environmental traits are more transitory. The purpose of this paper is to show that this Weismannian criterion is inconsistent and equivocal, and should, therefore, be recognized as one of the obsolete dogmas of heredity. Equivocal interpretation of relevant experiments is possible. Failure to distinguish active from passive environmental changes has been responsible for much confusion (...) in genetic thinking. It is argued that the Lamarckian problem is a spurious problem—the illegitimate offspring of an equivocal distinction between inherited and acquired characteristics. Also considered are: homeostasis and heredity, the chemical theory of development, inadequacies in germinal theories, and genetic relationship between life levels. 26 references. (PsycINFO Database Record (c) 2016 APA, all rights reserved). (shrink)

ICAP is a theory of active learning that differentiates students’ engagement based on their behaviors. ICAP postulates that Interactive engagement, demonstrated by co‐generative collaborative behaviors, is superior for learning to Constructive engagement, indicated by generative behaviors. Both kinds of engagement exceed the benefits of Active or Passive engagement, marked by manipulative and attentive behaviors, respectively. This paper discusses a 5‐year project that attempted to translate ICAP into a theory of instruction using five successive measures: (a) teachers’ understanding of ICAP after (...) completing an online module, (b) their success at designing lesson plans using different ICAP modes, (c) fidelity of teachers’ classroom implementation, (d) modes of students’ enacted behaviors, and (e) students’ learning outcomes. Although teachers had minimal success in designing Constructive and Interactive activities, students nevertheless learned significantly more in the context of Constructive than Active activities. We discuss reasons for teachers’ overall difficulty in designing and eliciting Interactive engagement. (shrink)

The coefficients of internal consistency and retest reliability had been rarely investigated within the methodology of dream content analysis. Analyzing a dream series of elderly, healthy persons obtained from weekly telephone interviews, the internal consistency of a series of 20 dreams and retests after 4 or 22 weeks, respectively, had been computed. The findings indicate that dream recall and dream length are quite stable, but dream characteristics such as bizarreness and emotional tone underlie large intraindividual fluctuations. In order to obtain (...) reliable measures for these variables which will be important for correlational studies, including waking-life trait measures, one has to obtain as many dreams as possible (about 20) in a very short time period. Further research is needed to extend the present findings to diary dreams and laboratory dreams. (shrink)

Peter Abelard (1079–1142 ce) was the most wide‐ranging philosopher of the twelfth century. He quickly established himself as a leading teacher of logic in and near Paris shortly after 1100. After his affair with Heloise, and his subsequent castration, Abelard became a monk, but he returned to teaching in the Paris schools until 1140, when his work was condemned by a Church Council at Sens. His logical writings were based around discussion of the “Old Logic”: Porphyry's Isagoge, aristotle'S Categories and (...) On Interpretation and boethius'S textbook on topical inference. They comprise a freestanding Dialectica (“Logic”; probably c.1116), a set of commentaries (known as the Logica [Ingredientibus], c. 1119) and a later (c. 1125) commentary on the Isagoge (Logica Nostrorum Petititoni Sociorum or Glossulae). In a work Abelard called his Theologia, issued in three main versions (between 1120 and c.1134), he attempted a logical analysis of trinitarian relations and explored the philosophical problems surrounding God's claims to omnipotence and omniscience. The Collationes (“Debates,” also known as “Dialogue between a Christian, a Philosopher and a Jew”; probably c.1130) present a rational investigation into the nature of the highest good, in which the Christian and the Philosopher (who seems to be modeled on a philosopher of pagan antiquity) are remarkably in agreement. The unfinished Scito teipsum (“Know thyself,” also known as the “Ethics”; c.1138) analyses moral action. (shrink)

ABSTRACT Global biodiversity declines are increasingly recognized as profound ecological and social crises. In areas subject to colonialization, these declines have advanced in lockstep with settler colonialism and imposition of centralized resource management by settler states. Many have suggested that resurgent Indigenous-led governance systems could help arrest these trends while advancing effective and socially just approaches to environmental interactions that benefit people and places alike. However, how dominant management and conservation approaches might be decolonized (i.e., how their underlying colonial structure (...) might be addressed, transformed, and replaced) is not always clear. Here, we describe a ‘Decolonial Model of Environmental Management and Conservation’ as an alternative paradigm to dominant approaches of conservation and management. The tenets of the model describe characteristics that might be expected of decolonized management, contrasted with those of dominant state-led approaches such as those embedded in the North American Model of Wildlife Conservation. The model does not prescribe how Indigenous governments or communities ought to govern their own territories, but instead offers insights into how external management and conservation agencies and practitioners might support (or stop impeding) Indigenous-led governance. We illustrate the model with a conservation ‘bright spot’: grizzly bear stewardship in the area now referred to as the Great Bear Rainforest in British Columbia, Canada, with a focus on work led by or in collaboration with, and within the territories of, the Haíɫzaqv, Kitasoo/xai’xais, Nuxalk, and Wuikinuxv First Nations. While acknowledging the important context-specific variability among place-based management and conservation applications, we also discuss the model’s broader applicability. (shrink)

The framework of Findlay & Walker's target article provides a first attempt to model the saccadic system at all levels. Their scheme is based on two main principles. These are “parallel processing of saccade timing and metrics” and “competitive inhibition through winner-take-all strategies.” In our opinion, however, both concepts are in their strictest sense at odds with the current knowledge of the saccadic system, and need to be refined to make the scheme more relevant.