It was only recently that people began to refer to God, occasionally, as “she.” Is it now possible to re-imagine divine power as a female force deeply related to the changing world? If so, then we can understand the deeper meaning of female images of divine power including depictions such as “The Goddess.” Carol Christ offers a new look at these female images of God in She Who Changes . She shows how many traditional ideas about divine power reject (...) the female body and connection to the natural world. She looks at the work of female theologians in Judaism, Christianity, and various religions that worship "The Goddess" to explore the way in which they are re-imagining both divine and human power as embodied both in a changing world and deeply related to all beings. (shrink)

Carol P. Christ reflects on her influential essay ‘Why Women Need the Goddess,’ responding to misinterpretations and arguing that women, men, and other living things still need the symbol of Goddess. As long as ‘Goddess’ and ‘God-She,’ like the word ‘feminist’ are controversial, we still have a long way to go before we as a culture can fully accept female power as a beneficent and independent power.

The article presents a dialogue between Carol P. Christ and Judith Plaskow. It argues that a process metaphysic provides an alternative to the Christian liberation paradigm and could help feminists in religion to articulate alternatives to the concept of God as a dominant male other found in classical theism. A shared metaphysic could help feminists in different religious traditions to recognize common concerns and commitments, to guard against claims of uniqueness and exclusivity of religious traditions, and to engage with (...) the complexities of diversity. Anticipating arguments against a feminist process paradigm, the dialogue addresses further questions: Is the idea of divinity as unfailing sympathy too good to be true? How do we explain bad things happening – is divinity evil as well as good? How does a process idea of divine sympathy differ from the traditional notions of God as love? Other issues considered are: self-sacrifice as love; the place of anger in a relational theology; co-creation and power with versus over. In conclusion the author suggests that the foundation of a shared spiritual feminist ethic would be understanding that life in the body is to be enjoyed by all and accepting responsibility to co-create a more just and harmonious world. (shrink)

Carol P. Christ discusses her new multi-pronged definition of patriarchy as an integral system: male dominance is enforced by violence which is a product of war; the control of female sexuality ensures the transfer private property and slaves which are the spoils of war in the male line; and the system as a whole is legitimated by religion. She argues, based on the new research on matriarchies that patriarchy is not eternal or universal, but that it arose in history, (...) and is inseparable from the rise of warfare and other forms of domination. (shrink)

In this article Carol P. Christ states that ‘thealogy matters’ because religious symbols not only articulate meaning but also provide orientation for ethical decision-making. Rejecting the notions that religious meaning is delivered from on high and that traditions must be uncritically accepted, she proposes a model of ‘embodied theology’ in which individuals and communities take responsibility for religious worldviews. She asks us to question Jungian theories of the feminine, images of the Goddess in patriarchal traditions, models of ritual practice (...) in the Wiccan tradition as articulated by Gerald Garner, and the idea of divine omnipotence modelled on the ‘tyrant ideal’ of God. She explores two ways in which process panentheism can help us to understand the divine power we call Goddess. (shrink)

In this article Carol Christ illustrates the ways in which process philosophy offers dynamic alternatives to dualistic habits of thought. She highlights how the Goddess is the most relational in the process and therefore the most sympathetic to the unfolding of the universe and those who inhabit it, human and non-human alike. Change she asserts is good, indeed divine, a statement in bold contrast to the Western tradition which attempts to fix and control all things. The individual and her (...) relationship to the environment becomes an active process, with neither reduced to mere things, and both ever changing in relationship. The article offers a resounding challenge to those still stuck in dualistic metaphysics and the world that springs from them. (shrink)

This paper lays out the case for a new metaphysics to underpin feminist work in religion, one that is experientially-based, relational and inherently open. The author suggests that the work of process philosophers, Alfred North Whitehead and Charles Hartshorne can provide a starting point for this venture. The author is mindful of the justified criticism that neither of these men paid attention to issues related to women and that philosophy in general has been an elitist male bastion. Nevertheless she is (...) insistent that metaphysical clarity is needed or feminist thealogies and theologies run the risk of becoming easily ignored or refuted assertions. (shrink)

I hope to open a wider dialogue between process philosophy and feminist spirituality. Process philosophy can help us to articulate the philosophical implications of feminist revisionings of divine power. Feminist spirituality can help us to understand the wider implications of process philosophy's rethinking of finitude, relationship, the body, and nature.

The earlier volume in this series dealt with two religions of Indian origin, namely, Buddhism and Jainism. The Indian religious scene, however, is characterized by not only religions which originated in India but also by religions which entered India from outside India and made their home here. Thus religious life in India has been enlivened throughout its history by the presence of religions of foreign origin on its soil almost from the very time they came into existence. This volume covers (...) three such religions—Zoraoastrianism, Judaism, and Islam. In the case of Zoraostianism, even its very beginnings are intertwined with India, as Zoroastrianism reformed a preexisting religion which had strong links to the Vedic heritage of India. This relationship took on a new dimension when a Zoroastrian community, fearing persecution in Persia after its Arab conquest, sought shelter in western India and ultimately went on to produce India’s pioneering nationalist in the figure of Dadabhai Naoroji ( 1825-1917), also known as the Grand Old Man of India. Jews found refuge in south India after the destruction of the Temple by the Romans in 70 C.E. and have remained a part of the Indian religious scene since then, some even returning to Israel after it was founded in 1948. Islam arrived in Kerala as soon as it was founded and one of the earliest mosques in the history of Islam is found in India. Islam differs from the previously mentioned religions inasmuch as it went on to gain political hegemony over parts of the country for considerable periods of time, which meant that its impact on the religious life of the subcontinent has been greater compared to the other religions. It has also meant that Islam has existed in a religiously plural environment in India for a longer period than elsewhere in the world so that not only has Islam left a mark on India, India has also left its mark on it. Indeed all the three religions covered in this volume share this dual feature, that they have profoundly influenced Indian religious life and have also in turn been profoundly influenced by their presence in India. (shrink)

The earlier volume in this series dealt with two religions of Indian origin, namely, Buddhism and Jainism. The Indian religious scene, however, is characterized by not only religions which originated in India but also by religions which entered India from outside India and made their home here. Thus religious life in India has been enlivened throughout its history by the presence of religions of foreign origin on its soil almost from the very time they came into existence. This volume covers (...) three such religions—Zoraoastrianism, Judaism, and Islam. In the case of Zoraostianism, even its very beginnings are intertwined with India, as Zoroastrianism reformed a preexisting religion which had strong links to the Vedic heritage of India. This relationship took on a new dimension when a Zoroastrian community, fearing persecution in Persia after its Arab conquest, sought shelter in western India and ultimately went on to produce India’s pioneering nationalist in the figure of Dadabhai Naoroji ( 1825-1917), also known as the Grand Old Man of India. Jews found refuge in south India after the destruction of the Temple by the Romans in 70 C.E. and have remained a part of the Indian religious scene since then, some even returning to Israel after it was founded in 1948. Islam arrived in Kerala as soon as it was founded and one of the earliest mosques in the history of Islam is found in India. Islam differs from the previously mentioned religions inasmuch as it went on to gain political hegemony over parts of the country for considerable periods of time, which meant that its impact on the religious life of the subcontinent has been greater compared to the other religions. It has also meant that Islam has existed in a religiously plural environment in India for a longer period than elsewhere in the world so that not only has Islam left a mark on India, India has also left its mark on it. Indeed all the three religions covered in this volume share this dual feature, that they have profoundly influenced Indian religious life and have also in turn been profoundly influenced by their presence in India. (shrink)

It is well established that demographic representation in clinical research is important for understanding the safety and effectiveness of novel therapeutics and vaccines in diverse patient populations. In recent years, the National Institutes of Health and Food and Drug Administration have issued guidelines and recommendations for the inclusion of women, older adults, and racial and ethnic minorities in research. However, these guidelines fail to provide an adequate explanation of why racial and ethnic representation in clinical research is important. This article (...) aims to both provide the missing arguments for why adequate representation of racial and ethnic minorities in clinical research is essential and to articulate a number of recommendations for improving diversity going forward.Appropriate racial and ethnic representation and fair inclusion help (1) increase the generalisability of clinical trial results, (2) equitably distribute any benefits of clinical research and (3) enable trust in the research enterprise. (shrink)

BACKGROUND: Many published accounts of clinical trials report no differences between the treatment arms, while being underpowered to find differences. This study determined how the authors of these reports interpreted their findings. STUDY DESIGN: We examined 54 reports of surgical trials chosen randomly from a database of 110 influential trials conducted in 2008. Seven that reported having adequate statistical power were excluded from further analysis, as were the 32 that reported significant differences between the treatment arms. We examined the remaining (...) 15 to see whether the authors interpreted their negative findings appropriately. Appropriate interpretations discussed the lack of power and/or called for larger studies. RESULTS: Three of the 7 trials that did not report an a priori power calculation offered inappropriate interpretations, as did 3 of the 8 trials that reported an a priori power < 0.90. However, we examined only a modest number of trial reports from 1 year. CONCLUSIONS: Negative findings in underpowered trials were often interpreted as showing the equivalence of the treatment arms with no discussion of the issue of being underpowered. This may lead clinicians to accept new treatments that have not been validated. (shrink)

The last decade has seen a slow but steady increase in the number of postdoctoral scholars employed in faculties of education. In this article, seven postdoctoral scholars who worked in the same Ca...

Sponges are important but often‐neglected organisms. The absence of classical animal traits (nerves, digestive tract, and muscles) makes sponges challenging for non‐specialists to work with and has delayed getting high quality genomic data compared to other invertebrates. Yet analyses of sponge genomes and transcriptomes currently available have radically changed our understanding of animal evolution. Sponges are of prime evolutionary importance as one of the best candidates to form the sister group of all other animals, and genomic data are essential to (...) understand the mechanisms that control animal evolution and diversity. Here we review the most significant outcomes of current genomic and transcriptomic analyses of sponges, and discuss limitations and future directions of sponge transcriptomic and genomic studies. (shrink)

Ethics & Behavior, Volume 21, Issue 5, Page 428-430, September-October 2011.

In the course of an immune response, antibodies undergo affinity maturation in order to increase their efficiency in neutralizing foreign invaders. Affinity maturation occurs by the introduction of multiple point mutations in the variable region gene that encodes the antigen binding site. This somatic hypermutation is restricted to immunoglobulin genes and occurs at very high rates. The precise molecular basis of this process remains obscure. However, recent studies using a variety of in vivo and in vitro systems have revealed important (...) regulatory regions, base motifs that are preferred targets of mutation and evidence that transcription may play an active role in hypermutation. BioEssays 20:227–234, 1998. © 1998 John Wiley & Sons, Inc. (shrink)

The federal government is funding a sea change in health care by investing in interventions targeting social determinants of health, which are significant contributors to illness and health inequity. This funding power has encouraged states, professional and accreditation organizations, health care entities, and providers to focus heavily on social determinants. We examine how this shift in focus affects clinical practice in the fields of oncology and emergency medicine, and highlight potential areas of reform.

These original essays by seven leading contemporary political philosophers spanning the political spectrum explore the possibility of achieving agreement in political theory. Each philosopher defends in a principal essay his or her own view of social justice and also comments on two or more of the other essays. The result is a lively exchange that leaves the reader to judge to what degree the contributors achieve agreement or reconciliation.

Important features of the self-concept can be located outside of the individual and inside close or related others. The authors use this insight to reinterpret data previously said to support the empathy-altruism model of helping, which asserts that empathic concern for another results in selflessness and true altruism. That is, they argue that the conditions that lead to empathic concern also lead to a greater sense of self-other overlap, raising the possibility that helping under these conditions is not selfless but (...) is also directed toward the self. In 3 studies, the impact of empathic concern on willingness to help was eliminated when oneness--a measure of perceived self-other overlap--was considered. Path analyses revealed further that empathic concern increased helping only through its relation to perceived oneness, thereby throwing the empathy-altruism model into question. The authors suggest that empathic concern affects helping primarily as an emotional signal of oneness. (shrink)

Astrobiologists are aware that extraterrestrial life might differ from known life, and considerable thought has been given to possible signatures associated with weird forms of life on other planets. So far, however, very little attention has been paid to the possibility that our own planet might also host communities of weird life. If life arises readily in Earth-like conditions, as many astrobiologists contend, then it may well have formed many times on Earth itself, which raises the question whether one or (...) more shadow biospheres have existed in the past or still exist today. In this paper, we discuss possible signatures of weird life and outline some simple strategies for seeking evidence of a shadow biosphere. Key Words: Weird life—Multiple origins of life—Biogenesis—Biomarkers—Extremophiles—Alternative biochemistry. Astrobiology 9, 241–249. (shrink)

In this article we report the findings of a randomised control clinical trial that assessed the impact of a Philosophy for Children program and replicated a previous study conducted in Scotland by Topping and Trickey. A Cognitive Abilities Test was administered as a pretest and a posttest to randomly selected experimental groups and control groups. The students in the experimental group engaged in philosophy lessons in a setting of structured, collaborative inquiry in their language arts classes for one hour per (...) week for a number of weeks. The control group received the standard language arts curriculum in that one hour. The study found that the seventh grade students who had experienced the P4C program showed significant gains relative to those in the seventh grade control group at a high level of statistical significance, but the eighth grade students in the experimental group did not show such gains over the eighth grade control group. It was discovered that the seventh grade teachers started the program early in the school year and continued it for a period of 22 to 26 weeks, while the eighth grade teachers started much later and used the program for only 4 to 10 weeks. Our findings suggest that the P4C program must involve students in activities for a significant period of time before the program shows results, but that a meaningful impact on students’ cognitive abilities can be achieved in about 24 weeks of lessons, less than half the time evidenced by the study by Topping and Trickey. (shrink)

Alexis de Tocqueville asserted that America had no truly great literature, and that American writers merely mimicked the British and European traditions of the eighteenth and nineteenth centuries. This new edited collection masterfully refutes Tocqueville's monocultural myopia and reveals the distinctive role American poetry and prose have played in reflecting and passing judgment upon the core values of American democracy. The essays, profiling the work of Mark Twain, F. Scott Fitzgerald, John Updike, Edith Wharton, Walt Whitman, Henry James, Willa Cather, (...) Walker Percy, and Tom Wolfe, reveal how America's greatest writers have acted as society's most ardent cheerleaders and its most penetrating critics. Christine Dunn Henderson's exciting new work offers literature as a portal through which to view the philosophical principles that animate America's political order and the mores which either reinforce or undermine them. (shrink)

There has been a growing concern over establishing norms that ensure the ethically acceptable and scientifically sound conduct of clinical trials. Among the leading norms internationally are the World Medical Association's Declaration of Helsinki, guidelines by the Council for International Organizations of Medical Sciences, the International Conference on Harmonization's standards for industry, and the CONSORT group's reporting norms, in addition to the influential U.S. Federal Common Rule, Food and Drug Administration's body of regulations, and information sheets by the Department of (...) Health and Human Services. There are also many norms published at more local levels by official agencies and professional groups.Any account of international standards should cover both scientific and ethical norms at once – the two are conceptually intertwined. Recent sources recognize that “[s]cientifically unsound research on human subjects is unethical in that it exposes research subjects to risks without possible benefit.”. (shrink)

A major shift has taken place since the 1960s concerning disclosure to patients that they have a diagnosis of cancer and that their disease is considered terminal. Full disclosure is now considered the patient's right in the United States. However, there remain many countries in which nondisclosure is still the norm. When patients from those countries are diagnosed with cancer in America, differences in attitudes and expectations can cause conflict and misunderstanding.

This is part 1 of 6 of the dossier What Do We Talk about when We Talk about Queer Death?, edited by M. Petricola. The contributions collected in this article sit at the crossroads between thanatology and queer theory and tackle questions such as: how can we define queer death studies as a research field? How can queer death studies problematize and rethink the life-death binary? Which notions and hermeneutic tools could be borrowed from other disciplines in order to better (...) define queer death studies? The present article includes the following contributions: – MacCormack P., What does queer death studies mean?; – Radomska M., On queering death studies; – Lykke N., Death as vibrancy; – Hillerup Hansen I., What concreteness will do to resolve the uncertain; – Olson P., Queer objectivity as a response to denials of death; – Manganas N., The queer lack of a chthonic instinct. (shrink)

Presents a plethora of approaches to developing human potential in areas not conventionally addressed. Organized in two parts, this international collection of essays provides viable educational alternatives to those currently holding sway in an era of high-stakes accountability.

This is part 1 of 6 of the dossier What Do We Talk about when We Talk about Queer Death?, edited by M. Petricola. The contributions collected in this article sit at the crossroads between thanatology and queer theory and tackle questions such as: how can we define queer death studies as a research field? How can queer death studies problematize and rethink the life-death binary? Which notions and hermeneutic tools could be borrowed from other disciplines in order to better (...) define queer death studies? The present article includes the following contributions: – MacCormack P., What does queer death studies mean?; – Radomska M., On queering death studies; – Lykke N., Death as vibrancy; – Hillerup Hansen I., What concreteness will do to resolve the uncertain; – Olson P., Queer objectivity as a response to denials of death; – Manganas N., The queer lack of a chthonic instinct. (shrink)

This research tested the hypothesis that prudence and altruism, in situations involving future desires, follow a similar developmental course between the ages of 3 and 5 years. Using a modified delay of gratification paradigm, 3- to 5-year-olds were tested on their ability to forgo a current opportunity to obtain some stickers in order to gratify their own future desires — or the current or future desires of a research assistant. Results showed that in choices involving current desires, altruistic behavior was (...) unrelated to age. However, prudence and altruism involving future situations were correlated with one another and with age. Children under 4 years of age demonstrated significantly less futureoriented prudence than the older children (F(1,49) = 15.75; p<.001) and significantly less altruism involving future situations (F(1,49) = 33.24; p<.001). The data for the 3-year-olds, but not for the older children, also showed agepartialled correlations between the two future-oriented choice situations. These results suggest that between 3 and 4 years, children acquire the ability to deal with future-oriented situations through the development of some common mechanism which affects both future-oriented prudence and altruism. (shrink)

These papers were presented at a panel, organized by us and chaired by Liz Wilson, on ‘Women’s Leadership and Monastic Organizations in Therav?da Buddhist Traditions’, at the 2008 American Academy of Religion meeting, Chicago. Here, we bring together articles that examine the roots of the teachings on nuns in P?li literature with others which investigate issues relating to contemporary Therav?da nuns, as well as an analysis of relevant debates in ancient China. The objective of these papers is to contribute to (...) discussion of the multiple ways in which professionally celibate women are represented, organized and empowered in the textual and contemporary traditions of P?li and Therav?da Buddhism, to study how representations of female monasticism are related to organizational structures of leadership and agency, and explore how debates over the need for ‘dual ordination’ have occurred in traditions other than the Therav?da. (shrink)

This article examines how Buddhist literatures construct the agency of Buddhist nuns. The first section explores the Vinaya collections of different schools, and examines the differences between the Bhikkhun?-vibha?ga and the Bhikkhu-vibha?ga on how nuns are expected to act. The second section explores material on the faculties in the P?li Abhidhamma-pi?aka and its commentaries so as to better understand how the abhidhamma analyses of ‘women’s nature’ and ‘men’s nature’ informed conceptions of agency. This article suggests that even though the abhidhamma (...) literature uses such terms as ‘women’s nature’, there is little basis for concluding, as some scholars have done, that Buddhist literature reflects an essentialist view of gender. The fact that the abhidhamma analyses of gender distinguish between ‘male faculties’ and ‘female faculties’ does not appear to make a difference in the agency accorded to nuns: nuns, like monks, are expected to behave in certain ways independent of the fact that they have ‘female faculties’ and thus are inclined toward certain kinds of stereotypically female behaviour. (shrink)

Ulm’s Theorem presents invariants that classify countable abelian torsion groups up to isomorphism. Barwise and Eklof extended this result to the classification of arbitrary abelian torsion groups up to L∞ω\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$L_{\infty \omega }$$\end{document}-equivalence. In this paper, we extend this classification to a class of mixed Zp\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\mathbb {Z}}_p$$\end{document}-modules which includes all Warfield modules and is closed under L∞ω\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} (...) \setlength{\oddsidemargin}{-69pt} \begin{document}$$L_{\infty \omega }$$\end{document}-equivalence. The defining property of these modules is the existence of what we call a partial decomposition basis, a generalization of the concept of decomposition basis. We prove a complete classification theorem in L∞ω\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$L_{\infty \omega }$$\end{document} using invariants deduced from the classical Ulm and Warfield invariants. (shrink)

Nul n'ignore, depuis l'arrêt Branly, que l'histoire peut être objet de chicane. L'évolution des mœurs ayant transformé l'institution judiciaire en caisse de résonance propre à mettre en lumière les causes les plus obscures, cette rencontre du droit et de l'histoire ne relève plus, aujourd'hui, de l'anecdote mais du phénomène social. Il ne s'agit plus seulement de réparer l'outrage causé par le silence de l'historien négligent sur l'œuvre d'un aïeul méritant. On ne craint plus d'ériger le juge en arbitre des différentes (...) lectures possibles des événements historiques récents. Il est parfois sommé de dire si la manière dont on a rapporté ces faits est licite, c'est-à-dire conforme au droit. Comment pourrait-il échapper à cette singulière mission quand la loi elle-même encourage la " judiciarisation " de l'histoire? L'un des apports majeurs de la thèse réside dans l'examen du rôle imparti au juge et à la loi en la matière : ce qu'il est et ce qu'il devrait être. On voit ainsi émerger de cette étude une conclusion inespérée. Carole Vivant démontre une tendance constante des tribunaux à prendre en considération la spécificité du travail de l'historien et son utilité sociale. Il en résulte un allègement des contraintes juridiques susceptibles de nuire à la recherche historique. Mieux : malgré les pressions qu'il subit, malgré quelques décisions isolées qui sont l'arbre cachant la forêt, il s'avère que le juge répugne à museler la liberté de l'historien, que ce soit au nom d'un intérêt privé ou en considération d'une certaine vision de l'intérêt général. Belle leçon donnée au législateur, qui pourrait s'inspirer de cette sagesse prétorienne. P.P. Les historiens se félicitent que les conclusions de cette thèse rejoignent et confortent leurs préoccupations de préserver l'indispensable liberté de la recherche. La publication du grand travail de Carole Vivant arrive à point. R. R. (shrink)

The aim of unpaid volunteer classroom assistants is to give extra support to children learning to read. The impact of using volunteers to improve children's acquisition of reading skills is unknown. To assess whether volunteers are effective in improving children's reading, we undertook a systematic review of all relevant randomised controlled trials (RCTs). An exhaustive search of all the main electronic databases was carried out (i.e. BEI, PsycInfo, ASSIA, PAIS, SSCI, ERIC, SPECTR, SIGLE). We identified eight experimental studies, of which (...) seven were RCTs. One of the RCTs was excluded because it did not meet the inclusion criteria. One RCT randomised intact classes and the other six studies randomised individual children and could therefore be included in a meta-analysis. All of the trials were fairly small, with the largest including 99 pupils. Four of the trials showed a positive outcome, while three showed a negative effect and the remaining study was equivocal. We pooled the four most homogeneous trials. The pooled data indicated an effect size of 0.19, which was not statistically significant ( p = 0.54, 95% confidence interval = -0.31 to 0.68). Overall, volunteering appeared to have a small effect on reading outcomes. However, the confidence intervals were wide, which could conceal a potentially large benefit or a harmful effect. Thus, more good quality RCTs are required in order to provide more conclusive evidence. (shrink)

Background and PurposeMany critically ill patients in intensive care units (ICUs) are unable to communicate their wishes about goals of care, particularly about the use of life-sustaining treatments. Surrogates and clinicians struggle with medical decisions because of a lack of clarity regarding patients’ preferences, leading to prolonged hospitalizations and increased costs. This project focused on the development and implementation of a tool to facilitate a better communication process by (1) assuring the early identification of a surrogate if indicated on admission (...) and (2) clarifying the decision-making standards that the surrogate was to use when participating in decision making. Before introducing the tool into the admissions routine, the staff were educated about its use and value to the decision-making process.Project and MethodsThe study was to determine if early use of a simple method of identifying a patient’s surrogate and treatment preferences might impact length of stay (LOS) and total hospital charges. A pre- and post-intervention study design was used. Nurses completed the surrogacy information tool for all patients upon admission to the neuroscience ICU. Subjects (total N=203) were critically ill patients who had been on a mechanical ventilator for 96 hours or longer, or in the ICU for seven days or longer. The project included staff education on biomedical ethics, critical communication skills, early identification of families and staff in crisis, and use of a simple tool to document patients’ surrogates and previously expressed care wishes. Data on hospital LOS and hospital charges were collected through a retrospective review of medical records for similar four-month time frames pre- and post-implementation of the assessment tool.ResultsSignificant differences were found between pre- and post-groups in terms of hospital LOS (F=6.39, p=.01) and total hospital charges (F=7.03, p=.009).ConclusionsProject findings indicate that the use of a simple admission assessment tool, supported by staff education about its completion, use, and available resources, can decrease LOS and lower total hospital charges. The reasons for the difference between the pre- and post-intervention groups remain unclear. Further research is needed to evaluate if the quality of communications between patients, their legally authorized representatives, and clinicians—as suggested in the literature—may have played a role in decreasing LOS and total hospital charges. (shrink)