We propose that hyper‐inflammation (HYPi) is a ‘‘runaway’’ consequence of acute inflammation (ACUi) that arises more easily (and also abates less easily) in those who host a pre‐existing chronic inflammation (CHRi), because (i) most factors involved in generating an ACUi to limit viral proliferation are already present when there is an underlying CHRi, and also because (ii) anti‐inflammatory (AI) mechanisms for the abatement of ACUi (following containment of viral proliferation) are suppressed and desensitized where there is an underlying CHRi, with (...) this causing the ACUi to spiral into a HYPi. Stress, pollution, diet, and gut microbiomes (alterable in weeks through dietary changes) have an intimate and bidirectional cause‐effect relationship with CHRi. We propose that avoidance of CHRi‐promoting foods and adoption of CHRi‐suppressing foods could reduce susceptibility to HYPi, in Covid‐19 and in other viral diseases, such as influenza, which are characterized by episodic and unpredictable HYPi. (shrink)

This article investigates the role of Big Data in situations of psychological stress such as during the recent pandemic caused by the COVID-19 health crisis. Quarantine measures, which are necessary to mitigate pandemic risk, are causing severe stress symptoms to the human body including mental health. We highlight the most common impact factors and the uncertainty connected with COVID-19, quarantine measures, and the role of Big Data, namely, how Big Data can help alleviate or mitigate these effects by comparing the (...) status quo of current technology capabilities with the potential effects of an increase of digitalization on mental health. We find that, while Big Data helps in the pre-assessment of potentially endangered persons, it also proves to be an efficient tool in alleviating the negative psychological effects of quarantine. We find evidence of the positive effects of Big Data on human health conditions by assessing the effect of internet use on mental health in 173 countries. We found positive effects in 110 countries with 90 significant results. However, increased use of digital media and exclusive exposure to digital connectivity causes negative long-term effects such as a decline in social empathy, which creates a form of psychological isolation, causing symptoms of acute stress disorder. (shrink)

As part of their corporate social responsibility, many organizations practice cause-related marketing, in which organizations donate to a chosen cause with every consumer purchase. The extant literature has identified the importance of the fit between the organization and the nature of the cause in influencing corporate image, as well as the influence of a connection between the cause and consumer preferences on brand attitudes and brand choice. However, prior research has not addressed which cause composition (...) most appeals to consumers or the impact of cause choice on corporate image. A between-subjects field experiment in the Netherlands examines the influence of three core cause attributes—cause type, cause scope, and cause acuteness—on consumers’ perceptions of corporate image. Furthermore, this experiment examines the extent to which consumer identification with the cause mediates the influence of the cause attributes on corporate image. The findings indicate that identification with the cause leads to more positive evaluations of marketing campaigns for cause type and cause scope. Also, however, our results uncover a negative direct relationship between cause scope and corporate image. Cause acuteness is only marginally influential in corporate image perceptions. By proposing and testing a comprehensive model of the influence of cause attributes on corporate image in cause-related marketing, this article provides important implications and suggests avenues for further research. (shrink)

As part of their corporate social responsibility, many organizations practice cause-related marketing, in which organizations donate to a chosen cause with every consumer purchase. The extant literature has identified the importance of the fit between the organization and the nature of the cause in influencing corporate image, as well as the influence of a connection between the cause and consumer preferences on brand attitudes and brand choice. However, prior research has not addressed which cause composition (...) most appeals to consumers or the impact of cause choice on corporate image. A between-subjects field experiment in the Netherlands examines the influence of three core cause attributes—cause type, cause scope, and cause acuteness—on consumers’ perceptions of corporate image. Furthermore, this experiment examines the extent to which consumer identification with the cause mediates the influence of the cause attributes on corporate image. The findings indicate that identification with the cause leads to more positive evaluations of marketing campaigns for cause type and cause scope. Also, however, our results uncover a negative direct relationship between cause scope and corporate image. Cause acuteness is only marginally influential in corporate image perceptions. By proposing and testing a comprehensive model of the influence of cause attributes on corporate image in cause-related marketing, this article provides important implications and suggests avenues for further research. (shrink)

Acute Myeloid Leukemia is a kind of fatal blood cancer with a high death rate caused by abnormal cells’ rapid growth in the human body. The usual method to detect AML is the manual microscopic examination of the blood sample, which is tedious and time-consuming and requires a skilled medical operator for accurate detection. In this work, we proposed an AlexNet-based classification model to detect Acute Myeloid Leukemia in microscopic blood images and compared its performance with LeNet-5-based model in Precision, (...) Recall, Accuracy, and Quadratic Loss. The experiments are conducted on a dataset of four thousand blood smear samples. The results show that AlexNet was able to identify 88.9% of images correctly with 87.4% precision and 98.58% accuracy, whereas LeNet-5 correctly identified 85.3% of images with 83.6% precision and 96.25% accuracy. (shrink)

BackgroundIn this article, the sources and features of moral distress as experienced by acute psychiatric care nurses are explored.Research designA qualitative design with 16 individual in-depth interviews was chosen. Braun and Clarke’s six analytic phases were used.Ethical considerationsApproval was obtained from the Norwegian Social Science Data Services. Participation was confidential and voluntary.FindingsBased on findings, a somewhat wider definition of moral distress is introduced where nurses experiencing being morally constrained, facing moral dilemmas or moral doubt are included. Coercive administration of medicines, (...) coercion that might be avoided and resistance to the use of coercion are all morally stressful situations. Insufficient resources, mentally poorer patients and quicker discharges lead to superficial treatment. Few staff on evening shifts/weekends make nurses worry when follow-up of the most ill patients, often suicidal, in need of seclusion or with heightened risk of violence, must be done by untrained personnel. Provision of good care when exposed to violence is morally challenging. Feelings of inadequacy, being squeezed between ideals and clinical reality, and failing the patients create moral distress. Moral distress causes bad conscience and feelings of guilt, frustration, anger, sadness, inadequacy, mental tiredness, emotional numbness and being fragmented. Others feel emotionally ‘flat’, cold and empty, and develop high blood pressure and problems sleeping. Even so, some nurses find that moral stress hones their ethical awareness.ConclusionMoral distress in acute psychiatric care may be caused by multiple reasons and cause a variety of reactions. Multifaceted ethical dilemmas, incompatible demands and proximity to patients’ suffering make nurses exposed to moral distress. Moral distress may lead to reduced quality care, which again may lead to bad conscience and cause moral distress. It is particularly problematic if moral distress results in nurses distancing and disconnecting themselves from the patients and their inner selves. (shrink)

Acute myocardial infarction (AMI) is a common disease in the Western world and has been the topic of much research. Conducting clinical trials with patients in the acute phase of a myocardial infarction, however, poses an ethical challenge. As patients are often under extreme stress and require urgent medical attention, the process of informed consent is severely constrained. Furthermore, the very procedure of informed consent, which is supposed to protect eligible patients, may be a cause of harm in itself (...) due to the delay in the provision of therapy which it causes. This paper describes how physicians have dealt with the informed consent process in various AMI trials and summarizes the results from empirical studies of the consent process of such trials. Finally, the ethical issues and their implications for future trials involving this particular group of patients are discussed. (shrink)

The ideal of trust pervades nursing. This article uses empirical material from acute psychiatry that reveals that it is distrust rather than trust that is prevalent in this field. Our data analyses show how distrust is expressed in the therapeutic environment and in the relationship between nurse and patient. We point out how trust can nonetheless be created in an environment that is characterized by distrust. Both trust and distrust are exposed as `fragile' phenomena that can easily `tip over' towards (...) their opposites. Trust is not something that nurses possess or are given; it is rather something that they earn and have to work hard to achieve. Regarding themselves as potential causes of distrust and active wielders of power can contribute to nurses developing a more realistic view of their practice. Assuming a realistic middle-way perspective can help to manoeuvre between the extremities of excellence and resignation, which in turn can lead to processes that create trust between psychotic patients and nurses. (shrink)

As a clinical geneticist I have been amazed at the speed of discovery over the past 20 years. The specific genetic causes of thousands of rare genetic conditions have been defined due to improvements in genomic sequencing, computing power and international collaborations to phenotype individuals with similar clinical features. This knowledge has resulted in an increased ability to make accurate molecular diagnoses which informs optimal treatment and clinical care, can remove the need for unnecessary investigations and informs reproductive decision-making. However (...) for any given individual, this genetic testing can often take weeks or months before the initial genetic diagnosis is made within a family. Occasionally genetic information is required more quickly to define a clinical action. For years point of care testing has been a mainstay of clinical care, for example, in confirming pregnancy or monitoring blood glucose. I had been keen to explore scenarios where a genetic POCT could be employed in clinical practice. To me, an obvious example appeared to be neonatal testing to avoid gentamicin-induced hearing loss. Here was a situation where we had known about the genetic …. (shrink)

In this rapid commentary, a mini-review is given of the present state-of-knowledge regarding the etiology and epidemiology of the new coronavirus 2019-nCoV and the risks for developing Acute respiratory distress syndrome. The available knowledge on the viral genomics, molecular biology and pathogenicity of viruses of the Coronaviridae family and other Nidovirales, forms a helpful template for understanding the present pandemic outbreak. However, important questions remain unanswered about the underlying mechanism causing the very high case fatality ratios and mechanisms regarding severe (...) reactions like ARDS, fatal cardiac and renal failures, associated with a number of important comorbidity factors. Immunological reactions to lung alveoles in particular in late phase ARDS in SARS-like CoV diseases, so far may not have received enough attention. Finally a shortlist of questions for high priority further research is suggested. (shrink)

This critical reflection on the ethical concerns of current practice is underpinned by a systematic synthesis of current evidence focusing on why and how children are held or restrained for clinical procedures within acute care and the experiences of those present when a child is held against their wishes. Empirical evidence from a range of clinical settings internationally demonstrates that frequently children are held for procedures to be completed; younger children and those requiring procedures perceived as urgent are more likely (...) to be held. Parents and health professionals express how holding children for procedures can cause feelings of moral distress expressed as uncertainty, guilt and upset and that this act breaches the trusting and protective relationship established with children. Despite this, children's rights and alternatives to holding are not always respected or explored. Children's experiences and perceptions are absent from current literature. Children and young people have a moral right to have their voice and protests heard and respected and for these to inform judgements of their best interests and the actions of health professionals. Without robust evidence, debate and recognition that children are frequently held against their wishes in clinical practice for procedures which may not be urgent, children's rights will continue to be compromised. (shrink)

With the high frequency and intensity of worldwide disasters, cause-related marketing campaigns with sudden disasters are becoming increasingly popular. However, little is known about whether and how cause acuteness may influence consumer attitudes. This research aims to extend this research area through investigating the relationship between cause acuteness and consumer attitudes toward the product, as well as its underlying mechanism and boundary conditions. Based on a moral psychology perspective, we propose a theoretical model focusing on (...) the mediating role of moral elevation in influencing consumer attitudes. This model also incorporates product-cause fit and information transparency as moderators underpinning necessary conditions that are likely to lead to positive consumer attitudes. Four empirical studies were conducted to test our model. Our research results reveal that consumers have more positive attitudes toward the product associated with a sudden disaster than with an ongoing tragedy. Furthermore, the positive effect of cause acuteness on consumer attitudes is mediated by enhanced moral elevation, which occurs under the conditions of high product-cause fit and high information transparency. (shrink)

BackgroundAdvance directives imply the promise of determining future medical treatment in case of decisional incapacity. However, clinical practice increasingly indicates that standardized ADs often fail to support patients’ autonomy. To date, little data are available about the quality and impact of ADs on end-of-life decisions for incapacitated acute stroke patients.MethodsWe analyzed the ADs of patients with fatal stroke, focusing on: their availability and type, stated circumstances to which the AD should apply, and stated wishes regarding specific treatment options.ResultsBetween 2011 and (...) 2014, 143 patients died during their hospitalization on our stroke unit. Forty-two of them had a completed and signed, written AD, as reported by their family, but only 35 ADs were available. The circumstances in which the AD should apply were stated by 21/35 as a “terminal condition that will cause death within a relatively short time” or an ongoing “dying process.” A retrospective review found only 16 of 35 ADs described circumstances that, according to the medical file, could have been considered applicable by the treating physicians. A majority of patients objected to cardiopulmonary resuscitation, mechanical ventilation, and artificial nutrition, while almost all directed that treatment for alleviation of pain or discomfort should be provided at all times even if it could hasten death.ConclusionsThe prevalence of ADs among patients who die from acute stroke is still low. A major flaw of the ADs in our cohort was their attempt to determine single medical procedures without focusing on a precise description of applicable scenarios. Therefore, less than half of the ADs were considered applicable for severe acute stroke. These findings stress the need to foster educational programs for the general public about advance care planning to facilitate the processing of timely, comprehensive, and individualized end-of-life decision-making. (shrink)

Background: Thrombolytic drugs to treat an acute ischaemic stroke reduce the risk of death or major disability. The treatment is, however, also associated with an increased risk of potentially fatal intracranial bleeding. This confronts the patient with the dilemma of whether or not to take a risk of a serious side effect in order to increase the likelihood of a favourable outcome. Objective: To explore acute stroke patients’ perception of risk and willingness to accept risks associated with thrombolytic drug treatment. (...) Design: Eleven patients who had been informed about thrombolytic drug treatment and had been through the process of deciding whether or not to participate in a thrombolytic drug trial went through repeated qualitative, semistructured interviews. Results: Many patients showed a limited perception of the risks connected with thrombolytic drug treatment. Some perceived the risk as not relevant to them and were reluctant to accept that treatment could cause harm. Others seemed to be aware that treatment would mean exposure to risk. The patients’ willingness to take a risk also varied substantially. Several statements revealed ambiguity and confusion about being involved in a decision about treatment. The patients’ reasoning about risk was put into the context of their health-related experiences and life histories. Several patients wanted the doctor to be responsible for the decisions. Conclusion: Acute stroke patients’ difficulties in perceiving and processing information about risk may reduce their ability to be involved in clinical decisions where risks are involved. (shrink)

Most scholars of Islamic intellectual history now agree on the distortedness of the traditional Western portrayal of al-Ġazālī as the defender of Muslim orthodoxy whose Incoherence of the Philosophers was such a powerful critique that it caused the annihilation of philosophical activity in Islamic civilization. Some in fact are coming to the conclusion that al-Ġazālī's importance in the history of Islamic philosophy and theology derives as much from his assiduous incorporation of basic metaphysical ideas into central doctrines of Sunnī kalām (...) , as from his far more celebrated bashing of the falāsifa . What is less well known is that al-Ġazālī's role in the ‘‘philosophizing” of Sunnī theology was not a lonely struggle by a single genius, but part of a broader trend that seems to have begun during Avicenna’s lifetime and that picked up speed in the first and second generations after Avicenna's death in 1037, with the work of al-Ġazālī's teacher, the Aš‘arite al-Gˇuwaynī , as well as of the Māturīdite al-Bazdawī , work that was carried forward by dozens of subsequent members of those two major Sunnī theological schools. It is clear, in fact, that the dividing line between the Sunnī theologians commonly referred to in the later Islamic tradition as mutaqaddimūn , and those referred to as muta’a&hbrevu;h&hbrevu;irūn , lies not with al-Ġazālī but with Avicenna himself, and that the turn in Sunnī kalām was therefore Avicennian, not Ġazālian. (shrink)

Inflammatory mediators have an established role in inducing insulin resistance and promoting hyperglycemia. In turn, hyperglycemia has been argued to drive immune cell dysfunction as a result of mitochondrial dysfunction. Here, the authors review the evidence challenging this view. First, it is pointed out that inflammatory mediators are known to induce altered mitochondrial function. In this regard, critical care patients suffer both an elevated inflammatory tone as well as hyperglycemia, rendering it difficult to distinguish between the effects of inflammation and (...) hyperglycemia. Second, emerging evidence indicates that a decrease in mitochondrial respiration and an increase in reactive oxygen species (ROS) production are not necessarily manifestations of pathology, but adaptations taking shape as the mitochondria is abdicating its adenosine triphosphate (ATP)‐producing function (which is taken over by glycolysis) and instead becomes “retooled” for an immunological role. Collectively, these observations challenge the commonly held belief that acute hyperglycemia induces mitochondrial damage leading to immune cell dysfunction. (shrink)

Rousseau is considered to be at once the most modern political thinker of the 18th century and the most ancient in his allegiance to classical republicanism. These essays address the place of liberty in his moral and political philosophy, and the origins, meaning, strength, weakness and significance of his argument.

In the history of the Christian Church in general, and Ukraine in particular, Orthodox-Catholic relations occupy an extremely important place. The dramatic, as a fact of church and religious life, they attracted the attention of a large number of scholars of different fields of knowledge and research interests. Arsena Rychynsky, a well-known Ukrainian religious scholar whose views on the problem of unity of the Christian Church, overwhelmingly, are scientifically valid, meaningfully original and prognostically relevant. Under such a review, we would (...) like to update some of the researcher's provisions, which directly or indirectly correlate with the uniqueness in her Ukrainian expression. To this end, we recall that, by the exact definition of I. Lysyak-Rudnytsky, Ukraine is quite rightly considered a classic country of the unified tradition. Located on the border of the two worlds, by which we understand the Orthodox East and the Catholic West, it has become the subject of influence of both the Greek and Roman Churches, which, after all, has caused acute religious and religious events in Rus-Ukraine. inter-confessional controversy and repeated attempts at Orthodox-Catholic reconciliation, and even unification. (shrink)

Few issues cause academics to disagree more than gender and race, especially when topics are addressed in terms of biological differences. To conduct research in these areas or comment favorably on research can subject one to scorn. When these topics are addressed, they generally take the form of philosophical debates. Anthony Walsh focuses upon such debates and supporting research. He divides parties into biologists and social constructionists, arguing that biologists remain focused on laboratory work, while constructionists are acutely aware (...) of the impact of biologists in contested territories. "Science Wars" introduces the ideas motivating the parties and examines social constructionism and its issues with science. He explores arguments over conceptual tools scientists love and constructionists abhor, and he provides a solid discussion of the co-evolution of genes and culture. Walsh then focuses his attention on gender, how constructionists view it, and the neuroscience explanation of gender differences. Moving to race, Walsh looks at how some have tried to bury the concept of race, while others emphasize it. He considers definitions of race--essentialist, taxonomic, population, and lineage--as they have evolved from the time of the Enlightenment to the present. And finally, he attempts to bring the opposing sides together by pointing out what each can bring to a meaningful discussion. (shrink)

This paper examines the meaning of space and its relationship to value. In this paper, I draw on Henri Lefebvre to suggest that our ethics produce and are produced by spaces. Space is not simply a passive material container or neutral geographic location. Space includes the ideas on which buildings are modeled, the ordering of objects and movement patterns within the space, and the symbolic meaning of the space and its objects. Although often unrecognized, space itself is value-laden, and its (...) values are suggested as people interact within that space. By reflecting on the spaces of health care, we will see that we not only must attend to the quandaries caused by the delivery of health care in non-acute places, but also to the values that produce and are produced by spaces. These values influence our moral imagination and shape us as people. (shrink)

Excessive alcohol consumption can have adverse effects on health, and patients who suffer from alcohol use disorders are subject to much stigmatization. Nurses are often the first point of contact when patients enter the acute medical unit, and it is pivotal that this contact establishes the basis for future collaboration. The aim of this study is to elucidate nurses’ lived experience of providing care to patients suffering from alcohol use disorders. This present study has a qualitative research design, anchored in (...) phenomenological and hermeneutical methodology as described in reflective lifeworld research. Ten in‐depth, open‐ended interviews with nurses working in an acute medical unit were conducted. The analysis showed that providing care to patients suffering from alcohol use disorders was a highly complex task to accomplish. This required the nurse to engage with the patient in a sensitive cooperation in order to be dealing with the intricacy of the patient's life situation and balancing care between standardized procedures and the complexity of the patients. Further, a two‐sided feeling of responsibility emerged: a professional responsibility and a personal responsibility causing the provision of care as being caught between feelings of despondency and resignation. Nurses lack opportunities for being creative in determining how to provide care; instead, patients' perspectives of well‐being should be taken into account and should guide the provision of a meaningful care. Nurses must call for opportunities to deviate from the firmly established procedures restraining the care of this population. (shrink)

Acute starvation can have long-term consequences that are mediated through epigenetic change. Some of these changes are affected by the activity of AMP-activated protein kinase, a master regulator of cellular energy homeostasis. In Caenorhabditis elegans, the absence of AMPK during a period of starvation in an early larval stage results in developmental defects following their recovery on food, while many of them become sterile. Moreover, the loss of AMPK during this quiescent period results in transgenerational phenotypes that can become progressively (...) worse with each successive generation. Our recent data describe a chromatin-based mechanism of how AMPK mediates adjustment to acute starvation in the germ cells, however, the heritable aspect of this AMPK mutant phenotype remains unresolved. Here, we explore how AMPK might affect this process and speculate how the initial transcription that occurs in the germ cells may adversely affect subsequent germline gene expression and/or genomic integrity. AMPK protects germ cell integrity during acute starvation by blocking inappropriate transcription. How these aberrant transcripts cause transgenerational defects is unclear. AMPK likely regulates germline integrity at multiple levels through several targets. The authors speculate here how AMPK disruption during starvation could result in the observed defects seen at each generation. (shrink)

To counter the pandemic caused by severe acute respiratory syndrome coronavirus 2, some have proposed accelerating SARS-CoV-2 vaccine development through controlled human infection trials. These trials would involve the deliberate exposure of relatively few young, healthy volunteers to SARS-CoV-2. We defend this proposal against the charge that there is still too much uncertainty surrounding the risks of COVID-19 to responsibly run such a trial.

Diphtheria is an acute toxin-mediated superficial infection of the respiratory tract or skin caused by the aerobic gram-positive bacillus Corynebacterium diphtheriae. The epidemiology of infection and clinical manifestations of the disease vary in different parts of the world. Historical accounts of diphtheria epidemics have been described in many parts of the world since antiquity. Developed in the late 19th century, the diphtheria antitoxin played a pivotal role in the history of public health and vaccinology prior to the advent of the (...) diphtheria-tetanus toxoids and acellular pertussis vaccine. One of the most significant demonstrations of the importance of DAT was its use in the 1925 diphtheria epidemic of Nome, Alaska. Coordinated emergency delivery of this life-saving antitoxin by dog-sled relay in the harshest of conditions has left a profound legacy in the annals of vaccinology and public health. Lead dogs Balto and Togo, and the dog-led antitoxin run of 1925 represent a dynamic illustration of the contribution made by non-human species towards mass immunization in the history of vaccinology. This unique example of cooperative interspecies fellowship and collaboration highlights the importance of the human-animal bond in the one-health initiative. (shrink)

A recognition of the acutely terministic and agonistic character of philosophizing has led to the perception of a dilemma in philosophical debates: differing positions are capable of being maintained only at the expense of ‘mutual unintelligibility,’ and a real ‘contact of minds’ could never be achieved without one side of the controversy abandoning its position and the enabling argumentative tension ceasing to exist. This perception is sustainable, however, only if we continue to accept the assumption that a direct, unmediated confrontation (...) between disputants personifying two sets of rigidly defined terms is the mode of philosophical argumentation. A triadic rather than diadic conception of a typical debate between opposing schools of thought, which differentiates between the opponent and the audience, would address the theoretical misgivings caused by the perceived predicament. (shrink)

BackgroundThe phenomenon of ‘moral distress’ has continued to be a popular topic for nursing research. However, much of the scholarship has lacked conceptual clarity, and there is debate about what it means to experience moral distress. Moral distress remains an obscure concept to many clinical nurses, especially those outside of North America, and there is a lack of empirical research regarding its impact on nurses in the United Kingdom and its relevance to clinical practice.Research aimTo explore the concept of moral (...) distress in nursing both empirically and conceptually.MethodologyFeminist interpretive phenomenology was used to explore and analyse the experiences of critical care nurses at two acute care trauma hospitals in the United Kingdom. Empirical data were analysed using Van Manen’s six steps for data analysis.Ethical considerationsThe study was approved locally by the university ethics review committee and nationally by the Health Research Authority in the United Kingdom.FindingsThe empirical findings suggest that psychological distress can occur in response to a variety of moral events. The moral events identified as causing psychological distress in the participants’ narratives were moral tension, moral uncertainty, moral constraint, moral conflict and moral dilemmas.DiscussionWe suggest a new definition of moral distress which captures this broader range of moral events as legitimate causes of distress. We also suggest that moral distress can be sub-categroised according to the source of distress, for example, ‘moral-uncertainty distress’. We argue that this could aid in the development of interventions which attempt to address and mitigate moral distress.ConclusionThe empirical findings support the notion that narrow conceptions of moral distress fail to capture the real-life experiences of this group of critical care nurses. If these experiences resonate with other nurses and healthcare professionals, then it is likely that the definition needs to be broadened to recognise these experiences as ‘moral distress’. (shrink)

SignificanceElectrical burns can cause severe damage to the nervous system, resulting in autonomic dysfunction with reduced cerebral perfusion. However, few studies have investigated these consequences.AimTo elucidate changes in prefrontal cerebral hemodynamics using functional near-infrared spectroscopy (fNIRS) during the head-up tilt table test (HUT) for patients with electrical burns.ApproachWe recruited 17 patients with acute electrical burns within 1 week after their accidents and 10 healthy volunteers. The NIRS parameters acquired using an fNIRS device attached to the forehead were analyzed in (...) five distinct HUT phases.ResultsBased on their HUT response patterns, patients with electrical burns were classified into the group with abnormal HUT results (APG, n = 4) or normal HUT results (NPG, n = 13) and compared with the healthy control (HC, n = 10) participants. We found trends in hemodynamic changes during the HUT that distinguished HC, NPG, and APG. Reduced cerebral perfusion and decreased blood oxygenation during the HUT were found in both the NPG and APG groups. Patients with electrical burns had autonomic dysfunction compared to the HC participants.ConclusionsUsing fNIRS, we observed that acute-stage electrical burn injuries could affect cerebral perfusion. (shrink)

Purpose ‐ The purpose of this paper is to explore the "resource curse" problem as a counter-example of creative performance and innovation by examining reliance on capital and physical resources, showing the gap between expectations and ex-post actual performance that became clearer under conditions of economic turmoil. Design/methodology/approach ‐ The analysis uses logistic regressions with dichotomous response and predictor variables on structured tables of count data, representing firm performance as an outcome of capital resources, physical resources and innovation where appropriate. (...) Findings ‐ Key findings relevant to economic and business practice follow. First, a typical characteristic of successful Vietnamese firms in the transition period is their reliance on either capital resources or physical asset endowments. Second, poor performers exhibit evidence of over-reliance on both capital and physical assets. Third, firms that relied on both types of resources tended to downplay creative performance. Some evidence suggests that firms face more acute problem caused by the law of diminishing returns in troubled times. Fourth, the "innovation factor" has not been tapped as a source of economic growth. Research limitations/implications ‐ This study has some limitations. The size of the survey sample is approximately 150 firms, while the potential sample of > 300 should be possible in the future. When the size increases, the research could be expanded to include further variables that will help investigate more deeply into the related issues and business implications. With regard to the implications of the study, the absence of innovations has made the notion of "resource curse" identical to "destructive creation" implemented by ex-ante resource-rich firms, and worsened the problem of resource misallocation in transition turmoil. The Vietnamese corporate sector's addiction to resources may contribute to economic deterioration, through a downward spiral of lower efficiency leading to consumption of more resources. Practical implications ‐ Insights obtained from this study could save transition economies' resources which have almost always been considered sine qua non before any critical major policymaking, while this is not necessarily true, and in many cases, even counterproductive. Originality/value ‐ Original data set on Vietnam stock market are collected, processed, prepared and used by the authors. Original design by the authors for regression equations with dichotomous predictor variables: dependence on endowed physical assets, reliance on capital resources and significant signs of creative performance/innovations. Original idea of viewing "resource curse" as absence of innovation and due to uncreative "destructive creation" of poor-performing commercial operations by resource-rich firms is used in the paper. We have searched the literature in business research and found that the empirical results have not been previously reported. (shrink)

Increased technological and pharmacological interventions in patient care when patient outcomes are uncertain have been linked to the escalation in moral and ethical dilemmas experienced by health care providers in acute care settings. Health care research has shown that facilities that are able to attract and retain nursing staff in a competitive environment and provide high quality care have the capacity for nurses to process and resolve moral and ethical dilemmas. This article reports on the findings of a systematic review (...) of the empirical literature (1980 — February 2007) on the effects of unresolved moral distress and poor ethical climate on nurse turnover. Articles were sought to answer the review question: Does unresolved moral distress and a poor organizational ethical climate increase nurse turnover? Nine articles met the criteria of the review process. Although the prevailing sentiment was that poor ethical climate and moral distress caused staff turnover, definitive answers to the review question remain elusive because there are limited data that confidently support this statement. (shrink)

One objection to enhancement technologies is that they might lead us to live inauthentic lives. Memory modification technologies (MMTs) raise this worry in a particularly acute manner. In this paper I describe four scenarios where the use of MMTs might be said to lead to an inauthentic life. I then undertake to justify that judgment. I review the main existing accounts of authenticity, and present my own version of what I call a “true self” account (intended as a complement, rather (...) than a substitute, to existing accounts). I briefly describe current and prospective MMTs, distinguishing between memory enhancement and memory editing . Moving then to an assessment of the initial scenarios in the light of the accounts previously described, I argue that memory enhancement does not, by its very nature, raise serious concerns about authenticity. The main threat to authenticity posed by MMTs comes, I suggest, from memory editing. Rejecting as inadequate the worries about identity raised by the President’s Council on Bioethics in Beyond Therapy , I argue instead that memory editing can cause us to live an inauthentic life in two main ways: first, by threatening its truthfulness, and secondly, by interfering with our disposition to respond in certain ways to some past events, when we have reasons to respond in such ways. This consideration allows us to justify the charge of inauthenticity in cases where existing accounts fail. It also gives us a significant moral reason not to use MMTs in ways that would lead to such an outcome. (shrink)

Although much of its history has been neglected or misunderstood, a structuralist 'tendency' has re-emerged within the philosophy of science. Broadly speaking, it consists of two fundamental strands: on the one hand, there is the identification of structural commonalities between theories; on the other, there is the metaphysical decomposition of objects in structural terms. Both have been pressed into service for the realist cause: the former has been identified primarily with Worrall's 'epistemic' structural realism; the latter with Ladyman's 'ontic' (...) form. And both raise important issues of general interest within the philosophy of science and metaphysics, respectively. The former invites questions regarding the identification and appropriate representation of these commonalities; the latter touches on different views regarding the nature of objects, the constitutive role of properties and the seat of causal powers. Both strands have recently come under critical fire. It is my intention to present a unified account of the 'structuralist tendency' which emphasizes the dual roles of structure as representational and constitutive, and to indicate how the more acute critical remarks can be dealt with. (shrink)

Background:Moral distress occurs when constraints prevent healthcare providers from acting in accordance with their core moral values to provide good patient care. The experience of moral distress in nurses might be magnified during the current Covid-19 pandemic.Objective:To explore causes of moral distress in nurses caring for Covid-19 patients and identify strategies to enhance their moral resiliency.Research design:A qualitative study using a qualitative content analysis of focus group discussions and in-depth interviews. We purposively sampled 31 nurses caring for Covid-19 patients in (...) the acute care units within large academic medical systems in Maryland and New York City during April to June 2020.Ethical considerations:We obtained approval from the Institutional Review Board at the University of Maryland, Baltimore.Results:We identified themes and sub-themes representative of major causes of moral distress in nurses caring Covid-19 patients. These included (a) lack of knowledge and uncertainty regarding how to treat a new illness; (b) being overwhelmed by the depth and breadth of the Covid-19 illness; (c) fear of exposure to the virus leading to suboptimal care; (d) adopting a team model of nursing care that caused intra-professional tensions and miscommunications; (e) policies to reduce viral transmission (visitation policy and PPE policy) that prevented nurses to assume their caring role; (f) practicing within crisis standards of care; and (g) dealing with medical resource scarcity. Participants discussed their coping mechanisms and suggested future strategies.Discussion/Conclusion:Our study affirms new causes of moral distress related to the Covid-19 pandemic. Institutions need to develop a supportive ethical climate that can restore nurses’ moral resiliency. Such a climate should include non-hierarchical interdisciplinary spaces where all providers can meet together as moral peers to discuss their experiences. (shrink)

-/- Although much of its history has been neglected or misunderstood, a structuralist ‘tendency’ has re-emerged within the philosophy of science. Broadly speaking, it consists of two fundamental strands: on the one hand, there is the identification of structural commonalities between theories; on the other, there is the metaphysical decomposition of objects in structural terms. Both have been pressed into service for the realist cause: the former has been identified primarily with Worrall's ‘epistemic’ structural realism; the latter with Ladyman's (...) ‘ontic’ form. And both raise important issues of general interest within the philosophy of science and metaphysics, respectively. The former invites questions regarding the identification and appropriate representation of these commonalities; the latter touches on different views regarding the nature of objects, the constitutive role of properties and the seat of causal powers. Both strands have recently come under critical fire. It is my intention to present a unified account of the 'structuralist tendency’ which emphasizes the dual roles of structure as representational and constitutive, and to indicate how the more acute critical remarks can be dealt with. (shrink)

Debate over whether health care institutions or individual providers should have a legally protected right to conscientiously refuse to offer legal services to patients who request them has grown exponentially due to the increasing legalization of morally contested services. This debate is particularly acute for Catholic health care providers. We elucidate Catholic teaching regarding the nature of conscience and the intrinsic value of being free to act in accord with one’s conscience. We then outline the primary positions defended in this (...) debate and respond to critics of Catholic teaching. In so doing, we show how Catholic health care providers’ claims to conscientiously refuse to offer specific health care services are not essentially faith-based, but are founded upon publicly defensible reasons. We also address the question of whether conscientiously refusing health care providers may become complicit in moral wrongdoing or potentially cause scandal by means of disclosure or referral to another provider. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 9.3 (2002) 265-269 [Access article in PDF] The Psychology and Physiology of Depression Walter Glannon Trauma and stressful events can disrupt the physiologic homeostasis of our bodies and brains. The physiologic stress response consists of neural and endocrine mechanisms whose function is to reestablish homeostasis. These mechanisms include the secretion of glucocorticoids (cortisol) and catecholemines (epinephrine and norepinephrine). Once an external event has ceased to (...) be a stressor or threat to a human organism, an integrated system of negative feedback loops inhibits the continued production of these hormones and effectively shuts down the stress response. These mechanisms are adaptive in the sense that they ensure the survival of the organism by reestablishing homeostasis. But prolonged exposure to real or perceived stressors can trigger prolonged secretion of stress hormones, thereby disrupting the feedback systems and causing a cascade of pathogenic events. The stress response is a double-edged sword. An acute stress response can protect an organism from external threats and reestablish homeostasis. But a chronic stress response can cause the body's defenses to become damaging rather than protective and to result in various disorders. Acute stress responses are adaptive. Chronic stress responses are often maladaptive and pathogenic.In "Depression as a Mind-Body Problem," I characterized major clinical depression as a disorder resulting from a maladaptive chronic stress response (Glannon 2003). Specifically, I argued that depression often results when our beliefs and emotions are out of proportion to the true nature of external events. The mind prolongs rather than constrains the physiologic stress response. Depression is not a disorder of the brain alone or the mind alone, however. Endocrine and immune dysfunction can contribute to the dysfunction in the brain and central nervous system that are involved in depression. Moreover, the contents of the mental states that initiate the sequence of events leading to depression are reflections of the person's natural and social environment. Thus, a satisfactory account of depression requires an analysis of the interconnections among the central nervous, endocrine, and immune systems, as well as the mind and the environment. All of these factors support the description of depression as a psychoneuroimmunologic disorder.Mike Martin (Martin 2003) and Thomas Fuchs (Fuchs 2003) discuss important aspects of depression that I did not elaborate in my paper. Martin argues that I fail to distinguish between depression as a mood and depression as a disorder. This is pertinent to the distinction evolutionary psychiatrists draw between moods that are adaptive and moods that are maladaptive. In contrast to my negative characterization of depression, Martin also makes a case for the positive [End Page 265] contributions of depression to meaningful life. Fuchs explores the notion of the brain as an organ of translation enabling patients to have meaningful subjective experience. The emphasis on subjectivity has important implications for potential preventive and therapeutic interventions for depression. For whether a person perceives an external event as a stressor may play a crucial role in the physiologic stress response. I will address the main points of these two authors in turn.Contrary to what Martin claims, I explicitly defined chronic depression as an affective (mood) disorder. My focus was on the clinical definition of major depression as a moderately severe to severe chronic disorder. It consists of affective, cognitive, and even physical dysfunction that interferes with a person's ability to carry out the normal tasks of daily life. This characterization of major chronic depression distinguishes it from milder forms of depression, such as dysthymia. Because these milder forms do not involve the same type or degree of dysfunction as more severe forms, they are not appropriately characterized as pathologies. For this reason, I focused on Nesse's (2000) discussion of depression rather than on his discussion of low mood. In fairness to Nesse and Stevens and Price (2000), not all forms of depression are pathologic according to the evolutionary view they defend. Some passive aspects of mild depression may be useful in alerting us to dangerous or wasteful behavior. It does seem plausible to describe depressed moods as falling along a continuum from those that... (shrink)

Individuals with body integrity identity disorder seek to address a non-delusional incongruity between their body image and their physical embodiment, sometimes via the surgical amputation of healthy body parts. Opponents to the provision of therapeutic healthy-limb amputation in cases of BIID make appeals to the envisioned harms that such an intervention would cause, harms such as the creation of a lifelong physical disability where none existed before. However, this concept of harm is often based on a normative biomedical model (...) of health and disability, a model which conflates amputation with impairment, and impairment with a disability. This article challenges the prima facie harms assumed to be inherent in limb amputation and argues in favour of a potential treatment option for those with BIID. To do this, it employs the social model of disability as a means to separate the concept of impairment and disability and thereby separate the acute and chronic harms of the practice of therapeutic healthy-limb amputation. It will then argue that provided sufficient measures are put in place to ensure that those with atypical bodily constructions are not disadvantaged, the chronic harms of elective amputation would cease to be. (shrink)

Individuals with body integrity identity disorder seek to address a non-delusional incongruity between their body image and their physical embodiment, sometimes via the surgical amputation of healthy body parts. Opponents to the provision of therapeutic healthy-limb amputation in cases of BIID make appeals to the envisioned harms that such an intervention would cause, harms such as the creation of a lifelong physical disability where none existed before. However, this concept of harm is often based on a normative biomedical model (...) of health and disability, a model which conflates amputation with impairment, and impairment with a disability. This article challenges the prima facie harms assumed to be inherent in limb amputation and argues in favour of a potential treatment option for those with BIID. To do this, it employs the social model of disability as a means to separate the concept of impairment and disability and thereby separate the acute and chronic harms of the practice of therapeutic healthy-limb amputation. It will then argue that provided sufficient measures are put in place to ensure that those with atypical bodily constructions are not disadvantaged, the chronic harms of elective amputation would cease to be. (shrink)

Individuals with body integrity identity disorder seek to address a non-delusional incongruity between their body image and their physical embodiment, sometimes via the surgical amputation of healthy body parts. Opponents to the provision of therapeutic healthy-limb amputation in cases of BIID make appeals to the envisioned harms that such an intervention would cause, harms such as the creation of a lifelong physical disability where none existed before. However, this concept of harm is often based on a normative biomedical model (...) of health and disability, a model which conflates amputation with impairment, and impairment with a disability. This article challenges the prima facie harms assumed to be inherent in limb amputation and argues in favour of a potential treatment option for those with BIID. To do this, it employs the social model of disability as a means to separate the concept of impairment and disability and thereby separate the acute and chronic harms of the practice of therapeutic healthy-limb amputation. It will then argue that provided sufficient measures are put in place to ensure that those with atypical bodily constructions are not disadvantaged, the chronic harms of elective amputation would cease to be. (shrink)

Individuals with body integrity identity disorder seek to address a non-delusional incongruity between their body image and their physical embodiment, sometimes via the surgical amputation of healthy body parts. Opponents to the provision of therapeutic healthy-limb amputation in cases of BIID make appeals to the envisioned harms that such an intervention would cause, harms such as the creation of a lifelong physical disability where none existed before. However, this concept of harm is often based on a normative biomedical model (...) of health and disability, a model which conflates amputation with impairment, and impairment with a disability. This article challenges the prima facie harms assumed to be inherent in limb amputation and argues in favour of a potential treatment option for those with BIID. To do this, it employs the social model of disability as a means to separate the concept of impairment and disability and thereby separate the acute and chronic harms of the practice of therapeutic healthy-limb amputation. It will then argue that provided sufficient measures are put in place to ensure that those with atypical bodily constructions are not disadvantaged, the chronic harms of elective amputation would cease to be. (shrink)

Multiple generality has long been known to cause confusion. For example, “Everyone has a donkey that is running” has two readings: either (i) there is a donkey, owned by everyone, and it is running; or (ii) everyone owns some donkey or other, and all such donkeys run. Medieval logicians were acutely aware of such ambiguities, and the logical problems they pose, and sought to sort them out. One of the most ambitious undertakings in this regard is a pair of (...) massive diagrams (magnae figurae) which map out the logical interrelations of two sets of doubly-general forms. These appear in a fourteenth-century MS of John Buridan’s Summulae de Propositionibus. In this paper, I present these diagrams, and determine the truth conditions of their different forms. To that end, I have developed a bespoke system of diagrams to display their truth conditions. As we will see, such forms present significant difficulties for an all-encompassing account of the role form plays in logic. Accordingly, they can tell us important things about the role logical form plays in Buridan’s account of logical foundations. (shrink)

A central figure in Victorian science, William Whewell held professorships in Mineralogy and Moral Philosophy at Trinity College, Cambridge, before becoming Master of the college in 1841. His mathematical textbooks, such as A Treatise on Dynamics, were instrumental in bringing French analytical methods into British science. This three-volume history, first published in 1837, is one of Whewell's most famous works. Taking the 'acute, but fruitless, essays of Greek philosophy' as a starting point, it provides a history of the physical sciences (...) that culminates with the mechanics, astronomy, and chemistry of 'modern times'. Volume 2 focuses on the rise and development of modern mechanics in the seventeenth century. Whewell shows how Galileo's laws of motion exemplify a paradigmatic shift from 'formal' to 'physical' sciences - a new approach concerned with explaining causes rather than merely observing phenomena. It also discusses the implications for physical astronomy of Newton's discoveries. (shrink)

Vietnam, with a geographical proximity and a high volume of trade with China, was the first country to record an outbreak of the new Coronavirus disease (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 or SARS-CoV-2. While the country was expected to have a high risk of transmission, as of April 4, 2020—in comparison to attempts to contain the disease around the world—responses from Vietnam are being seen as prompt and effective in protecting the interests of its citizens, (...) with 239 confirmed cases and no fatalities. This study analyzes the situation in terms of Vietnam’s policy response, social media and science journalism. A self-made web crawl engine was used to scan and collect official media news related to COVID-19 between the beginning of January and April 4, yielding a comprehensive dataset of 14,952 news items. The findings shed light on how Vietnam—despite being under-resourced—has demonstrated political readiness to combat the emerging pandemic since the earliest days. Timely communication on any developments of the outbreak from the government and the media, combined with up-to-date research on the new virus by the Vietnamese science community, have altogether provided reliable sources of information. By emphasizing the need for immediate and genuine cooperation between government, civil society and private individuals, the case study offers valuable lessons for other nations concerning not only the concurrent fight against the COVID-19 pandemic but also the overall responses to a public health crisis. (shrink)

The ethical question is whether university mask mandates should be relaxed. I argue that the use of face masks by healthy individuals has uncertain benefits, which potential harms may outweigh, and should therefore be voluntary. Systematic reviews by the World Health Organization (WHO) and Cochrane Acute Respiratory Infections concluded that the use of face masks by healthy individuals in the community lacks effectiveness in reducing viral transmission based on moderate-quality evidence. The only two randomized controlled trials of face masks published (...) during the pandemic found little to no benefit. Without high-quality evidence, it is difficult to justify a requirement rather than a recommendation. Notwithstanding, one might argue that the precautionary principle justifies mask mandates. If the precautionary principle can justify implementing mask mandates due to the risk of forgoing possible benefit, then it might also be able to justify not implementing mask mandates due to the risk of potential harm caused by the intervention. It is commonly thought that there is little to lose from the use of face masks, but this is not necessarily true. It is possible that masks have done more harm than good. (shrink)

The novel coronavirus – officially named severe acute respiratory syndrome coronavirus 2, causing a disease which has flu-like symptoms – seems to be responsible for the current global lockdown or maybe one can even refer to it as a global event. Neither the virus nor the disease that it causes is truly novel, as the virus is part of the SARS virus family and therefore known, and likewise the symptoms of the disease are also well known, even flu-like, and therefore (...) also not novel. Yet, what is truly novel about the virus or the disease it causes is its effect, not specifically referring to the health effect, but its global socio-economic and political effect. It is for the first time in the history of humanity that such drastic global lockdown measures have been taken and that governments have taken the conscious decisions to ‘lay lame’ their economies. Such a radical decision is truly novel. Besides the economic ‘lockdown’, there are numerous socio-economic repercussions; for example, in a single day, millions of citizens in the United States file for unemployment, and similarly in many other countries. Covid-19 is a challenge to the economies of the world, to society at large, to the poor and vulnerable in particular, and to individuals who are ‘locked safely’ in their homes. Religious institutions, which traditionally provide collective meaning, can no longer gather in public places, and offer communal solace. Covid-19 maybe challenges what being human means, or at least, what one has come to believe concerning the meaning of being human. In this article, this question of being human in the time of Covid-19 will be explored. (shrink)

The ethical obligation to provide a reasonably safe discharge option from the inpatient setting is often confounded by the context of homelessness. Living without the security of stable housing is a known determinant of poor health, often complicating the safety of discharge and causing unnecessary readmission. But clinicians do not have significant control over unjust distributions of resources or inadequate societal investment in social services. While physicians may stretch inpatient stays beyond acute care need in the interest of their patients (...) who are experiencing homelessness, they must also consider the implications of using an inpatient hospital bed for someone without the attendant level of medical need. Caring for patients in an inpatient setting when they no longer require acute care means fewer beds for acute care patients. And when a patient who is experiencing homelessness declines a medically safer option such as a skilled nursing facility, then clinicians may be faced with the sole option of discharge to the street, which raises troubling questions of nonmaleficence and social justice. Here we investigate the different forms of injustice that play out when patients are discharged to the street, and offer a map of the interwoven ethical responsibilities of clinicians, hospitals, and skilled nursing facilities. (shrink)