We focus on the production of efficient descriptions of objects, actions and events. We define a type of efficiency, textual economy, that exploits the hearer’s recognition of inferential links to material elsewhere within a sentence. Textual economy leads to efficient descriptions because the material that supports such inferences has been included to satisfy independent communicative goals, and is therefore overloaded in the sense of Pollack [18]. We argue that achieving textual economy imposes strong requirements on the representation and reasoning used (...) in generating sentences. The representation must support the generator’s simultaneous consideration of syntax and semantics. Reasoning must enable the generator to assess quickly and reliably at any stage how the hearer will interpret the current sentence, with its (incomplete) syntax and semantics. We show that these representational and reasoning requirements are met in the SPUD system for sentence planning and realization. (shrink)

We investigated the coupling between a speaker's and a listener's eye movements. Some participants talked extemporaneously about a television show whose cast members they were viewing on a screen in front of them. Later, other participants listened to these monologues while viewing the same screen. Eye movements were recorded for all speakers and listeners. According to cross-recurrence analysis, a listener's eye movements most closely matched a speaker's eye movements at a delay of 2 sec. Indeed, the more closely a (...) listener's eye movements were coupled with a speaker's, the better the listener did on a comprehension test. In a second experiment, low-level visual cues were used to manipulate the listeners' eye movements, and these, in turn, influenced their latencies to comprehension questions. Just as eye movements reflect the mental state of an individual, the coupling between a speaker's and a listener's eye movements reflects the success of their communication. (shrink)

Chronic kidney failure is a serious somatic disease. Addressing the issue of living with a chronic disease means fully considering the patients’ entourage, their families, and those close to them, especially their children and spouses.Objectives: The present paper focuses on the couple’s psychological experience when one of them suffers from a chronic disease, in this instance kidney disease. In particular, how is the spouse affected by the treatment provided? The aim is not only to see how care for sick (...) people can be improved, but also, more specifically, how relatives and especially partners can receive attention.Methodology: A qualitative approach is not only adopted, being based on the psychotherapeutic follow-up of the partners of patients with chronic kidney disease, but also of the patients themselves, addressing the matter of their life as a couple. Three couples were considered, and two case studies are presented here. The issues that cut across these different situations are examined.Results and Discussion: Some couples show considerable resourcefulness. However, over the years, that capacity for adaptation and inventiveness can also be interrupted by the periods of greater suffering and even despair, especially when the somatic pathology becomes chronic. Many spouses talk about how living with a sick partner weighs down on them, causing severe fatigue. Some aspects of the illness can also become traumatic. The disease regularly disrupts the daily life of the couple and the family. This leads to a reworking of family relations. Each couple has its own history with the condition. As it emerges, it can disrupt the bonds of filiation, especially when the illness is hereditary. Making psychological care more accessible to the partners involved constitutes a major challenge for our hospital care systems. (shrink)

Based on socioeconomic statistical data, transport data, and network big data, the urban connection index was constructed in terms of industry, transportation, information, and innovation, and the high-quality development index was established from five aspects: innovation, coordination, green development, openness, and sharing. Taking Lanzhou-Xining urban agglomeration as a case, the urban connection intensity and high-quality development level were measured to analyze the relationship between them. From 2012 to 2018, the UCI and HDI of each city showed different degrees of growth. (...) Note that there exist significant regional differences, with Lanzhou and Xining having the largest difference. The biggest gap among cities lies in the innovative connection intensity. Moreover, urban external connections are closely related to high-quality development, especially innovation and green development. For every 1% increase in industrial and transport connection, the HDI will increase by 0.317% and 0.159%, respectively. This study provides a methodological reference for measuring urban connectivity and provides decision support for high-quality development in China and other countries. (shrink)

editorial changes not yet reviewed by author Purpose My intent in this essay is to reflect on the history of some biological notions such as autopoiesis, structural coupling, and cognition, that I have developed since the early 1960’s as a result of my work on visual perception and the organization of the living. No doubt I shall repeat things that I have said in other publications (Maturana and Varela 1980 and 1988), and I shall present notions that once they (...) are said appear as obvious truisms. But the reader it is not invited to attend to the truisms, rather he or she is invited to attend to the consequences that they entail for the understanding of biological processes. After all, explanations or demonstrations always become self evident once they are understood and accepted. KEYWORDS Autopoiesis, structural coupling, cognition, explanations, self consciousness, 1. Autopoiesis 1.1 Origins of the notion In November 1960, a first year medical student asked me the question “What began three thousand eight hundred million years ago so that you can say now that living systems began then?” I realized that I could not properly answer that question, so I said “I cannot answer this question now, but if you come back next year I shall propose an answer then.” Thus I accepted the question of the student to be answered later, and as I did so, I accepted also the question for myself. I realized that to answer this question I had to create a living system, either conceptually or practically, because I had to be able to say what kind of systems were living system to be able to say how they began. While in the attempting to answer the dual questions of what kind of systems are living systems, and of how did they begin so that I could now speak of their origin, it became obvious to me that living systems exist as autonomous entities in the form of self contained closed molecular dynamics of self production, open to the flow of molecules through them. Indeed, one can say that living systems arose in the history of the earth in the moment in which some spontaneous networks of molecular autocatalytic processes became closed upon themselves.. (shrink)

Breast cancer treatments have multiple adverse effects, including concerns about body appearance and function that are experienced by most patients. Altered body image negatively affects mental health, social, and relationship functioning. While the relationship with a partner is critical for patients’ psychological wellbeing and partners can promote positive body image, limited research has investigated individual and relational factors affecting the experience of both. This cross-sectional study aimed at exploring rates of body image concerns among breast cancer patients, and identifying dyadic (...) profiles among participating dyads. Couples composed by patients who had undergone surgery and their romantic partners were recruited from the Breast Unit of a hospital in northern Italy. Both partners completed measures of personality characteristics, psychological distress, coping flexibility, dyadic coping, and closeness. Body image and adjustment to cancer measures were completed by patients only. K-mean cluster analyses identified 2-cluster solution among patients and partners, respectively. “Active patients” reported low rates of body image concerns, anxious preoccupation, negative dyadic coping, and self-oriented stress communication, compared to “worried patients”. “Comfortable partners” reported lower anxiety and depression, self-oriented negative dyadic coping and closeness than “uncomfortable partners”. Three different dyadic profiles emerged: functional, dysfunctional, and ambivalent. Significant variations by anxiety, depression, and delegating dyadic coping existed. Results indicate there are groups of couples at greater risk for impaired psychological distress and body image concerns, which should be addressed in the context of dyadic psychosocial interventions. (shrink)

ObjectiveBreast cancer may profoundly affect a couple’s sex life. The present study examines whether patient-, partner- and relationship-related characteristics are associated with sexual activity of couples following breast cancer diagnosis in the treatment phase and over time.MethodsWomen with breast cancer and their male cohabiting partners participated in a longitudinal study in Denmark. Logistic regression was used to examine associations of patient-, partner- and relationship-related characteristics at baseline with couples’ sexual activity at baseline, 5 and 12 months later. The longitudinal analyses (...) were stratified for couples’ sexual activity status at baseline.ResultsA total of 722, 533 and 471 couples were included in the analyses at baseline, 5- and 12-months follow-up, respectively. Older age, depressive symptoms and lower vitality of patients were associated with lower odds of couples’ sexual activity at baseline; chemotherapy treatment and older age of patients were associated with lower odds at 5-months follow-up in couples who were not sexually active at baseline. Higher ratings of emotional closeness, affectionate behavior and satisfaction with dyadic coping were associated with higher odds for sexual activity at baseline and over time in couples who were sexually active at baseline.ConclusionSexual counseling during cancer treatment and rehabilitation should include a couple perspective. Relationship-related variables may be a protective factor for remaining sexually active after breast cancer diagnosis. Interventions could focus on strengthening these factors. Health professionals also need to consider the patients’ breast cancer treatment, vitality, and emotional distress in counselling on sexuality. (shrink)

We consider scenarios with distributed decision processes, e.g., coupled majorities and personal union in parliament chambers, supranational decisions and supervisory boards. When computing the adoption rate for reaching a decision in these scenarios, multiple linear inequality restrictions in combinatorial countings are present. These rates cannot be computed in closed form. We introduce a general method for incorporating multiple inequality conditions in multiple majority decisions, which significantly reduces the number of involved summations and removes restrictions on the summation indices. Exact solutions (...) are provided through integral representations which can be evaluated numerically, and unrestricted, contracted sums over discrete events. Further, we provide methods to reduce the number of necessary summations by splitting or recurring the original problem to easier sub-problems. For five dedicated scenarios, full results are given which indeed require a single unrestricted summation only. (shrink)

The aim of this research was to examine the mediatization on the level of social relationships, and to figure out which impact media has on the everyday life of couples. A theoretical framework is gathered which is based on the concept of mediatization as background and is applying theoretical approaches on everyday life and close relationships. The empirical study was carried out with 10 couples in order to gain a contextualized description of partners' everyday life communication. The results picture (...) media communication as an integrative part of couples' communicative repertoires and the mediatization of partners' sharing everyday life conduct. Furthermore, the findings show processes of intensification of partners' mental representations related to communicative practices established via digital media. (shrink)

Background/ObjectiveSeveral studies have examined the impact of Parkinson’s disease on the quality of couples’ relationships. To date, few studies have explored how couples experience their relationship dynamic by taking into account the disease stage. The objectives of this study were to understand the experience of each partner and to study the mechanisms that underlie their couple organization in the advanced stage of PD.MethodsSemistructured individual interviews conducted with fifteen patients and their partners were the subject of a dyadic interpretative phenomenological analysis.ResultsThree (...) themes were identified from the analysis: the first, “A Closeness That Separates,” allows the identification of different patterns of interactions that lead to emotional distancing between the partners; the second, “The Adversity Is Not Unbearable, But Going It Alone Would Be,” emphasizes the importance of how the assisting partner provides support; and the third, “Be Prepared for Anything and Facing an Uncertain Future,” reveals the extent and modes of the dyadic regulation of the emotions linked to what the future may hold.ConclusionPsychological support is important to help couples express both their feelings and their respective needs in the evolving context of PD. (shrink)

Identifying biomarkers of developing mental disorder is crucial to improving early identification and treatment—a key strategy for reducing the burden of mental disorders. Cross-frequency coupling between two different frequencies of neural oscillations is one such promising measure, believed to reflect synchronization between local and global networks in the brain. Specifically, in adults phase–amplitude coupling (PAC) has been shown to be involved in a range of cognitive processes, including working and long-term memory, attention, language, and fluid intelligence. Evidence suggests (...) that increased PAC mediates both temporary and lasting improvements in working memory elicited by transcranial direct-current stimulation and reductions in depressive symptoms after transcranial magnetic stimulation. Moreover, research has shown that abnormal patterns of PAC are associated with depression and schizophrenia in adults. PAC is believed to be closely related to cortico-cortico white matter (WM) microstructure, which is well established in the literature as a structural mechanism underlying mental health. Some cognitive findings have been replicated in adolescents and abnormal patterns of PAC have also been linked to ADHD in young people. However, currently most research has focused on cross-sectional adult samples. Whereas initial hypotheses suggested that PAC was a state-based measure due to an early focus on cognitive, task-based research, current evidence suggests that PAC has both state-based and stable components. Future longitudinal research focusing on PAC throughout adolescent development could further our understanding of the relationship between mental health and cognition and facilitate the development of new methods for the identification and treatment of youth mental health. (shrink)

This paper presents an implementation of two radically different control schemes for a state-coupled two-tank liquid-level system. This is due to the purpose of transferring theoretical studies to industrial systems. The proposed schemes to be introduced and compared are the nonsingular terminal sliding mode control and the backstepping control. The performances of the developed methods are experimentally tested on a particular class of second-order nonlinear systems. The main purpose of the considered control schemes is to achieve a tracking trajectory for (...) a coupled-tank system. It is proved that the designed robust controllers guarantee the stability of the corresponding closed loop systems. The obtained results are verified with the same setup test to ensure a suitable basis for their comparison. During the experiments, we resorted to adding an integrator to the backstepping control so that we improve the results, leading to the appearance of the integrator backstepping control. To focus on the adequacy and applicability of the suggested control layout, theoretical comparisons as well as experimental results are afforded and debated. (shrink)

Because of the impact of close partner's touch on psychological and physical well-being by alleviating stress, it is important to explore the influence factors that underlie the stress-alleviating effect of close partner's touch. Previous studies suggested that the stress-alleviating effect was different when individuals were touched by different persons. Specifically, the stress was reduced significantly when the individual was touched by the close partner compared with the acquaintance and the stranger. However, whether the stress-alleviating effect of touch (...) was modulated by the close relationship quality is unknown. To examine this question, the participants performed a 3 × 2 within-subjects experiment. The results revealed that the stress of the participants alleviated significantly while close partners present with touch compared with without touch during facing a threat. We also found that the relationship quality of couple-members modulated touch-induced stress alleviation. Participants perceiving the low quality of alternatives and the high partners' commitment level showed stronger touch-induced stress-alleviating effect than participants perceiving the high quality of alternatives and the low partners' commitment level. The explained variance was around 16.8% jointly for actor and partner effects. These findings provide evidence for explaining the reasons for touch-induced alleviating stress and have important implications for predicting the future effect of interactive behaviors. (shrink)

Problem: Can communication emerge from the interaction of “self-referentially closed systems,” conceived as operating solely on the base of the “internal” output of their onboard means? Or in terms of philosophical conceptions: can communication emerge without (“outward” directed) “intention” or “will to be understood”? Method: Multi-agent simulation based on a conceptual analysis of the theory of social systems as suggested by Niklas Luhmann. Results: Agents that co-evolutionarily aggregate probabilities on how to cope with their environment can structurally couple and generate (...) a form of “eigenbehavior” that retrospectively (i.e., by an observer) might be interpreted as communication. Implications: The “intention” or the “will to be understood,” as prominently claimed to be indispensable in communication by theoreticians such as Jürgen Habermas, can be seen as a retrospective ascription to an emergent property of complex interaction. Constructivist content: The paper attempts to base constructivist reasoning on data generated in simulations. (shrink)

We investigate the order in which speakers produce the proper names of couples they know personally in English and Japanese, two languages with markedly different constituent word orders. Results demonstrate that speakers of both languages tend to produce the name of the person they feel closer to before the name of the other member of the couple (N = 180). In this way, speakers’ unique personal histories give rise to a remarkably systematic linguistic generalization in both English and Japanese. Insofar (...) as closeness serves as an index of cognitive accessibility, the current work demonstrates that systematicity emerges from a domain-general property of memory. (shrink)

A tic disorder (TD) is a neurodevelopmental disorder characterized by tics, which are repetitive movements and/or vocalizations that occur due to aberrant sensory gating. Its pathophysiology involves dysfunction in multiple parts of the cortico-striato-thalamo-cortical circuits. Spontaneous brain activity during the resting state can be used to evaluate the baseline brain state, and it is associated with various aspects of behavior and cognitive processes. Theta–gamma coupling (TGC) is an emerging technique for examining how neural networks process information through interactions. However, (...) the resting-state TGC of patients with TD and its correlation with cognitive function have not yet been studied. We investigated the resting-state TGC of 13 patients with TD and compared it with that of 13 age-matched healthy children. The participants underwent resting-state electroencephalography with their eyes closed. At the global level, patients with TD showed a significantly lower resting-state TGC than healthy children. Resting-state TGC with the eyes closed was significantly negatively correlated with the attention quotient calculated for omission errors in a selective visual attention test. These findings indicate that the resting-state brain network, which is important for the attentional processing of visual information, is dysfunctional in patients with TD. Additionally, these findings support the view that TGC reflects information processing and signal interactions at the global level. Patients with TD may have difficulty gating irrelevant sensory information in the resting state while their eyes are closed. (shrink)

This study concentrates on adaptive event-triggered control of complex dynamical networks with unpredictable coupling delays and stochastic deception attacks. The adaptive event-triggered mechanism is used to avoid the wasting of limited bandwidth. The probability of data communicated by the network is established by statistical properties and Bernoulli stochastic variables with an uncertain occurrence probability. Stability analysis based on Lyapunov–Krasovskii functional and the stability of the closed-loop system is guaranteed. Using the LMI technique, we obtain triggered parameters. To demonstrate the (...) feasibility and usefulness of the suggested methodology, two examples are shown. (shrink)

Recent research has investigated how the sense of relational entitlement diminishes couple satisfaction, but little is known about how SRE affects the daily quality of close, romantic relationships. Moreover, the evidence on how SRE interacts with other features of a satisfying relationship is scarce. Using an electronic daily diary, we examined 99 couples for 7 days, with two daily measurements for each partner. We used a dyadic double intercept multilevel model, which simultaneously computes effects for men and women. We (...) tested a model where one partner's daily couple satisfaction was predicted by their overall levels of SRE and by their daily and overall levels of self-disclosure, perceived partner self-disclosure, and perceived partner responsiveness. The model also included person-level interactions and cross-level interactions between the SRE types and variables of the interpersonal process model of relationships for each gender. The analysis indicated that person-level excessive SRE lowers couple satisfaction. Also, day and person-level perceived partner responsiveness and person-level self-disclosure are related to couple satisfaction, but the latter association is significant only for men. Finally, we found some significant person-level interactions that account for changes in couple satisfaction. For men, the links between couple satisfaction, excessive and restricted SRE were moderated by self-disclosure and perceived partner responsiveness, respectively, perceived partner self-disclosure and perceived partner responsiveness. For women, the associations between couple satisfaction, restricted and assertive SRE were moderated by self-disclosure, respectively, perceived partner self-disclosure. This study advances our understanding of the general implications of SRE in the dynamics of couple relationships. More specifically, it shows how SRE interacts with other couple-specific variables in shaping day-to-day couple satisfaction. The theoretical and clinical implications for couple therapy are discussed. (shrink)

Uncoupling the mirrors in Marinov's (1) coupled-mirrors experiment allows them to be separated as far apart as desired, and orders of magnitude improvement in accuracy can be obtained for the determination of the absolute velocity of the closed laboratory.

In business ethics literature, the figure of Machiavelli is often taken as a representation of that which is dark, sinister and negative—a source of inspiration for undesirable and unethical actions. In this research, we examine the evaluation of Niccolò Machiavelli’s thought in extant studies, and posit that Machiavelli’s works consist of ideas that may appear contradictory, which, coupled with historically contextualized close reading of his texts have more to offer. In this theoretical investigation, we construct new conceptual categories of (...) a leader’s decision-making rubric and attempt to provide a structured framework that will allow us to specify the boundary conditions under which the apparent contrary views may be accommodated, by undertaking a close reading of Machiavelli’s texts. Our work contributes to business ethics literature in at least three ways. First, we present a holistic assessment of the research area that applies the tenets of Machiavelli’s writings to business ethics, management, and organizational studies, and delineate the dominant themes. We outline and substantiate the informal research networks, thought structures, and “invisible colleges” that form the intellectual framework of this research area through a bibliometric analysis and literature review. Second, we present a contextualized close reading of Machiavelli’s major treatises. Third, we reimagine the critical landscape of business ethics literature, specifically pertaining to Machiavelli’s oeuvre by shifting the single-minded focus from _The Prince_, by including _The Discourses_, which, as we show, has new and unprecedented implications for business ethics. In light of this, the parameters for ethical action by business leaders can be redrawn according to a Machiavellian schema. This marks a radical departure from the long-standing association between Machiavelli’s tenets and the absence of ethics, instead proposing a more positive and affirmative relationship between Machiavelli and business ethics. Specifically, while pointing out that the existing ethical frameworks foisted on Machiavelli’s texts do not do justice to the political philosopher’s worldview, which are complex insights into ideas of leadership, we urge researchers to incorporate the thoughts offered in this research in future investigations. (shrink)

Social media platforms have become an important tool for travel advertisement. This study constructs the bounded confidence model to build an improved cross-platform competitive travel advertising information dissemination model based on open and closed social media platforms. Moreover, this study examines the evolution process of group opinions in cross-platform information dissemination with simulation experiments. Results reveal that based on strong relationships, the closed social media platform opinion leaders better guide in competitive travel advertising and can bring more potential consumers to (...) follow. However, being an opinion leader on an open social media platform will not result in more consumer following. (shrink)

This short, smart book tells you everything you need to know about " nothing." What remains when you take all the matter away? Can empty space--" nothing "--exist?

ObjectiveTo increase knowledge of how doctors perceive futile treatments and scarcity of resources at the end of life. In particular, their perceptions about whether and how resource limitations influence end-of-life decision making. This study builds on previous work that found some doctors include resource limitations in their understanding of the concept of futility.SettingThree tertiary hospitals in metropolitan Brisbane, Australia.DesignQualitative study using in-depth, semistructured, face-to-face interviews. Ninety-six doctors were interviewed in 11 medical specialties. Transcripts of the interviews were analysed using thematic (...) analysis.ResultsDoctors’ perceptions of whether resource limitations were relevant to their practice varied, and doctors were more comfortable with explicit rather than implicit rationing. Several doctors incorporated resource limitations into their definition of futility. For some, availability of resources was one factor of many in assessing futility, secondary to patient considerations, but a few doctors indicated that the concept of futility concealed rationing. Doctors experienced moral distress due to the resource implications of providing futile treatment and the lack of administrative supports for bedside rationing.ConclusionsDoctors’ ability to distinguish between futility and rationing would be enhanced through regulatory support for explicit rationing and strategies to support doctors’ role in rationing at the bedside. Medical policies should address the distinction between resource limitations and futility to promote legitimacy in end-of-life decision making. (shrink)

Background Victoria was the first Australian state to legalize voluntary assisted dying (elsewhere known as physician-assisted suicide and euthanasia). Some institutions indicated they would not participate in voluntary assisted dying. The Victorian government issued policy approaches for institutions to consider Objective To describe and analyse publicly available policy documents articulating an institutional objection to voluntary assisted dying in Victoria. Methods Policies were identified using a range of strategies, and those disclosing and discussing the nature of an institutional objection were thematically (...) analysed using the framework method. Results The study identified fifteen policies from nine policymakers and developed four themes: (1) extent of refusal to participate in VAD, (2) justification for refusal to provide VAD, (3) responding to requests for VAD, and (4) appeals to state-sanctioned regulatory mechanisms. While institutional objections were stated clearly, there was very little practical detail in most documents to enable patients to effectively navigate objections in practice. Conclusion This study demonstrates that despite having clear governance pathways developed by centralized bodies (namely, the Victorian government and Catholic Health Australia), many institutions’ public-facing policies do not reflect this guidance. Since VAD is contentious, laws governing institutional objection could provide greater clarity and regulatory force than policies alone to better balance the interests of patients and non-participating institutions. (shrink)

What remains when you eliminate all matter? Can empty space-a void-exist? _Frank Close takes the reader on a lively and accessible tour through ancient ideas and cultural superstitions (including Aristotle, who insisted that the vacuum was impossible) to the frontiers of current scientific research. These newest discoveries tell us extraordinary things about the cosmos and may provide answers to some of our most fundamental questions: What lies outside the universe? If there was once nothing, then how did the universe (...) begin? (shrink)

A book combining theories and practice of ethics in the practice of criminal justice.

Much of the commentary in the wake of the Charlie Gard litigation was aimed at apparent shortcomings of the law. These include concerns about the perceived inability of the law to consider resourcing issues, the vagueness of the best interests test and the delays and costs of having disputes about potentially life-sustaining medical treatment resolved by the courts. These concerns are perennial ones that arise in response to difficult cases. Despite their persistence, we argue that many of these criticisms are (...) unfounded. The first part of this paper sets out the basic legal framework that operates when parents seek potentially life-sustaining treatment that doctors believe is against a child’s best interests, and describes the criticisms of that framework. The second part of the paper suggests an alternative approach that would give decision-making power to parents, and remove doctors’ ability to unilaterally withhold or withdraw life-sustaining treatment that they regard is futile. This proposal is grounded in several values that we argue should guide these regulatory choices. We also contend that the best interests test is justifiable and since the courts show no sign of departing from it, the focus should be on how to better elucidate the underlying values driving decisions. We discuss the advantages of our proposed approach and how it would address some of the criticisms aimed at the law. Finally, we defend the current role that the judiciary plays, as an independent state-sanctioned process with a precedent-setting function. (shrink)

Fair grading is modeled on two fundamental principles. The first principle is that grading should be impartial and consistent. The second principle is that a fair grade should be based on the student’s competence in the academic content of the course. I derive corollary principles of fair grading from these two basic principles and use them to evaluate common grading practices. I argue that exempting students from completing certain grade components is unfair, as is grading on attendance, class rank, deportment,tardiness, (...) effort, institutional values, moral virtues such as cheerfulness and helpfulness, and other non-course-content criteria. (shrink)

BackgroundThis paper investigates the content of Australian policies that address withholding or withdrawing life-sustaining treatment to analyse the guidance they provide to doctors about the allocation of resources.MethodsAll publicly available non-institutional policies on withholding and withdrawing life-sustaining treatment were identified, including codes of conduct and government and professional organization guidelines. The policies that referred to resource allocation were isolated and analysed using qualitative thematic analysis. Eight Australian policies addressed both withholding and withdrawing life-sustaining treatment and resource allocation.ResultsFour resource-related themes were (...) identified: doctors’ ethical duties to consider resource allocation; balancing ethical obligations to patient and society; fair process and transparent resource allocation; and legal guidance on distributive justice as a rationale to limit life-sustaining treatment.ConclusionOf the policies that addressed resource allocation, this review found broad agreement about the existence of doctors’ duties to consider the stewardship of scarce resources in decision-making. However, there was disparity in the guidance about how to reconcile competing duties to patient and society. There is a need to better address the difficult and confronting issue of the role of scarce resources in decisions about life-sustaining treatment. (shrink)

PARC is an "appended numeral" system of natural deduction that I learned as an undergraduate and have taught for many years. Despite its considerable pedagogical strengths, PARC appears to have never been published. The system features explicit "tracking" of premises and assumptions throughout a derivation, the collapsing of indirect proofs into conditional proofs, and a very simple set of quantificational rules without the long list of exceptions that bedevil students learning existential instantiation and universal generalization. The system can be used (...) with any Copi-style set of inference rules, so it is quite adaptable to many mainstream symbolic logic textbooks. Consequently, PARC may be especially attractive to logic teachers who find Jaskowski/Gentzen-style introduction/elimination rules to be far less "natural" than Copi-style rules. The PARC system is also keyboard-friendly in comparison to the widely adopted Jaskowski-style graphical subproof system of natural deduction, viz., Fitch diagrams and Copi "bent arrow" diagrams. (shrink)

Background In June 2016, Canada legalized medical assistance in dying (MAiD). From the outset, some healthcare institutions (including faith-based and non-faith-based hospitals, hospices, and residential aged care facilities) have refused to allow aspects of MAiD onsite, resulting in patient transfers for MAiD assessments and provision. There have been media reports highlighting the negative consequences of these “institutional objections”, however, very little research has examined their nature and impact. Methods This study reports on findings from 48 semi-structured qualitative interviews conducted with (...) MAiD assessors and providers, MAiD team members (working to coordinate care and lead MAiD programs in institutions and health authorities), and family caregivers on their experiences with institutional objection. Participants were recruited from the Canadian provinces of British Columbia, Ontario, and Nova Scotia. Data were analyzed using inductive thematic analysis. Results Themes identified were: (1) basis for institutional objection (with objections commonly rooted in religious values and a particular philosophy of palliative care); (2) scope of objection (demonstrating a wide range of practices objected to); (3) lack of transparency regarding institutional position; (4) impacts on patients; (5) impacts on health practitioners; and (6) catalysts for change. Participants reported that many institutions’ objections had softened over time, lessening barriers to MAiD access and adverse impacts on patients and health practitioners. Participants attributed this positive change to a range of catalysts including advocacy by health practitioners and family members, policymaking by local health authorities, education, and relationship building. Nevertheless, some institutions, particularly faith-based ones, retained strong objections to MAiD, resulting in forced transfers and negative emotional and psychological impacts on patients, family members, and health practitioners. Conclusions This paper adds to the limited evidence base about the impacts of institutional objection and can inform practical and regulatory solutions in Canada and abroad. Reform is needed to minimize the negative impacts on patients, their caregivers, and health practitioners involved in MAiD practice. (shrink)