ZusammenfassungKlinische Therapieentscheidungen werden zumeist auf dem Boden einer medizinischen (bzw. ärztlichen) Indikationsstellung und der entsprechenden informierten Zustimmung des Patienten zu der vorgeschlagenen Behandlungsmaßnahme gefällt. Das Recht des Patienten, eine Behandlungsmaßnahme abzulehnen, ist in der juristischen und ethischen Bewertung breit abgesichert. Hingegen ist unklar, welche Rolle ein (positiv geäußerter) Wunsch des Patienten oder gar seiner Angehörigen nach einer bestimmten Behandlung im normativen Entscheidungsprozess spielen sollte, wenn überhaupt. Dieser Beitrag erörtert den Stellenwert des eigenständigen Patientenwunsches aus studienbezogener, klinischer und normativer Sicht. Ein (...) authentisches Fallbeispiel verdeutlicht das Spektrum zugrunde liegender Autonomiekonzepte und das Dilemma divergierender Bewertungsmaßstäbe zwischen Arzt und Patient in der Tumortherapie und Palliativmedizin. Der Beitrag zeigt auf, wie bestehende Konzepte von Autonomie und Indikation genutzt werden können, um einerseits den Behandlungswunsch eines Patienten konkret in den Entscheidungsprozess einzubeziehen, andererseits eine klare Abgrenzung zu einer unreflektierten „wunscherfüllenden Medizin“ aufrecht zu erhalten. (shrink)

O lidský svět -- Samomluvy a rozhovory -- Malé řeči sváteční -- Doplňky 1 -- Doplňky 2.

ZusammenfassungDie Palliative Sedierung als therapeutische Handlungsoption in anderweitig refraktären Behandlungssituationen wird in der Öffentlichkeit und in Fachkreisen in ihrer klinischen Wertigkeit grundsätzlich akzeptiert und weitgehend positiv konnotiert. Im Widerspruch dazu fallen sowohl die Quantität der empirischen Forschung als auch die Intensität der ethischen und klinischen Diskussion ins Auge, mit der konzeptuelle als auch durchführungsbezogene Aspekte der Palliativen Sedierung beschrieben und kontrovers erörtert werden. Anstatt eines distinkten Behandlungskonzeptes stellt sich hier eher ein komplexes Spektrum verschiedener Vorgehensweisen dar. Die folgende Übersichtsarbeit fasst (...) anhand der aktuellen Literatur zusammen, welche Aspekte im Kontext der Palliativen Sedierung als problematisch bewertet werden. (shrink)

ZusammenfassungKlinische Therapieentscheidungen werden zumeist auf dem Boden einer medizinischen (bzw. ärztlichen) Indikationsstellung und der entsprechenden informierten Zustimmung des Patienten zu der vorgeschlagenen Behandlungsmaßnahme gefällt. Das Recht des Patienten, eine Behandlungsmaßnahme abzulehnen, ist in der juristischen und ethischen Bewertung breit abgesichert. Hingegen ist unklar, welche Rolle ein (positiv geäußerter) Wunsch des Patienten oder gar seiner Angehörigen nach einer bestimmten Behandlung im normativen Entscheidungsprozess spielen sollte, wenn überhaupt. Dieser Beitrag erörtert den Stellenwert des eigenständigen Patientenwunsches aus studienbezogener, klinischer und normativer Sicht. Ein (...) authentisches Fallbeispiel verdeutlicht das Spektrum zugrunde liegender Autonomiekonzepte und das Dilemma divergierender Bewertungsmaßstäbe zwischen Arzt und Patient in der Tumortherapie und Palliativmedizin. Der Beitrag zeigt auf, wie bestehende Konzepte von Autonomie und Indikation genutzt werden können, um einerseits den Behandlungswunsch eines Patienten konkret in den Entscheidungsprozess einzubeziehen, andererseits eine klare Abgrenzung zu einer unreflektierten „wunscherfüllenden Medizin“ aufrecht zu erhalten. (shrink)

Since Tversky argued that similarity judgments violate the three metric axioms, asymmetrical similarity judgments have been particularly challenging for standard, geometric models of similarity, such as multidimensional scaling. According to Tversky, asymmetrical similarity judgments are driven by differences in salience or extent of knowledge. However, the notion of salience has been difficult to operationalize, especially for perceptual stimuli for which there are no apparent differences in extent of knowledge. To investigate similarity judgments between perceptual stimuli, across three experiments, we collected (...) data where individuals would rate the similarity of a pair of temporally separated color patches. We identified several violations of symmetry in the empirical results, which the conventional multidimensional scaling model cannot readily capture. Pothos et al. proposed a quantum geometric model of similarity to account for Tversky's findings. In the present work, we extended this model to a more general framework that can be fit to similarity judgments. We fitted several variants of quantum and multidimensional scaling models to the behavioral data and concluded in favor of the quantum approach. Without further modifications of the model, the best-fit quantum model additionally predicted violations of the triangle inequality that we observed in the same data. Overall, by offering a different form of geometric representation, the quantum geometric framework of similarity provides a viable alternative to multidimensional scaling for modeling similarity judgments, while still allowing a convenient, spatial illustration of similarity. (shrink)

Background:Clinical ethics committees have been broadly implemented in university hospitals, general hospitals and nursing homes. To ensure the quality of ethics consultations, evaluation should be...

Patient centred diagnosis is best practised through shared decision making; an iterative dialogue between doctor and patient, whichrespects a patient’s needs, values, preferences, and circumstances. -/- Shared decision making for diagnostic situations differs fundamentally from that for treatment decisions. This has important implications when considering its practical application. -/- The nature of dialogue should be tailored to the specific diagnostic decision; scenarios with higher stakes or uncertainty usually require more detailed conversations.

The study aimed to explore the subjective need of healthcare professionals for ethics consultation, their experience with ethical conflicts, and expectations and objections toward a Clinical Ethics Committee. Staff at a university hospital took part in a survey (January to June 2010) using a questionnaire with open and closed questions. Descriptive data for physicians and nurses (response rate = 13.5%, n = 101) are presented. Physicians and nurses reported similar high frequencies of ethical conflicts but rated the relevance of ethical (...) issues differently. Nurses stated ethical issues as less important to physicians than to themselves. Ethical conflicts were mostly discussed with staff from one’s own profession. Respondents predominantly expected the Clinical Ethics Committee to provide competent support. Mostly, nurses feared it might have no influence on clinical practice. Findings suggest that experiences of ethical conflicts might reflect interprofessional communication patterns. Expectations and objections against Clinical Ethics Committees were multifaceted, and should be overcome by providing sufficient information. The Clinical Ethics Committee needs to take different perspectives of professions into account. (shrink)

Extruded polystyrene (XPS) otherwise known as a thermoplastic polymer has a closed cell structure and is often stronger, with a higher mechanical performance. XPS is a pressed material and is sold in different thicknesses ranging from 2 cm to 10 cm, thus having a weight that varies from 28 to 45 kg/m3 due to the force and pressure exerted on it. In general, XPS material has very low thermal conductivity and is resistant to bending. This material obtains typical values of (...) thermal conductivity between 0.025 and 0.040 W/m∙K., which means that it is ideal for surfaces that have to withstand weight, continuous traffic, etc. It is also resistant to moisture absorption and has a homogeneous density. Other characteristics of the material are good acoustic properties, easy assembly, and high durability over time. It should always be kept in mind that the surface where the thermal insulation will be applied must be leveled, cleaned, and dried. Primer is applied, before placing the thermal insulation on the surface. Then, XPS boards are placed on the surface, adhering to the corresponding mortar. This paper will deal with different cases of application of XPS tiles in the city of Tirana. A closer look at the resistance of this material from the day of application until today will be analyzed. The results during the observations showed high thermal stability of the material and no mold surface. EPS Expanded Polystyrene, otherwise known by the Dow Chemical trademark name STYROFOAM, is a lightweight product made from expanded plastic beads. It was first discovered by Eduard Simon in 1839 in Germany. EPS in its composition has 95% air and only about 5% plastic. This material is used because of its excellent properties, including good thermal insulation, good protective properties, and extremely lightweight. EPS is inert in nature and therefore does not result in any chemical reaction. EPS is durable, strong, and lightweight and can be used as an insulated panel system for facades, walls, roofs, and floors, as floating material in marine construction, and as a lightweight filler in road and railway construction. Different examples from the city of Tirana, of buildings where XPS and EPS materials are applied, are going to be analyzed, drawing conclusions. (shrink)

In recent times, many Callimachean epigrams have been discussed in terms of their connection to contemporary inscribed epigrams. However, in the case of Ep. 1 Pf. influences of inscribed epigrams have not yet been detected. This article argues that similarities to various types of metrical inscriptions (especially funerary inscriptions and sign-posts) do exist and that the epigram could be read as a fictional sign-post with philosophical and possibly metapoetic overtones.

Bentley's emendation in Horace, Ep. 1.14.9.

This paper introduces and studies hypo-EP matrices of adjointable operators on Hilbert C ∗ -modules, based on the generalized Schur complement. The necessary and sufficient conditions for some modular operator matrices to be hypo-EP are given, and some special circumstances are also analyzed. Furthermore, an application of the EP operator in operator equations is given.

Edward P Thompson’s disapproval of Methodism (which was his own background) is well known, especially in The Making of the English Working Class. There he describes it as religious terrorism with a destructive moral machinery and all too reactionary. However, through a close reading of the sections on Methodism, this article reveals an ambivalence within Thompson’s own text. Again and again, he notes in passing that radicals emerged from the Methodist ranks, so much so that the Methodist Conference worked hard (...) to deal with the problem. It would seem that Thompson has stumbled across a political tension within theology, one that he was to explore in much greater detail in his study of Blake. (shrink)

In the famous exchange between Passennus Paulus and Javolenus Priscus at Plin. Ep. 6.15, it has not been previously recognized that Priscus’ reply is metrical and carries on the hexameter begun by Paulus. This opens up some interesting new possibilities for the interpretation of the letter.

sola scripturarum ars est, quam sibi omnes passim uindicent: ‘scribimus indocti doctique poemata passim’ [Hor. Epist. 2.1.117]. hanc garrula anus, hanc delirus senex, hanc soloecista uerbosus, hanc uniuersi praesumunt, lacerant, docent, antequam discant. alii adducto supercilio grandia uerba trutinantes inter mulierculas de sacris litteris philosophantur, alii discunt—pro pudor!—a feminis, quod uiros doceant, et, ne parum hoc sit, quadam facilitate uerborum, immo audacia disserunt aliis, quod ipsi non intellegunt. taceo de meis similibus, qui si forte ad scripturas sanctas post saeculares litteras (...) uenerint et sermone conposito aurem populi mulserint, quicquid dixerint, hoc legem dei putant nec scire dignantur, quid prophetae, quid apostoli senserint, sed ad sensum suum incongrua aptant testimonia, quasi grande sit et non uitiosissimum dicendi genus deprauare sententias et ad uoluntatem suam scripturam trahere repugnantem. quasi non legerimus Homerocentonas et Vergiliocentonas ac non sic etiam Maronem sine Christo possimus dicere Christianum, quia scripserit: ‘iam redit et uirgo, redeunt Saturnia regna, iam noua progenies caelo demittitur alto’ [Verg. Ecl. 4.6–7], et patrem loquentem ad filium: ‘nate, meae uires, mea magna potentia solus’ [Verg. Aen. 1.664], et post uerba saluatoris in cruce: ‘talia perstabat memorans fixusque manebat’ [Verg. Aen. 2.650]. puerilia sunt haec et circulatorum ludo similia, docere, quod ignores, immo, et cum stomacho loquar, nec hoc quidem scire, quod nescias. (shrink)