BackgroundResuscitation and treatment of critically ill newborn infants is associated with relatively high mortality, morbidity and cost. Guidelines relating to resuscitation have traditionally focused on the best interests of infants. There are, however, limited resources available in the neonatal intensive care unit, meaning that difficult decisions sometimes need to be made. This study explores the intuitions of lay people regarding resource allocation decisions in the NICU.MethodsThe study design was a cross-sectional quantitative survey, consisting of 20 hypothetical rationing scenarios. There were (...) 119 respondents who entered the questionnaire, and 109 who completed it. The respondents were adult US and Indian participants of the online crowdsourcing platform Mechanical Turk. Respondents were asked to decide which of two infants to treat in a situation of scarce resources. Demographic characteristics, personality traits and political views were recorded. Respondents were also asked to respond to a widely cited thought experiment involving rationing.ResultsThe majority of respondents, in all except one scenario, chose the utilitarian option of directing treatment to the infant with the higher chance of survival, higher life expectancy, less severe disability, and less expensive treatment. As discrepancy between outcomes decreased, however, there was a statistically significant increase in egalitarian responses and decrease in utilitarian responses in scenarios involving chance of survival, life expectancy, and cost of treatment. In the classic ‘lifeboat’ scenario, all but two respondents were utilitarian.ConclusionsThis survey suggests that in situations of scarcity and equal clinical need, non-health professionals support rationing of life-saving treatment based on probability of survival, duration of survival, cost of treatment or quality of life. However, where the difference in prognosis or cost is very small, non-health professionals preferred to give infants an equal chance of receiving treatment. (shrink)

The biological sciences study (bio)complex living systems. Research directed at the mechanistic explanation of the "live" state truly requires a pluralist research program, i.e. BioComplexity research. The program should apply multiple intra-level and inter-level theories and methodologies. We substantiate this thesis with analysis of BioComplexity: metabolic and modular control analysis of metabolic pathways, emergence of oscillations, and the analysis of the functioning of glycolysis.

The legal basis of informed consent in Texas may on first examination suggest an unqualified affirmation of persons as the source of authority over themselves. This view of individuals in the practice of informed consent tends to present persons outside of any social context in general and outside of their families in particular. The actual functioning of law and medical practice in Texas, however, is far more complex. This study begins with a brief overview of the roots of Texas law (...) and public policy regarding informed consent. This surface account is then contrasted with examples drawn from the actual functioning of Texas law: Texas legislation regarding out-of-hospital do-not-resuscitate (DNR) orders. As a default approach to medical decision-making when patients lose decisional capacity and have failed to appoint a formal proxy or establish their wishes, this law establishes a defeasible presumption in favor of what the law characterizes as “qualified relatives” who can function as decision-makers for those terminal family members who lose decisional capacity. The study shows how, in the face of a general affirmation of the autonomy of individuals as if they were morally and socially isolated agents, space is nevertheless made for families to choose on behalf of their own members. The result is a multi-tier public morality, one affirming individuals as morally authoritative and the other recognizing the decisional standing of families. (shrink)

MicroRNAs are non-coding parts of nuclear and mitochondrial genomes, preventing the weakest part of the genetic regulatory networks from being expressed and preventing the appearance of a too many attractors in these networks. They have also a great influence on the chromatin clock, which ensures the updating of the genetic regulatory networks. The post-transcriptional inhibitory activity by the microRNAs, which is partly unspecific, is due firstly to their possibly direct negative action during translation by hybridizing tRNAs, especially those inside the (...) mitochondrion, hence slowing mitochondrial respiration, and secondly to their action on a large number of putative m-RNA targets like those involved in immunetworks; We show that the circuits in the core of the interaction graphs are responsible for the small number of dedicated attractors that correspond to genetically controlled functions, partly due to a general filtering by the microRNAs. We analyze this influence as well as their impact on important functions like the control by the p53 network over the apoptosis/proliferation system and the homeostasis of the energy metabolism. In this last case, we show the role of two kinds of microRNAs, both involved in the control of the mitochondrial genome: (1) nuclear microRNAs, called mitoMirs, inhibiting mitochondrial genes and (2) putative mitochondrial microRNAs inhibiting the tRNAs functioning. (shrink)

The French school of theoretical biology has been mainly initiated in Poitiers during the sixties by scientists like J. Besson, G. Bouligand, P. Gavaudan, M. P. Schützenberger and R. Thom, launching many new research domains on the fractal dimension, the combinatorial properties of the genetic code and related amino-acids as well as on the genetic regulation of the biological processes. Presently, the biological science knows that RNA molecules are often involved in the regulation of complex genetic networks as effectors, e.g., (...) activators, inhibitors or hybrids. Examples of such networks will be given showing that there exist RNA “relics” that have played an important role during evolution and have survived in many genomes, whose probability distribution of their sub-sequences is quantified by the Shannon entropy, and the robustness of the dynamics of the networks they regulate can be characterized by the Kolmogorov–Sinaï dynamic entropy and attractor entropy. (shrink)

On April 26, 1995, the United States Supreme Court limited the reach of the preemption provision of ERISA in New York State Conference of Blue Cross & Blue Shield Plans v. Tavelers Insurance Co. ). In Travelers, the Supreme Court upheld the validity of a New York statute requiring hospitals to collect surcharges from patients covered by commercial insurers and requiring health maintenance organizations to pay a surcharge to the state's general fund that varies depending on the number of Medicaid-eligible (...) HMO members enrolled. Neither patients insured by Blue Cross/Blue Shield plans nor the plans themselves are similarly charged under the statute. Several commercial insurers and HMOs claimed the surcharges should be preempted under ERISA because they are levied on patients whose insurance or HMO membership premiums are purchased by an ERISA plan.The ERISA preemption clause means that federal regulation, or lack thereof, supersedes state regulation that is related to employee pension and benefit plans. This preemption clause prevents states from changing health care and benefit law for a significant portion of state residents. (shrink)

Background: Recent research demonstrates that people sometimes make different medical decisions for others than they would make for themselves. This finding is particularly relevant to end-of-life decisions, which are often made by surrogates and require a trade-off between prolonging life and maintaining quality of life. We examine the impact of decision role, patient age, decision maker age and multiple individual differences on these treatment decisions. Methods: Participants read a scenario about a terminally ill cancer patient faced with a choice between (...) an aggressive chemotherapy regimen that will extend life by two years and palliative treatments to control discomfort for one remaining month. Participants were randomly assigned to one of three decision roles (patient, physician, or an abstract other) and the scenario randomly varied whether the patient was described as 25 or 65-years old. Results: When deciding for a 65-year old patient, approximately 60% of participants selected aggressive chemotherapy regardless of decision role. When deciding for a 25-year old patient, however, participants were more likely to select chemotherapy for a patient (physician role) or another person (abstract other) than for themselves (70%, 67%, and 59%, respectively). In addition, confidence that powerful others (eg, physicians) control one’s health, as well as respondents’ age and race, consistently predicted treatment choices. Conclusions: Patient age appears to influence medical decisions made for others but not those that we make for ourselves. These findings may help to explain the discord that often occurs when younger cancer patients refuse life-extending treatments. (shrink)

James Madison wrote, 'Had every Athenian citizen been a Socrates, every Athenian assembly would still have been a mob'. The contributors to this volume discuss and for the most part challenge this claim by considering conditions under which many minds can be wiser than one. With backgrounds in economics, cognitive science, political science, law and history, the authors consider information markets, the internet, jury debates, democratic deliberation and the use of diversity as mechanisms for improving collective decisions. At the same (...) time, they consider voter irrationality and paradoxes of aggregation as possibly undermining the wisdom of groups. Implicitly or explicitly, the volume also offers guidance and warnings to institutional designers. (shrink)

The problem of stability in population dynamics concerns many domains of application in demography, biology, mechanics and mathematics. The problem is highly generic and independent of the population considered (human, animals, molecules,…). We give in this paper some examples of population dynamics concerning nucleic acids interacting through direct nucleic binding with small or cyclic RNAs acting on mRNAs or tRNAs as translation factors or through protein complexes expressed by genes and linked to DNA as transcription factors. The networks made of (...) these interactions between nucleic acids (considered respectively as edges and nodes of their interaction graph) are complex, but exhibit simple emergent asymptotic behaviours, when time tends to infinity, called attractors. We show that the quantity called attractor entropy plays a crucial role in the study of the stability and robustness of such genetic networks. (shrink)

The use of the Quality Adjusted Life-Year (QALY) as a measure of the benefit obtained from health care expenditure has been attacked on the ground that it gives a lower value to preserving the lives of people with a permanent disability or illness than to preserving the lives of those who are healthy and not disabled. The reason for this is that the quality of life of those with illness or disability is ranked, on the QALY scale, below that of (...) someone without a disability or illness. Hence we can, other things being equal, gain more QALYs by saving the lives of those without a permanent disability or illness than by saving the lives of those who are disadvantaged in these ways. But to do so puts these disadvantaged people under a kind of double jeopardy. Not only do they suffer from the disability or illness, but because of it, a low priority is given to forms of health care that can preserve their lives. This, so the objection runs, is unjust or unfair. This article assesses this objection to the use of QALYs as a basis for allocating health care resources. It seeks to determine what is sound in the double jeopardy objection, and then to show that the defender of QALYs has an adequate response to it. (shrink)

In a recent re-assessment of the medical aspects of the Plague of Athens which is, to date, the most scholarly and comprehensive, Poole and Holladay have emphasized the tendency of many infectious diseases markedly to decline in virulence over decades and centuries and, sometimes, significantly to change their clinical manifestations. In the light of modern medicine they consider four possibilities: The Plague was a disease which still exists today. This they regard as improbable, It still exists in some remote place (...) or places unknown to medical science. This is discussed and dismissed, It became extinct, It was caused by an agent which nowadays causes a significantly different clinical syndrome. They conclude as follows: ‘The truth, we suggest, almost certainly lies in possibility or . But we can see no way of choosing between them. On either view the question: “What was the Athenian Plague?” is in principle unanswerable if the questioner is wanting to attach to the Plagsie the name of some modern disease or diseases’. (shrink)

Ignoring the temporal dimension, an object such as a railway tunnel or a human body is a three-dimensional whole composed of three-dimensional parts. The four-dimensionalist holds that a physical object exhibiting identity across time—Descartes, for example—is a four-dimensional whole composed of 'briefer' four-dimensional objects, its temporal parts. Peter van Inwagen (1990) has argued that four-dimensionalism cannot be sustained, or at best can be sustained only by a counterpart theorist. We argue that different schemes of individuation of temporal parts are available, (...) which undermines van Inwagen's argument. (shrink)

This work extend to residuated lattices the results of [7]. It also provides a possible generalization to this context of frontal operators in the sense of [9].Let L be a residuated lattice, and f : Lk → L a function. We give a necessary and sufficient condition for f to be compatible with respect to every congruence on L. We use this characterization of compatible functions in order to prove that the variety of residuated lattices is locally affine complete.We study (...) some compatible functions on residuated lattices which are a generalization of frontal operators. We also give conditions for two operations P(x, y) and Q(x, y) on a residuated lattice L which imply that the function \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${x \mapsto min\{y \in L : P(x, y) \leq Q(x, y)\}}$$\end{document} when defined, is equational and compatible. Finally we discuss the affine completeness of residuated lattices equipped with some additional operators. (shrink)

There are doubtless many with personal experience of suffering, or of comforting others in distress, who would agree with Milton thus far that philosophic argument is powerless to satisfy those who in their anguish ask the question ‘Why did it happen to me?’ Yet to think so is to underestimate both the necessity and the power of reason: clarity of mind and the disposition to argue are commonly enhanced rather than diminished by suffering; and if reason is an essential part (...) of man's nature, it should serve him, if anywhere, in the trials of life. We have every justification, therefore, despite common opinion, for seeking a rational answer to the question proposed. It must, however, be admitted at the outset that there is no direct answer to the question which can both withstand critical scrutiny and bring genuine comfort to the afflicted, an answer, that is, which accepts the question as it stands with its attendant presuppositions; but there is an indirect answer, which, precisely by rejecting one or more of these presuppositions and restating the question, can indeed satisfy these two requirements. Before such an answer can be outlined, however, the question in its traditional form must be examined and the traditional answers to it critically reviewed. (shrink)