Across the world, pain is under-treated in emergency departments. We canvass the literature testifying to this problem, the reasons why this problem is so important, and then some of the main hypotheses that have been advanced in explanation of the problem. We then argue for the plausibility of two new hypotheses: pain's under-treatment in the ED is due partly to an epistemic preference for signs over symptoms on the part of some practitioners, and some ED practices that themselves worsen pain (...) by increasing patients' anxiety and fear. Our argument includes the following logic. Some ED practitioners depart from formal guidance in basing their acute pain assessments on observable features rather than on patient reports of pain. This is potentially due to an epistemic preference for signs over symptoms which aims to circumvent intentional and/or unintentional misrepresentation on the part of patients. However, conducting pain assessments in line with this epistemic preference contributes to the under-treatment of pain in at least three respects, which we detail. Moreover, it may do little to help the practitioner circumvent any intentional misrepresentation on the part of the patient, as we explain. Second, we examine at least four ED practices that may be contributing to the under-treatment of pain by increasing patient anxiety and fear, which can worsen pain. These practices include failing to provide orienting information and partially objectifying patients so as to problem-solve along lines pre-established by modern medical science. We conclude by touching on some potential solutions for ED practice. (shrink)

ABSTRACT In keeping with the pre‐eminent status accorded autonomy within Australia, Europe, and the United States, medical practice requires that patients authorize do‐not‐resuscitate (DNR) orders, intended to countermand the default practice in hospitals of instituting cardiopulmonary‐resuscitation (CPR) on all patients experiencing cardio‐pulmonary arrest. As patients typically do not make these decisions proactively, however, family members are often asked to act as surrogate decision‐makers and decide on the patient's behalf. Although the appropriateness of patients or their families having to decide about (...) the provision of CPR has been challenged, there has been little examination of how patients and their families talk about and negotiate such decisions, particularly in the context of the patient's imminent death. In this article, part of a larger study analysing interviews with 28 patients (13 female) with cancer within weeks of their death, and 20 others (predominantly family) attending, we argue that a common assumption underpinning participants' talk about the DNR decision (i.e. forgoing CPR) is that it requires a choice between life and death. Using illustrative examples, we demonstrate that in making decisions about CPR, patients and their families are implicitly required to make moral judgements about the value of the patient's life, including their relationships with significant others. We identify some implications of these empirical observations for the development of ethically appropriate policies and practices regarding patient autonomy and surrogacy at the end of life. (shrink)

We examine stigma and how it operates, then develop a novel framework to classify the range of positions that are conceptually possible regarding how stigma ought to be handled from a public health perspective. In the case of weight stigma, the possible positions range from encouraging the intentional use of weight stigma as an obesity prevention and reduction strategy to arguing not only that this is harmful but that weight stigma, independent of obesity, needs to be actively challenged and reduced. (...) Using weight stigma as an illustrative example, we draw on prior theoretical work on stigma mechanisms and intervention strategies to develop a framework for improving the understanding, evaluation, and planning of anti-stigma interventions. This framework has the potential to help public health actors to map out how protest, contact, education, and regulation strategies can be used to reduce direct discrimination, structural discrimination, and internalized stigma. (shrink)

The link between alcohol consumption and cancer is well established, but public awareness of the risk remains low. Mandated warning labels have been suggested as a way of ensuring “informed choice” about alcohol consumption. In this article we explore various ethical issues that may arise in connection with cancer warning labels on alcoholic beverages; in particular we highlight the potentially questionable autonomy of alcohol consumption decisions and consider the implications if the autonomy of drinking behavior is substantially compromised. Our discussion (...) demonstrates the need for the various ethical issues to be considered and addressed in any decision to mandate cancer warning labels. (shrink)

Background Although the importance of clinical ethics in contemporary clinical environments is established, development of formal clinical ethics services in the Australia health system has, to date, been ad hoc. This study was designed to systematically follow and reflect upon the first 18 months of activity by a newly established service, to examine key barriers and facilitators to establishing a new service in an Australian hospital setting. Methods: how the study was performed and statistical tests used A qualitative case study (...) approach was utilised. The study gathered and analysed data using observations of service committee meetings, document analysis of agendas and minutes, and semi-structured interviews with committee members to generate semantic themes. By interpreting the thematic findings in reference to national capacity building resources, this study also aimed to provide practice-based reflections for other health agencies. Results: the main findings An overarching theme identified in the data was a strong commitment to supporting clinicians facing difficult patient care decisions and navigating difficult discussions with patients and families. Another key theme was the role of the new clinical ethics support service in providing clinicians with a pathway to raise system-wide issues with the organisation Executive. While there was strong clinical engagement, consumer and community participation remained a challenge, as did unresolved governance issues and a need for clearer policy relationship between the service and the organisation. Conclusions: brief summary and potential implications Considering these themes in relation to the national capacity building resources, the study identifies three areas likely to require ongoing development and negotiation. These are: the role of the clinical ethics support service as a link between the workforce and the Executive; the incorporation of consumers and patients; and ethical reasoning. To improve the effectiveness of the service, it is necessary to increase clarity on the service’s role at the governance and policy level, as well as develop strategies for engaging consumers, patients and families. Finally, the capacity of the service to reflect on complex cases may be enhanced through explicit discussions of various different ethical frameworks and ways of deliberating. (shrink)

The classical interpretation of mathematical statements can be seen as comprising two separate but related aspects: a domain and a truth-schema. L. E. J. Brouwer’s intuitionistic project lays the groundwork for an alternative conception of the objects in this domain, as well as an accompanying intuitionistic truth-schema. Drawing on the work of Arend Heyting and Michael Dummett, I present two objections to classical mathematical semantics, with the aim of creating an opening for an alternative interpretation. With this accomplished, I then (...) make the case for intuitionism as a suitable candidate to fill this void. (shrink)

Mechanistic models are built using knowledge as the primary information source, with well-established biological and physical laws determining the causal relationships within the model. Once the causal structure of the model is determined, parameters must be defined in order to accurately reproduce relevant data. Determining parameters and their values is particularly challenging in the case of models of pathophysiology, for which data for calibration is sparse. Multiple data sources might be required, and data may not be in a uniform or (...) desirable format. We describe a calibration strategy to address the challenges of scarcity and heterogeneity of calibration data. Our strategy focuses on parameters whose initial values cannot be easily derived from the literature, and our goal is to determine the values of these parameters via calibration with constraints set by relevant data. When combined with a covariance matrix adaptation evolution strategy, this step-by-step approach can be applied to a wide range of biological models. We describe a stepwise, integrative and iterative approach to multiscale mechanistic model calibration, and provide an example of calibrating a pathophysiological lung adenocarcinoma model. Using the approach described here we illustrate the successful calibration of a complex knowledge-based mechanistic model using only the limited heterogeneous datasets publicly available in the literature. (shrink)

Based on our empirical research on global meaning in people with spinal cord injury and people with stroke, we formulated ‘inner posture’ as a concept in rehabilitation. Inner posture, as we concluded from our empirical data, refers to the way in which people bear what cannot be changed. It helps them to live with their injury. Considering that much has already been written about meaning from a variety of disciplines, the question arises whether the concept of inner posture adds something (...) new to the existing literature, or is just another name for a phenomenon that has already been described before in different terms. In this paper, we aim to investigate this and to clarify our conceptualization, by comparing the concept of inner posture with influential concepts in healthcare literature which seem to be more or less related. In the work of Puchalski regarding spirituality, Pargament regarding religion, Eliott regarding hope and Frankl regarding attitude, we found definitions and descriptions that seemed to come close to the phenomenon we refer to as inner posture. Because these concepts have various theoretical backgrounds, the comparison can help to better understand our concept of inner posture, through a process of dialogue between traditions, following Gadamer’s notion of dialogue as fusion of horizons of understanding. We conclude that inner posture differs from the other concepts in several ways. Some of these differences are more fundamental, other are partial. This suggests that we identified a new perspective on a phenomenon partially described earlier. The comparison also inspired us to slightly adjust our definition and to formulate new research questions. (shrink)

¿Qué significa vivir y filosofar bajo una dictadura militar? Tomaré como punto de partida la experiencia que he compartido con mis amigos chilenos, excluidos o marginados de su universidad, y pronto con otros, argentinos y uruguayos, en las postrimerías de los regímenes autoritarios, una aventura que dura cuarenta años. Al hacerlo, me viene a la memoria la frase de George Eliott que da título al excelente libro de Patrick Vauday, Comenzar. Variaciones sobre la idea de comienzo : “Los hombres (...) no pueden hacer nada sin la ficción de un comienzo”. Es el precio de toda historia o narración, pero “hay sin embargo una necesidad, la de dar cuenta de lo nuevo que no se desprende de lo que le precede sin al menos desviar o derivarse de su línea, como aspirado por lo que aspira a nacer”. (shrink)

A promise to do some action seems to create a binding obligation to do that action. And yet, paradoxically, an obligation seems not to be a fact that we can create or bring into existence; we can create an obligation only by creating or bringing into existence something else. The only way to avoid the paradox is to show that the act of promising creates something other than an obligation, which nonetheless binds us to perform the action in question. After (...) considering and rejecting various options such as the promisee's expectation and the promisor's resolve, Prichard locates the bindingness of a promise in a prior general promise, which allows the noises we make when promising to generate an obligation to perform the promised action. (shrink)

The transition from primary to secondary education is one of the most stressful events in a young person’s life (Zeedyk et al., 2003) and can have a negative impact on psychological wellbeing and academic achievement. One explanation for these negative impacts is that the transition coincides with early adolescence, a period during which certain psychological disorders (i.e., anxiety disorders) become more salient (Kessler et al., 2005) and marked social, biological, and psychological development occurs (Anderson, Jacobs, Schramm, & Splittgerber, 2000). This (...) review evaluates the existing literature on the psychological and academic impacts of the transition to secondary education on young adolescents. We examine the factors that plausibly increase or mitigate the risk of developing mental health issues and/or a decline in academic performance during the transition to secondary education. We also review the interplay between psychological health and academic achievement across and beyond the transition. We conclude with a summary of what schools and parents can learn from these findings to support children in a successful transition into secondary education. (shrink)

Invited commentary on Nicole A. Vincent and Emma A. Jane, “Interrogating Incongruence: Conceptual and Normative Problems with ICD-11’s and DSM-5’s Diagnostic Categories for Transgender People” Australasian Philosophical Review, in press. -/- The core of Vincent and Jane’s Interrogating Incongruence is critical of the appeal to the concept of incongruence in DSM-5 and ICD-11 characterisations of trans people, a critique taken to be ground-clearing for more trans-positive, psychiatrically-infused medical interventions. I concur with Vincent and Jane’s ultimate goals but depart from the (...) view developed in the paper on two fronts. The first is that I remain sceptical about the overall prospects for truly trans-positive psychiatry. Trans should follow homosexuality and other categories of sexual orientation that have been abandoned rather than reformed as constituents of psychiatric diagnosis and categorisation. The second is that I think that the authors’ central criticisms of the appeal to incongruence are misplaced. (shrink)

Background and Aim: Global trends and national policies have made internationalization and paying attention to the international markets of higher education inevitable on the one hand and becoming a legal requirement of Iranian medical sciences universities on the other hand. Therefore, the main goal of this article was to show, by examining the experience of international marketing of higher education in Tehran University of Medical Sciences, what are the futures of international marketing of higher education in medical sciences? Materials and (...) methods: in this documented data and the views, knowledge and lived experiences of the beneficiaries of the University of Medical Sciences were the basis of the study, and in the following, the methods of documentary studies, trend analysis, brainstorming, expert panel, theme analysis and scenario planning were used. Results: The most important achievement of this article is that among the challenges facing the international marketing of higher education in the University of Medical Sciences, two driving forces have the highest importance and uncertainty in shaping the future of this issue, including: sustainable security and cultural development. Conclusion: The normalization of political and economic relations with the world along with appropriate cultural development inside and outside the university and acceptance of cultural, racial, religious, intellectual, ethnic and gender differences strengthens the marketing process of higher education. In such a situation, the risk of investing in providing international higher education will be reduced. Therefore, the most expensive and the most important uncertainty facing the country's universities in international marketing is the attitude and approach of science and technology governance to the relations and structure governing the international system. (shrink)

Training under high interference conditions through interleaved practice results in performance suppression during training but enhances long-term performance relative to repetitive practice involving low interference. Previous neuroimaging work addressing this contextual interference effect of motor learning has relied heavily on the blood-oxygen-level-dependent response using functional magnetic resonance imaging methodology resulting in mixed reports of prefrontal cortex recruitment under IP and RP conditions. We sought to clarify these equivocal findings by imaging bilateral PFC recruitment using functional near-infrared spectroscopy while discrete key (...) pressing sequences were trained under IP and RP schedules and subsequently tested following a 24-h delay. An advantage of fNIRS over the fMRI BOLD response is that the former measures oxygenated and deoxygenated hemoglobin changes independently allowing for assessment of cortical hemodynamics even when there is neurovascular decoupling. Despite slower sequence performance durations under IP, bilateral PFC oxygenated and deoxygenated hemoglobin values did not differ between practice conditions. During test, however, slower performance from those previously trained under RP coincided with hemispheric asymmetry in PFC recruitment. Specifically, following RP, test deoxygenated hemoglobin values were significantly lower in the right PFC. The present findings contrast with previous behavioral demonstrations of increased cognitive demand under IP to illustrate a more complex involvement of the PFC in the contextual interference effect. IP and RP incur similar levels of bilateral PFC recruitment, but the processes underlying the recruitment are dissimilar. PFC recruitment during IP supports action reconstruction and memory elaboration while RP relies on PFC recruitment to maintain task variation information in working memory from trial to trial. While PFC recruitment under RP serves to enhance immediate performance, it does not support long-term performance. (shrink)

There is ambiguity with regard to what counts as an acceptable level of risk in clinical research in pregnant women and there is no input from stakeholders relative to such research risks. The aim of our paper was to explore what stakeholders who are actively involved in the conduct of clinical research in pregnant women deem an acceptable level of risk for pregnant women in clinical research. Accordingly, we used the APOSTEL VI study, a low-risk obstetrical randomised controlled trial, as (...) a case-study. We conducted a prospective qualitative study using 35 in-depth semi-structured interviews and one focus group. We interviewed healthcare professionals, Research Ethics Committee members and regulators who are actively involved in the conduct of clinical research in pregnant women, in addition to pregnant women recruited for the APOSTEL VI case-study in the Netherlands. Three themes characterise the way stakeholders view risks in clinical research in pregnant women in general. Additionally, one theme characterises the way healthcare professionals and pregnant women view risks with respect to the case-study specifically. First, ideas on what constitutes an acceptable level of risk in general ranged from a preference for zero risk for the foetus up to minimal risk. Second, the desirability of clinical research in pregnant women in general was questioned altogether. Third, stakeholders proposed to establish an upper limit of risk in potentially beneficial clinical research in pregnant women in order to protect the foetus and the pregnant woman from harm. Fourth and finally, the case-study illustrates that healthcare professionals’ individual perception of risk may influence recruitment. Healthcare professionals, RECs, regulators and pregnant women are all risk adverse in practice, possibly explaining the continuing underrepresentation of pregnant women in clinical research. Determining the acceptable levels of risk on a universal level alone is insufficient, because the individual perception of risk also influences behaviour towards pregnant women in clinical research. Therefore, bioethicists and researchers might be interested in changing the perception of risk, which could be achieved by education and awareness about the actual benefits and harms of inclusion and exclusion of pregnant women. (shrink)

Singular they has emerged as a key term in contemporary gender politics, reflecting growing usage of they/them as nonbinary personal pronouns. Drawing on interviews with 54 progressive gender activists, we consider how singular they can be used to resist and redo aspects of the prevailing gender structure. We identify three distinct usages of singular they: as a nonbinary personal pronoun, as a universal gender-neutral pronoun, and as an indefinite pronoun when a person’s self-identified gender is unknown. While previous research on (...) singular they as a gender-inclusive language practice has focused primarily on its usage as a nonbinary personal pronoun, our findings point to the relevance for gender politics of all three usages. Our analysis offers new insight into how nonbinary they challenges dominant gender norms and practices beyond incorporating additional gender categories. Given our findings, we propose further investigation of how using gender-neutral pronouns for everyone in specific contexts can advance progressive activists’ goals. Finally, we argue that the longstanding usage of singular they as an indefinite pronoun has new importance today in affirming gender as a self-determined identity. (shrink)

Arabic lanaguage; history and criticism.

Articles on Islamic philosophy and science.

One of the major causes of juvenile delinquency almost anywhere in the world, including Nigeria, is abusive conditions in the homes. The abusive condition in the Nigerian situation is exacerbated by the authoritarian concept of the home. Children are usually seen as mere objects who are to obey their parents, especially the father who has an absolute power over his children. Christian parents too are guilty of being authoritarian and their favourite cliché is 'children, obey your parents'. This article aims (...) at developing a theological guideline that would assist fathers in rearing their children from the biblical perspective via a socio-rhetorical study of Ephesians 6:4. It examines the rearing of children in the 1st century among the Jews and the Graeco-Romans - the original recipients. Then, it compares the social condition of Nigeria with that of the 1st century Graeco-Roman. It concludes by stating that the key to understanding the verse is the phrase μὴπαροργίζετε, a combination of μὴ and a present active imperative, which is used to prohibit actions already in progress. Thus, the verse becomes an appeal to fathers to stop exasperating their children. To achieve this, fathers should see their children as full-fledged human beings with a right to their opinions and decisions about their lives. CONTRIBUTION: This article holds that rather than being treated as obedient objects to fathers in all things, children must be seen as human beings created with will, mind and intelligence and therefore be given a say in issues that concerns them and be disciplined in love and not harshly. (shrink)

This is a condensed description of the contents and overarching argument found in Hippocrates’ Oath and Asclepius’ Snake: The Birth of the Medical Profession. In that work, I maintain that the basic medical ethical problem concerns iatrogenic harm. I focus particularly on what I refer to as ‘role-conflation’. This most egregious form of iatrogenic harm occurs when a physician deliberately adopts the role of wounder. A contemporary practice such as physician-assisted suicide exemplifies a doctor’s deliberate wounding. I argue that the (...) author of the Hippocratic Oath – aware of the chronic risk of role-conflation – responds to this threat by having the oath-taker specifically forswear signal acts that wound the sick, such as giving a deadly drug even if asked, giving an abortifacient, sexual predation, and gossiping. I argue that by means of the Oath, Hippocrates founds medicine as a profession, a practice intimately involving promising. (shrink)

The issue of how basic sensory and temporal processing are related is still unresolved. We studied temporal processing, as assessed by simple visual reaction times (RT) and double-pulse resolution (DPR), in patients with partial vision loss after visual pathway lesions and investigated whether vision restoration training (VRT), a training program designed to improve light detection performance, would also affect temporal processing. Perimetric and campimetric visual field tests as well as maps of DPR thresholds and RT were acquired before and after (...) a 3 months training period with VRT. Patient performance was compared to that of age-matched healthy subjects. Intact visual field size increased during training. Averaged across the entire visual field, DPR remained constant while RT improved slightly. However, in transition zones between the blind and intact areas (areas of residual vision) where patients had shown between 20 and 80% of stimulus detection probability in pre-training visual field tests, both DPR and RT improved markedly. The magnitude of improvement depended on the defect depth (or degree of intactness) of the respective region at baseline. Inter-individual training outcome variability was very high, with some patients showing little change and others showing performance approaching that of healthy controls. Training-induced improvement of light detection in patients with visual field loss thus generalized to dynamic visual functions. The findings suggest that similar neural mechanisms may underlie the impairment and subsequent training-induced functional recovery of both light detection and temporal processing. (shrink)

Sexual violence against women is an issue of urgency that arises in all cultures locally, nationally, globally and transnationally. This problem has broad dimensions in both the public and private domains, both cases that are reported or not reported to law enforcement. Factually, the trend of this problem has been identified as increasing every year in Maluku, Indonesia. Therefore, the church requires serious attention to prevention and systematic treatment to overcome it. This sensitivity and awareness are a manifestation of the (...) church’s sense of calling and responsibility for the restoration of human dignity. The pastoral sermon service model is the church’s strategic approach to handling this problem. This research aimed to develop a model of pastoral sermons for victims of sexual violence against women in Maluku. This research focused on identifying and exploring the tragic experiences and impacts of sexual violence against women. Furthermore, a cross-cultural pastoral model was created for victims of violence.Contribution: This article provided a new perspective from the post-modern homiletics to approach social issues. This new homiletical approach to dealing with the problem of women’s sexual violence is one of the main focuses of ‘Women’s Theological Studies’ in HTS. (shrink)

Patients and physicians do not know the cost of medical procedures. Opaque medical billing thus contributes to exorbitant, rising medical costs, burdening the healthcare system and individuals. After criticizing two proposed solutions to the problem of opaque medical billing, I argue that the Centers for Medicare and Medicaid Services should pursue a rule requiring that patients be informed by the physician of a reasonable out-of-pocket expense estimate for non-urgent procedures prior to services rendered.