AimWhite matter changes in individuals at ultra-high risk for psychosis (UHR) may be involved in the transition to psychosis. Sleep-wake disturbances commonly precede the first psychotic episode and predict development of psychosis. We examined associations between white matter microstructure and sleep-wake disturbances in UHR individuals compared to healthy controls (HC), as well as explored the confounding effect of medication, substance use, and level of psychopathology.MethodsSixty-four UHR individuals and 35 HC underwent clinical interviews and diffusion weighted imaging. Group differences on global (...) and callosal mean fractional anisotropy (FA) was tested using general linear modeling. Sleep-wake disturbances were evaluated using the subjective measures disturbed sleep index (DSI) and disturbed awakening index (AWI) from the Karolinska Sleep Questionnaire, supported by objective sleep measures from one-night actigraphy. The primary analyses comprised partial correlation analyses between global FA/callosal FA and sleep-wake measures. Secondary analyses investigated multivariate patterns of covariance between measures of sleep-wake disturbances and FA in 48 white matter regions of interest using partial least square correlations.ResultsUltra-high risk for psychosis individuals displayed lower global FA (F = 14.56, p < 0.001) and lower callosal FA (F = 11.34, p = 0.001) compared to HC. Subjective sleep-wake disturbances were significantly higher among the UHR individuals (DSI: F = 27.59, p < 0.001, AWI: F = 36.42, p < 0.001). Lower callosal FA was correlated with increased wake after sleep onset (r = −0.34, p = 0.011) and increased sleep fragmentation index (r = −0.31, p = 0.019) in UHR individuals. Multivariate analyses identified a pattern of covariance in regional FA which were associated with DSI and AWI in UHR individuals (p = 0.028), but not in HC. Substance use, sleep medication and antipsychotic medication did not significantly confound these associations. The association with objective sleep-wake measures was sustained when controlling for level of depressive and UHR symptoms, but symptom level confounded the covariation between FA and subjective sleep-wake measures in the multivariate analyses.ConclusionCompromised callosal microstructure in UHR individuals was related to objectively observed disruptions in sleep-wake functioning. Lower FA in ventrally located regions was associated with subjectively measured sleep-wake disturbances and was partly explained by psychopathology. These findings call for further investigation of sleep disturbances as a potential treatment target. (shrink)

K.J. Devlin has extended Jensen's construction of a model ofZFC andCH without Souslin trees to a model without Kurepa trees either. We modify the construction again to obtain a model with these properties, but in addition, without Kurepa trees inccc-generic extensions. We use a partially defined ◊-sequence, given by a fine structure lemma. We also show that the usual collapse ofκ Mahlo toω 2 will give a model without Kurepa trees not only in the model itself, but also inccc-extensions.

This article updates the author’s 1982 argument that lutetium and lawrencium, rather than lanthanum and actinium, should be assigned to the d-block as the heavier analogs of scandium and yttrium, whereas lanthanum and actinium should be considered as the first members of the f-block with irregular configurations. This update is embedded within a detailed analysis of Lavelle’s abortive 2008 attempt to discredit this suggestion.

We shall construct a smooth category of mice and embeddings in the core model for measures of order 0. The existence of such a category implies that the global principle □ holds in K. We then prove a much stronger, the so-called condensation-coherent version of global □. The key tool of the whole construction is a new criterion on preserving soundness under condensation.

Integration of music in an academic university teaching setting is an example of how artistic practice and competences have potentials to resonate beyond the immediate discipline. The article explo...

Background To allow patients to reflect about a decision to participate in a clinical trial, guidelines suggest a 24-h delay from when they are informed about the trial to when they give consent. In certain clinical settings, this is likely to hamper recruitment. Method After oral and written information about the trial has been given in person, the patient signs the declaration of consent knowing that they will be asked again after 24 h whether they confirm or regret the decision. (...) This procedure can be done by SMS. The investigators must document the response. The procedure was tried in a study in which the doctors were randomly assigned to receive a clinical communication skills course, and encounters with patients were videotaped before and after the course. Results 553 patients were approached, 530 (95.8%) gave initial consent, eight of these later regretted their consent. Discussion The low level of regrets suggests this is an acceptable procedure for patients. Trial registration The RCT was registered before initiation – registration # ISRCTN22153332. (shrink)

Using NORC annual survey data, the authors selected 21 questions describing respondent attitudes toward job, life in general, and financial status. Respondents were catigorized as management, white collar, blue collar, and those not affiliated with business organizations. Attitudes were compared across the four occupational groups. Little dissatisfaction was found in any but the blue collar group. Management as a group, and men as well as women managers showed high levels of satisfaction, with few significant differences found in responses by men (...) and women. This study does not support the earlier finding of widespread alienation in business firms. (shrink)

ABSTRACT In this survey we have investigated the experiences and attitudes of Danish physicians regarding end‐of life decisions. Most respondents have made decisions that involve hastening the death of a patient, and almost all find it acceptable to do so. Such decisions are made more often, and considered ethically more acceptable, with the informed consent of the patient than without. But both non‐resuscitation decisions, and decisions to provide pain relief in doses that will shorten the patient's life, have been made (...) and found acceptable by at least 50% of the respondents, even when there is no informed consent. Furthermore, 12% have doubled morphine dosages with fixed intervals, thus providing doses substantially higher than that necessary to control pain, without the informed consent of the patient. Two per cent have helped in assisted suicide, and 5% have administered a lethal injection at the patient's request. Respectively 37% and 34% find these last two practices ethically acceptable. Amongst those that do not find them acceptable, the most important reasons to be opposed are, the doctrine of double effect, the doctrine of doing and allowing, and the view that human life is sacred. Amongst supporters, the most important reasons mentioned are, that the patient's right to self‐determination should be respected, the view that a patient should not be forced to suffer, and the view that the patient has a right to be helped to a dignified death. (shrink)

BackgroundPeople with upper extremity amputations report receiving insufficient information about treatment options. Furthermore, patients commonly report not knowing what questions to ask providers. A question prompt sheet, or list of questions, can support patient-centered care by empowering patients to ask questions important to them, promoting patient-provider communication, and increasing patient knowledge. This study assessed information needs among people with UE amputations about UE vascularized composite allotransplantation and developed a UE VCA-QPS.MethodsThis multi-site, cross-sectional, mixed-methods study involved in-depth and semi-structured interviews with (...) people with UE amputations to assess information needs and develop a UE VCA-QPS. Qualitative data were analyzed by thematic analysis; quantitative data were analyzed by descriptive statistics. The initial UE VCA-QPS included 130 items across 18 topics.ResultsEighty-nine people with UE amputations participated. Most were male, had a mean age of 46 years, and had a unilateral and below-elbow amputation. Participants desired information about UE VCA eligibility, evaluation process, surgery, risks, rehabilitation, and functional outcomes. After refinement, the final UE VCA-QPS included 35 items, across 9 topics. All items were written at a ≤ 6th grade reading level. Most semi-structured interview participants reported being ‘completely’ or ‘very’ likely to use a UE VCA-QPS.ConclusionPeople with UE amputations have extensive information needs about UE VCA. The UE VCA-QPS aims to address patients’ information needs and foster patient-centered care. Future research should assess whether the UE VCA-QPS facilitates patient-provider discussion and informed decision-making for UE VCA. (shrink)

In this survey we have investigated the experiences and attitudes of Danish physicians regarding end-of-life decisions. Most respondents have made decisions that involve hastening the death of a patient, and almost all find it acceptable to do so. Such decisions are made more often, and considered ethically more acceptable, with the informed consent of the patient than without. But both non-resuscitation decisions, and decisions to provide pain relief in doses that will shorten the patient's life, have been made and found (...) acceptable by at least 50% of the respondents, even when there is no informed consent. Furthermore, 12% have doubled morphine dosages with fixed intervals, thus providing doses substantially higher than that necessary to control pain, without the informed consent of the patient. Two per cent have helped in assisted suicide, and 5% have administered a lethal injection at the patient's request. Respectively 37% and 34% find these last two practices ethically acceptable. Amongst those that do not find them acceptable, the most important reasons to be opposed are, the doctrine of double effect, the doctrine of doing and allowing, and the view that human life is sacred. Amongst supporters, the most important reasons mentioned are, that the patient's right to self-determination should be respected, the view that a patient should not be forced to suffer, and the view that the patient has a right to be helped to a dignified death. (shrink)

Consider a sequence of outcomes of descending value, A > B > C >... > Z. According to Larry Temkin, there are reasons to deny the continuity axiom in certain ‘extreme’ cases, i.e. cases of triplets of outcomes A, B and Z, where A and B differ little in value, but B and Z differ greatly. But, Temkin argues, if we assume continuity for ‘easy’ cases, i.e. cases where the loss is small, we can derive continuity for the ‘extreme’ case (...) by applying the axiom of substitution and the axiom of transitivity. The rejection of continuity for ‘extreme’ cases therefore renders the triad of continuity in ‘easy’ cases, the axiom of substitution and the axiom of transitivity inconsistent.As shown by Arrhenius and Rabinowitz, Temkin's argument is flawed. I present a result which is stronger than their alternative proof of an inconsistency. However, this result is not quite what Temkin intends, because it only refers to an ordinal ranking of the outcomes in the sequence, whereas Temkin appeals to intuitions about the size of gains and losses. Against this background, it is argued that Temkin's trilemma never gets off the ground. This is because Temkin appeals to two mutually inconsistent conceptions of aggregation of value. Once these are clearly separated, it will transpire, in connection with each of them, that one of the principles to be rejected does not appear plausible. Hence, there is nothing surprising or challenging about the result; it is merely a corollary to Expected Utility Theory. View HTML Send article to KindleTo send this article to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle. Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service.UNACCEPTABLE RISKS AND THE CONTINUITY AXIOMVolume 28, Issue 1Karsten Klint Jensen DOI: https://doi.org/10.1017/S0266267112000107Your Kindle email address Please provide your Kindle [email protected]@kindle.com Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Dropbox To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox. UNACCEPTABLE RISKS AND THE CONTINUITY AXIOMVolume 28, Issue 1Karsten Klint Jensen DOI: https://doi.org/10.1017/S0266267112000107Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Google Drive To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive. UNACCEPTABLE RISKS AND THE CONTINUITY AXIOMVolume 28, Issue 1Karsten Klint Jensen DOI: https://doi.org/10.1017/S0266267112000107Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Export citation Request permission. (shrink)

New natural law advocates are somewhat notorious for their loose action theory, having a track record of counterintuitive claims. In response to criticisms, advocates have entrenched, further defending their questionable action theory. This paper first rehearses the basic criticism against the new natural law action theory. It then examines four recent attempts to revive this action theory and finds these attempts wanting. Within these attempts, certain patterns arise. Given a certain means A to a goal C, a search is made (...) to determine whether any middle means B is implied by A. The standards of this search vary wildly, however. By some standards, a middle means can be found; by others, every middle means can be easily swept aside. The same author will sometimes use both kinds of standards, depending upon the situation. One great weakness of the action theory, then, is a lack of consistency in applying a universal standard. (shrink)

Christianity in Roman Africa: The Development of Its Practices and Beliefs. By J. Patout Burns, Jr., and Robin M. Jensen. Grand Rapids, Mich.: William B. Eerdmans Publishing Co., 2014. Pp. liii + 670, illus. $55.

What counts as an intuitively plausible set theoretic content (notion, axiom or theorem) has been a matter of much debate in contemporary philosophy of mathematics. In this paper I develop a critical appraisal of the issue. I analyze first R. B. Jensen's positions on the epistemic status of the axiom of constructibility. I then formulate and discuss a view of intuitiveness in set theory that assumes it to hinge basically on mathematical success. At the same time, I present accounts (...) of set theoretic axioms and theorems formulated in non-strictly mathematical terms, e.g., by appealing to the iterative concept of set and/or to overall methodological principles, like unify and maximize, and investigate the relation of the latter to success in mathematics. (shrink)