The ability of the medical profession to sustain life, or more appropriately, to prolong dying, in patients with terminal illness, creates a most complex and controversial situation for all involved: the patient, if mentally alert; the patient's family; and the medical care team including physicians, nurses and attendants. This situation is especially complex in large acute care hospitals where medical and nursing students, residents and house officers receive advanced medical training. A major problem, prolonging the dying of the terminally ill, (...) with its medical, legal, ethical and economic complexities now confronts American society. The problem is particularly acute in teaching hospitals, in which one finds a disproportionate number of terminally ill patients. The ability to work at these questions as a community rather than as adversaries will determine much about the ability of the health care system to respect the dignity and autonomy of those who seek aid and comfort when faced with serious illness and impending death. Better communication between the physicians, health care providers, the lawyers and ethicists must be developed in order to solve these problems. Over the next ten years society and our elected representatives will be making very demanding decisions about the use of the health dollar. One possible way to prevent increasing costs is to reach significant agreement on the proper care of the dying. Proper care for the dying is being considered, discussed, and evaluated by very thoughtful people. It is not governments which should decide who is to live or who is to die. There is the serious problem of the 'slippery slope' to euthanasia by omission if cost containment becomes the major force in formulating policy on the proper care of the dying. (shrink)

Esta obra se concentra en cuatro temas cruciales de la formación de docentes, tanto antes como durante el servicio y en la enseñanza en diferentes áreas y niveles educativos. En primer lugar, se aborda el asunto de las creencias que los docentes tienen sobre el proceso educativo, las cuales parecen influir en la práctica profesional que estos desarrollan y, por lo tanto, deberían recibir la atención explícita de los procesos de formación de docentes que deseen promover prácticas específicas. El segundo (...) tema de la obra es la relación entre la formación de docentes y la política pública que la rige. En particular, se analizan las reformas curriculares implementadas por varias licenciaturas en universidades privadas colombianas, en respuesta a reformas a la normatividad sobre las condiciones de calidad que a las que deben ajustarse todas las licenciaturas del país. El tercer tema analizado es en qué medida los docentes en educación superior van más allá del dominio de su saber disciplinar atribuyendo importancia a la pedagogía, la didáctica y la práctica reflexiva en su propia práctica docente. Finalmente, se discuten aspectos de la formación de docentes relacionados con los procesos vividos y los retos encontrados por los docentes al entrar en la profesión, su socialización en la comunidad docente, sus identidades como maestros y su motivación para ser docentes. Vale la pena señalar que las contribuciones a este libro comparten el uso de metodologías cualitativas y presentan los resultados de historias de vida, entrevistas, observaciones, y análisis documentales, entre otros. (shrink)

Abstract In the last 20 years the ruthless competition for natural resources, political instability, armed conflicts, and the terrorist attacks of 9/11 have paved the way for private military and security companies (PMSCs) to operate in areas which were until recently the preserve of the state. PMSCs, less regulated than the toy industry, commit grave human rights violations with impunity. The United Nations has elaborated an international binding instrument to regulate their activities but the opposition of the U.S., U.K., and (...) other Western governments?and from PMSCs, which prefer self-regulation?have prevented any advancement. (shrink)

This text explores the problem of transcendental stupidity in Sigmund Freud, Gilles Deleuze and Jacques Derrida’s works, seeking to combine it with (1) the paradoxical figure of Oedipus (the original complex) in psychoanalytical and philosophical tradition and (2) the symptomatic situation of some important animals (wolf and dog, symbols of wild and domestic life [i.e.: Freud’s Wolfs, Freud’s Chow-Chows]) in analyses and therapies. The case of the Man of the Wolves (der Wolfmann), the case of Mr. Sergei K. Pankejeff described (...) in Aus der Geschichte einer infantilen Neurose, a fundamental dream in contemporary culture history, would be the point of departure. (shrink)

PurposePlaying styles play a key role in winning soccer matches, but the technical and physical styles of play between home and away match considering team quality in the Chinese Soccer Super League remain unclear. The aim of this study was to explore the technical and physical styles of play between home and away matches integrating with team quality in the CSL.Materials and methodsThe study sample consists of 480 performance records from 240 matches during the 2019 competitive season in the CSL. (...) These match events were collected using a semi-automatic computerized video tracking system, Amisco Pro®. A k-means cluster analysis was used to evaluate team quality and then using principal component analysis to identify the playing styles between home and away matches according to team quality. Differences between home and away matches in terms of playing styles were analyzed using a linear mixed model.ResultsOur study found that PC1 presented a positive correlation with physical-related variables such as HIRD, HIRE, HSRD, and HSRE while PC2 was positively associated with the passing-related variables such as Pass, FPass, PassAcc, and FPAcc. Therefore, PC1 typically represents intense-play styles while PC2 represents possession-play styles at home and away matches, respectively. In addition, strong teams preferred to utilize intensity play whereas medium and weak teams utilized possession play whenever playing at home or away matches. Furthermore, the first five teams in the final overall ranking in the CSL presented a compensated technical-physical playing style whereas the last five teams showed inferior performance in terms of intensity and possession play.ConclusionIntensity or possession play was associated with the final overall ranking in the CSL, and playing styles that combine these two factors could be more liable to win the competition. Our study provides a detailed explanation for the impact of playing styles on match performances whereby coaches can adjust and combine different playing styles for ultimate success. (shrink)

Изложено понимание рассуждения как метода рационального познания, рассмотрены его разновидности: аргументативные, интерпретативные, прогностические, квалификационные и вычислительные. Для аспирантов и соискателей.

Belnap–Dunn’s relevance logic, \(\textsf{BD}\), was designed seeking a suitable logical device for dealing with multiple information sources which sometimes may provide inconsistent and/or incomplete pieces of information. \(\textsf{BD}\) is a four-valued logic which is both paraconsistent and paracomplete. On the other hand, De and Omori, while investigating what classical negation amounts to in a paracomplete and paraconsistent four-valued setting, proposed the expansion \(\textsf{BD2}\) of the four valued Belnap–Dunn logic by a classical negation. In this paper, we introduce a four-valued expansion (...) of BD called \({\textsf{BD}^\copyright }\), obtained by adding an unary connective \({\copyright }\,\ \) which is a consistency operator (in the sense of the Logics of Formal Inconsistency, _LFI_s). In addition, this operator is the unique one with the following features: it extends to \(\textsf{BD}\) the consistency operator of LFI1, a well-known three-valued _LFI_, still satisfying axiom _ciw_ (which states that any sentence is either consistent or contradictory), and allowing to define an undeterminedness operator (in the sense of Logic of Formal Undeterminedness, _LFU_s). Moreover, \({\textsf{BD}^\copyright }\) is maximal w.r.t. LFI1, and it is proved to be equivalent to BD2, up to signature. After presenting a natural Hilbert-style characterization of \({\textsf{BD}^\copyright }\) obtained by means of twist-structures semantics, we propose a first-order version of \({\textsf{BD}^\copyright }\) called \({\textsf{QBD}^\copyright }\), with semantics based on an appropriate notion of four-valued Tarskian-like structures called \(\textbf{4}\) -structures. We show that in \({\textsf{QBD}^\copyright }\), the existential and universal quantifiers are interdefinable in terms of the paracomplete and paraconsistent negation, and not by means of the classical negation. Finally, a Hilbert-style calculus for \({\textsf{QBD}^\copyright }\) is presented, proving the corresponding soundness and completeness theorems. (shrink)

Tom 1. Metafilosofii︠a︡, ontologii︠a︡, gnoseologii︠a︡, filosofii︠a︡ i metodologii︠a︡ nauki --.

In this paper I argue that Direct realism is less prone to internal incoherence as a theory of knowledge than alternative theories. The theory of Direct realism best grounds our capacity for cognition of the external world, whereas other epistemological theories claim to ground our capacity for cognition, but end in skepticism in the final analysis. I propose to show this contrast by bringing in different theories of a well-known Indirect realist, Bertrand Russell. Illustrating this point mainly through Russell makes (...) the approach purely historical in nature even when the paper includes a brief discussion of two theories in the current debate that support Direct realism. (shrink)

Self-understanding is to a great extent defined by narrative: who we are as human beings is determined by the stories we, and others, tell about ourselves. Yet many are unable to compose coherent personal narratives, as their experiences do not fall within the scope of an accepted conceptual framework. Survivors of trauma are particularly apt to fall into this “narrative rift,” where there can be no words to describe, and hence can be no assimilation of, their experiences. Using the example (...) of child sexual abuse, and drawing on the work of Bass, Spence, Schafer, and Guignon, I propose an examination of the nature of narrative fragmentation itself. Philosophical counselling may succeed where psychoanalysis might not: for where the latter has theoretical commitments to specific narratives, the former, through its reluctance to force epistemological or metaphysical assumptions on the narrator, may well facilitate a more comprehensive self-understanding. (shrink)

The development of gene expression profiling and next-generation sequencing technologies have steered oncogenomics to the forefront of precision medicine. This created a need for harmonious cooperation between clinicians and researchers to increase access to precision oncology, despite multiple implementation challenges being encountered. The aim is to apply personalised treatment strategies early in cancer management, targeting tumour subtypes and actionable gene variants within the individual’s broader clinical risk profile and wellbeing. A knowledge-generating database linked to the South African Medical Research Council’s (...) Genomic Centre has been created for the application of personalised medicine, using an integrated service and research approach. Insights gained from patient experiences related to tumour heterogeneity, access to targeted therapies and incidental findings of pathogenic germline variants in tumour DNA, provided practice-changing evidence for the implementation of a cost-minimisation pathology-supported genetic testing strategy. Integrating clinical care with genomic research through data sharing advances personalised medicine and maximises precision oncology benefits. (shrink)

A formal Ethics Consultation Service (ECS) can provide significant help to patients, families and hospital staff. As with any other form of clinical consultation, documentation of the process and the advice rendered is very important. Upon review of the published consult documentation practices of other ECSs, we judged that none of them were sufficiently detailed or structured to meet the needs and purposes of a clinical ethics consultation. Thus, we decided to share our method in order to advance the practice (...) of ethics consultation. Here, we describe a method of ECS documentation practice, including use of a formal consult report template, as well as a log for maintaining a chronological record of the consultations performed. These two documents facilitate order and organisation of the ECS. They also enable the ECS to keep an account of professional time and experience, enable quick consult trend assessments (by consult theme or ward, for example) and establish a potential registry of consults for future research study. This method of documentation, we believe, not only contributes significantly to the primary purpose of the consultation—namely, the evincing and sharing of ethical opinion about a case—but also enables consultants to improve their practice and to pursue research on clinical ethics consultation. (shrink)

Background: The Declaration of Helsinki prohibits the publication of articles that do not meet defined ethical standards for reporting of research ethics board approval and informed consent. Despite this prohibition and a call to highlight the deficiency for the reader, articles with potential ethical shortcomings continue to be published.Objective: To determine what proportion of articles in major medical journals lack statements confirming REB approval and informed consent, and whether accompanying commentary alerts readers to this deficiency.Design: Retrospective, observational study.Setting: Online review (...) of five major medical journals.Population: All clinical research articles published online between 1 January 2005 and 31 December 2006 in the BMJ, Lancet, Annals of Internal Medicine, JAMA and the New England Journal of Medicine.Measurements: Statement of REB approval and informed consent.Results: Of 1780 articles reviewed, 1133 met inclusion criteria , 36 articles lacked a statement of REB approval, 62 lacked disclosure of informed consent and 15 articles lacked both. Articles that did not state REB approval were associated with not stating informed consent . There were no editorial comments to alert readers to the lack of either REB approval or informed consent statements associated with any of the deficient articles.Conclusions: Articles that lack explicit statements of REB approval and informed consent are infrequent but continue to be published in major medical journals without editorial statements to alert the reader to this deficiency. (shrink)

Objective We sought to understand ethics and education needs of emergency nurses and physicians in paediatric and adult emergency departments in order to build ethics capacity and provide a foundation for the development of an ethics education programme. Methods This was a prospective cross-sectional survey of all staff nurses and physicians in three tertiary care EDs. The survey tool, called Clinical Ethics Needs Assessment Survey, was pilot tested on a similar target audience for question content and clarity. Results Of the (...) 123 participants surveyed, 72% and 84% of nurses and physicians fully/somewhat agreed with an overall positive ethical climate, respectively. 69% of participants reported encountering daily or weekly ethical challenges. Participants expressed the greatest need for additional support to address moral distress, conflict management with patients or families and resource issues. Of the 23 reported occurrences of moral distress, 61% were associated with paediatric mental health cases. When asked how the ethics consultation service could be used in the ED, providing education to teams was the most desired method. Conclusions Nurses report a greater need for ethics education and resources compared with their physician colleagues. Ethical challenges in paediatric EDs are more prevalent than adult EDs and nurses voice specific moral distress that are different than adult EDs. These results highlight the need for a suitable educational strategy, which can be developed in collaboration with the leadership of each ED and team of hospital ethicists. (shrink)

The founders of reformational philosophy, H. Dooyeweerd and D.H.Th. Vollenhoven, each published in short succession, viz. 1949 and 1950, a voluminous study in the history of philosophy. Whoever reads both works is struck by the remarkable differences in treatment. In this contribution these differences are analysed, but there is also indication of agreement. The article ends with a number of conclusions based on the analysis.

Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)

Background and objectives Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners' opinions exists. The American College of Obstetricians and Gynecologists (ACOG) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists' (OB/GYN) support for the recommendations. Design A national survey of OB/GYN physicians contained a vignette experiment in which an OB/GYN doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the ACOG ethics committee—whether the (...) doctor referred and whether the doctor disclosed their objection to the abortion. Participants and setting 1800 OB/GYN randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases. Measurement Physicians indicated their approval for the vignette doctor's decision. Main results Overall, 43% of OB/GYN physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure. Conclusion OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor–patient relationship. (shrink)

The idea of moral reform requires that morality be more than a description of what people do value, for there has to be some measure against which to assess progress. Otherwise, any change is not reform, but simply difference. Therefore, I discuss moral reform in relation to two prescriptive approaches to common morality, which I distinguish as the foundational and the pragmatic. A foundational approach to common morality (e.g., Bernard Gert’s) suggests that there is no reform of morality , but (...) of beliefs, values, customs, and practices so as to conform with an unchanging, foundational morality. If, however, there were revision in its foundation (e.g., in rationality), then reform in morality itself would be possible. On a pragmatic view, on the other hand, common morality is relative to human flourishing, and its justification consists in its effectiveness in promoting flourishing. Morality is dependent on what in fact does promote human flourishing and therefore, could be reformed. However, a pragmatic approach, which appears more open to the possibility of moral reform, would need a more robust account of norms by which reform is measured. (shrink)

Malgré l’accent porté sur les aspects publics, ritualistes de la pratique ancienne, les images et les objets grecs attestent des rencontres privées et personnelles avec des dieux. Cet article recourt à la documentation archéologique pour explorer les traits personnels, vécus, de la vie religieuse de l’Athènes attique. Bien qu’elles soient parfois décrites comme des « transactions », le développement des relations personnelles avec les dieux et de la manipulation de choses matérielles semble être l’un des éléments les plus saillants de (...) l’expérience religieuse des Grecs. Cette étude examine la matérialité religieuse et l’attitude dévotionnelle telle qu’elle existait en dehors de systèmes rituels organisés et des espaces sacrés. La documentation grecque suggère que la culture matérielle était « de la religion » sous forme physique et une part des méthodes des dévots pour développer des relations remarquablement intimes avec des figures sacrées dans un processus appelé « dévotionalisme ». Les femmes athéniennes utilisaient un objet commun de la vie quotidienne comme une forme de médium religieux: la tainia (ruban). Les femmes l’employaient dans tous les lieux de leur vie, y compris les maisons, les lieux de fêtes et les sanctuaires. La céramique suggère que les Athéniens ont employé de tels média dévotionnels pour interagir avec les défunts dans les cimetières. (shrink)

Objective: To provide an ethical analysis of whether the Ethiopian and Tanzanian national HIV/AIDS treatment guidelines can be considered legitimate and fair rationing tools.Method: Qualitative study and ethical analysis involving guideline documents and interviews with nine key members involved in the development of the guidelines. The analysis followed an editing organising style. The theoretical framework was a guideline-specific framework based on theories of just resource allocation in healthcare and conditions that ensure fair processes in guideline development. According to this framework, (...) legitimate rationing requires reasons for patient selection to be explicit, public and relevant, and decisions must be open to question and revision.Results: The only explicit rationing criteria that both guidelines recommended were clinical antiretroviral treatment indications. Explicit non-clinical rationing criteria were expressed in a separate Ethiopian implementation guideline. Neither of the guideline development processes fully satisfies minimal requirements of procedural fairness. There is a lack of transparency. The reasons for decisions are rarely given and are not publicly available. This reduces the opportunity for public questioning, debate and revisions. The guidelines were based on expert opinion and consensus. Recommendations from the WHO were copied without much discussion, disagreement or adjustment.Conclusions: The two national HIV treatment guidelines discussed are de facto mechanisms for rationing but were developed using methods that do not fully satisfy the requirements of fair processes. (shrink)

В монографии представлены взгляды авторов на возникновение и развитие либеральной и консервативной идеологий в политической истории российского государства.

In Sāṃkhya similes are an important means to communicate basic philosophical teachings. In the texts similes are frequently used, especially in the Sāṃkhya passages in the Mahābhārata, in the Sāṃkhyakārikā and in the Sāṃkhyasūtra. This paper compares the similes in these three texts and analyses changes in the philosophy as revealed in the similes. A comparison of the similes of Sāṃkhya texts produced over more than one thousand years reveals changes in the emphasis in this philosophical system. The purpose of (...) the similes in the Sāṃkhya passages of the Mahābhārata is to produce an intuitive understanding of the separateness of puruṣa and prakṛti. The similes are designed to lead the listener to understand this basic dualism. In the Sāṃkhyakārikā the most difficult issues are the relationship between prakṛti and puruṣa and the idea of prakṛti working for the salvation of puruṣa. One whole chapter of the Sāṃkhyasūtra is devoted to similes. (shrink)

Background The COVID-19 pandemic has influenced the approach to the health-disease system, raising the question about the principles of bioethics present in physician–patient relations. The principles while widely accepted may not be sufficient for a comprehensive ethical analysis. Therefore, the aim of this study was to explore the perception of these principles and the physician–patient relationship during a hospital stay through a qualitative approach. Method Sixteen semi-structured interviews took place to know the patients’ perception during their 2020 hospitalization for COVID-19. (...) The data was analyzed through the constant comparison method, creating categories and comparing them. In the end, seven categories were established and were grouped in three: bioethical principles (dignity, charity, vulnerability, autonomy), doctor-patient relationship (participant commitment, informed consent, health staff-patient relationship) and the experience of the disease (illness, the role of the family). Results The research found that most patients described a positive experience, with the feeling of having been well cared for with no sense of discrimination or injustice done. The majority also reported that their autonomy was respected in the treatment decisions. The evaluation of these attitudes is an area of opportunity, especially when the patients' vulnerability is at risk. Conclusions The ethics of virtue offers a better reflection of how human beings manifest themselves by emphasizing the development of virtuous character and behaviors that allow them to realize their values in life. Authorized by the Research Ethics Committee with registration: DI/18/105-B/3/308. (shrink)

The question of how an individual firm's social and environmental performance impacts its firm risk has not been examined in any empirical UK research. Does a company that strives to attain good environmental performance decrease its market risk or is environmental performance just a disadvantageous cost that increases such risk levels for these firms? Answers to this question have important implications for the management of companies and the investment decisions of individuals and institutions. The purpose of this paper is to (...) examine the relationship between corporate environmental performance and firm risk in the British context. Using the largest dataset assembled so far, with community and environmental responsibility (CER) rankings for all rated UK companies between 1994 and 2006, we show that a company's environmental performance is inversely related to its systematic financial risk. However, an increase of 1.0 in the CER score is associated with only a 0.028 reduction in its β. (shrink)