Clinical decision making is a challenging task that requires practical wisdom—the practised ability to help patients choose wisely among available diagnostic and treatment options. But practical wisdom is not a concept one typically hears mentioned in medical training and practice. Instead, emphasis is placed on clinical judgement. The author draws from Aristotle and Aquinas to describe the virtue of practical wisdom and compare it with clinical judgement. From this comparison, the author suggests that a more complete understanding of clinical judgement (...) requires its explicit integration with goals of care and ethical values. Although clinicians may be justified in assuming that goals of care and ethical values are implicit in routine decision making, it remains important for training purposes to encourage habits of clinical judgement that are consciously goal-directed and ethically informed. By connecting clinical judgement to patients' goals and values, clinical decisions are more likely to stay focused on the particular interests of individual patients. To cultivate wise clinical judgement among trainees, educational efforts should aim at the integration of clinical judgement, communication with patients about goals of care, and ethical reasoning. But ultimately, training in wise clinical judgement will take years of practice in the company of experienced clinicians who are able to demonstrate practical wisdom by example. By helping trainees develop clinical judgement that incorporates patients' goals of care and ethical reasoning, we may help lessen the risk that ‘clinical judgement’ will merely express ‘the clinician's judgement.’. (shrink)

Kurrâ’ya nispet edilen aynı kelimelerdeki edâ farklılıklarının tartışmalara sebep olmasından ötürü kıraat ihtilafı olan kelimelerde ihticâc yapılmasına gereksinim duyulmuştur. Delil getirmek manasında kullanılan ihticâc kavramı, kıraat ihtilafları için söz konusu olduğunda ise kıraat ihtilaflarının sıhhat zemininin ortaya konması kastedilmektedir. Ayrıca 2. asrın sonlarında kıraat tevcîhlerinin yapıldığı müstakil eserler ortaya çıkmakla birlikte kıraat alan yazınına ait genel telifatlarda da kıraat ihticâclarının yapıldığı görülmektedir. Kıraat müelliflerinden biri olan İbnu’l-Cezerî de Neşru’l-ḳırââti’l-‘aşr adlı eserinde zaman zaman kıraat ihticâcına yer vermektedir. Mezkûr eserdeki kıraat ihticâcları (...) hakkında tespit edilebildiği kadarıyla yapılmış tek bir çalışma bulunmaktadır. Fakat bu çalışmada, kıraatten ve bunun dışındaki disiplinlerden yeterince istifade edilmediği belirlenmiştir. Ayrıca selef ulemasının Neşru’l-ḳırââti’l-‘aşr adlı esere ihticâc konusunda etkisi özelinde bir çalışmaya da rastlanmamıştır. Buradan hareketle elinizdeki bu çalışmada, İbnu’l-Ce-zerî’nin kıraat ihticâcına dair uygulamaları Neşru’l-ḳırââti’l-‘aşr adlı eser özelinde incelenmiş, me‘âni’l-Kur’ân ve me‘âni’l-kıraat literatürlerinin ortaya çıktıkları dönem dikkate alınarak h. 2.-4. asırlarda kaleme alınan bu literatürlere ait eserlerin İbnu’l-Cezerî’ye ait kıraat tevcîhlerine etkisinin olup olmadığı araştırılmıştır. Çalışmanın neticesinde İbnu’l-Cezerî’nin yaptığı kıraat tevcîhlerinden ele alınanların bir kısmına, söz konusu üç asırda kaleme alınan me‘âni’l-Kur’ân ve me‘âni’l-kıraat telifatında ekseriyetle yer verilmediği saptanmıştır. İbnu’l-Cezerî’nin ise kıraat ihtilafının olmadığı yerlerde dahi ilgili edâ için ihticâc yaptığı müşahede edilmiştir. Buna ilaveten İbnu’l-Cezerî’nin Neşr’de yaptığı ihticâc uygulamalarının me‘âni’l-Kur’ân ve me‘âni’l-kıraat telifatında yapılan ihticâc işlemleriyle benzeştiği görülmüştür. Yine Neşr’in tevcîh eseri olmaması hasebiyle de İbnu’l-Cezerî tarafından yapılan ihticâcların ihtiyaç merkezli olarak kendini gösterdiği belirlenmiştir. (shrink)

Background Professional autonomy, which directly affects the quality of professional nursing in patient care, and cognitive flexibility, which is an important factor for adaptation to change and developing nursing roles, are important concepts for nursing. Research objectives This research was carried out to determine the effect of cognitive flexibility on attitudes towards professional autonomy in nurses. Research design This was a descriptive study. Participants and research context The research was conducted with 415 nurses working in a city hospital of a (...) province, meeting the inclusion criteria and agreeing to participate in the study. A questionnaire form, The Cognitive Flexibility Inventory (CFI), and the Attitude Toward Professional Autonomy Scale for Nurses (APASN) were used to collect data. Ethical considerations Ethical approval was obtained from the university ethics committee before starting the study. Institutional permission was obtained from the city hospital where the study was conducted. Electronic informed consent was obtained from the nurses included in the study. Findings In the study, the mean CFI score was 80.62 ± 11.55 and the mean APASN score was 70.42 ± 18.79. There was a weak positive correlation (r = 0.270; p < 0.05) between CFI and APASN scores. Moreover, the effect of the CFI mean score on the APASN mean score was found to be statistically significant (β = 0.278; p < 0.001). Furthermore, CFI explains 7.7% of APASN. Conclusion In the study, nurses’ attitudes towards professional autonomy and cognitive flexibility scores were found to be at a good level. Cognitive flexibility has a positive effect on attitudes towards professional autonomy. Interventional studies that will increase the level of cognitive flexibility are recommended in the development of nurses' attitudes towards professional autonomy. (shrink)

This article explores egg freezing experiences of women in Turkey. Since 2014, it has been legal in Turkey to use egg freezing technology for ageing women, while it was previously allowed only for disease-related purposes. In cooperation with a private fertility clinic in Istanbul, the authors conducted 21 interviews with older, single women who held either professional or managerial positions and who were undergoing or had undergone the procedure. Drawing on a qualitative analysis of these interviews, the authors explore the (...) social context in which women postpone motherhood and decide to freeze their eggs. The study also looks at the women’s emotional responses to ageing that were triggered by the experience of egg freezing and their narratives of empowerment as a result of the procedure. (shrink)

‘Ein vÖllig unverständliches Wortspiel’, said Friedlander. There have been many attempts to solve the riddle. The older commentators, following Domizio Calderini, offered a fantastic solution: Athenagoras was a doctor specializing in leprosy : ‘porro ducta uxore coepit lingere cunnum…unde factus est olficius, hoc est olfacit cunnum’! H. C. Schnur emended to Olbius : Albius Athenagoras , by marrying a rich wife, became Olbius. This explanation deprives the name ‘Albius’ of any point; nor is it particularly witty to say that Albius (...) married money. The most popular solution points to the biblical γ εμι τ Ἄλφα κα τ 'Σ [sc. πρτος κα σ×ατος] it can be shown with some plausibility that the expression was known to the Romans of Martial's time – and to Martial's phrases ‘alpha paenulatorum’ and ‘beta togatorum’ . Before marriage Athenagoras was A in his house; now he is last, in other words, henpecked. ‘Paenulatorum’ and ‘togatorum’, however, give ‘alpha’ and ‘beta’ a context which plain Alphius and Olphius do not possess. Moreover, in all the other passages which scholars quote in support of the A–Σ hypothesis,9 a letter of the alphabet becomes a byname for an individual, and is not incorporated in another name, as would be the case with Alphius and Σlphius. The presence of two names points to an etymological, not alphabetical, jeu des mots. (shrink)

Commentators onEpode11 generally begin by comparing the opening couplet with Archilochus : κα⋯ μ' οὔτ' ἰ⋯μβων οὔτε τερπωλ⋯ων μ⋯λει, and sometimes also Catullus 68. 1–40. In both of these the poet explains that grief at the death of a loved one has expelled all desire to compose verses. According to the comparison, Horace, in 1–2, is stating that the onset of love has, similarly, so absorbed his attention that he cannot write verse. The translation will then run ‘Pettius, I have (...) no pleasure any longer in writing verse, smitten as I am with a heavy love’. (shrink)

On the life and works of ancient Jaina philosophers.

Commentators onEpode11 generally begin by comparing the opening couplet with Archilochus : κα⋯ μ' οὔτ' ἰ⋯μβων οὔτε τερπωλ⋯ων μ⋯λει, and sometimes also Catullus 68. 1–40. In both of these the poet explains that grief at the death of a loved one has expelled all desire to compose verses. According to the comparison, Horace, in 1–2, is stating that the onset of love has, similarly, so absorbed his attention that he cannot write verse. The translation will then run ‘Pettius, I have (...) no pleasure any longer in writing verse, smitten as I am with a heavy love’. (shrink)

L. C. Holborow; V*—Blame, Praise and Credit, Proceedings of the Aristotelian Society, Volume 72, Issue 1, 1 June 1972, Pages 85–100, https://doi.org/10.1093/ari.

Background and objective: Code status discussions may fail to address patients’ treatment-related goals and their knowledge of cardiopulmonary resuscitation (CPR). This study aimed to investigate patients’ resuscitation preferences, knowledge of CPR and goals of care. Design, setting, patients and measurements: 135 adults were interviewed within 48 h of admission to a general medical service in an academic medical centre, querying code status preferences, knowledge about CPR and its outcome probabilities and goals of care. Medical records were reviewed for clinical information (...) and code status documentation. Results: 41 (30.4%) patients had discussed CPR with their doctor, 116 (85.9%) patients preferred full code status and 11 (8.1%) patients expressed code status preferences different from the code status documented in their medical record. When queried about seven possible goals of care, patients affirmed an average of 4.9 goals; their single most important goals were broadly distributed, ranging from being cured (n = 36; 26.7%) to being comfortable (n = 8; 5.9%). Patients’ mean estimate of survival to discharge after CPR was 60.4%. Most patients believed it was helpful to discuss goals of care (n = 95; 70.4%) and the chances of surviving inhospital CPR (n = 112; 83.0%). Some patients expressed a desire to change their code status after receiving information about survival following inhospital CPR (n = 11; 8.1%) or after discussing goals of care (n = 2; 1.5%). Conclusions: Doctors need to address patients’ knowledge about CPR and take steps to avoid discrepancies between treatment orders and patients’ preferences. Addressing CPR outcome probabilities and goals of care during code status discussions may improve patients’ knowledge and influence their preferences. (shrink)

The research presented in this volume demonstrates that it is no longer reasonable to ask whether or not synesthesia is real--we must now ask how we can account ...

Objective: To describe the frequency of support for terminal sedation among internists, determine whether support for terminal sedation is accompanied by support for physician assisted suicide , and explore characteristics of internists who support terminal sedation but not assisted suicide.Design: A statewide, anonymous postal survey.Setting: Connecticut, USA.Participants: 677 Connecticut members of the American College of Physicians.Measurements: Attitudes toward terminal sedation and assisted suicide; experience providing primary care to terminally ill patients; demographic and religious characteristics.Results: 78% of respondents believed that if (...) a terminally ill patient has intractable pain despite aggressive analgesia, it is ethically appropriate to provide terminal sedation . Of those who favoured terminal sedation, 38% also agreed that PAS is ethically appropriate in some circumstances. Along a three point spectrum of aggressiveness in end of life care, the plurality of respondents were in the middle, agreeing with terminal sedation but not with PAS. Compared with respondents who were less aggressive or more aggressive, physicians in this middle group were more likely to report having more experience providing primary care to terminally ill patients and attending religious services more frequently .Conclusions: Support for terminal sedation was widespread in this population of physicians, and most who agreed with terminal sedation did not support PAS. Most internists who support aggressive palliation appear likely to draw an ethical line between terminal sedation and assisted suicide. (shrink)

This article shows under which circumstances fraudulent accreditation can occur in Brazilian military hospitals, calling attention to the tone at the top as a critical aspect of military fraud deterrence – and hence as a critical aspect of this branch of military ethics. The problems allegedly found in Brazilian military health institutions were revealed through in-depth interviews conducted with 29 professionals who reported to work or have worked in a Brazilian military hospital. These fraud allegations were mostly associated with false (...) documentation and procedures designed to give the appearance that legal requirements for accreditation were met and could be traced back to a weak or corrupt “tone at the top” coming from military higher ranks. (shrink)

Self-monitoring theory explains the individual differences in using interpersonal adjustment techniques like self-control, self-regulation, and self-presentation. Self-monitoring plays a key role for understanding the social life. Therefore, it has been one of most popular research topics in social psychology. The aim of this study is to find out if there is a meaningful relationship between religious orientation and self-monitoring, and to determine the direction of the relationship if it exists. Besides, examining the effect of religious group membership on self-monitoring is (...) another aim of this study. In accordance with this purpose, Religious Orientation Scale and Revised Self-Monitoring Scale are applied to sample group which consists of 437 female and 369 male participants aged16 to 65+ living in Bursa. The results has revealed that there is a meaningful positive correlation between intrinsic religious orientation and self-monitoring. In addition, no meaningful relationship between religious group membership and self-monitoring has been confirmed.Summary: The adaptation process of the human being as a social creature starts in a mother's womb and becomes more complicated in consequence of coming into the world which is full of stimulus. In the beginning, this process has only a physical aspect, but with the inclusion of emotional, cognitive, and social factors over time turns into developmental tasks that people will struggle throughout their lives. The social development involves the process of becoming of the individual as an organic part of the society. As the individual realizes the existence of the other, he/she develops similar patterns of behavior that can be approved by the other. Because the meaningful relationships that form the backbone of social development constitute an important part of the self. Belonging is one of the main needs, that the individual shapes his emotions, actions, and decisions more or less in line with this need in order not to encounter the possibility of social exclusion. While belonging is a universal need for every healthy individual, there are differences between individuals in terms of directing the course of the relationship, role sharing, and using situational clues. Individual differences in how people construct interpersonal processes led Mark Snyder to systematize and theorize the concept of self-monitoring. Self-monitoring is a concept that expresses individuals' control of self-presentation, expressive behavior, and non-verbal emotional expression and their regulation. Accordingly, individuals with a high tendency to shape their behavior according to the context are classified as high self-monitors and those with low tendency are classified as low self-monitors. It can be said that adherence to religion, which is one of the determinants of social behavior, is related to self-monitoring. In this context, the main subject of this study is the relationship between self-monitoring and religiosity. The study aims to examine the effect of intrinsic-extrinsic religiosity on individuals' self-monitoring levels. Besides, as a form of religiosity, to reveal whether religious group religiosity affects self-monitoring, the study examines also self-monitoring levels of individuals belonging to the religious group and those who are not.The sample of the study was selected by a simple random sampling method and it consists of 806 participants aged 16 to 65+ living in Bursa in 2017. 437 (54.2%) of the participants in the research are women and 369 (45.8%) are men. In this study, a relational screening model was used for determining the presence, direction, and degree of the relationship between the variables. The questionnaire technique was preferred as the method of gathering information. The questionnaire was arranged in a way that does not require asking the participant any other questions apart from the questions on the form. The questionnaire form used in this research consists of 43 items. At the beginning of the questionnaire, there is a 9-item personal information form that includes demographic items consisting of age, gender, educational status, marital status, occupation, place of residence, socio-economic status, levels of subjective religious involvement, and religious group membership. For the measurement of self-monitoring, a 12-item "Self-Monitoring Scale", which was developed by Mark Snyder, revised by Richard Lennox and Raymond Wolfe and adapted by İlknur Özalp Türetgen and Sevim Cesur to Turkish (α =.80) was used. For the measurement of religious orientation, a 22-item “Religious Orientation Scale” developed by Gordon Allport and Michael Ross and adapted to Turkish by Fatma Gül Cirhinlioğlu was used (α =.90). Data collected through scales were processed by One Way Variance Analysis (ANOVA), t-Test, Pearson Correlation Analysis, and Simple Linear Regression Analysis and turned into research findings.According to the results of the simple linear correlation analysis conducted to reveal whether there is a relationship between the self-monitoring scores of the participants and the intrinsic religious orientation scores, there is a positive and significant relationship between the variables (r = 0.102, p = 0.004 0.05). The result of the correlation analysis between self-monitoring and the level of subjective religious involvement shows that no significant relationship is found (r = 0.051, p = 0.146> 0.05).This research expected that there was a negative relationship between self-monitoring and intrinsic religious orientation. However, the analyses has not reported anticipated results as addressed in the previous research. Therefore, this study opens the door for asking new questions about the subject. Religious groups, by their very nature, can refer the individual to self-presentation control, obedience, to act as deemed appropriate by the group, to adapt to the group, to change behavior without attitude change, and therefore, to attitude-behavior inconsistency. It can be argued that not only religious groups but, by their nature, all social groups create harmony-oriented pressure on the individual. Therefore, it can be predicted that belonging to a group, in general, may have a significant effect on the level of self-monitoring. The high self-monitoring scores of the participants, whether religious or non-religious group members of this study may have reduced the observability of the difference between the two groups. Therefore, repeating the study on a different sample may produce different results. (shrink)

Success in sport can provide a source of national pride for a society, and vast financial and personal rewards for an individual athlete. It is therefore not surprising that many athletes will go to great lengths in pursuit of success. The provision of healthcare for elite sports people has the potential to create many ethical issues for sports doctors; however there has been little discussion of them to date. This study highlights these issues. Respondents to a questionnaire identified many ethical (...) matters, common to other areas of medicine. However they also raised problems unique to sports medicine. Some of these ethical difficulties arise out of the place of the sports doctor within the hierarchy of sport. Yet others arise out of the special relationship between sports doctors and individual players/athletes. This study raises some important questions regarding the governance of healthcare in sport, and what support and guidance is available to sports doctors. As medical and scientific intervention in sport escalates, there is a risk that demands for enhanced performance may compromise the health of the athlete, and the role the sports doctor plays remains a critical question. (shrink)

We review the equivalence of the two-flavor Skyrme-Witten model and the two-flavor large-N c quark model. The claimed equivalence for three flavorsbetween these two models is shown to be incorrectly given in the literature, and the properly equivalent extended three-flavor large-N c quark model is constructed and discussed.

Kramers's equation specialized to the Coulomb field is factored using a rotationally invariant, angular momentum based, algebra of three anticommuting operators. Comparing the explicit chiral two-component solutions for the factored equation to the two-component solutions defined by the Foldy-Wouthuysen series for the Dirac-Coulomb Hamiltonian, it is concluded that this series cannot converge.

The coronavirus pandemic has necessitated extraordinary human resilience in order to preserve and prolong life and social order. Risks to health and even life are being confronted by workers in health and social care, as well as those in roles previously never defined as “frontline,” such as individuals working in community supply chain sectors. The strategy adopted by the United Kingdom government in facing the challenges of the pandemic was markedly different from other countries. The present study set out to (...) examine what variables were associated with resilience, burnout, and wellbeing in all sectors of frontline workers, and whether or not these differed between the UK and Republic of Ireland. Individuals were eligible if they were a frontline worker in the UK or RoI during the pandemic. Part of a larger, longitudinal study, the participants completed an online survey to assess various aspects of their daily and working lives, along with their attitudes toward their government’s handling of the crisis, and measurement of psychological variables associated with heroism. A total of 1,305 participants provided sufficient data for analysis. UK-based workers reported lower wellbeing than the RoI-based participants. In multivariate models, both psychological and pandemic-related variables were associated with levels of resilience, burnout, and wellbeing in these workers, but which pandemic-related variables were associated with outcomes differed depending on the country. The judgment of lower timeliness in their government’s response to the pandemic appeared to be a key driver of each outcome for the UK-based frontline workers. These findings provide initial evidence that the different strategies adopted by each country may be associated with the overall wellbeing of frontline workers, with higher detriment observed in the UK. The judgment of the relatively slow response of the UK government to instigate their pandemic measures appears to be associated with lower resilience, higher burnout, and lower wellbeing in frontline workers in the UK. (shrink)

Since Thomas Kuhn’s The Structure of Scientific Revolutions (1962), historians and philosophers of science have paid increasing attention to the implications of disciplinarity. In this chapter we consider restrictions posed to interdisciplinary exchange between ecology and economics that result from a particular kind of commitment to the ideal of disciplinary purity, that is, that each discipline is defined by an appropriate, unique set of objects, methods, theories, and aims. We argue that, when it comes to the objects of study in (...) ecology and economics, ideas of disciplinary purity have been underwritten by the artificial-natural distinction. We then problematize this distinction, and thus disciplinary purity, both conceptually and empirically. Conceptually, the distinction is no longer tenable. Empirically, recent interdisciplinary research has shown the epistemological and policy-oriented benefits of dealing with models which explicitly link anthropogenic (i.e., “artificial”) and non-anthropogenic factors (i.e., “natural”). We conclude that, in the current age of the Anthropocene, it is to be expected that without interdisciplinary exchange, ecology and economics may relinquish global relevance because the distinct and separate systems to which each “pure” science was originally made to apply will only diminish over time. (shrink)

The Objective Of This Highly Rewarding Book Indian Philosophy Of Knowledge Is To Highlight The Main Purpose Of Gaining Knowledge. The Highest Knowledge In Vedas And Upanisads Is The Knowledge Of Brahman Which Leads To Liberation. The Sankhya System Promises Complete Cessation Of All Sorrows. The Yoga Is Entirely Devoted To The Attainment Of Kaivalya. Gautama, In His Nyayasutra Asserts That Their Knowledge Would Lead To The Attainment Of The Liberation. The Vaisesika And Mimamsa Begins With The Interpretation Of Dharma (...) As The Means For Attainment Of The Worldly As Well As Transcendental Well-Being. The Buddhists Aim Of Knowledge Is To Remove Passions And To Show The Path Of Nirvana. The Removal Of Karmic Matter Is The Main Theme Of Knowledge In Jaina Philosophy. (shrink)

The context of Covid-19 has offered an unusual cultural landscape for examining how workers view their own position relative to others, and how individuals respond to prolonged exposure to workplace stress across different sectors and cultures. Through our recent work tracking the well-being of frontline workers in the UK and Ireland, we have uncovered additional psychological factors that have not been accounted for in previous models of occupational stress or burnout. In recent months, frontline workers have worked to protect the (...) community from the threat of SARS-CoV-2 and, simultaneously, have evaluated their perceptions of collective efforts of others as either congruent or incongruent with collective goals : we call this novel aspect solidarity appraisal. These frontline workers have been hailed as heroes, which we argue has led to the creation of an implicit psychological contract between frontline workers and the public. Here, the heroes are willing to “go above and beyond” for the greater good, with the expectation that we do our part by adhering to public health guidelines. Where frontline workers perceive incongruence between the words and actions of others in working toward collective goals this drives negative affect and subsequent burnout. In this perspective article, we evaluate the cultural context of the pandemic in the UK and Ireland and suggest important socio-cultural factors that contribute to perceptions of solidarity, and how this may relate to burnout and worker welfare during and beyond the pandemic context. (shrink)