Linked with existence of the almighty, the operation of division by zero which is considered as undefined or indeterminate or infinite sometimes, has been a topic of serious altercation among mathematicians and philosophers for so long. History is evident of the various attempts made to clearly define the algebra of zero, including the idea of division by zero. This includes the evolution of the idea of zero division and various insights from mathematicians like Euler, Craig and more. The realm of (...) the paper contains all such significant attempts and it deals with the idea of the history that wishes to explore the evolution of infinity and undefined. The prime aim of this paper is to clearly distinguish the three concepts of Undefined, Indeterminate and Infinity, along with the concept of division by zero. It strives to provide a notation to undefined expressions, along with citing justifications and results with the help of unpretentious examples from key branches. (shrink)

This study aimed to understand the preserved elements of self-identity in persons with moderate to severe dementia attributable to Alzheimer’s disease. A semi-structured interview was developed to explore the narrative self among residents with dementia in a residential care facility and residents without dementia in an independent living setting. The interviews were transcribed verbatim from audio recordings and analyzed for common themes, while being sensitive to possible differences between the groups. The participants with dementia showed evidence of self-reference even though (...) losses in explicit memory were evident. The most noticeable difference between the two groups was time frame reference. Nonetheless, all participants showed understanding of their role in relationships and exhibited concrete preferences. Our findings suggest that memory loss and other cognitive deficits associated with moderate to severe dementia do not necessarily lead to a loss of “self.”. (shrink)

We share Nair-Collins and Joffe's (2023) concern with the accuracy of the “whole brain-death” diagnosis, which fails to take into account current understandings of residual brain function (neurohor...

We agree with Nielsen Busch and Mjaaland’s (2023) assessment that the Dead Donor Rule (DDR) should be viewed as an essential requirement of the organ donation process, and that the essence of the r...

We welcome and applaud Wilkinson’s impressive and subtle exploration of the possible considerations of frailty as a criterion for triage in times of pandemic-dr...

The revised Declaration of Helsinki allows placebo-controlled trials to be used even when there is an established therapy, provided there are adequate ‘methodological’ reasons for doing so. This seems to violate the principle of beneficence: where there is an established therapy, physicians treating patients with a placebo are withholding a known effective therapy. Because of this problem, we hypothesised that clinical researchers may be unwilling to risk violating the principle of beneficence and employ placebo-controlled trials in cases where there is (...) an established therapy. In this paper, we began to investigate this hypothesis. After summarising the arguments for and against using placebo controls in clinical practice, we exploredthe extent to which placebo-controlled trials are used in cases where there is an established therapy. To do this, we conducted as systematic search for all placebo-controlled trials published in 2015 in the five highest impact general medical journals. We identified 70 placebo-controlled trials. Of these, 66 were for indications where there was no established effective therapy. Only four used a placebo control in spite of there being an available effective therapy. The infrequent use of placebo controlled trials where established therapy exists highlights a seeming discrepancy between what the Declaration of Helsinki allows and what clinical investigators believe to be ethically acceptable. The evidence presented in this paper suggests that the Declaration of Helsinki be reconsidered, and perhaps revised, in light of actual practice. (shrink)

BackgroundSimilar to many other countries, in Germany patients with alcohol-related liver disease are obliged to prove their abstinence before being accepted on a waitlist for liver transplantation. Health care professionals (HCPs) must both treat patients and ensure that patients have proven their abstinence. The aim of this exploratory study was to develop a deeper understanding of how HCPs deal with this dual role.MethodsThe study used semi-structured interviews as the source of data. 11 healthcare professionals from ten of the 22 German (...) transplant centers were interviewed. After transcription, a qualitative content analysis was performed.ResultsWe found that these HCPs faced an ethical dilemma, as they must balance the roles of being both a treatment provider (the therapist role) and an assessor (the monitoring role). To solve this dilemma, the strategy seems to be a tendency for the HCPs to take on one dominant role amongst these two roles. HCPs who prefer to take on the therapist role seem to feel burdened by the 6-month abstinence rule and the obligation to monitor their patients. HCPs who prefer to take on the monitoring role tend to have negative assumptions about the patients. HCPs also reported the impression that patients perceive HCPs as more involved in monitoring and less open to the therapeutic role. From this it can be deduced that current regulations and structures lead both to stress for HCPs and to suboptimal therapy for those affected.ConclusionsThe results showed that current transplantation guidelines can have a negative impact on both patient care and the burdens on the HCPs. From our point of view, there are various changes that could be made to the current clinical practice that would help solve this dilemma. For instance, integrating other assessment criteria that are more closely adapted to the health status trajectory and psychosocial background of the individual patient would be both possible and would lead to improvements in practice. (shrink)

The Human-Animal Boundary shifts the traditional anthropocentric focus of philosophy and literature by combining the question "what is human?" with the question "what is animal?" The objective is to expand the imaginative scope of human-animal relationships by combining perspectives from different disciplines, traditions, and cultural backgrounds.

This paper discusses the work of Ismat Chughtai (1911–1991), a controversial writer whose long literary career extending over four decades roughly corresponds to the formative stages of the Indian women's movement. It interprets Chughtai's novella The Heart Breaks Free (1966) to forward an anti-teleological enquiry of the women's movement in India. This progressive teleology often suggested by a discussion of the ‘waves’, ‘stages’ or ‘phases’ of the Euro-American women's movement and adopted to postcolonial women's movements, such as those in India, (...) Jamaica and South Africa, is belied by the piecemeal legislative gains won by activist efforts. Some of the questions governing my enquiry are: What lessons can a questioning of teleology teach us about the gains and losses of postcolonial women's movements? If the alternative to teleology is, as I suggest, a genealogy, then what constitutes a genealogical enquiry into the women's movement in India? In face of apparent and self-acknowledged losses and ineffectiveness in recent times, would the movement's apparent unity across religious differences be a way of initiating such an inquiry or is another mode of analysis required? The paper directs attention to the Indian women's movement's attempts at bringing together women of different religious persuasions, legislative, and religious edicts related to Muslim women's right to co-habitation and divorce, and ‘cases’ that serve as testing points of the movement's struggle against religious and state authority. It also points to the neglected factor of economic security for women as a way in which a genealogical inquiry can proceed so as to strengthen the legislation and the movement itself. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The TripletsManeesh BatraI am a neonatologist and for the majority of my clinical time I care for babies and their families at a large University-based referral neonatal intensive care unit (NICU) in the United States. In 2003, I first visited this rural Ugandan hospital shortly after the opening of a special care baby nursery there, and have been involved with development of that program ever since.Uganda is a beautiful, (...) land-locked country in East Africa with a sordid political history. It is a developing country that is poor, mostly rural with a high fertility rate and a life expectancy of 42 years. The government spends $5 per capita per year on healthcare. The district with the hospital has a population of 500,000, the majority of which is rural. Access to health services is poor, even by Ugandan standards, and child mortality is in the higher band in the country.Most people in the region live in extended family clans. A common home is made of earth, with a grass roof, and a jerry can out front for collecting water from the well. It is an exquisitely lush landscape with fecund soil. At the hospital, there is limited electricity, lab support, medications, blood supplies, and health care workers. For the 200 bed hospital (that accommodates upwards of 400 inpatients when necessary, no one is turned away) there are four to seven Ugandan doctors, who do everything from C-sections, to colostomies, to HIV care to resuscitate babies in the NICU. For a ward of 20-80 patients there are one to two nurses, and maybe a nursing aide. Families do the majority of the care in the hospital, even in the NICU. Mum's express breast milk, perform tube feeds, wash the linens, notify staff when an IV infiltrates, and keep babies warm.Day OneAnother beautiful morning, with fresh instant coffee in hand, birds chirping and kids playing outside. It is good to be back. Over the last eight years, I've [End Page 78] made some close friends here and its good to be among them again. Every time I visit and return home, I leave a piece of me here, and bring back something new with me. This morning that feeling is overwhelming me, an incredible inspiration swells. I am not tired and I want to be busy. It is no wonder that this is where I was inspired to pursue caring for babies as my career. Over these years, it has been amazing to see the staff care for the community's babies and mums here. As an outsider, an opinioned one at that, I feel burdened at the thought of these babies dying somewhat needlessly. Is it really no-one's fault? How should one act in the face of scarcity, knowing there is a better standard to be had if only circumstances were different?I walked into the NICU to find triplets had arrived! Born at about 33 weeks they were two months early. Since they weighed around 1.5kg (about 3 lbs) each, they were at very high risk of dying —however, it was absolutely incredible to see the way they were tucked in by the skilled team. Within an hour of delivery—they were in incubators with IVs, having their hypoglycemia corrected, and two out of three were on oxygen (all of them had their O2 saturations checked). The three babies were tucked in so calmly, with the finest skill and expertise neonatal care anywhere has to offer. In stark contrast to the first admissions I witnessed years ago, the nurses now knew exactly what to do and how to do it. As a result, they had saved many lives and restored hope among the mums of the region that there was somewhere to go to get help. This success resulted in a healthy swagger among the staff because they could intervene successfully.These were spontaneous triplets to this young mum, who already had three other children. She looked tired when she walked into the NICU one hour (yes one hour) after delivering the trio, but if I hadn't known prior, there was no way to know... (shrink)

Public health emergencies, including infectious disease outbreaks and natural disasters, are issues faced by every community. To address these threats, it is critical for all jurisdictions to understand how law can be used to enhance public health preparedness, as well as improve coordination and collaboration across jurisdictions. As sovereign entities, Tribal governments have the authority to create their own laws and take the necessary steps to prepare for, respond to, and recover from disasters and emergencies. Legal preparedness is a key (...) component of public health preparedness. This article first explains legal preparedness and Tribal sovereignty and then describes the relationship between Tribal Nations, the US government, and states. Specific Tribal concerns with respect to emergency preparedness and the importance of coordination and collaboration across jurisdictions for emergency preparedness are discussed. Examples of collaborative efforts between Tribal and other governments to enhance legal preparedness are described. (shrink)

Cloud computing paradigm is growing rapidly, and it allows users to get services via the Internet as pay-per-use and it is convenient for developing, deploying, and accessing mobile applications. Currently, security is a requisite concern owning to the open and distributed nature of the cloud. Copious amounts of data are responsible for alluring hackers. Thus, developing efficacious IDS is an imperative task. This article analyzed four intrusion detection systems for the detection of attacks. Two standard benchmark datasets, namely, NSL-KDD and (...) UNSW-NB15, were used for the simulations. Additionally, this study highlights the proliferating challenges for the security of sensitive user data and gives useful recommendations to address the identified issues. Finally, the projected results show that the hybridization method with support vector machine classifier outperforms the existing techniques in the case of the datasets investigated. (shrink)

Volume 19, Issue 11, November 2019, Page 29-31.

Despite a rich theoretical and clinical history, psychodynamic child and adolescent psychotherapy has been slow to engage in the empirical assessment of its effectiveness. This systematic review aims to provide a narrative synthesis of the evidence base for psychodynamic therapy with children and adolescents. Building on two earlier systematic reviews, which covered the period up to 2017, the current study involved two stages: an updated literature search, covering the period between January 2017 and May 2020, and a narrative synthesis of (...) these new studies with those identified in the earlier reviews. The updated search identified 37 papers. When combined with papers identified in the earlier systematic reviews, this resulted in a combined total of 123 papers. The narrative synthesis of findings indicates that there is evidence of effectiveness for psychodynamic therapy in treating a wide range of mental health difficulties in children and adolescents. The evidence suggests this approach may be especially effective for internalizing disorders such as depression and anxiety, as well as in the treatment of emerging personality disorders and in the treatment of children who have experience of adversity. Both the quality and quantity of empirical papers in this field has increased over time. However, much of the research demonstrates a range of methodological limitations, and only 22 studies were Randomized Controlled Trials. Further high-quality research is needed in order to better understand the effectiveness of psychodynamic psychotherapy for children and young people. (shrink)

Background and rationale Clinicians often encounter a variety of ethical challenges in their routine clinical practice, and it varies across healthcare and cultural settings of their practice. Despite of this, there are no clear-cut available guidelines concerning the right course of action in a given ethically challenging situation. A validated instrument that could capture the health care providers’ viewpoints in this regard is lacking from Indian settings. Thus, the current study aimed at developing an instrument to assess the HCP’s perspective (...) regarding different ethically challenging situations encountered in the Indian settings. Methods The questionnaire was developed by involving 15 medical experts. A mixed-method approach, Delphi-technique, and online survey were used for item generation and validation. Results The questionnaire comprised of 11 items representing four factors: health-resource constraints, medical responsibility of the HCP, obtaining patients/family members’ consent for the treatment, and treatment beyond the standard protocol. The gender and clinical disciplines of the participants were related to their level of endorsement for various domains of the ECCS-Q. Conclusions Ethical challenges in the clinical practice fall in different clusters. The clinicians’ course of action in such situations have many socio-demographic and professional determinants. Future studies are warranted to investigate these phenomena. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:184 THE ECONOMIC THOUGHT OF DAVID HUME David Hume's views on economics are expressed in his Essays, Moral, Political and Literary, Part II (1752). He was a contemporary of Adam Smith and read Smith's The Wealth of Nations shortly before his death. Some commentators have suggested that Hume exercised some influence over Smith's views on economics; others are not so sure. Hume's commentators over the last 200 years have (...) emphasized his theory of knowledge, doctrine of causality and belief, theory of morals and historical writing. His views on economics have been relatively neglected. The purpose of this essay is to summarize and clarify Hume's views on economics. Commerce and Trade Hume's essay "Of Commerce" is an extension of his view of property rights. Just as government should not impair property rights, it should not impair commerce, which is the freedom to contract between consenting parties. But Hume was not a 'pure' advocate of laissez-faire. He supported the infant industry argument: A tax on German linen encourages home manufacturers, and thereby multiplies our people and industry. A tax on brandy encreases the sale of rum, and supports our southern colonies. The bulk of workers are employed either in argiculture or manufacturing. In the more primitive societies, almost everyone is employed in agriculture (husbandry), and as agricultural techniques are improved, the land becomes able to support more nonagricultural workers, including artisans and providers of luxuries as well as manufacturers. Some of these 185 surplus (i.e., nonagricultural or manufacturing) workers are sometimes appropriated by the sovereign for use in the army or navy (OC 256), which prevents them from producing luxury goods and services, and leads to a different kind of state than would exist if their labor were not so appropriated. Increases in industry, the arts and trade generally increase both the power of the sovereign and the happiness of the people (OC 260). Trade is something that is mutually beneficial -- both parties gain. Hume spends a great deal of time refuting the idea that one nation's gain is another's trade loss. Thus, trade is a win-win rather than a win-lose situation, as some modern-day mercantilists (such as Thurow fThe Zero Sum Gamel and Batra G The Great Crash of 1989l)would have us believe. Hume views everything in the world as purchased by labor, and sees labor as being caused by people's passions (OC 261). In modern language, one could say that wealth is produced either from physical or mental labor, and that it is individual incentive that causes the human action to begin in the first place. Of course, this view overlooks the fact that labor does not exist in a vacuum, but is mixed with land and perhaps capital (which can be seen as the result of accumulated labor). Exchange occurs when producers of a commodity produce more than they can consume. At that point, they trade their surplus for other goods and services (OC 261). In peacetime, the farmers' surplus goes toward the acquisition of manufactures or the cultivation of the liberal arts. In war, the surplus can go toward the support of an army or navy. The state becomes more powerful as it can produce increasingly beyond subsistence, what Hume refers to as employment beyond mere necessities (OC 186 262). But rather than encouraging the increase in state power by force, such increase is best accomplished by allowing individuals to produce as much as they want, which they will do automatically in the absence of coercion, and then appropriate part of the surplus: It is a violent method, and in most cases impracticable, to oblige the labourer to toil, in order to raise from the land more than what subsists himself and family. Furnish him with manufactures and commodities, and he will do it himself. Afterwards you will find it easy to seize some part of his superfluous labour, and employ it in the public service, without giving him his wonted return. Being accustomed to industry, he will think this less grievous, than if, at once, you obliged him to an argumentation of labour without any reward. (OC 262) Countries that engage in... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Striving To Do Good:Well-Springs, Realities, and Paradoxes of Medical Humanitarian WorkRenée C. FoxThe voices that speak from the pages of these testimonial narratives are those of physicians who are engaged in medical humanitarian work. The preponderance of them are based in U.S. academic medical centers where they have clinical, teaching, and research responsibilities from which they regularly "commute" to care for patients in what the euphemistic language of "global (...) health" terms "resource-limited," rather than "poor" countries." This "hybrid life," as one of the physicians (Robert Riviello) refers to it, has transported them periodically to numerous African societies (to Algeria, Ethiopia, Gabon, Morocco, Rwanda, Sudan, Tanzania, and Uganda), to Haiti, to India and Nepal, and to Guatemala and Mexico. Three of the "stories" are written by physicians at work in the countries where they were born (Prasanta Tripathy in Eastern India, Sridevi Seetharam and colleagues in Southern India, and Paul Pierre, in Haiti).Only one group of physician-coauthors (Maricruz Merino, Jonathan Iralu, and Sonya Shin) write about their experiences in practicing medicine among poor and socially disadvantaged patients on the American mainland—in the setting of the Navajo Indian reservation in Gallup, New Mexico.All these physicians describe their involvement in humanitarian medicine as emanating from their commitment to "social justice," to "saving lives," and to "caring for the poor"; to their universalistic convictions about "human solidarity," and the non- otherness of others; to their indignation about the inequities and injustices of the world, particularly with regard to access to health care (in the words of Jeffrey Deal, "[They] deserve better. They all do"); and to their "passionate" desire, not just their "sense of duty," to help rectify these wrongs (Richard Keiden). I was struck by the fact that none of them uses the word "suffering" to describe the plight of the persons whom they feel they have been called to medically assist.Three of the physicians express the wellsprings of their motivation in religious terms. Richard Keiden refers to a "guiding principle of Judaism" on which his medical humanitarian work has been founded—"tzedakah"—which "translates as charity but actually means righteousness," is based on a "concept of social justice," and is "an obligation, not a choice." Robert Riveillo says that at the time of his graduation from high school he envisioned his "life's work as a long-term missionary surgeon"; he invokes "loving mercy," as well as justice, "in this work of solidarity" that he has undertaken; and he poignantly admits that "most days I still long to pack my things, my family, and our efforts and move to Africa for a life of direct service." What Jeffrey Deal writes is the most explicitly and ardently religious of all. He identifies his work as a physician in Sudan with Jesus's "desire for us to care [End Page 115] for the poor and downtrodden in His stead." He is haunted by his "failure" to deliver alive a "partially born" baby girl who for him incarnated "the least of the least" of whom Jesus "spoke passionately." And in touching "ever so briefly... [that] one, tiny being [he] encountered... [on ] that hot morning in Sudan," he attests, he "touched Jesus."Jeffrey Deal is not the only one who was so stricken by the death of a baby or a child. For a number of these physicians (Sadath Sayeed, Maneesh Batra, and for Sridevi Seetharam, Lisa Adams and their colleagues), it was a tragedy that they found hard to bear with "detached enlightenment" (Sayeed), or to accept. The most demonstrably heartbroken and morally outraged among them is Sadath Sayeed, who "wept uncontrollably" over the death of a baby boy, born "at home" in Haiti, "probably in one of the hundreds of make-shift tent cities." The baby was not breathing continuously, and was "handed" to him to care for. At the close of the "story " about this experience that he recounts, Sayeed lashes out with fury and angst at those who were likely to ask him, "How was it in Haiti?" Do you want to hear "my real answer?" he replies:... [L]et me summarize my last patient for you: Good luck Dad... (shrink)