IntroductionThe objectives of this study are to assess and compare differences in the intensity, frequency, and overall severity of moral distress among a diverse group of healthcare professionals.MethodsParticipants from within Baylor Health Care System completed an online seven-point Likert scale (range, 0 to 6) moral distress survey containing nine core clinical scenarios and additional scenarios specific to each participant’s discipline. Higher scores reflected greater intensity and/or frequency of moral distress.ResultsMore than 2,700 healthcare professionals responded to the survey (response rate 18.14 (...) percent); survey respondents represented multiple healthcare disciplines across a variety of settings in a single healthcare system. Intensity of moral distress was high in all disciplines, although the causes of highest intensity varied by discipline. Mean moral distress intensity for the nine core scenarios was higher among physicians than nurses, but the mean moral distress frequency was higher among nurses. Taking into account both intensity and frequency, the difference in mean moral distress score was statistically significant among the various disciplines. Using post hoc analysis, differences were greatest between nurses and therapists.ConclusionsMoral distress has previously been described as a phenomenon predominantly among nursing professionals. This first-of-its-kind multidisciplinary study of moral distress suggests the phenomenon is significant across multiple professional healthcare disciplines. Healthcare professionals should be sensitive to situations that create moral distress for colleagues from other disciplines. Policy makers and administrators should explore options to lessen moral distress and professional burnout that frequently accompanies it. (shrink)

The relevance of the research In the face of increasing global competition, business was challenged to seek new methods for creating their competitive advantage and at the same time the decreasing budgets of higher education institutions were pressured to find new streams of financing. In both cases, collaboration is seen as an important method for achieving their objectives but universities of today have as well to find the appropriate balance between teaching, basic and applied research, and entrepreneurship. Ten types of (...) university-business collaboration are related quite directly to the missions of the university and the needs of business. Curriculum development and delivery is one of that ten, which aim is to develop human resources to modern society. A summary of benefits was identified in the academic literature as arising from UBC in relation to curriculum design and delivery for multiple stakeholders including academics, students, university administration, business and community. Overall, UBC may take various forms that are influenced by different factors but even if all stakeholders seeks the main purpose of this process they may get different benefits. The research aim was to identify the benefits of universities and business organizations in curriculum development. The objectives of the research: to determine the instruments and activities used for universities and business organizations collaboration, to identify universities and business organizations benefits from collaboration to the various stakeholder groups. Analysis of recent research and publications. UBC became the subject of education and management sciences. P. D'Este and M. Perkmann explored the factors of UBC, the types were identified by T. Davey, T. Baaken, V. Galan Muros, A. Meerman, T. Barnes, A. Gibbons and the levels of UBC were represented by B.N. Ponomariov, P.C. Boardman, T. Davey, R. Laužackas. The benefits of UBC to research quality have been studied by researchers T. Davey, M. Crespo, N. Carayol, H. Forsyth, R. Laxton, S. Lamichhane, T. Nath Sharma, P. Van der Sijde and H. Dridi, as a collaborative factor for learning improvement by researchers K. Ramakrishnan, N.M. Yasin, A. Draghici. An overview of the study of this object shows that it was mostly analysed in vocational training and in last ten years’ period the publications is growing in UBC. Research methodology. The paper seeks to represent the UBC benefits for different stakeholders and collaboration forms, which was used by university with the business organizations from leisure industry. Quantitative research was used to gain quantify opinions of benefits and instruments of UBC – and generalize results from a larger sample population. Methods applied for the research was scientific literature review, a questionnaire survey for business organization leaders and mathematical statistics. Conclusion. The benefits of the UVB were grouped according to the type of stakeholder's: society, university administration, academics, entrepreneurs, students. The benefits of business stakeholders include additional funding, access to education resources, lecturer and coordinator, support in evaluating the program and developing new study subjects. The highest rated benefit to others stakeholders from their view could be reducing academic staff training costs, as well as business information available to student projects, skills development and student employment opportunities and human resource development in the region. (shrink)

Rapidly changing estimates on the Soviet régime's ability to survive show how difficult it is for American Sovietologists to grasp what is going on.

Merab Konstantinovich [Mamardashvili] met with me immediately, as soon as I requested it, although he forewarned me that he could only dimly remember much of that distant past in which I was most interested. But evidently that past still perturbed him as well, since he agreed to speak with me even though he had not yet completely recovered from his illness, and hence his voice was feeble, at times subsiding to a whisper; he would pronounce his words indistinctly, constantly sticking (...) one onto another; on top of that, for technical reasons the dictaphone was situated a bit away from him. It was therefore very difficult to transcribe the text, and I raised many questions with the idea of asking Merab Konstantinovich about them at our next meeting and clearing up some things. But alas, there was no next meeting … Hence I am permitting myself now to publish only some of the most clearly enunciated fragments of my conversation with him, one of the four "forefathers" of the Moscow Methodological Circle, whose name for us, today's participants (and hence neophytes) in the methodological movement, is enveloped by legends handed down by word of mouth. I kept my questions to a minimum. Mamardashvili's reminiscences, arguments, and reflections will seem contentious to many. But no matter, one can dispute points of substance even with those who have passed on. (shrink)

There is no doubt that custard apple diseases are among the important reasons that destroy the Custard Apple plant and its agricultural crops. This leads to obvious damage to these plants and they become inedible. Discovering these diseases is a good step to provide the appropriate and correct treatment. Determining the treatment with high accuracy depends on the method used to correctly diagnose the disease, expert systems can greatly help in avoiding damage to these plants. The expert system correctly diagnoses (...) Custard Apple disease to make it easier for farmers to find the right treatment based on the appropriate diagnosis. Objectives: A specialized syllable language system was established for the diagnosis of Custard Apple plant disease. (shrink)

This paper inquires into the nature of intertheoretic relations between psychology and neuroscience. This relationship has been characterized by some as one in which psychological explanations eventually will fall away as otiose, overthrown completely by neurobiological ones. Against this view it will be argued that it squares poorly with scientific practices and empirical developments in the cognitive neurosciences. We analyse a case from research on visual perception, which suggests a much more subtle and complex interplay between psychology and neuroscience than (...) a complete take-over of the former by the latter. In the case of vision, cross-theory influences between psychology and neuroscience go back and forth, resulting in refinement in both disciplines. We interpret this case study as showing that: (1) Mutual co-evolution of psychological and neurobiological theories, exemplifying persisting top-down influences from psychology, is a more empirically adequate way to describe psychoneural theory relations than a view on co-evolution, favoured by reductionists, which regards the cross-theory contributions from psychology as merely heuristically useful with no enduring influence on neurobiological theorizing; (2) In research on vision, discovering (or hypothesizing) the neural basis of functions vindicates psychological approaches, it does not eliminate them; (3) Current work on vision shows that many perceptual phenomena must be understood in terms of dynamical interactions between an observer and his/her environment. Therefore, we argue that internalist characterizations of the visual system must be supplemented with externalist accounts that address these reciprocal observer-environment interactions involved in vision. Such processes seem quite different from (internal) cellular and molecular ones, and as such seem to lie outside the scope of neuroscientific inquiry. We conclude that psychoneural reduction or elimination is implausible as a meta-theoretical prediction of theory choice in empirical work. Instead, this case study of vision shows that both psychology and neuroscience contribute to, and complement one another in the study of visual perception. (shrink)

Judgment aggregation theory, which concerns the translation of individual judgments on logical propositions into consistent group judgments, has shown that group consistency generally cannot be guaranteed if each proposition is treated independently from the others. Developing the right method of abandoning independence is thus a high-priority goal. However, little work has been done in this area outside of a few simple approaches. To fill the gap, we compare four methods based on distance metrics between judgment sets. The methods generalize the (...) premise-based and sequential priority approaches to judgment aggregation, as well as distance-based preference aggregation. They each guarantee group consistency and implement a range of distinct functions with different properties, broadening the available tools for social choice. A central result is that only one of these methods (not previously considered in the literature) satisfies three attractive properties for all reasonable metrics. (shrink)

Health care is transitioning from genetics to genomics, in which single-gene testing for diagnosis is being replaced by multi-gene panels, genome-wide sequencing, and other multi-genic tests for disease diagnosis, prediction, prognosis, and treatment. This health care transition is spurring a new set of increased or novel liability risks for health care providers and test laboratories. This article describes this transition in both medical care and liability, and addresses 11 areas of potential increased or novel liability risk, offering recommendations to both (...) health care and legal actors to address and manage those liability risks. (shrink)

Background One of the objectives of medicine is to relieve patients' suffering. As a consequence, it is important to understand patients' perspectives of suffering and their ability to cope. However, there is poor insight into what determines their suffering and their ability to bear it. Purpose To explore the constituent elements of suffering of patients who explicitly request euthanasia or physician-assisted suicide (EAS) and to better understand unbearable suffering from the patients' perspective. Patients and methods A qualitative study using in-depth (...) face-to-face interviews was conducted with 31 patients who had requested EAS. The grounded theory approach was used to analyse the data. Results Medical, psycho-emotional, socio-environmental and existential themes contributed to suffering. Especially fatigue, pain, decline, negative feelings, loss of self, fear of future suffering, dependency, loss of autonomy, being worn out, being a burden, loneliness, loss of all that makes life worth living, hopelessness, pointlessness and being tired of living were constituent elements of unbearable suffering. Only patients with a psychiatric (co)diagnosis suffered unbearably all the time. Conclusions Unbearable suffering is the outcome of an intensive process that originates in the symptoms of illness and/or ageing. According to patients, hopelessness is an essential element of unbearable suffering. Medical and social elements may cause suffering, but especially when accompanied by psycho-emotional and existential problems suffering will become ‘unbearable’. Personality characteristics and biographical aspects greatly influence the burden of suffering. Unbearable suffering can only be understood in the continuum of the patients' perspectives of the past, the present and expectations of the future. (shrink)

Suppose some person 'A' sets out to accomplish a difficult, long-term goal such as writing a passable Ph.D. thesis. What should you believe about whether A will succeed? The default answer is that you should believe whatever the total accessible evidence concerning A's abilities, circumstances, capacity for self-discipline, and so forth supports. But could it be that what you should believe depends in part on the relationship you have with A? We argue that it does, in the case where A (...) is yourself. The capacity for "grit" involves a kind of epistemic resilience in the face of evidence suggesting that one might fail, and this makes it rational to respond to the relevant evidence differently when you are the agent in question. We then explore whether similar arguments extend to the case of "believing in" our significant others -- our friends, lovers, family members, colleagues, patients, and students. (shrink)

Using the mathematical notion of an entity to represent states in quantum and classical mechanics, we show that, in a strict sense, proper superpositions are possible in classical mechanics.

The article examines the genre specificity of Friedrich Hebbel’s dramaturgy. The attention is drawn to the operation of various genre elements in his works. The basic principles of creation of philosophical and mythological tragedy by Friedrich Hebbel are analyzed. The gnoseological conception of cognition of the world which relies on the ontological structure, transferring the center of gravity of the drama to the idea development, extension of space and time at the expense of inserting mythological plot and symbolism as the (...) signs of the genre. The philosophical and mythological tragedy of Friedrich Hebbel makes sense of ontological categories, elaborates ideas of social philosophy and philosophy of history. (shrink)

Are values and social priorities universal, or do they vary across geography, culture, and time? This question is very relevant to Asia’s emerging economies that are increasingly looking at Western models for answers to their own outmoded health care systems that are in dire need of reform. But is it safe for them to do so without sufficient regard to their own social, political, and philosophical moorings? This article argues that historical and cultural legacies influence prevailing social values with regard (...) to health care financing and resource allocation, and that the Confucian dimension provides a helpful entry point for a deeper understanding of ongoing health care reforms in East Asia – as exemplified by the unique case of Singapore. (shrink)

The notion of a Sasaki projectionon an orthomodular lattice is generalized to a mapping Φ: E × E → E, where E is an effect algebra. If E is lattice ordered and Φ is symmetric, then E is called a Φ-symmetric effect algebra.This paper launches a study of such effect algebras. In particular, it is shown that every interval effect algebra with a lattice-ordered ambient group is Φ-symmetric, and its group is the one constructed by Ravindran in his proof that (...) every effect algebra that has the Riesz decomposition property is an interval algebra. It is shown that the doubling construction introduced in the paper is connected to the conditional event algebrasof Goodman, Nguyen, and Walker. (shrink)

This Is A New Release Of The Original 1920 Edition.

In St. Francis Regional Medical Center v. Blue Cross & Blue Shield of Kansas ), the United States Court of Appeals for the Tenth Circuit upheld Blue Cross/Blue Shield of Kansas's anti-assignment requirement, on the grounds that the Employee Retirement Income Security Act preempted a hospital's claim against Blue Cross. The court also held that public policy supported anti-assignment requirements in health plans not covered under ERISA.When drafting ERISA, Congress did not explicitly address assignability of health care benefits. According to (...) the court of appeals, congressional silence constituted an intent to allow the parties to negotiate freely the assignment of health care benefits. Examining non-ERISA health plans, the court adopted a balancing test to determine the validity of anti-assignment clauses; it found that anti-assignment requirements promote freedom of contract and may include medical costs. (shrink)