When evaluating an innovative intervention in a randomised controlled trial , choosing an appropriate control intervention is necessary for a clinically meaningful result. An RCT reported in 2000 addressed the relative merits of two tidal volume ventilatory strategies, 6 ml/kg and 12 ml/kg , in patients with acute respiratory distress syndrome. Critics claim that the 12 ml/kg volume did not represent the clinical practice standard at that time, and that lower tidal volumes had been used in some patients prior to (...) randomisation. The trialists responded that current practice involved the use of a broad range of tidal volumes, including 12 ml/kg. Appropriate control interventions for RCTs can be ensured by: a systematic review of the relevant literature; a formal survey of expert clinicians; and publication of the proposed research protocol to solicit critical appraisal. A global survey of experts during the RCT’s design stage would have been of probative value in determining the appropriate control tidal volume. Hypothetical, but plausible, results of such a survey are presented and examined to demonstrate the value of this method. (shrink)

Not only did he found his own school of philosophy, known as eclecticism, but he reintroduced into French intellectual life the study and appreciation of the history of philosophy, and produced studies and translations--of Plato and Proclus, Descartes and Pascal--that stand to this day as paradigms of exegetical thoroughness. And it was he who first pointed out to his countrymen that there was some serious philosophical work being carried out on the other side of the Rhine.

A lot of research has been done on the detection of mental workload using various bio-signals. Recently, deep learning has allowed for novel methods and results. A plethora of measurement modalities have proven to be valuable in this task, yet studies currently often only use a single modality to classify MWL. The goal of this research was to classify perceived mental workload using a deep neural network that flexibly makes use of multiple modalities, in order to allow for feature sharing (...) between modalities. To achieve this goal, an experiment was conducted in which MWL was simulated with the help of verbal logic puzzles. The puzzles came in five levels of difficulty and were presented in a random order. Participants had 1 h to solve as many puzzles as they could. Between puzzles, they gave a difficulty rating between 1 and 7, seven being the highest difficulty. Galvanic skin response, photoplethysmograms, functional near-infrared spectrograms and eye movements were collected simultaneously using LabStreamingLayer. Marker information from the puzzles was also streamed on LSL. We designed and evaluated a novel intermediate fusion multimodal DNN for the classification of PMWL using the aforementioned four modalities. Two main criteria that guided the design and implementation of our DNN are modularity and generalisability. We were able to classify PMWL within-level accurate on a seven-level workload scale using the aforementioned modalities. The model architecture allows for easy addition and removal of modalities without major structural implications because of the modular nature of the design. Furthermore, we showed that our neural network performed better when using multiple modalities, as opposed to a single modality. The dataset and code used in this paper are openly available. (shrink)

This volume brings together 14 classic papers by interpersonal pioneers. Collectively, these papers not only demonstrate the coherence and explanatory richness of interpersonal psychoanalysis; they anticipate the emphasis on relational patterns and analyst-analysand interaction that typifies much recent theorizing. Each paper receives a substantial introduction from a leading contemporary interpersonalist. The pioneers of interpersonal psychoanalysis are: H. Sullivan, F. Fromm-Reichmann, J. Rioch, C. Thompson, R. Crowley, E. Schachtel, E. Tauber, E. Fromm, H. Bone, E. Singer, D. Schecter, J. Barnett, S. (...) Arieti, and J.Schimel. (shrink)

A brief introductory note to the special issue of the Journal of Philosophy on "Parts and Wholes", setting the background for the seven papers included in the rest of the issue (by K. Fine, H. Hudson, M. Johnston, K. Koslicki, C. Normore, P. M. Simons, and P. van Inwagen).

Normal.dotm 0 0 1 66 378 Thorbjoern Mann Consulting 3 1 464 12.256 0 false 18 pt 18 pt 0 0 false false false Normal.dotm 0 0 1 80 459 Thorbjoern Mann Consulting 3 1 563 12.256 0 false 18 pt 18 pt 0 0 false false false Arguments commonly used in discussions about design, planning, policy-making issues have not been adequately analyzed in the literature. The structure of such ‘planning arguments’ is discussed. Based on the conceptual framework (...) of the ‘argumentative model of planning’ proposed by H. Rittel, an approach for their systematic and transparent evaluation by discourse participants is presented. Procedural implications for its application in the planning process are discussed, and the potential for information technology support for such processes explored. (shrink)

Proper utilization of antenatal and postnatal care services plays an important role in reducing the maternal mortality ratio and infant mortality rate. This paper assesses the utilization of health care services during pregnancy, delivery and post-delivery among rural women in Uttar Pradesh and examines its determinants. Data from a baseline survey of UP Community Mobilization project was utilized. A cross-sectional sample of currently married women who delivered a baby 15 months prior to the survey was included. Information was collected from (...) 2208 women spread over five districts of UP. Information on socio-demography characteristics, utilization of antenatal care, delivery and postnatal care services was collected. To examine the determinants of utilization of maternal health services, the variables included were three ANC visits, institutional delivery and PNC within 42 days of delivery. Separate multilevel random intercept logistic regressions were used to account for clustering at a block and gram panchayat level after adjusting for covariates. Eighty-three percent of women had any ANC. Of them, 61% reported three or more ANC visits. Although 68% of women delivered in a health facility, 29% stayed for at least 48 h. Any PNC within 42 days after delivery was reported by 26% of women. In the adjusted analysis, women with increasing number of contacts with the health worker during the antenatal period, women exposed to mass-media and non-marginalized women were more likely to have at least three ANC visits during pregnancy. Non-marginalized women and women with at least three ANC visits were more likely than their counterparts to deliver in an institution. Contacts with health worker during pregnancy, marginalization, at least three ANC visits and institutional delivery were the strong determinants for utilization of PNC services. Self-help group membership had no association with the utilization of maternal health services. Utilization of maternal health services was low. Contact with the health worker and marginalization emerged as important factors for utilization of services. Although not associated with the utilization, SHGs can be used for delivering health care messages within and beyond the group. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mere ReadingEva T. H. BrannI recall reading in college, some half a century ago, that the first Queen Elizabeth once represented herself to her people as “mere English.” She meant that she was English pure and simple, nothing but English. I want to set out a way with books, primarily but not only those ranged under “literature,” that I think of as mere reading. Neither the phrase “mere reading” (...) or “mere close reading” is new with me, nor is the mode, and I do not imagine myself on a lonely quest for some lost hermeneutic Eden. Children and the literate public merely read all the time. So do scholars liberated from the professional impositions of graduate school; they have achieved what Thomas Mann calls “the second ingenuousness.” They have read the articles claiming that all books and all approaches to books are of necessity theoretically or ideologically skewed and that a job of rectification, thorough enough perhaps even to postpone the actual reading indefinitely, is a precondition of liberation from the author’s subtle or unconscious agenda. Yet they have liberated themselves from the liberators, well knowing that if it’s a gift to be simple, it is also an achievement.I am, therefore, far from thinking that facing a book simply—facing it without “confronting” it—is an obsolescent activity or that either the straight and trustful reading of books or the making of books that present themselves to be so read is in real danger. I no more fear an impending cultural Armageddon than I long for a past interpretational paradise. For one thing, this is a golden age for the English novel, the premier genre of the present. All the assimilated immigrants and quondam colonials, with their delight in the elegancies of mere high English and their loving mastery of its local varieties, are writing their way into the center of English novelistic literature. They seem quite [End Page 383] aware of all those “readings”—Marxist, feminist, deconstructionist, etc. Nevertheless they write merrily on for an ingenuous yet discerning public.Consequently, the following baker’s dozen of preconditions and precepts are presented not with a sense of fending off impending doom, but for the pleasure of recognition they might give to those who have come to similar conclusions. In these pages I am apt to be preaching to the choir and, truth to tell, I feel no vocation to convert the unbelievers, the more so since I am convinced that it takes all kinds.1. The First-Person PluralThe coopting “we” is more insidiously imperial than ever was the regal first-person plural. Recall all the sentences in public intellectual speech that tell us what “we” all are thinking or are no longer permitted to think or are now required to think (or do) in matters intellectual in general and in matters interpretational in particular, by reason of our historical situation.When I read one of these dicta pushing and pulling me into my place in time or society, every aversive fiber tenses and signals “who ‘we’?—not me!” For the very thing said in our name to be needful may well be the thing most harmful and the impermissible move the one really required. It seems to me worth considering that in an analysis of “our historical situation” it might be the “our” that is the vitiating flaw.Precept: Don’t say “we” unless you have obtained consent. Try “I” or “some of us.” In particular, always qualify announcements of apocalypse so as to leave room for non-participants. This frame of mind is good for turning from sophisticated to mere reading.2. Critical SuperiorityJudges on their benches sit over the sinners arraigned before them, but that the critics in their studies should be above the writers who are their “subject” is plain comical. For one thing, judging is a social necessity, while criticizing is a discretionary activity; some of us could live without it. Some professors make students believe that criticism is work while writing is a self-indulgence that needs to be curbed. In truth, it is the other way around: the critic is parasitic on the writer; if nothing... (shrink)

A Clone of your Own provides a short, lucid, and very readable introduction to the science of human cloning and some of the central ethical issues surrounding it.The attractive 162 page pocket sized book is interspersed with original and often quirky drawings by David Mann. These drawings, as well as a good number of well chosen and sometimes equally quirky contemporary and archival photographs, provide context and texture and even a sense of wonder to the scientific and ethical discussion. (...) In addition, the author—US lawyer and bioethicist Arlene Klotzko—draws on a rich background of literary, cinematic, and cultural sources. She shows that certain fears associated with reproductive human cloning—such as the loss of personal identity and predictions about the disastrous consequences of hubristic attempts by humans to “play God” by forming humans in their image—have a long history and have given rise to a contemporary genre captured by terms, such as “Frankenscience”.Klotzko has an easy writing style and the ability to convey both complex scientific information, as well as the gist of ethical debates, to the lay reader. Serious discussion is interspersed with personal anecdotes, and the reader soon …. (shrink)

A cross-sectional study to ascertain what the Singapore population would regard as material risk in the anaesthesia consent-taking process and identify demographic factors that predict patient preferences in medical decision-making to tailor a more patient-centered informed consent. A survey was performed involving patients 21 years old and above who attended the pre-operative evaluation clinic over a 1-month period in Singapore General Hospital. Questionnaires were administered to assess patients’ perception of material risks, by trained interviewers. Patients’ demographics were obtained. Mann–Whitney (...) U test and Kruskal-Wallis one-way analysis of variance was used. Statistical significance was taken at p < 0.05. Four hundred fourteen patients were eligible of which 26 refused to participate and 24 were excluded due to language barrier. 364 patients were recruited. A higher level of education, being employed and younger age group are factors identified in patients who wanted greater participation in medical decisions. Gender, marital status, type of surgery, and previous surgical history did not affect their level of participation. The complications most patients knew about were Nausea, Drowsiness and Surgical Wound Pain. Patients ranked Heart Attack, Death and Stroke as the most significant risks that they wanted to be informed about in greater detail. Most patients wanted to make a joint decision with the anaesthetist, instead of letting the doctor decide or deciding for themselves. Discussion with the anaesthetist is the preferred medium of communication compared to reading a pamphlet or watching a video. Age and educational level can influence medical decision-making. Despite the digital age, most patients still prefer a clinic consult instead of audio-visual multimedia for pre-operative anaesthetic counselling. The local population appears to place greater importance on rare but serious complications compared to common complications. This illustrates the need to contextualize information provided during informed consent to strengthen the doctor-patient relationship. (shrink)

Objective To evaluate the modes of death and treatment offered in the last 24 h of life to patients dying in 10 Brazilian intensive care units (ICUs) over a period of 2 years. Design and setting Cross-sectional, multicentre, retrospective study based on medical chart review. The medical records of all patients that died in seven paediatric and three adult ICUs belonging to university and tertiary hospitals over a period of 2 years were included. Deaths in the first 24 h of (...) admission to the ICU and brain death were excluded. Intervention Two intensive care fellows of each ICU were trained in fulfilling a standard protocol (κ=0.9) to record demographic data and all medical management provided in the last 48 h of life. The Student t test, Mann–Whitney U test, χ2 test and RR were used for data comparison. Measurements and main results 1053 medical charts were included (59.4% adult patients). Life support limitation was more frequent in the adult group (86% vs 43.5%; p<0.001). A ‘do not resuscitate’ order was the most common life support limitation in both groups (75% and 66%), whereas withholding/withdrawing were more frequent in the paediatric group (33.9% vs 24.9%; p=0.02). The life support limitation was rarely reported in the medical chart in both groups (52.6% and 33.7%) with scarce family involvement in the decision making process (23.0% vs 8.7%; p<0.001). Conclusion Life support limitation decision making in Brazilian ICUs is predominantly centred on the medical perspective with scarce participation of the family, and consequently several non-coherent medical interventions are observed in patients with life support limitation. (shrink)

Nachdem bisher gedruckte Hilfsmittel zum Studium des Wortschatzes dieses großen Kappadokiers entweder nur summarisch und nicht ausreichend (Lampe, A Patristic Greek Lexicon) bzw. nur fragmentarisch, d.h. nur zu einigen Schriften (vgl. das Repertorio bibliográfico de la lexicografía griega, Madrid 1998, mit Supplement im Internet 2003) existierten, verfügen wir nun über ein ungewöhnlich umfassendes und detailliertes Lexikon, das noch dazu in einem unglaublich schnellen Rhythmus erscheint (inzwischen auch der fünfte, das ganze Kappa enthaltende Band, Leiden 2003, X + 560 S.). Auch (...) wenn uns daneben seit einiger Zeit Gregor von Nyssa auch im Thesaurus linguae graecae (TLG) zur Verfügung steht und im Rahmen des Corpus Christianorum auch ein besonderer „Thesaurus Gregorii Nysseni“ angekündigt ist, so wird dadurch der Unterschied zwischen Konkordanzen und Lexika nur noch deutlicher. (shrink)