The use of do not resuscitate (DNR) orders in Dutch hospitals was studied as part of a nationwide study on medical decisions concerning the end of life. DNR decisions are made in 6 per cent of all admissions, and 61 per cent of all in-hospital deaths were preceded by a DNR decision. We found that in only 14 per cent of the cases had the patients been involved in the DNR decision (32 per cent of competent patients). The concept of (...) futility is analysed as these findings are discussed. We conclude that determining the effectiveness of resuscitation is a medical judgement whereas determining the proportionality (burden/benefit ratio) of it requires a discussion between doctor and patient (or his or her surrogates). Since the respondents in the cases without patient involvement gave many reasons for their decision that went beyond determining effectiveness, we conclude that more patient involvement would have been desirable. (shrink)

Although at first sight the Speculum contains ‘too little Augustine’ for theologians who are attempting to discover the originality of this thought, it is in fact a revealing anthology. An examination of the criteria used for the selection of Scriptural quotations brings to light an important facet of his mystagogy. Both the exclusion and inclusion criteria demonstrate that Augustine’s intention is to confront his reader with his own imperfections, and this to a much greater degree than is suggested by the (...) understatement of Speculum 108 that the moral guidelines proffered should have an immediate impact. Augustine’s aim in writing the Speculum is to effect a confrontation of the reader with himself, in a first, but permanent step on the way of mystagogy. Scripture serves as a mirror to reflect as detailed and unpolished an image as possible of the person who looks into it; the confrontation must be as violent as possible. (shrink)

This new edition offers expanded selections from the works of Kongzi, Mengzi, Zhuangzi, and Xunzi ; two new works, the dialogues _Robber Zhi_ and _White Horse_; a concise general introduction; brief introductions to, and selective bibliographies for, each work; and four appendices that shed light on important figures, periods, texts, and terms in Chinese thought.

Inleidend overzicht van de wijsgerige ethiek.

We apply an online optimization process based on machine learning to the production of Bose-Einstein condensates. BEC is typically created with an exponential evaporation ramp that is optimal for ergodic dynamics with two-body s-wave interactions and no other loss rates, but likely sub-optimal for real experiments. Through repeated machine-controlled scientific experimentation and observations our ’learner’ discovers an optimal evaporation ramp for BEC production. In contrast to previous work, our learner uses a Gaussian process to develop a statistical model of the (...) relationship between the parameters it controls and the quality of the BEC produced. We demonstrate that the Gaussian process machine learner is able to discover a ramp that produces high quality BECs in 10 times fewer iterations than a previously used online optimization technique. Furthermore, we show the internal model developed can be used to determine which parameters are essential in BEC creation and which are unimportant, providing insight into the optimization process of the system. (shrink)

Isolated habitats, the consequence of the fragmentation process, are the object of external disturbance. This divides the patch area into two zones: interior and edge. The interior-to-edge ratio quantifies the potential disturbance impact. A method is presented to calculate a reference value for the interior-to-edge ratio, based upon the minimum edge for a given interior. The method is based on pixel geometry features and mathematical morphology. A corrected interior-to-edge ratio is defined using the reference value. The method is illustrated for (...) woodlot fragments in the Belgian Kempen region. (shrink)

In this paper the authors give a survey of biological phenomena , for which the term ‘differentiation’, used in the widest sense, has a meaningful application. The last chapter deals with some general aspects of differentiation and connected phenomena, such as polarity, symmetry, loss of potencies, dedifferentiation, redifferentiation, adifferentiation, regulation and integration.To prevent this article becoming too voluminous, the authors had to refrain from extending the treatment of differentiation to non-living matter and to human society.

In this article, an ethical analysis of an educational programme on renal replacement therapy options for patients and their social network is presented. The two main spearheads of this approach are: (1) offering an educational programme on all renal replacement therapy options ahead of treatment requirement and (2) a home-based approach involving the family and friends of the patient. Arguments are offered for the ethical justification of this approach by considering the viewpoint of the various stakeholders involved. Finally, reflecting on (...) these ethical considerations, essential conditions for carrying out such a programme are outlined. The goal is to develop an ethically justified and responsible educational programme. (shrink)