Extracorporeal membrane oxygenation (ECMO) is typically viewed as a time-limited intervention—a bridge to recovery or transplant—not a destination therapy. However, some patients with decision-making capacity request continued ECMO support despite a poor prognosis for recovery and lack of viability as a transplant candidate. In response, critical care teams have asked for guidance regarding the ethical permissibility of unilateral withdrawal over the objections of a capacitated patient. In this article, we evaluate several ethical arguments that have been made in favor of (...) withdrawal, including distributive justice, quality of life, patients’ rights, professional integrity, and the Equivalence Thesis. We find that existing justifications for unilateral withdrawal of ECMO support in capacitated patients are problematic, which leads us to conclude that either: (1) additional ethical arguments are necessary to defend this approach or (2) the claim that it is not appropriate to use ECMO as a destination therapy should be questioned. (shrink)

This paper sees intelligence as certainly not a thing which is the sole prerogative of man but rather as a category of skill, natural to all organisms, integral with their capacity for handling their environment, and increasingly well developed in the higher animals. Intelligence is seen as a natural property of living organisms at their highest levels: a characteristic of living things which is emergent in the same way as, and essentially in parallel with, perception, consciousness, and moral and spiritual (...) sensitivities. (shrink)

The evidence for the effectiveness of rehabilitation of three types of attention—selectivity, sustained attention, and attentional switching—is reviewed. Limited but significant effects in all three domains are observed, though evidence for generalization to wider everyday life functions remains relatively sparse. In the case of sustained attention and also in the case of spatial selectivity, the modulating effects of arousal are shown to be important, and higher level executive deficits may at times be exacerbated or even caused by lowered levels of (...) arousal. Conversely, methods of modulating arousal may be used to improve sustained attention and executive functions in a range of clinical conditions. Attentional functions are key to other cognitive domains such as attention and perception, and so the promising evidence for attentional rehabilitation may contribute to the rehabilitation of other cognitive domains also. (shrink)

Throughout the biological and biomedical sciences there is a growing need for, prescriptive ‘minimum information’ (MI) checklists specifying the key information to include when reporting experimental results are beginning to find favor with experimentalists, analysts, publishers and funders alike. Such checklists aim to ensure that methods, data, analyses and results are described to a level sufficient to support the unambiguous interpretation, sophisticated search, reanalysis and experimental corroboration and reuse of data sets, facilitating the extraction of maximum value from data sets (...) them. However, such ‘minimum information’ MI checklists are usually developed independently by groups working within representatives of particular biologically- or technologically-delineated domains. Consequently, an overview of the full range of checklists can be difficult to establish without intensive searching, and even tracking thetheir individual evolution of single checklists may be a non-trivial exercise. Checklists are also inevitably partially redundant when measured one against another, and where they overlap is far from straightforward. Furthermore, conflicts in scope and arbitrary decisions on wording and sub-structuring make integration difficult. This presents inhibit their use in combination. Overall, these issues present significant difficulties for the users of checklists, especially those in areas such as systems biology, who routinely combine information from multiple biological domains and technology platforms. To address all of the above, we present MIBBI (Minimum Information for Biological and Biomedical Investigations); a web-based communal resource for such checklists, designed to act as a ‘one-stop shop’ for those exploring the range of extant checklist projects, and to foster collaborative, integrative development and ultimately promote gradual integration of checklists. (shrink)

Justifying involuntary psychiatric treatment on the basis of a judgment that a person lacks capacity is usually expressed in terms of a person’s ability to make a decision about his or her health and treatment. Typically, this relates to the ability to refuse treatment. Exactly what “capacity” means, however, and how one determines when another individual lacks capacity, or lacks sufficient capacity, in this context is particularly controversial, with the United Nations Committee on the Rights of Persons with Disabilities insisting (...) that involuntary treatment be abandoned altogether and capacity tests avoided.Capacity is a concept that has multiple meanings and applications across different disciplines and... (shrink)

Physical activity and sedentary behaviour have been linked to the mental health of children and adolescents, yet the timing of behaviours may play a role in this relationship and clarifying this could inform interventions. We explored cross-sectional associations of PA and SED in varying time segments throughout the school day with the mental health of school-aged children and adolescents from rural Northeastern Ontario, Canada. A total of 161 students wore accelerometers for 8 days and completed a self-report survey. Mental health (...) was measured using the Strengths and Difficulties Questionnaire. Accelerometer-measured SED, light PA, and moderate and vigorous PA were estimated in the time-segments before school, school time, after school, and evenings. Associations were tested with multilevel linear regressions while adjusting for confounding factors. Students spent 72.6 min in MVPA, 209.0 min in LPA, and 621.0 min in SED per day. Daily SED was associated with less conduct problems. Evening LPA was inversely associated with hyperactivity, while SED was associated with hyperactivity and with peer problems before school, and during school. No associations were observed for MVPA, emotional symptoms, or prosocial behaviour. In conclusion, displacing SED with LPA in some specific periods of the day may benefit the mental health of students; taking this into account could strengthen interventions. (shrink)

This chapter outlines the practical rehabilitation implications of current theories and models of frontal lobe function, with the aim of providing some provisional principles for the rehabilitation of the dysexecutive patient. It argues that there must be a theory of the cause of an impairment before a treatment can be designed. However, currently there is a gap between pure experimental work from which such theories might evolve and potential treatment applications. There is actually more potential cross-talk between these concerns than (...) might at first appear. Six provisional principles for treatment are presented. (shrink)

This collection by some of the leading scholars of Strauss's work is the first devoted to Strauss's thought regarding education. It seeks to address his conception of education as it applies to a range of his most important concepts, such as his views on the importance of revelation, his critique of modern democracy and the importance of modern classical education.

Numenius and Ammonius, by E. R. Dodds.--Plotin zwischen Platon und Stoa, von W. Theiler.--Être, vie, pensée chez Plotin et avant Plotin, par P. Hadot.--Plotin et les gnostiques, par H. C. Puech.--Die Frage nach dem Transzendenten im Mittelplatonismus, von H. Dörrie.--Mito e poesia nelle Enneadi di Plotino, di V. Cilento.--Quelle oder Tradition? Von R. Harder.--"Bewusst" und "unbewusst" bei Plotin, von H. R. Schwyzer.--The background of the doctrine "That the intelligibles are not outside the intellect," by A. H. Armstrong.--Une comparaison chez Aristote, (...) Alexandre et Plotin, par P. Henry. (shrink)

Because of the important role which the ‘autocatalytic’ or ‘logistic’ equation has played in determining the direction of a good deal of research both in demography and in the study of individual growth phenomena, a critical and comparative evaluation of those leading ideas inRobertson's book which pertain to this equation and of some of the criticisms levelled against it seemed to be of interest. The present paper shows that, contrary to common belief,Robertson did not really assume that the autocatalytic (...) reactions to which he compared growth processes, took place in closed systems . On the other hand, he does not seem to have found a satisfactory representation of how the growth phenomena of the individual cells in an organism might interact to yield the overall growth of the organism as a whole. Nor is the manner in which he made his equation account for the openness of the individual cells free from possible criticism. An alternative equation is here proposed, which will be discussed in another paper. The properties of the solutions of this equation are such that the autocatalytic theory might never have gained a foothold if this, more realistic, equation would have been the object of the initial studies. (shrink)

The phenomenological calculus is a relational paradigm for complex systems, closely related in substance and spirit to Robert Rosen’s own approach. Its mathematical language is multilinear algebra. The epistemological exploration continues in this paper, with the expansion of the phenomenological calculus into the realm of anisotropy.

A. H. Louie's More Than Life Itself is an exploratory journey in relational biology, a study of life in terms of the organization of entailment relations in living systems. This book represents a synergy of the mathematical theories of categories, lattices, and modelling, and the result is a synthetic biology that provides a characterization of life. Biology extends physics. Life is not a specialization of mechanism, but an expansive generalization of it. Organisms and machines share some common features, but organisms (...) are not machines. Life is defined by a relational closure that places it beyond the reach of physicochemical and mechanistic dogma, outside the reductionistic universe, and into the realm of impredicativity. Function dictates structure. Complexity brings forth living beings. (shrink)

On the basis of previous studies in relational biology and the phenomenological calculus, in my contribution I outline the mathematical foundations of biological perception generally, and visual perception specifically. In this approach, the premise is that objects in nature are not directly accessible, and that real manifestations are projections of these invariant objects. The morphology of observables is mathematically entailed by the duality of projections and projectors in a bilinear algebra that is the phenomenological calculus. The relationships between what is (...) not directly accessible (which can be defined as noumena) and phenomena may be explicated in terms of metabolism and repair, whence a geometric theory of the perceived, the visible in particular, may be formulated in the category-theoretic language of relational biology. (shrink)

This is the first-ever critical history of sociology in Britain, written by one of the world's leading scholars in the field. A. H. Halsey presents a vivid and authoritative picture of the neglect, expansion, fragmentation, and explosion of the discipline during the past century. The book examines the literary and scientific contributions to the origin of the discipline, and the challenges faced by the discipline at the dawn of a new century.

Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and (...) participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses’ ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses’ own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner. (shrink)