Definition is in the nature of a survey, and a major part of its original purpose would seem to be to introduce a Soviet audience to definition rules used in the formal systems of mathematical logic. It offers a sympathetic introduction to the work of writers like Church, Curry, Kleene, Carnap, and Reichenbach.

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

We report the results of a randomized trial to assess the impact of an innovative ethics curriculum on the knowledge and confidence of 85 medical house officers in a university hospital programme, as well as their responses to a simulated clinical case. Twenty-five per cent of the house officers received a lecture series, 25 per cent received lectures and case conferences, with an ethicist in attendance, and 50 per cent served as controls. A post-intervention questionnaire was administered. Knowledge scores did (...) not differ among the groups. Confidence regarding ethical issues was significantly greater in the aggregate intervention group compared to the control group. Confidence regarding procedural issues related to ethics was significantly higher for the EI group than for the controls. Responses to a simulated case showed that significantly fewer house officers in the EI group would intubate a patient for whom such therapy would be futile. We conclude that ethics education can have an impact on house officers' confidence and their responses to a simulated case, and that the EI was more effective than the LI. Such results have implications regarding the implementation of ethics education during residency. (shrink)

In a recent article in this journal our unit was accused of a number of errors of judgment in applying covert video surveillance (CVS) to infants and children suspected of life-threatening abuse. The article implied, that on moving from the Royal Brompton Hospital in London to North Staffordshire Hospital, we failed to present our work to the Research Ethics Committee (REC). We did send our protocol to the REC though we did not consider that, after a total of 16 patients (...) had been documented as being the subject of life-threatening abuse, this was research. The REC in Staffordshire agreed with us. We were also accused of undertaking work that should be pursued by the Police. We agree with this. However, unlike the Metropolitan Police the Staffordshire Police would not undertake CVS. We fail to agree that 'working together' with parents is necessarily practical or safe when trying to protect children from life-threatening abuse of this kind. (shrink)

A laboratory-testable, solid-state Maxwell demon is proposed that utilizes the electric field energy of an open-gap p-n junction. Numerical results from a commercial semiconductor device simulator (Silvaco International–Atlas) verify primary results from a 1-D analytic model. Present day fabrication techniques appear adequate for laboratory tests of principle.

In 2000, a simple, foundational thermodynamic paradox was proposed: a sealed blackbody cavity contains a diatomic gas and a radiometer whose apposing vane surfaces dissociate and recombine the gas to different degrees (A $_{2} \rightleftharpoons $ 2A). As a result of differing desorption rates for A and A $_{2}$ , there arise between the vane faces permanent pressure and temperature differences, either of which can be harnessed to perform work, in apparent conflict with the second law of thermodynamics. Here we (...) report on the first experimental realization of this paradox, involving the dissociation of low-pressure hydrogen gas on high-temperature refractory metals (tungsten and rhenium) under blackbody cavity conditions. The results, corroborated by other laboratory studies and supported by theory, confirm the paradoxical temperature difference and point to physics beyond the traditional understanding of the second law. (shrink)

Little is known about distance processing in patients with posterior brain damage. Although many investigators have claimed that distance estimates are normal or abnormal in some of these patients, many of these observations were made informally and the examiners often asked for relative, and not absolute, distance estimates. The present investigation served two purposes. First, we wanted to contrast the use of distance information in peripersonal space for perceptual report as opposed to visuomotor control in our visual form agnosic patient, (...) DF. Second, we wanted to see to what extent her abilities to process distance cues were dependent on binocular vision, in light of Milner et al.'s (1991) observations of preserved stereopsis in DF, and Dijkerman et al.'s (1996) and Marotta et al.'s (1997) observations that her visual guidance of grasping may be particularly dependent on binocular vision of the target. We hypothesized that DF's visuomotor responses would show normal sensitivity to target distance, while her perceptual estimates would not. In the first experiment, we required DF and two age- and sex-matched control subjects to reach out and grasp black cubes placed at varying distances, or to estimate the distance of the cubes from the hand starting position without making a reaching movement. In the second experiment, we required DF and two age-matched control subjects to point as rapidly and accurately as possible to small LED targets which differed in spatial location, under binocular and monocular conditions. The results showed that, relative to the control subjects, DF's grasping movements produced normal peak velocity-distance scaling-when she reached for blocks which varied in depth or pointed to LED targets which were presented at different distances in depth. In contrast, in the cube experiment, her verbal estimates of object distance were poorly scaled, although they improved slightly under the binocular conditions. The results are discussed in terms of current theories of processing streams in extrastriate visual cortex and the distinction between categorical and coordinate spatial processing. (shrink)

Many medical ethicists accept the thesis that there is no moral difference between withholding and withdrawing life-sustaining therapy. In this paper, we offer an interesting counterexample which shows that this thesis is not always true. Withholding is distinguished from withdrawing by the simple fact that therapy must have already been initiated in order to speak coherently about withdrawal. Provided that there is a genuine need and that therapy is biomedically effective, the historical fact that therapy has been initiated entails a (...) claim to continue therapy that cannot be attributed to patients who have not yet received therapy. This intrinsic difference between withholding and withdrawing therapy is of moral importance. In many instances, patients will waive this claim. But when one considers withdrawing therapy from one patient to help another in a setting of scarce resources, this intrinsic moral difference comes into sharp focus. In an era of shrinking medical resources, this difference cannot be ignored. (shrink)

Anselm saw theology as fides quaerens intellectum, faith searching for understanding. Theology concerns itself with human awareness of something that transcends humanity. It starts where we are and involves a given-ness which forms its fundamental basis. Human experience or awareness of God is interpreted from within this agreed framework. Theology is a way of experiencing and interpreting life but it is also dynamic body of knowledge. Within the Christian tradition, this can be seen in the theologies from the so-called ‘margins’. (...) The study of such a dynamic body of knowledge has been the concern of theology and religious studies degree programmes in modern Universities. Theology is however, not the preserve of the elite professionals. The professional theologians need to stand alongside ordinary people and learning from their experiences as much as theirs. (shrink)

OBJECTIVES: To study the accuracy of reviewing ward notes (chart review) as a measure of the quality of care rendered to patients with "Do Not Resuscitate" (DNR) orders. DESIGN: We reviewed the charts of 19 consecutive, competent inpatients with DNR orders for evidence that the staff addressed a broad range of patient care needs called Concurrent Care Concerns (CCCs), such as withholding treatments other than resuscitation itself, and attention to patient comfort needs. We then interviewed the patient, consultant physician, house (...) officer, and primary nurse and compared the ward notes with the understandings of these staff members. SETTING: The medical service of an urban university medical centre. RESULTS: The average number of documented CCCs addressed per DNR order was 1.1. The ward notes generally agreed with the perceptions of patients, house officers, and nurses (% agreement with notes = 79%, 77%, and 82%; kappa = 0.43, 0.40, 0.50). Consultant physicians' understandings were poorly reflected in the ward notes (% agreement = 59%; kappa = 0.18). They overestimated attention to CCCs compared with the notes (P < 0.0001) and with other observers (P < 0.0001). CONCLUSION: Chart review for attention to CCCs accurately reflects the understandings of patients, house officers, and nurses, but consultant physicians report more attention to CCCs than is recorded in the ward notes or understood by other observers. Better communication regarding end-of-life care plans should be encouraged. (shrink)

Purpose: Physicians are often reluctant to discuss “Do Not Resuscitate” orders with patients. Although perceived self-efficacy is a known prerequisite for behavioural change, little is understood about the confidence of physicians regarding DNR discussions.Subjects and methods: A survey of 217 internal medicine attendings and 132 housestaff at two teaching hospitals about their attitudes and confidence regarding DNR discussions.Results: Participants were significantly less confident about their ability to discuss DNR orders than to discuss consent for medical procedures , and this was (...) true for both attendings and housestaff . In a multivariate logistic model of confidence regarding DNR discussions, women were less confident than men ; house officers were less confident than attendings , those who were less confident of their ability to discuss medical procedures were less confident discussing DNR , and those who found talking to patients about DNR orders very difficult reported less confidence than those who did not .Conclusion: We conclude that physicians’ confidence regarding DNR discussions is low compared with their confidence regarding other medical discussions and that confidence varies by sex and perceived difficulty of the task. Efforts to improve DNR discussions should explore the need to tailor educational interventions to fit these characteristics. (shrink)

In 1885, during initial discussions of J. C. Maxwell's celebrated thermodynamic demon, Whiting (1) observed that the demon-like velocity selection of molecules can occur in a gravitationally bound gas. Recently, a gravitational Maxwell demon has been proposed which makes use of this observation [D. P. Sheehan, J. Glick, and J. D. Means, Found. Phys. 30, 1227 (2000)]. Here we report on numerical simulations that detail its microscopic phase space structure. Results verify the previously hypothesized mechanism of its paradoxical behavior. This (...) system appears to be the only example of a fully classical mechanical Maxwell demon that has not been resolved in favor of the second law of thermodynamics. (shrink)

I will take David Hall and Roger Ames’s idea of “field and focus”—each unique individual is a unique focus in the communal field—as a central theme of the East Asian way of dealing with the relationship between the community and its constituent members. The pairing of these two concepts suggests the essential mutuality of the communal involvement of every person and the “insistent particularity” of each person. The worth of each individual becomes manifest only if the “egocentered” self yields to (...) the “selfless” self. An East Asian sense of justice thereby acquires the sense of attention to each unique focus (particular individual) in the field (community). Liberty and human rights are thus ineluctably bound up with a sense of communal responsibility. (shrink)

Science studies not only material entities and phenomena, but their reflections in the minds of men, in the form of sensations, perceptions, concepts, and the like. The study of a phenomenon like language involves simultaneous examinations of material entities and the aspect of language which pertains to meaning, which takes shape as a result of man's reflection in cognition of the world around him.

The National Conference of Catholic Bishops has argued for significant government involvement in health care in order to assure respect for what they regard as the right to health care. Critics charge that the bishops are wrong because health care is not a right. In this article, it is argued that these critics are correct in their claim that health care is not a right. However, it is also argued that the premise that health care is not a right does (...) not imply that the market is the most equitable and just system for providing health care. Natural law arguments in the tradition of Roman Catholic social teaching lead to the conclusion that a just and prosperous society has a moral obligation to provide health care even if there is no such right. Further, there are strong moral grounds for concluding that the bishops are correct in their claim that health care ought not to be considered a market commodity. It is argued that if health care ought not to be considered a commodity, then national health insurance is the best available alternative for fulfilling the social obligation to distribute health care resources justly and fairly at this time in American history. The bishops' case for government involvement can be made on the strength of the Catholic tradition in theological argumentation, independent of the claim that health care is a right. (shrink)