The right to refuse medical intervention is well established, but it remains unclear how best to respect and exercise this right in life support. Contemporary ethical guidelines for critical care give ambiguous advice, largely because they focus on the moral equivalence of withdrawing and withholding care without confronting the very real differences regarding who is aware and informed of intervention options and how patient values are communicated and enacted. In withholding care, doctors typically withhold information about interventions judged too futile (...) to offer. They thus retain greater decision-making burden and face weaker obligations to secure consent from patients or proxies. In withdrawing care, there is a clearer imperative for the doctor to include patients in decisions, share information and secure consent, even when continued life support is deemed futile. How decisions to withhold and withdraw life support differ ethically in their implications for positive versus negative interpretations of patient autonomy, imperatives for consent, definitions of futility and the subjective evaluation of benefits and burdens of life support in critical care settings are explored. Professional reflection is required to respond to trends favouring a more positive interpretation of patient autonomy in the context of life support decisions in critical care. Both the bioethics and critical care communities should investigate the possibilities and limits of growing pressure for doctors to disclose their reasoning or seek patient consent when decisions to withhold life support are made. (shrink)

PURPOSE: To evaluate the effects of social support on comprehension and recall of consent form information in a study of Parkinson disease patients and their caregivers.DESIGN and METHODS: Comparison of comprehension and recall outcomes among participants who read and signed the consent form accompanied by a family member/friend versus those of participants who read and signed the consent form unaccompanied. Comprehension and recall of consent form information were measured at one week and one month respectively, using Part A of the (...) Quality of Informed Consent Questionnaire .RESULTS: The mean age of the sample of 143 participants was 71 years . Analysis of covariance was used to compare QuIC scores between the intervention group and control group . In the 1-week model, no statistically significant intervention effect was found . However, the intervention status by patient status interaction was statistically significant . In the 1-month model, no statistically significant intervention effect was found . Again, however, the intervention status by patient status interaction was statistically significant . At both time periods, intervention group patients scored higher on the QuIC than did intervention group caregivers, and control group patients scored lower on the QuIC than did control group caregivers.IMPLICATIONS: Social support played a significant role in enhancing comprehension and recall of consent form information among patients. (shrink)

MACDONALD SE, NEWBURN‐COOK CV, ALLEN M and REUTTER L.Nursing Inquiry2013;20: 30–41 Embracing the population health framework in nursing researchIndividuals’ health outcomes are influenced not only by their knowledge and behavior, but also by complex social, political and economic forces. Attention to these multi‐level factors is necessary to accurately and comprehensively understand and intervene to improve human health. The population health framework is a valuable conceptual framework to guide nurse researchers in identifying and targeting the broad range of determinants of (...) health. However, attention to the intermediate processes linking multi‐level factors and use of appropriate multi‐level theory and research methodology is critical to utilizing the framework effectively. Nurse researchers are well equipped to undertake such investigations but need to consider a number of political, societal, professional and organizational barriers to do so. By fully embracing the population health framework, nurse researchers have the opportunity to explore the multi‐level influences on health and to develop, implement and evaluate interventions that target immediate needs, more distal factors and the intermediate processes that connect them. (shrink)

Drawing on a landscape analysis of existing data-sharing initiatives, in-depth interviews with expert stakeholders, and public deliberations with community advisory panels across the U.S., we describe features of the evolving medical information commons. We identify participant-centricity and trustworthiness as the most important features of an MIC and discuss the implications for those seeking to create a sustainable, useful, and widely available collection of linked resources for research and other purposes.

SOME suggestions are here made for improvement of the text and understanding of Pliny's Eastern Aegean geography. The editions studied for the purpose are Detlefsen's special edition of the geographical books and Mayhoff's Teubner vol. i . The citations of MSS. readings given below are normally taken from Mayhoff's apparatus, which gives a fuller coverage than Detlefsen's. The MSS. are cited by the letters given them in Mayhoff's edition and the Budé Pliny book i , pp. 37 f. One further (...) MS., hitherto not collated in the geographical books, is here cited. Following Campbell, who first drew attention to it, I cite it as c. This MS., formerly in the Phillipps collection in Cheltenham and now in the Pierpont Morgan Library , is assigned to Lorsch and said to be of the first half of the ninth century. It seems thus to be somewhat older than A and E, and in that case is the oldest known surviving MS. of the geographical books. (shrink)

Epilepsy surgery is the most effective therapeutic approach for children with drug resistant epilepsy. Recent advances in neurosurgery, such as the Laser Interstitial Thermal Therapy, improved the safety and non-invasiveness of this method. Electric and magnetic source imaging plays critical role in the delineation of the epileptogenic focus during the presurgical evaluation of children with DRE. Yet, they are currently underutilized even in tertiary epilepsy centers. Here, we present a case of an adolescent who suffered from DRE for 16 years (...) and underwent surgery at Cook Children's Medical Center. The patient was previously evaluated in a level 4 epilepsy center and treated with multiple antiseizure medications for several years. Presurgical evaluation at CCMC included long-term video electroencephalography, magnetoencephalography with simultaneous conventional EEG and high-density EEG in two consecutive sessions, MRI, and fluorodeoxyglucose - positron emission tomography. Video long-term EEG captured nine focal-onset clinical seizures with a maximal evolution over the right frontal/frontal midline areas. MRI was initially interpreted as non-lesional. FDG-PET revealed a small region of hypometabolism at the anterior right superior temporal gyrus. ESI and MSI performed with dipole clustering showed a tight cluster of dipoles in the right anterior insula. The patient underwent intracranial EEG which indicated the right anterior insular as seizure onset zone. Eventually LITT rendered the patient seizure free. Retrospective analysis of ESI and MSI clustered dipoles found a mean distance of dipoles from the ablated volume ranging from 10 to 25 mm. Our findings highlight the importance of recent technological advances in the presurgical evaluation and surgical treatment of children with DRE, and the underutilization of epilepsy surgery in children with DRE. (shrink)

I have argued that there is a philosophical problem posed by a need to determine the reference of expressions which seem to refer to kinds of stuff or matter and to make identity claims about it (e.g., ‘the gold’, ‘the same clay’). Ordinary sortal expressions such as ‘lump’, and ‘piece’ have been shown to be inadequate to the task of providing reference for the expressions in question. What is necessary is an expression which does not have an ordinary sortal use (...) and which meets certain other conditions which I have enumerated. There does not seem to be an expression in ordinary language which fits these conditions. The technical term, ‘quantity’, as defined by Helen Cartwright, meet the conditions. ‘Parcel’, suggested V. C. Chappell, fails to meet the conditions. Another technical term, ‘m-elements’, coined by Laycock, comes close to meeting the conditions, but has a number of difficulties. Mose of these difficulties stem from the fact that counting (rather than measuring, as with quantities) is behind the application of ‘m-elements’, and stuff is as a matter of fact measured, rather than counted, in most situations. I have also considered a possible difficulty with ‘quantity’ (that in most cases in which someone talks of ‘same stuff’ strictly speaking we don't have the same quantity of stuff) and shown it not to be a genuine difficulty. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Minutes of the Annual General Meeting 2023Cornelis de Waal, Editor-in-Chief, Richard Kenneth Atkins, André De Tienne, Director and General Editor, and Elizabeth Cooke[as approved on January 17, 2024]The Annual General Meeting of the Charles S. Peirce Society was held in conjunction with the Eastern Division Meeting of the APA on January 5, 2023, at the Sheraton Le Centre, Montréal, Quebec. Rosa Maria Mayorga chaired the meeting and called it (...) to order at 12:38 p.m.1. Moment of SilenceThe annual meeting began with a moment of silence in memory of Peirce scholars who passed away in the last year.2. Approval of Minutes of the 2022 MeetingMinutes of the 2022 Annual General Meeting had been posted online. Copies were also distributed at the annual meeting. Rosa Maria Mayorga asked for a motion to approve the minutes. James Liszka so moved and Fabienne Forster seconded. The minutes were approved unanimously.3. Report from the Executive CommitteeRichard Kenneth Atkins submitted the following report.The Executive Committee Meeting was held virtually via email. All members of the Executive Committee were contacted and responded regarding the agenda and items.Agenda Items(A) Non-profit Status Update:On December 5, 2022, we received notification from the IRS that we have been legally approved as a public non-profit foundation.(B) Funding for Scholarship:Every year, we set aside a certain amount of funding for scholarship, usually 2/3rds of the year's income. This includes the $1,000 set aside for the Peirce Essay prize. Atkins reported that the income this past year was $6,597.06. 2/3rds of that is $4,400. Atkins requested that that amount of money be set aside for funding for scholarship, with which the committee unanimously agreed.(C) Next Year's AGM:Atkins proposed that we continue to hold our annual conference in conjunction with the E-APA in New York, NY, especially as this keeps us in line with the calendar year which is also our fiscal year as a nonprofit. The committee unanimously agreed. [End Page 118](D) Any Other Business:Cornelis de Waal suggested that we add to the agenda for the annual business meeting a moment of silence to commemorate Peirce scholars who passed this year. The Executive Committee unanimously agreed.4. Report from the Transactions of the Charles S. Peirce SocietyCornelis de Waal submitted the following report on behalf of the Transactions of the Charles S. Peirce Society. Richard Kenneth Atkins read the report on his behalf.During the 2022 calendar year we produced four issues of the Transactions. We encountered some problems with the first issue, because the printer suffered a ransomware attack. This apparently wreaked havoc with their system and caused significant delay in the completion of the issue.Likely due to the (after) effects of the pandemic, quality submissions to the journal were down significantly, both in the Peirce segment and in the non-Peirce segment of the journal. In addition, there was a significant drop in book reviews. The latter led to the resignation of our long-term book review editor, Henrik Rydenfelt. For the last two months I have been taking over for him, and I'm first-hand experiencing some of the challenges, even including publishers simply not following through on requests for books. We did, though, publish a book symposium on James Liszka's Charles Peirce on Ethics, Esthetics and the Normative Sciences, and we have another book symposium forthcoming on Chris Voparil's Reconstructing Pragmatism: Richard Rorty and the Classical Pragmatists. Besides a number of excellent papers on Peirce, we published some very nice papers in American philosophy. The latter include an extensive portrait of Edwin Bissell Holt, a discussion of the use of the term pragmatism in 18th century Germany, the first English translation of two texts by Wilhelm Jerusalem, as well as work on George Santayana, Jonathan Edwards, and Emily Dickinson.With Henrik gone, the editorial team is now down to Robert Lane and me (hopefully briefly returning to the traditional Robin-Hare setup). I'll be attending the upcoming SAAP meeting in Denver, and Bob is planning to attend as well... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Imagined Apotheoses: Drake, Harriot, and Ralegh in the AmericasWilliam M. HamlinPerhaps the two best known stories of Europeans being taken for gods by non-European peoples are those of Hernan Cortés in Mexico and Captain James Cook in Hawaii. Separated by two hundred sixty years, five thousand miles, and vast differences in cultural and linguistic context, these two incidents nonetheless share many traits in the conventional telling. Cortés and (...) Cook were both strong leaders, for instance, both capable of inspiring devotion among their subordinates. Both men became amateur ethnographers during their lengthy sojourns away from Europe, both sought to promote an image of respectful rather than rapacious foreign incursion, and both are said to have been taken for returning gods by the native peoples among whom they landed: Cortés for the Toltec culture-hero and demigod Quetzalcoatl, Cook for the Hawaiian deity Lono. Click for larger view View full resolutionFigure 1.“The Far Side” cartoon by Gary Larson. Courtesy of Chronicle Features, San Francisco.Recent scholarly studies and debates—among them the rather strident dispute between Gananath Obeyesekere and Marshall Sahlins over the alleged deification of Cook by eighteenth-century Hawaiians—have opened up these returning-god theories to skeptical critique and detailed justification; but such discussions have had little, if any, impact on popular imagination. 1 [End Page 405] Indeed, the idea that redoubtable European explorers can be (and often are) perceived as supernatural beings by non-European “primitives” has been uncritically perpetuated to this day by filmmakers, fantasists, writers of popular history, and purveyors of cultural literacy. E. D. Hirsch, Jr., for instance, informs our children that Caribbean islanders encountered by Columbus “asked if he had come from heaven”—the implication being, of course, that they took him for a god. 2 And in the recent film, 1492: Conquest of Paradise, we hear the indefatigable Admiral (played by Gerard Depardieu) claim that “on every island the natives welcome us with great generosity and trust.... Because of our appearance, we have been mistaken for gods, and are treated accordingly.” 3 Fortunately, we also have a “Far Side” parody of the cultural conceit on which such ideas in part rely, but the cartoon serves as well to demonstrate just how thoroughly the conceit has permeated our collective awareness (see figure 1). 4 Click for larger view View full resolutionFigure 2.“It’s against my programming to impersonate a deity.” From The Return of the Jedi, dir. Richard Marquand, Lucasfilm, Ltd., 1983. All Rights Reserved. Courtesy of Lucasfilm, Ltd.Let me offer just one other example. Near the end of the popular 1983 film The Return of the Jedi, the forest-dwelling Ewoks begin to chant and salaam upon first glimpsing the golden robot C-3PO, who in turn tells his captured comrades, “I do believe they think I am some sort of god.” When Han Solo sarcastically asks the robot to use his “divine influence” to help extricate them from their predicament, C-3PO replies that such an action would be improper: “It’s against my programming to impersonate a deity.” Here we see, embedded within a film romance, both the classic trope of the apotheosized foreigner and the related motif of the foreigner’s reluctance to [End Page 406] play the god-role (see figure 2). It is worth noting, however, that while C-3PO may be unwilling to exploit the Ewoks’ misperception, Luke Skywalker is not; he uses the “Force” to convince the Ewoks of the robot’s magical prowess and, more to the point, to perpetuate their misapprehension. 5What I wish to suggest in this essay is that certain habitual Western assumptions or conceits regarding cross-cultural encounters—assumptions which have been usefully termed “myth models” inasmuch as they condition human perception and find frequent discursive expression—coexist easily but in fact disjunctively with certain other ideological structures in many early modern travel narratives and colonial accounts. Obeyesekere, in his provocative book on the supposed deification of Captain Cook in Hawaii, has linked such myth models to the conceptual structures of the longue durée as characterized by Fernand Braudel, and it is possible that they may also be... (shrink)

The usual way for new cells to come into being is by division of old cells. So the zygote, which is a—new—single cell formed from two, the sperm and ovum, is an exception. Textbooks of human genetics usually say that this new cell is beginning of a new human individual. What this indicates is that they suddenly forget about identical twins.

Gap junction intercellular communication channels permit the exchange of small regulatory molecules and ions between neighbouring cells and coordinate cellular activity in diverse tissue and organ systems. These channels have short half‐lives and complex assembly and degradation pathways. Much of the recent work elucidating gap junction biogenesis has featured the use of connexins (Cx), the constituent proteins of gap junctions, tagged with reporter proteins such as Green Fluorescent Protein (GFP) and has illuminated the dynamics of channel assembly in live cells (...) by high‐resolution time‐lapse microscopy. With some studies, however, there are potential short‐comings associated with the GFP chimeric protein technologies. A recent report by Gaietta et al., has highlighted the use of recombinant proteins with tetracysteine tags attached to the carboxyl terminus of Cx43, which differentially labels ‘old’ and ‘new’ connexins thus opening up new avenues for studying temporal and spatial localisation of proteins and in situ trafficking events.1 BioEssays 24:876–880, 2002. © 2002 Wiley Periodicals, Inc. (shrink)

BackgroundAdverse childhood experiences can cause serious mental problems in adolescents and therefore may expected to be associated with higher use of psychosocial care, potentially varying by type of specific ACE. The aim of our study is to explore the association of the number of ACE and types of specific ACE with entering and using psychosocial care.MethodsWe used data from the Slovak Care4Youth cohort study, comprising 509 adolescents from 10 to 16 years old. We used logistic regression models adjusted for age, (...) gender, and family affluence to explore the associations of number and type of specific ACE with the use of psychosocial care.ResultsHaving three or more ACE as well as experiencing some specific ACE increased the likelihood of using psychosocial care. Regarding experience with the death of somebody else you love, we found a decreased likelihood of the use of psychosocial care.ConclusionExperiencing ACE above a certain threshold and parent-related ACE increase the likelihood of adolescent care use. (shrink)

About one third of patients with epilepsy have seizures refractory to the medical treatment. Electrical stimulation mapping is the gold standard for the identification of “eloquent” areas prior to resection of epileptogenic tissue. However, it is time-consuming and may cause undesired side effects. Broadband gamma activity recorded with extraoperative electrocorticography during cognitive tasks may be an alternative to ESM but until now has not proven of definitive clinical value. Considering their role in cognition, the alpha and beta bands could further (...) improve the identification of eloquent cortex. We compared gamma, alpha and beta activity, and their combinations for the identification of eloquent cortical areas defined by ESM. Ten patients with intractable focal epilepsy participated in a delayed-match-to-sample task, where syllable sounds were compared to visually presented letters. We used a generalized linear model approach to find the optimal weighting of each band for predicting ESM-defined categories and estimated the diagnostic ability by calculating the area under the receiver operating characteristic curve. Gamma activity increased more in eloquent than in non-eloquent areas, whereas alpha and beta power decreased more in eloquent areas. Diagnostic ability of each band was close to 0.7 for all bands but depended on multiple factors including the time period of the cognitive task, the location of the electrodes and the patient’s degree of attention to the stimulus. We show that diagnostic ability can be increased by 3–5% by combining gamma and alpha and by 7.5–11% when gamma and beta were combined. We then show how ECoG power modulation from cognitive testing can be used to map the probability of eloquence in individual patients and how this probability map can be used in clinical settings to optimize ESM planning. We conclude that the combination of gamma and beta power modulation during cognitive testing can contribute to the identification of eloquent areas prior to ESM in patients with refractory focal epilepsy. (shrink)

PurposeTo explore the mindfulness practice, its long-term effects, facilitators and barriers, in clinical clerkship students 2 years after participation in an 8-week mindfulness-based stress reduction training.MethodA qualitative study was performed by semi-structured in-depth interviews with 16 clinical clerkship students selected by purposive sampling. Students had participated in a MBSR training 2 years before and were asked about their current mindfulness practice, and the long-term effects of the MBSR training. Thematic analysis was conducted using the constant comparison method. Data saturation was (...) reached after 16 interviews.ResultsMost interviewees were still engaged in regular, predominantly informal, mindfulness practice, although some discontinued mindfulness practice and reported an “unchanged lifestyle.” Three main themes came forward; “focused attention and open awareness” during daily activities as core elements of long-term mindfulness practice; “changes in behavior and coping” that resulted from taking a pause, reflecting, recognizing automatic behavioral patterns and making space for a conscious response; “integration in personal and professional life” by enhanced enjoyment of daily activities, improved work-life-balance and making different career choices. Barriers and facilitators in starting and maintaining mindfulness practice were understanding and intention as “pre-conditions”; practical, personal, and professional factors of students in maintaining practice.ConclusionTwo years after participation in a MBSR training, many interviewees were still engaged in mindfulness practice contributing to both personal and professional changes. In light of the high clerkship demands, MBSR training could be a valuable addition to medical curricula, supporting medical students in developing necessary competencies to become well-balanced professionals. (shrink)