This study is divided into two main parts: exposition of the main themes of Process and Reality and criticism. The exposition is organized around the twin motifs of "freedom" and "condition." The former refers to such notions as mental pole, conceptual feelings, final causation, novelty, flux, and subjective aim. The latter refers to things like physical pole, physical feelings, efficient causation, conformation of feeling, permanence, and objectification. The exposition, quite naturally and justifiably, is laid out with an eye to the (...) criticisms which will follow it. The points of criticism all relate to the general problem of the tension between the factor of freedom and the factor of condition. For example, the author tries to resolve the incompatibility between the indivisible unity of an actual occasion and the fact that it undergoes successive modifications of its subjective aim. He points out the difficulty in maintaining the doctrine of freedom when the modification of the subjective aim is effected by determinate elements. Pols feels that Whitehead's system places the seat of power in the eternal objects. It is they that are really effecting the difference between real and general potentiality. It is this special status of the eternal objects that, for Pols, constitutes "The Platonism of Whitehead." In general, the book is a tough minded refusal to allow Whitehead to eat and still have his metaphysical cake.--S. 0. H. (shrink)

The energy-spectrum of two point-like particles interacting in a 3-D isotropic Harmonic Oscillator (H.O.) trap is related to the free scattering phase-shifts \(\delta \) of the particles by a formula first published by Busch et al. It is here used to find an expression for the shift of the energy levels, caused by the interaction, rather than the perturbed spectrum itself. In the limit of high energy (large quantum number \(n\) of the H.O.) this shift (in H.O. units) is shown (...) to be given by \(\Delta =-2\frac{\delta }{\pi }\) , also exact in the limit of infinite scattering length ( \(\delta =\pm \frac{\pi }{2}\) ) in which case \(\Delta =\mp 1\) . Numerical investigation shows that this expression otherwise differs from the exact result of Busch et al., by less than \(\frac{1}{2}\,\%\) except for \(n=0\) when it can be as large as \(\approx \) 2.5 %. This result for the energy-shift is well known from another exactly solvable model, namely that of two particles interacting in a spherical infinite square-well trap (or box) of radius \(R\) in the limit \(R\rightarrow \infty \) , and/or in the limit of large energy. It is in solid state physics referred to as Fumi’s theorem. It can be (and has been) used in (infinite) nuclear matter calculations to calculate the two-body effective interaction in situations where in-medium effects can be neglected. It is in this context referred to as the phase-shift approximation a term also used throughout this report. (shrink)

Background Residual dried blood spots (rDBS) from newborn screening programmes represent a valuable resource for medical research, from basic sciences, through clinical to public health. In Hong Kong, there is no legislation for biobanking. Parents’ view on the retention and use of residual newborn blood samples could be cultural-specific and is important to consider for biobanking of rDBS. Objective To study the views and concerns on long-term storage and secondary use of rDBS from newborn screening programmes among Hong Kong Chinese (...) parents. Methods A mixed-method approach was used to study the views and concerns on long-term storage and secondary use of rDBS from newborn screening programmes among Hong Kong Chinese parents of children 0–3 years or expecting parents through focus groups (8 groups; 33 participants) and a survey (n = 1012, 85% mothers) designed with insights obtained from the focus groups. We used framework analysis to summarise the themes as supportive factors, concerns and critical arguments for retention and secondary use of rDBS from focus group discussion. We used multiple logistic regression to assess factors associated with support for retention and secondary use of rDBS in the survey. Results Both in focus groups and survey, majority of parents were not aware of the potential secondary use of rDBS. Overall secondary use of rDBS in medical research was well accepted by a large proportion of Hong Kong parents, even if all potential future research could not be specified in a broad consent. However parents were concerned about potential risks of biobanking rDBS including leaking of data and mis-use of genetic information. Parents wanted to be asked for permission before rDBS are stored and mainly did not accept an “opt-out” approach. The survey showed that parents born in mainland China, compared to Hong Kong born parents, had lower awareness of newborn screening but higher support in biobanking rDBS. Higher education was associated with support in rDBS biobanking only among fathers. Conclusion Long-term storage and secondary use of rDBS from newborn screening for biomedical research and a broad consent for biobanking of rDBS are generally acceptable to Hong Kong parents given their autonomy is respected and their privacy is protected, highlighting the importance of an accountable governance and a transparent access policy for rDBS biobanks. (shrink)

BackgroundThe COVID-19 pandemic has created ethical challenges for intensive care unit (ICU) professionals, potentially causing moral distress. This study explored the levels and causes of moral distress and the ethical climate in Dutch ICUs during COVID-19.MethodsAn extended version of the Measurement of Moral Distress for Healthcare Professionals (MMD-HP) and Ethical Decision Making Climate Questionnaire (EDMCQ) were online distributed among all 84 ICUs. Moral distress scores in nurses and intensivists were compared with the historical control group one year before COVID-19. ResultsThree (...) hundred forty-five nurses (70.7%), 40 intensivists (8.2%), and 103 supporting staff (21.1%) completed the survey. Moral distress levels were higher for nurses than supporting staff. Moral distress levels in intensivists did not differ significantly from those of nurses and supporting staff. “Inadequate emotional support for patients and their families” was the highest-ranked cause of moral distress for all groups of professionals. Of all factors, all professions rated the ethical climate most positively regarding the culture of mutual respect, ethical awareness and support. “Culture of not avoiding end-of-life-decisions” and “Self-reflective and empowering leadership” received the lowest mean scores. Moral distress scores during COVID-19 were significantly lower for ICU nurses (p < 0.001) and intensivists (p < 0.05) compared to one year prior.ConclusionLevels and causes of moral distress vary between ICU professionals and differ from the historical control group. Targeted interventions that address moral distress during a crisis are desirable to improve the mental health and retention of ICU professionals and the quality of patient care. (shrink)

Objective To determine the attitudes of Egyptian patients regarding their participation in research and with the collection, storage and future use of blood samples for research purposes. Design Cross-sectional survey. Study population Adult Egyptian patients (n=600) at rural and urban hospitals and clinics. Results Less than half of the study population (44.3%) felt that informed consent forms should provide research participants the option to have their blood samples stored for future research. Of these participants, 39.9% thought that consent forms should (...) include the option that future research be restricted to the illness being studied. A slight majority (66.2%) would donate their samples for future genetic research. Respondents were more favourable towards having their blood samples exported to other Arab countries (62.0%) compared with countries in Europe (41.8%, p<0.001) and to the USA (37.2%, p<0.001). Conclusions This study shows that many individuals do not favour the donation of a blood sample for future research. Of those who do approve of such future research, many favour a consent model that includes an option restricting the future research to the illness being studied. Also, many Egyptians were hesitant to have their blood samples donated for genetic research or exported out of the Arab region to the USA and European countries. Further qualitative research should be performed to determine the underlying reasons for many of our results. (shrink)

Background To describe the preferences for disclosure of individual biomarker results among mothers participating in a longitudinal birth cohort. Methods We surveyed 343 mothers that participated in the Health Outcomes and Measures of the Environment Study about their biomarker disclosure preferences. Participants were told that the study was measuring pesticide metabolites in their biological specimens, and that the health effects of these low levels of exposure are unknown. Participants were asked whether they wanted to receive their results and their child's (...) results. In addition, they were asked about their preferred method (letter vs in person) and format (more complex vs less complex) for disclosure of results. Results Almost all of the study participants wanted to receive their individual results (340/343) as well as their child's results (342/343). However, preferences for receiving results differed by education level. Mothers with less than a college degree preferred in-person disclosure of results more often than mothers with some college education or a college degree (34.3% vs 17.4% vs 7.9%, p<0.001). Similarly, mothers with less than a college education preferred a less complex disclosure format than mothers with some college education or a college degree (59.7% vs 79.1% vs 86.3%, p<0.0001). Conclusion While almost all study participants preferred to receive results of their individual biomarker tests, level of education was a key factor in predicting preferences for disclosure of biomarker results. To ensure effective communication of this information, disclosure of biomarker results should be tailored to the education level of the study participants. (shrink)

We prove a strong boundedness theorem for dilators: if A ⊆ DIL is Σ 1 1 , then there is a recursive dilator D 0 such that ∀ D ∈ A.

Recall that B is PA relative to A if B computes a member of every nonempty $\Pi ^0_1(A)$ class. This two-place relation is invariant under Turing equivalence and so can be thought of as a binary relation on Turing degrees. Miller and Soskova [23] introduced the notion of a $\Pi ^0_1$ class relative to an enumeration oracle A, which they called a $\Pi ^0_1{\left \langle {A}\right \rangle }$ class. We study the induced extension of the relation B is PA relative (...) to A to enumeration oracles and hence enumeration degrees. We isolate several classes of enumeration degrees based on their behavior with respect to this relation: the PA bounded degrees, the degrees that have a universal class, the low for PA degrees, and the ${\left \langle {\text {self}\kern1pt}\right \rangle }$ -PA degrees. We study the relationship between these classes and other known classes of enumeration degrees. We also investigate a group of classes of enumeration degrees that were introduced by Kalimullin and Puzarenko [14] based on properties that are commonly studied in descriptive set theory. As part of this investigation, we give characterizations of three of their classes in terms of a special sub-collection of relativized $\Pi ^0_1$ classes—the separating classes. These three can then be seen to be direct analogues of three of our classes. We completely determine the relative position of all classes in question. (shrink)

Background Informed consent confers upon participants the right to decline or accept participation in a study in equal measure. Consent declines can be used as a potential metric to assess the adequacy of the informed consent process. Limited literature is available on the reporting of consent declines in Clinical Research. We evaluated randomized controlled trials published in three high-impact factor journals for consent declines (four-year period) to assess the extent of exertion of autonomy by research participants. Methods CONSORT flow charts (...) in RCTs published in New England Journal of Medicine (NEJM), The Lancet and Journal of the American Medical Association (JAMA) between 2012 and 2015 were evaluated. The total and per journal proportion of RCTs reporting consent declines was calculated. Percentage of consent declines was also compared based on number of centers (single centric vs. multicentric) and type of setting (developed vs. developing). Between-groups analysis was done using Chi Square, Chi Square for trend and a Crude odds ratio [95% C.I] (cOR) were calculated. Results Only 3.7% (1103/29,825) of the published articles were RCTs. Of the 1103 RCTs, only 532 (48.2%) reported consent declines. JAMA had the highest RCTs reporting consent declines (171/267.64%), the Lancet [129,150/781,924, 16.5%] had the most participants declining consent. Difference was significant using Chi square for linear trend [ p < 0.00001]. Consent decline rate was higher in developed countries relative to developing countries [cOR(95% C.I): 2.27(2.23,2.32), p < 0.000001] and in single centric versus multicentric studies [cOR (95% C.I): 3.63(3.56,3.71), p < 0.0000001]. Conclusion Both authors and journal editors need to ensure better reporting of consent declines. (shrink)

Context. The identification of the sources that reionized the Universe and their specific contribution to this process are key missing pieces of our knowledge of the early Universe. Faint star-forming galaxies may be the main contributors to the ionizing photon budget during the epoch of reionization, but their escaping photons cannot be detected directly due to inter-galactic medium opacity. Hence, it is essential to characterize the properties of faint galaxies with significant Lyman continuum photon leakage up to z 4 to (...) define indirect indicators allowing analogues to be found at the highest redshift. Aims. Long gamma-ray bursts explode typically in star-forming regions of faint, star-forming galaxies. Through LGRB afterglow spectroscopy it is possible to detect directly LyC photons. Our aim is to use LGRBs as tools to study LyC leakage from faint, star-forming galaxies at high redshift. Methods. Here we present the observations of LyC emission in the afterglow spectra of GRB 191004B at z = 3:5055, together with those of the other two previously known LyC-emitting LGRB, to determine their LyC escape fraction and compare their properties. Results. From the afterglow spectrum of GRB 191004B we determine a neutral hydrogen column density at the LGRB redshift of og =17:2 0:15, and negligible extinction. The only metal absorption lines detected are C iv and Si iv. In contrast to GRB 050908 and GRB 060607A, the host galaxy of GRB 191004B displays significant Ly emission. From its Ly emission and the non-detection of Balmer emission lines we constrain its star-formation rate to 1 SFR 4:7 M yr. 1. We fit the Ly emission with a shell model and find parameters values consistent with the observed ones. The absolute LyC escape fractions we find for GRB 191004B, GRB 050908 and GRB 060607A are of 0:35+0:10.0:11, 0:08+0:05.0:04 and :20+0:05.0:05, respectively. We compare the LyC escape fraction of LGRBs to the values of other LyC emitters found from the literature, showing that LGRB afterglows can be powerful tools to study LyC escape for faint high-redshift star-forming galaxies. Indeed we could push LyC leakage studies to much higher absolute magnitudes. The host galaxies of the three LGRB presented here have all M1600 >.19:5 mag, with the GRB 060607A host at M1600 >.16 mag. LGRB hosts may therefore be particularly suitable for exploring the ionizing escape fraction in galaxies that are too faint or distant for conventional techniques. Furthermore the time investment is very small compared to galaxy studies. (shrink)

Despite their status as high-income food producing nations, children and their caregivers, both in the United States (U.S.) and Australia can experience food insecurity. Nutrition researchers formed a joint U.S.-Australia collaboration to help advance food security for households with young children aged 0–5 years. This study investigated food insecurity from the perspective of caregivers, especially their perceptions of the impact of food insecurity on their own childhood, their current life, and for the children in their care. Semi-structured interviews were conducted (...) from July to September 2020 during the COVID-19 pandemic. Participants were recruited in Omaha, Nebraska, U.S. (_n_ = 19) and Melbourne, Victoria, Australia (_n_ = 22), during periods of stay-at-home public health orders. These two case study sites enabled an exploration of some universal, and some context-specific, social, economic, and health conditions that buffer, or exacerbate, food insecurity for families in these neo-liberal political settings. An inductive thematic analysis was conducted and established six themes:_growing up poor_, _lessons learned_,_ feeding a family amidst a pandemic_,_ caregiver coping strategies_, _food security in the early years_ and _protecting (young) children_. Perspectives on local anti-hunger strategies were organized to outline participant’s preferred solutions. Household food insecurity is conceptualized in public policy in the U.S. and Australia as a short-term crisis for people, justifying austere, time-limited and patchwork solutions. A narrative of caregivers’ lived experience of food insecurity suggests that it is inter-generational, and exacerbated by a food system shock (i.e., COVID-19). These findings from two varying cities and nations offer a different conceptualization of the timespan and nature of the phenomenon of food insecurity, challenging a dominant policy narrative and highlighting the inadequacy of current so-called solutions. (shrink)

COVID-19, the most severe public health problem to occur in the past 10 years, has greatly impacted people's mental health. Colleges in China have reopened, and how to prevent college students from suffering secondary damage due to school reopening remains elusive. This cross-sectional study was aimed to evaluate the psychological impact of COVID-19 after school reopening and explore via machine learning the factors that influence anxiety and depression among students. Among the 478 valid online questionnaires collected between September 14th and (...) September 20th, 74 showed symptoms of anxiety, and 155 showed symptoms of depression. Descriptive analysis of basic personal characteristics indicated that students at a higher grade, having relatives or friends who have been infected, fearing being infected, and having a pessimistic attitude to COVID-19 easily experience anxiety or depression. The Synthetic Minority Oversampling Technique was utilized to counteract the imbalance of retrieved data. The Akaike Information Criterion and multivariate logistic regression were performed to explore significant influence factors. The results indicate that exercise frequency, alcohol use, school reopening, having relatives or friends who have been infected, self-quarantine, quarantine of classmates, taking temperature routinely, wearing masks routinely, sleep quality, retaining holiday, availability of package delivery, take-out availability, lockdown restriction, several areas in school closed due to COVID-19, living conditions in the school, taking the final examinations after school reopening, and the degree to which family economic status is influenced by COVID-19 are the primary influence factors for anxiety or depression. To evaluate the effect of our model, we used 5-fold cross-validation, and the average area under the curve values of the receiver operating characteristic curves of anxiety and depression on the test set reached 0.885 and 0.806, respectively. To conclude, we examined the presence of anxiety and depression symptoms among Chinese college students after school reopening and explored many factors influencing students' mental health, providing reasonable school management suggestions. (shrink)

Although various scholars underscore the importance of innovating responsibly in view of today's societal challenges, less attention has been paid to the entrepreneurial skillset, that is, the range of individual skills and organizational capabilities, that innovation-based organizations mobilize to deliver new responsible products and services. This paper thus explores the relationships between the entrepreneurial skillsets of 16 Canadian and Brazilian for-profit and not-for-profit organizations producing Responsible Innovations in Health (RIH) and their degree of responsibility. Our mixed methods study includes interviews (...) with entrepreneurs (n = 23) and fieldnotes as well as quantitative results from the RIH Assessment Tool. Our findings identify four skillset orientations—Technical, Technical + Business, Social, and Social + Business—that not only reflect (co)founders' training and entrepreneurial motivations but also a proclivity toward the consolidation of either “Technical” or “Social” skills and capabilities. Such consolidation is made possible by recruiting high-level executives with diverse backgrounds or by tapping on external knowledge sources (e.g., boards of directors, incubators, or volunteers). As five enterprises had no formal business skills, patterns associated to their overall RIH score (ranging from 1 to 5) reveal intriguing results. Organizations with a Social + Business skillset have a slightly lower RIH score (4.1) than those with a Social skillet (4.4) and those with a Technical + Business skillset have a slightly higher score (3.5) than those with a Technical skillset (3.0). The presence of business skills thus appears to mediate the relationship between entrepreneurial skillsets and the degree of responsibility, which may be linked to the distinct roles of ordinary (“doing things right”) and dynamic capabilities (“doing the right things”). These exploratory findings have scholarly and practical implications. First, the tensions and synergies characterizing responsible value creation should be approached by examining the complementary skills and capabilities that need to be assembled and consolidated. Second, the eight cases with a Social + Business skillset clarify the unique capabilities needed to produce highly responsible health innovations. Third, entrepreneurs with a scientific or engineering background should recognize that a Technical skillset is not enough. Fourth, recognizing that “falling in love with the cause” of RIH is not sufficient, investors and boards of directors should adequately support responsible entrepreneurs towards the proper orchestration of skills and capabilities that can reconcile economic and social goals. (shrink)

According to the Einstein-Mayer theory of the Riemanniann space-time with Einstein-Cartan teleparallelism, the local Lorentz invariance is broken by the gravitational field defining Machian reference systems. This breaking of symmetry implies the occurrence of “hidden matter” in the Einstein equations of gravity. The hidden matter is described by the non-Lorentz-invariant energy-momentum tensor $\hat \Theta _{ik}$ satisfying the relation $\hat \Theta _{i;k}^k = 0$ . The tensor $\hat \Theta _{ik}$ is formed from the Einstein-Cartan torsion field given by the anholonomy objects, (...) FAik=2hA[i,k], and appears together with Hilbert’s energy-momentum tensor T* ik and Poincaré’s pressure λgik on the right-hand side of Einstein’s equations so that one has $$R_{ik} - (1/2)g_{ik} R = - \kappa T*_{ik} - \lambda g_{ik} - \hat \Theta _{ik}$$ According to this theory, in the universe and in cosmic systems one must excep “invisible masses” described by the Poincaré and Einstein-Cartan terms to exist. The torsion field FAik makes the space-time a Machian universe; it is of the same nature as the “weak interacting matter” discussed in astrophysics. (shrink)

PurposeThis study aims to develop and validate a stigma scale for Chinese patients with breast cancer.MethodsPatients admitted to the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, for breast cancer treatment participated in this study. Development of the Breast Cancer Stigma Scale involved the following procedures: literature review, interview, and applying a theoretical model to generate items; the Breast Cancer Stigma Scale’s content validity was assessed by a Delphi study and feedback from patients with breast cancer ; (...) exploratory factor analysis was used to assess the construct validity; convergent validity was assessed with the Social Impact Scale ; internal consistency Cronbach’s α, split-half reliability, and test–retest reliability were used to identify the reliability of the scale.ResultsThe final version of the Breast Cancer Stigma Scale consisted of 15 items and showed positive correlations with the Social Impact Scale. Exploratory factor analysis revealed four components of the Breast Cancer Stigma Scale: self-image impairment, social isolation, discrimination, and internalized stigma, which were strongly related to our perceived breast cancer stigma model and accounted for 69.443% of the total variance. Cronbach’s α for the total scale was 0.86, and each subscale was 0.75–0.882. The test–retest reliability with intra-class correlation coefficients of the total scale was 0.947, and split-half reliability with intra-class correlation coefficients of the total scale was 0.911. The content validity index was 0.73–1.0.ConclusionThe newly developed Breast Cancer Stigma Scale offers a valid and reliable instrument for assessing the perceived stigma of patients with breast cancer in clinical and research settings. It may be helpful for stigma prevention in China. (shrink)

Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid organ transplant, thirty-nine (...) (65.0 per cent) for candidates and twenty-one (35.0 per cent ) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent, p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often navigated communication challenges between transplant and non-transplant healthcare professionals and patients and families. (shrink)

The current study aimed at identifying the effect of strategic control on customer satisfaction with e-marketing in the Kingdom of Saudi Arabia. The study used the descriptive approach. A questionnaire was prepared and administered to a sample of (315) customers in the Kingdom of Saudi Arabia. The study found a statistically significant correlation at the significance level of (0.05) between all strategic control dimensions, customer satisfaction with e-marketing, and customer approval of the positivity towards the practices and advantages of strategic (...) control in e-marketing. There is also a statistically significant effect at the significance level of (0.05) for strategic control dimensions: (management information systems, strategic control methods, strategic evaluation) on customers' satisfaction in e-marketing. The current study recommended the need to pay attention to the strategic control function and benefit from its philosophy and the benefits that accrue to supporting customer satisfaction with e-marketing, and raising the efficiency and awareness of employees about strategic control in an organized manner in order to build their capabilities to support and implement control mechanisms and make the necessary improvements. (shrink)

This paper consists primarily of a survey of results of Harvey Friedman about some proof-theoretic aspects of various forms of Kruskal's tree theorem, and in particular the connection with the ordinal Γ0. We also include a fairly extensive treatment of normal functions on the countable ordinals, and we give a glimpse of Verlen hierarchies, some subsystems of second-order logic, slow-growing and fast-growing hierarchies including Girard's result, and Goodstein sequences. The central theme of this paper is a powerful theorem due to (...) Kruskal, the ‘tree theorem’, as well as a ‘finite miniaturization’ of Kruskal's theorem due to Harvey Friedman. These versions of Kruskal's theorem are remarkable from a proof-theoretic point of view because they are not provable in relatively strong logical systems. They are examples of so-called ‘natural independence phenomena’, which are considered by most logicians as more natural than the metamathematical incompleteness results first discovered by Gödel. Kruskal's tree theorem also plays a fundamental role in computer science, because it is one of the main tools for showing that certain orderings on trees are well founded. These orderings play a crucial role in proving the termination of systems of rewrite rules and the correctness of Knuth-Bendix completion procedures. There is also a close connection between a certain infinite countable ordinal called Γo and Kruskal's theorem. Previous definitions of the function involved in this connection are known to be incorrect, in that, the function is not monotonic. We offer a repaired definition of this function, and explore briefly the consequences of its existence. (shrink)

Background: We aimed to determine the smallest changes in health-related quality of life (HRQoL) scores in the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire core 30 and the Brain Cancer Module (QLQ-BN20), which could be considered as clinically meaningful in brain cancer patients. Materials and methods: World Health Organisation performance status (PS) and mini-mental state examination (MMSE) were used as clinical anchors appropriate to related subscales to determine the minimal clinically important differences (MCIDs) in HRQoL (...) change scores (range 0-100) in the QLQ-C30 and QLQ-BN20. A threshold of 0.2 standard deviation (SD) (small effect) was used to exclude anchor-based MCID estimates considered too small to inform interpretation. Results: Based on PS, our findings support the following integer estimates of the MCID for improvement and deterioration, respectively: physical (6, 9), role (14, 12), and cognitive functioning (8, 8); global health status (7, 4(star)), fatigue (12, 9), and motor dysfunction (4(star), 5). Anchoring with MMSE, cognitive functioning MCID estimates for improvement and deterioration were (11, 2(star)) and for communication deficit were (9, 7). Estimates with asterisks were <0.2 SD and were excluded from our MCID range of 5-14. Conclusion: These estimates can help clinicians evaluate changes in HRQoL over time, assess the value of a health care intervention and can be useful in determining sample sizes in designing future clinical trials. (shrink)

Letκbe the cardinality of some saturated model of Peano Arithmetic. There is a set of${2^{{\aleph _0}}}$saturated models of PA, each having cardinalityκ, such that wheneverMandNare two distinct models from this set, then Aut(${\cal M}$) ≇ Aut ($${\cal N}$$).

Objectives Disclosures of funding sources and conflicts of interests (COI) in published peer-reviewed journal articles have recently begun to receive some attention, but many critical questions remain, for example, how often such reporting occurs concerning research conducted in the developing world and what factors may be involved. Design Of all articles indexed in Medline reporting on human subject HIV research in 2007 conducted in four countries (India, Thailand, Nigeria and Uganda), this study explored how many disclosed a funding source and (...) COI, and what factors are involved. Results Of 221 articles that met the criteria, 67.9% (150) disclosed the presence or absence of a funding source, but only 20% (44) disclosed COI. Studies from Uganda were more likely, and those from Nigeria were less likely to mention a funding source (p<0.001). Of articles in journals that had adopted International Committee of Medical Journal Editors (ICMJE) guidelines, 56% did not disclose COI. Disclosure of funding was more likely when: ≥50% of the authors and the corresponding author were from the sponsoring country, the sponsor country was the USA, and the articles were published in journals in which more of the editors were from the sponsoring countries. Conclusions Of the published studies examined, over a third did not disclose funding source (ie, whether or not there was a funding source) and 80% did not disclose whether COI existed. Most articles in ICMJE-affiliated journals did not disclose COI. These data suggest the need to consider alteration of policies to require that published articles include funding and COI information, to allow readers to assess articles as fully as possible. (shrink)

Rationale, aims and objectives To compare the pharmacotherapeutic approaches to diabetic hypertension of family physicians (FPs) and general practitioners (GPs). Methods A retrospective prescription-based study was conducted in 15 out of a total of 20 health centres, involving 115 primary care physicians – 77 FPs and 38 GPs, representing 74% of the primary care physicians of Bahrain. Prescriptions were collected during May and June 2000 to comprise a study population of 1266 diabetic-hypertensive patients. Results As monotherapy, angiotensin-converting enzyme (ACE) inhibitors (...) (37.9%) and β-blockers (38.3%) were the most commonly prescribed classes of antihypertensives by FPs and GPs, respectively. Calcium channel blockers (CCBs) were ranked third by both categories of physicians. For two-drug combinations, a β-blocker and an ACE inhibitor was the combination of choice for both physician categories. Patients managed by the FPs were more likely to receive a β-blocker–CCB combination (17.4 vs. 14.9%) or a diuretic–ACE inhibitor combination (16.7 vs. 11.4%) and less likely to receive a β-blocker–diuretic combination (11.8 vs. 16.7%) than those managed by the GPs. The proportion of patients receiving antihypertensive combinations was 40.6 and 38.5% for FPs and GPs, respectively. While the GPs prescribed CCB as a monotherapy to the elderly most often, the FPs choice was a β-blocker. Diuretics were less preferred by both FPs and GPs. β-Blocker–ACE inhibitor was again the most preferred combination of both FPs and GPs. FPs prescribed CCB–β-blocker combinations more often than GPs (P = 0.01), whereas CCB–ACE inhibitor combinations were less preferred (P = 0.09). A trend towards excessive use of short-acting nifedipine as monotherapy for elderly patients, both by FPs and by GPs, was noticed. Glibenclamide, alone or in combination with metformin, was the foremost antidiabetic drug prescribed by FPs and GPs. Middle-aged (45–64 years) patients seen by GPs were more likely to receive glibenclamide than those treated by FPs (P = 0.001) and less likely to receive gliclazide (P = 0.01). Combinations of a β-blocker with either glibenclamide or insulin were prescribed considerably more often by GPs.Conclusions Within the same practice setting, a substantial difference was observed between FPs and GPs in terms of preference for different classes of drugs in the management of diabetic hypertension. The compliance of both FPs and GPs was suboptimal; overall, the compliance of the FPs was closer to the recommended guidelines, however. Educational programmes should specifically address these inadequacies in order to improve the quality of health care. (shrink)

The aim of this study was to test red - green dichromats' ability to discriminate between illuminant and surface-reflectance changes in natural scenes. Stimuli were simulations of natural scenes presented on a colour monitor with 10-bit resolution per gun. The natural scenes were obtained with a fast hyperspectral imaging system. Six different scenes (including rocks, foliage, and buildings) were tested. In each trial, two images were presented in sequence, each for 1 s, with no interval. The images differed in the (...) phase of daylight on the scene: first with correlated colour temperature 25 000 K, then 6 700 K. The spectral reflectance of a region in the second image was changed randomly, consistent with a local change in daylight. The observer's task was to decide whether a particular surface in the successive images was the same (pure illuminant change) or different (illuminant change with a surface-reflectance change). The performance of four deuteranopes and five protanopes varied considerably across the scenes tested, with mean colour constancy indices (± 1 SEM) of 0.48 (± 0.13) and 0.19 (± 0.10), respectively (1.0 representing ideal performance). Deuteranopes seemed less disadvantaged than protanopes, performing close to normal with some scenes. (shrink)

We report on the small-scale (0.5 13 h - 1M, a large-scale bias of ~2.0 and a satellite fraction of 12 ± 2 per cent. Thus, these galaxies occupy haloes with average masses in between those of the higher redshift BOSS CMASS sample and the original SDSS I/II luminous red galaxy sample © 2012 The Authors Published by Oxford University Press on behalf of the Royal Astronomical Society © doi:10.1093/mnras/sts314.

Public health emergencies, such as the Covid-19 pandemic, put great pressure on healthcare workers (HCW) across the world, possibly increasing the risk of experiencing ethically challenging situations (ECS). Whereas experiencing ECS as a HCW in such situations is likely unavoidable, mitigation of their adverse effects (e.g., moral distress) is necessary to reduce the risk of long-term negative consequences. One possible route of mitigation of these effects is via work environmental factors. The current study aimed to examine: [1] risk factors associated (...) with ECS among HCW [2], intensity of moral distress associated with ECS across various occupational factors (i.e., profession, degree of exposure to patients with Covid-19), and [3] the impact of work environmental factors on this association, in a sample of HCW during the pandemic. We employed multiple logistic and linear regression to self-report data from 977 HCWs at four Norwegian hospitals responding to a survey at the fourth wave of the pandemic. About half of HCW in this study had experienced ECS during the pandemic, and levels of moral distress associated with such were higher than in previous studies using similar assessment methods. Younger age, female sex, geographical work area (mid-north of Norway), and profession (nurse) were all associated with higher odds (range of OR: 1.30–2.59) of experiencing ECS, as were direct contact with patients with Covid-19. Among those participants who reported that they had experienced ECS during the pandemic, moral distress levels when recalling those situations were moderate (Mean 5.7 on a 0–10 scale). Men reported somewhat lower intensity of moral distress (partial eta squared; ηp2 = 0.02). Reporting a manageable workload (ηp2 = 0.02), and greater opportunity to work according to best practice (ηp2 = 0.02), were associated with lower levels of moral distress. Our findings suggest that moral distress could potentially be mitigated on an organizational level, particularly by focusing on ensuring a manageable workload, and an ability to work according to best practice. To build sustainable healthcare systems robust enough to withstand future public health emergencies, healthcare organizations should implement measures to facilitate these aspects of HCWs’ work environment. (shrink)

Tradition II Hermeneutics, Ethics, and the Dispensation of the Good Stephen H. Watson Examines concepts of tradition in 20th-century Continental philosophy. In Tradition II, Stephen H. Watson engages post-Kantian Continental philosophy in his continuing investigation into the concept of tradition which he began in his work, Tradition. According to Watson, the problem of tradition became explicit in 20th-century philosophy, and is especially apparent in the work of Heidegger, Gadamer, Husserl, Benjamin, Adorno, Levinas, Kristeva, and Derrida, among others. By formulating a (...) series of dialogues between these philosophers and their predecessors, Watson articulates the issues and concerns surrounding tradition and traditionality. Taking on topics such as the hermeneutics of the self, the rationality of tradition, the pluralistic nature of historical interpretation, and the question of the "other," Watson emphasizes the importance of classical accounts of ethical and political discourse for contemporary philosophy and today’s multicultural world. Watson extends his analysis of tradition to include the problems of meaning and narrative and the nature of the self. He also considers the meaning of the Good and how Good is dispensed in the world. By questioning past philosophical narratives and their influence on modern and postmodern philosophy, Watson brings fresh perspective to the complex meanings of tradition for a pluralistic world. Stephen H. Watson is Professor of Philosophy and Chair of the Philosophy Department at the University of Notre Dame. He is author of Extensions: Essays on Interpretation, Rationality, and the Closure of Modernism and Tradition: Refiguring Community, Remembrance, and Virtue in Classical German Thought. Studies in Continental Thought—John Sallis, general editor June 2001 320 pages, 6 1/8 x 9 1/4, index cloth 0-253-33900-6 $35.00 s / £26.50. (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)

The Einstein equations can be written as Fierz-Pauli equations with self-interaction, $W\gamma _{ik} = - G_{ik} + \tfrac{1}{2}g_{ik} g^{mn} G_{mn} - k(T_{ik} - \tfrac{1}{2}g_{ik} g^{mn} T_{mn} )$ together with the covariant Hilbert-gauge condition, $(\gamma _i^h - \tfrac{1}{2}\delta _i^k g^{mn} \gamma _{mn} )_{;k} = 0$ where W denotes the covariant wave operator and G ik the Einstein tensor of the metric g ik collecting all nonlinear terms of Einstein's equations. As is known, there do not, however, exist plane-wave solutions γ ik(z)with (...) g ik Z,i Z,k=0of these equations such that what is essential to the introduction of gravitons is not satisfied in general relativity. This nonexistence corresponds with the uncertainty relation,Δp(Δg*)2(Δx)3≥h hG/ c 3 concerning the total nonlinear gravitational field g *ik =g k +γ k. (shrink)

OBJECTIVE: To report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients. DESIGN: Retrospective descriptive study. SETTING: A cancer clinical trials unit in a large teaching hospital. PATIENTS: From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied. MAIN MEASUREMENT: Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated. RESULTS: (...) DNR orders were written for 64.4% of patients. Patients in pain (odds ratio 0.45, 95% CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95% CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patients were taken home to die, a more likely occurrence if the patient was over 75 years (odds ratio 0.12, 95% CI 0.04-0.34), had children (odds ratio 0.14, 95% CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95% CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95% CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge. CONCLUSIONS: DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20% of dying patients are taken home to die, in accordance with local custom. (shrink)

Objective: To determine whether a moral reasoning exercise can improve response quality to surveys of healthcare priorities Methods: A randomised internet survey focussing on patient age in healthcare allocation was repeated twice. From 2574 internet panel members from the USA and Canada, 2020 (79%) completed the baseline survey and 1247 (62%) completed the follow-up. We elicited respondent preferences for age via five allocation scenarios. In each scenario, a hypothetical health planner made a decision to fund one of two programmes identical (...) except for average patient age (35 vs 65 years). Half of the respondents (intervention group) were randomly assigned to receive an additional moral reasoning exercise. Responses were elicited again 7 weeks later. Numerical scores ranging from –5 (strongest preference for younger patients) to +5 (strongest preference for older patients); 0 indicates no age preference. Response quality was assessed by propensity to choose extreme or neutral values, internal consistency, temporal stability and appeal to prejudicial factors. Results: With the exception of a scenario offering palliative care, respondents preferred offering scarce resources to younger patients in all clinical contexts. This preference for younger patients was weaker in the intervention group. Indicators of response quality favoured the intervention group. Conclusions: Although people generally prefer allocating scarce resources to young patients over older ones, these preferences are significantly reduced when participants are encouraged to reflect carefully on a wide range of moral principles. A moral reasoning exercise is a promising strategy to improve response quality to surveys of healthcare priorities. (shrink)

§0. Introduction. In [16], Barwise described his graduate study at Stanford. He told of his interactions with Kreisel and Scott, and said how he chose Feferman as his advisor. He began working on admissible fragments of infinitary logic after reading and giving seminar talks on two Ph.D. theses which had recently been completed: that of Lopez-Escobar, at Berkeley, on infinitary logic [46], and that of Platek [58], at Stanford, on admissible sets.Barwise's work on infinitary logic and admissible sets is described (...) in his thesis [4], the book [13], and papers [5]—[16]. We do not try to give a systematic review of these papers. Instead, our goal is to give a coherent introduction to infinitary logic and admissible sets. We describe results of Barwise, of course, because he did so much. In addition, we mention some more recent work, to indicate the current importance of Barwise's ideas. Many of the central results are stated without proof, but occasionally we sketch a proof, to indicate how the ideas fit together.Chapters 1 and 2 describe infinitary logic and admissible sets at the time Barwise began his work, circa 1965. From Chapter 3 on, we survey the developments that took place after Barwise appeared on the scene.§1. Background on infinitary logic. In this chapter, we describe the situation in infinitary logic at the time that Barwise began his work. We need some terminology. By a vocabulary, we mean a set L of constant symbols, and relation and operation symbols with finitely many argument places. As usual, by an L-structureM, we mean a universe set M with an interpretation for each symbol of L. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:James's Faith-Ladder JAMES C. S. WERNHAM JAMES WROTE OFTEN of a "faith-ladder."' What he said about it has drawn some side-glances from critics, but not yet any sustained and careful look.' That is surprising, for what he says is puzzling enough to invite inquiry. It is also important enough to deserve it. His presentations of the ladder show significant variation, so it is useful to look at a generous (...) sample. In the interest of brevity the following six passages have been extracted from contexts which sometimes have an important bearing on them. The unquoted contexts will get attention as needed. 1. "The inner process is a succession of 'synthetic judgments'. What is so good, may be, ought to be, must be, shall be,--so far as I am concerned, I won't admit the opposite. ''s 2. "[W]e have a conception which being opposed by another is only probab /e. But we feel, it is so good that it isfit to be true, it ought to be true, it must be true etc. And then we say it shall be true for me, it/s true. ''4 3- "Its [faith's] natural logic is the Sorites: fit to be, ought to be, may be, must be, shall be, is etc.''5 4. "The following steps may be called the 'faith-ladder': ~. There is nothing absurd in a certain view of the world being true, nothing self-contradictory; ' To the best of my knowledge, the name "faith-ladder'"does not occur before 19o6. It occurs in "Faith and Reason" and in "Faith and the Right to Believe," both written in that year. But expositions of the thing predate the name. They are found as early as 1899, and in close connection with the will-to-believe doctrine. 9 Levinson's discussion is a partial exception. His treatment is more extended than most. See H. S. Levinson, $c/ence, Metaphysicsand the Chan~e of Salvation (Missoula, MT: Scholars Press, 1978), 161--67; also his The Religious Investigations of Wdliam James (Chapel Hill: University of North Carolina Press, 198 0, 231-34. s Letter to Baldwin, quoted in'R. B. Perry, The Thoughtand Characterof WilliamJames, 2 vols. (Boston: Little, Brown and Co., 1935), 2: 243. 4 Letter to Marshall, Feb. 9, 1899, quoted in Perry, Thought and Character,2: 24~. 5 William James, A Pluralistic Universe (Cambridge, MA and London: Harvard Universit~t Press, 1977), 199. [1o5] lO6 JOURNAL OF THE HISTORY OF PHILOSOPHY 28" 1 JANUARY I990 2. If might have been true under certain conditions; 3- It may be true even now; 4. It isfit to be true; 5- It ought to be true; 6. It must be true; 7- It s/m//be true, at any rate true for me. ''6 5. "Faith's form of argument is something like this: Considering a view of the world: 'It isfit to be true', she feels; 'it would be well if it were true; it might be true; it may be true; it ought to be true', she says; 'it must be true', she continues; 'it shall be true', she concludes, 'for me; that is, I will treat it as if it were true so far as my advocacy and actions are concerned'. ''7 6. "A conception of the world arises in you somehow, no matter how. Is it true or not? you ask. It might be true somewhere, you say, for it is not self-contradictory. It may be true, you continue, even here and now. It is fit to be true, it would be well if it were true, it ought to be true, you presently feel. It must be true, something persuasive in you whispers next; and then--as a final result--it shall be held for true, you decide; it shall be as if true, for you. ''s 9. Between these statements there are clear similarities and clear differences too. Some of them deserve to be noted, some to be noted and explored. a. In these accounts of it the ladder varies in the number of its rungs. By James's own count in one place, it has as many as seven. In... (shrink)