Kwaku Marfo, Danielle Garcia, Saira Khalique, Karen Berger, Amy LuMontefiore Medical Center, Bronx, NY, USABackground: Medication errors are a prime concern for all in healthcare. As such the use of information technologies in drug prescribing and administration has received considerable attention in recent years, with the hope of improving patient safety. Because of the complexity of drug regimens in renal transplant patients, occurrence of medication errors is inevitable even with a well adopted computerized physician order entering system. Our objective (...) was to quantify medication error type and frequency in an inpatient renal transplant unit.Methods: Systemic evaluation of all medication errors during an initial 10-day audit and a 28-day follow-up audit in an inpatient renal transplant unit. Each error was concurrently evaluated for potential to result in adverse patient consequences, error type and associated medication class.Results: A total of 103 clinically significant medication errors were detected during the 10-day and 28-day audit time periods. The most common errors were wrong medication dose ordered and wrong time of drug administration. Thirty-six out of 66 prescribing/ordering errors reached the patient.Conclusions: Even with utilization of computerized physician order entry system in an inpatient renal transplant unit, post-kidney transplant patients are at risk for adverse outcomes due to medication errors. The risk factors may be multifactorial and will require both organizational and technical approaches to resolve.Keywords: medication errors, CPOE, inpatient, renal transplant patients. (shrink)

Leah Andress,1 Anjali Gupta,2 Nida Siddiqi,3 Kwaku Marfo2,3 1University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Department of Pharmacy Practice, Buffalo, 2Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine Department of Abdominal Organ Transplant Program, Bronx, 3Montefiore Medical Center, Department of Pharmacy, Bronx, NY, USA: Rabbit anti-thymocyte globulin has proven benefit as induction therapy in renal transplant recipients, achieving reduced acute rejection rates and better short-term allograft function, with slightly higher rates of complications such as (...) infections and malignancy. Compared with other agents, the most benefit from rATG induction has been observed in renal transplant recipients at high immunologic risk for rejection. However, in special populations, such as pediatrics, the elderly, and hepatitis C-positive and human immunodeficiency virus-positive renal transplant recipients, additional information is needed to delineate the absolute benefit of rATG induction compared with other induction agents. Selection of rATG as the choice of induction therapy in renal transplant recipients should be guided by a cost-effective approach in balancing efficacy, safety, and cost. This review summarizes the published literature on efficacy, safety, and cost of rATG induction in renal transplantation. Keywords: anti-thymocyte globulin, renal transplantation, induction therapy. (shrink)

The author proposes a method of verification for moral statements. (staff).

Phenomenological analyses of ageing and old age have examined themes such as alterity, finitude, and time, not seldom from the perspective of “healthy” aging. Phenomenologists have also offered detailed analyses of lived experiences of illness including lived experiences of dementia. This article offers a phenomenological account of what we label as entering the grey zone of aging between “healthy” aging and aging with a disease. This account is developed through a qualitative phenomenological philosophy analysis of elderly persons’ lived experiences of (...) being tested for dementia through primary care in Sweden, i.e., within a cultural context where dementia commonly is understood as a frightening a loss of self even though this understanding also is questioned. To enter this grey zone of aging, we argue, does not dissolve dynamic self-becoming but can involve an experience of oneself as being old. Further, in the grey zone, the self experiences itself as neither fully healthy nor as having a disease, and as needing to negotiate and live this ambiguity. To enter this grey zone is to enter an affectively charged, sociocultural and medicalized zone, and while the self can still act in different ways within it, staying in the grey zone can result in a re-orientation in the self’s mode of being, in ways that are thoroughly beyond its control. To stay in the grey zone can have detrimental effects on the self, even though the self does not have a disease: the self can become “stuck” in a reflective mode of attending to embodiment, aging, health, and disease. (shrink)

The ethical treatment of cancer patientsparticipating in clinical trials requiresthat patients are well-informed about thepotential benefits and risks associated withparticipation. When patients enrolled in phaseI clinical trials report that their chance ofbenefit is very high, this is often taken as evidence of a failure of the informed consent process. We argue, however, that some simple themes from the philosophy of language may make such a conclusion less certain. First, the patient may receive conflicting statements from multiple speakers about the expected (...) outcome of the trial. Patients may be reporting the message they like best. Second, there is a potential problem of multivocality. Expressions of uncertainty of the frequency type can be confused with expressionsof uncertainty of the belief type. Patients may be informed using frequency-type statements and respond using belief-type statements. Third, each speech episode involving the investigator and the patient regarding outcomes may subservemultiple speech acts, some of which may beindirect. For example, a patient reporting ahigh expected benefit may be reporting a beliefabout the future, reassuring family members,and/or attempting to improve his or her outcome by apublic assertion of optimism. These sources oflinguistic confusion should be considered injudging whether the patient's reported expectation isgrounds for a bioethical concern that there hasbeen a failure in the informed consent process. (shrink)

Fasıl ve vasıl konusu, nahvin atıf konusuyla da ilişkili olarak cümlelerin bağlanma hususunu ele alan belagatın me‘ânî alanının önemli bir konusudur. Bu konuda, cümleler arasındaki anlam ilişkilerine dair bir takım kavramlar geliştirilmiş, cümlelerin bağlanmasıyla ilgili esaslar oluşturulmuştur. Bu konunun ele aldığı cümleler, aralarında sebep-sonuç, zıtlık, karşılaştırma vb. anlam ilişkileri bulunan cümleler değil, bu tür anlam ilişkileri dışında art arda gelen ve paragrafın oluşumuna katkı sunan cümlelerdir. Bu cümleler, bağlama dışında başka bir anlamı olmayan vav bağlacıyla veya bağlaçsız biçimde sıralanır. Bağlaçsız (...) sıralanan cümleler arasında modern dönemde noktalama işaretleri kullanılmaktadır. Fasıl ve vasıl konusu kendi kavramları ve sistematiği içerisinde cümlelerin bağlanmasını ve bağlanma esaslarını açıklamaktadır. Ancak bu tür cümlelerin ve bunların bağlanma konusunun Türkçe dilbilgisindeki karşılığı tartışılmamıştır. Çalışmanın bir kısmında bu konunun Türkçe kavramsal karşılığı teorik olarak tartışılmakta ve sıralı bağlı cümleler olduğu tespiti yapılmaktadır. Çalışmanın diğer kısmında ise fasıl ve vasıl konusunda ele alınan cümleler Türkçe dilbilgisi perspektifinden hareketle yeni bir bakışla sunulmaktadır. Sıralı bağlı cümlelerin noktalama işaretleriyle ilişkisi olduğundan fasıl ve vasıl konusundaki cümlelerin bu işaretlerle olan ilişkisi de açıklığa kavuşturulmaktadır. (shrink)

A review of empirical and theoretical work on reasoning and linguistic inference, which will be a useful introduction to the subject for students of language and thought. The book focuses on the relationship between what people do and what people are supposed to do when making inferences.

Irreversibility, it is claimed, is a much broader concept than is entropy increase, as is shown by the occurrence of certain processes which are irreversible without seeming to involve any intrinsic entropy change. These processes include the spreading outwards into space of particles, or of radiation, and they also include certain biological and mental phenomena. For instance, the irreversible and treelike branching which is characteristic of natural evolution is not entropic when it is considered in itself—i.e. in abstraction from accompanying (...) biochemical and physiological activity. What appears to be the common feature of all forms of irreversibility is the fanning out of trajectories, new entities or new states, in the temporal direction towards the future. (shrink)

In ''''A Defense of Evolutionary Ethics'''' (1986), Robert J. Richardsendeavors to explain how moral ''oughts'' can be derived from thescience of evolutionary biology without committing the dreadednaturalistic fallacy. First, Richards assumes that ''ought'' as usedin ethical discourse bears the same meaning as ''ought'' used anywherein science, indicating merely that certain results or behaviors arepredicted based on prior structured contexts. To this extent, themoral behavior of animals, what they ''ought'' to do, could arguablybe predicted by evolutionary biology as effectively as, say,molecular (...) behavior may be predicted by chemistry. But afteracknowledging that biological inferences to this limited senseof ''ought'' were never contested by Moore''s naturalistic fallacy,Richard proposes to add to evolutionary ethics a decision procedureto determine which members of a set of predicted behaviors arethose which truly ought to occur – in the genuinelyprescriptive sense intended by ethical discourse. But theprocedure which Richards fabricates for this purpose appealsto such alleged ''facts'' as cultural conventions and moral opinionpolling, hardly a secure foundation for the sort of scientific ethics promised by Richards at the outset. (shrink)

Arapçada izâfet bütünleşik bir yapı arz eden ve ögeleri arasındaki kuvvetli bağ sebebiyle iki isimli bu yapının müfred isim mesabesinde kabul edildiği bir dizilimdir. Bu yapıyı oluşturan kelimelerin diziliminde herhangi bir yer değişimi olmamakla birlikte şiir zarureti gibi oldukça istisna sayılabilecek durumlar dışında bu iki ismin arasına başka bir sözün girmesi de karşılaşılan bir durum değildir. Sözü bu derece kuvvetli bir yapıyla ifade etmenin birtakım anlamsal gerekçeleri bulunmaktadır. Ancak yine anlamın etkili olduğu başka gerekçeler, izâfetle ifadesi mümkün olan bir sözün (...) farklı dizilimlerle dile getirilmesini gerekli kılmaktadır. Bu çalışma Arapçada izâfetle ifadesi mümkün olmakla birlikte farklı yapılarla meydana getirilen dizilimleri tespit edip incelemektedir. Çalışma bir yandan izâfetle ilişkili olup gramerde farklı başlıklar altında yer alan dizilimleri analiz edip değerlendirerek bir arada sunmayı, bir yandan da bu dizilimlerin yapısal farklılıklarını ve farklılığın anlamsal gerekçelerini değerlendirerek konunun öğretimine yönelik veriler oluşturmayı amaçlamaktadır. Konunun yapısal boyutunda bu dizilimlerin izâfetten farkı ve dönüşümün biçimsel boyuta nasıl yansıdığı incelenmektedir. Anlamsal boyutta ise izâfet ve izâfet dışındaki dizilimlerin tercihinde etkili olan anlamsal faktörler incelenmektedir. Her dizilimin biçime yansıyan kendine has oluşturulma gerekçesi olmakla beraber izâfetin tercihinde veciz olmasının, izâfet formunun değişimiyle elde edilen ifadelerde ise çalışmada ayrıntıları izah edilen diğer sebeplerin etkili olduğu sonucuna ulaşılmıştır. (shrink)

This study analyzed 16 potential ethics-related problems associated with use and abuse of video news releases (VNRs) by public relations practitioners and electronic journalists. Causes and possible solutions to the problems were suggested and model ethics code guidelines were developed. Moral rules, moral ideals, theories of ethics, public relations theories, and electronic journalism theories were used to provide a general foundation for the analysis. A more specific foundation was provided by guidelines from a variety of media codes of ethics.

A distinction between basic archetypes of urban form was made by Bruno Fortier: the accumulation city as opposed to the creation city. These archetypes derive from archaeology - being based on the Roman and the Egyptian city - but are interpreted as morphological paradigms, as a set of assumptions and underpinnings determining spatial planning and design. The creation city is described as expression of modernity - the paradigmatic origins of which can be traced back to Descartes’ ideas on the city (...) - analysed as an ontology of destruction, among other things. A conceptual framework connecting the creation city to modernity is presented by interpreting Fortier’s archetypes through the anthropological work of W.T. Jones. Influenced by postmodern cultural analysis and architectural discourse, the paradigmatic importance of the accumulation city seems to increase. It is argued that interest in the accumulation city is related to a discord which is characteristic of modernity but which seems to be denied by the urbanistic modernism of the 20th century. Methodologically, we argue that modernism should be seen as part of a post-paradigmatic phase of modernity rather than as an expression of modernity at its zenith. It is argued that the discord of modernism should not lead to a discussion of modernism and postmodernism as contrary paradigms, but that the understanding of the city oscillates dialectically between these two paradigms. (shrink)

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Purpose: This paper is a brief introduction to enactive cognitive science: a description of some of the main research concerns; some examples of how such concerns have been realized in actual research; some of its research methods and proposed explanatory mechanisms and models; some of the potential as both a theoretical and applied science; and several of the major open research questions. Findings: Enactive cognitive science is an approach to the study of mind that seeks to explain how the structures (...) and mechanisms of autonomous cognitive systems can arise and participate in the generation and maintenance of viable perceiver-dependent worlds -- rather than more conventional cognitivist efforts, such as the attempt to explain cognition in terms of the ``recovery'' of (pre-given, timeless) features of The (objectively-existing and accessible) World. As such, enactive cognitive science is resonant with radical constructivism. Research implications: As with other scientific efforts conducted within a constructivist orientation, enactive cognitive science is broadly ``conventional'' in its scientific methodology. That is, there is a strong emphasis on testable hypotheses, empirical observation, supportable mechanisms and models, rigorous experimental methods, acceptable criteria of validation, and the like. Nonetheless, this approach to cognitive science does also raise a number of specific questions about the scope of amenable phenomena (e.g., meaning, consciousness, etc.) -- and it also raises questions of whether such a perspective requires an expansion of what is typically considered within the purview of scientific method (e.g., the role of the observer/scientist). (shrink)

Structurally free logic LC was introduced in [4]. A natural extension of LC, in particular, in a sequent formulation, is by conjunction and disjunction that do not distribute over each other. We define a set theoretical semantics for these logics via constructing a representation of a lattice that we extend by intensional operations. Canonically, minimally overlapping filter-ideal pairs are used; this construction avoids the use of an equivalent of the axiom of choice and lends transparency to the structure. We also (...) discuss adapting the present semantics for substructural logics, as well as, the question of cannnonicity of LC+. (shrink)

Clinician gate-keeping is the process whereby healthcare providers prevent access to eligible patients for research recruitment. This paper contends that clinician gate-keeping violates three principles that underpin international ethical guidelines: respect for persons or autonomy; beneficence or a favourable balance of risks and potential benefits; and justice or a fair distribution of the benefits and burdens of research. In order to stimulate further research and debate, three possible strategies are also presented to eliminate gate-keeping: partnership with professional researchers; collaborative research (...) design and clinician education. (shrink)

Book Information Aspects of Reason. By Paul Grice. Clarendon Press. Oxford. 2001. Pp. xxxviii + 136. Hardback, US$29.95.

The paper explores the relationship between learning, spirituality and management. The American philoso pher Gregory Bateson's theory on categories of learning provides the backdrop for the analysis and this is compared with a model of spiritual development developed by S.K. Chakraborty from the Indian Institute of Management in Calcutta. These two models propose that spiritual development is linked with both learning and existence, but only those forms of learning and existence which are subjective in nature and inspire the learner to (...) pursue a path of self development. The models suggest that while the traditional frameworks of spiritual teaching via the church and the like might satisfy many Christians, its domination is coming under threat by a growing number in the community who are seeking a form of spirituality that is less connected with dogma. The form of learning that this movement represents finds its parallel in management, with the emergence offlatter structures and finding ways to involve employees in the decision-making process. The article presents the results of a survey conducted at the 1998 Spirituality, Leadership and Management (SLaM) conference to determine attendees'views on spirituality, leadership and management, and how these comform to the expectations as outlined in Bateson's categories of learning and Chakraborty's categories of existence. (shrink)