Background and objective: Code status discussions may fail to address patients’ treatment-related goals and their knowledge of cardiopulmonary resuscitation (CPR). This study aimed to investigate patients’ resuscitation preferences, knowledge of CPR and goals of care. Design, setting, patients and measurements: 135 adults were interviewed within 48 h of admission to a general medical service in an academic medical centre, querying code status preferences, knowledge about CPR and its outcome probabilities and goals of care. Medical records were reviewed for clinical information (...) and code status documentation. Results: 41 (30.4%) patients had discussed CPR with their doctor, 116 (85.9%) patients preferred full code status and 11 (8.1%) patients expressed code status preferences different from the code status documented in their medical record. When queried about seven possible goals of care, patients affirmed an average of 4.9 goals; their single most important goals were broadly distributed, ranging from being cured (n = 36; 26.7%) to being comfortable (n = 8; 5.9%). Patients’ mean estimate of survival to discharge after CPR was 60.4%. Most patients believed it was helpful to discuss goals of care (n = 95; 70.4%) and the chances of surviving inhospital CPR (n = 112; 83.0%). Some patients expressed a desire to change their code status after receiving information about survival following inhospital CPR (n = 11; 8.1%) or after discussing goals of care (n = 2; 1.5%). Conclusions: Doctors need to address patients’ knowledge about CPR and take steps to avoid discrepancies between treatment orders and patients’ preferences. Addressing CPR outcome probabilities and goals of care during code status discussions may improve patients’ knowledge and influence their preferences. (shrink)

Low‐energy, pulsed electromagnetic fields (PEMFs) have reversed therapeutically resistant pathologic processes in the musculo‐skeletal system. Their development as a non‐thermal therapeutic agent is based on 30 years of study of the electro‐biological properties of connective tissues. Specific energy characteristics in applied PEMFs produce selected biological effects by modifying synthetic and other behavioral patterns of target cells; some mechanisms of action are defined. The technology appears safe and effective in clinical treatment of un‐united fractures, avascular necrosis of bone, and chronic, refractory (...) tendinitis. An expanding, rational use in biomedical science is predicted. (shrink)

Background: In Switzerland, non-medical right-to-die organisations such as Exit Deutsche Schweiz and Dignitas offer suicide assistance to members suffering from incurable diseases.Objectives: First, to determine whether differences exist between the members who received assistance in suicide from Exit Deutsche Schweiz and Dignitas. Second, to investigate whether the practices of Exit Deutsche Schweiz have changed since the 1990s.Methods: This study analysed all cases of assisted suicide facilitated by Exit Deutsche Schweiz and Dignitas between 2001 and 2004 and investigated by the University (...) of Zurich’s Institute of Legal Medicine. Furthermore, data from the Exit Deutsche Schweiz study which investigated all cases of assisted suicide during the period 1990–2000 were compared with the data of the present study.Results: More women than men were assisted in both organisations. Dignitas provided more assistance to non-residents, younger persons : D: 64.5 ; E: 76.6 ; p = 0.001), and people suffering from fatal diseases such as multiple sclerosis and amyotrophic lateral sclerosis. Lethal medications were more often taken orally in cases assisted by Dignitas. The number of women and the proportion of older people suffering from non-fatal diseases among suicides assisted by Exit Deutsche Schweiz has increased since the 1990s : 69.3 to 76.9, p = 0.000), non-fatal diseases: 22% to 34%, p = 0.026).Conclusions: Weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide. The strong over-representation of women in both Exit Deutsche Schweiz and Dignitas suicides is an important phenomenon so far largely overlooked and in need of further study. (shrink)

Self-monitoring theory explains the individual differences in using interpersonal adjustment techniques like self-control, self-regulation, and self-presentation. Self-monitoring plays a key role for understanding the social life. Therefore, it has been one of most popular research topics in social psychology. The aim of this study is to find out if there is a meaningful relationship between religious orientation and self-monitoring, and to determine the direction of the relationship if it exists. Besides, examining the effect of religious group membership on self-monitoring is (...) another aim of this study. In accordance with this purpose, Religious Orientation Scale and Revised Self-Monitoring Scale are applied to sample group which consists of 437 female and 369 male participants aged16 to 65+ living in Bursa. The results has revealed that there is a meaningful positive correlation between intrinsic religious orientation and self-monitoring. In addition, no meaningful relationship between religious group membership and self-monitoring has been confirmed.Summary: The adaptation process of the human being as a social creature starts in a mother's womb and becomes more complicated in consequence of coming into the world which is full of stimulus. In the beginning, this process has only a physical aspect, but with the inclusion of emotional, cognitive, and social factors over time turns into developmental tasks that people will struggle throughout their lives. The social development involves the process of becoming of the individual as an organic part of the society. As the individual realizes the existence of the other, he/she develops similar patterns of behavior that can be approved by the other. Because the meaningful relationships that form the backbone of social development constitute an important part of the self. Belonging is one of the main needs, that the individual shapes his emotions, actions, and decisions more or less in line with this need in order not to encounter the possibility of social exclusion. While belonging is a universal need for every healthy individual, there are differences between individuals in terms of directing the course of the relationship, role sharing, and using situational clues. Individual differences in how people construct interpersonal processes led Mark Snyder to systematize and theorize the concept of self-monitoring. Self-monitoring is a concept that expresses individuals' control of self-presentation, expressive behavior, and non-verbal emotional expression and their regulation. Accordingly, individuals with a high tendency to shape their behavior according to the context are classified as high self-monitors and those with low tendency are classified as low self-monitors. It can be said that adherence to religion, which is one of the determinants of social behavior, is related to self-monitoring. In this context, the main subject of this study is the relationship between self-monitoring and religiosity. The study aims to examine the effect of intrinsic-extrinsic religiosity on individuals' self-monitoring levels. Besides, as a form of religiosity, to reveal whether religious group religiosity affects self-monitoring, the study examines also self-monitoring levels of individuals belonging to the religious group and those who are not.The sample of the study was selected by a simple random sampling method and it consists of 806 participants aged 16 to 65+ living in Bursa in 2017. 437 (54.2%) of the participants in the research are women and 369 (45.8%) are men. In this study, a relational screening model was used for determining the presence, direction, and degree of the relationship between the variables. The questionnaire technique was preferred as the method of gathering information. The questionnaire was arranged in a way that does not require asking the participant any other questions apart from the questions on the form. The questionnaire form used in this research consists of 43 items. At the beginning of the questionnaire, there is a 9-item personal information form that includes demographic items consisting of age, gender, educational status, marital status, occupation, place of residence, socio-economic status, levels of subjective religious involvement, and religious group membership. For the measurement of self-monitoring, a 12-item "Self-Monitoring Scale", which was developed by Mark Snyder, revised by Richard Lennox and Raymond Wolfe and adapted by İlknur Özalp Türetgen and Sevim Cesur to Turkish (α =.80) was used. For the measurement of religious orientation, a 22-item “Religious Orientation Scale” developed by Gordon Allport and Michael Ross and adapted to Turkish by Fatma Gül Cirhinlioğlu was used (α =.90). Data collected through scales were processed by One Way Variance Analysis (ANOVA), t-Test, Pearson Correlation Analysis, and Simple Linear Regression Analysis and turned into research findings.According to the results of the simple linear correlation analysis conducted to reveal whether there is a relationship between the self-monitoring scores of the participants and the intrinsic religious orientation scores, there is a positive and significant relationship between the variables (r = 0.102, p = 0.004 0.05). The result of the correlation analysis between self-monitoring and the level of subjective religious involvement shows that no significant relationship is found (r = 0.051, p = 0.146> 0.05).This research expected that there was a negative relationship between self-monitoring and intrinsic religious orientation. However, the analyses has not reported anticipated results as addressed in the previous research. Therefore, this study opens the door for asking new questions about the subject. Religious groups, by their very nature, can refer the individual to self-presentation control, obedience, to act as deemed appropriate by the group, to adapt to the group, to change behavior without attitude change, and therefore, to attitude-behavior inconsistency. It can be argued that not only religious groups but, by their nature, all social groups create harmony-oriented pressure on the individual. Therefore, it can be predicted that belonging to a group, in general, may have a significant effect on the level of self-monitoring. The high self-monitoring scores of the participants, whether religious or non-religious group members of this study may have reduced the observability of the difference between the two groups. Therefore, repeating the study on a different sample may produce different results. (shrink)

In a previous work [the second and the third author, “On paraconsistent deontic logic”, Philosophia 16, 293-303 (1986)] investigated certain systems of paraconsistent deontic in order to investigate the problem of contradiction in the domain of ethics. This paper continues this line of research, studying some paraconsistent systems containing alethic and deontic modalities. This approach allows us to treat the principles of Kant (OA→ \diamond A) and Hintikka (\square A → OA) from the classical and from the paraconsistent point of (...) view, and to propose systems in which either, both, or neither of these principles is valid. (shrink)

A multidisciplinary faculty committee designed a curriculum to shape biomedical graduate students into researchers with a high commitment to professionalism and social responsibility and to provide students with tools to navigate complex, rapidly evolving academic and societal environments with a strong ethical commitment. The curriculum used problem-based learning (PBL), because it is active and learner-centred and focuses on skill and process development. Two courses were developed: Scientific Professionalism: Scientific Integrity addressed discipline-specific and broad professional norms and obligations for the ethical (...) practice of science and responsible conduct of research (RCR). Scientific Professionalism: Bioethics and Social Responsibility focused on current ethical and bioethical issues within the scientific profession, and implications of research for society. Each small-group session examined case scenarios that included: (1) learning objectives for professional norms and obligations; (2) key ethical issues and philosophies within each topic area; (3) one or more of the RCR instructional areas; and (4) at least one type of moral reflection. Cases emphasised professional standards, obligations and underlying philosophies for the ethical practice of science, competing interests of stakeholders and oversight of science (internal and external). To our knowledge, this is the first use of a longitudinal, multi-semester PBL course to teach scientific integrity and professionalism. Both faculty and students endorsed the active learning approach for these topics, in contrast to a compliance-based approach that emphasises learning rules and regulations. (shrink)

Background: Discussions about medical errors facilitate professional learning for physicians and may provide emotional support after an error, but little is known about physicians’ attitudes and practices regarding error discussions with colleagues.Methods: Survey of faculty and resident physicians in generalist specialties in Midwest, Mid-Atlantic and Northeast regions of the US to investigate attitudes and practices regarding error discussions, likelihood of discussing hypothetical errors, experience role-modelling error discussions and demographic variables.Results: Responses were received from 338 participants . In all, 73% of (...) respondents indicated they usually discuss their mistakes with colleagues, 70% believed discussing mistakes strengthens professional relationships and 89% knew at least one colleague who would be a supportive listener. Motivations for error discussions included wanting to learn whether a colleague would have made the same decision , wanting colleagues to learn from the mistake and wanting to receive support . Given hypothetical scenarios, most respondents indicated they would likely discuss an error resulting in no harm , minor harm or major harm . Fifty-seven percent of physicians had tried to serve as a role model by discussing an error and role-modelling was more likely among those who had previously observed an error discussion .Conclusions: Most generalist physicians in teaching hospitals report that they usually discuss their errors with colleagues, and more than half have tried to role-model discussions. However, a significant number of these physicians report that they do not usually discuss their errors and some do not know colleagues who would be supportive listeners. (shrink)

Although research integrity practices in institutional settings is not a new area of study, because of its foundational importance in university settings it remains a topic worthy of study. In addition, rarely are all members of the university community included as participants in studies focused upon research integrity and ethics. Thus, to add to the existent literature, the authors investigated research integrity practices in a medium-sized Midwestern polytechnic university setting, including 467 participants from across all divisions of the university community. (...) This mixed data survey study was comprised of six sections; presented is information for two sections—sample demographics and research integrity. The demographics appear reflective of those of the larger survey, as well as the university setting of study. In the research integrity section there were two parts—one qualitative and one quantitative. Implications with regard to research integrity and ethics in the institutional setting of study are presented. (shrink)

Researchers are required to seek consent from Indigenous communities prior to conducting research but there is inadequate information about how Indigenous people understand and become fully engaged with this consent process. Few studies evaluate the preference or understanding of the consent process for research with Indigenous populations. Lack of informed consent can impact on research findings. The Picture Talk Project was initiated with senior Aboriginal leaders of the Fitzroy Valley community situated in the far north of Western Australia. Aboriginal people (...) were interviewed about their understanding and experiences of research and consent processes. Transcripts were analysed using NVivo10 software with an integrated method of inductive and deductive coding and based in grounded theory. Local Aboriginal interpreters validated coding. Major themes were defined and supporting quotes sourced. Interviews with Aboriginal leaders were facilitated by a local Aboriginal Community Navigator who could interpret if necessary and provide cultural guidance. Participants were from all four major local language groups of the Fitzroy Valley; aged 31 years and above; and half were male. Themes emerging from these discussions included Research—finding knowledge; Being respectful of Aboriginal people, Working on country, and Being flexible with time; Working together with good communication; Reciprocity—two-way learning; and Reaching consent. The project revealed how much more there is to be learned about how research with remote Aboriginal communities should be conducted such that it is both culturally respectful and, importantly, meaningful for participants. We identify important elements in community consultation about research and seeking consent. (shrink)

We explore the developmental paradox of false belief understanding. This paradox follows from the claim that young infants already have an understanding of false belief, despite the fact that they consistently fail the elicited-response false belief task. First, we argue that recent proposals to solve this paradox are unsatisfactory because they (i) try to give a full explanation of false belief understanding in terms of a single system, (ii) fail to provide psychological concepts that are sufficiently fine-grained to capture the (...) cognitive requirements for the various manifestations of false belief understanding, and (iii) ignore questions about system interaction. Second, we present a dual-system solution to the developmental paradox of false belief understanding that combines a layered model of perspective taking with an inhibition-selection-representation mechanism that operates on different levels. We discuss recent experimental findings that shed light on the interaction between these two systems, and suggest a number of directions for future research. (shrink)

Background: In Switzerland, non-medical right-to-die organisations such as Exit Deutsche Schweiz and Dignitas offer suicide assistance to members suffering from incurable diseases. Objectives: First, to determine whether differences exist between the members who received assistance in suicide from Exit Deutsche Schweiz and Dignitas. Second, to investigate whether the practices of Exit Deutsche Schweiz have changed since the 1990s. Methods: This study analysed all cases of assisted suicide facilitated by Exit Deutsche Schweiz (E) and Dignitas (D) between 2001 and 2004 and (...) investigated by the University of Zurich’s Institute of Legal Medicine (E: n = 147; D: n = 274, total: 421). Furthermore, data from the Exit Deutsche Schweiz study which investigated all cases of assisted suicide during the period 1990–2000 (n = 149) were compared with the data of the present study. Results: More women than men were assisted in both organisations (D: 64%; E: 65%). Dignitas provided more assistance to non-residents (D: 91%; E: 3%; p = 0.000), younger persons (mean age in years (SD): D: 64.5 (14.1); E: 76.6 (13.3); p = 0.001), and people suffering from fatal diseases such as multiple sclerosis and amyotrophic lateral sclerosis (D: 79%; E: 67%; p = 0.013). Lethal medications were more often taken orally in cases assisted by Dignitas (D: 91%; E: 76%; p = 0.000). The number of women and the proportion of older people suffering from non-fatal diseases among suicides assisted by Exit Deutsche Schweiz has increased since the 1990s (women: 52% to 65%, p = 0.031; mean age in years (SD): 69.3 (17.0) to 76.9 (13.3), p = 0.000), non-fatal diseases: 22% to 34%, p = 0.026). Conclusions: Weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide. The strong over-representation of women in both Exit Deutsche Schweiz and Dignitas suicides is an important phenomenon so far largely overlooked and in need of further study. (shrink)

In the academic world, a researcher's number of publications can carry huge professional and financial rewards. This truth has led to many unethical authorship assignments throughout the world of publishing, including within faculty-student collaborations. Although the American Psychological Association passed a revised code of ethics in 1992 with special rules pertaining to such collaborative efforts, it is widely acknowledged that unethical assignments of authorship credit continue to occur regularly. This study found that of the 604 APA-member respondents, 165 felt they (...) had been involved in an unethical or unfair authorship assignment. Furthermore, nontenured faculty members and women were statistically more likely to be involved in an unethical or unfair assignment of authorship credit than tenured faculty members or men. (shrink)

This article shows under which circumstances fraudulent accreditation can occur in Brazilian military hospitals, calling attention to the tone at the top as a critical aspect of military fraud deterrence – and hence as a critical aspect of this branch of military ethics. The problems allegedly found in Brazilian military health institutions were revealed through in-depth interviews conducted with 29 professionals who reported to work or have worked in a Brazilian military hospital. These fraud allegations were mostly associated with false (...) documentation and procedures designed to give the appearance that legal requirements for accreditation were met and could be traced back to a weak or corrupt “tone at the top” coming from military higher ranks. (shrink)

Commentators onEpode11 generally begin by comparing the opening couplet with Archilochus (frg. 215 West): κα⋯ μ' οὔτ' ἰ⋯μβων οὔτε τερπωλ⋯ων μ⋯λει, and sometimes also Catullus 68. 1–40. In both of these the poet explains that grief at the death of a loved one has expelled all desire to compose verses. According to the comparison, Horace, in 1–2, is stating that the onset of love (‘amore percussum gravi’, 2) has, similarly, so absorbed his attention that he cannot write verse. The translation (...) will then run ‘Pettius, I have no pleasure any longer in writing verse, smitten as I am with a heavy love’. (shrink)

‘Ein vÖllig unverständliches Wortspiel’, said Friedlander. There have been many attempts to solve the riddle. The older commentators, following Domizio Calderini, offered a fantastic solution: Athenagoras was a doctor specializing in leprosy : ‘porro ducta uxore coepit lingere cunnum…unde factus est olficius, hoc est olfacit cunnum’! H. C. Schnur emended to Olbius : Albius Athenagoras , by marrying a rich wife, became Olbius. This explanation deprives the name ‘Albius’ of any point; nor is it particularly witty to say that Albius (...) married money. The most popular solution points to the biblical γ εμι τ Ἄλφα κα τ 'Σ [sc. πρτος κα σ×ατος] it can be shown with some plausibility that the expression was known to the Romans of Martial's time – and to Martial's phrases ‘alpha paenulatorum’ and ‘beta togatorum’ . Before marriage Athenagoras was A in his house; now he is last, in other words, henpecked. ‘Paenulatorum’ and ‘togatorum’, however, give ‘alpha’ and ‘beta’ a context which plain Alphius and Olphius do not possess. Moreover, in all the other passages which scholars quote in support of the A–Σ hypothesis,9 a letter of the alphabet becomes a byname for an individual, and is not incorporated in another name, as would be the case with Alphius and Σlphius. The presence of two names points to an etymological, not alphabetical, jeu des mots. (shrink)

In recent times, daily, ordinary medical practices have incontrovertibly been developing under the condition of complexity. Complexity jeopardizes the moral core of practicing medicine: helping people, with their illnesses and suffering, in a medically competent way. Practical wisdom (a modification of the Aristotelian phronèsis) has been proposed as part of the solution to navigate complexity, aiming at the provision of morally good care. Practical wisdom should help practitioners to maneuver in complexity, where the presupposed linear ways of operating prove to (...) be insufficient. However, this solution is unsatisfactory, because the proposed versions of practical wisdom are too individualistic of nature, while physicians are continuously operating in varying teams, and dealing with complicated technologies and pressing structures. A second point of critique is, that these versions are theory based, and thus insufficiently attuned to the actual context of everyday medical practices. Now, our proposal is to use an approach of practical wisdom that enables medical practices to counter the complexity issue and to re-invent the moral core of medical practicing as well. This implies a practice oriented approach, as thematized by practice theory, qualitative empirical research from the inside, and abduction from actual performed practical wisdom towards an apt understanding of phronèsis. (shrink)