While visiting relatives in northern England in October 1865 the London chemist William Crookes witnessed firsthand the economic devastation of farming communities blighted by the cattle plague that had been sweeping Britain since June. Crookes delayed his return to London for several months and obtained official permission to begin experimenting on eradicating the disease with a new disinfectant, carbolic acid. In his report to the British government in 1866, Crookes was explicit that his experiments had been based on a germ (...) or contagion theory of the disease. Germs were considered to be airborne particles that might either be “living” material that “germinated” in the soil of animal flesh and blood or chemical poisons that decomposed flesh and blood.In the opening chapter of this fine study of the construction of British germ theories between the 1860s and 1900, Michael Worboys makes it clear that the cattle plague was a keystone in the long process of germ theory construction. Rinderpest was readily accepted by veterinary surgeons as a contagious disease to be controlled by wholesale culling with the poleax. On the other hand, they ignored or actively opposed the practical implications of a germ theory—disinfection , vaccination, and laboratory research—because these procedures posed a threat to the power and control of the veterinary profession. Plus ça change? In Britain, we are currently witnessing a similar example of party interest as a powerful Farmers' Union culls millions of cattle and sheep but prevents the use of vaccination in fighting a foot and mouth epidemic.Although a number of studies have celebrated the germ theory as the key development in producing scientific medicine in the late nineteenth century, this is the first critical book‐length study of its diffusion. The separate professional communities of veterinary practitioners, surgeons, and sanitarians are disarmingly shown to have developed different germ theories and differed over the practical consequences of their commitments. The closed subcultures inhabited by these groups meant that it took several decades before the germs of sanitarians were linked with those of surgeons and with the bacteria of microbiologists. Anyone who made a connection, such as the physicist John Tyndall, was dismissed as an inexpert interloper. Clearly, the singular specific disease germ theory was evolutionary in construction, not revolutionary.Worboys's ambitious monograph offers many fresh insights, including a finely tuned account of Joseph Lister's vacillating ideas and practices concerning wound management, and a splendid analysis of the problematic identification of specific germs causing cholera, smallpox, tuberculosis, diphtheria, typhoid fever, and scarlet fever. His meticulous survey of the contemporary literature unravels the deep uncertainty over whether “germs” were living organisms or chemicals, spontaneously generated or ancestral, causes or concomitants of disease. The fact that unpleasant wounds and the sick sometimes recovered spontaneously made sense only if patients constitutionally differed as an appropriate or inappropriate “soil” for “germ seeds” to blossom or perish. In this way ontological germ theories complemented the traditional medical concepts of constitutional strength and weakness and the healing power of nature. This insight underlines one of the strengths of the book, namely, its recognition of continuities in the construction of disease concepts and practices.Worboys successfully challenges the view that the British medical communities acted largely as onlookers while French and German practitioners honed a laboratory‐based medicine for the twentieth century. Overall, Worboys's monograph is a challenging and extremely readable medical history of germs. It will be essential reading for students taking history of medicine programs. (shrink)

ObjectiveTo investigate the effects of cell phone dependence on mental health among undergraduates during the COVID-19 pandemic and further identify the determinants that may affect their mental health in China.MethodsThe data were collected from 602 students at a medical school in Shanghai via an online survey conducted from December 2021 to February 2022. The Mobile Phone Addiction Index and Depression Anxiety Stress Scale were applied to evaluate CPD and mental health, respectively. Independent sample t-test and one-way analysis of variance (...) were employed to compare the means of continuous variables among categorical groups. Correlations between continuous variables were detected using Pearson's correlation analysis. Univariable and multivariable logistic regressions were employed to identify the determinants of mental health.ResultsAmong the 402 eligible students, 73.88% were women with an average age of 20.19 ± 2.36 years. On average, the DASS score was 32.20 ± 11.07, the CPD score was 36.23 ± 11.89, and the cell phone use duration was 7.67 ± 3.61 h/day. CPD was found to have a negative effect on mental health among college students in Shanghai. Additionally, cell phone use duration, age, being senior students, faculty-student relationship, insomnia, tobacco use, obesity, and life satisfaction were clarified as contributing factors to mental health among college students.ConclusionHigh degree of CPD could have a negative effect on college students' mental health, which might lead to some psychological problems. Appropriate actions and effective interventions are highly needed to prevent severe psychological injuries among college students in China. (shrink)

BackgroundSocial networking sites (SNSs) have penetrated all aspects of health care professionals’ (HCPs’) professional and private lives. A new term, e-professionalism, has emerged, which describes the linking of traditional values with this new dynamic online environment for HCPs. The four aims of this study were: (1) to examine their SNS prevalence and usage habits, (2) to examine their perception of e-professionalism, (3) to develop an e-professionalism assessment compatibility index and (4) to investigate their tendencies and differences in values of (...) the e-professionalism assessment compatibility index (ePACI).MethodsA cross-sectional study was conducted among MDs and DMDs in Croatia via email using a questionnaire. The questionnaire was distributed to all MDs and DMDs who were members of their respective chambers. In addition to descriptive statistics, Chi-square or Fisher’s exact test when appropriate, t-test, ANOVA and Mann–Whitney U tests were used to determine differences between groups. A principal component analysis (PCA) with varimax rotation was used to investigate dimensionality. Results of the PCA were compared to the coding based on the Social Media e-Professionalism rubric in order to create the ePACI.ResultsOf the 1013 gathered responses, 753 were from valid SNS users and suitable for further analysis. Facebook (91.6%) and Instagram (63.1%) were the predominant SNSs used. Both groups have a good understanding of e-professionalism. The newly developed ePACI deviates slightly in the “conservative” direction in the cases of both, MDs (t506 = 19.033, p < 0.001) and DMDs (t245 = 12.991, p < 0.001). HCPs who are older (r = 0.308, p < 0.001), who have fewer SNS profiles (rs = −0.142, p < 0.001), and who access their profiles less frequently (r = −0.166, p < 0.001) have statistically significantly more conservative ePACI values.ConclusionsMDs and DMDs in Croatia are frequent SNS users, with Facebook and Instagram being the main SNSs used. Both groups have a good understanding of e-professionalism. The newly developed ePACI deviates slightly towards the conservative side regarding perception of the e-professionalism content for both groups. The development of the ePACI, and its subsequent usage in further research, will have a direct influence in its validation, gathering comparable data, and be able to direct efforts in oversight, regulation and education. (shrink)

Background: Only data of published study results are available to the scientific community for further use such as informing future research and synthesis of available evidence. If study results are reported selectively, reporting bias and distortion of summarised estimates of effect or harm of treatments can occur. The publication and citation of results of clinical research conducted in Germany was studied.Methods: The protocols of clinical research projects submitted to the research ethics committee of the University of Freiburg in 2000 were (...) analysed. Published full articles in several databases were searched and investigators contacted. Data on study and publication characteristics were extracted from protocols and corresponding publications.Results: 299 study protocols were included. The most frequent study design was randomised controlled trial , followed by uncontrolled studies , laboratory studies and non-randomised studies . 182 were multicentre studies including 97 international collaborations. 152 of 299 had commercial funding and 46 non-commercial funding. 109 of the 225 completed protocols corresponded to at least one full publication ; the publication rate was 48%. 168 of 210 identified publications were cited in articles indexed in the ISI Web of Science. The median was 11 citations per publication .Conclusions: Results of German clinical research projects conducted are largely underreported. Barriers to successful publication need to be identified and appropriate measures taken. Close monitoring of projects until publication and adequate support provided to investigators may help remedy the prevailing underreporting of research. (shrink)

These essays, first presented at a conference, “Coping with Sickness,” held in Italy in 1997, address ethical and regulatory medical issues within a historical context. Many of the essays, while addressing interesting topics, combine policy analysis and critical cultural theory. Critical cultural theory can be intellectually engaging at times but is generally irrelevant to public officials concerned with specific policy issues.Coping with Sickness is the third and final volume derived from a series of conferences cosponsored by the European Science Foundation (...) and the Euroconferences Activity of the European Union. The eight essays are organized chronologically and cover a range of disparate topics: medical practitioners and the Spanish Inquisition , the history of autopsy legislation in German since 1800 , the history of “sadism” as a medical term in the nineteenth century , folk medicine in Holland in the late nineteenth century , abortion in Weimar Germany , drug testing in Africa in the early twentieth century , comparative policies toward STDs , and the debate over brain death in Germany . As might be expected in an anthology of this sort, the quality varies considerably. Nonetheless, the subjects addressed in this volume are engaging—much to the credit of the editors.Two pieces in particular represent the range of these collected essays. In “Vacher the Ripper and the Construction of the Nineteenth‐Century Sadist,” Angus McLaren, one of the best historians writing on the history of sexuality today, explores the “discovery” of sadism in the late nineteenth century by focusing on the dramatic trial of Joseph Vacher, who was charged in 1895 for the brutal sexual murder of a woman in Champuis. He later confessed to the murder and the sexual violation of another seven females and four males. Vacher had a long history of mental illness; indeed, he had been institutionalized in July 1893 following a failed attempt at suicide that left a bullet lodged in his head. At the trial the criminologist Alexandre Lacassagne was brought in as an expert witness to testify that Vacher was not insane but an antisocial sadist, as revealed by his dabbling in anarchism, vagabondism, and homosexuality. As a consequence, Vacher was found guilty and given a death sentence.McLaren finds in this trial an example of the social construction of a new medical concept, “sadism.” The emergence of the concept of sadism, he argues, reflected a “gendered notion” of defining appropriate male and female behavior; physicians at the turn of the century believed that “civilized men were most threatened, not by excess passion, but by the enervation spawned by urban life” . The concept of sadism was also employed by doctors to enhance their own authority and to alert the public to the dangers of a male manifesting “feminine traits” and to “beat back” homosexuality.There is much interesting conjecture to McLaren's study, but what policy lessons should be drawn from this remains unclear. If every concept is actually a social construction, reflecting the social anxieties of the age, then is the fashionable concept of social construction itself socially constructed to enhance the authority of the medical historian?More interesting methodologically is Claudia Wiesemann's absorbing essay on the historical debate in Germany over “brain death.” Relying on Ulrich Beck's social theory of simple and reflexive modernization, she shows that, when confronted with complex scientific questions, the public has to decide between competing plausible scientific claims; as a result, political groups make use of scientific expertise and counterexpertise to push their favorite practical and legal solutions. (shrink)

This impressive and closely researched intellectual biography transcends the usual categories in which Le Bon has often been placed: a precursor of fascism and the originator of prescriptions for Hitler, Mussolini, Lenin, or Stalin in their manipulation of the masses. Benoit Marpeau's concern is to present a valid historiographic account that involves both a closer and a wider view of Le Bon's prolific work. In recounting his intellectual journey , the author devotes no space to discussing Le Bon's personality. However, (...) Le Bon's dominant characteristics become clear: he was elitist, conservative, and anti‐Semitic; he valued the individual over the collective. Marpeau shows his sense of superiority to have been fragile, for his medical qualifications, at the start of his career, were minimal. He was a self‐styled “docteur.” His need to excel fueled his ambition to write on a variety of areas—scientific, psychological, sociological, educational—and on contemporary affairs.One of the major features of this biography is the importance that Marpeau attaches to the system of relationships in which Le Bon was involved. These centered on two regular social/intellectual reunions in which he was a key figure and organizer. Through these social events he was able to make useful connections that would advance both his social and intellectual status. Nevertheless, Le Bon remained outside the university domain; nor was his scientific work formally recognized by the Academy of Sciences; and he was overlooked for the Nobel Prize for science in 1903. If Le Bon was in some sense “marginal”—and Marpeau questions this description—he nevertheless exerted influence when he founded and became the director of the important Collection of the “Bibliothèque de Philosophie” published by Flammarion. Marpeau shows how this editorial post enhanced his standing and helped to disseminate his views, for Le Bon had the power to decide what could be published.The author also shows how Le Bon was a man of his times, for he reflected the views and interests held both by intellectuals and by a wider public. The idea of degeneration and the decadence of France was a particular concern. The scientific theory of recapitulation informed the hierarchy of races and defined both children and women, together with “primitive” races, as inferior. Le Bon endorsed these ideas, which were supported by craniometric studies.In his analysis of the most well‐known work, The Psychology of Crowds , Marpeau agrees in general with the thesis of Robert Nye , to which he makes some additions and qualifications. Marpeau does not see Le Bon as the originator of the methods of crowd manipulation, nor of the “offensive system” that the French military leaders later adopted.This biography is truly an intellectual one, constructed on historicist principles: hence the placing of Le Bon's work in its appropriate scientific and relational contexts. At various points Marpeau justifies a method that entails an examination in great detail of Le Bon's correspondence and the composition of his entourage at various stages of his life. However, this strategy is somewhat overstretched and produces accounts of undue length.This is not a book for readers interested in Le Bon's work or character. This is, rather, a biography for historians particularly interested in Marpeau's method and in historiographic issues. As such, it can serve as an example of commitment and thoroughness; it also offers an opportunity for the critical mind to assess the value of the various contributions that might explain an intellectual journey. (shrink)

Eighteenth-century Epicureanism is often viewed as radical, anti-religious, and politically dangerous. But to what extent does this simplify the ancient philosophy and underestimate its significance to the Enlightenment? Through a pan-European analysis of Enlightenment centres from Scotland to Russia via the Netherlands, France and Germany, contributors argue that elements of classical Epicureanism were appropriated by radical and conservative writers alike. They move beyond literature and political theory to examine the application of Epicurean ideas in domains as diverse as physics, natural (...) law, and the philosophy of language, drawing on the work of both major figures (Diderot, Helvétius, Smith and Hume) and of lesser-known but important thinkers (Johann Jacob Schmauss and Dmitrii Anichkov). -/- Table of Contents -/- Neven Leddy and Avi S. Lifschitz, Epicurus in the Enlightenment: an introduction -/- Elodie Argaud, Bayle’s defence of Epicurus: the use and abuse of Malebranche’s Méditations chrétiennes -/- Hans W. Blom, The Epicurean motif in Dutch notions of sociability in the seventeenth century -/- Thomas Ahnert, Epicureanism and the transformation of natural law in the early German Enlightenment -/- Charles T. Wolfe, A happiness fit for organic bodies: La Mettrie’s medical Epicureanism -/- Natania Meeker, Sexing Epicurean materialism in Diderot -/- Pierre Force, Helvétius as an Epicurean political theorist -/- Andrew Kahn, Epicureanism in the Russian Enlightenment: Dmitrii Anichkov and atomic theory -/- Matthew Niblett, Man, morals and matter: Epicurus and materialist thought in England from John Toland to Joseph Priestley -/- James A. Harris, The Epicurean in Hume -/- Neven Leddy, Adam Smith’s critique of Enlightenment Epicureanism -/- Avi S. Lifschitz, The Enlightenment revival of the Epicurean history of language and civilisation -/- Bibliography -/- Index. (shrink)

Self-injurious behavior is associated with diverse psychiatric conditions. Sometimes, SIB is the most dominant symptom, severely restricting the psychosocial functioning and quality of life of the patients and inhibiting appropriate patient care. In severe cases, it can lead to permanent physical injuries or even death. Primary therapy consists of medical treatment and if implementable, behavioral therapy. For patients with severe SIB refractory to conventional therapy, neuromodulation can be considered as a last recourse. In scientific literature, several successful lesioning and deep (...) brain stimulation targets have been described that can indicate a common underlying neuronal pathway. The objectives of this study were to evaluate the short- and long-term clinical outcome of patients with severe, therapy refractory SIB who underwent DBS with diverse underlying psychiatric disorders and to correlate these outcomes with the activated connectivity networks. We retrospectively analyzed 10 patients with SIB who underwent DBS surgery with diverse psychiatric conditions including autism spectrum disorder, organic personality disorder after hypoxic or traumatic brain injury or Tourette syndrome. DBS targets were chosen according to the underlying disorder, patients were either stimulated in the nucleus accumbens, amygdala, posterior hypothalamus, medial thalamus or ventrolateral thalamus. Clinical outcome was measured 6 months after surgery and at long-term follow-up after 10 or more years using the Early Rehabilitation Barthel index and time of restraint. Connectivity patterns were analyzed using normative connectome. Based on previous literature the orbitofrontal cortex, superior frontal gyrus, the anterior cingulate cortex, the amygdala and the hippocampus were chosen as regions of interest. This analysis showed a significant improvement in the functionality of the patients with DBS in the short- and long-term follow-up. Good clinical outcome correlated with higher connectivity to the amygdala and hippocampus. These findings may suggest a common pathway, which can be relevant when planning a surgical procedure in patients with SIB. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 10.2 (2000) 175-188 [Access article in PDF] Scope Note 38 Bioethics Resources on the Web * Once described as an "enormous used book store with volumes stacked on shelves and tables and overflowing onto the floor" (Pool, Robert. 1994. Turning an Info-Glut into a Library. Science 266 (7 October): 20-22, p. 20), Internet resources now receive numerous levels of organization, from basic directory listings (...) to elaborate "links" (cross-references to other Internet documents) that flash and glow in the dark. In many ways, the Internet functions as a direct extension of the traditional library. Following linked references across various sites is an electronic version of browsing library stacks, and the serendipitous discoveries made while "surfing the Net" recall the wonders of physically going "book-to-book." Although many of the Internet's best aspects augment library strengths by eliminating physical distance from sources, Net resources pose unique problems for researchers. It is not always clear who is responsible for the content of Web documents, when the document was produced, or how often (if ever) it is updated. Internet resource tools, then, must enable researchers to identify appropriate resources and to evaluate what they find when they get there. Web Research as Taking "Snapshots" Given the Internet's visual nature and fluid content, the process of conducting research on the Web has been likened to taking an informal picture of information on a specific date at a particular time. This metaphor also conveys the "zoom-in" aspect of searching through Web pages by going from general to specific categories. In the first section of this Scope Note, National Reference Center for Bioethics Literature (NRCBL) staff present a snapshot of bioethics resources taken during the spring months of 2000. Entries are divided into the categories of directories, electronic journals, full-text documents, news/current awareness, and teaching resources. In the two subsequent sections, this series of categories is repeated for entries on a specific topic within bioethics-genetics-and again for general search and evaluation tools. Where a Web site may contain pages applicable [End Page 175] to more than one category, multiple entries are made for that site with appropriate information for each category.Much as telecommunication advances have strengthened the relationship of patients and providers as partners, the dynamic nature of the Internet acknowledges that the researcher functions as a librarian whenever accessing the Web. It is our hope that BIOETHICSLINE and the other NRCBL databases not only will enable researchers to search the Web more efficiently, but also will help them to evaluate what they find when they get there. Bioethicsline on the Web: An International Plan in Progress Once only available through libraries, the U.S. National Library of Medicine (NLM), the funding agency for the ongoing development of the BIOETHICS LINE® database from the Kennedy Institute, has provided free Web access to that database of 63,000 citations since September 1998 through Internet Grateful Med. Plans are now underway to eliminate such specialty databases and incorporate all citations into PubMed (for journal articles) or LOCATORplus (for book-like materials and chapters in books). Both of these databases are likewise available at no cost on the Web. In the transition to PubMed and LOCATORplus some features of BIOETHICSLINE that presently are available may be lost. Researchers are encouraged to contact the National Reference Center for Bioethics Literature with search requests or for search strategy assistance with either the current or the future system ([email protected]).The inclusion of bioethics citations in PubMed and LOCATORplus will have several advantages. First, unique keywords from the Bioethics Thesaurus will be considered for inclusion in Medical Subject Headings (MeSH), the indexing vocabulary for PubMed and LOCATORplus, thereby enhancing retrieval of relevant clinical literature by offering more precise terminology covering ethical issues. Second, it will be easier to identify foreign-language materials, which are not currently included in the scope of BIOETHICSLINE. Third, the updating schedule will become more frequent. On the other hand, there may be some loss of searching precision because certain specialized features... (shrink)

Philosophy textbooks typically treat bioethics as a form of "applied ethics"-i.e., an attempt to apply a moral theory, like utilitarianism, to controversial ethical issues in biology and medicine. Historians, however, can find virtually no cases in which applied philosophical moral theory influenced ethical practice in biology or medicine. In light of the absence of historical evidence, the authors of this paper advance an alternative model of the historical relationship between philosophical ethics and medical ethics, the appropriation model. They offer two (...) historical case studies to illustrate the ways in which physicians have "appropriated" concepts and theory fragments from philosophers, and demonstrate how appropriated moral philosophy profoundly influenced the way medical morality was conceived and practiced. (shrink)

Recent publications on digital health technologies highlight the importance of ‘responsible’ use. References to the concept of responsibility are, however, frequently made without providing clear definitions of responsibility, thus leaving room for ambiguities. Addressing these uncertainties is critical since they might lead to misunderstandings, impacting the quality and safety of healthcare delivery. Therefore, this study investigates how responsibility is interpreted in the context of using digital health technologies, including artificial intelligence (AI), telemonitoring, wearables and mobile apps. We conducted a scoping (...) review with a systematic search in PubMed, Web of Science, Embase, CINAHL and Philosopher’s Index. A total of 34 articles were included and categorized using a theoretical framework of responsibility aspects, and revealed two main findings. First, we found that digital health technologies can expand and shift existing ‘role responsibilities’ among caregivers, patients and technology. Second, moral responsibility is often equated with liability or accountability, without clear justification. Articles describe new ways in which physicians can be held accountable, particularly in the context of AI, and discuss the emergence of a ‘responsibility gap’ where no-one can be fully responsible for AI-generated outcomes. The literature also shows that m-Health technologies can increase patients’ accountability for their own health. However, there was limited discussion in the reviewed literature on whether these attributions of accountability are appropriate. We conclude with implications for practice and suggestions for expanding the theoretical framework of moral responsibility, recommending further study on responsibility of collectives and artificial entities, and on the role of virtue in digital health. (shrink)

This essay reconsiders Paul Ramsey’s “medical indications” policy and argues that his reconstruction of the case of Joseph Saikewicz demonstrates that there is more room for caretakers to decline treatments for “voiceless dependents” than his interlocutors have sometimes thought. It furthermore draws on Ramsey’s earlier work to propose ways that Ramsey might have improved his policy, and argues that the shortcomings of Ramsey’s view arise from his bracketing of age in making determinations about what form of medical care is owed. (...) The reading of Ramsey set forth here suggests Cathleen Kaveny’s depiction of the ‘medical indications’ policy in Ethics at the Edges of Law is too rigid and inflexible, even while it affirms other aspects of her critique. (shrink)

Background: Identifying, maintenance, and promotion of dignity in different patients of various cultures is an ethical responsibility of healthcare workers. Research questions: This study was conducted to investigate factors related to dignity in patients with heart failure and test the validity of Dignity Model. Design: The study had a descriptive-correlational design, and data collection was carried out by means of four specific questionnaires. Participants and context: A total of 130 in-patients from cardiac wards in hospitals affiliated with Tehran and Shahid (...) Beheshti University of Medical Sciences participated. Ethical consideration: This study was approved by the Research Committee of Shahid Beheshti University of Medical Sciences. Findings: Significant correlation showed the following: between illness related worries with dignity conserving repertoire score, between illness related worries with social dignity, between illness related worries with dignity conserving repertoire score, and between social dignity with dignity score. Goodness Fit Index and Comparative Fit Index were calculated greater than 0.9. Discussion: This study affirms the importance of careful evaluation of individual patients to determine their needs related to dignity. Conclusion: According to the results, the necessity of using appropriate tools to assess various aspects of patients’ dignity by clinical healthcare staff and design activities with particular focus on the main factors affecting dignity such as illness related worries and social dignity is recommended. Attention to this issue in everyday clinical practice can facilitate health professionals/nurses to potentially improve their patients’ dignity, develop quality of care and treatment, and improve patients’ satisfaction. (shrink)

BackgroundIn China, undergraduate students face both academic and career selection pressures, sleep is an important physiological process for them. Investigate the physical exercise, sleep quality of undergraduate students in the education stage in Xuzhou City, and analyze the factors affecting their sleep quality, to promote the health education and psychological health of undergraduate students.Materials and methodsThe Physical Activity Rating Scale-3, the Pittsburgh Sleep Quality Index, and the demographic information questionnaire were used to survey a whole-group sample of four undergraduate (...) colleges and universities in Xuzhou by cluster sampling, the general characteristics including gender, grade, height, weight, domicile, race, economic income, etc., were collected, and the data were analyzed and processed using chi-square tests and multi-factor logistic regression.Results3,366 valid questionnaires were collected from four undergraduate colleges and universities, including 1,355 males and 2,011 females. The detection rate of exercise in Jiangsu Normal University was lower than that in other universities, and the detection rate of sleep disorders was higher than that in other universities. Xuzhou Medical University, the highest detection rate of large exercise, Xuzhou Institute of Technology, the lowest detection rate of sleep disorders. There were significant differences in the detection rate of large amount of exercise among college students of different genders, grades, body types, and majors. There were significant differences in the detection rate of sleep disorders among college students with different gender, grade, family economic status, daily cell phone use time, cell phone purposeless usage, and exercise level. Multivariate logistic regression analysis showed that grade, family economic status, cell phone use time, cell phone purposeless usage is the main influencing factors of sleep disorders in college students.ConclusionThe sleep problems of undergraduates are serious, especially in Jiangsu Normal University. Scientific and appropriate exercise is an important measure to solve the sleep problems of undergraduates. Colleges and universities should actively carry out health education, college students living habits such as cell phone use should be guided training. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bioethics ConsultationPat Milmoe McCarrick (bio)(John La Puma, M.D., from the Department of Medicine at Lutheran General Hospital in Chicago, contacted the National Reference Center for Bioethics Literature and suggested bioethics consultation as a topic for the Scope Note Series. He provided an extensive list of citations about ethics consultations collected by him and by David Schiedermayer, M.D., for their new book Ethics Consultation: A Practical Guide.)In Ethics Consultation in (...) Health Care, editors John Fletcher, Norman Quist, and Albert R. Jonsen (I, 1989) define ethics consultation as "the provision of specialized help in identifying, analyzing, and resolving ethical problems that arise in clinical care. In medical ethics the area of consultation has grown rapidly since 1978 when Edmund D. Pellegrino (II, 1978) noted, "we cannot separate technical-moral decisions from the philosophic principles we use to justify them. Medicine and ethics must be engaged with each other at every level."In 1980 Albert Jonsen raised the question of whether an ethicist could be a consultant and said that the ethicist as consultant is a casuist, one whose moral reasoning is based on a system of reasoning that is applied to particular cases. He describes historical casuistry in Western culture, comparing it to modern moral philosophy, and suggests that a "new casuistry seems timely" for ethics consultation (II, Jonsen 1980). By 1984 ethicist Ruth Purtilo recorded her thoughts following an ethics consultation. She raised questions about the ethicist's place on a hospital staff and how to make that role appropriate and beneficial to all concerned, saying that "the ethicist retreats after the consultation; under no circumstances would the outcome of an ethics consultation be that the ethicist became the primary care giver or assumed ongoing responsibility for the clinical management of a case" (II, Purtilo 1984). Nevertheless, in 1992 two physician-ethicists who had been called as ethics consultants for a patient who had requested that he be removed from his ventilator reported that they became the persons who turned off the ventilator and administered the drugs that eased his dying (II, Edwards and Tolle 1992).In recognition of the growing number of persons identifying themselves as [End Page 433] consultants, the Society for Bioethics Consultation was founded in October 1985 as a professional society of persons engaged in bioethics consultation. It encourages and supports consultation, assists in establishing clinical education programs, and raises funds for consultation education. Although the Society has no permanent office, the president (currently, George Kanoti in the Cleveland Clinic Foundation's Bioethics Department) conducts its work and plans an annual meeting.The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) established new criteria concerning ethics in its 1992 Manual (III, JCAHO 1992) and in a special issue of QRB devoted to ethics consultation (I, Defining Quality 1992). These publications undoubtedly have contributed to the increased use of experts in medical ethics. The Manual notes that all organizations seeking accreditation should have some sort of "mechanism for the consideration of ethical issues arising in the care of patients and to provide education to care givers and patients on ethical issues in health care." A health care institution's eligibility for JCAHO accreditation, which is required for federal reimbursement, requires adherence to this specification (III, JCAHO 1992).The new International Directory of Bioethics Organizations provides an index of 129 different groups that indicated to the authors that they offer bioethics consultations. Of these, 83 are in the United States and 46 are in other countries. The ethics consultants included in the directory encompass a broad group of professionals who will assist patients, families, and primary care medical staff in finding solutions to ethical dilemmas resulting from use of new technologies or new treatments in health care. Consultants often come from the health fields: physicians, nurses, and other health personnel, but other professionals are also active as ethics consultants. Lawyers, pastoral counselors, philosophers, and social workers also offer bioethics consultation services (III, Nolen and Coutts 1993).Drs. Siegler, Pellegrino, and Singer wrote in 1990 that "Physician-ethicists and professional ethicists will continue to work side by side in the future. One is not likely to replace the other, nor is this desirable, because... (shrink)

The dilemma of incapacitated patients with acute medical problems who want or try to leave the hospital is a common problem in American clinical ethics. One need only listen to clinicians who work...

Abortion has been legal in the United States since the Supreme Court's landmark 1973 ruling in Jane Roe, et al. v. Henry Wade, District Attorney of Dallas County. Over the past forty years, however, access to abortion has diminished as states have devised creative ways to regulate and restrict the abortion procedure. In the first half of 2011, state legislators introduced a record number of antiabortion bills. In 19 states alone, 80 laws ranging from mandatory counseling and waiting periods to (...) gestational laws and bans on insurance coverage were passed, a legislative testimony to the incremental successes of the antiabortion campaign. Since 2011, the rapid increase in restrictive... (shrink)

Medical errors are all too common. Ever since a report issued by the Institute of Medicine raised awareness of this unfortunate reality, an emerging theme has gained prominence in the literature on medical error. Fears of blame and punishment, it is often claimed, allow errors to remain undisclosed. Accordingly, modern healthcare must shift away from blame towards a culture of safety in order to effectively reduce the occurrence of error. Against this shift, I argue that it would serve the medical (...) community well to retain notions of individual responsibility and blame in healthcare settings. In particular, expressions of moral emotions—such as guilt, regret and remorse—appear to play an important role in the process of disclosing harmful errors to patients and families. While such self-blaming responses can have negative psychological effects on the individual practitioner, those who take the blame are in the best position to offer apologies and show that mistakes are being taken seriously, thereby allowing harmed patients and families to move forward in the wake of medical error. (shrink)

This paper explores how organizational members use documents to share their knowledge within and across work settings. I suggest that organizational studies of distributed knowledge sharing and information systems would greatly benefit from the linguistic analysis of communicative practices. Specifically, the paper highlights the notion of indexical centering as formulated by the linguistic anthropologist William Hanks and demonstrates its analytical power in studying documenting as a communicative practice. Drawing on a 15-month, multi-sited ethnographic study in several pediatric healthcare settings, the (...) paper focuses on how two doctors compose and use two medical histories found in two distinct medical information systems. The analysis suggests that the doctors use documents to index the temporal, spatial, and participatory dimensions of their knowledge sharing. They do so by indexing, on the one hand, the participants, times and places for their communicative practices and, on the other hand, the participants, times and places of their general care practices. The indexical analysis allows us to perceive documents, as more than mere vessels for knowledge transfer among organizational members, but as an integrated part of how people structure their work practices and situate their knowledge sharing in complex distributed organizational settings. (shrink)

Baker and McCullough (2007) criticize a 1979 article by this author for insufficiently appreciating how physicians have appropriated ideas from moral philosophy. This rejoinder argues that the two articles are complementary. The 1979 article summarized evidence that leading physicians in the nineteenth and twentieth centuries appropriated ideas from moral philosophy and related disciplines that reinforced their political goals of self-regulation and dominance of the allocation of resources for health. In retrospect the 1979 article also urged bioethicists to appropriate ideas from (...) other disciplines, including moral philosophy, which would contribute to improving the health of populations. (shrink)

Slurs are expressions that can be used to demean and dehumanize targets based on their membership in racial, ethnic, religious, gender, or sexual orientation groups. Almost all treatments of slurs posit that they have derogatory content of some sort. Such views—which I call content-based—must explain why in cases of appropriation slurs fail to express their standard derogatory contents. A popular strategy is to take appropriated slurs to be ambiguous; they have both a derogatory content and a positive appropriated content. However, (...) if appropriated slurs are ambiguous, why can only members in the target group use them to express a non-offensive/positive meaning? Here, I develop and motivate an answer that could be adopted by any content-based theorist. I argue that appropriated contents of slurs include a plural fi rst-person pronoun. I show how the semantics of pronouns like ‘we’ can be put to use to explain why only some can use a slur to express its appropriated content. Moreover, I argue that the picture I develop is motivated by the process of appropriation and helps to explain how it achieves its aims of promoting group solidarity and positive group identity. (shrink)

Is it ethical to perform a surgery whose purpose is to make a male look like a female or a female to appear male? Is it medically appropriate? Sexual reassignment surgery (SRS) violates basic medical and ethical principles and is therefore not ethically or medically appropriate. (1) SRS mutilates a healthy, non-diseased body. To perform surgery on a healthy body involves unnecessary risks; therefore, SRS violates the principle primum non nocere, “first, do no harm.” (2) Candidates for SRS may believe (...) that they are trapped in the bodies of the wrong sex and therefore desire or, more accurately, demand SRS; however, this belief is generated by a disordered perception of self. Such a fixed, irrational belief is appropriately described as a delusion. SRS, therefore, is a “category mistake”—it offers a surgical solution for psychological problems such as a failure to accept the goodness of one’s masculinity or femininity, lack of secure attachment relationships in childhood with same-sex peers or a parent, self-rejection, untreated gender identity disorder, addiction to masturbation and fantasy, poor body image, excessive anger, and severe psychopathology in a parent. (3) SRS does not accomplish what it claims to accomplish. It does not change a person’s sex; therefore, it provides no true benefit. (4) SRS is a “permanent,” effectively unchangeable, and often unsatisfying surgical attempt to change what may be only a temporary (i.e., psychotherapeutically changeable) psychological/psychiatric condition. National Catholic Bioethics Quarterly 9.1 (Spring2009): 97–125. (shrink)

In the United Kingdom, a number of National Health Service Clinical Commissioning Groups have proposed controversial measures to restrict elective surgery for patients who either smoke or are obese. Whilst the nature of these measures varies between NHS authorities, typically, patients above a certain Body Mass Index and smokers are required to lose weight and quit smoking prior to being considered eligible for elective surgery. Patients will be supported and monitored throughout this mandatory period to ensure their clinical needs (...) are appropriately met. Controversy regarding such measures has primarily centred on the perceived unfairness of targeting certain health states and lifestyle choices to save public money. Concerns have also been raised in response to rhetoric from certain NHS authorities, which may be taken to imply that such measures punitively hold people responsible for behaviours affecting their health states, or simply for being in a particular health state. In this paper, we examine the various elective surgery rationing measures presented by NHS authorities. We argue that, where obesity and smoking have significant implications for elective surgical outcomes, bearing on effectiveness, the rationing of this surgery can be justified on prognostic grounds. It is permissible to aim to maximise the benefit provided by limited resources, especially for interventions that are not urgently required. However, we identify gaps in the empirical evidence needed to conclusively demonstrate these prognostic grounds, particularly for obese patients. Furthermore, we argue that appeals to personal responsibility, both in the prospective and retrospective sense, are insufficient in justifying this particular policy. Given the strength of an alternative justification grounded in clinical effectiveness, rhetoric from NHS authorities should avoid explicit statements, which suggest that personal responsibility is the key justificatory basis of proposed rationing measures. (shrink)

This essay illustrates what the Chinese family-based and harmony-oriented model of medical decision making is like as well as how it differs from the modern Western individual-based and autonomy-oriented model in health care practice. The essay discloses the roots of the Chinese model in the Confucian account of the family and the Confucian view of harmony. By responding to a series of questions posed to the Chinese model by modern Western scholars in terms of the basic individualist concerns and values (...) embedded in the modern Western model, we conclude that the Chinese people have justifiable reasons to continue to apply the Chinese model to their contemporary health care and medical practice. (shrink)

Medical assistance in dying (MAiD) in Canada is a complex, novel interprofessional practice governed by stringent legal criteria. Often, patients need assistance navigating the system, and MAiD providers/assessors struggle with the administrative challenges of MAiD. Resultantly, the role of the MAiD care coordinator has emerged across the country as a novel practice dedicated to supporting access to MAiD and ensuring compliance with regulatory requirements. However, variability in the roles and responsibilities of MAiD care coordinators across Canada has highlighted the need (...) for accountability and standardization for this practice. This manuscript constitutes a first attempt to describe this emerging role, through discussion of proposed standards of practice, as well as roles and responsibilities, and ethical duties of this emergent professional practice. We detail the core commitments of MAiD care coordinators to patients, providers/assessors and institutions involved in the MAiD process. We address the core competencies that inform the unique skillset required by MAiD care coordinators to facilitate high-quality care, while highlighting the moral and ethical considerations embedded in this work. To illustrate the complexity of the MAiD care coordinator role, case examples involving ethical dilemmas encountered in practice are included. Finally, a code of ethics is proposed to serve as a guide for appropriate professional practice and conduct. This manuscript is intended to illustrate the importance of transparency and accountability for this new role that provides service to vulnerable patients and families; this is especially critical as the ethical complexity of MAiD is likely to increase with future changes in legislation opening MAiD access to new populations. (shrink)

Is medicalization always harmful? When does medicine overstep its proper boundaries? The aim of this article is to outline the pragmatic criteria for distinguishing between medicalization and over-medicalization. The consequences of considering a phenomenon to be a medical problem may take radically different forms depending on whether the problem in question is correctly or incorrectly perceived as a medical issue. Neither indiscriminate acceptance of medicalization of subsequent areas of human existence, nor criticizing new medicalization cases just because they are medicalization (...) can be justified. The article: (i) identifies various consequences of both well-founded medicalization and over-medicalization; (ii) demonstrates that the issue of defining appropriate limits of medicine cannot be solved by creating an optimum model of health; (iii) proposes four guiding questions to help distinguish medicalization from over-medicalization. The article should foster a normative analysis of the phenomenon of medicalization and contribute to the bioethical reflection on the boundaries of medicine. (shrink)

I argue that not all context dependent expressions are alike. Pure (or ordinary) indexicals behave more or less as Kaplan thought. But quasi indexicals behave in some ways like indexicals and in other ways not like indexicals. A quasi indexical sentence φ allows for cases in which one party utters φ and the other its negation, and neither party’s claim has to be false. In this sense, quasi indexicals are like pure indexicals (think: “I am a doctor”/“I am not a (...) doctor” as uttered by different individuals). In such cases involving a pure indexical sentence, it is not appropriate for the two parties to reject each other’s claims by saying, “No.” However, in such cases involving a quasi indexical sentence, it is appropriate for the par- ties to reject each other’s claims. In this sense, quasi indexicals are not like pure indexicals. Drawing on experimental evidence, I argue that gradable adjectives like “rich” are quasi indexicals in this sense. e existence of quasi indexicals raises trouble for many existing theories of context dependence, including standard contextualist and relativist theories. I propose an alternative semantic and pragmatic theory of quasi indexicals, negotiated contextualism, that combines insights from Kaplan 1989 and Lewis 1979. On my theory, rejection is licensed with quasi indexicals (even when neither of the claims involved has to be false) because the two utterances involve conflicting proposals about how to update the conversational score. I also adduce evidence that conflicting truth value assessments of a single quasi indexical utterance exhibit the same behavior. I argue that negotiated contextualism can account for this puzzling property of quasi indexicals as well. (shrink)

Abstract Medical futility is commonly understood as treatment that would not provide for any meaningful benefit for the patient. While the medical facts will help to determine what is medically appropriate, it is often difficult for patients, families, surrogate decision-makers and healthcare providers to navigate these difficult situations. Often communication breaks down between those involved or reaches an impasse. This paper presents a set of practical strategies for dealing with cases of perceived medical futility at a major cancer center. Content (...) Type Journal Article Pages 1-8 DOI 10.1007/s10730-011-9168-3 Authors Colleen M. Gallagher, Section for Integrated Ethics in Cancer Care, Unit 1430, The University of Texas MD Anderson Cancer Center, P.O. Box 301402, Houston, TX 77230-1402, USA Ryan F. Holmes, St. Louis University, St. Louis, MO, USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737. (shrink)

Medical science is advancing all the time. Researchers are constantly trying to find new ways to help people to have long and healthy lives. Thanks to their work, doctors today can cure diseases, lessen pain, replace unhealthy limbs or organs, and help infertile couples have children. Doctors can even keep seriously ill people alive against all odds. But not everyone is enamored with advances in medicine. They question whether it is appropriate to prolong life in all cases, or believe that (...) certain treatments have been developed unethically. This book looks at how the ways that doctors treat the sick are developed, and examines some of the questions that are raised by advances in medical science. (shrink)

Jerry Stannard. Pristina Medicamenta: Ancient and Medieval Medical Botany. Edited by, Katherine E. Stannard and Richard Kay. (Variorum Collected Studies Series.) xxii + 324 pp., frontis., illus., index. Brookfield, Vt.: Ashgate, 1999. $110.95. Jerry Stannard. Herbs and Herbalism in the Middle Ages and Renaissance. Edited by, Katherine E. Stannard and Richard Kay. (Variorum Collected Studies Series.) xvi + 342 pp., frontis., illus., tables, index. Brookfield, Vt.: Ashgate, 1999. $110.95.