In intensive care, disputes sometimes arise when patients or surrogates strongly desire treatment, yet health professionals regard it as potentially inappropriate. While professional guidelines confirm that physicians are not always obliged to provide requested treatment, determining when treatment would be inappropriate is extremely challenging. One potential reason for refusing to provide a desired and potentially beneficial treatment is because (within the setting of limited resources) this would harm other patients. Elsewhere in public health systems, cost effectiveness analysis is sometimes (...) used to decide between different priorities for funding. In this paper, we explore whether cost-effectiveness could be used to determine the appropriateness of providing intensive care. We explore a set of treatment thresholds: the probability threshold (a minimum probability of survival for providing treatment), the cost threshold (a maximum cost of treatment), the duration threshold (the maximum duration of intensive care), and the quality threshold (a minimum quality of life). One common objection to cost-effectiveness analysis is that it might lead to rationing of life-saving treatment. The analysis in this paper might be used to inform debate about the implications of applying cost-effectiveness thresholds to clinical decisions around potentially inappropriate treatment. (shrink)

To ensure that listeners pay attention and do not habituate, emotionally intense vocalizations may be under evolutionary pressure to exploit processing biases in the auditory system by maximising t...

Climate change has caused serious threats to global economic development and human well-being, and green finance is a new way to achieve ecological, economic, and social sustainable development, and it also has important theoretical significance and policy value. This study firstly aims to study the impact of green finance on regional carbon intensity. Then, it aims to determine the moderating effect of capital stock per capita on the relationship between green finance and carbon intensity based on moderating effect model as (...) well as to investigate the threshold effect of capital stock per capita on the relationship between green finance and carbon intensity based on threshold effect model. The main conclusions are as follows: Every 1% increase in green finance will lead to a 2% decrease in carbon intensity, and the inhibition of green finance on carbon intensity is most obvious in northeast and east China. The capital stock per capita has a significant moderating effect, which could enhance the restraining effect of green financial development on carbon intensity, and this moderating effect is most obvious in northeast China. The capital stock per capita has a threshold effect in the process of green finance development to suppress carbon intensity. The higher the capital stock per capita, the stronger the inhibition effect of green finance development on carbon intensity. Therefore, in the process of capital accumulation, attention should be paid to improve the relevant legal system and policy guarantee, optimization of financial structure, and stimulation of the capital allocation effect of green finance. Simultaneously, in order to strengthen the inhibitory effect of green finance on carbon intensity, differentiated green finance development policies should be formulated based on factor endowment structure and comparative advantages of different regions. (shrink)

With the aging of the general population and the ability of intensivists to support patients using ventilator support, tracheostomy has become a vital tool in the medical management of critically ill patients. While much of the medical literature on tracheostomy has focused on the optimal timing of and indications for performing this procedure, little is written on the ethical tensions that can revolve around decisions by patients, surrogates, and physicians on its use. This article will elucidate the ethical dilemmas that (...) can arise surrounding the use of tracheostomy in critically ill patients and how ethics consultants and committees can approach these cases to allow resolution. (shrink)

BackgroundReconciling results obtained using different types of sensory measures is a challenge for autism sensory research. The present study used questionnaire, psychophysical, and neurophysiological measures to characterize autistic sensory processing in different measurement modalities.MethodsParticipants were 46 autistic and 21 typically developing 11- to 14-year-olds. Participants and their caregivers completed questionnaires regarding sensory experiences and behaviors. Auditory and somatosensory event-related potentials were recorded as part of a multisensory ERP task. Auditory detection, tactile static detection, and tactile spatial resolution psychophysical (...) thresholds were measured.ResultsSensory questionnaires strongly differentiated between autistic and typically developing individuals, while little evidence of group differences was observed in psychophysical thresholds. Crucially, the different types of measures appeared to be largely independent of one another. However, we unexpectedly found autistic participants with larger auditory Tb ERP amplitudes had reduced hearing acuity, even though all participants had hearing acuity in the non-clinical range.LimitationsThe autistic and typically developing groups were not matched on cognitive ability, although this limitation does not affect our main analyses regarding convergence of measures within autism.ConclusionOverall, based on these results, measures in different sensory modalities appear to capture distinct aspects of sensory processing in autism, with relatively limited convergence between questionnaires and laboratory-based tasks. Generally, this might reflect the reality that laboratory tasks are often carried out in controlled environments without background stimuli to compete for attention, a context which may not closely resemble the busier and more complex environments in which autistic people’s atypical sensory experiences commonly occur. Sensory questionnaires and more naturalistic laboratory tasks may be better suited to explore autistic people’s real-world sensory challenges. Further research is needed to replicate and investigate the drivers of the unexpected association we observed between auditory Tb ERP amplitudes and hearing acuity, which could represent an important confound for ERP researchers to consider in their studies. (shrink)

Multidisciplinary studies indicate that auditory hallucinations may arise from speech perception neurocircuitry without disrupted theory of mind capacities. Computer simulations of excessive pruning in speech perception neural networks provide a model for these hallucinations and demonstrate that connectivity reductions just below a “psychotogenic threshold” enhance information processing. These data suggest a process whereby vulnerability to schizophrenia is maintained in the human population despite reproductive disadvantages of this illness.

The Temporal-Order Judgment (TOJ) paradigm has been widely investigated in previous studies as an accurate measure of temporal resolution and sequencing abilities in the millisecond time range. Two auditory TOJ tasks are often used: (1) a spatial TOJ task, in which two identical stimuli are presented in rapid succession monaurally and the task is to indicate which ear received the first stimulus and which ear received the second one ( left-right or right-left ), and (2) a spectral TOJ task, (...) in which two tones of different frequencies are presented asynchronously to both ears binaurally and the task is to report the sequence of these tones ( low-high or high-low ). The previous literature studies conducted on young volunteers indicated that the measured temporal acuity on these two tasks depended on the procedure used. As considerable data are now available about age-related decline in temporal resolution ability, the aim of the present study was to compare in elderly subjects the pattern of performance on these two tasks. A total of 40 normal healthy volunteers aged from 62 to 78 years performed two TOJ tasks. The measurement was repeated in two consecutive sessions. Temporal resolution was indexed by the Auditory Temporal-Order Threshold (ATOT), i.e., the minimum time gap between successive stimuli necessary for a participant to report a before-after relation with 75% correctness. The main finding of the present study was the indication of differences in the elderly in performance on two tasks. In the spatial task, the distribution of obtained ATOT values did not deviate from the Gaussian distribution. In contrast, the distribution of data in the spectral task deviated significantly from the Gaussian and was spread more to the right. Although lower ATOT values were usually observed in Session 2 than in Session 1, such difference was significant only in the spectral task. We conclude that although temporal acuity and sequencing abilities in the millisecond time range are probably based in neuronal oscillatory activity, the measured ATOTs in the elderly seem to be stimulus-dependent, procedure-related, and influenced by the perceptual strategies used by participants. (shrink)

About 75% of subjects diagnosed with schizophrenia experience auditory-verbal hallucination and report "hearing voices" that are not actually present. One notable feature of AVH is that it seems involuntary and not directly in the subject's control. With regard to content, these represented voices make utterances, typically commands and evaluations, and either are directed to the patient or speak about her in the third person. Voices may echo the subject's thoughts or comment on the subject's behavior and, in some cases, (...) the voices seem to carry on conversations or even argue. Subjects often experience the voices as having pitch, timbre, and intensity, and as having a... (shrink)