Background: Clinical ethics committees have been broadly implemented in university hospitals, general hospitals and nursing homes. To ensure the quality of ethics consultations, evaluation should be mandatory. Research question/aim: The aim of this article is to evaluate the perspectives of all people involved and the process of implementation on the wards. Research design and participants: The data were collected in two steps: by means of non-participating observation of four ethics case consultations and by open-guided interviews with 28 participants. Data analysis (...) was performed according to grounded theory. Ethical considerations: The study received approval from the local Ethics Commission (registration no.: 32/11/10). Findings: ‘Communication problems’ and ‘hierarchical team conflicts’ proved to be the main aspects that led to ethics consultation, involving two factors: unresolvable differences arise in the context of team conflicts on the ward and unresolvable differences prevent a solution being found. Hierarchical asymmetries, which are common in the medical field, support this vicious circle. Based on this, minor or major disagreements regarding clinical decisions might be seen as ethical conflicts. The expectation on the clinical ethics committee is to solve this (communication) problem, but the participants experienced that hierarchy is maintained by the clinical ethics committee members. Discussion: The asymmetrical structures of the clinical ethics committee reflect the institutional hierarchical nature. They endure, despite the fact that the clinical ethics committee should be able to detect and overcome them. Disagreements among care givers are described as one of the most difficult ethically relevant situations and should be recognised by the clinical ethics committee. On the contrary, discussion of team conflicts and clinical ethical issues should not be combined, since the first is a mandate for team supervision. Conclusion: To avoid dominance by physicians and an excessively factual character of the presentation, the case or conflict could be presented by both physicians and nurses, a strategy that strengthens the interpersonal and emotional aspects and also integrates both professional perspectives. (shrink)

ZusammenfassungKlinische Therapieentscheidungen werden zumeist auf dem Boden einer medizinischen (bzw. ärztlichen) Indikationsstellung und der entsprechenden informierten Zustimmung des Patienten zu der vorgeschlagenen Behandlungsmaßnahme gefällt. Das Recht des Patienten, eine Behandlungsmaßnahme abzulehnen, ist in der juristischen und ethischen Bewertung breit abgesichert. Hingegen ist unklar, welche Rolle ein (positiv geäußerter) Wunsch des Patienten oder gar seiner Angehörigen nach einer bestimmten Behandlung im normativen Entscheidungsprozess spielen sollte, wenn überhaupt. Dieser Beitrag erörtert den Stellenwert des eigenständigen Patientenwunsches aus studienbezogener, klinischer und normativer Sicht. Ein (...) authentisches Fallbeispiel verdeutlicht das Spektrum zugrunde liegender Autonomiekonzepte und das Dilemma divergierender Bewertungsmaßstäbe zwischen Arzt und Patient in der Tumortherapie und Palliativmedizin. Der Beitrag zeigt auf, wie bestehende Konzepte von Autonomie und Indikation genutzt werden können, um einerseits den Behandlungswunsch eines Patienten konkret in den Entscheidungsprozess einzubeziehen, andererseits eine klare Abgrenzung zu einer unreflektierten „wunscherfüllenden Medizin“ aufrecht zu erhalten. (shrink)

ZusammenfassungDie Palliative Sedierung als therapeutische Handlungsoption in anderweitig refraktären Behandlungssituationen wird in der Öffentlichkeit und in Fachkreisen in ihrer klinischen Wertigkeit grundsätzlich akzeptiert und weitgehend positiv konnotiert. Im Widerspruch dazu fallen sowohl die Quantität der empirischen Forschung als auch die Intensität der ethischen und klinischen Diskussion ins Auge, mit der konzeptuelle als auch durchführungsbezogene Aspekte der Palliativen Sedierung beschrieben und kontrovers erörtert werden. Anstatt eines distinkten Behandlungskonzeptes stellt sich hier eher ein komplexes Spektrum verschiedener Vorgehensweisen dar. Die folgende Übersichtsarbeit fasst (...) anhand der aktuellen Literatur zusammen, welche Aspekte im Kontext der Palliativen Sedierung als problematisch bewertet werden. (shrink)

Since Tversky argued that similarity judgments violate the three metric axioms, asymmetrical similarity judgments have been particularly challenging for standard, geometric models of similarity, such as multidimensional scaling. According to Tversky, asymmetrical similarity judgments are driven by differences in salience or extent of knowledge. However, the notion of salience has been difficult to operationalize, especially for perceptual stimuli for which there are no apparent differences in extent of knowledge. To investigate similarity judgments between perceptual stimuli, across three experiments, we collected (...) data where individuals would rate the similarity of a pair of temporally separated color patches. We identified several violations of symmetry in the empirical results, which the conventional multidimensional scaling model cannot readily capture. Pothos et al. proposed a quantum geometric model of similarity to account for Tversky's findings. In the present work, we extended this model to a more general framework that can be fit to similarity judgments. We fitted several variants of quantum and multidimensional scaling models to the behavioral data and concluded in favor of the quantum approach. Without further modifications of the model, the best-fit quantum model additionally predicted violations of the triangle inequality that we observed in the same data. Overall, by offering a different form of geometric representation, the quantum geometric framework of similarity provides a viable alternative to multidimensional scaling for modeling similarity judgments, while still allowing a convenient, spatial illustration of similarity. (shrink)

Background Artificial intelligence (AI) has revolutionized various healthcare domains, where AI algorithms sometimes even outperform human specialists. However, the field of clinical ethics has remained largely untouched by AI advances. This study explores the attitudes of anesthesiologists and internists towards the use of AI-driven preference prediction tools to support ethical decision-making for incapacitated patients. Methods A questionnaire was developed and pretested among medical students. The questionnaire was distributed to 200 German anesthesiologists and 200 German internists, thereby focusing on physicians who (...) often encounter patients lacking decision-making capacity. The questionnaire covered attitudes toward AI-driven preference prediction, availability and utilization of Clinical Ethics Support Services (CESS), and experiences with ethically challenging situations. Descriptive statistics and bivariate analysis was performed. Qualitative responses were analyzed using content analysis in a mixed inductive-deductive approach. Results Participants were predominantly male (69.3%), with ages ranging from 27 to 77. Most worked in nonacademic hospitals (82%). Physicians generally showed hesitance toward AI-driven preference prediction, citing concerns about the loss of individuality and humanity, lack of explicability in AI results, and doubts about AI’s ability to encompass the ethical deliberation process. In contrast, physicians had a more positive opinion of CESS. Availability of CESS varied, with 81.8% of participants reporting access. Among those without access, 91.8% expressed a desire for CESS. Physicians' reluctance toward AI-driven preference prediction aligns with concerns about transparency, individuality, and human-machine interaction. While AI could enhance the accuracy of predictions and reduce surrogate burden, concerns about potential biases, de-humanisation, and lack of explicability persist. Conclusions German physicians frequently encountering incapacitated patients exhibit hesitance toward AI-driven preference prediction but hold a higher esteem for CESS. Addressing concerns about individuality, explicability, and human-machine roles may facilitate the acceptance of AI in clinical ethics. Further research into patient and surrogate perspectives is needed to ensure AI aligns with patient preferences and values in complex medical decisions. (shrink)

The study aimed to explore the subjective need of healthcare professionals for ethics consultation, their experience with ethical conflicts, and expectations and objections toward a Clinical Ethics Committee. Staff at a university hospital took part in a survey (January to June 2010) using a questionnaire with open and closed questions. Descriptive data for physicians and nurses (response rate = 13.5%, n = 101) are presented. Physicians and nurses reported similar high frequencies of ethical conflicts but rated the relevance of ethical (...) issues differently. Nurses stated ethical issues as less important to physicians than to themselves. Ethical conflicts were mostly discussed with staff from one’s own profession. Respondents predominantly expected the Clinical Ethics Committee to provide competent support. Mostly, nurses feared it might have no influence on clinical practice. Findings suggest that experiences of ethical conflicts might reflect interprofessional communication patterns. Expectations and objections against Clinical Ethics Committees were multifaceted, and should be overcome by providing sufficient information. The Clinical Ethics Committee needs to take different perspectives of professions into account. (shrink)

The study aimed to explore the subjective need of healthcare professionals for ethics consultation, their experience with ethical conflicts, and expectations and objections toward a Clinical Ethics Committee. Staff at a university hospital took part in a survey (January to June 2010) using a questionnaire with open and closed questions. Descriptive data for physicians and nurses (response rate = 13.5%, n = 101) are presented. Physicians and nurses reported similar high frequencies of ethical conflicts but rated the relevance of ethical (...) issues differently. Nurses stated ethical issues as less important to physicians than to themselves. Ethical conflicts were mostly discussed with staff from one’s own profession. Respondents predominantly expected the Clinical Ethics Committee to provide competent support. Mostly, nurses feared it might have no influence on clinical practice. Findings suggest that experiences of ethical conflicts might reflect interprofessional communication patterns. Expectations and objections against Clinical Ethics Committees were multifaceted, and should be overcome by providing sufficient information. The Clinical Ethics Committee needs to take different perspectives of professions into account. (shrink)

Patient centred diagnosis is best practised through shared decision making; an iterative dialogue between doctor and patient, whichrespects a patient’s needs, values, preferences, and circumstances. -/- Shared decision making for diagnostic situations differs fundamentally from that for treatment decisions. This has important implications when considering its practical application. -/- The nature of dialogue should be tailored to the specific diagnostic decision; scenarios with higher stakes or uncertainty usually require more detailed conversations.

Extruded polystyrene (XPS) otherwise known as a thermoplastic polymer has a closed cell structure and is often stronger, with a higher mechanical performance. XPS is a pressed material and is sold in different thicknesses ranging from 2 cm to 10 cm, thus having a weight that varies from 28 to 45 kg/m3 due to the force and pressure exerted on it. In general, XPS material has very low thermal conductivity and is resistant to bending. This material obtains typical values of (...) thermal conductivity between 0.025 and 0.040 W/m∙K., which means that it is ideal for surfaces that have to withstand weight, continuous traffic, etc. It is also resistant to moisture absorption and has a homogeneous density. Other characteristics of the material are good acoustic properties, easy assembly, and high durability over time. It should always be kept in mind that the surface where the thermal insulation will be applied must be leveled, cleaned, and dried. Primer is applied, before placing the thermal insulation on the surface. Then, XPS boards are placed on the surface, adhering to the corresponding mortar. This paper will deal with different cases of application of XPS tiles in the city of Tirana. A closer look at the resistance of this material from the day of application until today will be analyzed. The results during the observations showed high thermal stability of the material and no mold surface. EPS Expanded Polystyrene, otherwise known by the Dow Chemical trademark name STYROFOAM, is a lightweight product made from expanded plastic beads. It was first discovered by Eduard Simon in 1839 in Germany. EPS in its composition has 95% air and only about 5% plastic. This material is used because of its excellent properties, including good thermal insulation, good protective properties, and extremely lightweight. EPS is inert in nature and therefore does not result in any chemical reaction. EPS is durable, strong, and lightweight and can be used as an insulated panel system for facades, walls, roofs, and floors, as floating material in marine construction, and as a lightweight filler in road and railway construction. Different examples from the city of Tirana, of buildings where XPS and EPS materials are applied, are going to be analyzed, drawing conclusions. (shrink)

This paper introduces and studies hypo-EP matrices of adjointable operators on Hilbert C ∗ -modules, based on the generalized Schur complement. The necessary and sufficient conditions for some modular operator matrices to be hypo-EP are given, and some special circumstances are also analyzed. Furthermore, an application of the EP operator in operator equations is given.

Bentley's emendation in Horace, Ep. 1.14.9.

Edward P Thompson’s disapproval of Methodism (which was his own background) is well known, especially in The Making of the English Working Class. There he describes it as religious terrorism with a destructive moral machinery and all too reactionary. However, through a close reading of the sections on Methodism, this article reveals an ambivalence within Thompson’s own text. Again and again, he notes in passing that radicals emerged from the Methodist ranks, so much so that the Methodist Conference worked hard (...) to deal with the problem. It would seem that Thompson has stumbled across a political tension within theology, one that he was to explore in much greater detail in his study of Blake. (shrink)

sola scripturarum ars est, quam sibi omnes passim uindicent: ‘scribimus indocti doctique poemata passim’ [Hor. Epist. 2.1.117]. hanc garrula anus, hanc delirus senex, hanc soloecista uerbosus, hanc uniuersi praesumunt, lacerant, docent, antequam discant. alii adducto supercilio grandia uerba trutinantes inter mulierculas de sacris litteris philosophantur, alii discunt—pro pudor!—a feminis, quod uiros doceant, et, ne parum hoc sit, quadam facilitate uerborum, immo audacia disserunt aliis, quod ipsi non intellegunt. taceo de meis similibus, qui si forte ad scripturas sanctas post saeculares litteras (...) uenerint et sermone conposito aurem populi mulserint, quicquid dixerint, hoc legem dei putant nec scire dignantur, quid prophetae, quid apostoli senserint, sed ad sensum suum incongrua aptant testimonia, quasi grande sit et non uitiosissimum dicendi genus deprauare sententias et ad uoluntatem suam scripturam trahere repugnantem. quasi non legerimus Homerocentonas et Vergiliocentonas ac non sic etiam Maronem sine Christo possimus dicere Christianum, quia scripserit: ‘iam redit et uirgo, redeunt Saturnia regna, iam noua progenies caelo demittitur alto’ [Verg. Ecl. 4.6–7], et patrem loquentem ad filium: ‘nate, meae uires, mea magna potentia solus’ [Verg. Aen. 1.664], et post uerba saluatoris in cruce: ‘talia perstabat memorans fixusque manebat’ [Verg. Aen. 2.650]. puerilia sunt haec et circulatorum ludo similia, docere, quod ignores, immo, et cum stomacho loquar, nec hoc quidem scire, quod nescias. (shrink)

In recent times, many Callimachean epigrams have been discussed in terms of their connection to contemporary inscribed epigrams. However, in the case of Ep. 1 Pf. influences of inscribed epigrams have not yet been detected. This article argues that similarities to various types of metrical inscriptions (especially funerary inscriptions and sign-posts) do exist and that the epigram could be read as a fictional sign-post with philosophical and possibly metapoetic overtones.

In the famous exchange between Passennus Paulus and Javolenus Priscus at Plin. Ep. 6.15, it has not been previously recognized that Priscus’ reply is metrical and carries on the hexameter begun by Paulus. This opens up some interesting new possibilities for the interpretation of the letter.

Por años, se consideró a las Fuerzas Armadas Revolucionarias de Colombia-Ejército del Pueblo como la principal y más grande insurgencia armada, enemigo número uno del Estado. Así mismo, desde 2012 se adelantó un proceso de diálogo y negociación política entre el gobierno colombiano y dichas fuerzas, que tuvo como resultado poner fin a la confrontación militar de más de seis décadas y habilitar un camino de reformas y apertura democrática para esta organización. Son muchos los factores que explican que la (...) posibilidad real del cese definitivo al fuego entre el establecimiento y las farc-ep haya sido exitosa. Sin embargo, la derrota estratégica de la primera guerrilla colombiana es la menos explorada y de escasos resultados en el subcampo del análisis político. Que la guerrilla de las farc-ep haya ingresado a un proceso de reincorporación no solo se explica por un desgaste obvio de la guerra, o una ventana de oportunidad a la salida política negociada, sino también porque en el plano político-militar hubo un escenario desfavorable que no se logró superar. El presente artículo es el resultado de un estudio con base en el enfoque de análisis de coyuntura, que reconoce un horizonte relacional y estratégico de la acción político-militar que comprende la identificación de actores, acontecimientos, escenarios, correlación de fuerzas y relación estructura-coyuntura a partir de la revisión bibliográfica de expertos y el Centro de Investigación en Memoria Histórica Militar, adscrito al Ministerio de Defensa. (shrink)