There is a growing interest in comparison of international health care data with the hope that such studies will enable individual systems to learn from other systems. Such comparisons, however, presuppose that there exist common criteria for evaluating health care systems. The main thesis of this paper is that these comparative studies are misleading because they employ inappropriate operationalizations of these criteria because the operarionalizations are based upon mistaken global conceptualizations of the criteria in question. The essay provides a methodological (...) critique of what has been done and sets a new agenda for future research. (shrink)

As a patient approaches death, family members often are asked about their loved one’s preferences regarding treatment at the end of life. Advance care directives may provide information for families and surrogate decision makers; however, less than one-third of Americans have completed such documents. As the U.S. population continues to age, many surrogate decision makers likely will rely on other means to discern or interpret a loved one’s preferences. While many surrogates indicate that they have some knowledge of their loved (...) one’s preferences, how surrogates obtain such knowledge is not well understood. Additionally, although research indicates that the emotional burden of end-of-life decision making is diminished when surrogates have knowledge that a loved one’s preferences are honored, it remains unclear how surrogates come to know these preferences were carried out. The current study examined the ways that next of kin knew veterans’ end-of-life preferences, and their ways of knowing whether those preferences were honored in Veteran Affairs Medical Center inpatient settings. (shrink)

A tight control of intracellular [Ca2+\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$^{2+}$$\end{document}] is essential for the survival and normal function of cells. In this study we investigate key mechanistic steps by which calcium is regulated and calcium oscillations could occur using in silico modeling of membrane transporters. To do so we give a deterministic description of intracellular Ca2+\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$^{2+}$$\end{document} dynamics using nonlinear dynamics in order to understand Ca2+\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} (...) \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$^{2+}$$\end{document} signaling. We first present the ordinary differential equations system for cell calcium kinetics and make a preliminary work on Sobol indices. We then describe and analyze complex transporters action. Besides, we analyze the whole system. We finally perform numerical simulations and compare our results to real data. (shrink)

To describe the content of practice guidelines on euthanasia and assisted suicide (EAS) and to compare differences between settings and guidelines developed before or after enactment of the euthanasia law in 2002 by means of a content analysis. Most guidelines stated that the attending physician is responsible for the decision to grant or refuse an EAS request. Due care criteria were described in the majority of guidelines, but aspects relevant for assessing these criteria were not always described. Half of the (...) guidelines described the role of the nurse in the performance of euthanasia. Compared with hospital guidelines, nursing home guidelines were more often stricter than the law in excluding patients with dementia (30% vs 4%) and incompetent patients (25% vs 4%). As from 2002, the guidelines were less strict in categorically excluding patients groups (32% vs 64%) and in particular incompetent patients (10% vs 29%). Healthcare institutions should accurately state the boundaries of the law, also when they prefer to set stricter boundaries for their own institution. Only then can guidelines provide adequate support for physicians and nurses in the difficult EAS decision-making process. (shrink)

William of Malmesbury's Regesta Regum Anglorum is one of the great histories of England, and one of the most important historical works of the European Middle Ages. Although its focus is national, its scope encompasses most of Western Europe and beyond, providing a full-scale account of the First Crusade. Apart from its formidable learning, it is characterized by narrative skill and entertainment value - with topics including unpowered flight and Henry I's zoo. This edition in the Oxford Medieval Texts series (...) is the first modern translation and edition. A full historical introduction is supplied in Volume II. (shrink)

Guido de Ruggiero (1888-1948) was perhaps the greatest Italian intellectual historian in the twentieth century. He was a fierce champion of liberalism, an ardent opponent of Fascism, an insightful critic and interpreter of his contemporaries, and a formidable philosopher in his own right. Idealism & Experience: The Philosophy of Guido de Ruggiero comprises eight new critical essays, as well as English translations of five of de Ruggiero's most important shorter writings, which chart the development of his thought between 1914 and (...) 1946. Taken together, these essays reveal the range, richness and philosophical sophistication of de Ruggiero's ideas, enabling Anglophone readers to appreciate their enduring relevance in our own troubled times. (shrink)

A formal Ethics Consultation Service (ECS) can provide significant help to patients, families and hospital staff. As with any other form of clinical consultation, documentation of the process and the advice rendered is very important. Upon review of the published consult documentation practices of other ECSs, we judged that none of them were sufficiently detailed or structured to meet the needs and purposes of a clinical ethics consultation. Thus, we decided to share our method in order to advance the practice (...) of ethics consultation. Here, we describe a method of ECS documentation practice, including use of a formal consult report template, as well as a log for maintaining a chronological record of the consultations performed. These two documents facilitate order and organisation of the ECS. They also enable the ECS to keep an account of professional time and experience, enable quick consult trend assessments (by consult theme or ward, for example) and establish a potential registry of consults for future research study. This method of documentation, we believe, not only contributes significantly to the primary purpose of the consultation—namely, the evincing and sharing of ethical opinion about a case—but also enables consultants to improve their practice and to pursue research on clinical ethics consultation. (shrink)

Mind uploading speculation and debate often concludes that a procedure described as gradual in-place replacement preserves personal identity while a procedure described as destructive scan-and-copy produces some other identity in the target substrate such that personal identity is lost along with the biological brain. This paper demonstrates a chain of reasoning that establishes metaphysical equivalence between these two methods in terms of preserving personal identity.