High-spin states have been studied in Pr-135(59), populated through the Cd-116(Na-23,4n) reaction at 115 MeV, using the Gammasphere gamma-ray spectrometer. The negative-parity yrast band has been significantly extended to spin similar to 45 (h) over bar and excitation energy 21.5 MeV, showing evidence for several rotational alignments. The positive-parity yrast band of Ce-135(58), populated through the p4n channel of this reaction, was also populated to spin similar to 38 (h) over bar and excitation energy 18 MeV. Cranking calculations indicate that (...) these nuclei are soft with respect to the triaxiality parameter gamma and that several competing nuclear shapes occur at high spin. (shrink)

Background: Health institutions can be considered as complex organizations because they need to be prepared to receive and satisfy patients. This clientele differs from other organizations because the use of hospital services is not a matter of choice. Another motive for this difference is that, most often, the patients do not determine what services and products they will use during their stay. Although they are the clients, usually, health professionals decide which service or product they will consume. Hence, nursing care (...) delivery based on competence, efficiency and ethics represents a challenge. Objective: This critical reflection is meant to draw attention to the relevance of the ethical aspects of nurses' actions involving patients' satisfaction with nursing care. Research design: This paper highlights the responsibility of nurses to develop ethical actions in their commitment to manage and provide care with quality, commitment and efficiency. Findings and discussion: Possibilities of actions needed emerged from this discussion, such as the provision of reliable and updated information to clients, respect for standards, routines of care, exams and others, as well as clients' education, in order to further their involvement and participation in decisions concerning the care planned for them. Conclusion: The adoption of this paradigm entails a change in the performance of nurses' management and care roles, which may have to observe attitudes previously disregarded in most services provided. (shrink)

The aim of this systematic review was to summarize and assess the quality of asthma intervention health economic studies from 2002 to 2007, compare the study findings with clinical management guidelines, and suggest avenues for future improvement of asthma health economic studies. Forty of the 177 studies met our inclusion criteria. We assessed the quality of studies using The Quality of Health Economic Studies validated instrument (total score range: 0-100). Six studies (15%) had quality category 2, 26 studies (65%) achieved (...) quality category 3, and the remaining eight (20%) studies were scored as the highest quality level, category 4. Overall, the findings from this review are in line with the Global Initiative for Asthma clinical guidelines. Many asthma health economic studies lacked appropriate long term time horizons to match the chronic nature of the disease and suffered from using effectiveness measures that did not capture all disease related risks and benefits. We recommend that new asthma simulation models: be flexible to allow for long term time horizons, focus on using levels of asthma control in their structure, and estimate both long term asthma specific outcomes like well-controlled time as well as generic outcomes such as quality adjusted survival. (shrink)

OBJECTIVE: To examine the long-term effects of an innovative curriculum on medical house officers' (HOs') knowledge, confidence, and attitudes regarding medical ethics. DESIGN: Long term cohort study. The two-year curriculum, implemented by a single physician ethicist with assistance from other faculty, was fully integrated into the programme. It consisted of monthly sessions: ethics morning report alternating with didactic conferences. The content included topics such as ethics vocabulary and principles, withdrawing life support, informed consent, and justice. Identical content was offered simultaneously (...) at the largest affiliated community hospital. SETTING: A multi-hospital university training programme from July, 1992 to June, 1994. PARTICIPANTS: Thirty-nine HOs responded in 92. Thirty HOs from the same cohort responded in 94 (response rates = 83% v 71%; P = 0.19). RESULTS: The curriculum was well received, with 96% of HOs finding the sessions stimulating. Previously validated scales of knowledge and confidence were administered at baseline and at follow-up. The average knowledge score improved 14% (P < 0.001). Confidence also improved, rising from 3.3 to 3.8 on a 5-point Likert scale (P < 0.001). These findings were independent of age, gender, religion, and prior education. The only attitudinal change was an increase in the proportion of residents who thought that ethics should be a required part of residency training (57% v 80%, P = 0.05). CONCLUSION: This curriculum appears practical, popular, and effective. It should be readily transferable to other institutions. (shrink)

Background: Omalizumab, an anti-immunoglobulin E antibody, reduces exacerbations and symptoms in uncontrolled allergic asthma. The study objective was to estimate the costs and consequences of omalizumab compared to usual care from a US payer perspective. Methods: We estimated payer costs, quality-adjusted survival (QALYs), and the incremental cost-effectiveness ratio (ICER) of omalizumab compared to usual care using a state-transition simulation model that included sensitivity analyses. Every 2 weeks, patients could transition between chronic asthma and exacerbation health states. The best available evidence (...) informed the clinical and cost input estimates. Five years of omalizumab treatment followed by usual care was assumed to estimate a lifetime horizon. Omalizumab responders (60.5% of treated) were modeled as a separate scenario where nonresponders reverted back to usual care after 16 weeks of active treatment. Results: The mean lifetime discounted costs and QALYs were $83 400 and 13.87 for usual care and $174 500 and 14.19 for omalizumab plus usual care resulting in $287 200/QALY (95% interval: $219 300, $557 900). The ICER was $172 300/QALY when comparing omalizumab to usual care in the responder scenario. One-way sensitivity analyses indicated that the results were sensitive to the difference in treatment-specific utilities for the chronic state, exacerbation-associated mortality, omalizumab price, exacerbation rates, and response definition. Conclusions: The results suggest that adding omalizumab to usual care improves QALYs at an increase in direct medical costs. The cost-effectiveness of omalizumab is similar to other chronic disease biologics. The value increases when omalizumab response is used to guide long-term treatment. (shrink)

African slavers used various articles, often of intrinsic value, in their slave business: in the purchase of slaves, in regulating the trade and in assigning special functions to slaves. These articles constitute valuable slavery artifacts in Africa today. Using the Grassfields of Cameroon as a case study, this paper shows how the study of these artifacts exposes not only how African slavers perceived and treated slaves but, more importantly, how these artifacts were used in regulating and controlling the trade. The (...) paper also stresses the fact that a great number of these artifacts of material history were seized, destroyed or looted by European colonialists and Christian missionaries, which accounts for their scarcity. The authors conclude that the study of slavery art constitutes a novel approach for researching the slave trade and African history from an African perspective. (shrink)

On life and philosophy of Nāgārjuna, 2nd century Buddhist philosopher; includes a portion on Buddhism.

Editors and commentators ancient and modern have not responded very well to the challenge of the two riddles which round off the contest between Damoetas and Menalcas at the end of Eclogue 3 . The first is generally regarded as impossibly difficult; the second as impossibly easy. Critics take refuge in quoting Servius' despairing statement: sciendum aenigmata haec sicuti pleraque carere aperta solutione. Yet it is most unlikely that Virgil would introduce insoluble or meaningless riddles into the Bucolica. If there (...) is no solution the lines become pointless, even tasteless; and these are not epithets to be applied lightly to Virgil's poetry. (shrink)

There is a common view in medical ethics that the patient's right to be informed entails, as well, a correlative right not to be informed, i.e., to waive one's right to information. This paper argues, from a consideration of the concept of autonomy as the foundation for rights, that there can be no such ‘right’ to refuse relevant information, and that the claims for such a right are inconsistent with both deontological and utilitarian ethics. Further, the right to be informed (...) is shown to be a mandatory right (though not a welfare right); persons are thus seen to have both a right and a duty to be informed. Finally, the consequences of this view are addressed: since the way in which we conceptualize our problems tends to determine the actions we take to resolve them, it is important properly to conceptualize patients' requests not to be informed. There may be many reasons for acting in accord with such a request, but it is a mistake to conceptualize one's act as ‘respecting a right possessed by persons’. Keywords: medical ethics, informed consent, autonomy, information-waivers, rights, obligations CiteULike Connotea Del.icio.us What's this? (shrink)

"It's a jungle out there. And in here, too. Through this jungle prowl all the demons of dirt and disorder. Though they must win eventually, the way to delay their victory is to keep everything in its proper place, and that means noticing any detail that doesn't fit." "Welcome to the world of former San Francisco police detective Adrian Monk, intellectual athlete and behavioral cripple, master of crime-solving and slave to his own terrors. Mr. Monk and Philosophy examines that world (...) through the lens of philosophy, bags all the evidence, and identifies DNA samples of Aristotle, Aquinas, Nietzsche, and Wittgenstein." --Book Jacket. (shrink)

This volume is a state-of-the-art survey of the psychology of reasoning, based around, and in tribute to, one of the field "s most eminent figures: Jonathan St B.T. Evans.

Bernard Williams charges that the moral psychology built into R. M. Hare’s utilitarianism is incoherent in virtue of demanding a bifurcated kind of moral thinking that is possible only for agents who fail to reflect properly on their own practical decision making. I mount a qualified defence of Hare’s view by drawing on the account of the ‘reactive attitudes’ found in P. F. Strawson’s ‘Freedom and Resentment’. Against Williams, I argue that the ‘resilience’ of the reactive attitudes ensures that our (...) taking an instrumental view of our dispositions to experience guilt and compunction, as Hare calls for us to do while engaged in ‘critical’ moral thinking, will not prevent us from experiencing these feelings as people ordinarily do while we are thinking ‘intuitively’. I also consider the implications of my argument for consequentialism more generally and (briefly) Kantianism. (shrink)