Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year survival of less than 50% who had advanced gastrointestinal or lung cancer or amyotrophic lateral sclerosis were interviewed. Each patient’s medical record was reviewed at enrollment and at 3 months for evidence of the discussion of patient wishes concerning (...) ventilator support, artificial nutrition and hydration , resuscitation and hospice care. A Kaplan–Meier analysis was also performed and 2-year survival calculated.Results: 60 cancer and 32 ALS patients were enrolled. ALS patients were more likely than cancer patients to have evidence of discussion about their wishes for ventilator support , ANH , DNR and hospice care . At 6 months, 91% of ALS patients were alive compared with 62% of cancer patients; at 2 years, 63% of ALS patients were alive compared with 23% of cancer patients .Conclusions: Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making. (shrink)

Purpose: To determine the relative value that patients place on consent for procedures in the emergency department (ED) and to define a set of procedures that fall in the realm of implied consent. Methods: A questionnaire was administered to a convenience sample 134 of 174 patients who were seen in the ED of a Midwestern teaching hospital. The questionnaire asked how much time they believed was necessary to give consent for various procedures. Procedures ranged from simple (venipuncture) to complex (procedural (...) sedation). Results: Participants valued a simple blood draw at a low mean of 1.02 minutes of extra time and a lumbar puncture at a high mean of 7.78 minutes. Of all participants 52% and 48% noted a time-value of ?0? time on blood draw and intravenous line starts, respectively, indicating that they desire no additional consent for these procedures. Conclusion: Defining a set of ED procedures covered under implied consent will be difficult because many patients value formal consent for even the simplest procedure. (shrink)

The relationship between corporate social responsiveness and profitability is investigated in a sample of corporate directors. The findings show there is no relationship between the level of director social responsiveness and corporate profitability. The implications of these results are discussed, especially as they relate to concerns about corporate governance.

I come from a medical family. My father and uncle were physicians, and my father also chaired a department at a West Coast medical school for over 30 years. I am sure I got my interest in teaching from him. My brother is a physician and is currently the safety and quality officer of a Canadian province. My mother operated the last non-automated medical laboratory in my state. I have always understood what sacrifices are made by health care professionals, and (...) I think I have managed to learn a bit about their motivations as well.I was in private practice for ten years with litigation firms, and the last five years of that time I worked for a firm that specialized in professional liability defense and health law. (shrink)

Using NORC annual survey data, the authors selected 21 questions describing respondent attitudes toward job, life in general, and financial status. Respondents were catigorized as management, white collar, blue collar, and those not affiliated with business organizations. Attitudes were compared across the four occupational groups. Little dissatisfaction was found in any but the blue collar group. Management as a group, and men as well as women managers showed high levels of satisfaction, with few significant differences found in responses by men (...) and women. This study does not support the earlier finding of widespread alienation in business firms. (shrink)

This collection of papers by prominent feminist thinkers advances the positive feminist project of remapping the moral by developing theory that acknowledges the diversity of women.

Family carers of individual’s living with Huntington’s Disease (HD) manage a distinct and unique series of difficulties arising from the complex nature of HD. This paper presents the validation of the definitive measure of quality of life for this group. The Huntington’s Disease Quality of Life Battery for carers (HDQoL-C) was expanded and then administered to an international sample of 1716 partners and family carers from 13 countries. In terms of the psychometric properties of the tool, exploratory analysis of half (...) of the sample, demonstrated good internal consistency and reliability. Some items on the full version did not meet psychometric thresholds and a short version (HDQoL-Cs) was developed based on more stringent criteria. Confirmatory Factor Analysis of the model structure showed a good fit for all Factors and, indicated that the HDQoL-C and HDQoL-Cs are psychometrically robust measures of quality of life. We found that carers who lived with and looked after their spouse/partner had reduced sense of coping, hope for the future and overall quality of life. Carers with children who were at risk, carried the gene or were symptomatic also had poorer quality of life outcomes. Findings indicated the HDQoL-C and HDQoL-Cs are valid in multiple languages and across varied cultures as measures of self-reported quality of life in family carers of individual’s living with HD. These psychometrically validated tools can aid and guide the implementation of therapeutic interventions to improve life quality in this population. (shrink)

This collection of essays, offered in honor of the distinguished career of prominent political philosophy professor Clifford Orwin, brings together internationally renowned scholars to provide a wide context and discuss various aspects of the virtue of “humanity” through the history of political philosophy.

Measuring neuronal activity with electrophysiological methods may be useful in detecting neurological dysfunctions, such as mild traumatic brain injury (mTBI). This approach may be particularly valuable for rapid detection in at-risk populations including military service members and athletes. Electrophysiological methods, such as quantitative electroencephalography (qEEG) and recording event-related potentials (ERPs) may be promising; however, the field is nascent and significant controversy exists on the efficacy and accuracy of the approaches as diagnostic tools. For example, the specific measures derived from an (...) electroencephalogram (EEG) that are most suitable as markers of dysfunction have not been clearly established. A study was conducted to summarize and evaluate the statistical rigor of evidence on the overall utility of qEEG as an mTBI detection tool. The analysis evaluated qEEG measures/parameters that may be most suitable as fieldable diagnostic tools, identified other types of EEG measures and analysis methods of promise, recommended specific measures and analysis methods for further development as mTBI detection tools, identified research gaps in the field, and recommended future research and development thrust areas. The qEEG study group formed the following conclusions: 1. Individual qEEG measures provide limited diagnostic utility for mTBI. However, many measures can be important features of qEEG discriminant functions, which do show significant promise as mTBI detection tools. 2. ERPs offer utility in mTBI detection. In fact, evidence indicates that ERPs can identify abnormalities in cases where EEGs alone are nondisclosing. 3. The standard mathematical procedures used in the characterization of mTBI EEGs should be expanded to incorporate newer methods of analysis including nonlinear dynamical analysis, complexity measures, analysis of causal interactions, graph theory and information dynamics. 4. and 5. are too long to include here. (shrink)

This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are dealing with professional boundary (...) issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. (shrink)

I explore one distinctive aspect of our relation to spaces which is particularly significant in our everyday aesthetic evaluations of cities (urban spaces): the frequent use of linguistic expressions referring to the sense of touch. We say that a space is oppressive or expansive, or warm or cold, or (more indirectly) cozy or desolate. Touching, as involved in these expressions, seems to refer, rather than to the contact of a physical object with our skin, to a sort of touching (...) with our life. To understand this, I try to make explicit both (a) what is being touched, i.e., the view of space behind these expressions; and (b) how and in which sense our life touches it. I propose to think about space as a plenum made of qualities (e.g., colors, smells, sounds, textures), some of which are penetrable and some of which are not. And as to how we touch spaces, I defend that we do so as we immerse ourselves in them. Once immersed in them, we are constantly both evaluating how well we fit in them as well as looking for a better-quality fitting. This is how we evaluate spaces aesthetically. Our embodied life fits better in a space when (a) we can realize more significant (for us, according to our ideal of life) possibilities in it, and (b) the felt quality of realizing those possibilities is enhanced by that space (“it feels better to read in this café”). (shrink)

In this introduction to part 4 of the Common Knowledge symposium “Peace by Other Means,” the journal's editor assesses the argument made by Peace, the spokesperson of Erasmus in his Querela Pacis, that the desire to impute and avenge wrongs against oneself is insatiable and at the root of both individual and social enmities. He notes that, in a symposium about how to resolve and prevent enmity, most contributions have to date expressed caveats about how justice and truth must take (...) precedence over peace, how recovery from ill treatment may be impossible, how quietism is not a moral option, and how realism demands a national policy and a personal strategy of, at best, contingent forgiveness. He concedes that the attitudes of those opposed to quietism are healthy but suggests that there may be goods worthier than health of human devotion. This essay concludes that the main differences between what it terms “judgmental” and “irenic” regimes are disagreements over anthropology and metaphysics. The presumptions that truths are objectively knowable and that human beings are moral and rational agents characterize judgmental regimes; irenic regimes are characterized by disillusionment with those assumptions. (shrink)

Why I am a theologian rather than a philosopher -- The Jewish need for theology, commentary -- Through the shadowed valley -- The autonomous Jewish self -- 'Im ba'et, eyma-since you object, let me put it this way.

Parental investment decisions guide parental actions regarding children’s productive work and are shaped by ecological context. Urban ecology enhances long-term payoffs to investment in human capital, increasing opportunity costs for work performed by children, and decreased workload should result. Using an embodied capital framework, self-reported data on urban and rural Indo-Fijian children’s work activities are compared. Results show higher workloads for older children, rural children, and girls. High scholastic achievement is associated with lower workloads for girls, but not (...) boys. This pattern is interpreted as daughter-biased investment in the context of urbanization. (shrink)

C.B. Macpherson's “Possessive Individualist” reading of Locke is one of the most radical and influential interpretations in the history of exegesis. Despite a substantial critical response over the past five decades, Macpherson's reading remains orthodox in various circles in the humanities generally, particularly in legal studies, and his interpretation of several crucial passages has unwittingly been followed even by his sharpest critics within Lockean scholarship. In order to present the definitive rebuttal to this interpretation, and so finally to lay it (...) to rest, I argue that every one of Macpherson's key pieces of textual evidence can be rejected entirely on its own terms; that is, by reference to no more than its immediate context. In this way I contend that fault of the Possessive Individualist reading lies far deeper than mere cherry-picking of the Lockean corpus, but centrally involves misreading, misplacing and misrepresenting the very parts of Locke's work Macpherson cites as evidence for his reading. (shrink)

The state, by V.I. Lenin.--The revolutionary part played by law and the state; a general doctrine of law, by P.I. Stuchka.--The theory of Petrazhitskii: Marxism and social ideology. Law, our law, foreign law, general law, by M.A. Reisner.--The general theory of law and Marxism, by E.B. Pashukanis.--The right deviation in the Communist Party of Bolsheviks. Political report of the Central (Party) Committee to the XVI Congress, 1930, by J.V. Stalin.-- The Soviet state and the revolution in law, by E.B. Pashukanis.--Socialism (...) and law, by P. Yudin.--The fundamental tasks of the science of Soviet socialist law, by A.Y. Vyshinsky.--Report to the XVIII Party Congress, by J.V. Stalin.--The theory of the state and law, by S.A. Golunskii and M.S. Strogovich.--The Soviet state in the war for the fatherland, by A.Y. Vyshinsky.--The relationship between state and law, by I.P. Trainin. (shrink)