RationaleSurrogates of critically ill patients often have inaccurate expectations about prognosis. Yet there is little research on how intensive care unit clinicians should discuss prognosis, and existing expert opinion-based recommendations give only general guidance that has not been validated with surrogate decision makers.ObjectiveTo determine the perspectives of key stakeholders regarding how prognostic information should be conveyed in critical illness.MethodsThis was a multicenter study at three academic medical centers in California, Pennsylvania, and Washington. One hundred eighteen key stakeholders completed in-depth semistructured (...) interviews. Participants included 47 surrogates of adult patients with acute respiratory distress syndrome; 45 clinicians working in study ICUs, including physicians, nurses, social workers, and spiritual care providers; and 26 experts in health communication, decision science, ethics, family-centered care, geriatrics, healthcare disparities, palliative care, psychology, psychiatry, and critical care.Measurements and main resultsThere was broad support among surrogates for existing expert recommendations, including truthful prognostic disclosure, emotional support, tailoring the disclosure strategy to each family's needs, and checking for understanding. In addition, stakeholders offered suggestions that add specificity to existing recommendations, including: In addition to conveying prognostic estimates, clinicians should help families "see the prognosis for themselves" by showing families radiographic images and explaining the clinical significance of physical manifestations of severe disease at the bedside. Many physicians did not support using numeric estimates to convey prognosis to families, whereas many surrogates, clinicians from other disciplines, and experts believed numbers could be helpful. Clinicians should conceptualize prognostic communication as an iterative process that begins with a preliminary mention of the possibility of death early in the ICU stay and becomes more detailed as the clinical situation develops. Although prognostic information should be initially disclosed by physicians, other members of the multidisciplinary team-nurses, social workers, and spiritual care providers-should be given explicit role responsibilities to reinforce physicians' prognostications and help families process a poor prognosis emotionally.ConclusionsFamily members, clinicians, and experts identified specific communication behaviors that clinicians should use to discuss prognosis in the critical care setting. These findings extend existing opinion-based recommendations and should guide interventions to improve communication about prognosis in ICUs. (shrink)

These texts, the property of the Egypt Exploration Society, were purchased, together with other literary and documentary material, from a Greek lady at Medînet-el-Faiyûm by Dr. J. de M. Johnson in 1914. I am grateful to the Secretary of the Society for permission to publish them.

On 18–19 May 2018, a symposium was held in the Research Institute of Irish and Scottish Studies at the University of Aberdeen to commemorate the tenth anniversary of the death of Ronald W. Hepburn (1927–2008). The speakers at this event discussed Hepburn’s oeuvre from several perspectives. For this book, the collection of the revised versions of their talks has been supplemented by the papers of other scholars who were unable to attend the symposium itself. Thus this volume contains contributions from (...) eighteen notable scholars of different disciplines, ranging from contemporary aesthetics and art theory through to philosophical approaches to religion, education and social anthropology. It also includes a bibliography of Hepburn’s writings. The essays were first published in two special issues of the Journal of Scottish Thought, vols. 10–11 (2018–2019). -/- Ronald William Hepburn was born in Aberdeen on 16 March 1927. He went to Aberdeen Grammar School, then he graduated with an M.A. in Philosophy (1951) and obtained his doctorate from the University of Aberdeen (1955). His tutor at Aberdeen was Donald MacKinnon (1913– 1994), a Scottish philosopher and theologian, the author of A Study in Ethical Theory (1957) and The Problem of Metaphysics (1974). Hepburn taught as Lecturer at the Department of Moral Philosophy at Aberdeen (1956–60), and he was also Visiting Associate Professor of Philosophy at New York University (1959–60). He returned from the United States as Professor of Philosophy at Nottingham University. In 1964, he was appointed as a Chair in Philosophy at the University of Edinburgh and between 1965 and 1968 he was also Stanton Lecturer in the Philosophy of Religion at the University of Cambridge. From 1975 until his retirement in 1996, he held the Professorship of Moral Philosophy at Edinburgh. He died in Edinburgh on 23 December 2008. His philosophical interests ranged from theology and the philosophy of religion through moral philosophy and the philosophy of education to art theory and aesthetics. Notably, Hepburn is widely regarded as the founder of modern environmental and everyday aesthetics as a result of the influence of papers in the 1960s which pioneered a new approach to the aesthetics of the natural world. (shrink)

The spectacular development of medical knowledge over the last two centuries has brought intrusive advances in the capabilities of medical technology. These advances have been remarkable over the last century, but especially over the last few decades, culminating in such high technology interventions as heart transplants and renal dialysis. These increases in medical powers have attracted societal interest in acquiring more such knowledge. They have also spawned concerns regarding the use of human subjects in research and regarding the byproducts of (...) basic research as in the recent recombinant DNA debate. As a consequence of the development of new biomedical knowledge, physicians and biomedical scientists have been placed in positions of new power and responsibility. The emergence of this group of powerful and knowledgeable experts has occasioned debates regarding the accountability of physicians and biomedical scientists. But beyond that, the very investment of resources in the acquisition of new knowledge has been questioned. Societies must decide whether finite resources would not be better invested at this juncture, or in general, in the alleviation of the problems of hunger or in raising general health standards through interventions which are less dependent on the intensive use of high technology. To put issues in this fashion touches on philosophical notions concerning the claims of distributive justice and the ownership of biomedical knowledge. (shrink)

Patient safety has only recently been subjected to wide-spread systematic study. Healthcare differs from other high risk industries in being more diverse and multi-contextual, and less certain and regulated. Also many patient safety problems are low-frequency events associated with many, varied contributing factors. The subject of this paper is the epistemology of patient safety (the science of the method of finding out about patient safety). Patient safety research is considered here on the background of a risk management framework which requires (...) researchers to: • Understand the context - as a subset of healthcare quality, services and systems research, with technical and human behavioural (cultural) components and a range of external and internal organisational influences, a wide range of research disciplines is necessary • Identify the risks - identify the things that go wrong and the frequency and nature of different types of incidents from sources such as medical record review, observational studies, audit, incident and medico-legal reports • Analyse the risks - deconstruct the things that go wrong, identifying contributing factors and trying to detect trends and patterns in contributing factors, detection, mitigation factors, ameliorating factors and actions taken to reduce risk • Evaluate the risks - decide on priorities, identifying preventive and corrective strategies and judging the risk- and cost-benefit of potential corrective strategies such as standardisation or simplification of a process or device • Manage the risk - evaluate and scope preventive and/or corrective strategies and then implement these, or place the problem on a risk register pending solution, or accept that what is needed is unaffordable • Communicate and consult - use interactive sessions, audit, on-going feedback, reminders and patient mediated prompts • Monitor and review the state of the problem - get baseline trends and patterns so that changes can be tracked and properly attributed to an intervention A hierarchy of levels of evidence has been proposed for clinical research and we argue that insufficient weighting has been given to lower ranked levels of research and to qualitative research, although critical interpretive synthesis is now gaining acceptance in mainstream thinking (e.g. by the Cochrane Collaboration). Fundamental challenges remain including how to grasp the elusive concept of patient safety, how to quantify, characterise and cost the problems, how to judge the extent to which harm can be attributed to errors, violations or system failures, how to identify contributing factors and the extent to which they can be implicated, how to judge whether incidents or their precursors are preventable, how to generate strong evidence to make healthcare safer and how to translate research into practice. Future directions include addressing the mundane as well as rare, dramatic events, and developing further research in non-hospital settings and in developing countries. In summary, a mixture of qualitative and quantitative methods, using information from all available data sources and combining retrospective, real time and prospective study designs, is necessary to address some of the more difficult patient safety problems. (shrink)

International Archives of the History of Ideas Archives internationales d'histoire des idées, Vol. 196. -/- Introduction, S. Hutton; Nicholas of Cusa : Platonism at the Dawn of Modernity, D. Moran; At Variance: Marsilio Ficino Platonism And Heresy, M.J.B. Allen; Going Naked into the Shrine:Herbert, Plotinus and the Consructive Metaphor, S.R.L.Clark; Commenius, Light Metaphysics and Educational Reform, J. Rohls ; Robert Fludd’s Kabbalistic Cosmos, W. Schmidt-Biggeman; Reconciling Theory and Fact:The Problem of ‘Other Faiths’ in Lord Herbert and the Cambridge Platonists, D. (...) Pailin; Trinity, Community and Love: Cudworth’s Platonism and the Idea of God, L. Armour; Chaos and Order in Cudworth’s Thought, J-L. Breteau; Cudworth, Prior and Passmore on the Autonomy of Ethics, R. Attfield; Substituting Aristotle: Platonic Themes In Dutch Cartesianism, H. van Ruler; Soul, Body, And World: Plato’s Timaeus And Descartes’ Meditations, C. Wilson ; Locke, Plato and Platonism, G.A.J. Rogers; Reflections on Locke’s Platonism, V. Nuovo; The Platonism at the Core of Leibniz’s Philosophy, C. Mercer; Leibniz and Berkeley: Platonic Metaphysics and ‘The Mechanical Philosophy’, S. Brown; Which Platonism for which Modernity? A Note on Shaftesbury’s Socratic Sea-Cards, L. Jaffro; Platonism, Aesthetics and the Sublime at the Origins Of Modernity, D. Hedley. (shrink)

This chapter describes the potential far‐reaching consequences of contemplative higher education for the fields of science and medicine.

A change in sense of self is an outcome commonly associated with Buddhist meditation. However, the sense of self is construed in multiple ways, and which changes in self-related processing are expected, intended, or possible through meditation is not well understood. In a qualitative study of meditation-related challenges, six discrete changes in sense of self were reported by Buddhist meditators: change in narrative self, loss of sense of ownership, loss of sense of agency, change in sense of embodiment, change in (...) self-other or self-world boundaries, and loss of sense of basic self. Changes in sense of self could be transient or enduring, positive or distressing, enhancing or impairing. These changes were also given varied appraisals, ranging from insights associated with Buddhist doctrines to psychopathologies such as depersonalization. In this study of practitioners reporting meditation-related challenges, more global changes in sense of self were associated with higher levels of impairment. These results have implications for both Buddhist meditation as well as mindfulness-based interventions. (shrink)

This essay is a response to Peter E. Vedder's Fall 2007 review of the authors' book, Norms of Liberty: A Perfectionist Basis for Non-Perfectionist Politics. Vedder argues that the authors 1) have a Kantian notion of self-directedness, and 2) are inconsistent in the application of their philosophical anthropology to their view of political liberty. In denying both claims, the authors assert that Vedder both fails to define certain terms and holds them to positions they do not accept.

We apply an online optimization process based on machine learning to the production of Bose-Einstein condensates. BEC is typically created with an exponential evaporation ramp that is optimal for ergodic dynamics with two-body s-wave interactions and no other loss rates, but likely sub-optimal for real experiments. Through repeated machine-controlled scientific experimentation and observations our ’learner’ discovers an optimal evaporation ramp for BEC production. In contrast to previous work, our learner uses a Gaussian process to develop a statistical model of the (...) relationship between the parameters it controls and the quality of the BEC produced. We demonstrate that the Gaussian process machine learner is able to discover a ramp that produces high quality BECs in 10 times fewer iterations than a previously used online optimization technique. Furthermore, we show the internal model developed can be used to determine which parameters are essential in BEC creation and which are unimportant, providing insight into the optimization process of the system. (shrink)