Background: Magnetic resonance spectroscopic imaging is a neuroimaging technique that may be useful for non-invasive mapping of brain temperature over a large brain volume. To date, intra-subject reproducibility of MRSI-based brain temperature has not been investigated. The objective of this repeated measures MRSI-t study was to establish intra-subject reproducibility and repeatability of brain temperature, as well as typical brain temperature range.Methods: Healthy participants aged 23–46 years were scanned at two time points ~12-weeks apart. Volumetric MRSI data were processed by reconstructing (...) metabolite and water images using parametric spectral analysis. Brain temperature was derived using the frequency difference between water and creatine for 47 regions of interest delineated by the modified Automated Anatomical Labeling atlas. Reproducibility was measured using the coefficient of variation for repeated measures, and repeatability was determined using the standard error of measurement. For each region, the upper and lower bounds of Minimal Detectable Change were established to characterize the typical range of TCRE values.Results: The mean global brain temperature over all subjects was 37.2°C with spatial variations across ROIs. There was a significant main effect for time [F = 37.0, p < 0.0001] and for brain region [F = 2.66, p < 0.0001]. The time*brain region interaction was not significant [F = 0.80, p = 0.83]. Participants' TCRE was stable for each ROI across both time points, with ROIs' COVrep ranging from 0.81 to 3.08% ; majority of ROIs had a COVrep <2.0%.Conclusions: Brain temperature measurements were highly consistent between both time points, indicating high reproducibility and repeatability of MRSI-t. MRSI-t may be a promising diagnostic, prognostic, and therapeutic tool for non-invasively monitoring brain temperature changes in health and disease. However, further studies of healthy participants with larger sample size and numerous repeated acquisitions are imperative for establishing a reference range of typical brain TCRE, as well as the threshold above which TCRE is likely pathological. (shrink)

Moral distress is a well-documented phenomenon for health care providers (HCPs). Exploring HCPs’ perceptions of participation in moral distress interventions using qualitative and quantitative methods enhances understanding of intervention effectiveness. The purpose of this study was to measure and describe the impact of a two-phased intervention on participants’ moral distress. Using a cross-over design, the project aimed to determine if the intervention would decrease moral distress, enhance moral agency, and improve perceptions about the work environment. We used quantitative instruments and (...) explored participants’ perceptions of the intervention using semi-structured interviews. Participants were from inpatient settings, within three major hospitals of a large, urban healthcare system in the Midwest, United States. Participants included nurses (80.6%) and other clinical care providers. Using generalized linear mixed modeling we assessed the change in each of the outcome variables over time controlling for groups. Interviews were audiotaped and professionally transcribed. The written narratives were coded into themes. The change in scores on study instruments trended in the desired direction however did not meet statistical significance. Qualitative interviews revealed that intervention effectiveness was derived from a combination of learning benefits, psychological benefits, and building community that promoted moral agency. Findings demonstrate a clear link between moral distress and moral agency and suggest that Facilitated Ethics Conversations can enhance the work environment. Findings provide insight for developing evidenced-based approaches to address moral distress of hospital nurses. (shrink)

This paper describes a practice innovation: the addition of formal weekly discussions of patients with prolonged PICU stay to reduce healthcare providers’ moral distress and decrease length of stay for patients with life-threatening illnesses. We evaluated the innovation using a pre/post intervention design measuring provider moral distress and comparing patient outcomes using retrospective historical controls. Physicians and nurses on staff in our pediatric intensive care unit in a quaternary care children's hospital participated in the evaluation. There were 60 patients in (...) the interventional group and 66 patients in the historical control group. We evaluated the impact of weekly meetings to establish goals of care for patients with longer than 10 days length of stay in the ICU for a year. Moral distress was measured intermittently and reported moral distress thermometer scores fluctuated. "Clinical situations" represented the most frequent contributing factor to moral distress. Post intervention, overall moral distress scores, measured on the moral distress scale revised, were lower for respondents in all categories, and on three specific items. Patient outcomes before and after PEACE intervention showed a statistically significant decrease in PRISM indexed LOS, a statistically significant increase in both code status changes DNR, and in-hospital death, with no change in patient 30 or 365 day mortality. The addition of a clinical ethicist and senior intensivist to weekly inter-professional team meetings facilitated difficult conversations regarding realistic goals of care. The study demonstrated that the PEACE intervention had a positive impact on some factors that contribute to moral distress and can shorten PICU length of stay for some patients. (shrink)

A recent Carnegie Report on Nursing Education – Educating Nurses: A Call for Radical Transformation challenges the nursing profession to embrace an education model that integrates knowledge, skilled know how and ethical comportment. Placing ethics in such a prominent position in nursing education is a radical transformation. Teaching ethics must be intentional and it is integral to the development of individual nurses and the profession as a whole. The development of moral imagination has a prominent place in this new education (...) model. The moral imagination is the ability to ponder and wonder about the inherent rightness or wrongness of decisions, choices and behaviors. This paper will review some key issues relevant to teaching ethics and then explore what nurturing the moral imagination could do for nurses as they learn to apply abstract ethics concepts to their clinical practice. (shrink)

Science and Convention: Essays on Henri Poincare's Philosophy of Science and The Conventionalist Tradition contains essays concerned with Henri Poincare's philosophy of science, physics in particular, and with the conventionalist tradition in philosophy that he revived and reshaped, simultaneously with, but independently of, Pierre Duhem. Separating five essays as chapters, the book discusses the main ideas of the philosophy (Essays 1 and 5), traces at least some of its historical background (Essays 1, 2, and 3), and provides some of its (...) developments (Essays 2 and 4). (shrink)

For decades a debate has played out in the literature about who bioethicists are, what they do, whether they can be considered professionals qua bioethicists, and, if so, what professional responsibilities they are called to uphold. Health care ethics consultants are bioethicists who work in health care settings. They have been seeking guidance documents that speak to their special relationships/duties toward those they serve. By approving a Code of Ethics and Professional Responsibilities for Health Care Ethics Consultants, the American Society (...) for Bioethics and Humanities (ASBH) has moved the professionalization debate forward in a significant way. This first code of ethics focuses on individuals who provide health care ethics consultation (HCEC) in clinical settings. The evolution of the code's development, implications for the field of HCEC and bioethics, and considerations for future directions are presented here. (shrink)

Table of ContentsAndrzej KLAWITER, Krzystof #ASTOWSKI: Introduction: Originality, Courage and Responsibility List of Books by Leszek NowakSelected Bibliography of Leszek Nowak's WritingsScience and Idealization Theo A.F. KUIPERS: On Two ...

This short note is a summary of the talk given at the Adam Mickiewicz University in Poznań during the conference on Philosophy of Mathematics, III , on October 17, 2011. We suggest to understand mathematical intuition as a collection of (verbalized) judgments constituting the core of the context of discovery in mathematics. Mathematical intuition is present not only in the axioms: it can be observed in mathematical research practice as well. A few examples of mathematical intuition in action are given. (...) We discuss the dynamic character of mathematical intuition, trying to reveal the sources of the corresponding changes of intuitive views in mathematics. There are several such sources, e.g.: paradoxes, new research programs (for instance, the program of arithmetization of analysis), explicit definitons of concepts understood so far in an intuitive way, and – of course – the development of the mathematical knowledge itself. We devote special attention to the distinction between standard, exception, and pathology. Finally, we say a few words about conflicts of intuitions in mathematics. (shrink)

The primary objective was to review pediatric ethics consultations at a large academic health center over a nine year period, assessing demographics, ethical issues, and consultant intervention. The secondary objective was to describe the evolution of PECs at our institution. This was a retrospective review of Consultation Summary Sheets compiled for PECs at our Academic Health Center between January 2008 and April 2017. There were 165 PECs reviewed during the study period. Most consult requests came from the inpatient setting, with (...) the Pediatric and Neonatal Intensive Care Units being the highest utilizers. Consultation utilization increased over the study period. The most common patient age was less than one year. Physicians were most likely to request consultation. Patient Best Interest, Withholding/Withdrawing of Life Sustaining Therapy, and Provider Moral Distress were ethical issues most commonly identified by the consultants. Making recommendations was the most common consultant intervention. The ethics consultation process evolved over time from informal provider discussions, to a hospital infant care review committee, to a pediatric only consultation service, to a combined adult/pediatric consultation service, with variable levels of salary support for consultants. Ethics consultation requests are growing at our institution. Similarities in identified ethical issues exist between our findings and existing literature, however meaningful comparisons remains elusive secondary to variability in approaches to investigation and reporting. A combined paid/volunteer/trainee ethics consultation service model appears sustainable and real time ethics consultation is feasible using this approach. (shrink)

Jerzy Perzanowski s ideas were based on an original blend of logic and ontology in what he called onto/logic, where the slash is meant to suggest a quotient of ontology by logic. Perzanowski began as a logician, his early works being on modal logic, then gradually shifted his interest to logical philosophy, meaning not so much philosophy of logic as philosophy informed by logic. Perzanowski was a rare breed of analytical philosopher who thought that a philosophical theory of everything (...) was worthwhile. In this systematic spirit, he began with method. He presented his method of total analysis and synthesis quite simply: reduce the object of research to its simplest possible constituents, and then combine them in some way. Better still, combine them in every possible way, thereby producing a space of possibilities analogous to (and in certain cases identical with) the logical space. Thus, analysis and synthesis differ from a trivial disassembly and reassembly.". (shrink)

Chciałem Go pożegnać. Kilkakrotnie próbowałem napisać choć parę słów. O Nim samym. Okazało się, że nie potrafię. Udało mi się tylko przedstawić Jego poglądy na reizm Tadeusza Kotarbińskiego, ale uczyniłem to gdzie indziej. Muszę tu poprzestać na ofiarowaniu Mu tego, co napisałem na Jego dziewięćdziesiąte urodziny, w osiemdziesięciolecie naszej przyjaźni.

Since 1992, institutions accredited by The Joint Commission have been required to have a process in place that allows staff members, patients, and families to address ethical issues or issues prone to conflict. While the commission's expectations clearly have made ethics committees more common, simply having a committee in no way demonstrates its effectiveness in terms of the availability of the service to key constituents, the quality of the processes used, or the outcomes achieved. Beyond meeting baseline accreditation standards, effective (...) ethics resources are requisite for quality care for another reason. The provision of care to the sick is a practice with profound moral dimensions. Clinicians need what Margaret Urban Walker has called “moral spaces,” reflective spaces within institutions in which to explore and communicate values and ethical obligations as they undergird goals of care. Walker proposed that ethicists needed to be concerned with the design and maintenance of these moral spaces. Clearly, that concern needs to extend beyond ethicists to institutional leaders. This essay uses Walker's idea of moral space to describe individuals and groups who are actual and potential ethics resources in health care institutions. We focus on four requisite characteristics of effective resources and the challenges to achieving them, and we identify strategies to build them. In our view, such moral spaces are particularly important for nurses and their colleagues on interprofessional teams and need to be expanded and strengthened in most settings. (shrink)

Contents: INTRODUCTION. Kazimierz TWARDOWSKI: The Majesty of the University. I. Zygmunt ZIEMBI??N??SKI: What Can Be Saved of the Idea of the University? Leszek KO??l??AKOWSKI: What Are Universities for? Leon GUMA??N??SKI: The Ideal University and Reality. Zygmunt BAUMAN: The Present Crisis of the Universities. II. Kazimierz AJDUKIEWICZ: On Freedom of Science. Henryk SAMSONOWICZ: Universities and Democracy. Jerzy TOPOLSKI: The Commonwealth of Scholars and New Conceptions of Truth. Klemens SZANIAWSKI: Plus ratio quam vis. III. Leon KOJ: Science, Teaching and Values. Klemens (...) SZANIAWSKI: The Ethics of Scientific Criticism. Jerzy BRZEZI??N??SKI: Ethical Problems of Research Work of Psychologists. IV. Janusz GO??L??KOWSKI: Tradition in Science. Jerzy KMITA: Is a "Creative Man of Knowledge" Needed in University Teaching? Leszek NOWAK: The Personality of Researchers and the Necessity of Schools in Science. RECAPITULATION. Jerzy BRZEZI??N??SKI: Reflections on the University. (shrink)

Campbell, Ulrich, and Grady (2016) should be commended for attempting to contribute to the discussion of what many believe is currently a messy concept. They propose that a broader definition of mo...

Jerzy Franczak comprehensively presents Jacques Rancière's thought by emphasizing the relations between politics and literature. The detailed analysis considers the context of modern aesthetics and political philosophy, which is why the book introduces further protagonists, such as Louis Althusser, Michel Foucault, Pierre Bourdieu, or Jean-François Lyotard. Franczak first reconstructs Rancière's original philosophy of literature so as to then immediately apply it in readings of select world literature masterpieces by Gustav Flaubert, Max Jacob, Bertold Brecht, Vladimir Nabokov, and Philip Roth.