IntroductionThe objectives of this study are to assess and compare differences in the intensity, frequency, and overall severity of moral distress among a diverse group of healthcare professionals.MethodsParticipants from within Baylor Health Care System completed an online seven-point Likert scale (range, 0 to 6) moral distress survey containing nine core clinical scenarios and additional scenarios specific to each participant’s discipline. Higher scores reflected greater intensity and/or frequency of moral distress.ResultsMore than 2,700 healthcare professionals responded to the survey (response rate 18.14 (...) percent); survey respondents represented multiple healthcare disciplines across a variety of settings in a single healthcare system. Intensity of moral distress was high in all disciplines, although the causes of highest intensity varied by discipline. Mean moral distress intensity for the nine core scenarios was higher among physicians than nurses, but the mean moral distress frequency was higher among nurses. Taking into account both intensity and frequency, the difference in mean moral distress score was statistically significant among the various disciplines. Using post hoc analysis, differences were greatest between nurses and therapists.ConclusionsMoral distress has previously been described as a phenomenon predominantly among nursing professionals. This first-of-its-kind multidisciplinary study of moral distress suggests the phenomenon is significant across multiple professional healthcare disciplines. Healthcare professionals should be sensitive to situations that create moral distress for colleagues from other disciplines. Policy makers and administrators should explore options to lessen moral distress and professional burnout that frequently accompanies it. (shrink)

We study the groups Gal L and Gal KP, and the associated equivalence relations EL and EKP, attached to a first order theory T. An example is given where EL≠ EKP. It is proved that EKP is the composition of EL and the closure of EL. Other examples are given showing this is best possible.

La evaluación constituye un elemento curricular decisivo para mejorar el aprendizaje del alumnado, siempre que se utilice de modo continuo y con carácter formativo. La evaluación formativa evalúa procesos, ofreciendo datos permanentes acerca de cómo se produce paso a paso ese aprendizaje, permitiendo así detectar las dificultades que se presentan y los talentos del alumnado y adoptar las medidas adecuadas de modo inmediato. Este planteamiento favorece la personalización de la evaluación y, con ello, la atención a cada estudiante en función (...) de sus peculiaridades, garantizando la inclusión educativa de calidad para todos. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

In this paper, we describe the use of legal ontologies as a basis to improve IT support for professional judges. As opposed to most legal ontologies designed so far, which are mostly based on dogmatic and normative knowledge, we emphasize the importance of professional knowledge and experience as an important pillar for constructing the ontology. We describe an intelligent FAQ system for junior judges that intensively use the ontology.

A Steiner triple system (STS) is a set S together with a collection B of subsets of S of size 3 such that any two elements of S belong to exactly one element of B. It is well known that the class of finite STS has a Fraïssé limit M_F. Here, we show that the theory T of M_F is the model completion of the theory of STSs. We also prove that T is not small and it has quantifier elimination, (...) TP2, NSOP1, elimination of hyperimaginaries and weak elimination of imaginaries. (shrink)

A model $M$ of countable similarity type and cardinality $\kappa$ is expandable if every consistent extension $T_{1}$ of its complete theory with $|T_{1}|\leq \kappa$ is satisfiable in $M$ and it is compactly expandable if every such extension which additionally is finitely satisfiable in $M$ is satisfiable in $M$ . In the countable case and in the case of a model of cardinality $\geq 2^{\omega}$ of a superstable theory without the finite cover property the notions of saturation, expandability and compactness for (...) expandability agree. The question of the existence of compactly expandable models which are not expandable is open. Here we present a test which serves to prove that a compactly expandable model of cardinality $\geq 2^{\omega}$ of a superstable theory is expandable. It is stated in terms of the existence of a certain elementary submodel whose corresponding theory of pairs of models satisfies a weak elimination of Ramsey quantifiers. (shrink)

We regret to inform our readers that Marianne (Tracy) Paget died of cancer in December 1989. She continued her work virtually until her death. She left a manuscript in which she writes about her own experiences with cancer. The Text from Life, which her colleagues and friends will have published. She was a courageous and remarkable scholar, a life long friend of this journal, and a dedicated phenomenologist. She will be greatly missed. The Editor.

Using delay differential equations to study mathematical models of Parkinson's disease and Huntington's disease is important to show how important it is for synchronization between basal ganglia loops to work together. We used the delay circuit RLC (resistor, inductor, capacitor) model to show how the direct pathway and the indirect pathway in the basal ganglia excite and inhibit the motor cortex, respectively. A term has been added to the mathematical model without time delay in the case of the hyperdirect pathway. (...) It is proposed to add a non-linear term to adjust the synchronization. We studied Hopf bifurcation conditions for the proposed models. The desynchronization of response times between the direct pathway and the indirect pathway leads to different symptoms of Parkinson's disease. Tremor appears when the response time in the indirect pathway increases at rest. The simulation confirmed that tremor occurs and the motor cortex is in an inhibited state. The direct pathway can increase the time delay in the dopaminergic pathway, which significantly increases the activity of the motor cortex. The hyperdirect pathway regulates the activity of the motor cortex. The simulation showed bradykinesia occurs when we switch from one movement to another that is less exciting for the motor cortex. A decrease of GABA in the striatum or delayed excitation of the substantia nigra from the subthalamus may be a major cause of Parkinson's disease. An increase in the response time delay in one of the pathways results in the chaotic movement characteristic of Huntington's disease. (shrink)

Domestic violence is one of the most serious forms of violation of basic human freedoms and rights regardless of ethnicity, gender, religion, and status. A reflection on many international statistics shows that women are the most frequent victims of domestic violence. Based on the definition of the phenomenon of domestic violence, the forms of abuse, the manner how violence is treated, the possibility of children, men, extramarital spouses, brothers, sisters, and old people living in an extended domestic community, of also (...) being victims is not excluded. Since domestic violence is not only a national problem but a worldwide problem, international organizations have worked towards the eradication of this phenomenon by sanctioning it in various international conventions. Also, the legal systems of many countries prohibit and sanction domestic violence by special laws obliging the state authorities to act in all situations when there are indications that there are direct or indirect violent acts in a family. In this paper, the authors present only the domestic violence against children as an evident problem in families, but which is often unreported. The legal frameworks of the Republic of North Macedonia and Republic of Kosovo are presented in this paper with the aim to describe the material-legal and procedural-legal treatment of domestic violence by pointing out the failure of the state authorities in implementing the laws on protection and prevention of this phenomenon. The authors take the approach of only treating the legal consequences of child abuse by parents that in both legislations is deprivation of parental rights for the violent parent. They conclude that the state authorities should intensify their work in taking control measures towards all the families where there are suspicions that the parental rights are neglected, and the child is abused. Because many cases of abuse have not been detected or reported, and in both countries a special study especially on domestic violence against children does not exist, the possibility that the number for this type of child abuse is great. (shrink)

The article analyzes the implementation of an online educational module and its impact on the organization of the classroom’s interaction order. The latter is institutionally constrained by the presence of a goal and the distribution of roles between teacher and students. The introduction of a digital learning platform adds a technological context to the institutional setting. The article considers technologies as possessing communicative affordances — opportunities for action made possible or delimited through their use. Technologies bring new interactive resources to (...) the process of ed­ucation and can affect the organization of the classroom’s interaction order. Using multimodal conversation analysis, we analyzed video recordings of the telemediated interaction of Russia-based students and teachers within a gamified online educational module. We investigate a case in which a student’s correct answer is nevertheless corrected by the teacher. We dem­onstrate that the teacher initiates the correction because they are guided by the ordering of the game elements within the interface. Based on a detailed analysis of the teacher’s mouse movement in relation to ongoing turns-at-talk, we show that this orientation is sustained by all participants. The work contributes to classroom interaction studies and affordance theory and develops the methodology of multimodal transcription for mediated contexts. The primary result of the study is an empirical demonstration that the relevance of technological affordances for interactants is situation­ally produced, and that this process is associated with the interweaving of the institutional and technical context of interaction. The conclusion discusses the relationship between affordances and institutional norms. (shrink)

The article addresses the issue of using English songs to assist students of non-language departments master basic linguistic skills and communicative abilities. The authors offer a systematic and flexible approach to dealing with educational songs, demonstrate advantages of implementing numerous tasks to be varied and adapted to the needs of particular target audiences. The considered approach is intended to raise students’ motivation in learning foreign language.

By decision of the World Council of Peace, progressive mankind marked, on October 5, 1963, the 250th anniversary of the birth of an outstanding representative of the French Enlightenment, Denis Diderot. Diderot occupies an honored place in the history of world thought on esthetics, as one of the greatest theoreticians of realist art. The esthetic theory founded by Diderot, calling for the representation of nature, was directed against the feudal, theological world view and against the aristocratic art of the court. (...) Diderot's esthetics, like his philosophy, served the cause of ideological preparation for the bourgeois revolution at the end of the 18th century in France. "Each age has its distinctive spirit," said Diderot. "The spirit of our age is the spirit of freedom.". (shrink)

The goal of this paper is to figure out whether Aristotle's response to the argument for fatalism in De Interpretatione 9 is a success. By "response" it is meant not simply the reasons Aristotle offers to highlight why fatalism does not accord with how we conduct our lives, but also the solution he devises to block the argument for fatalism. This paper finds that a) Aristotle's argument for fatalism is essentially bivalence plus that the truth of a proposition implies necessity, (...) b) that Aristotle's solution is to restrict bivalence, c) that this solution is coherent, and d) that while this solution does not rule out the possibility of fatalism, it does succeed in blocking the argument for fatalism offered within chapter 9. El objetivo de este trabajo es esclarecer si la respuesta de Aristóteles al argumento a favor del fatalismo en De Interpretatione 9 resulta exitosa. Por "respuesta" se entienden no solo las razones que da Aristóteles para destacar porqué el fatalismo no concuerda con la manera en que llevamos nuestras vidas, sino también la solución que ofrece para bloquear el argumento a favor del fatalismo. El artículo plantea a) que el argumento de Aristóteles respecto del fatalismo consiste esencialmente en la bivalencia más el hecho de que la verdad de una proposición implica necesidad; b) que la solución de Aristóteles es restringir la bivalencia; c) que esta solución es coherente, y d) que si bien esta solución no elimina la posibilidad del fatalismo, sí logra bloquear el argumento a favor del fatalismo ofrecido en el capítulo 9. O objetivo deste trabalho é esclarecer se a resposta de Aristóteles ao argumento a favor do fatalismo em De Interpretatione 9 é bem-sucedida. Por "resposta" se entendem não somente as razões que Aristóteles dá para destacar por que o fatalismo não está de acordo com a maneira em que levamos nossas vidas, mas também a solução que oferece para bloquear o argumento a favor do fatalismo. Este artigo propõe que: a) o argumento de Aristóteles a respeito do fatalismo consiste essencialmente na bivalência mais o fato de que a verdade de uma proposição implica necessidade; b) a solução de Aristóteles é restringir a bivalência; c) essa solução é coerente, e d) embora essa solução não elimine a possiblidade do fatalismo, consegue bloquear o argumento a favor dele oferecido no capítulo 9. (shrink)

The objectives of this study were to develop a high-density chromosome bin map of homoeologous group 7 in hexaploid wheat, to identify gene distribution in these chromosomes, and to perform comparative studies of wheat with rice and barley. We mapped 2148 loci from 919 EST clones onto group 7 chromosomes of wheat. In the majority of cases the numbers of loci were significantly lower in the centromeric regions and tended to increase in the distal regions. The level of duplicated loci (...) in this group was 24% with most of these loci being localized toward the distal regions. One hundred nineteen EST probes that hybridized to three fragments and mapped to the three group 7 chromosomes were designated landmark probes and were used to construct a consensus homoeologous group 7 map. An additional 49 probes that mapped to 7AS, 7DS, and the ancestral translocated segment involving 7BS also were designated landmarks. Landmark probe orders and comparative maps of wheat, rice, and barley were produced on the basis of corresponding rice BAC/PAC and genetic markers that mapped on chromosomes 6 and 8 of rice. Identification of landmark ESTs and development of consensus maps may provide a framework of conserved coding regions predating the evolution of wheat genomes. (shrink)

In order to accomplish the transition from avascular to vascular growth, solid tumours secrete a diffusible substance known as tumour angiogenesis factor (TAF) into the surrounding tissue. Endothelial cells which form the lining of neighbouring blood vessels respond to this chemotactic stimulus in a well-ordered sequence of events comprising, at minimum, of a degradation of their basement membrane, migration and proliferation. Capillary sprouts are formed which migrate towards the tumour eventually penetrating it and permitting vascular growth to take place. It (...) is during this stage of growth that the insidious process of invasion of surrounding tissues can and does take place. A model mechanism for angiogenesis is presented which includes the diffusion of the TAF into the surrounding host tissue and the response of the endothelial cells to the chemotactic stimulus. Numerical simulations of the model are shown to compare very well with experimental observations. The subsequent vascular growth of the tumour is discussed with regard to a classical reaction-diffusion pre-pattern model. (shrink)

Los análisis recientes de José Casanova, Jürgen Habermas, Gordon Lynch, Hans Joas, Robert Bellah, David Martin o el último Peter Berger -entre otros- han puesto el foco en las limitaciones asociadas a la teoría general de la secularización, convertida, durante décadas, en paradigma a partir del cual comprender e interpretar las relaciones entre lo secular y lo religioso. A través de la teoría de la post-secularización se ha podido re-graduar la mirada sociológica en torno a dichas relaciones, poniendo el (...) énfasis en la vitalidad y pluralidad de formas que adquiere lo religioso en la actualidad. Partiendo de este presupuesto, el objetivo de nuestro trabajo es realizar una genealogía sociológico-conceptual de la post-secularización centrada en el análisis de algunas de las principales aportaciones teóricas que han contribuido al desarrollo de esta nueva forma de aproximación a la secularización. Dicha genealogía no se va a limitar al análisis de la obra de autores que han articulado sus propuestas como respuesta a las insuficiencias de la teoría general de la secularización, sino también queremos estudiar brevemente algunas aportaciones de clásicos del pensamiento sociológico –concretamente de Durkheim y de Weber- cuyas reflexiones ya apuntaban a un horizonte de post-secularización. Así, tras la introducción presentaremos un primer apartado centrado en estudiar el politeísmo moderno según Weber y la cosa sagrada en la obra de Durkheim. Posteriormente presentaremos tres análisis teóricos actuales, concretamente los de Habermas, Casanova y Lynch, que nos ayudarán a perfilar los contornos conceptuales de la post-secularización. (shrink)

Many contemporary logicians acknowledge a plurality of logical theories and accept that theory choice is in part motivated by logical evidence. However, just as there is no agreement on logical theories, there is also no consensus on what constitutes logical evidence. In this paper, I outline Jean Piaget’s psychological theory of reasoning and show how he used it to diagnose and solve one of the paradoxes of material implication. I assess Piaget’s use of psychology as a source of evidence for (...) logical theory in light of reservations raised by psychologism, and I highlight some ramifications for exceptionalism and anti-exceptionalism about logic by considering his use of psychology as logical evidence in the framework of genetic epistemology, Piaget’s research programme. I conclude that Piaget’s psychological theory of reasoning not only plausibly serves as a source of evidence for logical theory but also makes a strong case for anti-exceptionalism about logic. (shrink)

The vast majority of contributions to the literature on spirituality in nursing make extravagant claims about transcendence, eternity, the numinous, higher powers, higher levels of existence, invisible forces, cosmic unity, the essence of humanity, or other supernatural concepts. Typically, these assertions are made without the support of argument or evidence; and, as a consequence, alternative ways of theorizing ‘spirituality’ have been closed off, while the lack of consistent scholarship has turned the topic into a metaphysical backwater. In this paper, I (...) adopt a different premise, rejecting unsupported claims, and surveying the ‘spirituality’ terrain from a naturalistic and reductionist perspective. I argue that, if we rid ourselves of non‐naturalistic assumptions, we will discover theoretical and clinical resources in health psychology, social psychology, neuropsychology, and pharmacopsychology – resources which confirm that it is possible to conceptualize the study of existential concerns, and how health professionals might respond to them, in a properly scientific manner. In order to illustrate the potential usefulness of these resources, I will take palliative care as an example. (shrink)

This text explores how human beings construe experience: experience as a resource, as a potential for understanding, representing and acting on reality.

There is a theistic argument which is discussed at least twice in the Hume corpus, both times rather perfunctorily. This perfunctoriness has carried over to some of his commentators, who are not always clear as to what the argument is or about the force of Hume’s comments on it. On page 23 of A Letter from a Gentleman to his Friend in Edinburgh Hume calls it “the metaphysical Argument a priori” and in Part 9 of Dialogues concerning Natural Religion simply (...) “the argument a priori”.1 It is the argument of Demea. (shrink)