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)

BackgroundBioethics as a field related to the health system and health service delivery has grown in the second half of the 20th century, mainly in North America. This is attributed, the author argues, to mainly three kinds of development that took place in the developed countries at a pace different than the developing countries. They are namely: development of the health system; moral development; and political development.DiscussionThis article discusses the factors that impede the development of the field of bioethics from (...) an academic activity to a living field that is known and practiced by the people in the developing countries. They are quite many; however, the emphasis here is on role of the political structure in the developing countries and how it negatively affects the development of bioethics. It presents an argument that if bioethics is to grow within the system of health service, it should be accompanied by a parallel changes in the political mindsets in these countries.SummaryFor bioethics to flourish in developing countries, it needs an atmosphere of freedom where people can practice free moral reasoning and have full potential to take their life decisions by themselves. Moreover, bioethics could be a tool for political change through the empowerment of people, especially the vulnerable.To achieve that, the article is proposing a practical framework for facilitating the development of the field of bioethics in the developing countries. (shrink)

SummaryIn the formative period of London's scientific instrument industry membership of a guild was a necessary step towards owning a business in the City. Through the guilds' formal system of apprenticeship, boys received first-class training in a skilled trade, and learned essential marketing and managerial techniques. By analysing the guilds' records of apprenticeship and subsequent guild life it is possible to determine chains of masters and apprentices by which the knowledge passed from generation to generation. At the same time, dates (...) can be established for the training and subsequent working life of many known makers. The chains of knowledge reveal new and often important masters who were previously unknown because, by chance, their instruments or advertisements have not survived to the present day. Two guilds have been used to illustrate the chains: Broderers' Company and Joiners' Company. (shrink)

Some ethicists argue that patient confidentiality is absolute and thus should never be broken. I examine these arguments that when critically scrutinised, become porous. I will explore the concept of patient confidentiality and argue that although, this is a very important medical and bioethical issue, this needs to be wisely delivered to reduce third party harm or even detriment to the patient. The argument for absolute confidentiality is particularly weak when it comes to genetic information and inherited disease.

An appropriate kind of curved Hilbert space is developed in such a manner that it admits operators of $\mathcal{C}$ - and $\mathfrak{D}$ -differentiation, which are the analogues of the familiar covariant and D-differentiation available in a manifold. These tools are then employed to shed light on the space-time structure of Quantum Mechanics, from the points of view of the Feynman ‘path integral’ and of canonical quantisation. (The latter contains, as a special case, quantisation in arbitrary curvilinear coordinates when space is (...) flat.) The influence of curvature is emphasised throughout, with an illustration provided by the Aharonov-Bohm effect. (shrink)

Find out all about dreams and you will know all about insanity. ?Hughlings Jackson.

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)

Contour adaptation is a recently described paradigm that renders otherwise salient visual stimuli temporarily perceptually invisible. Here we investigate whether this illusion can be exploited to study visual awareness. We found that CA can induce seconds of sustained invisibility following similarly long periods of uninterrupted adaptation. Furthermore, even fragmented adaptors are capable of producing CA, with the strength of CA increasing monotonically as the adaptors encompass a greater fraction of the stimulus outline. However, different types of adaptor patterns, such as (...) distinctive shapes or illusory contours, produce equivalent levels of CA suggesting that the main determinants of CA are low-level stimulus characteristics, with minimal modulation by higher-order visual processes. Taken together, our results indicate that CA has desirable properties for studying visual awareness, including the production of prolonged periods of perceptual dissociation from stimulation as well as parametric dependencies of that dissociation on a host of stimulus parameters. (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 book provides a clear and nuanced appraisal of Hegel's treatment of Africa, India, and Islam, and of the implications of this treatment for postcolonial and global studies. Analyzing Hegel's master-slave dialectic and his views on Africa, India, and Islam, it situates these views not only within Hegel's historical scheme but also within a broader European philosophical context and the debates they have provoked within Hegel scholarship. Each chapter explores various in depth readings of Hegel by postcolonial critics, investigating both (...) the Eurocentric and potentially global nature of his dialectic. Ultimately, the book shows both where of this profoundly influential thinker archetypally embodies certain Eurocentric traits that have characterized modernity and how, ironically, he himself gives us the tools for working towards a more global vision. Offering a concise introduction not only to an important dimension of Hegel's thought - his orientation towards "empire" - but also to the various issues raised by postcolonial theory and global studies, this book will be of use to philosophers as well as advanced students of literary and cultural theory alike. (shrink)

Psychological research has shown that cognitive illusions, of which visual illusions are just a special case, are systematic and pervasive, raising epistemological questions about how error in all forms of research can be identified and eliminated. The quantitative sciences make use of statistical techniques for this purpose, but it is not clear what the qualitative equivalent is, particularly in view of widespread scepticism about validity and objectivity. I argue that, in the light of cognitive psychology, the ‘error question’ cannot be (...) dismissed as a positivist obsession, and that the concepts of truth and objectivity are unavoidable. However, they constitute only a ‘minimal realism’, which does not necessarily bring a commitment to ‘absolute’ truth, certainty, correspondence, causation, reductionism, or universal laws in its wake. The assumption that it does reflects a misreading of positivism and, ironically, precipitates a ‘crisis of legitimation and representation’, as described by constructivist authors. (shrink)