As out-of-hospital emergencies become more commonplace, so does the call for a “doctor in the house”. New York City paediatrician Mitchell Rubin has responded to numerous such crises over the past 25 years. He explores reactions on all sides of this peculiar physician–victim relationship, his growing concerns and fears, and possible reasons why many doctors hesitate to act. His thoughts and experiences instigate the discussion about the need for a universal system of Good Samaritan physician respondersWhile flying to Italy (...) last spring, the pilot’s voice came over the loudspeaker: “Is there a doctor on board”? How many times have I heard this request in the last 25 years? A passenger had fainted. As I began caring for her, the pilot asked me, “Should we take the plane down?”. Surprised to be given this responsibility, I took my best guess and answered “no”. After a stressful landing, while I gave oxygen to the prostrate woman, we were met by an ambulance on the tarmac. The woman was appreciative and gracious, the pilot scarcely offered thanks, and I began my vacation exhausted.Having been trained as a paediatrician, I have responded to nearly two dozen “Good Samaritan” scenarios, where a person was injured or became critically sick in a public setting. Perhaps I have had more than my fair share, but I wonder if this is an important and mounting phenomenon. With America growing older and more and more people with serious, chronic illnesses remaining active in the community, we should not be surprised to see increasing numbers of out-of-hospital emergencies. And, as this becomes more commonplace, I become less and less certain of the role I—and other physicians like me—should have.When I was young, cocky and fearless, the call to meet an emergency was exciting. Shortly after training, an …. (shrink)

> Wealthy nations must do much more, much faster. The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference 26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature (...) and protect health. Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades.1 The science is unequivocal; a global increase of 1.5°C above the preindustrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse.2 3 Despite the world’s necessary preoccupation with COVID-19, we cannot wait for the pandemic to pass to rapidly reduce emissions. Reflecting the severity of the moment, this editorial appears in health journals across the world. We are united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory. The risks to health of increases above 1.5°C are now well established.2 Indeed, no temperature rise is ‘safe’. In the past 20 years, heat-related mortality among people aged over 65 has increased by more than 50%.4 Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality.5 6 Harms disproportionately affect the most vulnerable, including children, older populations, ethnic minorities, poorer communities and those with underlying health problems.2 4 Global heating is also contributing to the decline in …. (shrink)

In 2015, the major critical care societies issued guidelines outlining a procedural approach to resolving intractable conflict between healthcare professionals and surrogates over life-sustaining treatments (LST). We report our experience with a resolving conflict procedure. This was a retrospective, single-centre cohort study of ethics consultations involving intractable conflict over LST. The resolving conflict process was initiated eleven times for ten patients over 2,015 ethics consultations from 2000 to 2020. In all cases, the ethics committee recommended withdrawal of the contested LST. (...) In seven cases, the patient died or was transferred or a legal injunction was obtained before completion of the process. In the four cases in which LST was withdrawn, the time from ethics consultation to withdrawal of LST was 24.8 ± 12.2 days. Healthcare provider and surrogate were often distressed during the process, sometimes resulting in escalation of conflict and legal action. In some cases, however, surrogates appeared relieved that they did not have to make the final decision regarding LST. Challenges regarding implementation included the time needed for process completion and limited usefulness in emergent situations. Although it is feasible to implement a due process approach to conflict over LST, there are factors that limit the procedure’s usefulness. (shrink)

Critical care society guidelines recommend that ethics committees mediate intractable conflict over potentially inappropriate treatment, including Do Not Resuscitate status. There are, however, limited data on cases and circumstances in which ethics consultants recommend not offering cardiopulmonary resuscitation despite patient or surrogate requests and whether physicians follow these recommendations. This was a retrospective cohort of all adult patients at a large academic medical center for whom an ethics consult was requested for disagreement over DNR status. Patient demographic predictors of ethics (...) consult outcomes were analyzed. In 42 of the 116 cases, the patient or surrogate agreed to the clinician recommended DNR order following ethics consultation. In 72 of 74 of the remaining cases, ethics consultants recommended not offering CPR. Physicians went on to write a DNR order without patient/surrogate consent in 57 of those cases. There were no significant differences in age, race/ethnicity, country of origin, or functional status between patients where a DNR order was and was not placed without consent. Physicians were more likely to place a DNR order for patients believed to be imminently dying. The median time from DNR order to death was 4 days with a 90-day mortality of 88.2%. In this single-center cohort study, there was no evidence that patient demographic factors affected ethics consultants’ recommendation to withhold CPR despite patient/surrogate requests. Physicians were most likely to place a DNR order without consent for imminently dying patients. (shrink)

Systematic study of the intersection of ethics consultation services and solid organ transplants and recipients can identify and illustrate ethical issues that arise in the clinical care of these patients, including challenges beyond resource allocation. This was a single-centre, retrospective cohort study of all adult ethics consultations between January 1, 2007, and December 31, 2017, at a large academic medical centre in the north-eastern United States. Of the 880 ethics consultations, sixty (6.8 per cent ) involved solid organ transplant, thirty-nine (...) (65.0 per cent) for candidates and twenty-one (35.0 per cent ) for recipients. Ethics consultations were requested for 4.3 per cent of heart, 4.9 per cent of lung, 0.3 per cent of liver, and 0.3 per cent of kidney transplant recipients over the study period. Nurses were more likely to request ethics consultations for recipients than physicians (80.0 per cent vs 20.0 per cent, p = 0.006). The most common reason for consultation among transplant candidates was discussion about intensity of treatment or goals of care after the patient was not or was no longer a transplant candidate. The most common reason for ethics consultation among transplant recipients was disagreement between transplant providers and patients/families/non-transplant healthcare professionals over the appropriate intensity of treatment for recipients. Very few consultations involved questions about appropriate resource allocation. Ethics consultants involved in these cases most often navigated communication challenges between transplant and non-transplant healthcare professionals and patients and families. (shrink)

This is the first book to examine individual rights from an economic perspective, collecting together leading articles in this emerging area of interest and showing the vibrant and expanding scholarship that relates them. Areas covered include The implications of constitutional protections of individual rights and freedoms, including freedom of speech and of the press, The right to bear arms, The right against unreasonable searches, The right against self-incrimination, The right to trial by jury, The right against cruel and unusual punishment, (...) including capital punishment. The focus of these papers is both theoretical and empirical, examining how economics can illuminate the entire sequence of crime and punishment, from the decision to commit a crime, to police methods for apprehending and arresting criminals, to the rules used in trials to the scope of punishment for the convicted. (shrink)

ABSTRACTNew methods of calculating indices from the dot-probe task measure temporal dynamics in attention bias or fluctuations in attention bias towards and away from emotional stimuli over time. H...

Modelling data in applied areas particularly in reliability engineering is a prominent research topic. Statistical models play a vital role in modelling reliability data and are useful for further decision-making policies. In this paper, we study a new class of distributions with one additional shape parameter, called a new generalized exponential-X family. Some of its properties are taken into account. The maximum likelihood approach is adopted to obtain the estimates of the model parameters. For assessing the performance of these estimators, (...) a comprehensive Monte Carlo simulation study is carried out. The usefulness of the proposed family is demonstrated by means of a real-life application representing the failure times of electronic components. The fitted results show that the new generalized exponential-X family provides a close fit to data. Finally, considering the failure times data, the Bayesian analysis and performance of Gibbs sampling are discussed. The diagnostics measures such as the Raftery–Lewis, Geweke, and Gelman–Rubin are applied to check the convergence of the algorithm. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:RANSOM'S GOD WITHOUT THUNDER: REMYTHOLOGIZING VIOLENCE AND POETICIZING THE SACRED Gary M. Ciuba Kent State University From tree-lined Vanderbilt University of 1930 Nashville, the modernist poet and critic John Crowe Ransom longed to hear in his imagination the God who thundered fiercely in ancient Greece, Rome, and Israel. The God of sacrifice who in Homer's Iliad, "his thunder striking terror," received libations from the warring armies (230). The God (...) of jealousy who in Aeschylus' Prometheus Bound "drove the sleepless thunderbolt, / plunged the fire spurting shaft/ down" on Typhon for defying heaven with his violence (46). The God of vengeance who in Ovid's Metamorphoses sent "blinding / Thunder [to shake] Olympus, and Pelim / Thrust down by heaven's bolt crashed over Ossa" when the giants piled mountain upon mountain to reach Jove's throne (35). The God ofviolence who in Psalm 78:48 delivered the cattle ofthe obstinate Egyptians "to the hail, and their flocks to hot thunderbolts" or who in 1 Samuel 7:10 "thundered with great thunder" to smite the Philistines. In God Without Thunder: An Unorthodox Defense of Orthodoxy Ransom attacked the modern heresy that deprived the deity ofsuch awful might and summoned Americans to live under a new myth of sacred violence. IfRansom listened with the ears ofthe Methodist faith in which he had been raised, he might have heard how the god of old was muted at the university where he studied and later taught. Ten years before Ransom was born, Methodist-sponsored Vanderbilt had eliminated the lectureship of naturalist Alexander Winched because hisPre-Adamites had challenged the Creation story in Genesis. But in 1914, when Ransom returned to his alma Gary M. Ciuba41 mater to begin more than two decades of teaching there, the Methodists ended their affiliation with Vanderbilt because of a dispute about church governance of the university (Bailey 9-10, 31-4). When the Scopes Trial caused a furor in 1925, Ransom was invited by Vanderbilt to condemn the Fundamentalists to the southeast in Dayton. He refused-not because he sided with the anti-Darwinists but because he believed that the tyranny of science was threateningthe poetic foundation ofreligion (Quinlan 40, n. 3). Ransom's thunderless plight was virtually imagined by H.L. Mencken, one of the most stinging critics of the creationists, when in 1922 he penned a tongue-in-cheek lament forthe passing ofthe ancient deities. "Where is the graveyard of dead gods? What lingering mourner waters their mounds? There was a time when Jupiter was the king ofthe gods, and any man who doubted his puissance was ipso facto a barbarian and an ignoramus," Mencken mock-elegized in "Memorial Service." "But where in all the world is there a man who worships Jupiter today?" (95). God Without Thunder provides the answer to Mencken's archly lugubrious question: it is John Crowe Ransom. Grieving the demise ofthe deity ofyore, Ransom's treatise on the religious imagination heralds a one-man revival of Jupiter Tonans. Ransom believes that the god ofantiquity has been muffled bythe spirit of scientific abstraction that reigns notjust in Tennessee but across all of America.7 Hetraces this modern cult ofthe mind beyond the current efforts ofreligion to seek a rapprochement with biology and physics; beyond the science-driven Prometheus of Shelley, the rationalism of the Protestant Reformation, and the inquiry of Copernicus; beyond the errors of early Christianity, to a kind of primal sin. Humans have used their intelligence first to set themselves above nature, then to order the world according to their ways, and finally to exploit all ofcreation for their use. Demystified by science, thunder has become not the mighty weapon ofthe ancient God who tolerated no rivals but only the noise of heated and expanding air. Ransom views science as having such ultimacy that it exercises a mimetic function: it provides Girardian models for desire. "Science directs us to amuse ourselves, between desires," Ransom writes, "by simulating 7 Louis Rubin reads Ransom's "Armageddon" as a poetic companion piece to God Without Thunder, for it tells how divine wrath has been compromised amid the suavities of the modern world At the apocalyptic battle of the poem's title, a militant... (shrink)

In their paper, “Helpful Lessons and Cautionary Tales: How Should COVID-19 Drug Development and Access Inform Approaches to Non-Pandemic Diseases?” Holly Fernandez Lynch and colleagues have present...

Music can reduce stress and anxiety, enhance positive mood, and facilitate social bonding. However, little is known about the role of music and related personal or cultural variables in maintaining wellbeing during times of stress and social isolation as imposed by the COVID-19 crisis. In an online questionnaire, administered in 11 countries, participants rated the relevance of wellbeing goals during the pandemic, and the effectiveness of different activities in obtaining these goals. Music was found to be the most effective activity (...) for three out of five wellbeing goals: enjoyment, venting negative emotions, and self-connection. For diversion, music was equally good as entertainment, while it was second best to create a sense of togetherness, after socialization. This result was evident across different countries and gender, with minor effects of age on specific goals, and a clear effect of the importance of music in people's lives. Cultural effects were generally small and surfaced mainly in the use of music to obtain a sense of togetherness. Interestingly, culture moderated the use of negatively valenced and nostalgic music for those higher in distress. (shrink)

BackgroundThere is increasing evidence that research misbehaviour is common, especially the minor forms. Previous studies on research misbehaviour primarily focused on biomedical and social sciences, and evidence from natural sciences and humanities is scarce. We investigated what academic researchers in Amsterdam perceived to be detrimental research misbehaviours in their respective disciplinary fields.MethodsWe used an explanatory sequential mixed methods design. First, survey participants from four disciplinary fields rated perceived frequency and impact of research misbehaviours from a list of 60. We then (...) combined these into a top five ranking of most detrimental research misbehaviours at the aggregate level, stratified by disciplinary field. Second, in focus group interviews, participants from each academic rank and disciplinary field were asked to reflect on the most relevant research misbehaviours for their disciplinary field. We used participative ranking methodology inducing participants to obtain consensus on which research misbehaviours are most detrimental.ResultsIn total, 1080 researchers completed the survey (response rate: 15%) and 61 participated in the focus groups (3 three to 8 eight researchers per group). Insufficient supervision consistently ranked highest in the survey regardless of disciplinary field and the focus groups confirmed this. Important themes in the focus groups were insufficient supervision, sloppy science, and sloppy peer review. Biomedical researchers and social science researchers were primarily concerned with sloppy science and insufficient supervision. Natural sciences and humanities researchers discussed sloppy reviewing and theft of ideas by reviewers, a form of plagiarism. Focus group participants further provided examples of particular research misbehaviours they were confronted with and how these impacted their work as a researcher.ConclusionWe found insufficient supervision and various forms of sloppy science to score highly on aggregate detrimental impact throughout all disciplinary fields. Researchers from the natural sciences and humanities also perceived nepotism to be of major impact on the aggregate level. The natural sciences regarded fabrication of data of major impact as well. The focus group interviews helped to understand how researchers interpreted ‘insufficient supervision’. Besides, the focus group participants added insight into sloppy science in practice. Researchers from the natural sciences and humanities added new research misbehaviours concerning their disciplinary fields to the list, such as the stealing of ideas before publication. This improves our understanding of research misbehaviour beyond the social and biomedical fields. (shrink)

The United Nations Educational, Scientific and Cultural Organization recently declared transhumance pastoralism as an Intangible Cultural Heritage of Humanity. The notion of heritage seeks to recognize the culture behind the seasonal grazing movements along herding routes, between distant and dissimilar ecosystems. The pastoral families move with their herds from pasturelands used during the winter (winter-lands) to areas pastured during the summer (summer-lands). Whereas this is a key step towards the recognition of the cultural dimension associated to this ancient practice, a (...) relevant feature of transhumance pastoralism is its strong linkage with environmental dynamics. This activity developed in a spatiotemporal and co-evolutionary trajectory, which gave rise to a pastoral territory. A territory is the union or linkage of a meaning with a specific place, that is, the space that is appropriated and valued, both symbolically and instrumentally, by human groups. Hence, the pastoral territory represents the socio-ecological system that integrates a pastoral-based community with the natural environment that it inhabits. We propose a co-evolutionary approach to analyzing some key attributes of transhumant pastoralism, which modulate the socio-ecological interdependence. Based on a study case from Northwest Patagonia, Argentina, we identified and characterized seven attributes: (I) mobility, (II) connectivity, (III) temporal synchrony, (IV) local interdependence, (V) local ecological knowledge, (VI) adaptive capacity legacy, and (VII) mixture of land tenure. We discuss these features as examples that represent keystone socio-ecological attributes for the recognition of transhumant pastoral territories as a biocultural heritage. (shrink)

In the Platonic work Alcibiades I, a divinely guided Socrates adopts the guise of a lover in order to divert Alcibiades from an unthinking political career. The contributors to this carefully focussed volume cover aspects of the background to the work; its arguments and the philosophical issues it raises; its relationship to other Platonic texts, and its subsequent history up to the time of the Neoplatonists. Despite its ancient prominence, the authorship of Alcibiades I is still unsettled; the essays and (...) two appendices, one historical and one stylometric, come together to suggest answers to this tantalising question. (shrink)

The hopes and fears expressed in the debate on human enhancement are not always based on a realistic assessment of the expected possibilities. Discussions about extreme scenarios may at times obscure the ethical and policy issues that are relevant today. This paper aims to contribute to an adequate and ethically sound societal response to actual current developments. After a brief outline of the ethical debate concerning neuro-enhancement, it describes the current state of the art in psychopharmacological science and current uses (...) of psychopharmacological enhancement, as well as the prospects for the near future. It then identifies ethical issues regarding psychopharmacological enhancements that require attention from policymakers, both on the professional and on the governmental level. These concern enhancement research, the gradual expansion of medical categories, off-label prescription and responsibility of doctors, and accessibility of enhancers on the Internet. It is concluded that further discussion on the advantages and drawbacks of enhancers on a collective social level is still needed. (shrink)

This book brings philosophical aesthetics into a broader cultural interest in the fine arts and draws together the classics of the history of aesthetics, the mid-twentieth century or "Analytic" aesthetics, and late-twentieth century or "Continental" post-structuralist "theory.".

Peckham claims that my "behavior" in dealing with the quotations in Natural Supernaturalism is the same, in methodology and validity, as the interpretative behavior of Booth's waiter. But the great bulk of the utterances in my quotations—and no less, of the utterances constituting Peckham's own essay—do not consist of orders, requests, or commands. Instead, they consist of assertions, descriptions, judgments, exclamations, approbations, condemnations, and many other kinds of speech-acts, the meanings of which are not related to my interpretative behavior, even (...) in the indirect way in which the meaning of Booth's order is related to the future behavior of his waiter. M. H. Abrams, author of Natural Supernaturalism and The Mirror and the Lamp and Class of 1916 Professor of English at Cornell University, responds in this essay to Morse Peckham's "The Infinitude of Pluralism" . Morse Peckham, in his Critical Response, was commenting on issues raised by the forum on "The Limits of Pluralism" , to which M. H. Abrams contributed. Previous contributions to Critical Inquiry are "Rationality and Imagination in Cultural History: A Reply to Wayne Booth" and "The Deconstructive Angel". (shrink)

The study aimed to identify the knowledge management processes and their role in achieving competitive advantage at Al-Quds Open University. The study was based on the descriptive analytical method, and the study population consists of academic and administrative staff in each of the branches of Al-Quds Open University in (Tulkarm, Nablus and Jenin). The researchers selected a sample of the study population by the intentional non-probability method, the size of (70) employees. A questionnaire was prepared and supervised by a number (...) of specialists in order to obtain the results of the study. The study concluded that there is a positive direct relationship, that is, the higher the degree of application of knowledge management processes, the greater the degree of competitive advantage. Knowledge Technology came first with a score of 80.02% on all items. Competitive advantage came second with 81.74%. In the third place came "knowledge generation" where the total score on all paragraphs in this area (78.24%). In the fourth place, "knowledge transfer" (77.21%). "Developing and storing knowledge" came in fifth place (77.13%). "Acquisition of knowledge" came in sixth place (76.45%). Knowledge Organization ranked seventh (74.26%). The study recommended that the university should enable the employees to benefit from the experiences and expertise available to help generate knowledge. The University encourages the creation of knowledge through the system of incentives and open the way for creators to apply their creations and spread and invest in excellence and creativity. The university should design work performance levels based on the integration of knowledge and organize it according to policies that support freedom of research. The need for Palestinian universities to adopt a knowledge management approach. The need to adopt a system of incentives that rewards cognitive efforts, and give workers enough freedom to enable them to apply their knowledge. (shrink)

During the debates about the legalization of Voluntary Assisted Dying in Victoria, Australia, the presence of anti-VAD health professionals in the medical community and reported high rates of conscientious objection to VAD suggested access may be limited. Most empirical research on CO has been conducted in the sexual and reproductive health context. However, given the fundamental differences in the nature of such procedures and the legislation governing it, these findings may not be directly transferable to VAD. Accordingly, we sought to (...) understand how CO operates in the context of VAD. Prior to the implementation of the VAD legislation in June 2019, we conducted semi-structured interviews with seventeen health professionals with a self-declared CO to VAD, to explore what motivated their CO. Participants identified multiple motivations, which can be broadly categorized as: concerns for oneself; concerns for patients; concerns about the current Victorian legislation; and concerns for the medical profession. Participants’ moral commitments included personal, professional, and political commitments. In some cases, one’s CO was specific to Victoria’s current legislation rather than VAD more broadly. Our findings suggest CO motivations extend beyond those traditionally cited and suggest a need to better understand and manage CO in the healthcare context. (shrink)