Copyright © 2015 by the Society of Criti. Objective: Global lung stress varies considerably with low tidal volume ventilation for acute respiratory distress syndrome. High stress despite low tidal volumes may worsen lung injury and increase risk of death. No widely available parameter exists to assess global lung stress. We aimed to determine whether the volume delivered during a recruitment maneuver is inversely associated with lung stress and mortality in acute respiratory distress syndrome. Design: Substudy of an acute respiratory distress (...) syndrome clinical trial on esophageal pressure-guided positive end-expiratory pressure titration. Setting: U.S. academic medical center. Patients: Forty-two patients with acute respiratory distress syndrome in whom airflow, airway pressure, and esophageal pressure were recorded during the recruitment maneuver. Interventions: A single recruitment maneuver was performed before initiating protocol-directed ventilator management. Recruitment maneuvers consisted of a 30-second breath hold at 40 cm H2O airway pressure under heavy sedation or paralysis. VRM was calculated by integrating the flow-time waveform during the maneuver. End-inspiratory stress was defined as the transpulmonary pressure during end-inspiratory pause of a tidal breath and tidal stress as the transpulmonary pressure difference between end-inspiratory and end-expiratory pauses. Measurements and Main Results: VRM ranged between 7.4 and 34.7 mL/kg predicted body weight. Lower VRM predicted high end-inspiratory and tidal lung stress. After adjusting for Pao2/Fio2 and either driving pressure, tidal volume, or plateau pressure and positive end-expiratory pressure, VRM remained independently associated with both end-inspiratory and tidal stress. In unadjusted analysis, low VRM predicted increased risk of death. VRM remained significantly associated with mortality after adjusting for study arm. Conclusions: Low VRM independently predicts high lung stress and may predict risk of death in patients with acute respiratory distress syndrome. (shrink)

This is the first book to offer the best essays, articles, and speeches on ethics and intelligence that demonstrate the complex moral dilemmas in intelligence collection, analysis, and operations. Some are recently declassified and never before published, and all are written by authors whose backgrounds are as varied as their insights, including Robert M. Gates, former Director of the Central Intelligence Agency; John P. Langan, the Joseph Cardinal Bernardin Professor of Catholic Social Thought at the Kennedy Institute of Ethics, Georgetown (...) University; and Loch K. Johnson, Regents Professor of Political Science at the University of Georgia and recipient of the Owens Award for contributions to the understanding of U.S. intelligence activities. Creating the foundation for the study of ethics and intelligence by filling in the gap between warfare and philosophy, this is a valuable collection of literature for building an ethical code that is not dependent on any specific agency, department, or country. (shrink)

Discussions of the liberal international order, both inside and outside the academy, tend to take its necessity and desirability for granted. While its specific contours and content are left somewhat open in such debates, the idea that this international order is essential for global peace and stability is left largely unquestioned. What is more, the potential loss or end of this order is often taken to mean a return to anarchy, chaos, and disorder. In this essay, I question the presumed (...) necessity and desirability of the liberal international order that most discussions of it seem to share. By rethinking the international order as processual, emergent, and grounded in the social and political contexts that shape its constitution and operation, I suggest that fears about the crisis of international order are less about international order itself and more about the loss of a specific order. This specific order, I argue, constituted in part through processes of racialization, is not so much a rules-based order of sovereign equality but rather an international order of White sovereignty that secures the domination and rule of some over others, of Whiteness over non-Whiteness. Recognizing the role of White sovereignty in the contemporary international order points toward a need to take seriously calls for abolition. Rather than signifying a return to chaos and disorder, the prospect and promise of abolition represents a call to break free from the constraints of the present order and reach into an as-yet-unimaginable future. (shrink)

Recently, a number of philosophers of biology have endorsed views about random drift that, we will argue, rest on an implicit assumption that the meaning of concepts such as drift can be understood through an examination of the mathematical models in which drift appears. They also seem to implicitly assume that ontological questions about the causality of terms appearing in the models can be gleaned from the models alone. We will question these general assumptions by showing how the same equation (...) — the simple 2 = p2 + 2pq + q2 — can be given radically different interpretations, one of which is a physical, causal process and one of which is not. This shows that mathematical models on their own yield neither interpretations nor ontological conclusions. Instead, we argue that these issues can only be resolved by considering the phenomena that the models were originally designed to represent and the phenomena to which the models are currently applied. When one does take those factors into account, starting with the motivation for Sewall Wright’s and R.A. Fisher’s early drift models and ending with contemporary applications, a very different picture of the concept of drift emerges. On this view, drift is a term for a set of physical processes, namely, indiscriminate sampling processes. (shrink)

Hospital systems commonly face the challenge of determining just ways to allocate scarce drugs during national shortages. There is no standardised approach of how this should be instituted, but principles of distributive justice are commonly used so that patients who are most likely to benefit from the drug receive it. As a result, clinical indications, in which the evidence for the drug is assumed to be established, are often prioritised over research use. In this manuscript, we present a case of (...) a phase II investigational trial of intravenous thiamine for delirium prevention in patients undergoing haematopoietic stem cell transplantation to emphasise several shortcomings in the overarching prioritisation of clinical over research uses of scarce drugs. Specifically, we present the following considerations: clinical use may not have stronger evidence than research use; a strong scientific rationale for research use may outweigh the claim for clinical indications in which there is weak evidence; treatment within the context of a clinical trial may be the standard of care; and research use may not only benefit patients receiving the treatment but also offers the prospect of improving future clinical care. In summary, we argue against allocation schemes that prohibit all research uses of scarce drugs and instead recommend that allocation schemes include a balanced approach that weighs risks and benefits of access to scarce drugs irrespective of the research versus clinical use designation. (shrink)

We examine the interface of entrepreneurship and society by considering a novel source of gender bias (public opinion) and a novel expression of it (affective evaluations). We posit that women-led teams displaying success will trigger a “penalty for success” bias, and this will be inhibited if the team receives a “stamp of approval” from a gender congruent individual (i.e., an investor who is a man). Analysis from our first study, based on archival data, indicated that other mechanisms might be at (...) play that we could not tease apart in our archival data, so we conducted a follow-up experimental study to further examine our initial findings. Results jointly indicate that women are viewed unfavorably unless either (a) they are validated by success or endorsement from a man, or (b) they fail but are “warm and accommodating” about it. We also find that while men benefit from being validated by success or endorsement of an opposite-gender investor, they do not face a similarly steep penalty absent that validation. (shrink)

Idiopathic Parkinson’s disease impairs working memory, but the exact nature of this deficit in terms of the underlying cognitive mechanisms is not well understood. In this study patients with mild clinical symptoms of PD were compared with matched healthy control subjects on a computerized battery of tests designed to assess spatial working memory and verbal working memory. In the spatial working memory task, subjects were required to recall a sequence of four locations. The verbal working memory task was methodologically identical (...) except for the modality of the stimuli used, requiring subjects to orally recall a sequence of six digits. In either case, half of the sequences were structured in a way that allowed ‘chunking’, while others were unstructured. This manipulation was designed to dissociate the strategic component of task performance from the memory-load component. Mild medicated patients with PD were impaired only on the structured versions of the verbal working memory tasks. The analogous deficit in the spatial working memory was less pronounced. These findings are in agreement with the hypothesis that working memory deficits in PD reflect mainly the executive component of the tasks and that the deficits may be at least partly modality-independent. (shrink)

Constructive engagement in international business practice is defined as purpose-driven behavior in which economic contributions by the foreign investor also advance social progress in the host country. This paper distinguishes between amoral and moral social agency, and proposes a model of principled constructive engagement that describes a principled constructive engagement regime enacted in a disciplined, morally-directed manner.

WITHTHE OVERWHELMINGLY DISPROPORTIONATE NUMBER OF BLACK MEN on death row, some argue that today's death penalty executions in the United States are the equivalent of legalized lynching. Others may charge this equivalence as hyperbole, but the numbers betray a system of racialized injustice that people of good will ought to reject today as did like-willed people of the churches, synagogues, and community organizations of the years leading up to the civil rights movement and beyond. This essay exposes the factors of (...) race and poverty that lead to determinations of the guilt or innocence and the likelihood of a death or life sentence to those convicted of capital crimes. (shrink)

There have undoubtedly been ample reasons to discourage a translator from approaching this commentary on the Metaphysics. The reasons stem mainly from the lack of a critical text. As is well enough known, such a text is at present in preparation by the Dominicans. Until it appears, attempts even at discussing the many disconcerting problems about the commentary run the risk of proving futile. In consequence, discussions have fallen off in recent years. As Rowan is careful to point out in (...) his introduction, there is sufficient evidence not only that errors have been made through simple negligence in the editions of the commentary, but also that "all sorts of liberties" may have been taken with the text. What we have at present, moreover, might possibly be a running text based on redactions dating from different years in St. Thomas' teaching career. If one may judge from the way Rowan presents the different views, he personally prefers hypotheses that simplify the situation and allow the text now available to be considered as a single continuous writing left in its present form by Aquinas himself. (shrink)

This book contains 20 previously published papers from internationally recognised journals. The original view of phenomenology is applied to understand behaviour, attachment, psychopathology, cognitive behavioural, existential and person-centred therapy. It presents the "intentionality model" of integrative therapy. This is a model for integration that primarily focuses on psychological understanding.