Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year survival of less than 50% who had advanced gastrointestinal or lung cancer or amyotrophic lateral sclerosis were interviewed. Each patient’s medical record was reviewed at enrollment and at 3 months for evidence of the discussion of patient wishes concerning (...) ventilator support, artificial nutrition and hydration , resuscitation and hospice care. A Kaplan–Meier analysis was also performed and 2-year survival calculated.Results: 60 cancer and 32 ALS patients were enrolled. ALS patients were more likely than cancer patients to have evidence of discussion about their wishes for ventilator support , ANH , DNR and hospice care . At 6 months, 91% of ALS patients were alive compared with 62% of cancer patients; at 2 years, 63% of ALS patients were alive compared with 23% of cancer patients .Conclusions: Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making. (shrink)

The hardest thing in appropriating [a] holistic natural law perspective is to recognise the invisible mean of judgement, which alone contains the limits of all things... The notion of mean and limits - so fundamental to ethics - calls for inner understanding that the nature of the mean cannot be defined 'a priori', because it involves an exercise of judgement, ethical judgement.

Mapping one's ignorance also has affective benefits. Wherever mastery of knowledge and skills creates professional status, especially in practices that give professional power over clients, there arises a natural pride that rests on what one knows, and a regrettable tendency for authority to develop arrogance. We know the effects: failure to listen, premature dismissal of relevant information, overreaching and overbearing professional conduct, mistakes and the denial of them, and so on. An explicit acknowledgement of ignorance may generate a corrective humility, (...) a desire to see rather than presume understanding, alertness to unforeseen consequences, and openness to alternative approaches. (shrink)

We present a modernized proof, with a modification by M.A. Shtan’ko, of the Markov theorem on the unsolvability of the homeomorphy problem for manifolds. We then discuss a proof of the S.P. Novikov theorem on the unrecognizability of spheres for n≥5, from which we obtain a corollary about unrecognizability of all manifolds of dimension at least five. An analogous argument then proves the unrecognizability of stabilizations of all four-dimensional manifolds. We also give a brief overview of known results concerning algorithmic (...) recognizability of three-dimensional manifolds. (shrink)

Using covariant derivatives and the operator definitions of quantum mechanics, gauge invariant Proca and Lehnert equations are derived and the Lorenz condition is eliminated in U(1) invariant electrodynamics. It is shown that the structure of the gauge invariant Lehnert equation is the same in an O(3) invariant theory of electrodynamics.

McGavin, PA The Holy Father often speaks without a prepared text, and it is amazing how accurately he reads in transcription. This was brilliantly so in Light of the World interviews. Even his brief words at pages 118-119 on condoms - so breathlessly and inaccurately treated in the media - are so cast as to withstand close scrutiny. It is with this recognition that I address his lack of precision and perception in speaking on the question of homosexuality and sacred (...) ordination. (shrink)

Relativistic quantum mechanics has been formulated as a theory of the evolution ofevents in spacetime; the wave functions are square-integrable functions on the four-dimensional spacetime, parametrized by a universal invariant world time τ. The representation of states with spin is induced with a little group that is the subgroup of O(3, 1) leaving invariant a timelike vector nμ; a positive definite invariant scalar product, for which matrix elements of tensor operators are covariant, emerges from this construction. In a previous study (...) a second-order equation was introduced similar to the second-order Dirac equation, based on a quadratic function of two operators which are the self-adjoint parts, in this new scalar product, of γμpμ. It is shown in this paper that one of these operators, in fact the one from which the gyromagnetic moment is obtained, can be used to construct a first-order equation. The corresponding quantum theory is somewhat analogous to Dirac's spinor form; the Hamilton equations appear to describe dynamical degrees of freedom in a spacelike hyperplane orthogonal to nμ (in Dirac's theory the motion appears to be lightlike). It is shown that the integration over nμ required by unitarity results in timelike motion (as in the expectation value of Dirac's α). Explicit forms are obtained for the wave functions and currents for free motion. The general form of the theory is written for the (five-dimensional) pre-Maxwell fields required by gauge invariance. (shrink)

The article reveals the value and contribution of A.I. Vvedensky in the formation of Russian neo-Kantianism on the example of a systematic and integrated review of his research. The author reveals the significance of A.I. Vvedensky critical methodology for the subsequent development of Russian neo-Kantianism in the first third of the XX century. The method of “logicism” is designated as an integral part of criticism, which consists in the elimination of dogmatic foundations from philosophical discourse. In turn, the critical methodology, (...) understood as a theoretical tool for constructing a holistic picture of the world on the principles of science, serves as the basis for identifying the problems of the correlation of the rational and the irrational. The indicated problem in the works of A.I. Vvedensky becomes the beginning of the formation of Russian neo-Kantianism, which is opposed to dogmatism and religious and philosophical research. Developing a critical methodology, the Russian philosopher turns to the consideration of the role of philosophy in the formation of ideological foundations. The contents of the article consistently reveal the key provisions of the philosophy of A.I. Vvedensky, from raising the question of the methodological foundations of criticism to identifying the specifics of philosophy in relation to scientific disciplines, on the example of experimental psychology, based mainly on empirical methods. In conclusion, the article indicates the prospect of further comprehensive study of the works of A.I. Vvedensky in order to establish a reliable understanding of the development of the national philosophy of thought. (shrink)