Objective: To evaluate feasibility of the guidelines of the Groupe Francophone de Réanimation et Urgence Pédiatriques for limitation of treatments in the paediatric intensive care unit .Design: A 2-year prospective survey.Setting: A 12-bed PICU at the Hôpital Jeanne de Flandre, Lille, France.Patients: Were included when limitation of treatments was expected.Results: Of 967 children admitted, 55 were included with a 2-day median delay. They were younger than others , had a higher paediatric risk of mortality score , and a higher (...) paediatric overall performance category score at admission ; all p<0.002. 34 children died. A limitation decision was made without meeting for 7 children who died: 6 received do-not-resuscitate orders and 1 received withholding decision. Decision-making meetings were organised for 31 children, and the following decisions were made: 12 DNROs , 4 withholding , with 14 withdrawing and 1 continuing treatment . After limitation, 21 children died and 10 survived . 13 procedures were interrupted because of death and 11 because of clinical improvement . Parents’ opinions were obtained after 4 family conferences , 3 days after inclusion. The first meeting was planned for 6 days after inclusion and held on the 7th day after inclusion; 80% of parents were immediately informed of the decision, which was implemented after half a day.Conclusions: GFRUPs procedure was applicable in most cases. The main difficulties were anticipating the correct date for the meeting and involving nurses in the procedure. Children for whom the procedure was interrupted because of clinical improvement and who survived in poor condition without a formal decision pointed out the need for medical criteria for questioning, which should systematically lead to a formal decision-making process. (shrink)

In his 1947 British Academy lecture on Naturalistic Ethics, Mr. W. F. R. Hardie is concerned to ask himself whether a naturalistic theory of ethics can give a “satisfactory account of our moral knowledge or convictions,” or whether some form of non-naturalism is demanded by our moral experience. It will be remembered that after a careful sifting and examination of certain features of our moral knowledge or convictions, Mr. Hardie suspends judgment between naturalism and non-naturalism, observing that “on the one (...) hand philosophers who start from the ostensible facts of our moral experience and thinking, and are most careful and accurate in their rendering of these facts, have tended to be led to objectivist and anti-naturalistic conclusions. Where they least carry conviction is in the moral epistemology which they assume or defend. When we reflect, with the epistemological issue in mind, on the actual process in ourselves of moral reflection and decision, we are more inclined to sympathize with a ‘moral sentiment’ theory than we ought to be if the rationalists are wholly in the right.” In what follows I wish to consider another feature of our moral experience which Mr. Hardie did not examine in his lecture and which appears to be of considerable importance, namely the situation where, to put it very roughly for the moment, we find ourselves at variance with another person or persons on a moral issue, where, for instance, I hold that a certain course of conduct is right, and the other person or persons hold that it is wrong, or vice versa , and where further we may pursue divergent courses of action accordingly. I wish to ask myself whether the naturalistic commentary on this situation of ethical disagreement is altogether satisfactory when we consider it in the light of “the ostensible facts of our moral experience and thinking,” whether, in fact, to use another phrase of Mr. Hardie's, it squares altogether with “our fundamental moral convictions” in regard to such a situation. The naturalistic commentary with which I am primarily concerned is that which is now sometimes labelled “the emotive theory of ethics,” and is to be found admirably developed, for example, in Professor Stevenson's book Ethics and Language. (shrink)

Mutagenesis makes it possible to examine the effect of amino acid replacements on the folding and stability of proteins. The evaluation of kinetic and equilibrium folding data using reaction coordinate diagrams allows one to determine the roles that single amino acids play in the folding mechanism.

The US neutrino community gathered at the Workshop on the Intermediate Neutrino Program at Brookhaven National Laboratory February 4-6, 2015 to explore opportunities in neutrino physics over the next five to ten years. Scientists from particle, astroparticle and nuclear physics participated in the workshop. The workshop examined promising opportunities for neutrino physics in the intermediate term, including possible new small to mid-scale experiments, US contributions to large experiments, upgrades to existing experiments, R&D plans and theory. The workshop was organized into (...) two sets of parallel working group sessions, divided by physics topics and technology. Physics working groups covered topics on Sterile Neutrinos, Neutrino Mixing, Neutrino Interactions, Neutrino Properties and Astrophysical Neutrinos. Technology sessions were organized into Theory, Short-Baseline Accelerator Neutrinos, Reactor Neutrinos, Detector R&D and Source, Cyclotron and Meson Decay at Rest sessions.This report summarizes discussion and conclusions from the workshop. (shrink)