Experiences and attitudes towards end-of-life decisions amongst Danish physicians

In this survey we have investigated the experiences and attitudes of Danish physicians regarding end-of-life decisions. Most respondents have made decisions that involve hastening the death of a patient, and almost all find it acceptable to do so. Such decisions are made more often, and considered ethically more acceptable, with the informed consent of the patient than without. But both non-resuscitation decisions, and decisions to provide pain relief in doses that will shorten the patient's life, have been made and found acceptable by at least 50% of the respondents, even when there is no informed consent. Furthermore, 12% have doubled morphine dosages with fixed intervals, thus providing doses substantially higher than that necessary to control pain, without the informed consent of the patient. Two per cent have helped in assisted suicide, and 5% have administered a lethal injection at the patient's request. Respectively 37% and 34% find these last two practices ethically acceptable. Amongst those that do not find them acceptable, the most important reasons to be opposed are, the doctrine of double effect, the doctrine of doing and allowing, and the view that human life is sacred. Amongst supporters, the most important reasons mentioned are, that the patient's right to self-determination should be respected, the view that a patient should not be forced to suffer, and the view that the patient has a right to be helped to a dignified death.     

DNA-based patents: an empirical analysis

The perception of rising litigation rates is driving the push for patent reform.     

Attitudes towards Muslims and fear of terrorism

This article looks at explanatory approaches of fear of terrorism. Until now, empirical studies looking at determinants of fear of terrorism have used the theoretical framework from the field of research regarding fear of crime. We argue that the cognitive link between terrorism and Islam is currently so strong that explanatory models should include measures of attitudes towards Muslims. On an argumentative level, the fear of crime theoretical framework is unconvincing. Our empirical analysis using structural equation modelling shows that fear of terrorism shares almost no determinants with the fear of violent crime. Negative attitudes towards Muslims are the strongest determinant of fear of terrorism and totally mediate all other effects. Discussions about tackling the issue of fear of terrorism should consider these findings as solutions may otherwise be inappropriate, at best. At worst, solutions based on an improper understanding of the determinants of fear of terrorism may serve only to exacerbate the problem.     

Citizen participation in patient prioritization policy decisions: an empirical and experimental study on patients' characteristics

Health systems worldwide are grappling with the need to control costs to maintain system viability. With the combination of worsening economic conditions, an aging population and reductions in tax revenues, the pressures to make structural changes are expected to continue growing. Common cost control mechanisms, e.g. curtailment of patient access and treatment prioritization, are likely to be adversely viewed by citizens. It seems therefore wise to include them in the decision making processes that lead up to policy changes. In the context of a multilevel iterative mixed-method design a quantitative survey representative of the German population (N = 2031) was conducted to probe the acceptance of priority setting in medicine and to explore the practicability of direct public involvement. Here we focus on preferences for patients' characteristics (medical aspects, lifestyle and socio-economic status) as possible criteria for prioritizing medical services. A questionnaire with closed response options was fielded to gain insight into attitudes toward broad prioritization criteria of patient groups. Furthermore, a discrete choice experiment was used as a rigorous approach to investigate citizens' preferences toward specific criteria level in context of other criteria. Both the questionnaire and the discrete choice experiment were performed with the same sample. The citizens' own health and social situation are included as explanatory variables. Data were evaluated using corresponding analysis, contingency analysis, logistic regression and a multinomial exploded logit model. The results show that some medical criteria are highly accepted for prioritizing patients whereas socio-economic criteria are rejected.     

Health care ethics and health law in the Dutch discussion on end-of-life decisions: a historical analysis of the dynamics and development of both disciplines

Over the past three or four decades, the concept of medical ethics has changed from a limited set of standards to a broad field of debate and research. We define medical ethics as an arena of moral issues in medicine, rather than a specific discipline. This paper examines how the disciplines of health care ethics and health care law have developed and operated within this arena. Our framework highlights the aspects of jurisdiction (Abbott) and the assignment of responsibilities (Gusfield). This theoretical framework prompted us to study definitions and changing responsibilities in order to describe the development and interaction of health care ethics and health law. We have opted for the context of the Dutch debate about end-of-life decisions as a relevant case study. We argue that the specific Dutch definition of euthanasia as 'intentionally taking the life of another person by a physician, upon that person's request' can be seen as the result of the complex jurisdictional process. This illustrates the more general conclusion that the Dutch debate on end-of-life decisions and the development of the two disciplines must be understood in terms of mutual interaction.     

Post-high-throughput screening analysis: an empirical compound prioritization scheme

An empirical scheme to evaluate and prioritize screening hits from high-throughput screening (HTS) is proposed. Negative scores are given when chemotypes found in the HTS hits are present in annotated databases such as MDDR and WOMBAT or for testing positive in toxicity-related experiments reported in TOXNET. Positive scores were given for higher measured biological activities, for testing negative in toxicity-related literature, and for good overlap when profiled against drug-related properties. Particular emphasis is placed on estimating aqueous solubility to prioritize in vivo experiments. This empirical scheme is given as an illustration to assist the decision-making process in selecting chemotypes and individual compounds for further experimentation, when confronted with multiple hits from high-throughput experiments. The decision-making process is discussed for a set of G-protein coupled receptor antagonists and validated on a literature example for dihydrofolate reductase inhibition.     

Transitive inference in non-human animals: an empirical and theoretical analysis

Transitive inference has long been considered one of the hallmarks of human deductive reasoning. Recent reports of transitive-like behaviors in non-human animals have prompted a flourishing empirical and theoretical search for the mechanism(s) that may mediate this ability in non-humans. In this paper, I begin by describing the transitive inference tasks customarily used with non-human animals and then review the empirical findings. Transitive inference has been demonstrated in a wide variety of species, and the signature effects that usually accompany transitive inference in humans (the serial position effect and the symbolic distance effect) have also been found in non-humans. I then critically analyze the most prominent models of this ability in non-human animals. Some models are cognitive, proposing for instance that animals use the rules of formal logic or form mental representations of the premises to solve the task, others are based on associative mechanisms such as value transfer and reinforcement and non-reinforcement. Overall, I argue that the reinforcement-based models are in a much better empirical and theoretical position. Hence, transitive inference in non-human animals should be considered a property of reinforcement history rather than of inferential processes. I finalize by shedding some light on some promising lines of research.     

transition priors for protein hidden Markov models: an empirical study towards maximum discrimination.

Insertions and deletions in a profile hidden Markov model (HMM) are modeled by transition probabilities between insert, delete and match states. These are estimated by combining observed data and prior probabilities. The transition prior probabilities can be defined either ad hoc or by maximum likelihood (ML) estimation. We show that the choice of transition prior greatly affects the HMM's ability to discriminate between true and false hits. HMM discrimination was measured using the HMMER 2.2 package applied to 373 families from Pfam. We measured the discrimination between true members and noise sequences employing various ML transition priors and also systematically scanned the parameter space of ad hoc transition priors. Our results indicate that ML priors produce far from optimal discrimination, and we present an empirically derived prior that considerably decreases the number of misclassifications compared to ML. Most of the difference stems from the probabilities for exiting a delete state. The ML prior, which is unaware of noise sequences, estimates a delete-to-delete probability that is relatively high and does not penalize noise sequences enough for optimal discrimination.     

The neural correlates of consciousness: an analysis of cognitive skill learning.

This paper presents a functional brain-imaging strategy designed to isolate neural correlates of consciousness in humans. This strategy is based on skill learning. In the example presented (rapidly generating verbs for visually presented nouns), a cognitive skill is examined before and after practice. As shown, there are marked qualitative differences in the neural circuitry supporting performance of this task in the naive and practised state that include, importantly, both increases and decreases from the baseline activity of the brain.     

Attitudes and sterotypes of supporting fields towards the persons with disabilities

The aim of this research was to establish the attitudes, the views and reactions of the helping fields (which include social workers and medical nurses) and those who aren't the part of that cathegory, towards the mentally ill people. One hundred and twenty persons questioned have taken part in this research where in the group of supporting fields consisted of social workers and medical nurses (N = 40). The questionnaire was used in examining the attitudes of those questioned persons, the questionnaire that was used in Joki?-Begi?'s research (2005) and it turned out to be a really good one in defining the attitudes and stereotypes towards the mentally ill persons. The questionnaire consisted of several parts in which different things have been examined such as stereotypes, knowledge, attitudes, level of acceptance and social- demographic information. The research has shown the differences among the attitudes and the level of acceptance of the mentally ill as well as the level of knowledge which the examinees had. All the examinees that have been the part of this research mentioned "ill" as a dominant trait of the mentally disturbed person. Furthermore, the characteristics such as instability, insecurity, nervousness and inclination to suicide, indicate that all of these three groups of examinees have sterotypes about unstable emotional condition and state of mind of the sick. The examinees that don't belong to this group of supporting fields have enough knowledge neither about the emergence of the disease nor about its development and preventive measures. However, the social workers have a bit more negative attitude towards the mentally ill if compared to medical nurses which could be explained by insufficient working experience with the mentioned group of patients. It's important to say that all of the three groups of examinees don't have extremely negative attitudes towards the people with mental disorder. We shouldn't ignore the fact that these three groups have noticable social restraint towards the mentally ill and they cannot easily accept them in their own environment. Considering the fact there is a low number of researches that deal with this problem of labelling or in other words- stigmatization of the mentally ill, this research gives a great stimulus for writeup this very important problem area, especially if we take into consideration that the attitude of the community may help to bring about the feeling of marginalization and unacceptability with the mentally ill.     

Character analysis: an empirical approach applied to advanced snakes

Fifty characters of extant advanced snakes were selected for phyletic analysis, with the primary aim of determining evolutionary paths of the venomous taxa. The characters chosen showed roughly equivalent variation. States of characters were distinguished with reference to range of variation at species and generic levels. The heterogeneous, widespread and abundant family Colubridae was designated as representing the ancestral group. Direction of change in states was then determined by reference to colubrid conditions. Criteria used for judgement of direction were (1) uniqueness, (2) relative abundance, (3) correlation of derived states, (4) morphological specialization, (5) ecological specialization, (6) geographic restriction, (7) closely related taxa, and (8) correlation of applicable criteria. Two other criteria, (9) genetic structure and (10) fossil record, were not applicable.
Characters used as examples of the approach are number of palatine teeth and the pattern of the head shields. In the latter, the derivative states are correlated with particular modes of life (aquatic, fossorial and terrestrial). The familial level taxa show rather different frequency distributions in respect to the four states of this character, with one derived state unique to the viperids.
The second character, number of palatine teeth, was divided into classes by using a span covering most intraspecific variation. The resulting classes were lumped into four states emphasizing the classes of low numbers of teeth. The extreme derived states are correlated in the colubrids with distinctive modes of life (burrowing and digging) and with functional morphological specializations. The distribution of the states shows a trend toward low numbers of teeth in all the venomous families.     

Cultural transmission of ethnobotanical knowledge and skills: an empirical analysis from an Amerindian society

The modeling of cultural transmission is of great importance for understanding the maintenance, erosion, and spread of cultural traits and innovations. Researchers have hypothesized that, unlike biological transmission, cultural transmission occurs through at least three different, non-mutually exclusive paths: (1) from parents (vertical); (2) from age peers (horizontal); and (3) from older generations (oblique). We used data from 270 adults in a society in the Bolivian Amazon to estimate the association between a person's knowledge and skills and the knowledge and skills of the (1) same-sex parent, (2) age peers (or individuals born in the same village as the subject within ±4 years of the subject's year of birth), and (3) parental cohort (excluding parents). We found a statistically significant association between personal and parental and old cohort knowledge. The magnitude of the association is larger for old cohort knowledge than for parental knowledge, suggesting that, for the studied population, the transmission of ethnobotanical knowledge and skills is mostly oblique.     

Development of an Item Scale to Assess Attitudes towards Domestic Dogs in the United Republic of Tanzania

ABSTRACT

Domestic dogs are important sources of rabies exposure for humans in the developing world. Control of the disease in endemic areas relies on the vaccination of owned dogs, and thus owners' attitudes and behavior towards household dogs may be of relevance to rabies control programs. However, none of the instruments used to evaluate attitudes towards companion animals have been validated for use in developing countries. In this paper, we present the development of an item scale to measure attitudes towards owned dogs in Tanzania. We assess the scale's reliability and validity, and conduct a preliminary analysis of factors affecting respondents' attitudes. Twelve 5-point Likert scale items were selected from an item pool during the pilot phase. Following administration of these items to 824 dog owners across 12 study sites in Tanzania, two subscales were derived, representing the acceptance of dogs as equals and physical interactions with household dogs. Both subscales showed acceptable levels of reliability and concurrent validity, although the latter estimates were found to be influenced by interviewer identity. Male respondents had significantly higher scores on both subscales than females, and Muslim respondents showed more positive attitudes towards dogs as equals than did Christians. Among those respondents who were also the heads of their households, those whose dogs were vaccinated against rabies had a more positive attitude towards dogs as equals. It is hoped that the derived item scale will serve as a basis to further understanding of the motivational considerations of attitudes towards dogs in developing countries, and how these may influence aspects of dog ownership, welfare, and disease control.     

Attitudes of medical staff towards the psychiatric label "schizophrenic patient" tested by an anti-stigma questionnaire

The aim of this research was to investigate the opinions and attitudes of medical staff towards schizophrenic patients. The research included three groups of examinees, 200 physicians of various specialties, 200 nurses and technicians working in Zagreb city hospitals, and 200 3rd and 4th year students of the School of Medicine in Zagreb. Previously validated anti-stigma questionnaire was used, consisting of 25 questions divided into three thematic groups, structured and adapted to the specific requirements of this study. The results were mutually compared and statistically analyzed by applying the chi 2-test. Significant difference (p < 0.01) between the answers of physicians and those of medical students was found in questions 2, 4, 5, 6, 11, 13, 15, 16, 18, 22, 23, 25, and between physicians and nurses/technicians in answers to questions 4, 15, 22, 23. Significant difference (p < 0.01) between the answers given by nurses/technicians and medical students was found in questions 10, 13, 22, 23. The results point to the existence of prejudices and stigmatizing attitudes in all three investigated groups. The most frequent reasons for stigmatizing attitude of students are based on fear and insufficient knowledge about mental patients and schizophrenia as a disease, while there are a high percentage of positive answers to the questions on rehabilitation and resocialization. The nurses/technicians also show a high degree of mistrust towards schizophrenic patients and mostly answer with "I don't know", thus presenting insufficiently formed attitudes about the mentioned problems. The physicians in their answers confirm fear, mistrust and stigmatizing attitudes towards schizophrenic patients found in general population in Croatia. The consequences of such attitudes are the low quality of life of schizophrenic patients, and slow, often incomplete, resocialization.     

Enniatin B and valinomycin as ion carriers: an empirical force field analysis

The alkali-ion binding properties of two natural depsipeptide ion carriers, enniatin B (EnB) and valinomycin (VM), are examined and compared by the empirical force field method. While VM has been shown to bind preferentially K+, Rb+, and Cs+ over Na+ in most solvents, EnB is considerably less specific. We find that EnB forms two kinds of complexes, internal and external. In internal complexes, the ion binds to all six carbonyl oxygens, while in external ones, only three oxygens, preferentially those of the D-hydroxy-isovaleryl residues, are bound. The size of the internal cavity is best suited for Na+, while K+ and Rb+ squeeze in asymmetrically by distorting the molecule, and Cs+ not at all. External binding is much less specific. Since internal complexes possess much higher strain energies than external ones, the latter may be at least as stable as the former, even in fairly non-polar solvents. VM is calculated to bind only internally, and with much less strain energy than EnB. The size of its internal cavity is well suited for binding the ions K+, Rb+, and Cs+, but is too big for Na+. The difference between the binding energies of Na+ and K+ is much smaller than that between the corresponding hydration enthalpies, thus explaining the binding preference for the latter ion.     

The electrodermal indices of the subjective perception of performance errors during drowsy changes in consciousness

The study was aimed at searching for objective criteria of subject's perception of errors in performance due to drowsiness and estimating the time between the onset of errors and the moment of their awareness. Healthy subjects (n = 64) with the pronounced EEG alpha were examined under conditions without sleep deprivation. Experiments (n = 280) lasted for 40 min. During the experiments, the EEG, EOG, EDR, EKG, and button pressings were recorded and subject's reports were registered. The subjects were waken up after the onset of errors or 20 min after the beginning of the performance independently of errors. The error onset was shown to be preceded by the EEG "drowsy pattern" and decrease in the rate of spontaneous EDR. The performance reappearance after the error was accomplished by alpha-rhythm independently from error awareness. The interrogation of subjects after the error and activity revival demonstrated a correlation between the error subjective perception and appearance of the EDR. The interval between the error and the first following EDR (mean 10.1 s) was significantly (p < 0.001, t-test for dependent samples) shorter than the interval between the error and the last preceding EDR (mean 69.8 s). It is suggested that the subjective perception of an error is a significant endogenous stimulus, which evokes the orienting response and accompanying sympathetic activation.