End‑of‑life care for patients with advanced lung cancer and chronic obstructive pulmonary disease: Survey among Polish pulmonologists

Copyright by Medycyna Praktyczna, Kraków 2019 INTRODUCTION There is evidence that people with nonmalignant disease receive poorer end‑of‑life (EOL) care compared with people with cancer. OBJECTIVES The aim of the study was to assess the selected aspects of symptomatic treatment and communication between physicians and patients diagnosed with either advanced chronic obstructive pulmonary disease (COPD) or lung cancer. METHODS A questionnaire survey was conducted online among members of the Polish Respiratory Society. RESULTS Properly completed questionnaires were returned by 174 respondents (27.2% of those proved to be contacted by email). In COPD, 32% of respondents always or often used opioids in chronic breathlessness and 18.3% always or often referred patients to a palliative care (PC) specialist. Nearly 80% of the respondents claimed that bedside discussions on EOL issues with people with COPD are essential, although only 20% would always or often initiate them. In people with lung cancer, opioids were routinely used for relief of chronic breathlessness by 80% of physicians; 81.7% referred patients to a PC specialist. More than half of the respondents always or often discussed EOL issues only with the patient’s caregivers or relatives. Younger physicians, those at an earlier stage of their career, those caring for higher numbers of patients with lung cancer, and those who were better acquainted with Polish Respiratory Society recommendations for PC in chronic lung diseases seemed to provide better EOL care for COPD patients. CONCLUSIONS Patients with COPD, as compared with patients with lung cancer, were less frequently treated with opioids to relieve chronic breathlessness or referred for a PC consultation. Discussing the EOL issues with a patient was generally found challenging by physicians, and most often pursued with caregivers instead. The COPD recommendations on PC may prove helpful in providing better EOL care by pulmonologists

Human breast tissue cancer diagnosis by Raman spectroscopy

Abstract. Differences between Raman spectra of normal, malignant and benign tissues have been recorded and analyzed as a method for the early detection of cancer. To the best of our knowledge, this is one of the most statistically reliable research (67 patients) on Raman spectroscopy-based diagnosis of breast cancers among the world women population. The paper demonstrates that Raman spectroscopy is a promising new tool for real-time diagnosis of tissue abnormalities

Morphological study of the antennal sensilla in Gerromorpha (Insecta: Hemiptera: Heteroptera)

The external morphology and distribution of the antennal sensilla of 21 species from five families of semiaquatic bugs (Gerromorpha) were examined using scanning electron microscopy. Nine main types were distinguished based on their morphological structure: sensilla trichoidea, sensilla chaetica, sensilla leaflike, sensilla campaniformia, sensilla coeloconica, sensilla ampullacea, sensilla basiconica, sensilla placoidea and sensilla bell-mouthed. The specific morphological structure of one type of sensilla (bell-mouthed sensilla) was observed only in Aquarius paludum. Several subtypes of sensilla are described, differentiated by number, location and type of sensillum characteristic for each examined taxon. The present study provides new data about the morphology and distribution of the antennal sensilla in Gerromorpha

How AI Systems Challenge the Conditions of Moral Agency?

The article explores the effects increasing automation has on our conceptions of human agency. We conceptualize the central features of human agency as ableness, intentionality, and rationality and define responsibility as a central feature of moral agency. We discuss suggestions in favor of holding AI systems moral agents for their functions but join those who refute this view. We consider the possibility of assigning moral agency to automated AI systems in settings of machine-human cooperation but come to the conclusion that AI systems are not genuine participants in joint action and cannot be held morally responsible. Philosophical issues notwithstanding, the functions of AI systems change human agency as they affect our goal setting and pursuing by influencing our conceptions of the attainable. Recommendation algorithms on news sites, social media platforms, and in search engines modify our possibilities to receive accurate and comprehensive information, hence influencing our decision making. Sophisticated AI systems replace human workforce even in such demanding fields as medical surgery, language translation, visual arts, and composing music. Being second to a machine in an increasing number of fields of expertise will affect how human beings regard their own abilities. We need a deeper understanding of how technological progress takes place and how it is intertwined with economic and political realities. Moral responsibility remains a human characteristic. It is our duty to develop AI to serve morally good ends and purposes. Protecting and strengthening the conditions of human agency in any AI environment is part of this task.Peer reviewe

Application of GRADE: Making evidence-based recommendations about diagnostic tests in clinical practice guidelines

<p>Abstract</p> <p>Background</p> <p>Accurate diagnosis is a fundamental aspect of appropriate healthcare. However, clinicians need guidance when implementing diagnostic tests given the number of tests available and resource constraints in healthcare. Practitioners of health often feel compelled to implement recommendations in guidelines, including recommendations about the use of diagnostic tests. However, the understanding about diagnostic tests by guideline panels and the methodology for developing recommendations is far from completely explored. Therefore, we evaluated the factors that guideline developers and users need to consider for the development of implementable recommendations about diagnostic tests.</p> <p>Methods</p> <p>Using a critical analysis of the process, we present the results of a case study using the Grading of Recommendations Applicability, Development and Evaluation (GRADE) approach to develop a clinical practice guideline for the diagnosis of Cow Milk Allergy with the World Allergy Organization.</p> <p>Results</p> <p>To ensure that guideline panels can develop informed recommendations about diagnostic tests, it appears that more emphasis needs to be placed on group processes, including question formulation, defining patient-important outcomes for diagnostic tests, and summarizing evidence. Explicit consideration of concepts of diagnosis from evidence-based medicine, such as pre-test probability and treatment threshold, is required to facilitate the work of a guideline panel and to formulate implementable recommendations.</p> <p>Discussion</p> <p>This case study provides useful guidance for guideline developers and clinicians about what they ought to demand from clinical practice guidelines to facilitate implementation and strengthen confidence in recommendations about diagnostic tests. Applying a structured framework like the GRADE approach with its requirement for transparency in the description of the evidence and factors that influence recommendations facilitates laying out the process and decision factors that are required for the development, interpretation, and implementation of recommendations about diagnostic tests.</p

Spor o metodę we wspołszesnej filozofii prawa

В статье освещается вопрос влияния интеллектуальной традиции на развитие правовой реальности. Акцентировано на таких характеристиках интеллектуальной традиции постмодерна как: принцип плюрализма, интерсубьективности, идея антропоцентризма, гуманизма, верховенства права и т.д. Утверждается идея необходимости глубинного реформирования правовой системы Украины. Изменение существующей интеллектуальной традиции в направлении сближения с постмодерным мышлением обусловит коренное реформирование правовой системы Украины.The article is considered the intellectual tradition influence at the law reality development. It’s accented at such characteristics of postmodern intellectual tradition as: pluralism principle, anthropocentricities idea, humanity, law leadership, etc. The idea of deep reform of Ukraine law system is affirmed. The modern intellectual tradition change at the direction of approaching with postmodern law thing is stipulated deep reform of Ukraine law system

The compatibilist fallacy

Some believe that humans lack a free will, that free will is a necessary condition for responsibility and that therefore humans cannot be responsible for their doings. Others, so-called ‘compatibilists’, believe that humans can be, and normally are, responsible for what they do and in support of this belief they assume that free will is not necessary for responsibility. This article argues that compatibilists are right in their claim that responsibility is compatible with the absence of free will, but wrong in assuming that compatibility can be founded on our social practice. This assumption would involve the ‘compatibilist fallacy’. The argument is based on the starting point that there are two fundamentally different ways of looking at humans as agents and their acts. The ‘phenomenological’ view starts from the way in which people subjectively experience their acts, including their own role as agents who perform these acts. The ‘realist’ view starts from the facts as they can be established by the sciences, facts which are assumed to be independent of our knowledge of them or the way we experience them. The main message is that these two views are hard to combine, but that a separation is not well possible

New photocatalyst for decomposition of humic acids in photocatalysis and photo-Fenton processes

Humic acid Leonardite IHSS standard was decomposed on TiO2 and TiO2 modifi ed by FeC2O4 via the photocatalysis and photo-Fenton processes under UV irradiation. Humic acid (HA) were favorable adsorbed on TiO2 surface and followed decomposition during UV irradiation faster on TiO2 than on the modifi ed samples. However, when H2O2 was added to the solution, the photo-Fenton process occurred on the prepared TiO2 samples, contained iron together with photocatalysis and high acceleration of HA decomposition was observed. In this case the mineralization degree was much higher than in the applied photocatalysis only, around 75% HA (with concentration of 18 mg/L) was mineralized after 3 h of adsorption and 5 h of UV irradiation in the presence of H2O2 and modifi ed TiO2 whereas on TiO2 mineralisation of HA occurred in around 45% only. The measured fl uorescence spectra of HA solutions showed that in the presence of H2O2 polycyclic aromatics were rapidly oxidized to the lower size products such as alcohols, aldehydes, ketones and carboxylic acids, what accelerated the process of HA decomposition