'Round-table' ethical debate: is a suicide note an authoritative 'living will'?

Living wills are often considered by physicians who are faced with a dying patient. Although popular with the general public, they remain problems of authenticity and authority. It is difficult for the examining physician to know whether the patient understood the terms of the advance directive when they signed it, and whether they still consider it authoritative at the time that it is produced. Also, there is little consensus on what spectrum of instruments constitutes a binding advance directive in real life. Does a 'suicide note' constitute an authentic and authoritative 'living will'? Our panel of authorities considers this problem in a round-table discussion

Trabalhadoras domésticas: trajetórias, vivências e vida cotidiana

Em um contexto de mudanças na legislação, com ampliação de direitos no trabalho doméstico, foi desenvolvida uma pesquisa para investigar as práticas e os sentidos produzidos no cotidiano de trabalhadoras domésticas. A pesquisa foi realizada em duas regiões metropolitanas brasileiras: Grande Florianópolis e Baixada Fluminense. A partir dos chamados métodos biográficos, foram entrevistadas 27 trabalhadoras domésticas, mensalistas e diaristas, tendo como instrumentos complementares fotografias e agenda colorida. A análise resultou na identificação de três núcleos de significação: 1) trajetórias educacionais e laborais, 2) vivências no trabalho e 3) gestão da vida cotidiana e trabalho. As trajetórias revelam entrada precoce na vida laboral e baixa escolaridade como fatores que contribuíram para que exercessem o trabalho doméstico remunerado. As vivências foram permeadas por ambiguidades afetivas nas relações com contratantes e familiares, particularmente para as mensalistas. A gestão do cotidiano revela peculiaridades do trabalho de diaristas e mensalistas e capacidade de negociação com uso de astúcias e saberes tácitos. A análise evidencia a articulação entre ambiguidades afetivas e demandas imperativas num cotidiano de trabalho intenso, íntimo e com traços de herança escravagista.In a context of changes in legislation and with expansion of rights in domestic service, it was made a research to investigate the practices and the meanings produced in the daily lives of domestic workers. The investigation occurred in two Brazilian metropolitan regions: Grande Florianópolis and Baixada Fluminense. Based on biographic methods, 27 domestic workers (housemaids and cleaners) were interviewed, with use of photographs and colorful schedule. In the analysis, three meaning cores were identified: educational and work trajectories, labor experiences and management of daily life and work. The trajectories reveal early entry into working life and low education level as factors that reinforced to perform paid domestic work. The experiences were constituted by emotional ambiguities in relations with employers and families, particularly for the housemaids. The management of daily life reveals peculiarities of housemaids and cleaners work and ability to negotiate with cunning and tacit knowledge. The analysis stresses the articulation between emotional ambiguities and imperative demands in an intense, intimate everyday work life marked by traces of slave heritage

Perceived barriers to the regionalization of adult critical care in the United States: a qualitative preliminary study

<p>Abstract</p> <p>Background</p> <p>Regionalization of adult critical care services may improve outcomes for critically ill patients. We sought to develop a framework for understanding clinician attitudes toward regionalization and potential barriers to developing a tiered, regionalized system of care in the United States.</p> <p>Methods</p> <p>We performed a qualitative study using semi-structured interviews of critical care stakeholders in the United States, including physicians, nurses and hospital administrators. Stakeholders were identified from a stratified-random sample of United States general medical and surgical hospitals. Key barriers and potential solutions were identified by performing content analysis of the interview transcriptions.</p> <p>Results</p> <p>We interviewed 30 stakeholders from 24 different hospitals, representing a broad range of hospital locations and sizes. Key barriers to regionalization included personal and economic strain on families, loss of autonomy on the part of referring physicians and hospitals, loss of revenue on the part of referring physicians and hospitals, the potential to worsen outcomes at small hospitals by limiting services, and the potential to overwhelm large hospitals. Improving communication between destination and source hospitals, provider education, instituting voluntary objective criteria to become a designated referral center, and mechanisms to feed back patients and revenue to source hospitals were identified as potential solutions to some of these barriers.</p> <p>Conclusion</p> <p>Regionalization efforts will be met with significant conceptual and structural barriers. These data provide a foundation for future research and can be used to inform policy decisions regarding the design and implementation of a regionalized system of critical care.</p

Independent Component Analysis of the Effect of L-dopa on fMRI of Language Processing

L-dopa, which is a precursor for dopamine, acts to amplify strong signals, and dampen weak signals as suggested by previous studies. The effect of L-dopa has been demonstrated in language studies, suggesting restriction of the semantic network. In this study, we aimed to examine the effect of L-dopa on language processing with fMRI using Independent Component Analysis (ICA). Two types of language tasks (phonological and semantic categorization tasks) were tested under two drug conditions (placebo and L-dopa) in 16 healthy subjects. Probabilistic ICA (PICA), part of FSL, was implemented to generate Independent Components (IC) for each subject for the four conditions and the ICs were classified into task-relevant source groups by a correlation threshold criterion. Our key findings include: (i) The highly task-relevant brain regions including the Left Inferior Frontal Gyrus (LIFG), Left Fusiform Gyrus (LFUS), Left Parietal lobe (LPAR) and Superior Temporal Gyrus (STG) were activated with both L-dopa and placebo for both tasks, and (ii) as compared to placebo, L-dopa was associated with increased activity in posterior regions, including the superior temporal area (BA 22), and decreased activity in the thalamus (pulvinar) and inferior frontal gyrus (BA 11/47) for both tasks. These results raise the possibility that L-dopa may exert an indirect effect on posterior regions mediated by the thalamus (pulvinar)

The new enclosures: critical perspectives on corporate land deals

The contributions to this collection use the tools of agrarian political economy to explore the rapid growth and complex dynamics of large-scale land deals in recent years, with a special focus on the implications of big land deals for property and labour regimes, labour processes and structures of accumulation. The first part of this introductory essay examines the implications of this agrarian political economy perspective. First we explore the continuities and contrasts between historical and contemporary land grabs, before examining the core underlying debate around large- versus small-scale farming futures. Next, we unpack the diverse contexts and causes of land grabbing today, highlighting six overlapping mechanisms. The following section turns to assessing the crisis narratives that frame the justifications for land deals, and the flaws in the argument around there being excess, empty or idle land available. Next the paper turns to an examination of the impacts of land deals, and the processes of inclusion and exclusion at play, before looking at patterns of resistance and constructions of alternatives. The final section introduces the papers in the collection.ESR