How do physicians perceive quality of life? Ethical questioning in neonatology

International audienceBackground: The outcome of very preterm infants is marked by the development of complications that can have an impact on the quality of life of the children and their families. The concept of quality of life and its evaluation in the long term raise semantic and ethical problems for French physicians in perinatal care. Our reflection aims to gain a better understanding of the representations surrounding quality of life in neonatal medicine.Discussion: If French physicians hesitate to face this concept (through self-interest and apprehension), it is because the debate has become more complex. Formerly, the dilemma was between respect for life versus quality of life. Today, although this dilemma is still with us, the questions raised by French physicians show us that autonomy is given increasing importance. The equation to be solved now contains three variables: respect for life, well-being, autonomy. So we find ourselves between three positions and no longer two: respect for life (the ethics of conviction), quality of life based on autonomy (rationalist and secular deontologism), and quality of life based on the differential between well-being and suffering (utilitarianism).Summary: A solution could lie in consequentialism, which integrates the consequences for future generations in terms of both safeguarding of autonomy and quality of life, and puts the sacredness of life in second place but without sacrificing it. By evaluating their future quality of life, we can better respond to the needs of these children

Barriers in Referring Neonatal Patients to Perinatal Palliative Care: A French Multicenter Survey

International audienceBackground When an incurable fetal condition is detected, some women (or couples) would rather choose to continue with the pregnancy than opt for termination of pregnancy for medical reasons, which, in France, can be performed until full term. Such situations are frequently occurring and sometimes leading to the implementation of neonatal palliative care. The objectives of this study were to evaluate the practices of perinatal care french professionals in this context; to identify the potential obstacles that might interfere with the provision of an appropiate neonatal palliative care; and, from an opposite perspective, to determine the criteria that led, in some cases, to offer this type of care for prenatally diagnosed lethal abnormality. Methods We used an email survey sent to 434 maternal-fetal medicine specialists (MFMs) and fetal care pediatric specialists (FCPs) at 48 multidisciplinary centers for prenatal diagnosis (MCPD). Results Forty-two multidisciplinary centers for prenatal diagnosis (87.5%) took part. In total, 102 MFMs and 112 FCPs completed the survey, yielding response rate of 49.3%. One quarter of professionals (26.2%) estimated that over 20% of fetal pathologies presenting in MCPD could correspond to a diagnosis categorized as lethal (FCPs versus MFMs: 24% vs 17.2%, p = 0.04). The mean proportion of fetal abnormalities eligible for palliative care at birth was estimated at 19.30% (+/- 2.4) (FCPs versus MFMs: 23.4% vs 15.2%, p = 0.029). The degree of diagnostic certainty appears to be the most influencing factor (98.1%, n = 207) in the information provided to the pregnant woman with regard to potential neonatal palliative care. The vast majority of professionals, 92.5%, supported considering the practice of palliative care as a regular option to propose antenatally. Conclusions Our study reveals the clear need for training perinatal professionals in perinatal palliative care and for the standardization of practices in this field

On the Continuity Set of an omega Rational Function

In this paper, we study the continuity of rational functions realized by B\"uchi finite state transducers. It has been shown by Prieur that it can be decided whether such a function is continuous. We prove here that surprisingly, it cannot be decided whether such a function F has at least one point of continuity and that its continuity set C(F) cannot be computed. In the case of a synchronous rational function, we show that its continuity set is rational and that it can be computed. Furthermore we prove that any rational Pi^0_2-subset of X^omega for some alphabet X is the continuity set C(F) of an omega-rational synchronous function F defined on X^omega.Comment: Dedicated to Serge Grigorieff on the occasion of his 60th Birthda

Nomenclature- and Database-Compatible Names for the Two Ebola Virus Variants that Emerged in Guinea and the Democratic Republic of the Congo in 2014

In 2014, Ebola virus (EBOV) was identified as the etiological agent of a large and still expanding outbreak of Ebola virus disease (EVD) in West Africa and a much more confined EVD outbreak in Middle Africa. Epidemiological and evolutionary analyses confirmed that all cases of both outbreaks are connected to a single introduction each of EBOV into human populations and that both outbreaks are not directly connected. Coding-complete genomic sequence analyses of isolates revealed that the two outbreaks were caused by two novel EBOV variants, and initial clinical observations suggest that neither of them should be considered strains. Here we present consensus decisions on naming for both variants (West Africa: “Makona”, Middle Africa: “Lomela”) and provide database-compatible full, shortened, and abbreviated names that are in line with recently established filovirus sub-species nomenclatures

Filovirus RefSeq Entries: Evaluation and Selection of Filovirus Type Variants, Type Sequences, and Names

Sequence determination of complete or coding-complete genomes of viruses is becoming common practice for supporting the work of epidemiologists, ecologists, virologists, and taxonomists. Sequencing duration and costs are rapidly decreasing, sequencing hardware is under modification for use by non-experts, and software is constantly being improved to simplify sequence data management and analysis. Thus, analysis of virus disease outbreaks on the molecular level is now feasible, including characterization of the evolution of individual virus populations in single patients over time. The increasing accumulation of sequencing data creates a management problem for the curators of commonly used sequence databases and an entry retrieval problem for end users. Therefore, utilizing the data to their fullest potential will require setting nomenclature and annotation standards for virus isolates and associated genomic sequences. The National Center for Biotechnology Information’s (NCBI’s) RefSeq is a non-redundant, curated database for reference (or type) nucleotide sequence records that supplies source data to numerous other databases. Building on recently proposed templates for filovirus variant naming [ ()////-], we report consensus decisions from a majority of past and currently active filovirus experts on the eight filovirus type variants and isolates to be represented in RefSeq, their final designations, and their associated sequences

Virus genomes reveal factors that spread and sustained the Ebola epidemic.

The 2013-2016 West African epidemic caused by the Ebola virus was of unprecedented magnitude, duration and impact. Here we reconstruct the dispersal, proliferation and decline of Ebola virus throughout the region by analysing 1,610 Ebola virus genomes, which represent over 5% of the known cases. We test the association of geography, climate and demography with viral movement among administrative regions, inferring a classic 'gravity' model, with intense dispersal between larger and closer populations. Despite attenuation of international dispersal after border closures, cross-border transmission had already sown the seeds for an international epidemic, rendering these measures ineffective at curbing the epidemic. We address why the epidemic did not spread into neighbouring countries, showing that these countries were susceptible to substantial outbreaks but at lower risk of introductions. Finally, we reveal that this large epidemic was a heterogeneous and spatially dissociated collection of transmission clusters of varying size, duration and connectivity. These insights will help to inform interventions in future epidemics

Temporal and spatial analysis of the 2014-2015 Ebola virus outbreak in West Africa

West Africa is currently witnessing the most extensive Ebola virus (EBOV) outbreak so far recorded. Until now, there have been 27,013 reported cases and 11,134 deaths. The origin of the virus is thought to have been a zoonotic transmission from a bat to a two-year-old boy in December 2013 (ref. 2). From this index case the virus was spread by human-to-human contact throughout Guinea, Sierra Leone and Liberia. However, the origin of the particular virus in each country and time of transmission is not known and currently relies on epidemiological analysis, which may be unreliable owing to the difficulties of obtaining patient information. Here we trace the genetic evolution of EBOV in the current outbreak that has resulted in multiple lineages. Deep sequencing of 179 patient samples processed by the European Mobile Laboratory, the first diagnostics unit to be deployed to the epicentre of the outbreak in Guinea, reveals an epidemiological and evolutionary history of the epidemic from March 2014 to January 2015. Analysis of EBOV genome evolution has also benefited from a similar sequencing effort of patient samples from Sierra Leone. Our results confirm that the EBOV from Guinea moved into Sierra Leone, most likely in April or early May. The viruses of the Guinea/Sierra Leone lineage mixed around June/July 2014. Viral sequences covering August, September and October 2014 indicate that this lineage evolved independently within Guinea. These data can be used in conjunction with epidemiological information to test retrospectively the effectiveness of control measures, and provides an unprecedented window into the evolution of an ongoing viral haemorrhagic fever outbreak.status: publishe

Quelques perspectives de la métaphysique de maître Eckhart et son écriture latine

The work of Meister Eckhard (in particular all of the Latin texts) on the question of God, appear to deal with the major themes of metaphysics : Being, The One, The Mind ; these very topics ar the speculative movements which are to become distinct languages, albeit connected within the same basic thought system. The language of ontology attempts to define, using traditional references, the constituent relation between Being and existence while avoiding falling into the pitfalls of univocity and equivocalness. Henological language, inspired by Neoplatonism, is applied to the Divine Nature and creation, with a unifying radicalness which appears to move in the direction of apophatism. Noetic language, revealing the influence of Aristotelian logic, moves in the direction of an interpretation of God as Pure Action, in his capacity as that which exists, through his Logos, the a priori for the existence and truth of all things. These languages are based, both in their development and in their articulation, on the principle of the convertibility of transcendentals. Seen in this way, the metaphysical thought system of Meister Eckhart stands within the context of the Sacred Writings which deal with the nature of God.L'œuvre de maître Eckhart (notamment l'ensemble des textes latins) sur la question de Dieu, semble traversée par des grandes directions métaphysiques : l'Être, l'Un, l'Intellect ; ce sont là, ainsi indiqués, des mouvements spéculatifs qui se projettent dans des langages distincts, mais liés au sein d'une même pensée fondamentale. Le langage ontologique veut penser, à partir de références traditionnelles, le rapport constitutif entre l'Être et l'étant en écartant les écueils de l'univocité et de l'équivocité. Le langage hénologique, inspiré du Néoplatonisme, est appliqué à la Nature divine et à la création, dans le sens d'une radicalité unifiante qui fait signe vers un certain apophatisme. Le langage noétique où se révèle l'influence de l'aristotélisme, s'oriente en direction d'une interprétation de Dieu comme Agir pur mis en capacité d'être, par son Verbe, l'a-priori d'existence et de vérité de toutes choses. Ces langages reposent, dans leur développement comme dans leur articulation, sur le principe de la convertibilité de transcendantaux. Ainsi envisagée, la pensée métaphysique de maître Eckhart se constitue sur l'horizon de l'Écriture sacrée où se donne à l'interprétation la vie absolue de Dieu.Gire Pierre. Quelques perspectives de la métaphysique de maître Eckhart et son écriture latine. In: Revue des Sciences Religieuses, tome 73, fascicule 3, 1999. pp. 314-330

Mystique et christianisme chez Eckhart

Eckhart is a philosopher, a theologian and a mystic. He is a Christian thinker, influenced by many intellectual and spiritual traditions (Greek philosophy, Christian neoplato- nism, apophatism, Domican school, Jewish and Arabic thought). This is from this intricate scope of intelligibility, that it is possible to interpret the meaning of mystical experience as the metaphysical proof of the Absolute life of God in the reality of the human creature. This proof appears in the image of the pre- existential root of the soul in the Deity through the necessary mediation of the Holy Word. It is given to the human being, in his very being, to become son in the Son by carrying out radical detachment, whose passage points out the astonishing strentgh. Finally, mystical life is only here Christian experience, brought to its climax. It appears as the very witness, given to Holy life which bears everything in Eternity.Eckhart est simultanément philosophe, théologien et mystique. Il s'inscrit dans le christianisme, au carrefour de traditions intellectuelles et spirituelles multiples (écoles philosophiques grecques, néoplatonisme chrétien, tradition spirituelle de la négativité, école dominicaine, influences théologiques juive et musulmane). C'est à partir de cet horizon complexe d'intelligibilité qu'il est possible d'interpréter la signification de son expérience mystique comme l'épreuve métaphysique de la Vie absolue de Dieu dans la réalité de la créature humaine. Cette épreuve s'offre dans la figure de l'enracinement pré-existentiel de l'âme au sein de la Déité par la médiation nécessaire du Verbe divin. Il s'agit pour l'homme, en son être même, d'être fils dans le Fils en s'appuyant sur une pratique du détachement radical dont la percée révèle la force inouïe. La vie mystique n'est ici en définitive que l'expérience chrétienne, élevée à son extrême intensité. Elle se donne comme le témoignage véritable rendu à la Vie divine qui porte toutes choses dans l'éternité.Gire Pierre. Mystique et christianisme chez Eckhart. In: Revue des Sciences Religieuses, tome 76, fascicule 1, 2002. pp. 3-13

Satan : aspects philosophiques

To develop a philosophical consideration of Satan, two conditions are presupposed:a) the existence or non-existence of Satan does not enter into the argument,b) Satan’s presence is not excluded from his mythology in culture.Philosophy reminds us that the appearance of Satan’s figure remains in connection with the expression of the imaginary with regard to the irreductible experiences of humanity, that his mythology is creative of meaning to be imposed on the various changing figures of the inhuman, and that belief in his activity is not dissociated from its different uses in society.Whatever form it takes, Satan will remain in culture because, in all likelihood, humanity is incapable of living without mythology: mythology, which is humanity’s cause for self-reflection and a means for it to ward off its self-doubts