Killing and Letting Die: The Irrelevant Distinction

The object of this essay is to explain why the distinctions made in euthanasia between killing vs. letting die and willingness to kill vs. unwillingness to kill are not relevant to real life euthanasia cases. The specific purpose of the research is to isolate the relevant factor for debate when discussing the morality of euthanasia. It begins with a brief examination of some vocabulary that is commonly used when discussing euthanasia. Following this is a quick overview of what the word euthanasia meant in the ancient Greco-Roman world compared to what it means in the modern vernacular. I use an article by James Rachels about the lack of distinction between killing and letting die (which is one possible relevant factor) and a reply by William Nesbitt which attempts to shift the focus onto willingness to kill (another possible relevant factor). I conclude that Rachels is correct that killing and letting die are morally equivalent when all other factors are the same, but that other factors are never the same and that Nesbitt is closer to the real morally relevant factor in his discussion of willingness to kill. However, Nesbitt is not entirely correct or clear about his ideas. Willingness to kill can, in a case of euthanasia, be equivalent to a willingness to help and is not always a negative thing. The more generalized intention of the person performing the euthanasia is the most relevant factor to the morality of the act

Ronald Reagan, Bill Clinton, and the Populist Tradition in Presidential Rhetoric

Populism is one of the most ambiguous terms in rhetorical scholarship. It can be a political strategy, a genuine reflection of personality, a deep manipulation of core American values, and much more. Political pundits have used it as a descriptive term, and on occasion as an insult. Some have deemed the concept’s flexibility confusing and even counterproductive, which sparked an interest in studying what is meant when analysts and scholars address political speakers as populist. This thesis examines populism in detail, by analyzing the rhetoric of former presidents Ronald Reagan and Bill Clinton. Two questions drove the research: (1) What do people mean when they label a politician as populist? (2) Is this an illuminating descriptor? The research found that that populism’s ambiguity contributes to its utility; however, it is also essential that critics, writers, and others who use the term do so carefully in order to clarify their intent

A placebo-controlled pilot study of intensification of antiretroviral therapy with mycophenolate mofetil

PURPOSE: We studied the safety, tolerability, virologic, and immunologic effects of mycophenolate mofetil (MMF) added to a stable antiretroviral therapy (ART) in the setting of low-level viremia. METHODS: MMF 500 mg BID or placebo was given to patients thought to be adherent on stable ART with plasma viremia between 200 and 4000 copies/mL. At week 4 unblinding was performed and patients on placebo were offered open-label MMF. RESULTS: Six patients were enrolled. At entry mean plasma HIV-1 RNA (VL) was 2.98 log(10 )copies/mL; mean CD4 count was 523. All subjects randomized to placebo elected to cross over to open label MMF. No significant adverse events were observed during MMF therapy. Three patients on MMF achieved VL < 50 copies/mL by week 4; a fourth had VL decline of > 0.5 log. Two patients on placebo had declines of VL. One of these had further decline on open label MMF. Cell surface markers of apoptosis, activation, and proliferation on CD4+ and CD8+ cells declined modestly or remained low. CD4 counts were stable at week 24. All but one subject had rebound of viremia by week 24, universally associated with missed doses of medication by pill count. CONCLUSION: MMF appears to be safe, and its administration lead to decreased T cell activation. During periods of adherence to therapy, the use of MMF was correlated with declines in viremia, but this small pilot study could not prove this association. Further study of MMF in patients with viremia should be considered for whom additional or alternative antiretrovirals are impractical

‘I don't think I can catch it’: women, confidence and responsibility in football coach education

Whilst women’s participation in sport continues to increase, their presence remains ideologically challenging given the significance of sport for the construction of gendered identities. As a hegmonically masculine institution, leadership roles across sport remain male-dominated and the entry of women into positions of authority (such as coaching) routinely contested. But in powerful male-typed sports, like football, women’s participation remains particularly challenging. Consequently, constructions of gender inequity in coaching were explored at a regional division of the English Football Association through unstructured interviews and coaching course observation. Using critical discourse analysis we identified the consistent re/production of women as unconfident in their own skills and abilities, and the framing of women themselves as responsible for the gendered inequities in football coaching. Women were thereby strategically positioned as deservedly on the periphery of the football category,whilst the organization was positioned as progressive and liberal

Patient preferences in tinnitus outcomes and treatments:a qualitative study

In order to identify patient preferences in care for tinnitus an in depth grounded theory study was conducted. This consisted of interviews with 41 patients who had sought help for tinnitus across a range of locations and tinnitus services in England. Preferences for outcomes were for both the removal of the tinnitus and for improved coping and management of the tinnitus. Preferences for treatment were for individualized care, tailored information and for treatment to assist with psychological adjustment and auditory distraction. Adoption of treatments to manage tinnitus were based on a trial and error approach. Patients? preferences for individual treatments varied but were informed by the information they received. Information plays an important role in care for people with tinnitus. Patients hold individual preferences and require engagement in shared decision making

From “getting things right” to “getting things right now”: Developing COVID-19 guidance under time pressure and knowledge uncertainty

Background - At the start of the COVID-19 pandemic, guidance was needed more than ever to direct frontline healthcare and national containment strategies. Rigorous guidance based on robust research was compromised by the emergence of the pandemic and the urgency of need for guidance. Rather than aiming to “get guidance right”, guidance developers needed to “get guidance right now”. Aim - To examine how guidance developers have responded to the need for credible guidance at the start of the COVID-19 pandemic. Methods - An exploratory mixed-methods study was conducted among guidance developers. A web-based survey and follow-up interviews were used to examine the most pertinent challenges in developing COVID-19 guidance, strategies used to address these, and perspectives on the implications of the COVID-19 pandemic on future guidance development. Results - The survey was completed by 46 guidance developers. Survey findings showed that conventional methods of guidance development were largely unsuited for COVID-19 guidance, with 80% (n = 37) of respondents resorting to other methods. From the survey and five follow-up interviews, two themes were identified to bolster the credibility of guidance in a setting of extreme uncertainty: (1) strengthening end-user involvement and (2) conjoining evidence review and recommendation formulation. 70% (n = 32) of survey respondents foresaw possible changes in future guidance production, most notably shortening development time, by reconsidering how to balance between rigour and speed for different types of questions. Conclusion - “Getting guidance right” and “getting guidance right now” are not opposites, rather uncertainties are always part of guidance development and require guidance developers to balance scientific robustness with usability, acceptability, adequacy and contingency. This crisis points to the need to acknowledge uncertainties of scientific evidence more explicitly and points to mechanisms to live with such uncertainty, thus extending guidance development methods and processes more widely

Effects of Electricity and Altered Conductivity on Rainbow Trout Embryos: A Study to Determine Efficacy of Electricity for Eradication of Invasive Salmonids

Electricity has been an applied means of facilitating capture and removal of invasive fishes for many years. Current methods involve use of electrodes to establish a current through which passing fish will be susceptible to a brief shock to stun. This method, however, only affects free swimming individuals and is not inclusive of early life history stages such as embryos within spawning substrate. This study evaluates the susceptibility of embryonic and larval stage rainbow trout (Oncorhynchus mykiss) to direct DC current between 2-20v/cm in varying conductive waters to determine lethality for invasive salmonid eradication efforts. Rainbow trout embryos (n = 10 embryos/exposure) were initially exposed to homogeneous electric fields for 5 sec with a water conductivity of 220uS/cm from 1 day post fertilization (DPF)/ 27 temperature units (TU) to 15 DPF/405TU. Mortality was assessed 24 hours post exposure and the LV50 (lethal voltage) at 220uS/cm was determined for each TU. Embryos from six periods of development were then exposed to their respective LV50 voltages in varying conductive waters (20-600uS/cm). Susceptibility to direct DC voltages increased with voltage but overall susceptibility decreased with development. Susceptibility to a constant voltage increased with increasing conductivity and was consistent throughout early development (81TU-292TU), but the effects of increased conductivity were not enhanced in eyed embryos after 364TU. Results indicate that direct DC current applied prior to eyed embryonic stages, the period of greatest trout embryo susceptibility, is an effective means of eradicating invasive and nuisance salmonids

Towards the TIGER International Framework for Recommendations of Core Competencies in Health Informatics 2.0: Extending the Scope and the Roles

This paper describes the methodology and developments towards the TIGER International Recommendation Framework of Core Competencies in Health Informatics 2.0. This Framework is meant to augment the scope from nursing towards a series of six other professional roles, i.e. direct patient care, health information management, executives, chief information officers, engineers and health IT specialists and researchers and educators. Health informatics core competency areas were compiled from various sources that had integrated the literature and were grouped into consistent clusters. The relevance of these core competency areas was rated in a survey by 718 professional experts from 51 countries. Furthermore, 22 local case studies illustrated the competencies and gave insight into examples of local educational practice. The Framework contributes to the overall discourse on how to shape health informatics education to improve quality and safety of care by enabling useful and successful health information systems

A Team Observed Structured Clinical Encounter (TOSCE) for Pre-Licensure Learners in Maternity Care: A Short Report on the Development of an Assessment Tool for Collaboration

Background: Despite the support for Interprofessional Education (IPE) among policymakers, educators and professional regulating bodies, the research literature is limited with respect to the evaluation of effective assessment strategies. This short report outlines the development of a Team Observed Structured Clinical Encounter (TOSCE), which brings together learners from three health professions involved in primary care obstetrics-family physicians, midwives, and obstetricians-as a strategy for assessing collaborative competencies.Methods: An interprofessional research team was brought together to develop and implement the TOSCE. The process by which the team generated TOSCE scenario stations is outlined, including the consensus-building process, based on a modified Delphi technique, to include expert input from others in the field of practice.Findings: The scenarios developed by the research team for the TOSCE are highlighted including the assessment criteria, based on the Canadian InterprofessionalHealth Collaborative's National Competency Framework.Conclusions: The TOSCE is an emerging and innovative learning tool that encourages the development of essential collaborative competencies. The process of developing a TOSCE outlined in this report offers an affordable, streamlined approach that could be used by educators in many disciplines as a summative or formative assessment strategy