The Reasonableness of Argumentation from Expert Opinion in Medical Discussions: Institutional Safeguards for the Quality of Shared Decision Making

The ideal of shared decision making starts from the assumption that physicians and patients are able to take a joint decision as to what is the best treatment. However, since medical consultations are to be viewed as discussions between an expert and a layman, in practice it will often be the case that the patient has to rely on the physician’s expertise. In this article we examine the extent to which the Dutch laws, guidelines and professional conventions within the medical domain positively influence the quality of the process of shared decision making, even in cases where the physician makes use of an argument from expert opinion. To this end, we will chart some of the most important institutional safeguards for the quality of medical decisions and analyze how these safeguards relate to the critical questions associated with the argument scheme of argumentation from expert opinion

Constructing a Periodic Table of Arguments

The existing classifications of arguments are unsatisfying in a number of ways. This paper proposes an alternative in the form of a Periodic Table of Arguments. The newly developed table can be used as a systematic and comprehensive point of reference for the analysis, evaluation and production of argumentative discourse as well as for various kinds of empirical and computational research in the field of argumentation theory

Do-Not-Attempt-Resuscitation orders for people with intellectual disabilities : dilemmas and uncertainties for ID physicians and trainees. The importance of the deliberation process

Item does not contain fulltextBACKGROUND: Not much is known about Do-Not-Attempt-Resuscitation (DNAR) decision-making for people with intellectual disabilities (IDs). The aim of this study was to clarify the problems and pitfalls of non-emergency DNAR decision-making for people with IDs, from the perspective of ID physicians. METHODS: This qualitative study was based on semi-structured individual interviews, focus group interviews and an expert meeting, all recorded digitally and transcribed verbatim. Forty ID physicians and trainees were interviewed about problems, pitfalls and dilemmas of DNAR decision-making for people with IDs in the Netherlands. Data were analysed using Grounded Theory procedures. RESULTS: The core category identified was 'Patient-related considerations when issuing DNAR orders'. Within this category, medical considerations were the main contributory factor for the ID physicians. Evaluation of quality of life was left to the relatives and was sometimes a cause of conflicts between physicians and relatives. The category of 'The decision-maker role' was as important as that of 'The decision procedure in an organisational context'. The procedure of issuing a non-emergency DNAR order and the embedding of this procedure in the health care organisation were important for the ID physicians. CONCLUSION: The theory we developed clarifies that DNAR decision-making for people with IDs is complex and causes uncertainties. This theory offers a sound basis for training courses for physicians to deal with uncertainties regarding DNAR decision-making, as well as a method for advance care planning. Health care organisations are strongly advised to implement a procedure regarding DNAR decision-making

The minimal N=4 no-scale model from generalized dimensional reduction

We consider the generalized dimensional reduction of pure ungauged N=4, D=5 supergravity, where supersymmetry is spontaneously broken to N=2 or N=0 with identically vanishing scalar potential. We explicitly construct the resulting gauged D=4 theory coupled to a single vector multiplet, which provides the minimal N=4 realization of a no-scale model. We discuss its relation with the standard classification of N=4 gaugings, extensions to non-compact twists and to higher dimensions, the N=2 theories obtained via consistent Z_2 orbifold projections and prospects for further generalizations.Comment: 1+28 pages, no figures, JHEP3 LaTeX, published versio

Analysis of C/E results of fission rate ratio measurements in several fast lead VENUS-F cores

During the GUINEVERE FP6 European project (2006-2011), the zero-power VENUS water-moderated reactor was modified into VENUS-F, a mockup of lead cooled fast spectrum system with solid components that can be operated in both critical and subcritical mode. The Fast Reactor Experiments for hybrid Applications (FREYA) FP7 project was launched in 2011 to support the designs of the MYRRHA Accelerator Driven System (ADS) and the ALFRED Lead Fast Reactor (LFR). Three VENUS-F critical core configurations, simulating the complex MYRRHA core design and one configuration devoted to the LFR ALFRED core conditions were investigated in 2015. The MYRRHA related cores simulated step by step design peculiarities like the BeO reflector and in pile sections. For all of these cores the fuel assemblies were of a simple design consisting of 30 % enriched metallic uranium, lead rodlets to simulate the coolant and Al2O3 rodlets to simulate the oxide fuel. Fission rate ratios of minor actinides such as Np-237, Am-241 as well as Pu-239, Pu-240, Pu-242 and U-238 to U-235 were measured in these VENUS-F critical assemblies with small fission chambers in specially designed locations, to determine the spectral indices in the different neutron spectrum conditions. The measurements have been analyzed using advanced computational tools including deterministic and stochastic codes and different nuclear data sets like JEFF-3.1, JEFF-3.2, ENDF/B7.1, ENDF/B6.8, JENDL-4.0 and TENDL-2014. The analysis of the C/E discrepancies will help to improve the nuclear data in the specific energy region of fast neutron reactor spectra

Sublingual sufentanil for postoperative pain relief: First clinical experiences

Background: The sublingual sufentanil tablet system (SSTS) is a novel hand-held patientcontrolled analgesia device developed for treatment of moderate-to-severe postoperative pain. Here we present the first results of its clinical use. Methods: Adult patients undergoing major surgery in five hospitals in the Netherlands received the SSTS for postoperative pain relief as part of multimodal pain management that further included paracetamol and a nonsteroidal anti-inflammatory drug (NSAID). The following variables were collected: postoperative pain scores using the 11-point numerical rating score (NRS) at rest, number of tablets used, occurrence of nausea, and patient satisfaction scores. Results: We included 280 patients in the study; the majority underwent laparoscopic abdominal (49%) or orthopedic (knee replacement) surgery (34%). The median NRS was 3.5 (interquartile range 2.3–4.0) on the day of surgery, 3.3 (2.3–4.0) on the first postoperative day, and 2.8 (2.0–4.0) on the second postoperative day; pain scores did not differ between surgery types. Mean number of tablets used was 19 (range 0–86). Nausea occurred in 34% of patients, more often in women (45% vs 19%). Overall satisfaction was high in 73% of patients. Satisfaction was correlated with pain relief (p < 0.001) and inversely correlated with occurrence of nausea (p=0.01). Discussion: In this data set obtained under real-life conditions we show that the SSTS effectively managed postoperative pain in abdominal and orthopedic surgeries. Future studies should determine patient populations that benefit most from the SSTS, assess the added values versus intravenous patient-controlled analgesia, and determine the pharmacoeconomics of the system

Gauged N=4 supergravities

We present the gauged N=4 (half-maximal) supergravities in four and five spacetime dimensions coupled to an arbitrary number of vector multiplets. The gaugings are parameterized by a set of appropriately constrained constant tensors, which transform covariantly under the global symmetry groups SL(2) x SO(6,n) and SO(1,1) x SO(5,n), respectively. In terms of these tensors the universal Lagrangian and the Killing Spinor equations are given. The known gaugings, in particular those originating from flux compactifications, are incorporated in the formulation, but also new classes of gaugings are found. Finally, we present the embedding chain of the five dimensional into the four dimensional into the three dimensional gaugings, thereby showing how the deformation parameters organize under the respectively larger duality groups.Comment: 36 pages, v2: references added, comments added, v3: published version, references added, typos corrected, v4: sign mistakes in footnote 4 and equation (2.13) correcte

N=3 Warped Compactifications

Orientifolds with three-form flux provide some of the simplest string examples of warped compactification. In this paper we show that some models of this type have the unusual feature of D=4, N=3 spacetime supersymmetry. We discuss their construction and low energy physics. Although the local form of the moduli space is fully determined by supersymmetry, to find its global form requires a careful study of the BPS spectrum.Comment: 27 pages, v2: 32pp., RevTeX4, fixed factors, slightly improved sections 3D and 4B, v3: added referenc