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1.
Perspect Biol Med ; 65(2): 213-220, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35938429

RESUMO

Dignity and indignity, risk and safety, are pairs of concepts on a continuum, and this continuum can have fuzzy boundaries and differing interpretations. Risk is typically defined and apprehended by an actor and an observer and can shift according to time, place, context, and voice. Moreover, when the dignity of risk is considered, it typically involves the subject who is deemed to be taking the risk(s) and the other who is considering protection or safeguards and weighing in at a specific moment in time, focusing on a window of information and conceptualization. This can lead to reflexive responses and confirmatory biases. This article draws on the author's experience as a psychologist and clinical ethicist and focuses on judgments about the other, the meaning of risk, and the confounding nature of human perceptions and attributions about risk. As humans in relationship with each other, we are imperfect evaluators of risk for the other. Humility and an openness to situational factors may open up much needed space for reflection.


Assuntos
Respeito , Humanos
3.
Hastings Cent Rep ; 52(3): 37-48, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35678515

RESUMO

The impression of bioethicists as "dangerous," as articulated in Mouth Magazine in 1994, has continued to be a theme in the disability movement. We respond to three common responses by bioethicists to this impression-namely, this is from the past, and bioethicists are different now; this is an angry and extremist position; and the Americans with Disabilities Act and other disability rights and justice efforts have solved historical inequities. We draw on the historical record and on our collective experiences as bioethicists engaged in clinical consultation and education and as the founding, former, and current directors of a program focused on disability and rehabilitation ethics to argue that ableism and unexamined assumptions about people with disabilities have persisted in bioethics despite decades of counternarratives, research, and divergent perspectives. Ableism and such assumptions can lead to health care decisions that are prone to bias, mistreatment, and a lack of consideration of viable options for living with disability. As the field of bioethics moves toward certification examinations and as new generations join the field's ranks, these problems need to be rectified with solutions at the individual, interpersonal, and structural levels. It is past time to take disability seriously.


Assuntos
Bioética , Pessoas com Deficiência , Bioética/educação , Eticistas , Humanos , Justiça Social
6.
PM R ; 13(8): 915-921, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33951299
7.
Biomed Res Int ; 2021: 8844356, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33855085

RESUMO

BACKGROUND: The foot posture index (FPI) is a valid, reliable, and multidimensional method for determining foot posture in a wide range of clinical settings. To date, no normative data of healthy young adults in Saudi Arabia have been available for comparison and reference. Hence, this study is aimed at establishing the FPI reference values, gender, and side differences of FPI and their association with anthropometric determinants, balance, functional mobility, and hypermobility. METHODS: FPI was assessed in 581 (291 men and 290 women) healthy young adults aged 18-25 years. The FPI range was obtained for both feet as the sum of the scores (-2, -1, 0, 1, and 2) given to each criterion: (-1 to -12) supinated foot, (0 to +5) neutral foot, and (+6 to +12) pronated foot. The study furthermore assessed the balance using a near tandem balance test, functional mobility by stair ascent and descent test, and joint hypermobility via the Beighton scale. RESULTS: The average FPI score was 2.76 ± 5.23 for all subjects, 2.98 ± 5.02 for men and 2.55 ± 5.43 for women. Neutral foot posture was most frequent in this study (52.9%). A higher proportion of women had pronated (21.0%) and supinated (11.7%) feet than men which were 16.8% and 10.3%, respectively. This study also confirmed that side differences were found to be significant (p value < 0.001), whereas gender differences were significant only in the normal, pronated, and supinated foot groups. CONCLUSION: The most common foot posture in both genders was ranged from neutral to slight pronation. We also found a correlation between balance with FPI in the supinated and hypersupinated foot groups, functional mobility with FPI of pronated and supinated foot groups, and joint hypermobility with FPI of the hyperpronated foot group.


Assuntos
Antropometria , Pé/fisiologia , Instabilidade Articular/fisiopatologia , Equilíbrio Postural/fisiologia , Postura/fisiologia , Feminino , Humanos , Locomoção/fisiologia , Masculino , Valores de Referência , Arábia Saudita , Adulto Jovem
10.
J Clin Ethics ; 31(3): 219-227, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32773404

RESUMO

When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward.


Assuntos
Consultoria Ética/organização & administração , Pandemias/ética , Centros Médicos Acadêmicos , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Humanos , Cidade de Nova Iorque/epidemiologia , Pneumonia Viral/epidemiologia , SARS-CoV-2
11.
Hastings Cent Rep ; 50(3): 10-11, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32369192

RESUMO

As I organize a pile of ethics consult chart notes in New York City in mid-April 2020, I look at the ten cases that I have co-consulted on recently. Nine of the patients were found to be Covid positive. The reasons for the consults are mostly familiar-surrogate decision-making, informed refusal of treatment, goals of care, defining futility. But the context is unfamiliar and unsettling. Bioethicists are in pandemic mode, dusting off and revising triage plans. Patients and potential patients are fearful-of the disease itself and of the amplification of health disparities and inequities. There is much to contemplate, but as I go through my cases, I worry about disability, about biases and racist stereotypes. In this pandemic, historically marginalized communities are at risk of further disenfranchisement.


Assuntos
Temas Bioéticos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Betacoronavirus , COVID-19 , Infecções por Coronavirus/etnologia , Alocação de Recursos para a Atenção à Saúde/ética , Humanos , Cidade de Nova Iorque , Pandemias , Planejamento de Assistência ao Paciente/ética , Pneumonia Viral/etnologia , SARS-CoV-2 , Triagem/ética
13.
Eur Neurol ; 83(2): 131-137, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32348996

RESUMO

BACKGROUND: Hand-arm bimanual intensive therapy (HABIT) has been shown to be an effective method for improving upper-extremity function. However, owing to ambiguity within the evidence of HABIT's effects on hand function among children with unilateral spastic cerebral palsy (CP), this meta-analysis sought to elucidate whether the same was true in this patient population. SUMMARY: A computerized database search yielded 468 studies. After meticulous scrutiny and screening of these studies according to the selection criteria, 4 full-text articles were included in the meta-analysis. All 4 studies underwent a methodological quality assessment according to the Physiotherapy Evidence Database Scale (PEDro), with a score of greater than 8. Five comparisons were then made involving the 4 selected randomized controlled trials (RCTs). The effect size was measured using the correlation coefficient (r value). The effect sizes of the individual studies were 0.006, 0.03, 0.04, 0.22, and 0.15. The total effect size was 0.06. Key Message: This meta-analysis determined that there is a trivial benefit using HABIT when compared to constraint-induced movement therapy or structured and unstructured bimanual therapy in pediatric patients with unilateral spastic CP. More RCTs are needed to substantiate our evidence.


Assuntos
Paralisia Cerebral/radioterapia , Mãos/fisiopatologia , Atividade Motora/fisiologia , Modalidades de Fisioterapia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Extremidade Superior
15.
J Clin Ethics ; 30(3): 262-269, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31573971

RESUMO

Debates regarding clinical ethicists' scope of practice are not novel and will continue to evolve. Rapid changes in healthcare delivery, outcomes, and expectations have necessitated flexibility in clinical ethicists' roles whereby hospital-based clinical ethicists are expected to be woven into the institutional fabric in a way that did not exist in more traditional relationships. In this article we discuss three emerging roles: the ethicist embedded in the interdisciplinary team, the ethicist with an expanded educational mandate, and the ethicist as a therapeutic presence in the patient care space. Such expanded capacities offer more robust, positive contributions to institutional culture, stakeholders' relationships, and patient-centered care.


Assuntos
Eticistas , Hospitais , Assistência Centrada no Paciente , Atenção à Saúde , Humanos , Assistência Centrada no Paciente/ética
17.
Med Sci Monit ; 25: 5683-5689, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31365521

RESUMO

BACKGROUND Due to lack of normal reference values of forward and lateral reach tests for Saudi young adults, this study aimed to formulate normative values of the forward reach test and lateral reach test and to assess the correlation between the demographic variables and the reach test results. MATERIAL AND METHODS We randomly assigned 240 normal young Saudi adults ages 20-23 years to assess reach test scores in forward and lateral directions. All the subjects had been measured for distance reached in forward and lateral direction on graph paper fixed to a white board. RESULTS The mean and standard deviation of forward and lateral reach distances were 25±8.14 cm and 19.78±5.70 cm, respectively. Significant differences were found between males and females for forward reach and lateral reach scores (p<0.001). Forward reach and lateral reach values showed a moderate correlation with height, lower limb length, and upper limb length. The intra-rater reliability assessed by intra-class correlation coefficient was 0.91 and 0.92 for the forward and lateral reach test scores, respectively. CONCLUSIONS This study established reference values of forward and lateral reach scores for Saudi young adults ages 20-23 years. Height, upper limb length, and lower limb length were moderately correlated with the reach distances in forward and lateral directions. Males performed longer reach distances than females.


Assuntos
Braço/fisiologia , Pesos e Medidas Corporais/métodos , Antropometria/métodos , Fenômenos Biomecânicos , Teste de Esforço/métodos , Feminino , Humanos , Masculino , Equilíbrio Postural/fisiologia , Psicometria , Valores de Referência , Reprodutibilidade dos Testes , Arábia Saudita , Adulto Jovem
18.
Chemosphere ; 235: 365-372, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31265982

RESUMO

The search for an effective and sustainable treatment method to remove the recalcitrant atom-bridged bis-anilino compounds, 4,4'-methylenedianiline (MDA) and 4,4'-thiodianiline (TDA) from water is a major challenge and focus of this study. The escalating discharge of these two toxic and carcinogenic pollutants from industrial sources may pose a serious threat to the environment. Crude soybean peroxidase (SBP), isolated from soybean seed hulls (coats), catalyzes the oxidative polymerization of these aqueous pollutants in the presence of hydrogen peroxide. The effects of several process parameters, i.e., pH, hydrogen peroxide-to-substrate concentration ratio and SBP concentration, were investigated to optimize the performance of enzymatic treatment. The minimum effective SBP concentration required for removal of MDA was 0.70 U/mL, which was higher than that of TDA (0.15 U/mL). The reaction time course to achieve ≥95% removal of these compounds from water was determined under those optimum conditions. Identification of the transformed products was performed by means of high-resolution electrospray ionization mass spectrometry. The products generally observed were protonated oxidized oxidative dimers and higher oligomers (most commonly azo-coupled products). Michaelis constant, KM, and maximum reaction velocity, Vmax, obtained from the Michaelis-Menten (M-M) model revealed that TDA had a 65-fold lower KM than MDA (indicating TDA's higher affinity for SBP), and almost 5-fold higher Vmax than MDA. A pro-forma cost analysis is presented to assess the possibility of commercialization of enzymatic treatment as an alternative to conventional/traditional treatment methods.


Assuntos
Peroxidases/metabolismo , Soja/enzimologia , Poluentes Químicos da Água/isolamento & purificação , Purificação da Água/métodos , Compostos de Anilina/isolamento & purificação , Catálise , Peróxido de Hidrogênio , Cinética , Oxirredução , Peroxidases/química , Soja/metabolismo , Água , Poluentes Químicos da Água/química
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