J, Volume 5, Issue 3 (September 2022) – 6 articles

Decisions regarding invasive ventilation with tracheostomy (TIV) in patients with amyotrophic lateral sclerosis (ALS) involve serious ethical issues. Cultural differences in the attitudes of patients, caregivers, and physicians toward TIV initiation and withdrawal decisions have been analyzed based on a narrative review approach, comparing the situation between Japan and the U.S. Three main issues were identified regarding the implementation of TIV. The first is the lack of Advance Care Planning. Second, some patients may choose TIV based on the wishes of their physicians or caregivers, even if the patients themselves do not want TIV in the Japanese context. Third is the influence of patient associations, which advocate for the protection of patients’ rights. Next, this study identifies the following issues related to TIV discontinuation. The main concern here is cultural differences in legislation and ethical intuitions regarding the discontinuation of TIV. The treatment guidelines for patients with ALS advise physicians to reassure patients that TIV can be withdrawn at any point. However, TIV withdrawal is not explicitly discussed in Japan. Moreover, Japanese ALS treatment guidelines state that ventilation withdrawal is currently impossible, due to a lack of legal support. Most Japanese physicians have told patients that they are not allowed to stop ventilation via such a request. Unlike in the U.S., withholding and withdrawing ventilators are not ethically equivalent in Japan. In conclusion, the decision-making process regarding TIV is difficult, not only for the patients and caregivers, but also for physicians. Even if patients are legally entitled to refuse unwanted treatment, there have been cases in which Japanese physicians have felt an ethical dilemma in stopping TIV for patients with ALS. However, few studies have investigated in detail why physicians oppose the patient’s right to discontinue TIV in Japan. Full article

In this paper, we discuss a few simple methods for computing the local topological index and its various analogs for vector fields and differential forms given on complex varieties with singularities of different types. They are based on properties of regular meromorphic and logarithmic differential forms, of the dualizing (canonical) module and related constructions. In particular, we show how to compute the index on Cohen–Macaulay, Gorenstein and monomial curves, on normal and non-normal surfaces and some others. In contrast with known traditional approaches, we use neither computers, nor integration, perturbations, deformations, resolution of singularities, spectral sequences or other related standard tools of pure mathematics. Full article

Background: Physicians and nurses experience poor psychological well-being relative to other employees in healthcare fields. This study aimed to evaluate the psychological well-being among physicians and nurses in Makkah’s major hospitals. Methods: In this cross-sectional study, 460 physicians and nurses from seven major hospitals in Makkah were recruited to investigate their psychological well-being using the General Health Questionnaire-12 (GHQ-12) based on social dysfunction, anxiety, and confidence loss. Results: Over half (64.3%) of the physicians and nurses in this study scored at or above the GHQ-12 cut-off point (12), which is a positive result for poor psychological well-being. There were significant differences in the psychological well-being mean between Saudis and non-Saudis (t = 2.203, p = 0.028), years of work experience (t = 3.349, p = 0.001), hospitals (F = 2.848, p = 0.010), attending psychological support sessions (t = 2.082, p = 0.038), and history of visiting psychological clinics (t = −4.949, p < 0.001). There was also a significant association between the three GHQ-12 factors and the participants’ socio-demographic characteristics. Conclusion: The psychological well-being of physicians and nurses is low. The alarming number of physicians and nurses suffering from social dysfunction, anxiety, and loss of confidence should be addressed in Makkah’s major hospitals. The employee assistance program (EAP) could be highly valuable and effective for addressing the well-being of employees and their personal problems that may impact their work performance, conduct, health, and overall well-being at the Ministry of Health. Full article

In a 2021 survey, we found that “limit or suppression experiences” were related to a willingness to use enhancement technologies. However, the concept of “limit or suppression experiences” is vague and difficult to interpret in relation to neuroethics/enhancement. Thus, we aimed to better understand “limit or suppression experiences” and establish a robust philosophical concept of the topic. To do so, we exploratively investigated the concept to determine individual experiences with the presence or absence of sensing limits, investigate different ways in which limits can be sensed (factors of the sense of limits: “FSLs”), and identify factors that correlate with the strength of FSLs. Data from an Internet survey investigating respondents’ experiences with limits (1258 respondents) were analyzed using exploratory factor analysis and a linear regression model. Five variables were extracted as the FSLs. The highest regression coefficients were found between physical FSL and sports activities and between cognitive FSL and academics. The lowest regression coefficients were found between relational FSL and academics, sports activities, and arts and cultural activities. The results facilitate a detailed discussion of the motivations of enhancement users, and the extraction of the suppression experience opens new enhancement directions. Further normative and empirical studies are required. Full article

Research on attention restoration theory has provided consistent results over the years, and exposure to nature has been found to significantly improve and restore directed attention fatigue. However, rapid urbanisation has made it increasingly difficult for human beings to interact with unpolluted nature. Countries such as Singapore began to integrate nature into city planning and into the designs of buildings to help resident satisfaction and well-being. Local studies have had contradictory outcomes; residents report significantly higher restoration and affect towards vertical integrated greeneries, but many would still prefer traditional on-the-ground foliage. Interest in outdoor greenspaces is variable because Singapore’s high heat and humid climate make it uncomfortable to interact with outside nature for prolonged periods. The current study tested alternative modalities that can provide residents with on-the-ground foliage interactions, without the discomfort of being outdoors. Virtual exposures with different levels of immersion (high and low) and types of scenes (nature and urban) were tested for effects on perceived presence, perceived restoration and objective restoration. A total of 120 adult participants completed the study, which revealed that a virtual reality-nature condition provided significantly superior directed attention restoration and higher presence ratings. Immersive tendency did not affect perceived presence; neither did it moderate the relationship between perceived presence and its corresponding perceived restoration. Full article

The riddle of the origin of Cosmic Rays (CR) has been an open question for over a century. Gamma ray observations above 100 MeV reveal the sites of cosmic ray acceleration to energies where they are unaffected by solar modulation; recent evidence supports the existence of hadronic acceleration in Supernova Remnants (SNR), as expected in the standard model of cosmic ray acceleration. Nevertheless, the results raise new questions, and no final answer has been provided thus far. Among the suggested possible alternative accelerators in the Very High Energy (VHE) gamma ray sky, pulsar wind nebulae (PWNe, which together with dark matter are the main candidates to explain the local positron excess as well) are the dominant population among known Galactic sources. However, the most numerous population in absolute terms is represented by unidentified sources (~50% of VHE gamma ray sources). The relationship between PWNe and unidentified sources seems very close; in fact, in a PWN, the lifetime of inverse Compton (IC) emitting electrons not only exceeds the lifetime of its progenitor pulsar, but also exceeds the age of the electrons that emit via synchrotron radiation. Therefore, during its evolution, a PWN can remain bright in IC such that its GeV-TeV gamma ray flux remains high for timescales much larger than the lifetimes of the pulsar and the X-ray PWN. In addition, the shell-type remnant of the supernova explosion in which the pulsar was formed has a much shorter lifetime than the electrons responsible for IC emission. Hence, understanding PWNe and VHE unidentified sources is a crucial piece of the solution to the riddle of the origin of cosmic rays. Both theoretical aspects (with particular emphasis on the ancient pulsar wind nebulae scenario) and their observational proofs are discussed in this paper. Specifically, the scientific cases of HESS J1616-508 and HESS J1813-126 are examined in detail. Full article