Death is inevitable, but dying well is not. Despite the role of medical professionals as overseers of dying in contemporary society, there is comparatively little discourse among doctors about the constituents of a good death. In the 15th century, by contrast, the Ars moriendi portrayed normative medieval ideas about good and bad deaths. At a time when dying could be viewed as a performed battle against damnation, the Ars moriendi codified a set of moral precepts that governed the expression of autonomy, relations between the dying and the living and orientation towards God. In these images, dying well is a moral activity that results from active decisions by the dying person to turn from earthly preoccupations to contemplation of, and submission to, the divine. It is likely in contemporary society that there is a range of understandings of the "good death". While attitudes to personal autonomy may differ, reflectiveness and dying at home in the presence of family (expressed in the Ars moriendi), remain part of many modern notions of the good death. We argue that medical institutions continue to construct death as a performed battle against physical debility, even when patients may have different views of their preferred deaths. The dialectic approach of the Ars moriendi may offer a way for contemporary doctors to reflect critically on the potential dissonance between their own approach to death and the variety of culturally valorised "good deaths".
This paper discusses a new and unique undergraduate entrepreneurship program at the University of Maryland. -The Hinman Campus Entrepreneurship Opportunities (CEOs) Program. The CEOs Program was initiated in the fall semester of 2000 for students interested in starting entrepreneurial ventures when they graduate. The University and its corporate partners provide many resources, activities, courses, technologies and services to assist the students in learning how to start successful companies. An important feature is that students admitted to the Program live together in an incubator-like residence hall where they can freely exchange ideas with likeminded students. Living and learning together, these students are provided with a unique opportunity to interact with their fellow CEOs. This environment has the potential to impact the way the CEOs think about their careers, their destinies, and their ability to start businesses right out of school.
Topic Significance & Study Purpose/Background/Rationale: Allogeneic hematopoietic stem cell transplant (HSCT) patients are at high risk for infection during the pre-engraftment period. Current guidelines recommend fluoroquinolone prophylaxis for adults with anticipated neutropenia >6 days. This study was performed to determine optimal timing and antibiotic prophylaxis regimen for myeloablative allogeneic HSCT recipients. Methods, Intervention, & Analysis: An IRB-approved, singleinstitution retrospective study assessed patients undergoing myeloablative allogeneic HSCT with total body irradiation (TBI) between 3/2011 and 5/2016. Patients were grouped by antibiotic prophylaxis regimen. Early prophylaxis was defined as ciprofloxacin/metronidazole initiated in the first half of the preparative regimen. Late prophylaxis was defined as ciprofloxacin/metronidazole initiated in the latter half of the preparative regimen or on day of stem cell infusion. Ciprofloxacin-only early prophylaxis was defined as ciprofloxacin initiated in the first half of the preparative regimen. Neutropenia onset was defined as early (before Day −1), average (Day −1 to +1), or late (after Day +1). Microbiology results were reviewed from preparative regimen onset through 30 days post-transplant. Multiple logistic regression models compared effects of prophylaxis regimens adjusting for sex, Hematopoietic Cell Transplantation-Specific Comorbidity Index, Karnofsky performance status (KPS), prior BSI, and neutropenia onset. Findings & Interpretation: One hundred twenty-six patients met inclusion criteria (46 early, 50 late, 30 early ciprofloxacin-only prophylaxis). Groups did not differ significantly by sex, age, disease, KPS, allograft type, C. difficile history, BSI history, or neutropenia onset. Multiple logistic regression revealed significant differences in gram negative BSI and C. difficile infection rates. Gram negative BSI were less frequent with early versus late prophylaxis (adjusted OR .15, 95% CI .02-.78) and with early ciprofloxacin-only versus late prophylaxis (adjusted OR .12, 95% CI .006-.81). C. difficile infections were less frequent with early versus late prophylaxis (adjusted OR .13, 95% CI .02-.57) and early versus early ciprofloxacin-only prophylaxis (adjusted OR .18, 95% CI .02-.99). Total and Gram positive BSI rates did not differ significantly by prophylaxis regimen. Discussion & Implications: In this study, early prophylaxis with ciprofloxacin was associated with decreased Gram negative BSI. Metronidazole incorporation into early prophylaxis was associated with decreased C. difficile infection. These data support earlier antibiotic prophylaxis initiation with a fluoroquinolone and metronidazole.
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