Localization of the Ca 2+ + Mgt+ -ATPase of the sarcoplasmic reticulum in rat papillary muscle was determined by indirect immunofluorescence and immunoferritin labeling of cryostat and ultracryotomy sections, respectively . The Ca 2+ + Mg t+ -ATPase was found to be rather uniformly distributed in the free sarcoplasmic reticulum membrane but to be absent from both peripheral and interior junctional sarcoplasmic reticulum membrane, transverse tubules, sarcolemma, and mitochondria . This suggests that the Ca 2+ + Mgt+ -ATPase of the sarcoplasmic reticulum is antigenically unrelated to the Ca 2+ + Mg t+ -ATPase of the sarcolemma . These results are in agreement with the idea that the sites of interior and peripheral coupling between sarcoplasmic reticulum membrane and transverse tubules and between sarcoplasmic reticulum and sarcolemmal membranes play the same functional role in the excitation-contraction coupling in cardiac muscle .
What constitutes clinical reasoning is a disputed subject regarding the processes underlying accurate diagnosis, the importance of patient-specific versus population-based data, and the relation between virtue and expertise in clinical practice. In this paper, I present a model of clinical reasoning that identifies and integrates the processes of diagnosis, prognosis, and therapeutic decision making. The model is based on the generalized empirical method of Bernard Lonergan, which approaches inquiry with equal attention to the subject who investigates and the object under investigation. After identifying the structured operations of knowing and doing and relating these to a self-correcting cycle of learning, I correlate levels of inquiry regarding what-is-going-on and what-to-do to the practical and theoretical elements of clinical reasoning. I conclude that this model provides a methodical way to study questions regarding the operations of clinical reasoning as well as what constitute significant clinical data, clinical expertise, and virtuous health care practice.
After a review of terminology, I identify-in addition to Margaret Battin's list of five primary arguments for and against aid-in-dying-the argument from functional equivalence as another primary argument. I introduce a novel way to approach this argument based on Bernard Lonergan's generalized empirical method (GEM). Then I proceed on the basis of GEM to distinguish palliative sedation, palliative sedation to unconsciousness when prognosis is less than two weeks, and foregoing life-sustaining treatment from aid-in-dying. I conclude (1) that aid-in-dying must be justified on its own merits and not on the basis of these well-established palliative care practices; and (2) that societies must decide, in weighing the merits of aid-in-dying, whether or not to make the judgment that no life is better than life-like-this (however this is specified) part of their operative value structure.
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