PHL283H5 Lecture Notes - Hippocratic Oath, Reasonable Person, Shared Decision-Making In Medicine

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viridiancockroach622

25 Oct 2011

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1. people have to be able to consent to things going on that involve them. What would it take for a person to refuse treatment under informed consent. Faden and beauchamp autonomous authorization: a particular action that a patient does to authorize a medical personnel, or when a research patient authorizes the scientists , agreeing to go along with something. What it cant be authorization: ex. What do the patients need to know? objective standard. Ideal of a reasonable patient what would this person need to know in order to make a decision about this particular kind of case? subjective standard. What"s going to happen is that they are going to focus on risks rather than benefits informed consent will become a procedure of going through every possible risk. Her values, level of understanding, relationships with other people. Why do we worry about the potential impact of lifestyle, etc.

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When the heart pumps blood into the aorta, the pressuregradient-the difference between the blood pressure inside the heartand the blood pressure in the artery-is an important diagnosticmeasurement. A direct measurement of the pressure gradient isdifficult, but an indirect determination can be made by measuringthe Doppler shift of reflected ultrasound. Blood is essentially atrest in the heart; when it leaves and enters the aorta, it speedsup significantly and-according to Bernoulli's equation-the pressuremust decrease. A doctor using ultrasound of 2.5 MHz measures a 5400Hz frequency shift as the ultrasound reflects from blood ejectedfrom the heart.
Part A
What is the speed of the blood in the aorta? Assume that the speedof sound in human body is 1540 m/s
A:1.7 m/s
***Part B
What is the difference in blood pressure between the inside of theheart and the aorta? Assume that the patient is lying down and thatthere is no difference in height as the blood moves from the heartinto the aorta.

Consider three identical spherical conductors. One conductor,labeled A, is given a
charge of 7mC of type Nell. The charge state of the second andthird conductors, B and C, are unknown. The conductors undergo asequence of 3 contacts that occur ONLY between pairs of conductors.After the contacts, the net charge on each conductor is A: (0.25mCof type Nell), B: (1.875mC of type Nell) and C: (1.875mC of typeNell). Letâs make the assumption that the type Paul charge statecorresponds to an excess of electrons.

Because these three spheres are ______________________ the_______________ can be
freely exchanged between any pair of conductors in contact. Sincethese conductive
spheres all have the same size, when the spheres are placed incontact the ______
_____________ will evenly distribute between the two spheres.Because charge is a
property of particles and the particles can not be destroyed ANDthere is no outside
source of charge, the _______________ charge of the ______________must remain
constant at 4mC of type Nell. Based on this information, we candetermine that the
charge of at least one of B or C must be of type_______________.

To determine the order of contacts we must start from the lastcontact and work our way to the first contact. It is important tonote that because we have no initial charge state information forspheres B and C that we have the ability to make an arbitrarydecision about the initial charge state of these two spheres. Inother words, the charge states of sphere B and C areinterchangeable. Third and last Contact: Because spheres ________and _______ have the same charge we can determine that they were______ in contact. If we look at spheres B and C as the system, wefind that the total charge of the sub system consisting of B and Cwas ______________ of type _________.

Second contact: We can safely assume that A touched either B or Cprior to B and C
being brought into contact. Here we can make the arbitrary choicethat B touched A in the second contact. If this is the case, weknow that the charge of B ___________ it touched C must have been______________ of type __________ because it must have the sameamount and type of charge as the final state of _______. Therefore,at this instant we know that the charge on sphere C was________________ of type ____________________ it touched B.

First contact: Now we have an interesting situation. We find thatthe charge state of
sphere C would be consistent with sphere C being initially____________ and being
placed in contact with _______________ since the charge state of Cis exactly
__________ that of ____________ initially. This would mean that thecharge state of
sphere A after contact with ______ would be _____________ of type__________.
However, we already determined that the __________ charge of thesystem containing sphere _______ and sphere _______ in the secondcontact was ____________ of type __________. The only way this ispossible is if sphere B has a charge of __________ of type____________.

Final Results
The initial charge state of sphere Ais:_________________________________________
The initial charge state of sphere Bis:_________________________________________
The initial charge state of sphere Cis:_________________________________________
In the first contact of sphere ___________ to sphere_________________ how many
electrons were transferred from one sphere to the other?
In the second contact of sphere ___________ to sphere_________________ how many
electrons were transferred from one sphere to the other?
In the third contact of sphere ___________ to sphere_________________ how many
electrons were transferred from one sphere to the other?

An important question to consider when thinking about globalwarming is, "If the ice sheets near the poles melt, how much willthe sea level rise?" This seems like a difficult question, giventhe odd shapes of both the ice sheets and the oceans. But there aresome accurate approximations that allow the answer to be estimatedfairly accurately with reasonably simple calculations.

The critical idea is that both the thickness of the ice sheets andthe amounts of the sea-level rise are extremely small compared tothe radius of the earth. The radius of the earth is about 2/p x 107m -- more than 6000 kilometers. The ice sheet thicknesses we willbe concerned with are single digit miles and the sea level riseswill be in dozens of feet. As a result, in thinking about them, wecan essentially ignore the curvature of the earth. We can imaginepeeling the map of the earth off a globe and flattening it out (bymaking cuts, not by stretching it, so that we preserve the area).Then, both the ice and the sea level rise can be treated as right(not tilted) cylinders (though with funny shaped bases and tops).Since we know that the volume of a right cylinder is the area ofthe base times the height, we can easily estimate all the volumeswe need. A schematic picture of this approximation (with the heightof the ice mass greatly exaggerated -- you couldn't see it if Ididn't) is shown below. The error in these approximations is on theorder of the height of the cylinder considered divided by theradius of the earth; a very small number.
a. Assume that (after flattening the surface of the earth in ourimaginations) the ice sheet to be considered covers an area, A, andhas a thickness, d. The oceans currently cover about 75% of theearth's surface, and note that the surface area of a sphere is 4pr2where r is the radius of the sphere.

Generate an equation that will allow you to calculate h, the heightthe ocean levels will rise due to the melting of a an ice sheet interms of A, d, and r

b. As shown in the combined satellite photo on the right (fromGoogle Earth), Greenland is covered by a sheet of ice. This ice hasbeen measured to have a mean thickness of about 2 km. Recentobservations indicate that this ice sheet is beginning to retreat-- that it is melting at an accelerating rate.

Using the depth of the ice sheet and the scale given on thepicture, estimate how much sea level rise would be produced by themelting of the entire ice sheet lying on Greenland. (Note: You caneasily look this information up on the web. But the goal of thisproblem is in part to develop your estimation skills for thepurpose of building your ability to decide for yourself whether anygiven piece of information you find on the web is reasonable orbogus.)

PHL283H5 Lecture Notes - Hippocratic Oath, Reasonable Person, Shared Decision-Making In Medicine

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