Definition is in the nature of a survey, and a major part of its original purpose would seem to be to introduce a Soviet audience to definition rules used in the formal systems of mathematical logic. It offers a sympathetic introduction to the work of writers like Church, Curry, Kleene, Carnap, and Reichenbach.

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

Many medical ethicists accept the thesis that there is no moral difference between withholding and withdrawing life-sustaining therapy. In this paper, we offer an interesting counterexample which shows that this thesis is not always true. Withholding is distinguished from withdrawing by the simple fact that therapy must have already been initiated in order to speak coherently about withdrawal. Provided that there is a genuine need and that therapy is biomedically effective, the historical fact that therapy has been initiated entails a (...) claim to continue therapy that cannot be attributed to patients who have not yet received therapy. This intrinsic difference between withholding and withdrawing therapy is of moral importance. In many instances, patients will waive this claim. But when one considers withdrawing therapy from one patient to help another in a setting of scarce resources, this intrinsic moral difference comes into sharp focus. In an era of shrinking medical resources, this difference cannot be ignored. (shrink)

OBJECTIVE: To examine the long-term effects of an innovative curriculum on medical house officers' (HOs') knowledge, confidence, and attitudes regarding medical ethics. DESIGN: Long term cohort study. The two-year curriculum, implemented by a single physician ethicist with assistance from other faculty, was fully integrated into the programme. It consisted of monthly sessions: ethics morning report alternating with didactic conferences. The content included topics such as ethics vocabulary and principles, withdrawing life support, informed consent, and justice. Identical content was offered simultaneously (...) at the largest affiliated community hospital. SETTING: A multi-hospital university training programme from July, 1992 to June, 1994. PARTICIPANTS: Thirty-nine HOs responded in 92. Thirty HOs from the same cohort responded in 94 (response rates = 83% v 71%; P = 0.19). RESULTS: The curriculum was well received, with 96% of HOs finding the sessions stimulating. Previously validated scales of knowledge and confidence were administered at baseline and at follow-up. The average knowledge score improved 14% (P < 0.001). Confidence also improved, rising from 3.3 to 3.8 on a 5-point Likert scale (P < 0.001). These findings were independent of age, gender, religion, and prior education. The only attitudinal change was an increase in the proportion of residents who thought that ethics should be a required part of residency training (57% v 80%, P = 0.05). CONCLUSION: This curriculum appears practical, popular, and effective. It should be readily transferable to other institutions. (shrink)

In 1885, during initial discussions of J. C. Maxwell's celebrated thermodynamic demon, Whiting (1) observed that the demon-like velocity selection of molecules can occur in a gravitationally bound gas. Recently, a gravitational Maxwell demon has been proposed which makes use of this observation [D. P. Sheehan, J. Glick, and J. D. Means, Found. Phys. 30, 1227 (2000)]. Here we report on numerical simulations that detail its microscopic phase space structure. Results verify the previously hypothesized mechanism of its paradoxical behavior. This (...) system appears to be the only example of a fully classical mechanical Maxwell demon that has not been resolved in favor of the second law of thermodynamics. (shrink)

We report the results of a randomized trial to assess the impact of an innovative ethics curriculum on the knowledge and confidence of 85 medical house officers in a university hospital programme, as well as their responses to a simulated clinical case. Twenty-five per cent of the house officers received a lecture series, 25 per cent received lectures and case conferences, with an ethicist in attendance, and 50 per cent served as controls. A post-intervention questionnaire was administered. Knowledge scores did (...) not differ among the groups. Confidence regarding ethical issues was significantly greater in the aggregate intervention group compared to the control group. Confidence regarding procedural issues related to ethics was significantly higher for the EI group than for the controls. Responses to a simulated case showed that significantly fewer house officers in the EI group would intubate a patient for whom such therapy would be futile. We conclude that ethics education can have an impact on house officers' confidence and their responses to a simulated case, and that the EI was more effective than the LI. Such results have implications regarding the implementation of ethics education during residency. (shrink)

First published in 1966. Professor Dryer has furnished a highly illuminating account of Kant’s _Critique of Pure Reason _by unfolding its central argument. _Kant’s Solution for Verification in Metaphysics _brings out the light which Kant has to throw on central topics of philosophy. It takes its place as an indispensable guide to every student of the _Critique of Pure Reason. _.

Recent studies in semantics of modal and superintuitionistic predicate logics provided many examples of incompleteness, especially for Kripke semantics. So there is a problem: to find an appropriate possible- world semantics which is equivalent to Kripke semantics at the propositional level and which is strong enough to prove general completeness results. The present paper introduces a new semantics of Kripke metaframes' generalizing some earlier notions. The main innovation is in considering "n"-tuples of individuals as abstract "n"-dimensional vectors', together with some (...) transformations of these vectors. Soundness of the semantics is proved to be equivalent to some non- logical properties of metaframes; and thus we describe the maximal semantics of Kripke- type. (shrink)

In any competition for monuments of wasted labour the collection of accidental acrostics in Latin poets published by I. Hilberg would stand a good chance of a prize. But amongst his examples of ‘neckische Spiele des Zufalls’ is one I am gullible enough to believe may be more significant. In Aeneid 7. 601–15 Vergil describes the custom of opening the gates of war in a long anacoluthic sentence, the first four lines of which run: Mos erat Hesperio in Latio, quern (...) protinus urbes Albanae coluere sacrum, nunc maxima rerum Roma colit, cum prima movent in proelia Mortem, Sive Getis inferre manu lacrimabile bellum…. (shrink)

A laboratory-testable, solid-state Maxwell demon is proposed that utilizes the electric field energy of an open-gap p-n junction. Numerical results from a commercial semiconductor device simulator (Silvaco International–Atlas) verify primary results from a 1-D analytic model. Present day fabrication techniques appear adequate for laboratory tests of principle.

In a recent article in this journal our unit was accused of a number of errors of judgment in applying covert video surveillance (CVS) to infants and children suspected of life-threatening abuse. The article implied, that on moving from the Royal Brompton Hospital in London to North Staffordshire Hospital, we failed to present our work to the Research Ethics Committee (REC). We did send our protocol to the REC though we did not consider that, after a total of 16 patients (...) had been documented as being the subject of life-threatening abuse, this was research. The REC in Staffordshire agreed with us. We were also accused of undertaking work that should be pursued by the Police. We agree with this. However, unlike the Metropolitan Police the Staffordshire Police would not undertake CVS. We fail to agree that 'working together' with parents is necessarily practical or safe when trying to protect children from life-threatening abuse of this kind. (shrink)

In 2000, a simple, foundational thermodynamic paradox was proposed: a sealed blackbody cavity contains a diatomic gas and a radiometer whose apposing vane surfaces dissociate and recombine the gas to different degrees (A $_{2} \rightleftharpoons $ 2A). As a result of differing desorption rates for A and A $_{2}$ , there arise between the vane faces permanent pressure and temperature differences, either of which can be harnessed to perform work, in apparent conflict with the second law of thermodynamics. Here we (...) report on the first experimental realization of this paradox, involving the dissociation of low-pressure hydrogen gas on high-temperature refractory metals (tungsten and rhenium) under blackbody cavity conditions. The results, corroborated by other laboratory studies and supported by theory, confirm the paradoxical temperature difference and point to physics beyond the traditional understanding of the second law. (shrink)

A recently formulated concept of stochastic localizability is shown to be consistent with a concept of stochastic microcausality, which avoids the conclusions of Hegerfeldt's no-go theorem as to the inconsistency of sharp localizability of quantum particles and Einstein causality. The proposed localizability on quantum space-time is shown to lead to strict asymptotic causality. For finite time evolutions, upper bounds on propagation to the exterior of stochastic light cones are derived which show that the resulting probabilities are too small to be (...) actually observable in a realistic context. (shrink)

Little is known about distance processing in patients with posterior brain damage. Although many investigators have claimed that distance estimates are normal or abnormal in some of these patients, many of these observations were made informally and the examiners often asked for relative, and not absolute, distance estimates. The present investigation served two purposes. First, we wanted to contrast the use of distance information in peripersonal space for perceptual report as opposed to visuomotor control in our visual form agnosic patient, (...) DF. Second, we wanted to see to what extent her abilities to process distance cues were dependent on binocular vision, in light of Milner et al.'s (1991) observations of preserved stereopsis in DF, and Dijkerman et al.'s (1996) and Marotta et al.'s (1997) observations that her visual guidance of grasping may be particularly dependent on binocular vision of the target. We hypothesized that DF's visuomotor responses would show normal sensitivity to target distance, while her perceptual estimates would not. In the first experiment, we required DF and two age- and sex-matched control subjects to reach out and grasp black cubes placed at varying distances, or to estimate the distance of the cubes from the hand starting position without making a reaching movement. In the second experiment, we required DF and two age-matched control subjects to point as rapidly and accurately as possible to small LED targets which differed in spatial location, under binocular and monocular conditions. The results showed that, relative to the control subjects, DF's grasping movements produced normal peak velocity-distance scaling-when she reached for blocks which varied in depth or pointed to LED targets which were presented at different distances in depth. In contrast, in the cube experiment, her verbal estimates of object distance were poorly scaled, although they improved slightly under the binocular conditions. The results are discussed in terms of current theories of processing streams in extrastriate visual cortex and the distinction between categorical and coordinate spatial processing. (shrink)

This is an intellectual biography of Benjamin Kidd, a leading Social Darwinist in the years before World War I, and a social prophet in the tradition of Comte and Spencer. His first book Social Evolution, published in 1894, was an immediate and enormous success around the world. In it, Kidd developed a collectivist form of Social Darwinism in tune with the values of Progressivism in America and the 'new liberalism' in Britain. By many it was regarded as the basis for (...) a properly scientific sociology, and the combination of its claims to scientific methodology, with an emphasis on non-rational forces as the agents of progress accurately caught the temper of its times. Launched on his career as a writer, Kidd's subsequent books and journalism continued to exercise extraordinary influence. His 'social imperialism', linking a bio-political defence of empire with a programme of social reform, won currency in the Anglo-American world at a time of expansionary fervour. (shrink)

OBJECTIVES: To study the accuracy of reviewing ward notes (chart review) as a measure of the quality of care rendered to patients with "Do Not Resuscitate" (DNR) orders. DESIGN: We reviewed the charts of 19 consecutive, competent inpatients with DNR orders for evidence that the staff addressed a broad range of patient care needs called Concurrent Care Concerns (CCCs), such as withholding treatments other than resuscitation itself, and attention to patient comfort needs. We then interviewed the patient, consultant physician, house (...) officer, and primary nurse and compared the ward notes with the understandings of these staff members. SETTING: The medical service of an urban university medical centre. RESULTS: The average number of documented CCCs addressed per DNR order was 1.1. The ward notes generally agreed with the perceptions of patients, house officers, and nurses (% agreement with notes = 79%, 77%, and 82%; kappa = 0.43, 0.40, 0.50). Consultant physicians' understandings were poorly reflected in the ward notes (% agreement = 59%; kappa = 0.18). They overestimated attention to CCCs compared with the notes (P < 0.0001) and with other observers (P < 0.0001). CONCLUSION: Chart review for attention to CCCs accurately reflects the understandings of patients, house officers, and nurses, but consultant physicians report more attention to CCCs than is recorded in the ward notes or understood by other observers. Better communication regarding end-of-life care plans should be encouraged. (shrink)

This study represents an improvement in the ethics scales inventory published in a 1988 Journal of Business Ethics article. The article presents the distillation and validation process whereby the original 33 item inventory was reduced to eight items. These eight items comprise the following ethical dimensions: a moral equity dimension, a relativism dimension, and a contractualism dimension. The multidimensional ethics scale demonstrates significant predictive ability.

Purpose: Physicians are often reluctant to discuss “Do Not Resuscitate” orders with patients. Although perceived self-efficacy is a known prerequisite for behavioural change, little is understood about the confidence of physicians regarding DNR discussions.Subjects and methods: A survey of 217 internal medicine attendings and 132 housestaff at two teaching hospitals about their attitudes and confidence regarding DNR discussions.Results: Participants were significantly less confident about their ability to discuss DNR orders than to discuss consent for medical procedures , and this was (...) true for both attendings and housestaff . In a multivariate logistic model of confidence regarding DNR discussions, women were less confident than men ; house officers were less confident than attendings , those who were less confident of their ability to discuss medical procedures were less confident discussing DNR , and those who found talking to patients about DNR orders very difficult reported less confidence than those who did not .Conclusion: We conclude that physicians’ confidence regarding DNR discussions is low compared with their confidence regarding other medical discussions and that confidence varies by sex and perceived difficulty of the task. Efforts to improve DNR discussions should explore the need to tailor educational interventions to fit these characteristics. (shrink)

It may be concluded that Mitchell's peace evolutionism incorporated most of the features of the cooperationist and Novicovian traditions. He questioned the conflict paradigm that underpinned biological militarism, and reinforced a holistic and more peaceful model of nature by reference to the emerging discipline of ecology. His “restrictionist” objections to the deterministic tendencies of much prevailing biosocial thought combined philosophical with biological arguments to assert that human history was sui generis, based upon the unique development of human consciousness and the (...) cultural transmission of knowledge. Mitchell's opposition to biological militarism reflected Victorian anxieties about the legitimacy of evolutionary ethics. However, he introduced an innovatory note, linked to the “modernist” intellectual milieu of the time, when he put objections to the use of analogy on the grounds (1) that the Darwinist paradigm had not been properly established, and (2) that scientific laws themselves were uncertain and subjective.The first objection related to the bitter controversies that racked the biological world in the 1900s when mutation theory thrust the Darwinian concept of natural selection into temporary disrepute. In this respect Mitchell encoutered continuing Darwinist orthodoxy, not least from peace biology itself, while confusion was added by his personal devotion to Darwinism and his sociopolitical suspicion of Mendelian hereditarianism. The later triumph of a new Darwinian synthesis under men like R. A. Fisher made Mitchell's criticisms seem outmoded. In the second respect, Mitchell's attack on the primacy of naturalistic science echoed the epistemology of the “new physics” and movements such as German neo-Kantianism. However, positivism was still deeply embedded in Britain, indeed enjoying a resurgence from the last decade of the nineteenth century.79 Mitchell's critique of the Darwinist version of it seems to have been too novel and puzzling to influence a generation still convinced of the soundness of the science.Mitchell made more impact when he put his objections to the use of analogy on the grounds of professional methodology. As a naturalist, he could argue:It is impossible to make correct comparisons even between an insect and spider, two creatures so closely allied that only zoologists would separate them, unless we could trace the qualities of the insect and of the spider respectively down to their common ancestor, and in so doing we should almost certainly lose all that made the comparison interesting and significant, and be left with little more than the qualities common to all protoplasm..., It is quite true that the whole web of life is in physical and physiological community, but considerations drawn from any part of it require so much modification before they can be applied to any other part, that they become merely verbal.80This type of criticism was to have a more lasting heritage. Chalmers Mitchell is worth remembering as an articulate early spokesman of a persistent, if often embattled, modern tradition that has resisted interpretations of human nature and history based upon genetic determinants or immutable biological laws, or upon the use of animal analogies to generalize too freely about human aggression and war. (shrink)

Assessments of the acceptability of new transplantation practices require a pinpointing of not only the meaning of death, but also the timing of death. They typically perceive elective ventilation as occurring just prior to death and non-heart-beating donor protocols as operative just after death. However, such practices in fact highlight the general vagueness and ambiguity surrounding these issues in both law and ethics. Supply-side dilemmas in transplantation lend real urgency to this "life or death" debate.

Cultural space knows no official boundary. Civilizational interaction, recorded and unrecorded, is an ongoing process. Diffusionism and parallelism get interfused in civilizational studies. To think of one-sided borrowing or lending in the realm of culture rests on bias or prejudice, perhaps both. To think that originally there was only one culture (Egypt or India or China) and that all other cultures are its diffused or dispersed form is incorrect, both theoretically and evidentially. Comparably incorrect is the anthropological hypothesis that different (...) cultures, in response to diverse social and natural stimuli or conditions, developed quite independently and in parallel manner. Once we believe, as I think we must, that cultural space is a continuum, the parallelistic thesis is bound to collapse. If, on the other hand, we totally reject the possibility of independent, relatively independent, origin and development of different cultures, we are obliged to deny the differentiable identity and personality and distinct cultures. To deny cultural pluralism is psychologically untenable and ideologically pernicious, and I have argued the point at length elsewhere. (shrink)

Early in the Nicomachean Ethics Aristotle writes, “It is a common principle which must be accepted that we must act in accord with orthos logos. What orthos logos is will be discussed later”. Although scholars have pored over Aristotle’s Ethics for centuries and can paraphrase what he says about orthos logos, obscurity remains as to just what he understands by it. This obscurity can be dispelled by focusing once again on those few sections in Aristotle familiar to all students of (...) the Ethics which bear most directly upon the topic. Aristotle explains what he understands by orthos logos in the context of being good at deliberating. Since he frequently illustrates deliberating by instances of deliberation in the practice of an art, we may first examine what he has to say about deliberating in such a context. (shrink)