The human blood coagulation system comprises a series of linked glycoproteins that upon activation induce the generation of downstream enzymes ultimately forming fibrin. This process is primarily important to arrest bleeding (hemostasis). Hemostasis is a typical example of a molecular machine, where the assembly of substrates, enzymes, protein cofactors and calcium ions on a phospholipid surface markedly accelerates the rate of coagulation. Excess, pathological, coagulation activity occurs in “thrombosis”, the formation of an intravascular clot, which in the most dramatic form (...) precipitates in the microvasculature as disseminated intravascular coagulation. Thrombosis occurs according to a biochemical machine model in the case of atherothrombosis on a ruptured atherosclerotic plaque, but may develop at a slower rate in venous thrombosis, illustrating that the coagulation machinery can act at different velocities. The separate coagulation enzymes are also important in other biological processes, including inflammation for which the rapid conversion of one coagulation factor by the other is not a prerequisite. The latter role of coagulation enzymes may be related to the old and probably maintained function of the coagulation machine in innate immunity. BioEssays 25:1220–1228, 2003. © 2003 Wiley Perioicals, Inc. (shrink)

This article discusses various ethical and philosophical aspects of heroin addiction. It arose as a result of the plan by the Amsterdam city council to supply free heroin to drug addicts. The objective of treatment of heroin addicts is ambivalent because what is in fact a socio-cultural problem is transformed into a medical problem. The characteristics of this treatment are made explicit through a philosophical analysis which sees the medical intervention as part of a strategy aimed at achieving social normalisation. (...) The reason why such a social control function is practised by physicians is discussed, as well as the reason why heroin users in particular are the object of such a process. In this paper, heroin addiction is considered primarily as a cultural problem. The consequences of this for treatment and ethics form the conclusion. (shrink)

Interactive technology assessment (iTA) provides an answer to the ethical problem of normative bias in evaluation research. This normative bias develops when relevant perspectives on the evaluand (the thing being evaluated) are neglected. In iTA this bias is overcome by incorporating different perspectives into the assessment. As a consequence, justification of decisions based on the assessment is provided by stakeholders having achieved agreement. In this article, agreement is identified with wide reflective equilibrium to show that it indeed has the potential (...) of justifying decisions. We work out several conditions for this agreement to be achievable and just. (shrink)

Health technology assessment (HTA) is often biased in the sense that it neglects relevant perspectives on the technology in question. To incorporate different perspectives in HTA, we should pursue agreement about what are relevant, plausible, and feasible research questions; interactive technology assessment (iTA) might be suitable for this goal. In this way a kind of procedural ethics is established. Currently, ethics too often is focussed on the application of general principles, which leaves a lot of confusion as to what really (...) is the matter in specific cases; in an iTA clashes of values should not be approached by use of such ethics. Instead, casuistry, as a tool used within the framework of iTA, should help to articulate and clarify what is the matter, as to make room for explication and consensus building. (shrink)

The growth of knowledge and its effects on the practice of medicine have been issues of philosophical and ethical interest for several decades and will remain so for many years to come. The outline of the present volume was conceived nearly three years ago. In 1987, a conference on this theme was held in Maastricht, the Netherlands, on the occasion of the founding of the European Society for Philosophy of Medicine and Health Care (ESPMH). Most of the chapters of this (...) book are derived from papers presented at that meeting, and for the purpose of editing the book Stuart Spicker, Ph. D., joined two founding members of ESPMH, Henk ten Have and Gerrit Kimsma. The three of them successfully brought together a number of interesting contribu tions to the theme, and ESPMH is grateful and proud to have initiated the production of this volume. The Society intends that annual meetings be held in different European countries on a rotating basis and to publish volumes related to these meetings whenever feasible. In 1988, the second conference was held in Aarhus, Denmark on "Values in Medical Decision Making and Resource Allocation in Health Care". In 1989, a meeting was held in Czestochowa, Poland, on "European Traditions in Philosophy of Medicine. From Brentano to Bieganski". It is hoped that these conferences and the books to be derived from them, will initiate a new European tradition, lasting well into the 21 st century! P. J. (shrink)

About one third of patients with epilepsy have seizures refractory to the medical treatment. Electrical stimulation mapping is the gold standard for the identification of “eloquent” areas prior to resection of epileptogenic tissue. However, it is time-consuming and may cause undesired side effects. Broadband gamma activity recorded with extraoperative electrocorticography during cognitive tasks may be an alternative to ESM but until now has not proven of definitive clinical value. Considering their role in cognition, the alpha and beta bands could further (...) improve the identification of eloquent cortex. We compared gamma, alpha and beta activity, and their combinations for the identification of eloquent cortical areas defined by ESM. Ten patients with intractable focal epilepsy participated in a delayed-match-to-sample task, where syllable sounds were compared to visually presented letters. We used a generalized linear model approach to find the optimal weighting of each band for predicting ESM-defined categories and estimated the diagnostic ability by calculating the area under the receiver operating characteristic curve. Gamma activity increased more in eloquent than in non-eloquent areas, whereas alpha and beta power decreased more in eloquent areas. Diagnostic ability of each band was close to 0.7 for all bands but depended on multiple factors including the time period of the cognitive task, the location of the electrodes and the patient’s degree of attention to the stimulus. We show that diagnostic ability can be increased by 3–5% by combining gamma and alpha and by 7.5–11% when gamma and beta were combined. We then show how ECoG power modulation from cognitive testing can be used to map the probability of eloquence in individual patients and how this probability map can be used in clinical settings to optimize ESM planning. We conclude that the combination of gamma and beta power modulation during cognitive testing can contribute to the identification of eloquent areas prior to ESM in patients with refractory focal epilepsy. (shrink)

As an alternative to universalism and particularism, Intermedialities: Philosophy, Arts, Politics proposes "intermedialities" as a new model of social relations and intercultural dialogue. The concept of "intermedialities" stresses the necessity of situating debates concerning social relations in the divergent contexts of new media and avant-garde artistic practices as well as feminist, political, and philosophical analyses.

OBJECTIVES: Cognitive and sensory difficulties frequently jeopardize informed consent of frail elderly patients This study is the first to test whether preliminary research experience could enhance geriatric patients' capacity to consent. DESIGN/SETTING: A step-wise consent procedure was introduced in a study on fluid balance in geriatric patients. Eligible patients providing verbal consent participated in a try-out of a week, during which bioelectrical impedance and weight measurements were performed daily. Afterwards, written informed consent was requested. Comprehension, risk and inconvenience scores (ranges: (...) 0-10) were obtained before and after the try-out by asking ten questions about the study's essentials and by asking for a risk and inconvenience assessment on a ten-points rating scale. SUBJECTS AND RESULTS: Seventy of the 78 eligible subjects started the try-out and 53 (68%) provided written consent. The comprehension score increased from 5.0 (+/- 2.3) to 7.0 (+/- 1.9) following the try-out (P < 0.001). The number of subjects capable of weighing risks and inconveniences increased from 32 to 48 (P < 0.001). CONCLUSIONS: Research experience improved the capacity to consent, still enabling an acceptable participation rate. Therefore, experienced consent seems a promising tool to optimize informed consent in frail elderly subjects. (shrink)

Objective To evaluate the modes of death and treatment offered in the last 24 h of life to patients dying in 10 Brazilian intensive care units (ICUs) over a period of 2 years. Design and setting Cross-sectional, multicentre, retrospective study based on medical chart review. The medical records of all patients that died in seven paediatric and three adult ICUs belonging to university and tertiary hospitals over a period of 2 years were included. Deaths in the first 24 h of (...) admission to the ICU and brain death were excluded. Intervention Two intensive care fellows of each ICU were trained in fulfilling a standard protocol (κ=0.9) to record demographic data and all medical management provided in the last 48 h of life. The Student t test, Mann–Whitney U test, χ2 test and RR were used for data comparison. Measurements and main results 1053 medical charts were included (59.4% adult patients). Life support limitation was more frequent in the adult group (86% vs 43.5%; p<0.001). A ‘do not resuscitate’ order was the most common life support limitation in both groups (75% and 66%), whereas withholding/withdrawing were more frequent in the paediatric group (33.9% vs 24.9%; p=0.02). The life support limitation was rarely reported in the medical chart in both groups (52.6% and 33.7%) with scarce family involvement in the decision making process (23.0% vs 8.7%; p<0.001). Conclusion Life support limitation decision making in Brazilian ICUs is predominantly centred on the medical perspective with scarce participation of the family, and consequently several non-coherent medical interventions are observed in patients with life support limitation. (shrink)

Francis Bacon's New Atlantis -- Galileo and the authority of science -- Rene Descartes : workshop thinking -- Giambattista Vico : going mad rationally -- Mary Shelley's hideous idea -- Auguste Comte's religion of humanity -- Max Weber : authority and bureaucracy -- Kemal Atatørk : science and patriotism -- Edmund Husserl : cultural crisis -- Hannah Arendt : action -- Conclusion.

After half a century of cognitive revolution we remain far from agreement about what cognition is and what cognition does. It was once thought that these questions could wait until the data were in. Today there is a mountain of data, but no way of making sense of it. The time for tackling the fundamental issues has arrived. The biogenic approach to cognition is introduced not as a solution but as a means of approaching the issues. The traditional, and still (...) predominant, methodological stance in cognitive inquiry is what I call the anthropogenic approach: assume human cognition as the paradigm and work ‘down’ to a more general explanatory concept. The biogenic approach, on the other hand, starts with the facts of biology as the basis for theorizing and works ‘up’ to the human case by asking psychological questions as if they were biological questions. Biogenic explanations of cognition are currently clustered around two main frameworks for understanding biology: self-organizing complex systems and autopoiesis. The paper describes the frameworks and infers from them ten empirical principles—the biogenic ‘family traits’—that constitute constraints on biogenic theorizing. Because the anthropogenic approach to cognition is not constrained empirically to the same degree, I argue that the biogenic approach is superior for approaching a general theory of cognition as a natural phenomenon. (shrink)

The emotion of anger, when chronic, is especially problematic. Frequent and intense experiences of anger predict quite a few adverse health outcomes and are especially implicated in cardiovascular...

Originally published in 1957, The Uniqueness of the Individual is a collection of 9 essays published from the ten years preceding publication. The essays deal with some of the central problems of biology. These are among the questions put and answered from the standpoint of modern experimental biology. What is ageing and how is it measured? What theories have been held to account for it, and with what success? Did ageing evolve, and if so how? Is Lamarckism and adequate explanation (...) of evolutionary process? Does evolution sometimes go wrong? Do human beings evolve in a way peculiar to themselves? Other essays touch upon the problems of scientific method and of growth and transformation. This book will be of interest to natural historians, evolutionists and anthropologists. (shrink)

Gordon Baker and I had been colleagues at St John’s for almost ten years when we resolved, in 1976, to undertake the task of writing a commentary on Wittgenstein’s Philosophical Investigations. We had been talking about Wittgenstein since 1969, and when we cooperated in writing a long critical notice on the Philosophical Grammar in 1975, we found that working together was mutually instructive, intellectually stimulating and great fun. We thought that we still had much to say about Wittgenstein’s philosophy, and (...) it seemed to us that misinterpretations of passages in the Investigations were so extensive that it would be worth trying to write a detailed analytical commentary. It is difficult to recapture the excitement of those early days in being among the first to work on the microfilms and, subsequently, on the photocopies of Wittgenstein’s Nachlass. We spent many hundreds of hours poring over the typescripts and the often only semi-legible manuscripts, fascinated and privileged to be able to try to follow the development of the thoughts of a great philosophical genius. We talked endlessly about what we had found in Wittgenstein’s manuscripts and typescripts, and debated how it should be understood. The first fruit of our labours was Wittgenstein – Understanding and Meaning. Its guiding idea was to draw attention to the manner in which Wittgenstein linked the concepts of meaning, understanding and explanation, and so to bypass the connections between meaning, truth and truth-conditions that so fascinated philosophers of the 1970s, and to abandon the red-herring of assertion-conditions and anti-realism. After a hiatus of four years, during which time we wrote a controversial book entitled Frege – Logical Excavations and a polemical book on contemporary philosophy of language – Language, Sense. (shrink)

Ten years on and the debate about the foundations of judicial review continues. Two themes have remained constant throughout. The species of legislative intent have multiplied to include specific, general and constructive intent, and who knows what further ‘adjectival variants’ remain to be discovered. Those opposed to the common law model advance dire warnings of the dangers of ignoring their preferred adjectival version. In Allan's case my previous analytical criticism of constructive legislative intent, henceforth CLI, has provoked more extreme claims (...) and more intemperate language about the alleged consequences of adherence to the common law model. These are, as will be seen, wrong. They serve moreover to mask the problems with CLI. Allan claims repeatedly that I confuse literal and constructive legal intent in his reasoning. This is quite mistaken: I take issue with the very meaning and application of CLI. (shrink)

The Upanishads reveal that in the beginning, nothing existed: “This was but non-existence in the beginning. That became existence. That became ready to be manifest”. (Chandogya Upanishad 3.15.1) The creation began from this state of non-existence or nonduality, a state comparable to (0). One can add any number of zeros to (0), but there will be nothing except a big (0) because (0) is a neutral number. If we take (0) as Nirguna Brahman (God without any form and attributes), then (...) from where and how did the universe come into existence? -/- The neutral power (0) cannot produce anything without having an element of duality in it. Although Nirguna Brahman is neutral, it has a positive, negative, and neutral pole, constituting its Prakriti or nature. Prakriti has three latent Gunas (modes or qualities): Satva, Rajas, and Tamas. They are related to Gyana Shakti (the power of knowledge) Sankalpa Shakti (the power of ideation), and Kriya Shakti (the power of action). Science says that Atom is the basic element from which the universe evolved. The Atom has three nuclei- electron, pluton, and neutron. The Satva, Rajas, and Tamas in Indian spirituality are nothing but the mystical names for the nuclei of an atom. -/- According to Bhagavata Purana, Prakriti is also constituted of the elements of Time, Karma (action/destiny) and Swabhava (innate nature). Time disturbs the equilibrium of Gunas. From the aspect of Karma is produced an entity called Mahat, in the form of intelligence. Mahat is dominated by Satva and Rajas. From Mahat manifests the next evolute dominated by Tamas with three predominant qualities – Dravya (substance), Kriya (action), as well as intelligence. It forms to become the Ego principle (Ahamkara). -/- Ahamkara has three modes – Satvic, Rajasic and Tamasic. Satvic is Jnana oriented, Rajasic action-oriented and Tamasic Dravya (substance) oriented. From the Tamasic Ahankara, five gross elements are produced (ether, air, fire, water, and earth - Akash, Vayu, Agni, Jal and Prithvi). From the Satvic Ahamkara, guardian deities (the sun and moon, deities of sense organs, and organs of action) and from Rajasic Ahamkara, ten senses (Indriyas), five senses of perception, five organs of action, the faculties of intellect and Prana (life breath) are produced. -/- Bhagavata says that since these energies, elements, and faculties remained disassociated, they were combined to form a Cosmic Egg. The egg floats in the primal waters for a thousand years. Then God enters this Cosmic Egg and manifests himself as the Cosmic Purusha. He is the first nucleus, the God particle equivalent to the number (1) which is the embodiment of everything in the universe. The concept of creation and dissolution in Hinduism can be compared to the waves in an ocean that appear and disappear incessantly. The Manvantaras are such successive episodes of creation emerging from the Cosmic Person, the Manu who is embodied God-Consciousness, God himself. These episodes of creation are measured in Hinduism in terms of Manvantaras, the epochs of Manus. -/- Manu is the ‘First-Born’ (1) of God, the Cosmic Purusha from whom the world has originated. This Cosmic Person (Purusha) has been described as having fourteen biospheres (heavens) that are inhabited by various life forms in the order of evolution of consciousness. If we begin from the human biosphere (Bhuloka), there are ten astral biospheres that a man must transcend to attain liberation or Mukti from the cycle of births and deaths. -/- The number (1) produces the primary numbers up to (9) through the transmutation of the creational energies and qualities. The process can be related to the descent and cyclical evolution of (1) through ten spiritual stages, finally merging with the nondual (0). The number (10) marks the merger of (1) with (0). The Hindu worldview is that all life forms in an episode of creation must evolve to become one with the non-dual state (0) to attain liberation from the cycle of births and deaths in a cyclical process. -/- . (shrink)

United States of America demographic profiles illustrate a nation rich in cultural and racial diversity. Approximately 29% of the population are minorities and demographic projections indicate an increase to 50% by the year 2050. This creates a highly mobile and constantly changing environment, revealing the need for new levels of cultural awareness and sensitivity. These issues are particularly critical in the medical community where medical professionals must understand the impact cultural differences and barriers can have on evaluation, treatment, and rehabilitation. (...) During times of stress, such as when injury strikes, problems associated with lack of cultural sensitivity are intensified. Cultural diversity is of particular concern when standard measures for diagnosis and prognosis are derived from established norms for responding, because culture defines norms. This paper details a ten point checklist designed to facilitate cultural awareness and sensitivity in medical settings to ensure maximum successful recovery and outcomes for all patients. (shrink)

A woman and a man desire to come together stirred by the primal fire of Kama and the man deposits his egg in the womb of the woman. This egg develops into a human undergoing nine or ten months of evolution. This process is the microscopic replication of the method evolved by God to create the universe. Rigveda (10.121) mentions Hiranyagarbha, the Golden Egg as the source of the creation of the universe. It is said that God, wishing to create (...) the world, produced an egg as big as the cosmos. God meditated for a thousand years sitting inside the egg and when the egg burst, the Lord himself was born out of the egg as the Progenitor of the universe (“He made Himself by Himself.”, Taitiriya Upanishad: 2.7.1). The Rishis called the Egg Brahmanda (the Cosmic Egg), and the Progenitor Manu. Scientists have discovered that the universe has an oval shape. Like the nine months of the evolution of the human egg, the Cosmic Egg also undergoes nine stages of evolution before it gets dissolved during what we call ‘Maha Pralaya’. The Puranas mention that Brahmanda has 14 biospheres, seven nether and seven upper inhabited by different types of souls. If we count from the human world, there are ten dimensions of consciousness. Rishis called these astral biospheres Mandalas/Lokas with different wavelengths and colours. Sri Karunakara Guru referred to them as Avasthas, or spiritual stages. The Buddhists and Hindu esoteric sects such as the Theosophical Society explain these levels of the Absolute in terms of Physical plane, Astral plane, Mental plane, Buddhic plane, Atmic plane, Anupadaka plane, Adi plane and Shiv and Shakti. These Avasthas are related to the expanding consciousness reaching up to the core of the Cosmic Egg, the Paramatma. Like a spider which creates a web around it sitting in the centre, and withdraws it in the end, Paramatma creates and withdraws webbed multi-dimensional universes. Nobody can say when it started and when it will end as it is a beginningless and endless process. (shrink)

For all his peculiarities, man is not the only animal who knows. But he is, as far as it is possible to judge, the only animal who knows that he knows, and who seeks to understand the nature and meaning of the act of knowing itself. Michael Polanyi has been engaged in this search for more than twenty years, and the book here under review is an ‘interim report’ on the development of his thought since the publication of Personal Knowledge (...) and The Study of Man just ten years ago. Its three short chapters are substantially the Terry Lectures which he delivered at Yale University in 1962. This review will attempt no more than to summarise the central theme of Polanyi’s argument. A detailed, critical analysis of its philosophical significance is beyond the competence of a biologist. (shrink)

In the year of Eubulus' archonship at Athens , Timoleon the Corinthian, who had been chosen by his fellow citizens to command at Syracuse, prepared for his expedition to Sicily. He hired seven hundred mercenaries and having put his soldiers aboard four triremes and three fast sailing ships departed from Corinth. Following the coastal route he picked up three further ships from the Leucadians and Corcyreans and then with ten ships in all crossed the Ionian gulf to Italy. Thus far (...) Diodorus Siculus 16. 66. 1–2. In the course of the crossing, Diodorus continues , a peculiar and miraculous event befell Timoleon, with the supernatural order coming to the support of his enterprise and foreshadowing his eventual fame and the glory of his achievements. I now quote Diodorus' own words: δι' λης γρ τς νυκτς προηγετο λαμπάς καιομένη κατ τν ορανόν μέχρι ο συνέβη τν στόλον ες τν ταλίαν καταπλεσαι In translation: ‘throughout the whole night he was preceded by a torch that blazed in the sky until the flotilla reached land in Italy’. No more than a single night would, of course, have been required in order to accomplish the crossing of the gulf, with Timoleon presumably heading from Corcyra for the Iapygian promontory as was normal procedure in such transits. Diodorus goes on to recount that Timoleon, who had been informed in Corinth that Demeter and Persephone would accompany him on his voyage, recognized the actual assistance of the two goddesses, dedicated his best ship to them and named it Sacred vessel of Demeter and Kore. After diplomatic activity at Metapontum and Rhegium Timoleon proceeded from Italy to Sicily, where he landed at Tauromenium still in the year of Eubulus. (shrink)

De redactie van Philosophia Reformata heeft een belangrijk project opgezet. Aan de schrijvers van het boek van de Open Universiteit waaraan vertegenwoordigers van verschillende levensbeschouwelijke richtingen hebben meegewerkt, is de mogelijkheid geboden met elkaar in dialoog te treden. De bijdrage van Kees Klop biedt daarvoor om verschillende redenen een uitstekende basis. Ik heb het getroffen met een commentator die de lijn van mijn verhaal voortreffelijk heeft samengevat. We behoeven dus geen tijd te verdoen met het rechtzetten van misverstanden, iets dat (...) doorgaans een belangrijk onderdeel vormt van reacties. Ik vlei mij een beetje met de gedachte dat Klops sympathieke weergave van de essentie van mijn betoog ook wellicht daarom zo goed geslaagd is, omdat wij putten uit ten dele verwant gedachtengoed. Ik ben namelijk, net als Klop, onder de indruk van het werk van Dooyeweerd. Dat gaat terug op de tijd dat ik als student-assistent verbonden was aan de afdeling Encyclopedie van de rechtswetenschap van de VU bij Prof. H.J. van Eikema Hommes. Laatstgenoemde was, zoals de lezers van Philosophia Reformata bekend is, een leerling van Dooyeweerd. (shrink)

Under today's conditions, when the Soviet Union is successfully engaged in the comprehensive construction of a communist society, and the prospect of uniform advancement toward communism seems possible for the socialist countries, the theoretical problems relating to the transition from socialism to communism acquire major importance. In our day, problems of scientific communism are resolved in practice, in the creative activity of tens and hundreds of millions of people. The success of the construction of communism depends to a very large (...) degree upon the correct theoretical solution of these problems. (shrink)

Economics: Beyond the Millennium contains articles by leading authorities in various fields of economic theory and econometrics, each of whom gives an account of the current state of the art in their own field and indicate the direction that they think it will take in the next ten years. The fields covered are grouped into three categories: the microfoundations of macroeconomics, where Malinvaud evaluates the theory of resource allocation and Hildenbrand examines the empirical content of economic thories; markets and and (...) organizations, where both Gabszewicz and D'Aspremont et al. look at imperfect competition and general equilibrium, Scotchmer and Thiess consider spatial economics, Ponssard the future of managerial economics, while Van Damme looks at the next stage of game theory; and econometrics, where Gourieroux reviews econometric modelling in general, Maravall looks at time series, Lubrand and Bauwens examine Bayesian analysis, and Blundell looks at the rapidly expanding area of microeconometrics. (shrink)

Praised for its unique combination of accessibility and comprehensiveness, Philosophy: The Quest for Truth provides an excellent selection of ninety-one classical and contemporary readings—on nineteen key problems in philosophy—carefully organized so that they present pro/con dialogues that allow students to compare and contrast the philosophers' positions. Each of the readings is accompanied by study questions, end-of-reading reflective questions, and an individual introduction featuring a biographical sketch of the philosopher. A tutorial on logic and argument, a time line, boldfaced key terms, (...) a detailed glossary, and an appendix on reading and writing philosophy papers further enhance the text's pedagogical value. In addition, each major section opens with a substantial introduction and ends with a short bibliography. NEW TO THIS EDITION * Ten new selections, two of which appear in a new section on same-sex marriage * A completely revised introduction to Part V: Freedom of the Will and Determinism * An updated Instructor's Manual and Test Bank on CD that includes sample syllabi, selection summaries, key terms with definitions, web links, and multiple-choice, true/false, and essay questions * An updated Companion Website at www.oup.com/us/pojman containing all of the material from the Instructor's CD along with student resources—essay questions, interactive quizzes, flashcards, and additional web links. (shrink)