Rationale, aims and objectives To compare the pharmacotherapeutic approaches to diabetic hypertension of family physicians (FPs) and general practitioners (GPs). Methods A retrospective prescription-based study was conducted in 15 out of a total of 20 health centres, involving 115 primary care physicians – 77 FPs and 38 GPs, representing 74% of the primary care physicians of Bahrain. Prescriptions were collected during May and June 2000 to comprise a study population of 1266 diabetic-hypertensive patients. Results As monotherapy, angiotensin-converting enzyme (ACE) inhibitors (...) (37.9%) and β-blockers (38.3%) were the most commonly prescribed classes of antihypertensives by FPs and GPs, respectively. Calcium channel blockers (CCBs) were ranked third by both categories of physicians. For two-drug combinations, a β-blocker and an ACE inhibitor was the combination of choice for both physician categories. Patients managed by the FPs were more likely to receive a β-blocker–CCB combination (17.4 vs. 14.9%) or a diuretic–ACE inhibitor combination (16.7 vs. 11.4%) and less likely to receive a β-blocker–diuretic combination (11.8 vs. 16.7%) than those managed by the GPs. The proportion of patients receiving antihypertensive combinations was 40.6 and 38.5% for FPs and GPs, respectively. While the GPs prescribed CCB as a monotherapy to the elderly most often, the FPs choice was a β-blocker. Diuretics were less preferred by both FPs and GPs. β-Blocker–ACE inhibitor was again the most preferred combination of both FPs and GPs. FPs prescribed CCB–β-blocker combinations more often than GPs (P = 0.01), whereas CCB–ACE inhibitor combinations were less preferred (P = 0.09). A trend towards excessive use of short-acting nifedipine as monotherapy for elderly patients, both by FPs and by GPs, was noticed. Glibenclamide, alone or in combination with metformin, was the foremost antidiabetic drug prescribed by FPs and GPs. Middle-aged (45–64 years) patients seen by GPs were more likely to receive glibenclamide than those treated by FPs (P = 0.001) and less likely to receive gliclazide (P = 0.01). Combinations of a β-blocker with either glibenclamide or insulin were prescribed considerably more often by GPs.Conclusions Within the same practice setting, a substantial difference was observed between FPs and GPs in terms of preference for different classes of drugs in the management of diabetic hypertension. The compliance of both FPs and GPs was suboptimal; overall, the compliance of the FPs was closer to the recommended guidelines, however. Educational programmes should specifically address these inadequacies in order to improve the quality of health care. (shrink)

Pancreatitis is a complex, progressively destructive inflammatory disorder. Alcohol was long thought to be the primary causative agent, but genetic contributions have been of interest since the discovery that rare PRSS1, CFTR and SPINK1 variants were associated with pancreatitis risk. We now report two associations at genome-wide significance identified and replicated at PRSS1-PRSS2 and X-linked CLDN2 through a two-stage genome-wide study. The PRSS1 variant likely affects disease susceptibility by altering expression of the primary trypsinogen gene. The CLDN2 risk allele is (...) associated with atypical localization of claudin-2 in pancreatic acinar cells. The homozygous CLDN2 genotype confers the greatest risk, and its alleles interact with alcohol consumption to amplify risk. These results could partially explain the high frequency of alcohol-related pancreatitis in men. © 2012 Nature America, Inc. All rights reserved. (shrink)

The COVID-19 pandemic has resulted in more than 524 million cases and 6 million deaths worldwide. Various drug interventions targeting multiple stages of COVID-19 pathogenesis can significantly reduce infection-related mortality. The current within-host mathematical modeling study addresses the optimal drug regimen and efficacy of combination therapies in the treatment of COVID-19. The drugs/interventions considered include Arbidol, Remdesivir, Interferon and Lopinavir/ritonavir. It is concluded that these drugs, when administered singly or in combination, reduce the number of infected cells and viral load. (...) Four scenarios dealing with the administration of a single drug, two drugs, three drugs and all four are discussed. In all these scenarios, the optimal drug regimen is proposed based on two methods. In the first method, these medical interventions are modeled as control interventions and a corresponding objective function and optimal control problem are formulated. In this framework, the optimal drug regimen is derived. Later, using the comparative effectiveness method, the optimal drug regimen is derived based on the basic reproduction number and viral load. The average number of infected cells and viral load decreased the most when all four drugs were used together. On the other hand, the average number of susceptible cells decreased the most when Arbidol was administered alone. The basic reproduction number and viral load decreased the most when all four interventions were used together, confirming the previously obtained finding of the optimal control problem. The results of this study can help physicians make decisions about the treatment of the life-threatening COVID-19 infection. (shrink)

Much has been written on the relative merits of different readings of Wittgenstein's Tractatus Logico-Philosophicus. The recent renewal of the debate has almost exclusively been concerned with variants of the ineffabilist (metaphysical) reading of TL-P - notable such readings have been advanced by Elizabeth Anscombe, P. M. S. Hacker and H. O. Mounce - and the recently advanced variants of therapeutic (resolute) readings - notable advocates of which are James Conant, Cora Diamond, Juliet Floyd and Michael Kremer. During this debate, (...) there have been a number of writers who have tried to develop a third way, incorporating what they see as insights and avoiding what they see as flaws in both the ineffabilist and resolute readings. The most prominent advocates of these elucidatory readings of TL-P are Dan Hutto (2003) and Marie McGinn (1999). In this paper we subject Hutto's and McGinn's readings of TL-P to critical scrutiny. We find that in seeking to occupy the middle ground they ultimately find themselves committed to (and in the process commit Wittgenstein to) the very ineffabilism they (and Wittgenstein) are seeking to overcome. (shrink)

Purpose This paper aims to formalize long-term trajectories of human civilization as a scientific and ethical field of study. The long-term trajectory of human civilization can be defined as the path that human civilization takes during the entire future time period in which human civilization could continue to exist. -/- Design/methodology/approach This paper focuses on four types of trajectories: status quo trajectories, in which human civilization persists in a state broadly similar to its current state into the distant future; catastrophe (...) trajectories, in which one or more events cause significant harm to human civilization; technological transformation trajectories, in which radical technological breakthroughs put human civilization on a fundamentally different course; and astronomical trajectories, in which human civilization expands beyond its home planet and into the accessible portions of the cosmos. -/- Findings Status quo trajectories appear unlikely to persist into the distant future, especially in light of long-term astronomical processes. Several catastrophe, technological transformation and astronomical trajectories appear possible. -/- Originality/value Some current actions may be able to affect the long-term trajectory. Whether these actions should be pursued depends on a mix of empirical and ethical factors. For some ethical frameworks, these actions may be especially important to pursue. (shrink)

The paper points out that the modern formulation of Bohm’s quantum theory known as Bohmian mechanics is committed only to particles’ positions and a law of motion. We explain how this view can avoid the open questions that the traditional view faces according to which Bohm’s theory is committed to a wave-function that is a physical entity over and above the particles, although it is defined on configuration space instead of three-dimensional space. We then enquire into the status of the (...) law of motion, elaborating on how the main philosophical options to ground a law of motion, namely Humeanism and dispositionalism, can be applied to Bohmian mechanics. In conclusion, we sketch out how these options apply to primitive ontology approaches to quantum mechanics in general. (shrink)

Context: The majority of contemporary enactivist work is influenced by the philosophical biology of Hans Jonas. Jonas credits all living organisms with experience that involves particular “existential” structures: nascent forms of concern for self-preservation and desire for objects and outcomes that promote well-being. We argue that Jonas’s attitude towards living systems involves a problematic anthropomorphism that threatens to place enactivism at odds with cognitive science, and undermine its legitimate aims to become a new paradigm for scientific investigation and understanding of (...) the mind. Problem: Enactivism needs to address the tension between its Jonasian influences and its aspirations to become a new paradigm for cognitive science. By relying on Jonasian phenomenology, contemporary enactivism obscures alternative ways in which phenomenology can be more smoothly integrated with cognitive science. Method: We outline the historical relationship between enactivism and phenomenology, and explain why anthropomorphism is problematic for a research program that aspires to become a new paradigm for cognitive science. We examine the roots of Jonas’s existential interpretation of biological facts, and describe how and why Jonas himself understood his project as founded on an anthropomorphic assumption that is incompatible with a crucial methodological assumption of scientific enquiry: the prohibition of unexplained natural purposes. We describe the way in which phenomenology can be integrated into Maturana’s autopoietic theory, and use this as an example of how an alternative, non-anthropomorphic science of the biological roots of cognition might proceed. Results: Our analysis reveals a crucial tension between Jonas’s influence on enactivism and enactivism’s paradigmatic aspirations. This suggests the possibility of, and need to investigate, other ways of integrating phenomenology with cognitive science that do not succumb to this tension. Implications: In light of this, enactivists should either eliminate the Jonasian inference from properties of our human experience to properties of the experience of all living organisms, or articulate an alternative conception of scientific enquiry that can tolerate the anthropomorphism this inference entails. The Maturanian view we present in the article’s final section constitutes a possible framework within which enactivist tools and concepts can be used to understand cognition and phenomenology, and that does not involve a problematic anthropomorphism. Constructivist content: Any constructivist approach that aims for integration with current scientific practice must either avoid the type of anthropomorphic inference on which Jonas bases his work, or specify a new conception of scientific enquiry that renders anthropomorphism unproblematic. (shrink)

It is sometimes suggested that expressivism in meta-ethics is to be criticized on grounds which do not themselves concern meta-ethics in particular, but which rather concern philosophy of language more generally. Frank Jackson and Philip Pettit (1998; see also Jackson and Pettit 1999, and Jackson 2001) have recently advanced a novel version of such an argument. They begin by noting that expressivism in its central form makes two claims—that ethical sentences are not truth evaluable, and that to assert an ethical (...) sentence is to express one’s desires or feelings rather than to report a fact. They then argue that, given some plausible premises in the philosophy of language emanating mainly from Locke, the two central claims of expressivism are contradictory: when combined with the plausible premises, they say, the second claim refutes the first. The purpose of this paper is to formulate Jackson and Pettit’s Lockean argument, and to suggest that it fails. (shrink)

In the Appendix to the Treatise of Human Nature, Hume famously recants his position on personal identity. There he confesses: “upon a strict review of the section concurring personal identity I find myself involv’d in such a labyrinth that... I neither know how to correct my former opinions, nor how to render them consistent.” By his own admission, then, something has gone wrong in Hume’s account of personal identity, something that, at least to his eyes, did not go wrong in (...) his accounts of body and necessary connection. For those accounts were not grossly inconsistent or patently absurd. The case is different, however, with personal identity. There his philosophical enterprise suffers shipwreck, and it is important to understand why. Unfortunately, however, Hume confesses that he finds his former opinions false as well as inconsistent, but neglects to specify how or why he came to this conclusion. This paper is an attempt to address just that question. (shrink)

The editorial in the September 1982 issue of this journal and many articles before and since have addressed the problem of informed consent. Is it possible? Is it a useful concept? Is there anything new to be said about it? In this article the basic rationale of the rule (patient autonomy) is explained and the extent of the rule explored. Various exceptions have been offered by the law and an attempt is made to catalogue the chief of these. A number (...) of specially vulnerable groups are then identified, the most important, and vexed, being children. How can informed consent be secured in the case of young patients? Finally, a few problems are mentioned in an attempt to get this subject back to reality. The appeal to the principle primum non nocere may be medical paternalism in disguise. Informed consent is the competing principle that reminds us of the primacy of human autonomy. A pointer is given to the future: even the use of sound recordings to explain medical procedures and to activate informed consent so that it may become a reality and not just a lawyer's myth, should be considered. (shrink)

This book studies the interfaces of ethics, economics, and politics. Public policy issues involve all three of these subjects. Although it may be seen as suggesting the nucleus of a joint university course, the book is accessible to and should interest all those concerned with political decisions. Any such decision needs a criterion for judging whether one action or outcome is better than another. Even a dictator must to some extent be concerned about the economic welfare of the citizens; and (...) a democratic government more so. But how is a person's economic welfare to be judged? Furthermore, any political decision affects the economic welfare of different people differently. How then is the welfare of a community to be judged? This is an ethical question. Underlying any coherent public policy there must be a relevant moral code. (shrink)

The Greeks and Romans have been charged with destroying the ecosystems within which they lived. In this book, however, M. D. Usher argues rather that we can find in their lives and thought the origin of modern ideas about systems and sustainability, important topics for humans today and in the future. With chapters running the gamut of Greek and Roman experience – from the Presocratics and Plato to Roman agronomy and the Benedictine Rule – Plato's Pigs brings together unlikely bedfellows, (...) both ancient and modern, to reveal surprising connections. Lively prose and liberal use of anecdotal detail, including an afterword about the author's own experiments with sustainable living on his sheep farm in Vermont, add a strong authorial voice. In short, this is a unique, first-of-its-kind book that is sure to be of interest to anyone working in Classics, environmental studies, philosophy, ecology, or the history of ideas. (shrink)

While much has been written on the cultural and intellectual antecedents that gave rise to Carolus Linnaeus?s herbarium and his Systema Naturae, the tools that he used to transform his raw observations into nomenclatural terms and categories have been neglected. Focusing on the Philosophia Botanica, the popular classification handbook that he published in 1751, it can be shown that Linnaeus cleverly ordered and reordered the work by employing commonplacing techniques that had been part of print culture since the Renaissance. Indeed, (...) the functional adaptability of commonplace heads allowed him to split and combine the book?s chapters and tables and played a notable conceptual role in the way in which he spatialized words and, to a certain extent, specimens. (shrink)

This article identifies two trends in Dooyeweerd’s conception of ‘cosmic time’, and elaborates their consequences for the philosophy of history. The first trend, connecting time to modal diversity and the order of the modal aspects, prevails in Dooyeweerd’s analysis. The application of the second trend, emphasizing that in each relation frame the temporal order governs subject-subject relations and subjectobject relations, sheds a new light on the interpretation of history conceived of as development of the culture and civilization of mankind. The (...) distinction of faith and religion and the position of the aspect of faith in the order of the modal aspects play important parts in this discussion, in particular with respect to the possibility of transcending time. (shrink)