Coastal ecosystems are increasingly dominated by humans. Consequently, the human dimensions of sustainability science have become an integral part of emerging coastal governance and management practices. But if we are to avoid the harsh lessons of land management, coastal decision makers must recognize that humans are one of the more coastally dependent species in the biosphere. Management responses must therefore confront both the temporal urgency and the very real compromises and sacrifices that will be necessary to achieve a sustainable coastal (...) ecosystem, one that is economically feasible, socially just, and ecologically sound. (shrink)

Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year survival of less than 50% who had advanced gastrointestinal or lung cancer or amyotrophic lateral sclerosis were interviewed. Each patient’s medical record was reviewed at enrollment and at 3 months for evidence of the discussion of patient wishes concerning (...) ventilator support, artificial nutrition and hydration , resuscitation and hospice care. A Kaplan–Meier analysis was also performed and 2-year survival calculated.Results: 60 cancer and 32 ALS patients were enrolled. ALS patients were more likely than cancer patients to have evidence of discussion about their wishes for ventilator support , ANH , DNR and hospice care . At 6 months, 91% of ALS patients were alive compared with 62% of cancer patients; at 2 years, 63% of ALS patients were alive compared with 23% of cancer patients .Conclusions: Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making. (shrink)

The nature of necessary truth was a central concern of Ludwig Wittgenstein. It was present in his early reflections on logic, a core motif of the Tractatus, and a topic he returned to over and again in his reflections on language, logic, and mathematics. This chapter explores the aspects of Wittgenstein's account of necessity and apriority, beginning with the Tractatus, where many of his core insights received their first expression. It discusses two more contemporary accounts of these topics: conceptual role (...) semantic theories of the a priori, and the arguments for divorcing apriority from necessity. Necessity in the Tractatus appears at two locations. One is at the level of individual elementary propositions. The other is at the level of the inferential connections between propositions. The chapter looks at the Tractatus theory of the proposition. Wittgenstein saw an important difference between the formulations of the rules of grammar and descriptions of states of affairs. (shrink)

Alexander George has put forward a novel interpretation of the Quine-Carnap debate over analyticity. George argues that Carnap's claim that there exists an analytic-synthetic distinction was held by Carnap to be empty of empirical consequences. As a result, Carnap understood his position to be empirically indistinguishable from Quine's. Although George defends his interpretation only briefly, I show that it withstands further examination and ought to be accepted. The consequences of accepting it undermine a common understanding of Quine's criticism of Carnap, (...) and I argue that it is difficult to find a perspective from which Quine can criticize Carnap in a non-question-begging way. (shrink)

Tom 1. Rannekhristianskiĭ gnosticheskiĭ tekst v rossiĭskoĭ kulʹture (21 i︠a︡nvari︠a︡ 2011 g.) -- Tom 2. Sudʹby religiozno-filosofskikh iskaniĭ Nikolai︠a︡ Novikova i ego kruga (15-17 okti︠a︡bri︠a︡ 2012 g.).

In attempting to realize the tasks facing Soviet philosophers today, at a crucial moment in the life of our society, and in an attempt to contribute as best we can to clearing up the intellectual atmosphere of the country, we turn again to the question of what philosophy is, what its place in the life of society is, and how it can and must develop. The present article is dedicated to an examination of one of the aspects of this complex (...) question. (shrink)

Книга предназначена для исследователей, специалистов, преподавателей, аспирантов, студентов, а также всех тех, кто интересуется вопросами философии.

В книге продолжается обсуждение тем, представленных в труде "Психология нравственности", изданном в 2010 году. Авторы обсуждают пути решения проблем и преодоления переживаемого нашим обществом глубокого нравственного кризиса.

A cross-sectional study to ascertain what the Singapore population would regard as material risk in the anaesthesia consent-taking process and identify demographic factors that predict patient preferences in medical decision-making to tailor a more patient-centered informed consent. A survey was performed involving patients 21 years old and above who attended the pre-operative evaluation clinic over a 1-month period in Singapore General Hospital. Questionnaires were administered to assess patients’ perception of material risks, by trained interviewers. Patients’ demographics were obtained. Mann–Whitney U (...) test and Kruskal-Wallis one-way analysis of variance was used. Statistical significance was taken at p < 0.05. Four hundred fourteen patients were eligible of which 26 refused to participate and 24 were excluded due to language barrier. 364 patients were recruited. A higher level of education, being employed and younger age group are factors identified in patients who wanted greater participation in medical decisions. Gender, marital status, type of surgery, and previous surgical history did not affect their level of participation. The complications most patients knew about were Nausea, Drowsiness and Surgical Wound Pain. Patients ranked Heart Attack, Death and Stroke as the most significant risks that they wanted to be informed about in greater detail. Most patients wanted to make a joint decision with the anaesthetist, instead of letting the doctor decide or deciding for themselves. Discussion with the anaesthetist is the preferred medium of communication compared to reading a pamphlet or watching a video. Age and educational level can influence medical decision-making. Despite the digital age, most patients still prefer a clinic consult instead of audio-visual multimedia for pre-operative anaesthetic counselling. The local population appears to place greater importance on rare but serious complications compared to common complications. This illustrates the need to contextualize information provided during informed consent to strengthen the doctor-patient relationship. (shrink)