_341_ _Objectives: _In patients with multivessel disease both the detection of the culprit lesion and the exact allocation are important preconditions for sufficient treatment and improved outcome. In a vessel based approach the combination of quantitative coronary angiography and fractional flow reserve measured by a pressure wire should be advantageous compared to myocardial SPECT, as morphological and functional information is delivered simultaneously. Therefore our aim was to evaluate MS in the detection and allocation of hemodynamically significant stenoses obtained by the (...) combined gold standard QCA plus FFR in patients with multivessel disease. _Methods: _FFR and QCA of 95 vessels in 80 patients have been evaluated. Hemodynamically significant target lesions were defined as intermediate stenoses between 50 and 75% with an FFR. (shrink)

This paper develops some modal metatheory for quantified modal logic. In such a theory, the logic of a first-order modal object-language is made sensitive to the modal facts, stated in the metalanguage. This is radically different from possible worlds semantics, which reduces questions of validity to questions of nonmodal set theory. We consider theories which characterize a notion of truth under a second-order interpretation, where an operator for metaphysical necessity is treated homophonically. The form they take is crucially influenced by (...) whether the Barcan formulas are part of the metalogic. The main result is that, with the Barcan formulas, formulating a modal metatheory is easy; principles of classical semantics transfer over smoothly with natural adaptations to the modal setting. Without the Barcan formulas, it seems to be much harder. Several options are considered, but each involves commitments plausibly in tension with the underlying philosophical motivations for rejecting them. (shrink)

Intelligent humanoid robots (IHRs) are becoming likely to be integrated into nursing practice. However, a proper integration of IHRs requires a detailed description and explanation of their essential capabilities, particularly regarding their competencies in replicating and portraying emotive functions such as empathy. Existing humanoid robots can exhibit rudimentary forms of empathy; as these machines slowly become commonplace in healthcare settings, they will be expected to express empathy as a natural function, rather than merely to portray artificial empathy as a replication (...) of human empathy. This article works with a twofold purpose: firstly, to consider the impact of artificial empathy in nursing and, secondly, to describe the influence of Affective Developmental Robotics (ADR) in anticipation of the empathic behaviour presented by artificial humanoid robots. The ADR has demonstrated that it can be one means by which humanoid nurse robots can achieve expressions of more relatable artificial empathy. This will be one of the vital models for intelligent humanoid robots currently in nurse robot development for the healthcare industry. A discussion of IHRs demonstrating artificial empathy is critical to nursing practice today, particularly in healthcare settings dense with technology. (shrink)

A discussion of José-Antonio Orosco’s new book, Star Trek’s Philosophy of Peace and Justice: A Global, Anti-Racist Approach. Orosco has been finding wisdom in Star Trek episodes since he watched late night reruns with his mother. Then, recently, in honor of the 50th anniversary of Star Trek’s debut, Orosco began to teach the series as source material for peace philosophy. Philosophical concepts can be brought to bear on Star Trek stories; but Orosco argues that the stories also assert philosophical meanings (...) that are instructive to peace studies. Martin Luther King Jr. was a fan of the first season, famously encouraging the late Nichelle Nichols (1932-2022) to persist in the role of Nyota Uhura after she had decided to resign. In our book discussion, Orosco centers the importance of Critical Race Theory as a tool for exploring Star Trek’s presentation of peace and justice. Andrew Fiala questions Orosco about Star Trek’s militarism. Jennifer Kling asks how the treatment of refugees intersects with Starfleet’s Prime Directive, which commands noninterference with intergalactic populations. (shrink)

A thirty-year-old single mother with recurrent, metastatic, treatment-refractory cancer presents to the emergency room with severe difficulty breathing due to an obstructive tumor in her neck, compounded by progressive disease in her lungs and a new pulmonary embolism. She cannot be safely intubated and would require an emergent awake tracheotomy. Even if the airway can be successfully secured surgically, the likelihood that she will be able to be weaned from mechanical ventilation is very low. The surgeon, a young mother too, (...) appreciates the patient's desire for more time with her toddler. But the surgeon knows the significant risk of surgery, the massive responsibility she would accept in trying to get the patient through it, and the emotional toll of an intraoperative death on surgical staff. And she can imagine the second-guessing that will come during the inevitable morbidity and mortality conference if the patient should die in the perioperative window. Yet the surgeon does not want to take the “easy” way out; after all, critically ill patients undergo aggressive resuscitation all the time. What should she do? (shrink)

In this volume, Simona Goi and Frederick M. Dolan gather stimulating arguments for the indispensability of fiction_including poetry, drama, and film_as irreplaceable sites for wrestling with nature, meaning, shortcomings, and the future of modern politics.

BackgroundCommunity engagement is a key component in health research. One of the ways health researchers ensure community engagement is through Community Advisory Boards (CABs). The capacity of CABs to properly perform their role in clinical research has not been well described in many resource limited settings. In this study, we assessed the capacity of CABs for effective community engagement in Uganda.MethodsWe conducted a cross sectional study with mixed methods. We used structured questionnaires and key informant interviews (KII) to collect data (...) from CAB members, trial investigators, and community liaison officers. For quantitative data, we used descriptive statistics while for qualitative data we used content analysis.ResultsSeventy three CAB members were interviewed using structured questionnaires; 58.9% males, median age 49 years (IQR 24–70), 71.2% had attained tertiary education, 42.5% never attended any research ethics training, only 26% had a training in human subject protection, 30.1% had training in health research, 50.7% never attended any training about the role of CABs, and 72.6% had no guidelines for their operation. On the qualitative aspect, 24 KIIs cited CAB members to have some skills and ability to understand and review study documents, offer guidance on community norms and expectations and give valuable feedback to the investigators. However, challenges like limited resources, lack of independence and guidelines, and knowledge gaps about research ethics were cited as hindrances of CABs capacity.ConclusionThough CABs have some capacity to perform their role in the Ugandan setting, their functionality is limited by lack of resources to facilitate their work, lack of independence, lack of guidelines for their operations and limited knowledge regarding issues of research ethics and protection of the rights of trial participants. (shrink)

As human beings age, they become weak, fragile, and feeble. It is a slowly progressing yet complex syndrome in which old age or some disabilities are not prerequisites; neither does loss of human parts lead to frailty among the physically fit older persons. This paper aims to describe the influences of transhumanist perspectives on human‐technology enhancements and replacements in the transcendence of human frailties, including those of older persons, in which technology is projected to deliver solutions toward transcending these frailties. (...) Through technologies including genetic screening and other technological manipulations, intelligent machines and augmented humans improve, maintain, and remedy human‐linked susceptibilities. Furthermore, other technologies replace parts fabricated through inorganic‐mechanical processes such as 3D‐printing. Advancing technologies are reaching the summit of technological sophistication contributing to the transhumanist views of being human in a technological world. Technologies enhance the transcendence of human frailties as essential expressions of the symbiosis between human beings and technology in a transcendental world. (shrink)

Students in two classes in the fall of 2004 making extensive use of online courseware were logged as they visited over 500 different “learning pages” which varied in length and in difficulty. We computed the time spent on each page by each student during each session they were logged in. We then modeled the time spent for a particular visit as a function of the page itself, the session, and the student. Surprisingly, the average time a student spent on learning (...) pages was of almost no value in predicting how long they would spend on a given page, even controlling for the session and page difficulty. The page itself was highly predictive, but so was the average time spent on learning pages in a given session. This indicates that local considerations, e.g., mood, deadline proximity, etc., play a much greater role in determining student pace and attention than do intrinsic student traits. We also consider the average time spent on learning pages as a function of the time of semester. Students spent less time on pages later in the semester, even for more demanding material. (shrink)

We describe the results of an experiment testing for the presence of strong altruism among Christians in New Zealand. The study examined anonymous participant generosity to cohort. We found that in modified dictator games, anonymous Christians in New Zealand gave significantly more to Canadian Christians than anonymous New Zealand citizens gave to their fellow citizens. The gifting opportunities occurred after anonymous benefactors observed recipients willingly undertake costly acts of group commitment. We found that mean gifting after witnessing a fellow group (...) member metaphorically "fall on a hand grenade" to punish a member of an out-group was almost four times greater in the Christian group than it was in the New Zealand control. Our data support the hypothesis that religious altruism exists and is especially strong among Christians in New Zealand. The data also weakly support a multi-level selection hypothesis for the evolution of religious altruism. (shrink)

Matteo Ricci (1552-1610) was an Italian Jesuit and one of the first Christian missionaries to China in the modern era. He was a genuine polymath—a translator, cartographer, mathematician, astronomer, and musician. Above all, Ricci was a missionary for the gospel. As we briefly examine his 1603 seminal work, The True Meaning of the Lord of Heaven, our hope is that we, as evangelical educators, will perceive some of the deeper principles necessary for our own missionary work among unreached people.

According to moral testimony pessimists, the testimony of moral experts does not provide non-experts with normative reasons for belief. Moral testimony optimists hold that it does. We first aim to show that moral testimony optimism is, to the extent such things may be shown, the more natural view about moral testimony. Speaking roughly, the supposed discontinuity between the norms of moral beliefs and the norms of non-moral beliefs, on careful reflection, lacks the intuitive advantage that it is sometimes supposed to (...) have. Our second aim is to highlight the difference in the nature of the pragmatic reasons for belief that support moral testimony optimism and moral testimony pessimism, setting out more clearly the nature and magnitude of the challenge for the pessimist. (shrink)

BackgroundHIV prevention research in resource-limited countries is associated with a variety of ethical dilemmas. Key amongst these is the question of what constitutes an appropriate standard of health care (SoC) for participants in HIV prevention trials. This paper describes a community-focused approach to develop a locally-appropriate SoC in the context of a phase III vaginal microbicide trial in Mwanza City, northwest Tanzania.MethodsA mobile community-based sexual and reproductive health service for women working as informal food vendors or in traditional and modern (...) bars, restaurants, hotels and guesthouses has been established in 10 city wards. Wards were divided into geographical clusters and community representatives elected at cluster and ward level. A city-level Community Advisory Committee (CAC) with representatives from each ward has been established. Workshops and community meetings at ward and city-level have explored project-related concerns using tools adapted from participatory learning and action techniques e.g. chapati diagrams, pair-wise ranking. Secondary stakeholders representing local public-sector and non-governmental health and social care providers have formed a trial Stakeholders' Advisory Group (SAG), which includes two CAC representatives.ResultsKey recommendations from participatory community workshops, CAC and SAG meetings conducted in the first year of the trial relate to the quality and range of clinic services provided at study clinics as well as broader standard of care issues. Recommendations have included streamlining clinic services to reduce waiting times, expanding services to include the children and spouses of participants and providing care for common local conditions such as malaria. Participants, community representatives and stakeholders felt there was an ethical obligation to ensure effective access to antiretroviral drugs and to provide supportive community-based care for women identified as HIV positive during the trial. This obligation includes ensuring sustainable, post-trial access to these services. Post-trial access to an effective vaginal microbicide was also felt to be a moral imperative.ConclusionParticipatory methodologies enabled effective partnerships between researchers, participant representatives and community stakeholders to be developed and facilitated local dialogue and consensus on what constitutes a locally-appropriate standard of care in the context of a vaginal microbicide trial in this setting.Trial registrationCurrent Controlled Trials ISRCTN64716212. (shrink)

This book provides a collection of essays representing the state of the art in the research into argumentation in classical antiquity. It contains essays from leading and up and coming scholars on figures as diverse as Parmenides, Gorgias, Seneca, and Classical Chinese "wandering persuaders." The book includes contributions from specialists in the history of philosophy as well as specialists in contemporary argumentation theory, and stimulates the dialogue between scholars studying issues relating to argumentation theory in ancient philosophy and contemporary argumentation (...) theorists. Furthermore, the book sets the direction for research into argumentation in antiquity by encouraging an engagement with a broader range of historical figures, and closer collaboration between contemporary concerns and the history of philosophy. (shrink)

We study the degrees of bi-hyperhyperimmune sets. Our main result characterizes these degrees as those that compute a function that is not dominated by any ∆02 function, and equivalently, those that compute a weak 2-generic. These characterizations imply that the collection of bi-hhi Turing degrees is closed upwards.

In Big Gods, Norenzayan (2013) presents the most comprehensive treatment yet of the Big Gods question. The book is a commendable attempt to synthesize the rapidly growing body of survey and experimental research on prosocial effects of religious primes together with cross-cultural data on the distribution of Big Gods. There are, however, a number of problems with the current cross-cultural evidence that weaken support for a causal link between big societies and certain types of Big Gods. Here we attempt to (...) clarify these problems and, in so doing, correct any potential misinterpretation of the cross-cultural findings, provide new insight into the processes generating the patterns observed, and flag directions for future research. (shrink)

We study the relative computational power of structures related to the ordered field of reals, specifically using the notion of generic Muchnik reducibility. We show that any expansion of the reals by a continuous function has no more computing power than the reals, answering a question of Igusa, Knight, and Schweber [7]. On the other hand, we show that there is a certain Borel expansion of the reals that is strictly more powerful than the reals and such that any Borel (...) quotient of the reals reduces to it. (shrink)

Combinatorial operations on sets are almost never well defined on Turing degrees, a fact so obvious that counterexamples are worth exhibiting. The case we focus on is the symmetric-difference operator; there are pairs of degrees for which the symmetric-difference operation is well defined. Some examples can be extracted from the literature, e.g. from the existence of nonzero degrees with strong minimal covers. We focus on the case of incomparable r.e. degrees for which the symmetric-difference operation is well defined.

Introduction This article is a response to Zagouras, Ellick, and Aulisio who presented a case study justifying the questioning of the capacity and autonomy of a young woman with a physical disability who was pregnant and facing coercive pressure to terminate. Case description Julia is described as a 26-year-old woman with a neurological disability that requires her to receive assistance with activities of daily living. She was described as living with her parents who provided her with personal care assistance. Julia (...) became pregnant and her parents wished her to terminate because they did not want to care for her child in addition to her. In fact, Julia's parents threatened her with institutionalization if she did not elect to terminate the pregnancy. Her health care team questioned her decision-making capacity based on her alleged “mental age” and experiences of being sheltered and excluded. The health care team used directive tactics to convince Julia to terminate the pregnancy, which describe as both an ethical and feminist intervention. Discussion The current authors take issue with the case analysis provided by and argue that they neglected to account for numerous instances of systemic ableism that adversely affected Julia, demonstrated prejudicial and judgmental attitudes toward pregnancy and disability, inappropriately questioned her decision-making capacity by infantilizing her, misconstrued the feminist concept of relational autonomy, and colluded with coercive interference from family members. This is a classic example of discriminatory and culturally incompetent reproductive health care for a disabled woman. (shrink)

:In this paper, the author argues that Joseph Fins’ mosaic decisionmaking model for brain-injured patients is untenable. He supports this claim by identifying three problems with mosaic decisionmaking. First, that it is unclear whether a mosaic is a conceptually adequate metaphor for a decisionmaking process that is intended to promote patient autonomy. Second, that the proposed legal framework for mosaic decisionmaking is inappropriate. Third, that it is unclear how we ought to select patients for participation in mosaic decisionmaking.

The arts of rule cover the exercise of power by princes and popular sovereigns, but they range beyond the domain of government itself, extending to civil associations, political parties, and religious institutions. Making full use of political philosophy from a range of backgrounds, this festschrift for Harvey Mansfield recognizes that although the arts of rule are comprehensive, the best government is a limited one.

Hailed by Margaret Thatcher as the founder of modern conservatism, Keith Joseph is commonly ranked among the most influential politicians of the late-20th century. A complex and enigmatic figure Joseph was almost unique among Mrs Thatcher's senior ministers in refusing to write his own memoirs. Challenging both the "mad monk" view held by his critics and his status of mythical hero to his admirers, the authors present a picture of Joseph as a thinker and decision-maker. the authors (...) tell of Joseph's formative years before he entered Parliamnet in 1956: the powerful Jewish dynasty into which Josph was born; his time at Harrow; at Oxford; his war years in the Royal Artillery; and his Fellowship at All Souls. This volume charts the political career of Keith Joseph. The authors challenge Joseph's self-declared conversion to Conservatism in 1974 and the importance of his "education" of Margaret Thatcher. His own ambition, intellectual integrity and consistency are all examined and a different picture emerges of his role as the intellectual driving force behind Conservative Government policy in the 1980s. (shrink)

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis – the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances’ responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first – what is the nature of psychiatric illness – and that in some manner all further (...) questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis. This reflection leads toward a view of psychiatric disorders – and future nosologies – as far more complex and uncertain than we have imagined. (shrink)

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role (...) of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances. (shrink)

Bracken offers two new approaches to the God-world relationship. He replaces substance metaphysics with Whitehead’s field metaphysics or social ontology “in which societies or structured fields of activity are the conventional units of reality ”, and here he makes a solid contribution. He also introduces emergence to explain the God-world relation; here he could have explored more potentially valuable options.

Peter Abelard (1079–1142 ce) was the most wide‐ranging philosopher of the twelfth century. He quickly established himself as a leading teacher of logic in and near Paris shortly after 1100. After his affair with Heloise, and his subsequent castration, Abelard became a monk, but he returned to teaching in the Paris schools until 1140, when his work was condemned by a Church Council at Sens. His logical writings were based around discussion of the “Old Logic”: Porphyry's Isagoge, aristotle'S Categories and (...) On Interpretation and boethius'S textbook on topical inference. They comprise a freestanding Dialectica (“Logic”; probably c.1116), a set of commentaries (known as the Logica [Ingredientibus], c. 1119) and a later (c. 1125) commentary on the Isagoge (Logica Nostrorum Petititoni Sociorum or Glossulae). In a work Abelard called his Theologia, issued in three main versions (between 1120 and c.1134), he attempted a logical analysis of trinitarian relations and explored the philosophical problems surrounding God's claims to omnipotence and omniscience. The Collationes (“Debates,” also known as “Dialogue between a Christian, a Philosopher and a Jew”; probably c.1130) present a rational investigation into the nature of the highest good, in which the Christian and the Philosopher (who seems to be modeled on a philosopher of pagan antiquity) are remarkably in agreement. The unfinished Scito teipsum (“Know thyself,” also known as the “Ethics”; c.1138) analyses moral action. (shrink)