IntroductionCerebral visual impairment is an important cause of visual impairment in western countries. Perinatal hypoxic-ischemic damage is the most frequent cause of CVI but CVI can also be the result of a genetic disorder. The majority of children with CVI have cerebral palsy and/or developmental delay. Early diagnosis is crucial; however, there is a need for consensus on evidence based diagnostic tools and referral criteria. The aim of this study is to develop guidelines for diagnosis and referral in CVI according (...) to the grade method.Patients and MethodsWe developed the guidelines according to the GRADE method 5 searches on CVI were performed in the databases Medline, Embase, and Psychinfo, each with a distinct topic.ResultsBased on evidence articles were selected on five topics: 1. Medical history and CVI-questionnaires 23. 2. Ophthalmological and orthoptic assessment 37. 3. Neuropsychological assessment 5. 4. Neuroradiological evaluation and magnetic resonance imaging 9. 5. Genetic assessment 5.ConclusionIn medical history taking, prematurity low birth weight and APGAR Scores are important. Different questionnaires are advised for children under the age of 3 years, older children and for specific risk groups. In ophthalmological examination, eye movements, specially saccades, accommodation, crowding, contrast sensitivity and visual fields should be evaluated. OCT can show objective signs of trans-synaptic degeneration and abnormalities in fixation and saccades can be measured with eye tracking. Screening of visual perceptive functioning is recommended and can be directive for further assessment. MRI findings in CVI in Cerebral Palsy can be structured in five groups: Brain maldevelopment, white and gray matter lesions, postnatal lesions and a normal MRI. In children with CVI and periventricular leukomalacia, brain lesion severity correlates with visual function impairment. A differentiation can be made between cortical and subcortical damage and related visual function impairment. Additional assessments can be necessary to complete the diagnosis of CVI and/or to reveal the etiology. (shrink)

In the Netherlands, current policy opinion emphasizes demand-driven health care. Central to this model is the view, advocated by some Dutch health policy makers, that patients should be encouraged to be aware of and make use of health quality and health outcomes information in making personal health care provider choices. The success of the new health care system in the Netherlands is premised on this being the case. After a literature review and description of the new Dutch health care system, (...) the adequacy of this demand-driven health policy is tested. The data from a July 2005, self-administered questionnaire survey of 409 patients (response rate of 94%) as to how they choose a hospital are presented. Results indicate that most patients did not choose by actively employing available quality and outcome information. They were, rather, referred by their general practitioner. Hospital choice is highly related to the importance a patient attaches to his or her physician’s opinion about a hospital. Some patients indicated that their hospital choice was affected by the reputation of the hospital, by the distance they lived from the hospital, etc. but physician’s advice was, by far, the most important factor. Policy consequences are important; the assumptions underlying the demand-driven model of patient health provider choice are inadequate to explain the pattern of observed responses. An alternative, more adequate model is required, one that takes into account the patient’s confidence in physician referral and advice. (shrink)

The existence of various physical phenomena stems from the concept called asymptotic emergence, that is, they seem to be exclusively reserved for certain limiting theories. Important examples are spontaneous symmetry breaking (SSB) and phase transitions: these would only occur in the classical or thermodynamic limit of underlying finite quantum systems, since for finite quantum systems, due to the uniqueness of the relevant states, such phenomena are excluded by Theory. In Nature, however, finite quantum systems describing real materials clearly exhibit such (...) effects. In this paper we discuss these apparently “paradoxical” phenomena and outline various ideas and mechanisms that encompass both theory and reality, from physical and mathematical points of view. (shrink)

The study is designed to provide an informal summary of what is known about consumer switching of health insurance plans and to contribute to knowledge about what motivates consumers who choose to switch health plans. Do consumers switch plans largely on the basis of critical reflection and assessment of information about the quality, and price? The literature suggests that switching is complicated, not always possible, and often overwhelming to consumers. Price does not always determine choice. Quality is very hard for (...) consumers to understand. Results from a random sample survey ( n = 2791) of the Alkmaar region of the Netherlands are reported here. They suggest that rather than embracing the opportunity to be active critical consumers, individuals are more likely to avoid this role by handing this activity off to a group purchasing organization. There is little evidence that consumers switch plans on the basis of critical reflection and assessment of information about quality and price. The new data reported here confirm the importance of a group purchasing organizations. In a free-market-health insurance system confidence in purchasing groups may be more important for health insurance choice than health informatics. This is not what policy makers expected and might result a less efficient health insurance market system. (shrink)

Apparent tensions, even contradictions, within the letters of Paul have led some to abandon the attempt to find coherence in his theology, and others to locate it in his psychological make-up lather than his thought, neither solution represents an adequate response to the apostle's theological reflections.

The 2005 UNESCO Convention on the Protection and Promotion of the Diversity of Cultural Expressions provides an international policy lens for analysing broad debates on issues of cultural globalization and development. The interdisciplinary contributions in this volume offer a fresh understanding of these key issues whilst examining cultural globalization, which is conceived in terms of artistic expressions and entertainment industries and interpreted anthropologically as the rituals, symbols, and practices of everyday life. The broad gamut of theories, methods, and evidence collected (...) by the editors outlines UNESCO's accomplishments, shortcomings, and future policy prospects. This edited collection has a clear message: The Convention is a useful and important instrument in the debate on cultural diversity, but not broad enough or sufficient to confront major challenges concerning human rights, sustainability, and cultural diversity as a whole. (shrink)

Bernard Lonergan argued that a Thomist theory of intellect must begin with advertence to the act of understanding. He distinguished his cognitional theory from a conceptualism that neglects the experience of insight and reflection on it. Early in his career, he explained how the conceptualist approach misinterprets Aquinas and creates problems for the metaphysics of rational psychology. This article explains Lonergan’s position and illustrates the conceptualist alternative by analysing Joseph Owens’s view of cognition. By explaining the metaphysical differences between Lonergan’s (...) and Owens’s opposing views of human knowing in relation to their distinctive readings of Aquinas, this article contributes to a more accurate reading of Aquinas on the act of understanding. (shrink)

In 'Vague Identity: Evans Misunderstood' David Lewis defends Gareth Evans against a widespread misunderstanding of an argument that appeared in his article 'Can There be Vague Objects?'. Lewis takes himself to be 'defending Evans' and not just correcting a mistake; witness his remark that, 'As misunderstood, Evans is a pitiful figure: a "technical philosopher" out of control of his technicalities, taken in by a fallacious proof of an absurd conclusion'. Let me say at the outset that I take Lewis to (...) be exactly right in regarding as a misunderstanding the interpretation of Evans which he exposes as such. On Lewis's account, everything Evans says 'falls into place', and he quotes from a letter that 'settles the matter'. (shrink)

A dictionary definition of Bioethics is, 'the ethics, or moral principles and rules of conduct, of medical and biological research'. This book is an introductory text of just biological and not medical bioethics. It covers the ethics of experimentation, including genetic manipulation, in plants and animals; ethics and biodiversity, ethics and the environment. There is increasing interest in bioethics - both in academia and by the media and the general public. Awareness of bioethics is incorporated into Biological / Environmental Science (...) courses, plus the first dedicated modular courses on bioethics are starting up. Includes case studies Has questions for students Chapters include environmental, animal, agricultural and reproductive ethics as well as a wide range of issues regarding genetic manipulation. (shrink)

A dictionary definition of Bioethics is, 'the ethics, or moral principles and rules of conduct, of medical and biological research'. This book is an introductory text of just biological and not medical bioethics. It covers the ethics of experimentation, including genetic manipulation, in plants and animals; ethics and biodiversity, ethics and the environment. There is increasing interest in bioethics - both in academia and by the media and the general public. Awareness of bioethics is incorporated into Biological / Environmental Science (...) courses, plus the first dedicated modular courses on bioethics are starting up. * Includes case studies * Has questions for students * Chapters include environmental, animal, agricultural and reproductive ethics as well as a wide range of issues regarding genetic manipulation. (shrink)