Merab Konstantinovich [Mamardashvili] met with me immediately, as soon as I requested it, although he forewarned me that he could only dimly remember much of that distant past in which I was most interested. But evidently that past still perturbed him as well, since he agreed to speak with me even though he had not yet completely recovered from his illness, and hence his voice was feeble, at times subsiding to a whisper; he would pronounce his words indistinctly, constantly sticking (...) one onto another; on top of that, for technical reasons the dictaphone was situated a bit away from him. It was therefore very difficult to transcribe the text, and I raised many questions with the idea of asking Merab Konstantinovich about them at our next meeting and clearing up some things. But alas, there was no next meeting … Hence I am permitting myself now to publish only some of the most clearly enunciated fragments of my conversation with him, one of the four "forefathers" of the Moscow Methodological Circle, whose name for us, today's participants (and hence neophytes) in the methodological movement, is enveloped by legends handed down by word of mouth. I kept my questions to a minimum. Mamardashvili's reminiscences, arguments, and reflections will seem contentious to many. But no matter, one can dispute points of substance even with those who have passed on. (shrink)

Are values and social priorities universal, or do they vary across geography, culture, and time? This question is very relevant to Asia’s emerging economies that are increasingly looking at Western models for answers to their own outmoded health care systems that are in dire need of reform. But is it safe for them to do so without sufficient regard to their own social, political, and philosophical moorings? This article argues that historical and cultural legacies influence prevailing social values with regard (...) to health care financing and resource allocation, and that the Confucian dimension provides a helpful entry point for a deeper understanding of ongoing health care reforms in East Asia – as exemplified by the unique case of Singapore. (shrink)

Causal understanding is a defining characteristic of human cognition. Like many animals, human children learn to control their bodily movements and act effectively in the environment. Like a smaller subset of animals, children intervene: they learn to change the environment in targeted ways. Unlike other animals, children grow into adults with the causal reasoning skills to develop abstract theories, invent sophisticated technologies and imagine alternate pasts, distant futures and fictional worlds. In this Review, we explore the development of human-unique causal (...) learning and reasoning from evolutionary and ontogenetic perspectives. We frame our discussion using an ‘interventionist’ approach. First, we situate causal understanding in relation to cognitive abilities shared with non-human animals. We argue that human causal understanding is distinguished by its depersonalized (objective) and decontextualized (general) representations. Using this framework, we next review empirical findings on early human causal learning and reasoning and consider the naturalistic contexts that support its development. Then we explore connections to related abilities. We conclude with suggestions for ongoing collaboration between developmental, cross-cultural, computational, neural and evolutionary approaches to causal understanding. (shrink)

The article explores the main cloud technology models. The reasoned choice of the SaaS model for creating a Web application for educational process information support has been made. A software tool environment has been formed, including Heroku, ClearDB, MySQL SSL, Apache Maven to support the design and operation of the application. Roles and functionality for each user of the application are developed. The possibilities of access to it, changes and replenishment are determined.

The article examines the algorithms for JPEG and JPEG-2000 compression of various graphic images. The main steps of the operation of both algorithms are given, their advantages and disadvantages are noted. The main differences between JPEG and JPEG-2000 are analyzed. It is noted that the JPEG-2000 algorithm allows re-moving visually unpleasant effects. This makes it possible to highlight important areas of the image and improve the quality of their compression. The features of each step of the algorithms are considered and (...) the difficulties of their implementation are compared. The effectiveness of each algorithm is demonstrated by the example of a full-color image of the BSU emblem. The obtained compression ratios were obtained and shown in the corresponding tables using both algorithms. Compression ratios are obtained for a wide range of quality values from 1 to ten. We studied various types of images: black and white, business graphics, indexed and full color. A modified LZW-Lempel-Ziv-Welch algorithm is presented, which is applicable to compress a variety of information from text to images. The modification is based on limiting the graphic file to 256 colors. This made it possible to index the color with one byte instead of three. The efficiency of this modification grows with increasing image sizes. The modified LZW-algorithm can be adapted to any image from single-color to full-color. The prepared tests were indexed to the required number of colors in the images using the FastStone Image Viewer program. For each image, seven copies were obtained, containing 4, 8, 16, 32, 64, 128 and 256 colors, respectively. Testing results showed that the modified version of the LZW algorithm allows for an average of twice the compression ratio. However, in a class of full-color images, both algorithms showed the same results. The developed modification of the LZW algorithm can be successfully applied in the field of site design, especially in the case of so-called flat design. The comparative characteristics of the basic and modified methods are presented. (shrink)

No consensus yet exists on how to handle incidental fnd-ings in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are fndings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers (...) have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed. (shrink)

This paper inquires into the nature of intertheoretic relations between psychology and neuroscience. This relationship has been characterized by some as one in which psychological explanations eventually will fall away as otiose, overthrown completely by neurobiological ones. Against this view it will be argued that it squares poorly with scientific practices and empirical developments in the cognitive neurosciences. We analyse a case from research on visual perception, which suggests a much more subtle and complex interplay between psychology and neuroscience than (...) a complete take-over of the former by the latter. In the case of vision, cross-theory influences between psychology and neuroscience go back and forth, resulting in refinement in both disciplines. We interpret this case study as showing that: (1) Mutual co-evolution of psychological and neurobiological theories, exemplifying persisting top-down influences from psychology, is a more empirically adequate way to describe psychoneural theory relations than a view on co-evolution, favoured by reductionists, which regards the cross-theory contributions from psychology as merely heuristically useful with no enduring influence on neurobiological theorizing; (2) In research on vision, discovering (or hypothesizing) the neural basis of functions vindicates psychological approaches, it does not eliminate them; (3) Current work on vision shows that many perceptual phenomena must be understood in terms of dynamical interactions between an observer and his/her environment. Therefore, we argue that internalist characterizations of the visual system must be supplemented with externalist accounts that address these reciprocal observer-environment interactions involved in vision. Such processes seem quite different from (internal) cellular and molecular ones, and as such seem to lie outside the scope of neuroscientific inquiry. We conclude that psychoneural reduction or elimination is implausible as a meta-theoretical prediction of theory choice in empirical work. Instead, this case study of vision shows that both psychology and neuroscience contribute to, and complement one another in the study of visual perception. (shrink)

Background One of the objectives of medicine is to relieve patients' suffering. As a consequence, it is important to understand patients' perspectives of suffering and their ability to cope. However, there is poor insight into what determines their suffering and their ability to bear it. Purpose To explore the constituent elements of suffering of patients who explicitly request euthanasia or physician-assisted suicide (EAS) and to better understand unbearable suffering from the patients' perspective. Patients and methods A qualitative study using in-depth (...) face-to-face interviews was conducted with 31 patients who had requested EAS. The grounded theory approach was used to analyse the data. Results Medical, psycho-emotional, socio-environmental and existential themes contributed to suffering. Especially fatigue, pain, decline, negative feelings, loss of self, fear of future suffering, dependency, loss of autonomy, being worn out, being a burden, loneliness, loss of all that makes life worth living, hopelessness, pointlessness and being tired of living were constituent elements of unbearable suffering. Only patients with a psychiatric (co)diagnosis suffered unbearably all the time. Conclusions Unbearable suffering is the outcome of an intensive process that originates in the symptoms of illness and/or ageing. According to patients, hopelessness is an essential element of unbearable suffering. Medical and social elements may cause suffering, but especially when accompanied by psycho-emotional and existential problems suffering will become ‘unbearable’. Personality characteristics and biographical aspects greatly influence the burden of suffering. Unbearable suffering can only be understood in the continuum of the patients' perspectives of the past, the present and expectations of the future. (shrink)

This paper reports on a survey that investigated the moral decision processes of accountants. A formal belief revision model is adapted and hypotheses based on theorizations from the cognitive-developmental school are tested. The moral decision processes of accountants are hypothesized to be influenced by professional expectations, organizational expectations and internalized expectations. Subjects provided specific demographic data and were asked to access the appropriateness of fourteen principles for making moral decisions in business. Subjects were also asked to indicate which of the (...) fourteen approaches would be most appropriate for resolving each of five ethical situations that are representative of common ethical dilemmas in accounting.Subjects'' responses to the appropriateness of the fourteen principles are reduced to two dimensions using factor analysis. The factors are consistent and representative of important underlying dimensions of the stages of moral development. Demographic variables are correlated with the extracted factors using analysis of variance. (shrink)

Rapidly changing estimates on the Soviet régime''s ability to survive show how difficult it is for American Sovietologists to grasp what is going on.

BackgroundThe COVID-19 pandemic has created ethical challenges for intensive care unit (ICU) professionals, potentially causing moral distress. This study explored the levels and causes of moral distress and the ethical climate in Dutch ICUs during COVID-19.MethodsAn extended version of the Measurement of Moral Distress for Healthcare Professionals (MMD-HP) and Ethical Decision Making Climate Questionnaire (EDMCQ) were online distributed among all 84 ICUs. Moral distress scores in nurses and intensivists were compared with the historical control group one year before COVID-19. ResultsThree (...) hundred forty-five nurses (70.7%), 40 intensivists (8.2%), and 103 supporting staff (21.1%) completed the survey. Moral distress levels were higher for nurses than supporting staff. Moral distress levels in intensivists did not differ significantly from those of nurses and supporting staff. “Inadequate emotional support for patients and their families” was the highest-ranked cause of moral distress for all groups of professionals. Of all factors, all professions rated the ethical climate most positively regarding the culture of mutual respect, ethical awareness and support. “Culture of not avoiding end-of-life-decisions” and “Self-reflective and empowering leadership” received the lowest mean scores. Moral distress scores during COVID-19 were significantly lower for ICU nurses (p < 0.001) and intensivists (p < 0.05) compared to one year prior.ConclusionLevels and causes of moral distress vary between ICU professionals and differ from the historical control group. Targeted interventions that address moral distress during a crisis are desirable to improve the mental health and retention of ICU professionals and the quality of patient care. (shrink)

The description Ausonius has given us of his family and of the teachers and professors of Bordeaux in the mid-fourth century is exceptional among our sources because of its detail and completeness. There is no reason to suppose that the picture he gives is untypical of life in the provinces and it makes a welcome change from the histories of aristocratic politics at Rome or Constantinople. It provides an excellent opportunity for a pilot study in which we may see how (...) the conflicting elements of social status were in practice reconciled and applied. In the traditional, and still prevalent view, the society of the Later Roman Empire was ‘crushed … in the iron clamp of castes separated from one another by barriers which could not be passed’. The evidence of Ausonius suggests that this judgement should be qualified. The society of the fourth century may have been stable. It was not static. (shrink)

ABSTRACT Vague concepts are represented by L-fuzzy sets. It is argued that any vague concept carries with it an approximate identity which is a fuzzy equivalence relation. The relation also fulfills the criterion of ? indiscernibility of Identicals ?, which is called ? saturatedness ? in this context. An application in knowledge representation is indicated.

Hegel raises many real problems on the basis of the phenomenology of spirit: logico-ontological, gnoseological, and philosophico-historical problems. But in all spheres, levels, and forms of consciousness, Hegel investigates particularly the formation of the socially developed and historically oriented universal subject of thought, will, and action in the context of the forms of the manifest spirit, forms that in reality assume the status of being. It is precisely this investigation that constitutes the real problematic of Hegel's Phenomenology of Spirit.

In St. Francis Regional Medical Center v. Blue Cross & Blue Shield of Kansas ), the United States Court of Appeals for the Tenth Circuit upheld Blue Cross/Blue Shield of Kansas's anti-assignment requirement, on the grounds that the Employee Retirement Income Security Act preempted a hospital's claim against Blue Cross. The court also held that public policy supported anti-assignment requirements in health plans not covered under ERISA.When drafting ERISA, Congress did not explicitly address assignability of health care benefits. According to (...) the court of appeals, congressional silence constituted an intent to allow the parties to negotiate freely the assignment of health care benefits. Examining non-ERISA health plans, the court adopted a balancing test to determine the validity of anti-assignment clauses; it found that anti-assignment requirements promote freedom of contract and may include medical costs. (shrink)

The roots of much of Western medicine lie in the Christian monastic tradition and its commitment to nonstigmatizing compassionate care throughout the life cycle and to the ideal of empathic personal connection between physicians, patients, and the communities and relationships in which both of these are embedded. In the modern West, these Christianly informed aspects of medicine are increasingly being undercut as medical care becomes ever more specialized, technologized, and depersonalized. At the same time, there exist a variety of efforts (...) to counter these tendencies and to foster a practice of medicine that is more sensitive to the personal, relational, familial, and narrative dimensions of health, illness, and medical care. There are, in particular, considerable numbers of physicians, psychologists, and psychotherapists working at the intersections of biomedical and psychosocial care, of care for individuals and care for families, and of the body and the mind. Given the natural affinity that Christian bioethicists might be expected to have to communitarian, narrative, and family-oriented approaches to health care, it is thus remarkable that there appears to be no work of Christian bioethics that interacts in any discernible way with this psychotherapeutic literature concerning health, illness, families, and the mind-body interface. Instead, Christian bioethicists appear to endorse a narrowly reductionistic biomedical view of health and illness while either ignoring the psychosocial, integrative, and collaborative literature, or actively blaming and shaming those pastors or lay Christians who might have anything to do with psychotherapy or psychosocial care. This is unbecoming and unhelpful. In the fragmented, complex, and potentially dehumanizing world that is modern medical care, those who would think Christianly about the care of the sick cannot afford to despise psychology and psychosocial care. On the contrary, the church needs psychotherapy. In this article, I will thus consider, first, what the state of the conversation is where Christian bioethics and psychosocial and psychotherapeutic care are concerned. I will then turn to some of the principal landmarks in the professional literature concerning psychotherapeutic work with the sick, the disabled, the dying, and the bereaved, particularly as these are considered in contexts that include families and lay and professional caregivers. I will then identify a few opportunities for practical and theological reflection that present themselves in this literature, and will conclude with a few comments on the substance and relationship of salvation and health. (shrink)

The importance of communities in strengthening the ethics of international collaborative research is increasingly highlighted, but there has been much debate about the meaning of the term ‘community’ and its specific normative contribution. We argue that ‘community’ is a contingent concept that plays an important normative role in research through the existence of morally significant interplay between notions of community and individuality. We draw on experience of community engagement in rural Kenya to illustrate two aspects of this interplay: (i) that (...) taking individual informed consent seriously involves understanding and addressing the influence of communities in which individuals’ lives are embedded; (ii) that individual participation can generate risks and benefits for communities as part of the wider implications of research. We further argue that the contingent nature of a community means that defining boundaries is generally a normative process itself, with ethical implications. Community engagement supports the enactment of normative roles; building mutual understanding and trust between researchers and community members have been important goals in Kilifi, requiring a broad range of approaches. Ethical dilemmas are continuously generated as part of these engagement activities, including the risks of perverse outcomes related to existing social relations in communities and conditions of ‘half knowing’ intrinsic to processes of developing new understandings. (shrink)

The mind is not structured anatomically, as emphasized by modern pathology. Instead, it is expanded as a whole in a subtle form behind the physical body. In the Indian system of medical philosophy, the mind is considered as the astral nerves made third body, which identified as the ‘Manomaya-sharira’ (subconscious mind). The mind is composed of millions of astralnadis, through which Pranic-energies circulate freely into the astral anatomy of mind. Seven-chakras are found parallel to the spine, serving as the major (...) seven innovation centres in the body. These Chakras facilitate the connection of the mind with the seven dimensions of the inner world. From these dimensions the Pranic-energies including Sattva, Raja, Tama are exported to the mind and its Nadi-tantras, influencing both the outer and inner subconscious minds. Subsequently, these elements, viz., Sattva, Raja and Tama are thrown from the mind to the outer world through the seven sense organs, manifesting as either constructive or destructive activities. Thus the mind exists due to ‘Prana’, (energy of Omkara) which increases through deeper meditation, sound sleep, and breathing exercises (O2). The positional behaviour of the mind shifts according to the physical and mental temperament, namely Triguna and Tridosha, or Panchavikara. The negative energy (Tama-guna) of the fourth dimension enters the astral Nadis-system of the mind via the interspace of the solar plexus, which crushes the mind’s structures, and consequently, all the Chakras are corrupted and the Nadis are blocked, so it generates a break in the circulation of ‘Prana’ into the Nadis. As a result, many socio-economic challenges and psychosomatic disorders occur. (shrink)