In preparing for a lecture on the ethics of surgical complications, it became apparent that confusion exists about the definition of a ‘‘surgical complication.’’ Is it, as one medical website states, ‘‘any undesirable result of surgery?’’ . In the European Journal of Surgery, Veen et al.  provide a more elaborate definition: ‘‘every unwanted development in the illness of the patient or in the treatment of the patient’s illness that occurs in the clinic’’ . An esteemed historian of science suggests (...) yet another definition in a recent volume on surgical complications: ‘‘a complication, in any sphere of endeavour, is something out of the norm, and the product of extraneous and unexpected factors’’ . Such is the discrepancy in definitions that Rampersaud et al.  declared in 2006 that ‘‘presently, there is no clear or consistent definition of a complication in the surgical literature.’’ Much research in surgery aims to reduce the risk of surgical complications. However, until we have a stable and agreed definition of what counts as a surgical complication, we cannot reliably compare different studies to discover what best reduces the chance of surgical complications . Therefore, the topic is more than mere pedantry; defining surgical complications will help us with the broader question of how to improve surgical practice. A basic PubMed search returned nearly 800 articles with the phrases ‘‘surgical complications’’ or ‘‘surgical complication’’ in the title. But unlike the sources above. (shrink)
In the first book-length study of American philosophy at the turn of the century, Daniel J. Wilson traces the formation of philosophy as an academic discipline. Wilson shows how the rise of the natural and physical sciences at the end of the nineteenth century precipitated a "crisis of confidence" among philosophers as to the role of their discipline. Deftly tracing the ways in which philosophers sought to incorporate scientific values and methods into their outlook and to redefine (...) philosophy itself, Wilson moves between close analysis of philosophical texts and consideration of professional careers of illustrative philosophers, such as Charles Sanders Peirce, John Dewey, and Josiah Royce. The author situates the emergence of professional philosophy in the context of the professionalization of American higher education and articulates, in the case of philosophy, the structures and values of a professional discipline. One of the most important consequences of this transformation was a new emphasis on communal theories of truth. Peirce, Dewey, and Royce all developed sophisticated and important theories of community as they were engaged in reshaping and redefining the limits of philosophy. This book will be of great importance for those interested in the history of philosophy, the rise of professions, and American intellectual and educational history, and to all those seeking to understand the contemporary revival of pragmatic thought and theories of community. (shrink)
First kudos, followed by some friendly badinage, and then renewed appreciation and a look ahead. This commentary is meant to clarify main arguments, redress incorrect attributions, and strengthen an excellent contribution that draws further attention to the importance of evolutionary epidemiology. Keller & Miller (K&M), despite significant errors, have done well to further systematize the evolutionary epidemiology of psychopathology. (Published Online November 9 2006).
The paper offers contextual and integrating comments about sex, evolution and psychopathology as a point of departure toward a new and more scientific understanding of human neurosis. The evolved roots of neurotic behavior are firmly linked to theorems of evolution, which is emerging as the basic science of psychopathology. Evolutionary tenets serve to: 1) redefine key aspects of neuroses, 2) place neurotic behavior in a broad and integrated evolutionary context, and 3) pose basic questions for all psychopathology. Readers who wish (...) to expand, clarify or confirm elements of might well consult basic books in either field as a passing familiarity with psychiatry and biology is assumed. (shrink)
Chances are if someone were to ask you, right now, if you were happy, you'd say you were. Claiming that you're happy Â—that is, to an interviewer who is asking you to rate your "life satisfaction" on a scale from zero to tenÂ—appears to be nearly universal, as long as you're not living in a war zone, on the street, or in extreme emotional or physical pain. The Maasai of Kenya, soccer moms of Scarsdale, the Amish, the Inughuit of Greenland, (...) European businessmenÂ—all report that they are happy. When happiness researcher Ed Diener, the past president of the International Society of Quality of Life Studies, synthesized 916 surveys of over a million people in forty-five countries, he found that, on average, people placed themselves at seven on the zero-to-ten scale. (shrink)
Epidemiology is a science of disease which specifies rates (illness prevalences, incidences, distributions, etc.). Evolution is a science of life which specifies changes (gene frequencies, generations, forms, function, etc.). Evolutionary Epidemiology is a synthesis of these two sciences which combines the empirical power of classical methods in genetical epidemiology with the interpretive capacities of neo-darwinian evolutionary genetics. In particular, prevalence rates of genetical diseases are important data points when reformulated for the purpose of analysis in terms of their evolutionary frequencies. (...) Traits which exceedprevalences beyond the rates of mutation (in Hardy-Weinberg calculations) or evidence unusualrange of phenotypic reaction are of special interest. This is because traits which did not confer advantages in the environment of evolutionary adaptation cannot accede, through natural selection, to anything but low rates of genomic prevalence.Evolutionary epidemiology is, in all of medicine, of particular promise in ongoing efforts to better understand psychopathology. Many complexities of phenotypic adjustment arise when new developmental demands are placed on an old genome. The new and complex biosocial ecology of human mass society now evokes different phenotypes than those in the prehistorical ecology to which the genome is structurally and functionally better adapted. Some of these new phenotypes are darwinian failures. In this paper, the theoretical implications of evolutionary epidemiology are extended and some tentative points of clinical application (particularly to psychiatry) are offered. (shrink)
In this target article, Walker seeks to clarify the current state of knowledge regarding sleep and memory. Walker's review represents an impressively heuristic attempt to synthesize the relevant literature. In this commentary, we question the focus on procedural memory and the use of the term “consolidation,” and we consider the extent to which empirically testable predictions can be derived from Walker's model.
Henrich et al.'s nice cross-cultural experiments would benefit from models that specify the decision rules that humans use and the specific developmental pathways that allow cooperative norms to be internalized. Such models could help researchers to design further experiments to examine human social adaptations. We must also test whether the “same” experiments measure similar constructs in each culture, using additional methods and measures.
This paper recognizes the complexity of the debate on informed consent and discusses the importance of the ongoing process of consent for people affected by Huntington's disease (HD). Although written information may not be the most appropriate form of obtaining informed consent in qualitative research, it remains an important part of the ethical approval process for health research in the UK. This paper draws on a study in which the information sheet and consent form were specifically designed to help obtain (...) consent from people who may be impaired by the cognitive and physical effects of HD. The forms were developed by drawing on expert opinion and relevant literature and fall in line with recommendations from the Mental Capacity Act 2005 to encourage people to make their own decisions. The paper describes the feasibility of a method for obtaining consent as an ongoing process with patients affected by HD using information sheets and consent forms specifically designed for people with potential cognitive and/or physical impairments. In conclusion, this paper adds a pragmatic approach to the debate on informed consent by describing the development of a written information sheet and consent form being used in a current social research study. Particular emphasis is placed on the importance of written information being adapted according to the needs of potential participants. (shrink)
Introduction Future HIV vaccine efficacy trials with adolescents will need to ensure that participants comprehend study concepts in order to confer true informed assent. A Hepatitis B vaccine trial with adolescents offers valuable opportunity to test youth understanding of vaccine trial requirements in general. Methods Youth reviewed a simplified assent form with study investigators and then completed a comprehension questionnaire. Once enrolled, all youth were tested for HIV and confirmed to be HIV-negative. Results 123 youth completed the questionnaire (mean age=15 (...) years; 63% male; 70% Hispanic). Overall, only 69 (56%) youth answered all six questions correctly. Conclusions Youth enrolled in a Hepatitis B vaccine trial demonstrated variable comprehension of the study design and various methodological concepts, such as treatment group masking. (shrink)
The successful fund raising appeals of the March of Dimes employed images of cute crippled children standing on braces and forearm crutches, sitting in wheelchairs, or confined to iron lungs. Those who had to use these devices as a result of polio, however, were often stigmatized as cripples. American cultural antipathy to these assistive devices meant that polio survivors often had to overcome an emotional and psychological resistance to using them. Whatever their fears, polio survivors quickly discovered the functionality of (...) braces and wheelchairs. By confronting the cultural stigma associated with these devices and in some sense embracing these mechanical “friends,” polio survivors compensated for their paralyzed bodies and became active in the wider world of home, school and work. (shrink)
Tuberculosis was clearly one of the most predominant diseases of the early twentieth century. At this time, Americans involved in the eugenics movement grew increasingly interested in methods to prevent this disease's potential hereditary spread. To do so, as this essay examines, eugenicists' attempted to shift the accepted view that tuberculosis arose from infection and contagion to a view of its heritable nature. The methods that they employed to better understand the propagation and control of tuberculosis are also discussed. Finally, (...) the essay explores the interpretative analyses of data that the Eugenics Record Office used in an attempt to convince contemporaries of the hereditary transmission of tuberculosis. (shrink)
Though better recognized for its immediate endeavors in human embryo research, the Carnegie Department of Embryology also employed a breeding colony of rhesus macaques for the purposes of studying human reproduction. This essay follows the course of the first enterprise in maintaining a primate colony for laboratory research and the overlapping scientific, social, and political circumstances that tolerated and cultivated the colony's continued operation from 1925 until 1971. Despite a new-found priority for reproductive sciences in the United States, by the (...) early 1920s an unfertilized human ovum had not yet been seen and even the timing of ovulation remained unresolved. Progress would require an organized research approach that could extend beyond the limitations of working with scant and inherently restrictive human subjects or with common lab mammals like mice. In response, the Department of Embryology, under the Carnegie Institution of Washington (CIW), instituted a novel methodology using a particular primate species as a surrogate in studying normal human reproductive physiology. Over more than 40 years the monkey colony followed an unpremeditated trajectory that would contribute fundamentally to discoveries in human reproduction, early embryo development, reliable birth control methods, and to the establishment of the rhesus macaque as a common model organism. (shrink)
Daniel dennett has offered a set of necessary and sufficient conditions for something's being the proper object of our moral commitment, That is, For something's being a person. Strict application of these largely pragmatic conditions, However, Would result in a moral community with quite a surprising membership roster, Because of both who is on it and who isn't. The problem is that "your" being a person should amount to more than a function of "my" goals and cleverness.
Those most intimate with the works of H. Richard Niebuhr, who return to them time after time for theological and ethical sustenance, know that they exemplify a more interesting thinker than his brother, Reinhold. Of course, Reinhold was and remains the more public figure, read seriously in his time by politicians and theologians, celebrated by our current president, and enjoying renewed scholarly interest resulting in new editions of out-of-print works and a number of critical studies. Meanwhile, H. Richard continues to (...) exert decisive influence on American Protestant thought. Such diverse thinkers as Paul Ramsey, James Gustafson, Stanley Hauerwas, William Schweiker, Kathryn Tanner, Gordon Kaufman, Emilie Townes .. (shrink)
Many weak or readily saturable nuclear magnetic resonances can be detected only by the use of the dispersion mode in a nuclear induction system, and dispersion records of complicated or partially resolved spectra may be difficult to interpret. However, it is shown in this paper that, for systems obeying Bloch or Redfield equations, the Kronig-Kramers (K-K) relations may justifiably be used to transform a dispersion record taken in the presence of saturation, under slow modulation conditions, into the more readily interpretable (...) absorption record. The K-K relations are shown to apply to the derivatives of the absorption and dispersion line shapes, which are the quantities usually recorded, and to transform a modulation-broadened dispersion curve into the appropriate modulation-broadened absorption curve. The relations hold for derivatives of any order and may, therefore, be applied to records from an apparatus employing phase-sensitive detection at any harmonic of the modulation frequency. Results are presented for some analytical cases, and details of the computational method are given. Simple trapezoidal integration is found to yield high accuracy. The resonance of 9Be in beryl is used to confirm the applicability of the K-K relations in the presence of saturation. (shrink)
James K.A. Smith argues that the ontology of participation associated with Radical Orthodoxy is incompatible with a Christian affirmation of the intrinsic being and goodness of creatures. In response, he proposes a Leibnizian view in which things are endowed with the innate dynamism of ‘force’. Creatures have a certain depth of being, and are intrinsically good, just because they each have an inner virtuality that they bring into expression. Such force is said to be a metaphysical component of the (...) agent. In this paper it is asked whether John Milbank's ontology of participation can be defended by distinguishing between two senses of being a subject. Perhaps it is possible for a creature to bring into expression what is an infused ‘alien’ gift rather than a metaphysical component – to be expressive subject, but not ontic subject, for divine power. However, while this distinction promises to make sense of the reception of an indwelling ‘other’ in grace, knowledge and love, neither proper substance nor proper existence can be received in this way. A creature must be the ontic subject for its being, after all. Still, divine being might proceed from God as radical indwelling gift, as non-ontic ground for ontic being. (shrink)