IntroductionDeep brain stimulation (DBS) is increasingly used to treat the symptoms of various neurologic and psychiatric conditions. People can undergo the procedure during reproductive years but the safety of DBS in pregnancy remains relatively unknown given the paucity of published cases. We thus conducted a review of the literature to determine the state of current knowledge about DBS in pregnancy and to determine how eligibility criteria are approached in clinical trials with respect to pregnancy and the potential for pregnancy.MethodsA literature (...) review was conducted in EMBASE to identify articles involving DBS and pregnancy. Two reviewers independently analyzed the articles to confirm inclusion. Data extracted for analysis included conditions treated, complications at all stages of pregnancy, neonatal/pediatric outcomes, and DBS target. A second search was then conducted using www.clinicaltrials.gov. The same two reviewers then assessed whether each trial excluded pregnant individuals, lactating individuals, or persons of childbearing age planning to conceive. Also assessed was whether contraception had to be deemed adequate prior to enrollment.ResultsThe literature search returned 681 articles. Following independent analysis and agreement of two reviewers, 8 pregnancy related DBS articles were included for analysis. These articles described 27 subjects, 29 pregnancies (2 with subsequent pregnancies), and 31 infants (2 twin pregnancies). There was 1 preterm birth at 35 weeks, and 3 patients who experienced discomfort from the DBS battery (i.e., impulse generator) placement site. All 27 patients had a DBS device implanted before they became pregnant, which remained in use throughout their pregnancy. There was exclusion of pregnant individuals from 68% of 135 interventional trials involving DBS. Approximately 44% of these trials excluded persons of childbearing age not on “adequate contraception” or wishing to conceive in the coming years. Finally, 22% excluded breastfeeding persons.ConclusionThe data from 29 pregnancies receiving DBS treatment during pregnancy was not associated with unexpected pregnancy or post-partum complication patterns. Many clinical trials have excluded pregnant individuals. Documentation of outcomes in larger numbers of pregnancies will help clarify the safety profile and will help guide study designs that will safely include pregnant patients. (shrink)

The work reported in this monograph was begun in the winter of 1967 in a graduate seminar at Berkeley. Many of the basic data were gathered by members of the seminar and the theoretical framework presented here was initially developed in the context of the seminar discussions. Much has been discovered since1969, the date of original publication, regarding the psychophysical and neurophysical determinants of universal, cross-linguistic constraints on the shape of basic color lexicons, and something, albeit less, can now also (...) be said with some confidence regarding the constraining effects of these language-independent processes of color perception and conceptualization on the direction of evolution of basic color term lexicons. (shrink)

The doctrine of double effect, together with other moral principles that appeal to the intentions of moral agents, has come under attack from many directions in recent years, as have a variety of rationales that have been given in favor of it. In this paper, our aim is to develop, defend, and provide a new theoretical rationale for a secular version of the doctrine. Following Quinn (1989), we distinguish between Harmful Direct Agency and Harmful Indirect Agency. We propose the following (...) version of the doctrine: that in cases in which harm must come to some in order to achieve a good (and is the least costly of possible harms necessary), the agent foresees the harm, and all other things are equal, a stronger case is needed to justify Harmful Direct Agency than to justify Harmful Indirect Agency. We distinguish between two Kantian rationales that might be given for the doctrine, a “dependent right” rationale, defended by Quinn, and an “independent right” rationale, which we defend. We argue that the doctrine and the “independent right” rationale for it are not vulnerable to counterexamples or counterproposals, and conclude by drawing implications for the larger debate over whether agents' intentions are in any way relevant to permissibility and obligation. (shrink)

Sandplay is a growing field of interest for Jungian and other psychotherapists. _Sandplay - Silent Workshop of the Psyche_ by Kay Bradway and Barbara McCoard, provides an introduction to sandplay as well as extensive new material for those already using this form of therapy. Based on the authors' wide-ranging clinical work, it includes: in-depth sandplay case histories material from a wide range of adults and children over 90 illustrations in black and white and colour detailed notes on interpretation of sand (...) trays an examination of symbols and concepts used in sandplay. Clearly written and soundly based in theory, this book provides historical background for understanding sandplay as well as helpful discussion of how it works in a clinical context. Kay Bradway and Barbara McCoard bring their indispensable personal experience to the subject to stress the healing potential of sandplay. They also reflect on the nature of a therapy where the psyche works largely in silence. (shrink)

This paper starts by investigating Ackermann's interpretation of finite set theory in the natural numbers. We give a formal version of this interpretation from Peano arithmetic (PA) to Zermelo-Fraenkel set theory with the infinity axiom negated (ZF−inf) and provide an inverse interpretation going the other way. In particular, we emphasize the precise axiomatization of our set theory that is required and point out the necessity of the axiom of transitive containment or (equivalently) the axiom scheme of ∈-induction. This clarifies the (...) nature of the equivalence of PA and ZF−inf and corrects some errors in the literature. We also survey the restrictions of the Ackermann interpretation and its inverse to subsystems of PA and ZF−inf, where full induction, replacement, or separation is not assumed. The paper concludes with a discussion on the problems one faces when the totality of exponentiation fails, or when the existence of unordered pairs or power sets is not guaranteed. (shrink)

The author means to show how focusing on the sense of hearing can sharpen our understanding of Kierkegaard’s argument – in the first portion of Either/Or – that Don Giovanni ranks supreme among works of art. After explaining how he takes Kierkegaard’s case to rest on the issue of the ear being the “most spiritually qualified sense,” he shows how attending to the importance of hearing within the original Don Juan myth, as well as within Mozart and Da Ponte’s treatment (...) of it, can help us understand the myth’s dependence on and repudiation of Christianity: unlike sight, hearing places us in close spiritual intimacy with its source, even as it also opens up specific possibilities of theatricality and deceit. He concludes by arguing why hearing should be regarded as the paradigmatic sense in relation to which Kierkegaard understands the task of philosophy itself, in contrast to earlier philosophical emphases on visible intelligibility. (shrink)

Belief in propositions has had a long and distinguished history in analytic philosophy. Three of the founding fathers of analytic philosophy, Gottlob Frege, Bertrand Russell, and G. E. Moore, believed in propositions. Many philosophers since then have shared this belief; and the belief is widely, though certainly not universally, accepted among philosophers today. Among contemporary philosophers who believe in propositions, many, and perhaps even most, take them to be structured entities with individuals, properties, and relations as constituents. For example, the (...) proposition that Glenn loves Tracy has Glenn, the loving relation, and Tracy as constituents. What is it, then, that binds these constituents together and imposes structure on them? And if the proposition that Glenn loves Tracy is distinct from the proposition that Tracy loves Glenn yet both have the same constituents, what is about the way these constituents are structured or bound together that makes them two different propositions? In The Nature and Structure of Content, Jeffrey C. King formulates a detailed account of the metaphysical nature of propositions, and provides fresh answers to the above questions. In addition to explaining what it is that binds together the constituents of structured propositions and imposes structure on them, King deals with some of the standard objections to accounts of propositions: he shows that there is no mystery about what propositions are; that given certain minimal assumptions, it follows that they exist; and that on his approach, we can see how and why propositions manage to have truth conditions and represent the world as being a certain way. The Nature and Structure of Content also contains a detailed account of the nature of tense and modality, and provides a solution to the paradox of analysis. Scholars and students working in the philosophy of mind and language will find this book rewarding reading. (shrink)

The recent “turn to matter” evident in material feminist theories of the more‐than‐human world offers distinct posthuman understandings of the world as continuously relationally entangled, emergent or materializing. In this paper, I consider how these premises both trouble conventional understandings of matter and/or materials, but likewise potentially revise and revitalize understandings of the political for health and inequalities, and for nursing. This is both timely and much needed given contemporary contexts of austerity‐driven neoliberalism in health care and the unprecedented growth (...) in disparities of wealth and well‐being. I wish to explore whether material feminisms allow us to retheorize connections between abstract theory and material concerns like health and inequalities, differently. This is not theory in opposition to practice or activism, but theory conceptualized as sets of entangled emergent practices, but also what constitutes the political, as more fully relational to and in praxis with health‐related activism. I will argue these theories further justify how practitioners can visibly care for and care more about social and health inequalities. Drawing mainly on the work of material feminist, Karen Barad, and her bringing together of queer and feminist theory, as well as feminist new materialisms and understandings of posthumanism, I discuss how this turn to matter together with meaning might transform understandings of health and inequalities. (shrink)

The challenges posed by postmodern and poststructural theories profoundly disrupt the certainties of feminist and nursing research, yet at the same time offer possibilities for developing new epistemologies. While there are an increasing number of accounts discussing the theoretical implications of these ideas for nursing research, I wish to discuss the practical and the methodological implications of using postmodern feminist theories within empirical research. In particular, I identify the challenges I encountered through an examination of specific aspects of the research (...) process and through examples drawn from empirical research. I conclude that using postmodern feminist theories requires a continuous engagement with, and interrogation of, the modern epistemological and ontological assumptions of qualitative, feminist nursing research and, in so doing, presents the possibility for nurse scholars to begin to develop a ‘passionately interested’ methodological approach to nursing inquiry. (shrink)

Each book in the series includes six 40-minute studies designed to draw you into God’s Word through basic inductive Bible study.

Despite claims of ‘evidence based policy’, the place of empirical evidence in family law reform is ambiguous. There is ongoing socio-legal analysis of the differential value and uses of quantitative data and anecdote in detailing women’s experiences and advocating for change. In this paper, we engage with these issues through a focus on how data were constructed in a key government report, Every Picture Tells a Story, which was used to officially define the problem and outline recommendations in the controversial (...) 2006-08 reform of the Australian Child Support Scheme. Our discussion focuses on two questions: what legitimacy is accorded to different kinds of evidence in family law reform processes?; and, how is this legitimacy gendered? We applied feminist critical discourse analysis to the type, source and claims of the data included in the child support chapter of the report. Our findings indicate that both quantitative data and anecdote were used to privilege fathers’ financial interests and autonomy; in contrast, women’s voices and interests were marginalised. Thus, we argue the legitimacy of data is ascribed through its relationship to the gendered definition of the ‘problems’ of child support, rather than the type of data per se. (shrink)

In Chapter 4 of his essay Utilitarianism, “Of what sort of Proof the Principle of Utility is susceptible,” J. S. Mill undertakes to prove, in some sense of that term, the principle of utility. It has very commonly been argued that in the course of this “proof” Mill commits two very obvious fallacies. The first is the naturalistic fallacy which he is held to commit when he argues that since “the only proof capable of being given that an object is (...) visible, is that people actually see it. The only proof that a sound is audible is that people hear it: and so of the other sources of our experience. In like manner … the sole evidence it is possible to produce that anything is desirable, is that people do actually desire it.”1 Here Mill appears to hold that “X is desirable ”—a value judgment—follows deductively from “People desire x”—a factual statement. And the second is the fallacy of composition which seems to be involved in Mill'zs argument that since “each person's happiness is a good to that person … the general happiness, therefore, a good to the aggregate of all persons.”2. (shrink)

What, exactly, makes humans human? A close look at nonhuman animal domestication practices reveals how people came to view their own uniqueness in western cultural process. The study of domestication across time shows the multiple human impulses underlying acts of animal enclosure and domestication. Animals can be beloved companions or eaten for a meal. These impulses involve contradictory moralities-a rich subject for inquiries into the dynamics of power and possession, at scales ranging from local to global.

This undergraduate textbook covers the key material for a typical first course in logic, in particular presenting a full mathematical account of the most important result in logic, the Completeness Theorem for first-order logic. Looking at a series of interesting systems, increasing in complexity, then proving and discussing the Completeness Theorem for each, the author ensures that the number of new concepts to be absorbed at each stage is manageable, whilst providing lively mathematical applications throughout. Unfamiliar terminology is kept to (...) a minimum, no background in formal set-theory is required, and the book contains proofs of all the required set theoretical results. The reader is taken on a journey starting with König's Lemma, and progressing via order relations, Zorn's Lemma, Boolean algebras, and propositional logic, to completeness and compactness of first-order logic. As applications of the work on first-order logic, two final chapters provide introductions to model theory and nonstandard analysis. (shrink)

Recently, there has been a debate focusing on the question of whether groups can literally have beliefs. For the purposes of epistemology, however, the key question is whether groups can have knowledge. More specifi cally, the question is whether “group views” can have the key epistemic features of belief, viz., aiming at truth and being epistemically rational. I argue that, while groups may not have beliefs in the full sense of the word, group views can have these key epistemic features (...) of belief. However, I argue that on Margaret Gilbert's infl uential “plural subject” account of group belief, group views are unlikely to be epistemically rational. (shrink)

In this fascinating study, the author analyzes the conceptual roots of molecular biology and the social matrix in which it was developed.

Objectives—To assess perceptions of the informed consent process in patients undergoing urgent abdominal surgery.Design—A prospective observational study was carried out using structured questionnaire-based interviews. Patients who had undergone urgent abdominal surgery were interviewed in the postoperative period to ascertain their perceptions of the informed consent process. Replies were compared to responses obtained from a control group undergoing elective surgery, to identify factors common to the surgical process and those specific to urgent surgery. Patients' perceptions of received information were also compared (...) to the information perceived to have been provided by the consent obtainers. Setting—Gastrointestinal surgical service of a university teaching hospital.Patients—Seventy-four consecutive patients undergoing urgent abdominal surgery and 80 control patients undergoing elective surgery. Main measurements—Principal outcome measures were patients' perceptions of factors interfering with the ability to give informed consent, assessment of the quality of informed consent and the degree of discussion of the expected outcomes. Results—Forty-nine of the seventy-four (66%) patients undergoing urgent surgery perceived that pain did not affect their ability to give informed consent. Twenty-seven reported an adverse effect of analgesia on the ability to give informed consent. Only 22% of patients undergoing urgent surgery perceived that there had been any discussion of potential side effects and complications of surgery. Conclusion–The majority of patients in this series with acute intra-abdominal surgical conditions perceive that they retain the ability to give informed consent for surgery. There is a need for improved discussion of therapeutic options and likely outcomes. (shrink)

In this paper I take up a critical position in regard to the theme of debility around which this collection is framed. I argue that theorisations of ‘debility’ do little to progress theory and policy in regard to disability and share many of the problems inherent to the social model. I also suggest that the theorisation of debility is rooted in and reinforces ablebodied privilege. I begin with a critical analysis of the social model of disability and explore the dualisms (...) by which it either negates the body altogether or can only conceive the disabled body in negative terms. I then go on to explore how Puar's work on debility continues this negation of the disabled body. From this position I use the work of Inahara to excavate the foundations of ablebodied privilege. In Inahara's work gender is the analytic starting point, but for me white privilege is a much more effective mechanism through which to understand the impact and reproduction of ablebodied privilege— what McRuer refers to as ‘compulsory ablebodiedness'—which I argue underpins Puar's work. I conclude with some reflections upon how a critical analysis of ablebodied privilege might function and I reiterate its importance for a critical theory that goes beyond the mere repetition of binary structures of ablebodiedness and disability. (shrink)

RATIONALE: The concept of evidence-based medicine is important in providing efficient health care. The process uses research findings as the basis for clinical decision making. Evidence-based practice helps optimize current health care and enables the practitioners to be suitably accountable for the interventions they provide. Little work has been undertaken to examine how allied health professionals change their clinical practice in light of the latest evidence. The use of opinion leaders to disseminate new evidence around the management of low back (...) pain into practice has been proposed. AIMS: The aim of this study was to investigate if physiotherapists' clinical management of patients with low back pain would change following an evidence-based education package, which utilized local opinion leaders and delivered the best evidence. METHOD: Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster randomized by location of work, to two groups. The intervention group received an evidence-based programme on the management of low back pain, including advice regarding increasing activity levels and return to normal activity and challenging patients' fears and beliefs about their pain. The control group received a standard in-service training package on the management of common knee pathologies. The physiotherapists' clinical management of patients with low back pain was measured prior to training and 6 months post training. Outcome measures were based on physiotherapists completing 'discharge summary' questionnaires, which included information relating to the use and importance of therapies for treating their low back pain patients. RESULTS: There were few significant differences in treatment options between the intervention and control groups post training. Whilst there was some indication that physiotherapists were already utilizing aspects of psychosocial management for patients with low back pain, there was little change in what physiotherapists perceived to be important to patient recovery and actual clinical practice following the intervention. CONCLUSIONS: Psychosocial factors have been identified as an important factor in the recovery of patients with low back pain. This project incorporated the latest evidence on the management of low back pain and utilized the theory of opinion leaders to disseminate this evidence into clinical practice. Whilst there were some limitations in the overall size of the study, the results help to give an insight into the challenges faced by the health care system and researchers alike to ensure quality evidence is actually utilized by practitioners for the benefits of patient care. (shrink)

Obesity is now commonly recognised to be a significant public health issue worldwide with its increasing prevalence frequently described as a global epidemic. In the United Kingdom, primary care nurses are responsible for weight management through the provision of healthy eating advice and support with lifestyle change. However, nurses themselves are not immune to the persistent and pervasive global levels of weight gain. Drawing on a Gadamerian informed phenomenological study of female primary care nurses in England, this paper considers the (...) complex gendered understandings and experiences of being overweight, and of food and eating. The nurses’ emotional and injurious experiences of being large is found to be capable of producing embodied caring practices, involving a fusion of horizons with patients over how it feels to inhabit a large body. Yet, even though subjected to similar derogatory stereotypes as patients, they simultaneously reinforce the dominant and damaging individualising psychopathology inherent to anti‐obesity discourses. This suggests an urgent need to expose and challenge harmful discourses surrounding women’s body size and weight in order to avoid nursing practices that unthinkingly reproduce culturally dominant and gendered understandings of weight, body size, food and eating. (shrink)