BackgroundBeta thalassemia major is a severe inherited form of hemolytic anemia that results from ineffective erythropoiesis. Allogenic hematopoietic stem cell transplantation (HSCT) remains the only potentially curative therapy. Unfortunately, the subgroup of adult thalassemia patients with hepatomegaly, portal fibrosis and a history of irregular iron chelation have an elevated risk for transplantation-related mortality that is currently estimated to be about 29 percent.DiscussionThalassemia patients may be faced with a difficult choice: they can either continue conventional transfusion and iron chelation therapy or (...) accept the high mortality risk of HSCT in the hope of obtaining complete recovery.Throughout the decision making process, every effort should be made to sustain and enhance autonomous choice. The concept of conscious consent becomes particularly important. The patient must be made fully aware of the favourable and adverse outcomes of HSCT. Although it is the physician's duty to illustrate the possibility of completely restoring health, considerable emphasis should be put on the adverse effects of the procedure. The physician also needs to decide whether the patient is eligible for HSCT according to the "rule of descending order". The patient must be given full details on self-care and fundamental lifestyle changes and be fully aware that he/she will be partly responsible for the outcome.SummaryOnly if all the aforesaid conditions are satisfied can it be considered reasonable to propose unrelated HSCT as a potential cure for high risk thalassemia patients. (shrink)

The informed consent process is the legal embodiment of the fundamental right of the individual to make decisions affecting his or her health., and the patient’s permission is a crucial form of respect of freedom and dignity, it becomes extremely important to enhance the patient’s understanding and recall of the information given by the physician. This statement acquires additional weight when the medical treatment proposed can potentially be detrimental or even fatal. This is the case of thalassemia patients pertaining to (...) class 3 of the Pesaro classification where Allogenic hematopoietic stem cell transplantation remains the only potentially curative treatment. Unfortunately, this kind of intervention is burdened by an elevated transplantation-related mortality risk , equal to 30% according to published reports. In thalassemia, the role of the patient in the informed consent process leading up to HSCT has not been fully investigated. This study investigated the hypothesis that information provided by physicians in the medical scenario of HSCT is not fully understood by patients and that misunderstanding and communication biases may affect the clinical decision-making process. (shrink)

This article examines the Nasa peoples’ resistance praxis known as “Desalambrar”. Through the analysis of Nasayuwe language, textile art, and ritual dance, the article looks at the idea of ontological continuum at the heart of this praxis, exploring how this concept provides the Nasa with a philosophical standpoint for what they have called “the liberation of Mother Earth”. The article then examines how this idea challenges the Eurocentric divide between Man and Nature/Woman and what it can possibly mean (...) for women, gender, feminism, and the environment. (shrink)

Alternate View Column AV-70 Keywords: Casimir effect negative energy quantum nonlocality tachyons extra dimensions Published in the February-1995 issue of Analog Science Fiction & Fact Magazine ; This column was written and submitted 7/13/94 and is copyrighted ©1994 by John G. Cramer. All rights reserved. No part may be reproduced in any form without the explicit permission of the author.

Treatise on Jaina religious life and ethics with Bālāvabodha, auto-commentary, Gujarati translation and interpretation.

On 16 September 1987, the main chlorofluorocarbon-producing and -consuming countries signed the Montreal Protocol, despite the absence of a scientific consensus on the mechanisms of ozone depletion over Antarctica. We argue in this article that the rapid diffusion from late 1985 onwards of satellite images showing the Antarctic ozone hole played a significant role in this diplomatic outcome. Whereas negotiators claimed that they chose to deliberately ignore the Antarctic ozone hole during the negotiations since no theory was able yet to (...) explain it, the images still loomed large for many of the actors involved. In Western countries, the National Aeronautics and Space Administration's (NASA) satellite visualizations were diffused through the general press and television stations. Other popular and mass media outlets followed quickly. In describing the circulation and appropriation processes of these images within and beyond the scientific and negotiation arenas, we show that the ozone hole images did play an important part in ozone diplomacy in the two years leading up to the signing of the Montreal Protocol, both in the expert and diplomatic arenas and as public diplomacy tools. We conclude by encouraging scholars to engage with new visual archives and to contribute to the development of the vibrant new field of research on visual diplomacy. (shrink)

Diane Vaughan’s popular book, The Challenger Launch Decision: Risky Technology, Culture and Deviance at NASA, advances a thesis that I termed the “cog in the machine manifesto”: since the Challenger disaster was the result of the determined, mechanistic movement of the parts of the organizational system; once the mechanism was set in motion, the disaster was inevitable, and could not have been prevented. In order to expose the fallacies of the cog in the machine manifesto, I consider an alternative (...) umbrella thesis and four sub-theses. The umbrella thesis proposes that the causes of the Challenger disaster were the lack of an overall 'safety first' ethos, and irresponsible choice and poor decision-making practices in the lead up to and including the final risky decision. The four sub-theses are as follows: (1) the widespread justification that one always faces inherent risk when one operates in the realm of risky technology (a thesis foreshadowed by Vaughan’s book) is an illicit and misleading justification when one considers that there is no binding necessity to employ the risky technology; (2) the real culprit is not so much "risky technology," which locates the risk in the technology, but "risky assessment," which locates the risk in the decision to employ technology while not basing that decision on known safe designs and continued use on performance data; (3) the decision to choose an Orbiter without a passenger and crew abort system is proof in and of itself of a lack of a "safety first" management priority; (4) an analysis of the fateful eve of the Challenger launch teleconference launch decision makes it impossible to construe it as a banal, routine and inevitable organizational mistake. A careful examination of the “cog in the machine manifesto” and similar frameworks that purport to explain moral disasters will reveal that the language of risky technology, organizational complexity, and inevitable accidents is deeply pernicious and should thus be avoided at all costs. (shrink)

Supercommentary on Siddhāntabindu of Madhusūdana Sarasvatī, exegesis of Daśaślokī, treatise of the Advaita school in Indic philosophy, by Śaṅkarācārya and Advaitabrahmasiddhi by Madhusūdana Sarasvatī.

Las comunidades indígenas en Colombia atraviesan un fuerte proceso de eliminación, que no es reciente, se inició en los tiempos de la colonia con la llegada de los españoles en el siglo XVI. Actualmente, estos pueblos siguen siendo objeto de saqueos y penetración a sus territorios para aprovecharse de sus riquezas naturales y de sus conocimientos milenarios. Así la estrategia de penetración ha seguido la diferencia colonial; perspectiva binaria que clasifica a los agrupamientos humanos en superiores- inferiores, desarrollados-subdesarrollados, cultos incultos (...) y en útiles e inútiles, desde esta máquina de clasificación se han subalternizado formas otras de pensar, de sentir, de imaginar, de relacionarse con la naturaleza, de sociabilidad, de ocio y de re-creación como humanos, lo que nos ha alejado y nos sigue alejando de una convivencia con fundamento en la interculturalidad y en la prevalencia de lo diverso como condición existencial. (shrink)

On spiritual aspects of the Bhagavadgītā and Krishna, Hindu deity.