Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year survival of less than 50% who had advanced gastrointestinal or lung cancer or amyotrophic lateral sclerosis were interviewed. Each patient’s medical record was reviewed at enrollment and at 3 months for evidence of the discussion of patient wishes concerning (...) ventilator support, artificial nutrition and hydration , resuscitation and hospice care. A Kaplan–Meier analysis was also performed and 2-year survival calculated.Results: 60 cancer and 32 ALS patients were enrolled. ALS patients were more likely than cancer patients to have evidence of discussion about their wishes for ventilator support , ANH , DNR and hospice care . At 6 months, 91% of ALS patients were alive compared with 62% of cancer patients; at 2 years, 63% of ALS patients were alive compared with 23% of cancer patients .Conclusions: Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making. (shrink)

Nolan, Ann MC In the past fifty years there has been a stream of commentary on the documents of Vatican II. Have we not had so much commentary, so much interpretation, that further commentary is unnecessary? Fifty years on, one might ponder how to interpret the sixteen documents for the church of our times, indeed to wonder whether they continue to have any relevance at all. Faced with this thought, we could turn to one scholar whose works span almost the (...) whole of this fifty-year period, yet whose thought in relation to the documents has not remained static: the renaissance historian John O'Malley SJ. (shrink)

The Oxford Handbook of Economic Inequality presents a new and definitive analysis of economic inequality in developed countries. Bringing together the world's top scholars, this comprehensive and authoritative volume contains an impressive array of original research on topics in economic inequality.

This paper advances a new paradigm in clinical ethics education that not only emphasizes development of individual cli but also focuses on the institutional context within which health care professionals work. This approach has been applied to the goal of improving the care provided to critically and terminally ill adults. The model has been adopted by about thirty hospitals and nursing homes; additional institutions will soon join the program, entitled Decisions Near the End of Life. Here, we describe the history (...) and rationale for this approach, its goals, pedagogical assumptions, and design. (shrink)

The uses of the most “social” of the social sciences—sociology and anthropology—in international agricultural research and development (R&D) have often been poorly understood. Drawing upon a decade of work by the Sociology Project of the Small Ruminant Collaborative Research Support Program, this article exemplifies how and where social scientists can and have contributed to major development initiatives, and it illustrates some of the larger lessons to be learned for human values concerns in international agriculture.

High-spin states have been studied in Pr-135(59), populated through the Cd-116(Na-23,4n) reaction at 115 MeV, using the Gammasphere gamma-ray spectrometer. The negative-parity yrast band has been significantly extended to spin similar to 45 (h) over bar and excitation energy 21.5 MeV, showing evidence for several rotational alignments. The positive-parity yrast band of Ce-135(58), populated through the p4n channel of this reaction, was also populated to spin similar to 38 (h) over bar and excitation energy 18 MeV. Cranking calculations indicate that (...) these nuclei are soft with respect to the triaxiality parameter gamma and that several competing nuclear shapes occur at high spin. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:How Can Satan Cast Out Satan? Violence and the Birth of the Sacred in Christopher Nolan’s The Dark Knight1Nicholas Bott (bio)Last Summer, Christopher Nolan’s final installment of the Batman trilogy hit theaters. The Dark Knight Rises promised to be the epic conclusion of a hero’s journey, a journey of a man’s transformation into a legend. Little was revealed in the official trailers, except that evil was rising in Gotham (...) City, and so too must The Batman. But in this essay I’d like to suggest that we didn’t need to view The Dark Knight Rises before seeing either evil, or Batman rise; by the end of the second film, evil and Batman have already risen—and together—in the sacred form of The Dark Knight.This essay first elucidates how Bruce Wayne’s strategy to inspire good among the citizens of Gotham, first articulated in Batman Begins, encompasses the hallmarks of Girard’s mimetic theory, including: mimesis, rivalry, scandal, and, finally, the outworking of the mimetic mechanism of the surrogate victim—the scapegoat. Next, this essay takes a closer look at the goodness, or lack thereof, of Batman’s climactic self-sacrifice with its attendant resolution. Finally, this essay demonstrates that interpretations [End Page 239] of Batman’s self-sacrifice in the movie have mirrored the disparate interpretations of Christ’s self-sacrifice, in relation to the climax and resolution of the Passion accounts.Mimetic Structure in Bruce Wayne’s StrategyBeginning With the EndThe final visual the audience is given in The Dark Knight is of Batman escaping on his Batpod. The screenplay’s description of this final scene reads: “The batpod streaks through Gotham’s underground streets, the Batman’s cape fluttering behind. A wraith...”; (TDK, 140).2 Commissioner Gordon’s voice is overheard saying, “... He’s not our hero. He’s a silent guardian, a watchful protector, a dark knight” (TDK, 140). Bruce Wayne has sacrificed himself for the sake of Gotham. But what kind of sacrifice has he made?3 In the words of Alfred, “The sacrifice he’s making [is]—to not be a hero. To be something more” (TDK, 73). And Batman has become something more. No longer a hero, the language Commissioner Gordon uses to describe Batman on behalf of Gotham is mythical and sacred. Girard understands this sacralization to be the completion of the surrogate victim mechanism, the satanic process whereby the sacrifice of an innocent scapegoat reconciles a community in the midst of crisis and violent upheaval.4 This sacred vision of Batman represents the final stage of the surrogate victim mechanism, providing evidence that the satanic has been at work. But if this is the case, something has gone terribly awry in Bruce Wayne’s strategy to inspire good. With this conclusion in mind, the flaws in Wayne’s strategy as it develops throughout Batman Begins and The Dark Knight become apparent, and correspond with each step in the mimetic process.Mimesis as PlotMimesis, or imitation, stands at the heart of The Dark Knight’s plot because it stands at the heart of Bruce Wayne’s strategy to inspire good. We encounter this strategy in Nolan’s first film, Batman Begins, as Wayne explains to Alfred his reasons for returning to Gotham City:Alfred:Are you coming back to Gotham for long, sir? [End Page 240]Bruce:As long as it takes. I want to show the people their city doesn’t belong to the criminals and the corrupt.Alfred:In the depression, your father nearly bankrupted Wayne Enterprises combating poverty. He believed his example could inspire the wealthy of Gotham to save their city.Bruce:Did it?Alfred:In a way. Their murder shocked the wealthy and the powerful into action.Bruce:People need dramatic examples to shake them out of apathy. I can’t do that as Bruce Wayne. As a man... I’m flesh and blood, I can be ignored, destroyed. But as a symbol... As a symbol, I can be incorruptible. I can be everlasting.Alfred:What symbol?Bruce:Something elemental, something terrifying.(Batman Begins)5By invoking the symbolic, Bruce Wayne believes Batman will be... (shrink)

Is God's foreknowledge compatible with human freedom? One of the most attractive attempts to reconcile the two is the Ockhamistic view, which subscribes not only to human freedom and divine omniscience, but retains our most fundamental intuitions concerning God and time: that the past is immutable, that God exists and acts in time, and that there is no backward causation. In order to achieve all that, Ockhamists distinguish ‘hard facts’ about the past which cannot possibly be altered from ‘soft facts’ (...) about the past which are alterable, and argue that God's prior beliefs about human actions are soft facts about the past. (shrink)

Retrospective issues: the discursive approach to genre and the misdirection film -- -- The truth is out there: manufacturing conspiratorial narrative coherence -- Constructing the (im)perfect cover: masculine masquerade and narrative agency -- -- Start making sense: narrative complexity, DVD, and online fandom -- The masters of misdirection: branding M. Night Shyamalan and Christopher Nolan -- Genre prestige: the misdirection film as blockbuster and middlebrow art -- Conclusion.

In lieu of an abstract, here is a brief excerpt of the content:212 HISTORY OF PHILOSOPHY with Gassendi and his studies on atomism. Yet Papi gives us very little which is not already generally known. There is but a mere hint of how atomistic philosophy was handled by the Aristotelians and to what extent they actually absorbed some of that tradition themselves. Nothing in detail is said of the process whereby atomistic and Platonic motives became coupled, not only by Bruno, (...) but by Ficino before and by Cudworth afterwards. On the credit side, however, the author does call attention to the commentary and paraphrase of Lucretius by Girolamo Frachetta of Rovigo (printed 1589), a work of some interest, which has been but little studied. Such rays of light are all too infrequent in this section and Papi is usually content to follow the conventional beaten path. For one to write a book on Bruno which breaks new ground is now difficult, for the field has been so thoroughly worked over. This one takes up a number of interesting themes found in Bruno's writings and sheds some light on them, but it seldom if ever says anything very different from the well-established tradition of Bruno scholarship in Italy which has produced so many mediocre books over the years. The specialist on Bruno and the sixteenth century will find little to detain him; the more casual reader could be ~rected to a number of superior treatments of various aspects of the Nolan's thought. In short, this study adds but little to what is already known. CHAm~V_SB. ScH~rrr University of Leeds Sir Walter Ralegh dcrivain, l'~uvre et les iddes. By Pierre Lefranc. (Qutbec: Les Presses de l'Universit~ Laval, 1968. Pp. 733. $19.50) This excellent study, the fruit of more than a dozen years of research, throws much light on Ralegh's thought and literary achievement. Lefranc has examined the manuscript sources, and unearthed quite a few new ones, and has patiently, carefully, and with much detective work, established what is no doubt the best available hypothesis of what is authentic among Ralegh's purported prose and poetic writings, and the date and circumstances of their composition. He has analyzed them in the context of Ralegh's carver, and has developed an exciting and rich interpretation of his political, philosophical and religious ideas. Ralegh's role in intellectual history derives mainly from his reputation as a Machiavellian, as an atheist, and from his mammoth, "pious," much-read providential History of the World (written during his years as a prisoner in the Tower of London). Lefranc deftly sorts and weighs the evidence for the various views and attitudes attributed to Ralegh in his own day and by interpreters ever since, and emerges from this examination with a fresh and striking picture of one of the liveliest bridge figures between the Elizabethan Renaissance and the modern world. The establishment of the canon leads to discarding as not by Ralegh many writings that have previously been used in interpreting the courtier's views. Three philosophical works which have played a role in twentieth-century interpretation, "A Treatise of the Soule," "The Prince, or Maxims of State" and "The Sceptick" are shown to be doubtful to a greater or lesser degree. "The Sceptick," which Strathmann (Sir Walter Ralegh,,4 Study in Elizabethan Skepticism, New York, 1951) had used to interpret Ralegh as a sceptical-Christian fideist, had been questioned earlier by Lefranc, Sprott, and myself. It is just a translation of portions of Book I of Sextus F_znpiricus' Outlinea of Pyrrhonism, and contains no connection with Ralegh, except that it was BOOK REVIEWS 213 published in his literary remains in 1651. Lefranc now, examining the evidence of the four manuscripts that have been discovered, concludes that it was a part of Ralegh's documentation when he was doing his research, but that 'Tattribution de 'The Sceptick' Ralegh lui-m~me ne repose sur rien" (p. 67). With the canon shorn of the dubious items, Lefranc proceeds to unfold a picture of Ralegh's intellectual world. As a practical statesman, buccaneer and explorer, Ralegh had a view of the role England should play vis-,'t-vis Spain and the New World that contained... (shrink)

Written by leading experts in the field, Stellar Spectral Classification is the only book to comprehensively discuss both the foundations and most up-to-date techniques of MK and other spectral classification systems. Definitive and encyclopedic, the book introduces the astrophysics of spectroscopy, reviews the entire field of stellar astronomy, and shows how the well-tested methods of spectral classification are a powerful discovery tool for graduate students and researchers working in astronomy and astrophysics. The book begins with a historical survey, followed by (...) chapters discussing the entire range of stellar phenomena, from brown dwarfs to supernovae. The authors account for advances in the field, including the addition of the L and T dwarf classes; the revision of the carbon star, Wolf-Rayet, and white dwarf classification schemes; and the application of neural nets to spectral classification. Copious figures illustrate the morphology of stellar spectra, and the book incorporates recent discoveries from earth-based and satellite data. Many examples of spectra are given in the red, ultraviolet, and infrared regions, as well as in the traditional blue-violet optical region, all of which are useful for researchers identifying stellar and galactic spectra. This essential reference includes a glossary, handy appendixes and tables, an index, and a Web-based resource of spectra. In addition to the authors, the contributors are Adam J. Burgasser, Margaret M. Hanson, J. Davy Kirkpatrick, and Nolan R. Walborn. (shrink)

In “Imposing Risks,” Judith Thomson gives a case in which, by turning on her stove, she accidentally causes her neighbor’s death. She claims that both the following are true: (1) she ought not to have caused her neighbor’s death; (2) it was permissible for her to turn her stove on. In this paper it is argued that it cannot be that both (1) and (2) are true, that (2) is true, and that therefore (1) is false. How this is so (...) is explained, and the implications of this position regarding the relation between rights and duties is explored. (shrink)

Plato's Timaeus contains a powerful and influential myth, of the construction of the universe by a divine craftsman. A god imposes reason on necessity, to bring order from a primeval 'receptacle' of disordered matter. There results the 'child' that is the cosmos - a copy of an eternally-existing perfect model. Here eight new essays from a distinguished international cast, explore aspects of this challenging work: the principles of the mythical narrative, how the world soul and human body are formed, implications (...) for illness - mental and physical, the importance of music and harmonious proportion. Later developments are also treated: Aristotle's theory of generation, the commentary of Proclus and elements of modern evolutionary theory. (shrink)

This is the first of two companion articles drawn from a larger project, provisionally entitled Undisciplining Moral Epistemology. The overall goal is to understand how moral claims may be rationally justified in a world characterized by cultural diversity and social inequality. To show why a new approach to moral justification is needed, it is argued that several currently influential philosophical accounts of moral justification lend themselves to rationalizing the moral claims of those with more social power. The present article explains (...) how discourse ethics is flawed just in this way. The article begins by identifying several conditions of adequacy for assessing reasoning practices designed to achieve moral justification and shows that, when used in contexts of cultural diversity and social inequality, discourse ethics fails these conditions. It goes on to argue that the failure of discourse ethics is rooted in its reliance on a broader conception of moral epistemology that is invidiously idealized. It concludes by pointing to the need to rethink both the mission and the method of moral epistemology. (shrink)

According to the standard analysis of degree questions, the logical form of a degree question contains a variable that ranges over individual degrees and is bound by the degree question operator how. In contrast with this, we claim that the variable bound by the degree question operator how does not range over individual degrees but over intervals of degrees, by analogy with Schwarzschild and Wilkinson's proposal regarding the semantics of comparative clauses. Not only does the interval-based semantics predict the existence (...) of certain readings that are not predicted under the standard view, it is also able, together with other natural assumptions, to account for the sensitivity of degree questions to negative islands, as well as for the fact, uncovered by Fox and Hackl, that negative islands can be obviated by some properly placed modals. Like Fox and Hackl, we characterize negative island effects as arising from the fact that the relevant question, due to its meaning alone, can never have a maximally informative answer. Contrary to Fox and Hackl, however, we do not need to assume that scales are universally dense, nor that the notion of maximal informativity responsible for negative islands is blind to contextual parameters. (shrink)