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)

There is currently a debate over whether cognitive architecture is classical or connectionist in nature. One finds the following three comparisons between classical architecture and connectionist architecture made in the pro-connectionist literature in this debate: (1) connectionist architecture is neurally plausible and classical architecture is not; (2) connectionist architecture is far better suited to model pattern recognition capacities than is classical architecture; and (3) connectionist architecture is far better suited to model the acquisition of pattern recognition capacities by learning than (...) is classical architecture. If true, (1)-(3) would yield a compelling case against the view that cognitive architecture is classical, and would offer some reason to think that cognitive architecture may be connectionist. We first present the case for (1)-(3) in the very words of connectionist enthusiasts. We then argue that the currently available evidence fails to support any of (1)-(3). (shrink)

Taking the position that scientific hypotheses explain the world and do not merely classify data, the author describes the decline of the Newtonian world picture and the development of a new, "ether-theoretical" view. The nineteenth century founders of electromagnetism—Faraday, Maxwell, Hertz, Lorentz—all tendered theories of a medium, usually called the "ether," which filled the space between any two noncontiguous bodies and transported electromagnetic actions from one to the other. After Einstein profoundly reinterpreted the concept of medium, it came to be (...) called the "field." In giving this history, William Berkson explains what problems each scientist faced and how the process of solving them led to new discoveries. He also draws out the philosophical consequences of the history, especially for the positions of Popper, Meyerson, Agassi and Kuhn. (shrink)

This volume "contains eight articles dealing with the intellectual and institutional developments in physics from the mid-1840’s to the mid-1920’s. The primary focus is on the quantum and relativity theories and Einstein’s contributions to these theories. The secondary focus is on thermodynamics and its kinetic theory basis in the nineteenth century." Slightly more than one third of the book is devoted to various aspects of Einstein’s work: M. J. Klein analyzes his difference with Bohr in 1923-1925; R. McCormmach traces the (...) problem area which he extracted from Lorentz’ electron theory in about the first decade of this century; and S. Goldberg considers the British response to his special theory of relativity in 1905-1911. In the editor’s foreword, McCormmach illustrates from the current investigation of Einstein a general thesis about "the limitations of contemporary writing in the history of science." Thus, this anthology may well become a standard secondary source for Einstein scholarship. A fourth of the book has to do with thermodynamics: Y. Elkana follows Helmholtz’ formulation of its first law ; E. E. Daub looks at the evolution of concepts essential to its second law ; and E. W. Garber delineates Clausius’ contribution to its underpinnings. Just two articles are unrelated to these two foci: P. Forman, in the longest paper in the volume, considers Lande’s search for a theory of the anomalous Zooman effect in 1919-1921; and R. Sviedrys, in an exchange with A. Thackray, examines the rise of physical science at Cambridge University during the Victorian era. (shrink)

This massive, expensive tome comprises all the proceedings of the 1970 biennial meeting of the Philosophy of Science Association. Beyond the selection of the papers to be presented at the meeting, there has been no winnowing of the good from the bad. Further, there is no indexing. Thus, the technical philosopher of science, to whose interest the contributed papers in this anthology will appeal, faces the prospect of doing these jobs himself. The symposium papers, which account for a relatively small (...) fraction of this volume, will interest readers of this journal the most. These papers investigate three topics: theoretical entities in statistical explanation; capacities and natures; history of science and its rational reconstruction. (shrink)

The primary purpose of this book "is to analyze and clarify certain fundamental concepts, principles, and procedures in both classical and relativistic mechanics." At the same time, it attempts to provide a grounding in the theory for the philosopher of science who must deal with the sometimes technical literature on the philosophical implications of relativistic mechanics. "This book, then, is an attempt at fundamental philosophic clarification embedded in the format of an introductory work." Its first six chapters deal with the (...) methodological foundations of classical mechanics and electrodynamics, as conceived prior to Einstein. Thus, the next six chapters introduce special relativity in such a way that it is connected with the tradition from which it arose. Although the book is not primarily a historical treatment of the theory, this added perspective is welcome because almost invariably philosophers of relativity portray the theory as if it arose without the intermediary of electrodynamics. (shrink)

A generally clear and well-written introduction to Thomistic natural theology which, like most such "textbook" treatments, suffers from too much commentary and too little Aquinas. The nature and existence of God are dealt with in some detail, and two interesting sections on "Invalid Reasons for Holding the Existence of God" and "Some Controverted Arguments" are included.--B. P. H.

Immediately after the publication of Darwin's book on the origin of species, Engels, having familiarized himself with it, wrote to Marx on December 12, 1859: "All in all, Darwin, whom I am reading right now, is superb. Teleology had hitherto not yet been destroyed in one of its aspects, and now this has been done. Moreover, hitherto there has never been so sweeping an attempt to prove historical development in nature, especially with such success." Soon Marx enlarged upon the evaluation (...) of Darwinism. In his letter of December 19, 1860, he commented that this theory "provides a foundation in natural history for our views." It is therefore no accident that Engels, in developing the principles of dialectical materialism and problems of the dialectics of nature, interested himself so deeply and comprehensively in the theory of evolution. (shrink)

Placebo-controlled trials are controversial when individuals might be denied existing beneficial medical interventions. In the case of malaria, most patients die in rural villages without healthcare facilities. An artesunate suppository that can be given by minimally skilled persons might be of value when patients suddenly become too ill for oral treatment but are several hours from a facility that can give injectable treatment for severe disease. In such situations, by default, no treatment is (or can be) given until the patient (...) reaches a facility, making the placebo control design clinically relevant; alternative bioequivalence designs at the facility would misrepresent reality and risk incorrect conclusions. We describe the ethical issues underpinning a placebo-controlled trial in severe malaria. To protect patients and minimise risk, all patients were referred immediately to hospital so that each had a higher chance of prompt treatment through participation. There was no difference between artesunate and placebo in patients who reached clinic rapidly; among those who could not, a single artesunate suppository significantly reduced death or permanent disability, a finding of direct and indirect benefit to patients in participating villages and elsewhere. (shrink)

Correct interpretation of the data from integral laboratory tests, including Thrombin Generation Test, requires biochemistry-based mathematical models of blood coagulation. The purpose of this study is to describe the experimental TGT data from healthy donors and hemophilia A and B patients. We derive a simplified ODE model and apply it to analyze the TGT data from healthy donors and HA/HB patients with in vitro added tissue factor pathway inhibitor antibody. This model allows the characterization of hemophilia patients in the space (...) of three most important model parameters. The proposed approach may provide a new quantitative tool for the analysis of experimental TGT. Also, it gives a reduced model of coagulation verified against clinical data to be used in future theoretical large-scale modeling of thrombosis in flow. (shrink)

Aim: This study explores priority dilemmas in dialysis treatment and care offered elderly patients within the Norwegian public healthcare system.Background: Inadequate healthcare due to advanced age is frequently reported in Norway. The Norwegian guidelines for healthcare priorities state that age alone is not a relevant criterion. However, chronological age, if it affects the risk or effect of medical treatment, can be a legitimate criterion.Method: A qualitative approach is used. Data were collected through semistructured interviews and analysed through hermeneutical content analysis. (...) The informants were five physicians and four nurses from dialysis wards.Findings: Pressing priority dilemmas centre around decision-making concerning withholding and withdrawal of dialysis treatment. Advanced age is rarely an absolute or sole priority criterion. It seems, however, that advanced age appears to be a more subtle criterion in relation with, for example, comorbidity, functional status and cognitive impairment. Nurses primarily prioritise specialised dialysis care and not comprehensive nursing care. The complex needs of elderly patients are therefore often not always met.Conclusions: Clinical priorities should be made more transparent in order to secure legitimate and fair resource allocation in dialysis treatment and care. Difficult decisions concerning withholding or withdrawal of dialysis ought to be openly discussed within the healthcare team as well as with patients and significant others. The biomedical focus and limitations on comprehensive care during dialysis should be debated. (shrink)

Data taken by the Mark II detector at the PEP storage ring was used to measure the rate of dilepton production in multihadronic events produced by e+e- annihilation at √s=29 GeV. We determine the probability that a hadron initially containing a b quark decays to a positive lepton to be 0.17-0.08+0.15, with 90% confidence level limits of 0.06 and 0.38. © 1990.

Predation and escaping from predation through hiding are two fundamental phenomena in ecology. The most common approach to reducing the chance of predation is to use a refuge. Here, we consider a three species fishery model system with prey refuge induced by a Holling type-II functional response. These three species of fish populations are named prey, middle predator, and top predator. Harvesting is employed in most fishery models to achieve both ecological and commercial benefits. Research proves that non-linear harvesting returns (...) more realistic outcomes. So, we have combined the Michaelis–Menten type of harvesting efforts for all populations. Uniform boundedness conditions for the solutions of the model are discussed. The existence conditions for possible equilibrium points with stability are presented. We explain the dynamical behavior at each equilibrium point through bifurcation analysis. The persistent criteria of the system are examined. Bionomic equilibrium and optimal harvesting control using Pontryagin’s maximum principle are calculated. For validation of the model in the real world, we have implemented this in the freshwater ecosystem of Lake Victoria. Extraction of native fish species and ecological balances are the foremost solicitude of Lake Victoria. We may resolve this concern partially by implementing prey refuge, since it may sustain the ecology of Lake Victoria, and therefore also its economical importance. Lake Victoria is acclaimed worldwide for the trade of fishing. Also, it provides the largest employment in east-central Africa and is beneficial to fishing equipment manufacturers. So, the bionomic equilibrium and harvesting control have significant applications in the fisheries. All the analytical studies are verified by numerical simulations. We have plotted phase portraits, bifurcation diagrams, Lyapunov exponents to explore the dynamics of the proposed model. (shrink)

This essay explores some concerns about the quality of informed consent in patients whose autonomy is diminished by fatal illness. It argues that patients with diminished autonomy cannot give free and voluntary consent, and that recruitment of such patients as subjects in human experimentation exploits their vulnerability in a morally objectionable way. Two options are given to overcome this objection: (i) recruit only those patients who desire to contribute to medical knowledge, rather than gain access to experimental treatment, or (ii) (...) provide prospective subjects the choice to participate in standard doubleblind study or receive the experimental treatment. Either option would guarantee that patients in desperate conditions are given a more meaningful choice and a richer freedom, and thus a higher quality of informed consent, than under standard randomized trials. (shrink)