sirIn the January 4 issue of the New England Journal of Medicine three articles appeared on the unapproved use of Misoprostol , which raise an interesting ethical question. The synthetic prostaglandin analogue, Misoprostol, has been successfully used by obstetricians and gynaecologists for a number of years for the induction of a medical abortion in the first or second trimester, for the induction of labour, and for the prevention of postpartum haemorrhages.1 Strangely enough the pharmaceutical company which produces and markets the (...) drug, Searle, …. (shrink)

In the Netherlands the incidence of methicillin resistant Staphylococcus aureus infections in hospitals is surprisingly low when compared to that of neighbouring countries. It is believed that this favourable condition is caused by stringent precautionary measures such as complete isolation of the patients. In one case the nurse taking care of such patients was herself MRSA positive. This condition changed and she became MRSA negative after removal of her tonsils. The question is raised how far one should go to protect (...) patients when the preventive measures taken may endanger the health of those who take care of them. (shrink)

Although there are exceptions, the principle of primum nil nocere remains the cornerstone of the practice of medicine. In the well known handbook, Goodman and Gilman’s The Pharmacological Basis of Therapeutics1 a case is presented which raises doubts about the permissibility of off-label administration of certain drugs to healthy troops as a preventive measure. The following citation from this handbook gives a clear description of the problem:"Prophylaxis in cholinesterase inhibitor poisoning. Studies in experimental animals have shown that pretreatment with pyridostigmine (...) reduces the incapacitation and mortality associated with “nerve agent” poisoning, particularly for agents, such as soman, that … ". (shrink)

In 1998 a lawyer working for the Dutch consumer organisation, Consumentenbond, suggested that hospitals, like hotels, should be classified according to the quality of service they provide.1 For the establishment of such a register it would of course be necessary to determine various parameters, including the incidence of complications occurring in each hospital. It did not take long before this proposal was rejected by van Herk2 on the grounds that it would promote defensive medicine, which would not improve the ….

A case is described of a man who discovered years after donating sperm for artificial insemination, that he had a serious genetic disease, autosomal dominant cerebellar ataxia . This manifests itself only years after puberty and occurs in 50% of the progeny. The sperm had been used for the conception of 18 children in 13 women. The parents were only told three years after the insemination. This long time interval was unavoidable since many of the parents had to be found (...) and the hospital director wished first to discuss the matter with his legal advisors and other experts.In future, in agreement with the new law only 10 inseminations will take place with sperm from one donor. This will reduce still further the availability of donor sperm. (shrink)

In September 1998 the Dutch Ministry of Health together with the Dutch Society of General Practitioners , the Royal Dutch Society of Pharmacists , and the Dutch Patient and Consumer Federation published a pamphlet entitled: The same medicine in a different coat. Drugs without a trademark, equally effective, but cheaper. Patients could obtain a copy at the local pharmacy or in the waiting room of their general practitioner. It deals with the question whether the name of the patent drug should (...) be written on the prescription or only the active component. This is important because, according to the authors, the costs of health care can be reduced without reducing the quality of the care if the doctor prescribes the generic form. It is also mentioned that another advantage of prescribing the generic form is that, contrary to the …. (shrink)

A case is described of a man who discovered years after donating sperm for artificial insemination, that he had a serious genetic disease, autosomal dominant cerebellar ataxia . This manifests itself only years after puberty and occurs in 50% of the progeny. The sperm had been used for the conception of 18 children in 13 women. The parents were only told three years after the insemination. This long time interval was unavoidable since many of the parents had to be found (...) and the hospital director wished first to discuss the matter with his legal advisors and other experts.In future, in agreement with the new law only 10 inseminations will take place with sperm from one donor. This will reduce still further the availability of donor sperm. (shrink)

Recently I reported in this journal1 how it became necessary for a judge to settle a dispute between the pharmaceutical industry and certain Dutch pharmacists. It considered the question of whether a pharmacist is permitted, without prior consultation, to give a patient a generic drug instead of the patent drug mentioned on the prescription.Another dispute has now arisen after the pharmaceutical industry discovered that healthcare insurers were paying general practitioners a bonus if they prescribed generic drugs, such as simvastatin or (...) omeprazol (which reduces the …. (shrink)

A case is described of a man who discovered years after donating sperm for artificial insemination, that he had a serious genetic disease, autosomal dominant cerebellar ataxia. This manifests itself only years after puberty and occurs in 50% of the progeny. The sperm had been used for the conception of 18 children in 13 women. The parents were only told three years after the insemination. This long time interval was unavoidable since many of the parents had to be found and (...) the hospital director wished first to discuss the matter with his legal advisors and other experts.In future, in agreement with the new law only 10 inseminations will take place with sperm from one donor. This will reduce still further the availability of donor sperm. (shrink)

Dynamical collapse models embody the idea of a physical collapse of the wave function in a mathematically well-defined way. They involve modifications to the standard rules of quantum theory in order to describe collapse as a physical process. This appears to introduce a time reversal asymmetry into the dynamics since the state at any given time depends on collapses in the past but not in the future. Here we challenge this conclusion by demonstrating that, subject to specified model constraints, collapse (...) models can be given a structurally time symmetric formulation in which the collapse events are the primitive objects of the theory. Three different examples of time asymmetries associated with collapse models are then examined and in each case it is shown that the same dynamical rule determining the collapse events works in both the forward and backward in time directions. Any physically observed time asymmetries that arise in such models are due to the asymmetric imposition of initial or final time boundary conditions, rather than from an inherent asymmetry in the dynamical law. This is the standard explanation of time asymmetric behaviour resulting from time symmetric laws. (shrink)

R&D collaborations between industry, government, civil society, and research ) have recently gained attention from R&D theorists and practitioners. In aiming to come to grips with their complexity, past models have generally taken a stakeholder-analytical approach based on stakeholder types. Yet stakeholder types are difficult to operationalise. We therefore argue that a processual model is more suited for studying the interaction in QHCs because it eschews matters of titles and identities. We develop such a model in which the QHC is (...) represented as a process of generating four types of value: research value, market value, political value, and societal value. We then apply this processual model in analysing real-life cases of friction in QHCs. Friction is seen, not as an interpersonal clash, but as a discrepancy between two or more value-creation processes that compete for limited resources. (shrink)

Coastal ecosystems are increasingly dominated by humans. Consequently, the human dimensions of sustainability science have become an integral part of emerging coastal governance and management practices. But if we are to avoid the harsh lessons of land management, coastal decision makers must recognize that humans are one of the more coastally dependent species in the biosphere. Management responses must therefore confront both the temporal urgency and the very real compromises and sacrifices that will be necessary to achieve a sustainable coastal (...) ecosystem, one that is economically feasible, socially just, and ecologically sound. (shrink)

Compared to our understanding of positive prediction error signals occurring due to unexpected reward outcomes, less is known about the neural circuitry in humans that drives negative prediction errors during omission of expected rewards. While classical learning theories such as Rescorla–Wagner or temporal difference learning suggest that both types of prediction errors result from a simple subtraction, there has been recent evidence suggesting that different brain regions provide input to dopamine neurons which contributes to specific components of this prediction error (...) computation. Here, we focus on the brain regions responding to negative prediction error signals, which has been well-established in animal studies to involve a distinct pathway through the lateral habenula. We examine the activity of this pathway in humans, using a conditioned inhibition paradigm with high-resolution functional MRI. First, participants learned to associate a sensory stimulus with reward delivery. Then, reward delivery was omitted whenever this stimulus was presented simultaneously with a different sensory stimulus, the conditioned inhibitor. Both reward presentation and the reward-predictive cue activated midbrain dopamine regions, insula and orbitofrontal cortex. While we found significant activity at an uncorrected threshold for the CI in the habenula, consistent with our predictions, it did not survive correction for multiple comparisons and awaits further replication. Additionally, the pallidum and putamen regions of the basal ganglia showed modulations of activity for the inhibitor that did not survive the corrected threshold. (shrink)

Short-term limb immobilization results in skeletal muscle decline, but the underlying mechanisms are incompletely understood. This study aimed to determine the neurophysiologic basis of immobilization-induced skeletal muscle decline, and whether repetitive Transcranial Magnetic Stimulation could prevent any decline. Twenty-four healthy young males underwent unilateral limb immobilization for 72 h. Subjects were randomized between daily rTMS using six 20 Hz pulse trains of 1.5 s duration with a 60 s inter-train-interval delivered at 90% resting Motor Threshold, or Sham rTMS throughout immobilization. (...) Maximal grip strength, EMG activity, arm volume, and composition were determined at 0 and 72 h. Motor Evoked Potentials were determined daily throughout immobilization to index motor excitability. Immobilization induced a significant reduction in motor excitability across time. The rTMS intervention increased motor excitability at 0 h. Despite daily rTMS treatment, there was still a significant reduction in motor excitability, loss in EMG activity, and a loss of maximal grip strength after immobilization. Interestingly, the increase in biceps and posterior forearm skinfold thickness with immobilization in Sham treatment was not observed following rTMS treatment. Reduced MEPs drive the loss of strength with immobilization. Repetitive Transcranial Magnetic Stimulation cannot prevent this loss of strength but further investigation and optimization of neuroplasticity protocols may have therapeutic benefit. (shrink)

This University of Münster dissertation deals with the problem of how to interpret the coming-into-being of the world as described in the Timaeus: does Plato really mean that the world was generated or is his account merely a mythical expression of the composition of a world which is eternal? Scheffel shows how this issue has divided both ancient and modern interpreters: Aristotle, Vlastos, and Hackforth, for example, taking the former view; Xenocrates and the Academy, A. E. Taylor, Cherniss, and Cornford (...) taking the latter. In this book Scheffel argues for the "Aristotelian" view and develops the positions of Vlastos and Hackforth. In a preparatory section he briefly presents two ancient proponents of his position, Aristotle and Plutarch, noting that Plato's Laws does not support Plutarch's conception of an evil soul animating the unordered chaos of the Timaeus. In the main part of the book Scheffel comments on the text of the Timaeus, organizing his exposition into chapters on "The Exposition of the Cosmogony," "The Concept of Space in the Timaeus," "The Doctrine of Movement in the Timaeus," "The Concept of Soul in the Timaeus," "The Platonic Distinction between First and Second Causes." Some subordinate issues are also discussed, in particular that of the possible contradiction between the eternal soul of the Phaedrus and the generated soul of the Timaeus. Scheffel's final position on the main issue is that Plato in the Timaeus means that the world is generated, not in time, but in an "einmalige überzeitliche Formungsakt" by the demiurge. This is perhaps not all that distant from the old position which concluded that to be generated outside time is to be causally dependent in some non-temporal way on the eternal. Scheffel does not appear, however, to have thought out what an "einmalige überzeitliche Formungsakt" might turn out to be. His argument is not always very convincing and this is unlikely to be the last word on an interesting and important problem.--D.O. (shrink)

Thirty distinguished American philosophers and scientists have contributed pieces ranging form two to twenty pages, summing up their contributions to the third annual New York University Institute of Philosophy. Topics discussed are grouped under three heads: The Mind-Body Problem; The Brain and the Machine; and Concept-Formation. The discussion is lively and controversial, although not very consecutive. Very up-to-date on American research in cybernetics, but surprisingly unaware of contemporary European work in the areas discussed, e.g., the writings of the Phenomenologists and (...) Piaget.--D. D. O. (shrink)

This paper argues that professionals who make boundary-related decisions should be guided by relationship-based practice. In our roles as service users and professionals, drawing from our lived experiences of professional relationships, we argue we need to move away from distance-based practice. This includes understanding the boundary stories and narratives that exist for all of us – including the people we support, other professionals, as well as the organisations and systems within which we work. When we are dealing with professional boundary (...) issues, we should centre relationship-building skills that are central to many other aspects of our work. Skills that foster relationships at all levels – between professionals, service users, and services – need to be revalued. Our final recommendation is to create, develop, and foster safer spaces within and outside of organisations, as well as inter-professionally, for the discussion and exploration of boundary-related issues and practice. We are interested in hearing from those with experiences of being marginalised by boundaries so that they can inform a reshaping of our collective ideas around boundary related practices. To foster relationship-based practices in organisations, we have outlined several recommendations here; however, we recognize that these do not go far enough, and that collective action is needed to inform systemic change. (shrink)

Mathematical Essays in Honor of Gian-Carlo Rota, Boston, Basel, Berlin, ... Crapo, H. (1993), On the Anick-Rota Representation of the Bracket Ring of the ...

Abstract. In this article we developed scientific and applied foundations of commercialization of the nature-resource potential of anthropogenic objects, on the example of exhausted mines. It is determined that the category of “anthropogenic object” can be considered in a narrow-applied sense, as specific anthropogenic objects to ensure the target needs, and in a broad theoretical sense, meaning everything that is created and changed by human influence, that is the objects of both artificial and natural origin. It was determined that problems (...) of commercialization of the natural-resource potential of anthropogenic objects are most often considered by researchers for specific objects, without having complex methodological coverage from the point of view of combining environmental, technical, economic and managerial components. When studying the substantiation of the scientific base, the authors confirmed the feasibility of the commercialization of natural-resource potential of anthropogenic objects on the example of a number of theoretical scientific studies in reclamation, reconstruction, recreation, remediation, restoration of biological productivity and economic value of land disturbed by economic activity. The considered examples of exhausted mines in the 21st century in the USA, Canada, Germany, Romania, and Poland indicate a wide range of opportunities for their commercialization. The study of the potential for commercialization of exhausted mines in the post-Soviet countries testified to the underused reserves for the commercialization of their nature-resource potential and their high potential for further development. The authors proposed the identification of anthropogenic objects on the basic livelihood spheres of society. There were identified the main system (natural, biological, technical, economic, social, managerial) and structural (subjects, trends, threats, risks, problems, challenges) factors of diagnosing the state of an anthropogenic object. A set of measures has been developed for commercialization of an anthropogenic object in functional and production activities, product policy, financial and investment spheres, pricing and sales policies, promotion, management and determination of property rights. Recommendations were provided on optimizing the management decision-making process based on a set of positivistic development principles, methods, and management functions. The study allows international organizations, state and local authorities, territorial communities, owners and potential investors to see new opportunities and make mutually beneficial decisions on the rational use of the nature-resource potential of anthropogenic objects. (shrink)

A unique description of the phenomena that arise from the interaction between quantum systems and their environment. Because of the novel character of the approach discussed, the book addresses scientists from all fields of physics and related disciplines as well as students of physics.

High-spin states in the odd-odd N = Z nucleus Co-54 have been investigated by the fusion-evaporation reaction Si-28(S-32,1 alpha 1p1n)Co-54. Gamma-ray information gathered with the Ge detector array Gammasphere was correlated with evaporated particles detected in the charged particle detector system Microball and a 1 pi neutron detector array. A significantly extended excitation scheme of Co-54 is presented, which includes a candidate for the isospin T = 1, 6(+) state of the 1f(7/2)(-2) multiplet. The results are compared to large-scale shell-model (...) calculations in the fp shell. Effective interactions with and without isospin-breaking terms have been used to probe isospin symmetry and isospin mixing. A quest for deformed high-spin rotational cascades proved negative. This feature is discussed by means of cranking calculations. (shrink)

Two rotational bands have been identified and characterized in the proton-magic N = Z + 1 nucleus Ni-57. These bands complete the systematics of well-and superdeformed rotational bands in the light nickel isotopes starting from doubly magic Ni-56 to Ni-60. High-spin states in Ni-57 have been produced in the fusion-evaporation reaction Si-28(S-32, 2p1n)Ni-57 and studied with the gamma-ray detection array GAMMASPHERE operated in conjunction with detectors for evaporated light charged particles and neutrons. The features of the rotational bands in Ni-57 (...) are compared to those of neighbouring isotopes and interpreted by means of configuration-dependent cranked Nilsson-Strutinsky calculations. The two observed high-spin bands are considered signature partners and assigned to configurations with one 1g(9/2) proton and one 1g(9/2) neutron, resulting in an unambiguous understanding of the energetically favoured signature alpha = -1/2 band but a somewhat less satisfactory description of the signature alpha = +1/2 band. (shrink)

A new multi-stage deterministic model for the transmission dynamics of syphilis, which incorporates disease transmission by individuals in the early latent stage of syphilis infection and the reversions of early latent syphilis to the primary and secondary stages, is formulated and rigorously analysed. The model is used to assess the population-level impact of preventive and therapeutic measures against the spread of the disease in a community. It is shown that the disease-free equilibrium of the model is globally-asymptotically stable whenever the (...) associated control reproduction number is less than unity. A special case of the model is shown to have a unique and globally-asymptotically stable endemic equilibrium whenever the associated reproduction number exceeds unity. Uncertainty and sensitivity analysis of the model, using parameter values and ranges relevant to syphilis transmission dynamics in Nigeria, show that the top three parameters that drive the syphilis infection are the disease transmission rate, compliance in condom use and efficacy of condom. Numerical simulations of the model show that the targeted treatment of secondary syphilis cases is more effective than the targeted treatment of individuals in the primary or early latent stage of syphilis infection. (shrink)

Burning fossil fuel in the North American continent contributes more to the CO2 global warming problem than in any other continent. The resulting climate changes are expected to alter food production. The overall changes in temperature, moisture, carbon dioxide, insect pests, plant pathogens, and weeds associated with global warming are projected to reduce food production in North America. However, in Africa, the projected slight rise in rainfall is encouraging, especially since Africa already suffers from severe shortages of rainfall. For all (...) regions, a reduction in fossil fuel burning is vital. Adoption of sound ecological resource management, especially soil and water conservation and the prevention of deforestation, is important. Together, these steps will benefit agriculture, the environment, farmers, and society as a whole. (shrink)

The complex hexaploid wheat genome offers many challenges for genomics research. Expressed sequence tags facilitate the analysis of gene-coding regions and provide a rich source of molecular markers for mapping and comparison with model organisms. The objectives of this study were to construct a high-density EST chromosome bin map of wheat homoeologous group 2 chromosomes to determine the distribution of ESTs, construct a consensus map of group 2 ESTs, investigate synteny, examine patterns of duplication, and assess the colinearity with rice (...) of ESTs assigned to the group 2 consensus bin map. A total of 2600 loci generated from 1110 ESTs were mapped to group 2 chromosomes by Southern hybridization onto wheat aneuploid chromosome and deletion stocks. A consensus map was constructed of 552 ESTs mapping to more than one group 2 chromosome. Regions of high gene density in distal bins and low gene density in proximal bins were found. Two interstitial gene-rich islands flanked by relatively gene-poor regions on both the short and long arms and having good synteny with rice were discovered. The map locations of two ESTs indicated the possible presence of a small pericentric inversion on chromosome 2B. Wheat chromosome group 2 was shown to share syntenous blocks with rice chromosomes 4 and 7. (shrink)