Locked-in syndrome (LIS) is one of the most dramatic neurological outcomes and has a profound impact on patients and their families. Most patients have intact cognition and intellectual ability and perception. Communication is possible with eyelid and/or eyeball movement. According to the literature, the wish to die is not an important issue in acute and chronic LIS. This study describes and analyses the ethical decision-making process in two opposite cases of LIS in the intensive care unit. One patient expressed the (...) wish to prolong her life for as long as possible; the other patient asked for deliberate termination of life. Both wishes were honoured. In conclusion, most patients with LIS are competent and intellectually intact. In The Netherlands the autonomy of the patient is respected by law. In respecting this autonomy, medical choices can be different in comparable patients. (shrink)

The essays in this volume explore current work in central areas of philosophy, work unified by attention to salient questions of human action and human agency. They ask what it is for humans to act knowledgeably, to use language, to be friends, to act heroically, to be mortally fortunate, and to produce as well as to appreciate art. The volume is dedicated to J. O. Urmson, in recognition of his inspirational contributions to these areas. All the essays but one have (...) been specially written for this volume. (shrink)

Severe Traumatic Brain Injury (TBI) remains a major cause of death and disability afflicting mostly young adult males and elderly people, resulting in high economic costs to society. Therapeutic approaches focus on reducing the risk on secondary brain injury. Specific ethical issues pertaining in clinical testing of pharmacological neuroprotective agents in TBI include the emergency nature of the research, the incapacity of the patients to informed consent before inclusion, short therapeutic time windows, and a risk-benefit ratio based on concept that (...) in relation to the severity of the trauma, significant adverse side effects may be acceptable for possible beneficial treatments. Randomized controlled phase III trials investigating the safety and efficacy of agents in TBI with promising benefit, conducted in acute emergency situations with short therapeutic time windows, should allow randomization under deferred consent or waiver of consent. Making progress in knowledge of treatment in acute neurological and other intensive care conditions is only possible if national regulations and legislations allow waiver of consent or deferred consent for clinical trials. (shrink)

In a thought-provoking article – or how she herself named it, ‘a thought experiment’ – the philosopher-medical ethicist Anna Smajdor analyzed in this journal the idea of whole-body gestational donation (WBGD) in brain-dead female patients, as an alternative means of gestation for prospective women who cannot or prefer not to become pregnant themselves. We have serious legal, economical, medical and ethical concerns about this proposal. First, consent for eight months of ICU treatment can never be assumed to be derived from (...) consent for post-mortem organ donation; these two are of an incomparable and entirely different medical and ethical order. Moreover, the brain-dead woman is very likely to be medically unfit for high-tech surrogacy and the brain-dead state poses a high risk for deficient embryo/fetal development. Second, from a scarcity perspective, occupying an ICU bed for eight months appears to be unjust. The costs for eight months of ICU treatment are far too high compared to the costs of surrogacy for a living, selected, and healthy woman. Neither insurance companies nor prospective parents will want to pay these exceptionally high costs for a dead woman if a living surrogate mother can be hired for a considerably lower amount. Third, there is an increased risk for harm of the child to be in WBGD. And finally, WBGD risks violating the brain-dead woman’s dignity and harming the interests of her loved ones. In short, there is simply no need for brain-dead women as surrogates. (shrink)

The essays in this volume explore current work in central areas of philosophy, work unified by attention to salient questions of human action and human agency. They ask what it is for humans to act knowledgeably, to use language, to be friends, to act heroically, to be mortally fortunate, and to produce as well as to appreciate art. The volume is dedicated to J. O. Urmson, in recognition of his inspirational contributions to these areas. All the essays but one have (...) been specially written for this volume. (shrink)

Background The European Union aims to optimize patient protection and efficiency of health-care research by harmonizing procedures across Member States. Nonetheless, further improvements are required to increase multicenter research efficiency. We investigated IRB procedures in a large prospective European multicenter study on traumatic brain injury, aiming to inform and stimulate initiatives to improve efficiency. Methods We reviewed relevant documents regarding IRB submission and IRB approval from European neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury. (...) Documents included detailed information on IRB procedures and the duration from IRB submission until approval. They were translated and analyzed to determine the level of harmonization of IRB procedures within Europe. Results From 18 countries, 66 centers provided the requested documents. The primary IRB review was conducted centrally or locally and primary IRB approval was obtained after one, two or three review rounds with a median duration of respectively 50 and 98 days until primary IRB approval. Additional IRB approval was required in 55% of countries and could increase duration to 535 days. Total duration from submission until required IRB approval was obtained was 114 days and appeared to be shorter after submission to local IRBs compared to central IRBs. Conclusion We found variation in IRB procedures between and within European countries. There were differences in submission and approval requirements, number of review rounds and total duration. Research collaborations could benefit from the implementation of more uniform legislation and regulation while acknowledging local cultural habits and moral values between countries. (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)

This article seeks through Ejagham women’s experience in the ritual dances of Ngbokondem and Moninkim to engage the notion of patriarchal control of African women’s sexuality in ‘female genital mutilation’ discourses as postulated by second-wave feminist theorists such as Daly, Koedt, Hosken and so on. A firmly based patriarchy threatens culture, sexuality and identity; the article shows how women use varied coping mechanisms, including aid schemes, sexual insurgency and even breaking of bodies to define their place and identity in a (...) patriarchal society. However, some Ejagham women’s practices are themselves laced with patriarchal violence where women postulate as main participants. The article coins the term ‘triple patriarchy’ to capture this phenomenon. It portrays how Ejagham women, who are interrogating domination, also act in ways that reinforce patriarchy. Using womanist theological lens as the hermeneutic framework, the article concludes that women initiation practices are the foundations through which women grasp the meanings of Christian initiation rituals such as baptism, eucharist, marriage and so on. Hence, they should not be destroyed but fine-tuned; for there is more about the women’s practices that need to be engaged than labelled. (shrink)

We anticipate a further decline of patients who eventually will become brain dead. The intensive care unit (ICU) is considered a last resort for patients with severe and multiple organ dysfunction. Patients with primary central nervous system failure constitute the largest group of patients in which life-sustaining treatment is withdrawn. Almost all these patients are unconscious at the moment physicians decide to withhold and withdraw life-sustaining measures. Sometimes, however competent ICU patients state that they do not want to live anymore (...) because of the severity of their illness or the poor prognosis and ask for withdrawal of life-sustaining measures like mechanical ventilation. Do we consider the unconscious patient as potential organ donor before withdrawal of mechanical ventilation? This is paradoxically rare in the case of the conscious ICU patient. Is it practically possible and ethically feasible to obtain consent for organ donation from this group of patients? (shrink)

The Kiki-Bouba effect comprises a relation between two abstract figures and two non-words: the star-shaped figure is called 'Kiki' and the rounded figure 'Bouba'. The effect is explained by a sound-vision synaesthesia: certain sounds are associated with certain shapes in a non-arbitrary manner.When we asked the participants to decide which of the two figures, the star-shaped or the rounded one, to call yin and which yang, some 85% choose the star-shaped figure as yin. There are previous cases of synaesthesia where (...) personality is attributed to numbers or letters. In our results, the word Kiki is overall happy, clever, small, thin, young, unpleasant, and nervous. The starshaped figure is overall clever, tall, small, slim, nervous, unpleasant, and upper-class. That is, the correspondence above all concerns the qualifying adjectives clever, unpleasant, and nervous, as well as the physical appearance small and thin. This brings us to the fat-thin effect. Cinema, literature, comics, and children's programmes are full of contrasting figures: Don Quixote and Sancho Panza, Laurel and Hardy , Asterix and Obelix, Tintin and Captain Haddock, Bert and Ernie , or the Spanish comic about very naughty twin boys called Zipi and Zape . Our main conclusion is that first names and last names are not entirely arbitrary. There is a correspondence between names and physical characteristics and concepts . The Kiki-Bouba effect is a semantic one. (shrink)

We address the thesis recently proposed by Andy Clark, that skill-mediated access to modality implies phenomenal feel. We agree that a skill theory of perception does indeed offer the possibility of a satisfactory account of the feel of perception, but we claim that this is not only through explanation of access to modality but also because skill actually provides access to perceptual property in general. We illustrate and substantiate our claims by reference to the recently proposed 'sensorimotor contingency' theory of (...) visual awareness. We discuss why this theory offers a distinctively attractive access-based approach to perceptual consciousness because it 'dereifies' experience and permits otherwise problematic aspects of phenomenal perceptual consciousness to be explained. We suggest our approach thus offers the prospect of 'naturalizing phenomenology'. (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)

To localize wheat ESTs on chromosomes, 882 homoeologous group 6-specific ESTs were identified by physically mapping 7965 singletons from 37 cDNA libraries on 146 chromosome, arm, and sub-arm aneuploid and deletion stocks. The 882 ESTs were physically mapped to 25 regions flanked by 23 deletion breakpoints. Of the 5154 restriction fragments detected by 882 ESTs, 2043 were localized to group 6 chromosomes and 806 were mapped on other chromosome groups. The number of loci mapped was greatest on chromosome 6B and (...) least on 6D. The 264 ESTs that detected orthologous loci on all three homoeologs using one restriction enzyme were used to construct a consensus physical map. The physical distribution of ESTs was uneven on chromosomes with a tendency toward higher densities in the distal halves of chromosome arms. About 43% of the wheat group 6 ESTs identified rice homologs upon comparisons of genome sequences. Fifty-eight percent of these ESTs were present on rice chromosome 2 and the remaining were on other rice chromosomes. Even within the group 6 bins, rice chromosomal blocks identified by 1-6 wheat ESTs were homologous to up to 11 rice chromosomes. These rice-block contigs were used to resolve the order of wheat ESTs within each bin. (shrink)

An ecumenical effort, sensitive to both the scriptural and dogmatic issues, and directed at laying open the often overlooked, historical and doctrinal affinities underlying Protestant and Catholic Marian theology. As O'Meara correctly points out, while Luther and Calvin did indeed remove Mary from some aspects of the Church, it was some of their later followers who removed her entirely from any essential involvement with the mystery of Christ and the Church. But as in all ecumenical discussions worthy of that name, (...) genuine difficulties are not glossed over. In particular O'Meara questions the prevailing, either/or tendency in Protestant theology not to admit the possibility of a middle range of worship, i.e., hyperdulia, as falling between latria and dulia. While the treatment is for the most part scrupulously fair, O'Meara's defense of the traditional Catholic exegesis of the "I know not man" passage, which is crucial for the Catholic teaching on the virginity of Mary, seems to place an unfair burden of proof on the Protestant interpretation, which is prima facie the more obvious one.—J. J. O. (shrink)

Introduction , Sophie Gibb 1. Mental Causation , John Heil 2. Physical Realization without Preemption , Sydney Shoemaker 3. Mental Causation in the Physical World , Peter Menzies 4. Mental Causation: Ontology and Patterns of Variation , Paul Noordhof 5. Causation is Macroscopic but not Irreducible , David Papineau 6. Substance Causation, Powers, and Human Agency , E. J. Lowe 7. Agent Causation in a Neo-Aristotelian Metaphysics , Jonathan D. Jacobs and Timothy O’Connor 8. Mental Causation and Double Prevention , (...) Sophie Gibb 9. The Identity Theory as a Solution to the Exclusion Problem , David Robb 10. Continuant Causation, Fundamentality, and Freedom , Peter Simons 11. There is no Exclusion Problem , Steinvor Tholl Arnadottir and Tim Crane. (shrink)

From the time of Gustav Schneider’s Quae sit causae finalis apud Aristotelem vis atque natura titles on the Aristotelian final cause are strangely lacking. The present book finds only one monograph precisely dedicated to its theme, and pointing rather to an undeniable lacuna than to definitive results. While not presuming to "exhaust" the problem in a single study, Capecci undertakes the project of bringing to light some aspects of the Aristotelian teleology, in particular the "logical structure" of the final causality (...) used by the Stagirite in his physical and metaphysical investigations. (shrink)

If the density matrix is treated as an objective description of individual systems, it may become possible to attribute the same objective significance to statistical mechanical properties, such as entropy or temperature, as to properties such as mass or energy. It is shown that the de Broglie--Bohm interpretation of quantum theory can be consistently applied to density matrices as a description of individual systems. The resultant trajectories are examined for the case of the delayed choice interferometer, for which Bell [Int. (...) J. Quantum chem. 155--159, (1980)] appears to suggest that such an interpretation is not possible. Bell’s argument is shown to be based upon a different understanding of the density matrix to that proposed here. (shrink)

Recent studies have shown the importance of integrating multisensory information in the body representation for constituting self-consciousness. However, one idea that has received only scant attention is that our body representation is also constituted by knowledge of bodily visual characteristics . Here in two experiments we used a full body crossmodal congruency task in which visual distractors were presented on a photograph of the participant, another person, who was either familiar or unfamiliar, or an object. Results revealed that during the (...) ‘self-condition’ CCEs were enhanced compared to the ‘other condition’. The CCE was similar for unfamiliar and familiar others. CCEs for the object condition were significantly smaller. The results show that presentation of an irrelevant image of a body affects multimodal processing and that the effect is enhanced when that image is of the self. The results hold intriguing implications for body representation in social situations. (shrink)

A total of 1918 loci, detected by the hybridization of 938 expressed sequence tag unigenes from 26 Triticeae cDNA libraries, were mapped to wheat homoeologous group 4 chromosomes using a set of deletion, ditelosomic, and nulli-tetrasomic lines. The 1918 EST loci were not distributed uniformly among the three group 4 chromosomes; 41, 28, and 31% mapped to chromosomes 4A, 4B, and 4D, respectively. This pattern is in contrast to the cumulative results of EST mapping in all homoeologous groups, as reported (...) elsewhere, that found the highest proportion of loci mapped to the B genome. Sixty-five percent of these 1918 loci mapped to the long arms of homoeologous group 4 chromosomes, while 35% mapped to the short arms. The distal regions of chromosome arms showed higher numbers of loci than the proximal regions, with the exception of 4DL. This study confirmed the complex structure of chromosome 4A that contains two reciprocal translocations and two inversions, previously identified. An additional inversion in the centromeric region of 4A was revealed. A consensus map for homoeologous group 4 was developed from 119 ESTs unique to group 4. Forty-nine percent of these ESTs were found to be homoologous to sequences on rice chromosome 3, 12% had matches with sequences on other rice chromosomes, and 39% had no matches with rice sequences at all. Limited homology was found between wheat ESTs on homoeologous group 4 and the Arabidopsis genome. Forty-two percent of the homoeologous group 4 ESTs could be classified into functional categories on the basis of blastX searches against all protein databases. (shrink)

To the editor of a classical text manuscripts are useful as they can be induced to yield the truth. The purpose of this article is purely practical: to discuss in moderate compass, though in greater detail than an O.G.T. preface seems to demand, how the manuscripts of these poems can be used to find out what Ovid wrote. His text has been transmitted to us in circumstances which defy the rigid application of this or that ‘method’ of recension; and his (...) editors will sometimes be wise to recognize the limitations of the evidence and to cultivate a robust indifference to unnecessary detail. (shrink)

A total of 944 expressed sequence tags generated 2212 EST loci mapped to homoeologous group 1 chromosomes in hexaploid wheat. EST deletion maps and the consensus map of group 1 chromosomes were constructed to show EST distribution. EST loci were unevenly distributed among chromosomes 1A, 1B, and ID with 660, 826, and 726, respectively. The number of EST loci was greater on the long arms than on the short arms for all three chromosomes. The distribution of ESTs along chromosome arms (...) was nonrandom with EST clusters occurring in the distal regions of short arms and middle regions of long arms. Duplications of group 1 ESTs in other homoeologous groups occurred at a rate of 35.5%. Seventy-five percent of wheat chromosome 1 ESTs had significant matches with rice sequences, where large regions of conservation occurred between wheat consensus chromosome 1 and rice chromosome 5 and between the proximal portion of the long arm of wheat consensus chromosome 1 and rice chromosome 10. Only 9.5% of group 1 ESTs showed significant matches to Arabidopsis genome sequences. The results presented are useful for gene mapping and evolutionary and comparative genomics of grasses. (shrink)

Changes being introduced to deregulate the Dutch health care system after decades of extensive state control are to be welcomed, and will in future require consumers to be ‘well‐informed, cost‐conscious and assertive patients, who are aware of their responsibility for their own health.’ R.B. Kool MD, PhD and E.J.J.M. Kimman PhD are attached to the Department of Business Ethics in the Faculty of Economics and Econometrics at The Free University, P.O. Box 7161, 10107 MC Amsterdam.

Initial responses to questionnaires used to assess participants' understanding of informed consent for malaria vaccine trials conducted in the United States and Mali were tallied. Total scores were analyzed by age, sex, literacy (if known), and location. Ninety-two percent (92%) of answers by United States participants and 85% of answers by Malian participants were correct. Questions more likely to be answered incorrectly in Mali related to risk, and to the type of vaccine. For adult participants, independent predictors of higher scores (...) were younger age and female sex in the United States, and male sex in Mali. Scores in the United States were higher than in Mali (P = 0.005). Despite this difference participants at both sites were well informed overall. Although interpretation must be qualified because questionnaires were not intended as research tools and were not standardized among sites, these results do not support concerns about systematic low understanding among research participants in developing versus developed countries. (shrink)