Obese people consume significantly greater amounts of health resources. This study set out to determine if health resource utilization by obese people decreases after losing weight in a comprehensive medically supervized weight management programme. Four hundred and fifty-six patients enrolled in a single-centred, multifaceted weight loss programme in a universal health care system were studied. Patient information was anonymously linked with administrative databases to measure health resource utilization for 1 year before and after the programme. Mean body mass index (BMI) (...) decreased by more than 15%. The mean annual physician visits (pre = 9.6, post = 9.4) did not change significantly after the programme. However, patients saw a significantly fewer number of different physicians per year following the programme (pre = 4.5, post = 3.9; P < 0.001). Mean annual number of emergency visits (pre = 0.2; post = 0.2) and hospital admissions (pre = 0.05; post = 0.08) did not change. Neither baseline BMI, nor its change during the programme, influenced changes in health resource utilization. Our study suggests that weight loss in a supervized weight management programme does not necessarily decrease short-term health resource utilization. Further study is required to determine if patients who maintain their weight loss experience a decrease in health utilization. (shrink)

In this paper, we view creativity through the lens of innovation, a concept familiar to archaeologists across a range of contexts and theoretical perspectives. Most attempts to understand ancient innovation thus far, we argue, have been limited by their lack of capacity to cope with the multiple scales of innovation: Those that track widespread changes, like the beginnings of metallurgy, fail to account for the changes experiences by individual craftspeople; those that do justice to the details of the micro-scale, with (...) ‘thick’ description, cannot well explain the regional adoption of new practices. Here we develop an intermediary position, at the meso-scale, which we hope can serve to integrate these different scales. It is based on the notions that all innovation entails learning (and hence cognitive transformations) and that learning is very often supported at this meso-scale, through ‘communities of practice’. Drawing on the ethno-archaeological literature in particular, we emphasise how learning is a process of embodied cognition. Our archaeological case study is then drawn from the Bronze Age east Mediterranean, where a striking innovation in pottery making — the use of rotative kinetic energy via the potter’s wheel — sees a very uneven uptake from region to region over the course of many centuries. We propose certain differences in community organization from one region to another that might account for such variation in the adoption of an innovation, with the island of Crete in particular seeing a much more stable trajectory of adoption than many of its neighbouring areas. (shrink)

In this article a case is made for the importance of a previously overlooked phenomenon, physical empathy orcompathy,defined as the physical manifestation of caregiver distress that occurs in the presence of a patient in physical pain or distress. According to the similarity of a caregiver's response to the original symptoms, there can be four types of compathetic response: identical, initiated, transferred, and converted. Controlling for the compathetic response may involve narrowing one's focus and/or changing caregiver attitudes. Finally, we argue that (...) while the compathetic response may be beneficial to the caregiving relationship, enabling the provision of appropriate and adequate humane treatment and care, the caregiver must at times shield against the compathetic response in order to provide care. (shrink)

Developing countries face numerous barriers to conducting effective and efficient ethics reviews of international collaborative research. In addition to potentially overlooking important scientific and ethical considerations, inadequate or insufficiently trained ethics committees may insist on unwarranted changes to protocols that can impair a study's scientific or ethical validity. Moreover, poorly functioning review systems can impose substantial delays on the commencement of research, which needlessly undermine the development of new interventions for urgent medical needs. In response to these concerns, the Drugs (...) for Neglected Diseases Initiative, an independent nonprofit organization founded by a coalition of public sector and international organizations, developed a mechanism to facilitate more effective and efficient host country ethics review for a study of the use of fexinidazole for the treatment of late stage African Trypanosomiasis. The project involved the implementation of a novel ‘pre-review’ process of ethical oversight, conducted by an ad hoc committee of ethics committee representatives from African and European countries, in collaboration with internationally recognized scientific experts. This article examines the process and outcomes of this collaborative process. (shrink)

Exploring Practical Knowledge investigates professional practices from a hermeneutic perspective. The book presents, discusses and applies notions such as practical knowledge, practical wisdom, tacit knowledge, and normativity to the professional lifeworld. These contributions focus on both specific practices and more general questions concerning theories and investigations of practice. This volume comes as the result of a cooperation of three research centres: The two Centres for Practical Knowledge in Bodø, Norway and in Södertörn, Sweden, as well as the Research Group Value-Oriented (...) Professionalisation at the University of Applied Sciences in Utrecht, the Netherlands. It offers empirical studies of professionals as well as discussing the underlying theories, approaches and methods of exploring practical knowledge - including the limits to any articulation of these aspects of professional action. In contrast to the objectivist paradigm that otherwise dominates professional studies, each chapter presents central perspectives and possibilities drawing from humanistic and interdiscipkinary research traditions. The book explores professions in a style accessible to scholars and practitioners alike. It is interesting for those studying practices within these professions and for vocational studies in education, social work, health care, police work, journalism, etc. (shrink)

The way politicians get in contact with local polities in Flanders bas been examined based on the sociological distinction between ascribed and achieved status positions. Politically active relatives were considered characteristic of ascribed local mandates.Membership of different associations was seen as a way of personally achieving a local mandate. The results indicate that a combination of both was most frequently occuring. In spite of popular convictions, family was still quite important to get in contact with politics. This is shown in (...) the high rates of respondents having politically active relatives.Next to this, a lot of political involvement occured via participation in a diversity of associations. Participations considered were membership, diligence and officeholding in a political party, a union, a health insurance organisation, an advisory body and all other political or non-political associations. (shrink)

Someone asked ‘What time is it?’ when her watch reads 3:08 is likely to answer ‘It is 3:10.’ We argue that a fundamental factor that explains such rounding is a psychological disposition to give an answer that, while not necessarily strictly truthful or accurate, is an optimally relevant one (in the sense of relevance theory) i.e. an answer from which hearers can derive the consequences they care about with minimal effort. A rounded answer is easier to process and may carry (...) the same consequences as one that is accurate to the minute. Hence rounding is often a way of optimising relevance. Three simple experiments give support and greater precision to the view that relevance is more important than strict truthfulness in verbal communication. (shrink)

Moral Constraints on War offers a principle-by-principle presentation of the transcultural roots of the ethics of war in an age defined by the increasingly international nature of military intervention.

Recent analysis of genome sequences has identified individuals that are healthy despite carrying severe disease‐associated mutations. A possible explanation is that these individuals carry a second genomic perturbation that can compensate for the detrimental effects of the disease allele, a phenomenon referred to as suppression. In model organisms, suppression interactions are generally divided into two classes: genomic suppressors which are secondary mutations in the genome that bypass a mutant phenotype, and dosage suppression interactions in which overexpression of a suppressor gene (...) rescues a mutant phenotype. Here, we describe the general properties of genomic and dosage suppression, with an emphasis on the budding yeast. We propose that suppression interactions between genetic variants are likely relevant for determining the penetrance of human traits. Consequently, an understanding of suppression mechanisms may guide the discovery of protective variants in healthy individuals that carry disease alleles, which could direct the rational design of new therapeutics. (shrink)

We define a multi-modal version of Computation Tree Logic (CTL) by extending the language with path quantifiers $E^\delta $ and $E^\delta $ where δ denotes one of finitely many dimensions, interpreted over Kripke structures with one total relation for each dimension. As expected, the logic is axiomatised by taking a copy of a CTL axiomatisation for each dimension. Completeness is proved by employing the completeness result for CTL to obtain a model along each dimension in turn. We also show that (...) the logic is decidable and that its satisfiability problem is no harder than the corresponding problem for CTL. We then demonstrate how Normative Systems can be conceived as a natural interpretation of such a multi-dimensional CTL logic. (shrink)

Peer review is a widely accepted instrument for raising the quality of science. Peer review limits the enormous unstructured influx of information and the sheer amount of dubious data, which in its absence would plunge science into chaos. In particular, peer review offers the benefit of eliminating papers that suffer from poor craftsmanship or methodological shortcomings, especially in the experimental sciences. However, we believe that peer review is not always appropriate for the evaluation of controversial hypothetical science. We argue that (...) the process of peer review can be prone to bias towards ideas that affirm the prior convictions of reviewers and against innovation and radical new ideas. Innovative hypotheses are thus highly vulnerable to being “filtered out” or made to accord with conventional wisdom by the peer review process. Consequently, having introduced peer review, the Elsevier journal Medical Hypotheses may be unable to continue its tradition as a radical journal allowing discussion of improbable or unconventional ideas. Hence we conclude by asking the publisher to consider re-introducing the system of editorial review to Medical Hypotheses. (shrink)

We define a multi-modal version of Computation Tree Logic (ctl) by extending the language with path quantifiers E δ and A δ where δ denotes one of finitely many dimensions, interpreted over Kripke structures with one total relation for each dimension. As expected, the logic is axiomatised by taking a copy of a ctl axiomatisation for each dimension. Completeness is proved by employing the completeness result for ctl to obtain a model along each dimension in turn. We also show that (...) the logic is decidable and that its satisfiability problem is no harder than the corresponding problem for ctl. We then demonstrate how Normative Systems can be conceived as a natural interpretation of such a multi-dimensional ctl logic. (shrink)

Les Journées maliotes organisées à l'École française d'Athènes les 2 et 3 novembre 2007 portaient sur l'organisation des espaces et l'exploitation des ressources, thèmes qui permettaient d'unir les approches effectuées ces dernières années selon deux échelles différentes, celle de l'agglomération et de l'urbanisme d'une part, celle de l'organisation du territoire d'autre part. Les contributions portent toutes sur des recherches en cours, dont la publication est récente ou proche. Elles sont publiées ici sous forme de résumés argumentés et reflètent fidèlement les (...) discussions qui les suivirent. (shrink)

The general question of this theoretical reflection concerns the impact of the multi-level organisation of policy processes for the division of power between collective social actors. Firstly, We deal with the shrinking of the political capacity in the contemporary era of postfordism and deterritorialisation. In this framework, attention is paid to the ideological significance of governance.Using the concept of 'jumping of scales', We then consider the different consequences of the sui generis European multi-level setting for organised labour and capital, which (...) serves as a case-study for our general proposition. Multi-level governance is looked upon as a new gestalt of scales, which enables some actors and hinders others to build their own jumping strategy between the different levels. The conclusion is that the European multi-level setting is the result of, as well as, the platform for power relations. (shrink)

The longevity of the Berlin and Kay theses results from the way in which they were formulated, contrasted with extreme relativism. Saunders & van Brakel need not reject colour opponency to reject universal colour categories. Colour opponency does not manifest itself in language, even when dealing directly with spectral colours.

Non-combatant Immunity and Irregular Warfare The Ethical Problem of Human Shields One of the basic principles of the Just War Theory is that of non-combatant immunity. Basically, this principle is about protecting the civilian population against the violence of war. Now, despite the fact that this principle is firmly ingrained in our collective moral conscience and in international humanitarian law, the truth is that the civilian population has never been really insulated from the horrors of war. Quite on the contrary. (...) This seems to be especially the case in so-called irregular warfare. In order to avoid military defeat against a stronger opponent, non-state armed movements very often use tactics that entail important risks for the civilian population. These irregular combatants hide and fight, for instance, among the civilian population or they intentionally blur the distinction between combatants and non-combatants. One of those tactics consists in using non-combatants as human shields. It goes without saying that this tactic presents a complex moral challenge for conventional troops. Should these human shields be treated like any other innocent bystanders, or should they be considered as partial combatants? And can the non-combatant immunity principle be of any moral assistance here? It is the objective of this article to shed more light on this issue. The argument will be developed in four stages. First, we will take a closer look at the principle of non-combatant immunity as it is understood within the Just War Theory. In order to see if and to what extent the principle of non-combatant immunity can be of any assistance in confronting human shields, we will conduct a first case-based analysis. Next, we aim to develop a moral continuum of paradigmatic cases of human shields, the purpose of which is to provide an instrument that will help us to formulate more nuanced moral appreciations. Finally, we will briefly look at the practical relevance of the proposed approach. (shrink)

This contribution to the MLG-debate wants to focus on the question of legitimate authority for the use of military force in the framework of international interventions. More in particular, it is the main objective of this article to verify whether the international intervention in Former Yugoslavia was characterised by a sufficient legitimate authority quality. The analysis itself will be developed in two steps. In a first step, we will describe the three main approaches to the concept of the legitimate authority (...) in the post Cold War literature. Secondly, it is our intention to apply these three legitimate authority approaches in the context of the international intervention in Former Yugoslavia. The final results of this study allow us to formulate a rather remarkable conclusion from an ethical point ofview. Due to the reluctance of the international community to use military force, the central issue concerning the legitimate authority debate no longer seems to be "who among the many candidates has the right to intervene?", but rather 'who has the duty to do so?". (shrink)