Chad A Witt, Ramsey R Hachem Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, MO, USA: The role of donor-specific antibodies to human leukocyte antigens and the burden of antibody-mediated rejection in lung transplantation remain enigmatic. Over the past several years, evidence has been emerging that humoral immunity plays an important role in the development of both acute and chronic lung allograft dysfunction. Multiple case reports and case series have (...) identified lung allograft recipients with clinical findings consistent with acute AMR. However, there is currently no widely accepted definition for AMR in lung transplantation, and this has been a significant barrier to furthering our understanding of this form of rejection. Nonetheless, the development of DSA after transplantation has consistently been identified as an independent risk factor for persistent and high-grade acute cellular rejection and CLAD. This has raised the possibility that chronic AMR may be a distinct phenotype of CLAD although evidence supporting this paradigm is still lacking. Additionally, antibodies to lung-restricted self-antigens have been associated with primary graft dysfunction early and the development of CLAD late after transplantation, and emerging evidence underscores significant interactions between autoimmunity and alloimmunity after transplantation. There is currently an active International Society for Heart and Lung Transplantation working group that is developing an operational definition for AMR in lung transplantation. This will be critical to improve our understanding of this form of rejection and conduct clinical trials to identify optimal treatment strategies. This review will summarize the literature on DSA and AMR in lung transplantation and discuss the impact of antibodies to self-antigens on lung allograft dysfunction. Keywords: antibody-mediated rejection, donor-specific antibodies, lung transplantation. (shrink)

Bradford C Bemiss, Chad A WittDepartment of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO, USA: Chronic rejection is a major cause of death after the first year following lung transplantation. Bronchiolitis obliterans is the most common pathologic finding on biopsy, characterized by fibrous granulation tissue, which obliterates the lumen of the bronchiole. Clinically, in the absence of tissue for pathology, BO syndrome refers to a progressive irreversible drop in the forced (...) expiratory volume in 1 second. Recently, a broader definition of chronic rejection, termed "chronic lung allograft dysfunction", has been used to encompass a more inclusive definition of posttransplant dysfunction. Recently, the lung transplant community has come to realize that chronic rejection may be the final common result after repetitive epithelial insults. Acute rejection, infection, and alloreactivity to mismatched HLA antigens are a few of these insults that damage the surface of the bronchioles. Recent evidence of autoimmunity to the normally hidden structural proteins collagen V and K-α1 tubulin have been correlated with a BO phenotype as well, perhaps correlating the epithelial damage with a mechanism for developing BO lesions. Many immunomodulatory medications and treatments have been studied for effectiveness for the treatment of chronic lung allograft dysfunction. New drugs, which more precisely target the immune system, are being developed and tested. Further study is required, but recent advances have improved our understanding of the pathogenesis and potential intervention for this common and deadly complication of lung transplantation.Keywords: lung transplant, bronchiolitis obliterans syndrome, rejection. (shrink)

Students in an undergraduate legal and ethical issues course continually told the authors that they did not have time to study for the course because they were busy studying for their clinical courses. Faculty became concerned that students were failing to realize the value of legal and ethical concepts as applicable to clinical practice. This led the authors to implement a transformational learning experience in which students applied legal and ethical course content in a high-fidelity human simulation (HFHS) scenario. A (...) preliminary evaluation compared the new HFHS experience with in-person and online student groups using the same case. Based on both student and faculty perceptions, the HFHS was identified as the best of the three approaches for providing a transformational learning experience regarding legal and ethical content. (shrink)

This article provides ethical guidance on using race in health research as a variable or in defining the study population. To this end, a plain, non-exhaustive checklist is provided for researchers and research ethics committees, preceded by a brief introduction on the need for justification when using race as a variable or in defining a study population, the problem of exoticism, that distinctions pertain between race, ethnicity and ancestry, the problematic naming of races, and that race does not serve well (...) as a presumed biological construct in genetic research. (shrink)

This book offers an introduction to the thought of Robert Holcot, a great and influential but often underappreciated medieval thinker. Holcot was a Dominican friar who flourished in the 1330's and produced a diverse body of work including scholastic treatises, biblical commentaries, and sermons. By viewing the whole of Holcot's corpus, John T. Slotemaker and Jeffrey C. Witt provide a comprehensive account of his thought. Challenging established characterizations of him as a skeptic or radical, they show Holcot to be (...) primarily concerned with affirming and supporting the faith of the pious believer. At times, this manifests itself as a cautious attitude toward absolutist claims about the power of natural reason. At other times Holcot reaffirms, in Anselmian fashion, the importance of rational effort in the attempt to understand and live out one's faith. Over the course of this introduction the authors unpack Holcot's views on faith and heresy, the divine nature and divine foreknowledge, the sacraments, Christ, and political philosophy. They also examine Holcot's approach to several important medieval literary genres, including the development of his unique. (shrink)

This article offers an introduction to the question of God’s omnipresence as debated within the late medieval scholastic tradition as seen through the lens of Francis of Meyronnes. In Meyronnes’s commentary on distinction 37 of Peter Lombard’s Sentences, he attempts to categorize the various ways one might prove God’s existence in all things through a four-fold classification. In following his classifications, we are able to look back at some of the historical ways earlier scholastics have attempted to prove God’s omnipresence (...) and follow some of the changes in those approaches as the tradition has developed. Likewise, Meyronnes’s fourth and final classification will point us toward the future. His fourth way—interesting and puzzling in and of itself—offers early hints of future debates about God’s omnipresence and his relationship to place that will emerge in the late 14th century and then again in the 15th, 16th, and 17th centuries. (shrink)

It is a genuine pleasure to engage with the insightful and generous comments of my colleagues. I have learned a lot from them, and I hope to continue our conversations in the future. The range of c...

In this article we conclude, via a comparison of the 19th C. scientific publications concerning the Belgian parliament and the state of parliamentological research of the day, that Belgian writers achieved an international standard. In Belgium, as elsewhere in Europe, parliamentology was pursued from the standpoint of various complementary schools of thought. Modern political history provided very detailed information about the functioning of the parliamentary institution; constitutional law investigated the juridical aspects of it ; political science transcended these juridical boundaries (...) and took account of the political aspects as well ; this method was also pursued in the field of political economy which, from a methodological point of view, can be regarded as the fundamental current of parliamentary sociology.It can be asserted that these writers are the founders of modern parliamentology despite the rather weak methodological foundation of their studies, the relative lack of empirical data-collection and the infiuenceof political commitment. As is still the case today, so also in the 19th C, the formal-juridical approach was dominant ; however, it was also insight-fully recognized that the most important problems of power lay in the mutual relations of the members of parliament themselves and in their relation to the majority, the opposition and the executive power. These studies furnish, therefore, very interesting lines of inquiry for the diachronic treatment of the majority of the problems of contemporary parliamentology. (shrink)

Michael Wedin’s Aristotle’s Theory of Substance provides an interpretation of primary substance in Metaphysics Book Z that is compatible with the ontology of the Categories. The incompatibilist position holds that primary substance in the Categories is the concrete, individual substance, like Socrates, whereas the title of primary substance in Metaphysics Z goes to the eidos, the form or the species. Hence, the ontology of the Categories is incompatible with the ontology of Metaphysics Z. One compatibilist strategy argues that the c-substance (...) remains primary substance in Metaphysics Z. Wedin takes another tack. He argues that c-substances are ontologically primary in both texts, and that Metaphysics Z introduces a new kind of priority, explanatory priority, awarded to the form of c-substances. Since c-substances and their forms are prior in different senses, the incompatibility vanishes. Wedin’s claim is stronger than mere compatibilism, however, since what forms explain are basic features of c-substances. Hence, Metaphysics Z is not only compatible with the Categories, “it is a theory about the theory of the Categories”. Wedin argues for what I call strong compatibilism. (shrink)

This volume contains the selected discourses of four seventeenth-century philosophers, carefully chosen to illustrate the tenets characteristic of the influential movement known as Cambridge Platonism. Fundamental to their beliefs is the statement most clearly voiced by Benjamin Whichcote, their leader by common consent, that the spiritual is not opposed to the rational, nor Grace to nature. Religion is based on reason, even in the presence of 'mystery'. Free will and Grace are not mutually exclusive. The editor's comprehensive introduction delineates the (...) main principles of the Cambridge Platonists, in the light of their heritage. It compares their attitude to contemporary thought, stressing their mistrust both of institutionalised religion and of the rising tide of materialism. The sermons are reprinted from the original texts and fully annotated with comparisons and references to a wide range of works. The editor also includes a useful list for further reading, biographical notes and a comprehensive index. (shrink)

As a result of the developments in science and technology, humanity began to experience a digital transformation after the 19th century. With this digital transformation, it is seen that a serious change has occurred in human beings biologically, socially, and, more specifically, religiously. One could say that different trends have emerged at many points where human relations, the relationship of the human with the environment and with God are also affected. Among the most comprehensive and prominent of these trends is (...) transhumanism because of its aims for humanity and the world. Transhumanism, which views technology as the main point of reference for the future of humanity, is also considered a cultural, social, and ideological human movement with its statements intended for society. It considers immortality as a goal, along with such claims as improving welfare, extending human life, and wiping out diseases by using technology in every aspect of human life. Transhumanists, who claim that they can achieve immortality thanks to technology, argue that this will happen in two ways. The first is biological immortality. It will be achieved by eliminating all kinds of biological factors that lead to humans aging and death. The second is digital or virtual immortality, which is achieved by transferring human consciousness from the biological body to computer interfaces and installing it in any desired entity. This perspective must be critically examined as it can be considered an attempt to challenge death, which is the basic doctrine of classical religions. In the present study, human immortality, considered the most important claim made by transhumanists, is criticized within kalām, Islamic theology. Of course, transhumanists’ account of human immortality is impossible, according to kalām. It can be said that transhumanists view of immortal human can be considered in the category of created beings, which is defined in kalām as "the being created later and needs another being in order to exist and to continue its existence". Given that transhumanists base the idea of the immortal being upon biological healing or digital transmission, it is clear that both types of beings need someone else. Therefore, one could say that it would be more reasonable to define transhumanists’ notion of immortality as the act of prolonging human life. It is because the life of immortal beings, accepted as biological or digital entities, is shaped by many factors. If these factors disappear, so does the being. On the other hand, the attribute of immortality, which belongs to the eternal being only, according to kalām, must come from itself without needing any other being. Therefore, the notion of immortal being suggested by the transhumanists must be reexamined within kalām and be redefined as the extension of life. The redefined immortality as the extension of life hardly poses kalāmī (or theological) problems. In fact, Islam encourages using all types of tools and equipment to enable humans to have a healthy and blissful life. (shrink)

This volume contains the selected discourses of four seventeenth-century philosophers, carefully chosen to illustrate the tenets characteristic of the influential movement known as Cambridge Platonism. Fundamental to their beliefs is the statement most clearly voiced by Benjamin Whichcote, their leader by common consent, that the spiritual is not opposed to the rational, nor Grace to nature. Religion is based on reason, even in the presence of 'mystery'. Free will and Grace are not mutually exclusive. The editor's comprehensive introduction delineates the (...) main principles of the Cambridge Platonists, in the light of their heritage. It compares their attitude to contemporary thought, stressing their mistrust both of institutionalised religion and of the rising tide of materialism. The sermons are reprinted from the original texts and fully annotated with comparisons and references to a wide range of works. The editor also includes a useful list for further reading, biographical notes and a comprehensive index. (shrink)

I explore the view that the imago Dei is essential to us as humans but accidental to us as persons. To image God is to resemble God, and resemblance comes in degrees. This has the straightforward—and perhaps disturbing—implication that we can be more or less human, and possibly cease to be human entirely. Hence, I call it the spectrum view. I argue that the spectrum view is complementary to the Biblical data, helps explain the empirical reality of horrendous evil, and (...) offers an elegant rapprochement between the traditional view of hell and its rivals. (shrink)

Our trust in the word of others is often dismissed as unworthy, because the illusory ideal of "autonomous knowledge" has prevailed in the debate about the nature of knowledge. Yet we are profoundly dependent on others for a vast amount of what any of us claim to know. Coady explores the nature of testimony in order to show how it might be justified as a source of knowledge, and uses the insights that he has developed to challenge certain widespread assumptions (...) in the areas of history, law, mathematics, and psychology. (shrink)

I argue that Social Trinitarians can and should conceive of God as a group person. They can by drawing on recent theories of group agency realism that show how groups can be not just agents but persons distinct from their members – albeit, I argue, persons of a different kind. They should because the resultant novel view of the Trinity – that God is three ‘intrinsicist’ persons in one ‘functional’ person – is theologically sound, effectively counters the most trenchant criticisms (...) of Social Trinitarianism, and enjoys independent theological support from the biblical notion of ‘corporate personality’. (shrink)

The issue of power has been addressed as part of human actions, which form the basis of the discussions of destiny in Islamic theology. Various schools of kalām have extensively discussed the issue of power throughout history. The locus of power is also one of the critical concerns that have been emphasized within these discussions. The schools of the Mu'tazila, al-Ashʿarī and al-Māturīdī have put forward different perspectives on whether the locus of power exists or not and where it exists (...) if it does so. Mutazilites are known to be in agreement with the view that te human body is the substrate of power. On the other hand, However, they hold different views, not only on the exact locus of power in the body but also on its type. While some argue that the locus of power in the body is the organs, others claim that it is not the organs. The schools of al-Ashʿarī and al-Māturīdī accept that there is no locus for power and emphasize that power is created by Allah the moment it would initiate action. When these views of the kalām schools are considered within the framework of the data from the modern science of anatomy, it is seen that what modern science has to say on this issue concurs well with the Mu'tazilite view that the locus of power is the body and that it creates the action by managing the organs from a single center. This is because, when considered from the lens of anatomy, what is meant by the schools of kalām with “power” is electrical activity (stimulus) that activates the muscles. Therefore, scientifically considered, for any movement to occur, an electrical activity must first begin in the brain and be transmitted to the muscles via motor nerves. If there were no electrical activity in the brain, the muscles and energy that make up the human movement system would not be active, so movement would hardly take locus. Therefore, the claim made some of the Mu'tazili scholars that the power is in the organs is scientifically not valid. As for the debates on whether the power in different organs is the same or different in terms of its type, the views of the scholars who argue that they are the same genus are apparently correct. This is because the electrical activity, which we accept as power, spreads to the organs after it is formed in the brain. This implies that the power which activates the organs is of the same type. However, it can be said that Mu'tazila’s idea of the constant presence of power in its locus conflicts with modern scientific data. The views of al-Ash'arite and al-Maturidite schools that power is free from being in a constant location are compatible with the findings of recent experiments on brain activities. That is, some experimental studies have indicated that the electrical activity that creates an act occurs in the brain before the act itself and outside the will of the human. In brief, the view of Ash'arite and Maturidite scholars that power is not constantly present in the body and that it is created by Allah each time it is needed is compatible with the creation of power, which we define as electrical activity. (shrink)

Coady explores the challenges that morality poses to politics. He confronts the complex intellectual tradition known as realism, which seems to deny any relevance of morality to politics, especially international politics. He argues that, although realism has many serious faults, it has lessons to teach us: in particular, it cautions us against the dangers of moralism in thinking about politics and particularly foreign affairs. Morality must not be confused with moralism: Coady characterizes various forms of moralism and sketches their distorting (...) influence on a realistic political morality. He seeks to restore the concept of ideals to an important place in philosophical discussion, and to give it a particular pertinence in the discussion of politics. He deals with the fashionable idea of "dirty hands," according to which good politics will necessarily involve some degree of moral taint or corruption. Finally, he examines the controversial issue of the role of lying and deception in politics. Along the way Coady offers illuminating discussion of historical and current political controversies. This lucid book will provoke and stimulate anyone interested in the interface of morality and politics. (shrink)

THE MOST SACRED FREEDOM includes eight essays that were first presented at the 2014 A.V. Elliott Conference on Great Books and Ideas, the seventh annual conference sponsored by Mercer Universitys Thomas C. and Ramona E. McDonald Center for Americas Founding Principles. Together, these essays explore the great principle of religious liberty by charting its development in the Western tradition and reconsidering its place at Americas founding. The book begins with a comparison between the flood accounts in Genesis and the Mesopotamian (...) Atra-Has's and advances all the way to the 2014 Supreme Court case Burwell v. Hobby Lobby. The intervening chapters examine the contributions of figures such as Emperor Julian, Roger Williams, Cecilius Calvert, John Locke, Jean-Jacques Rousseau, and the American Founders. Contributors to the volume are Steven Grosby, Jeremiah H. Russell, Maura Jane Farrelly, Daniel Cullen, John Witte, Jr., Scott Yenor, David Ramsey, and Michael Novak. (shrink)

The basis of Muslim philosophy and science is the instruction embedded in the Quran. At an early date this tradition was enlarged and strengthened by the infiltration into Muslim culture of Greek philosophy and science through the translation of Greek classics by Muslims. The Indian tradition of thought also made its contribution. This book traces the development and interaction of these strands in Muslim thinking. The author is concerned to show both how philosophy and science are related to specifically religious (...) thought, and how they have made distinctive contributions to method and discovery. (shrink)

Political violence in the form of wars, insurgencies, terrorism and violent rebellion constitutes a major human challenge. C. A. J. Coady brings a philosophical and ethical perspective as he places the problems of war and political violence in the frame of reflective ethics. In this book, Coady re-examines a range of urgent problems pertinent to political violence against the background of a contemporary approach to just war thinking. The problems examined include: the right to make war and conduct war, terrorism, (...) revolution, humanitarianism, mercenary warriors, the ideal of peace and the right way to end war. Coady attempts to vindicate the contemporary relevance of the just war tradition to current problems without applying the tradition in a merely mechanical or uncritical fashion. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 41.2 (2003) 276-277 [Access article in PDF] Wiep Van Bunge. From Stevin to Spinoza: An Essay on Philosophy in the Seventeenth-Century Dutch Republic. Leiden: Brill, 2001. Pp. xii + 217. Cloth, $80.00 By 1660 there were probably more followers of Descartes in the Dutch Republic, population 1.4 million, than in France, population 20 million. Protestantism and prosperity encouraged high rates of literacy and (...) the universities of Leiden and Utrecht were among the liveliest in the world. This vibrancy infused the metaphors that Descartes put into his great Discours de la methode published first in Leiden in 1637. In it he spoke about the beauty of cities that looked as if they had been built by a single architect and of the freedom to be found among people so busy with their business as to leave thinkers to their pursuits. Indirectly he spoke about his adopted homeland where he found many followers—some more eager than loyal. By the 1640s disputes raged in the Republic and the anti-Cartesian forces were led by the Aristotelian and anti-Copernican Gisbertus Voetius. What has been missing in our scholarship up to now has been any convincing account as to why these disputes occurred, and how they resonated within the Dutch context. Wiep Van Bunge's book takes a big step toward closing that knowledge gap.Van Bunge convincingly argues that the vibrancy of the stadtholder-less period up to 1672 produced a willingness to entertain new ideas. It also did not hurt to have Descartes on the scene and active on behalf of his mechanical philosophy, even to the point of addressing the Utrecht magistrates publicly and asking that his critics be chastised. What is remarkable—especially given the resistance to Descartes seen at Oxford and Cambridge—was the speed with which Cartesian ideas entered the Dutch classrooms where as many as a third of the students came from abroad. Again Van Bunge provides context when he starts with the Dutch engineer Simon Stevin and demonstrates the vitality of mathematics for a commercial society but also for a militant one. (The Netherlands was at war with Spain up to 1609.) A recent exhibition at the J. Paul Getty Museum in Los Angeles, April to July 2002, also illustrates another aspect of mathematics in the Republic. Precisely in the 1630s when Descartes was putting the finishing touches on his Discours, Pieter Saenredam applied geometry to the interiors of the elegant Utrecht churches so as to give his paintings a regularity and precision worthy of the Cartesian dream of order and clarity. The Dutch commitment to discipline and order also made their army one of the most accomplished in the world. It was perhaps over-determined that Descartes, who had trained with it, would find such a sympathetic audience in the Republic.One of the more fascinating aspects of Van Bunge's detailed study, first of Cartesianism and then of Spinozism in the Republic, concerns the political and ideological meanings to be extracted from the new philosophy. Hobbes also finds a place in the narrative, surprisingly taken up by republicans eager to construct a state that could control the passions. Abraham van Berkel, who put Hobbes's Leviathan into Dutch in 1667, gave the allegiance of his text and himself to Jan de Witt and the cause of the regents and the estates. We can only wonder what Hobbes would have made of the association. The republican affiliations of the mechanical philosophy in the Republic provide a distinctively Dutch context to the [End Page 276] political writings of Spinoza, the most famous and outrageous Cartesian of the century. Van Bunge is especially deft in finding Spinozists and providing far more evidence than I could back in 1981 when I argued for a radical enlightenment within the late seventeenth-century Dutch context (see The Radical Enlightenment. Pantheists, Freemasons and Republicans [London: 1981]). None of these positions with their deeply heretical implications could be taken lightly or without danger. Men lost... (shrink)

In the past thirty years, two fundamental issues have emerged in the philosophy of science. One concerns the appropriate attitude we should take towards scientific theories--whether we should regard them as true or merely empirically adequate, for example. The other concerns the nature of scientific theories and models and how these might best be represented. In this ambitious book, da Costa and French bring these two issues together by arguing that theories and models should be regarded as partially rather than (...) wholly true. They adopt a framework that sheds new light on issues to do with belief, theory acceptance, and the realism-antirealism debate. The new machinery of "partial structures" that they develop offers a new perspective from which to view the nature of scientific models and their heuristic development. Their conclusions will be of wide interest to philosophers and historians of science. (shrink)

While people’s lives continue to be put at risk by the dearth of organs available for transplantation, we must give urgent consideration to any option that may make up the shortfall. A market in organs from living donors is one such option. The market should be ethically supportable, and have built into it, for example, safeguards against wrongful exploitation. This can be accomplished by establishing a single purchaser system within a confined marketplace.Statistics can be dehumanising. The following numbers, however, have (...) more impact than most: as of 24th November, during 2002 in the United Kingdom, 667 people have donated organs, 2055 people have received transplants, and 5615 people are still awaiting transplants.1 It is difficult to estimate how many people die prematurely for want of donor organs. “In the world as a whole there are an estimated 700 000 patients on dialysis . . . . In India alone 100 000 new patients present with kidney failure each year”2 . Almost “three million Americans suffer from congestive heart failure . . . deaths related to this condition are estimated at 250 000 each year . . . …. (shrink)

First published in 2002. Routledge is an imprint of Taylor & Francis, an informa company.