The development of gene expression profiling and next-generation sequencing technologies have steered oncogenomics to the forefront of precision medicine. This created a need for harmonious cooperation between clinicians and researchers to increase access to precision oncology, despite multiple implementation challenges being encountered. The aim is to apply personalised treatment strategies early in cancer management, targeting tumour subtypes and actionable gene variants within the individual’s broader clinical risk profile and wellbeing. A knowledge-generating database linked to the South African Medical Research Council’s (...) Genomic Centre has been created for the application of personalised medicine, using an integrated service and research approach. Insights gained from patient experiences related to tumour heterogeneity, access to targeted therapies and incidental findings of pathogenic germline variants in tumour DNA, provided practice-changing evidence for the implementation of a cost-minimisation pathology-supported genetic testing strategy. Integrating clinical care with genomic research through data sharing advances personalised medicine and maximises precision oncology benefits. (shrink)

In this article the authors seek to conceptualize a dynamic and inclusive understanding of personal identity within multicultural democracies such as South Africa, which will draw on both the liberal and communitarian traditions' respect for the project of self. A preliminary lay out for such a project emerges from a literature survey of recent, primarily South African publications on identity and culture, and it suggests that selfhood depends on: a) virtues, cultivated within cooperative communities which allow for effective freedom; b) (...) a venture into existential uncertainty, which alleviates that fear of loss of identity that is supposedly central to many multicultural conflicts; c) the hermeneutic construction of identity through narratives that allow for a plurality of voices; and d) the creative transcending and re- interpretation of values and traditions. The authors contend that such an under standing of identity goes some way towards addressing the question of the way that diverse personal and group identities are to be accommodated in South Africa's multicultural democracy, and to re thinking the unity which underlies diversity without resorting to liberalism's reduction of personal identity to rational autonomy. S. Afr. J. Philos. Vol.20(3) 2001: 35-54. (shrink)

Plants belonging to the genus Salsola (Family: Chenopodiaceae) are common in the arid and semiarid regions of our planet with no less than 69 different Salsola species found in Namibia and the Republic of South Africa. This genus is used as a traditional medicine and aqueous extracts of Salsola have been used by Bushmen women as an oral contraceptive. Ingestion of the Namibian shrub Salsola tuberculatiformis Botsch. by pregnant Karakul sheep leads to prolonged gestation and fetal post‐maturity and, as a (...) result, the pelts of the new‐born karakul lambs are worthless. This initiated an investigation into the active agents in the plant, using the terminal enzyme in adrenal corticosteroidogenesis, cytochrome P450‐dependent 11β‐hydroxylase (P450c11), as a bioassay. Although the active fraction, S2, was extremely labile, partial structure determination suggested the presence of synephrine and a highly reactive aziridine. Therefore a more stable analogue, 2‐(4‐acetoxyphenyl)2‐chloro‐N‐methylethylammonium‐chloride (compound A), was synthesised, which, like the active plant extracts, inhibited adrenal steroidogenesis and acted as a contraceptive. In addition, compound A was stabilised by interaction with steroid‐binding globulins in plasma thus enhancing biological activity in vivo. These findings provided explanations for the complex biological effects of the shrub as well as a new insight into the mode of action of chemically labile plant products in vivo. BioEssays 25:612–619, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

A study is made of the dominant terms of an earlier model-based formula describing the dispersion energy of axially symmetric interacting molecules. The existence of mixed-pole eighth-order terms is noted.

The incarnation of the missio Dei practice model for the Dutch Reformed Church of Africa. The decline of the church in the West is of great concern to many today. The Netherdutch Reformed Church of Africa (NRCA), experiences the same tendency. We are living in a time when survival is on the mind of most mainline congregations and denominations. The question is what shall we do to turn this situation around? The answer is to be found in the rediscovery of (...) what it means for the church to be missional. The knowledge about how the early church functioned helps us to rediscover the character of early Christian mission, much of what is drawn together in the concept of incarnational mission. This article examines incarnational mission as the understanding and practise of Christian witness that is rooted in and shaped by the life, ministry, suffering, death and resurrection of Jesus. Understanding mission incarnationally in this manner is an integrative way to approach the church’s missionary vocation and to avoid the typical Western reduction of mission to one of the many programms of the church. The article, by exploring the meaning of incarnational mission, endeavours to be both constructive with regard to the biblical and theological understanding of the message, and polemical with regard to the context and history of mission, especially in the Western tradition. This article follows Darrell Guder in arguing that the historical ‘happenedness’ of Jesus’ life both enables and defines Christian witness. In exploring the missional ignificance of the incarnation, the article tries to avoid any dilution of the centrality of the incarnation event. (shrink)

OBJECTIVES: To identify the factors that influence the assessment of reported cases of physician-assisted death by members of the public prosecution. DESIGN/SETTING: At the beginning of 1996, during verbal interviews, 12 short case-descriptions were presented to a representative group of 47 members of the public prosecution in the Netherlands. RESULTS: Assessment varied considerably between respondents. Some respondents made more "lenient" assessments than others. Characteristics of the respondents, such as function, personal-life philosophy and age, were not related to the assessment. Case (...) characteristics, i.e. the presence of an explicit request, life expectancy and the type of suffering, strongly influenced the assessment. Of these characteristics, the presence or absence of an explicit request was the most important determinant of the decision whether or not to hold an inquest. CONCLUSIONS: Although the presence of an explicit request, life expectancy and the type of suffering each influenced the assessment, each individual assessment was dependent on the assessor. The resulting danger of legal inequality and legal uncertainty, particularly in complicated cases, should be kept to a minimum by the introduction of some form of protocol and consultation in doubtful or boundary cases. The notification procedure already promotes a certain degree of uniformity in the prosecution policy. (shrink)

This article summarises and comments on the book Studies in Matthew’s Gospel: Literary design, intertextuality, and social setting, by Wim Weren, published during 2014. The essence of this book is all about meaning: the meaning of a structure, texts, and consequently the understanding of the Gospel of Matthew. For Weren, ‘Meaning is the result of the interplay between a textual unit and such other factors as language, literary context, and cultural setting’. This relates to the three parts of the content (...) of this monograph. His approach in studying Matthew comes from three perspectives: firstly intratextuality, then intertextuality, and finally extratextuality. He has deliberately chosen this order of successive steps so that they complement each other. (shrink)

Research on social influences often distinguishes between social and quality incentives to ascribe meaning to the value that popularity conveys. This study examines the neural correlates of those incentives through which popularity influences preferences. This research reports an functional magnetic resonance imaging experiment and a behavioral task in which respondents evaluated popular products with three focus perspectives; unspecified focus, focus on social aspects, and focus on quality. The results show that value derived with a social focus reflects inferences of approval (...) and reward value, and positively affects preferences. Value derived with a quality focus reflects inferences of quality and negatively affects preferences. This study provides evidence of two distinct inferential routes on both a neurological level, represented by different regions in the brain, and a behavioral level. These results provide the first evidence that a single popularity cue can in different ways influence the value derived from product popularity. (shrink)

Health care professionals often face moral dilemmas. Not dealing constructively with moral dilemmas can cause moral distress and can negatively affect the quality of care. Little research has been documented with methodologies meant to support professionals in care for the homeless in dealing with their dilemmas. Moral case deliberation is a method for systematic reflection on moral dilemmas and is increasingly being used as ethics support for professionals in various health-care domains. This study deals with the question: What is the (...) contribution of MCD in helping professionals in an institution for care for the homeless to deal with their moral dilemmas? A mixed-methods responsive evaluation design was used to answer the research question. Five teams of professionals from a Dutch care institution for the homeless participated in MCD three times. Professionals in care for the homeless value MCD positively. They report that MCD helped them to identify the moral dilemma/question, and that they learned from other people’s perspectives while reflecting and deliberating on the values at stake in the dilemma or moral question. They became aware of the moral dimension of moral dilemmas, of related norms and values, of other perspectives, and learned to formulate a moral standpoint. Some experienced the influence of MCD in the way they dealt with moral dilemmas in daily practice. Half of the professionals expect MCD will influence the way they deal with moral dilemmas in the future. Most of them were in favour of further implementation of MCD in their organization. (shrink)

Der ungarische Philosoph Melchior (Menyhert) Palägyi hatte niemals eine unmittelbare Kritik der Meinongschen Philosophie verfaßt; 1902 erwog er sogar die Möglichkeit, sich bei Meinong zu habilitieren. Dennoch ist die Gegenstandstheorie Meinongs durch die von Palägyi aufgebaute, sprachphilosophisch begründete Widerlegung des logischen Objektivismus eines Bolzano oder Husseri an sich zweifellos ebenfalls berührt. Palägyis Kritik an dem modernen Piatonismus, durch Herder, Max Müller und vermutlich Nietzsche beeinflußt, die bezüglichen Argumente des späteren Wittgenstein und von Eric Havelock in gar mancher Hinsicht vorwegnehmend, ist (...) weitgehend unbekannt und unbeachtet geblieben. Indem der Aufsatz die Prinzipien dieser Kritik nun eben auf die Gegenstandstheorie anwendet, sollen gewisse grundsätzliche Züge der Meinongschen Begriffsbildung in einer geschichtlich angemessenen Weise kritisch beleuchtet werden. (shrink)

Der ungarische Philosoph Melchior (Menyhert) Palägyi hatte niemals eine unmittelbare Kritik der Meinongschen Philosophie verfaßt; 1902 erwog er sogar die Möglichkeit, sich bei Meinong zu habilitieren. Dennoch ist die Gegenstandstheorie Meinongs durch die von Palägyi aufgebaute, sprachphilosophisch begründete Widerlegung des logischen Objektivismus eines Bolzano oder Husseri an sich zweifellos ebenfalls berührt. Palägyis Kritik an dem modernen Piatonismus, durch Herder, Max Müller und vermutlich Nietzsche beeinflußt, die bezüglichen Argumente des späteren Wittgenstein und von Eric Havelock in gar mancher Hinsicht vorwegnehmend, ist (...) weitgehend unbekannt und unbeachtet geblieben. Indem der Aufsatz die Prinzipien dieser Kritik nun eben auf die Gegenstandstheorie anwendet, sollen gewisse grundsätzliche Züge der Meinongschen Begriffsbildung in einer geschichtlich angemessenen Weise kritisch beleuchtet werden. (shrink)

Der Aufsatz schildert den platonisierenden Antipsychologismus welchen Bolzano, der junge Brentano, Twardowski, Meinong, der Husserl der Logischen Untersuchungen, Frege, der Russell der Jahrhundertwende und der junge Wittgenstein philosophisch vertraten, und versucht eine soziologische und ideologiekritische Interpretation sowohl dieser Einstellung als auch derjenigen des traditionellen Psychologismus des achtzehnten Jahrhunderts. Der Platonismus des neunzehnten und zwanzigsten Jahrhunderts wird als ein Ausdruck fiir ? oder vielmehr als eine Reaktion gegen ? den Verfall der klassischen burgerlichen Werte aufgefaBt. In Wittgensteins Tractatus spielen Elemente sowohl (...) eines platonisierenden Antipsychologismus wie auch eines relativistischen, verhaltensphanomenologisch orientierten Antipsychologismus eine Rolle: dieses Werk wird also als eine grelle Manifestation des Uberganges von der klassischen zur spatbiirgerlichen Weltanschauung, als ein Obergang vom Glauben an ewige Wahrheiten zur Hinnahme einer Gebrauchs?Theorie der Bedeutung und deren Konsequenzen interpretiert. (shrink)

Family carers of individual’s living with Huntington’s Disease (HD) manage a distinct and unique series of difficulties arising from the complex nature of HD. This paper presents the validation of the definitive measure of quality of life for this group. The Huntington’s Disease Quality of Life Battery for carers (HDQoL-C) was expanded and then administered to an international sample of 1716 partners and family carers from 13 countries. In terms of the psychometric properties of the tool, exploratory analysis of half (...) of the sample, demonstrated good internal consistency and reliability. Some items on the full version did not meet psychometric thresholds and a short version (HDQoL-Cs) was developed based on more stringent criteria. Confirmatory Factor Analysis of the model structure showed a good fit for all Factors and, indicated that the HDQoL-C and HDQoL-Cs are psychometrically robust measures of quality of life. We found that carers who lived with and looked after their spouse/partner had reduced sense of coping, hope for the future and overall quality of life. Carers with children who were at risk, carried the gene or were symptomatic also had poorer quality of life outcomes. Findings indicated the HDQoL-C and HDQoL-Cs are valid in multiple languages and across varied cultures as measures of self-reported quality of life in family carers of individual’s living with HD. These psychometrically validated tools can aid and guide the implementation of therapeutic interventions to improve life quality in this population. (shrink)

Der Aufsatz schildert den platonisierenden Antipsychologismus welchen Bolzano, der junge Brentano, Twardowski, Meinong, der Husserl der Logischen Untersuchungen, Frege, der Russell der Jahrhundertwende und der junge Wittgenstein philosophisch vertraten, und versucht eine soziologische und ideologiekritische Interpretation sowohl dieser Einstellung als auch derjenigen des traditionellen Psychologismus des achtzehnten Jahrhunderts. Der Platonismus des neunzehnten und zwanzigsten Jahrhunderts wird als ein Ausdruck fiir - oder vielmehr als eine Reaktion gegen - den Verfall der klassischen burgerlichen Werte aufgefaBt. In Wittgensteins Tractatus spielen Elemente sowohl (...) eines platonisierenden Antipsychologismus wie auch eines relativistischen, verhaltensphanomenologisch orientierten Antipsychologismus eine Rolle: dieses Werk wird also als eine grelle Manifestation des Uberganges von der klassischen zur spatbiirgerlichen Weltanschauung, als ein Obergang vom Glauben an ewige Wahrheiten zur Hinnahme einer Gebrauchs-Theorie der Bedeutung und deren Konsequenzen interpretiert. (shrink)

We performed an EEG graph analysis on data from 31 typical readers and 24 dyslexics, recorded while they were engaged in an audiovisual task and during resting-state. The task simulates reading acquisition as participants learned new letter-sound mappings via feedback. EEG data was filtered for the delta, theta, alpha, and beta bands. We computed the Phase Lag Index to provide an estimate of the functional connectivity between all pairs of electrodes per band. Then, networks were constructed using a Minimum Spanning (...) Tree, a unique sub-graph connecting all nodes without loops, aimed at minimizing bias in between groups and conditions comparisons. Both groups showed a comparable accuracy increase during task blocks, indicating that they correctly learned the new associations. The EEG results revealed lower task-specific theta connectivity, and lower theta degree correlation over both rest and task recordings, indicating less network integration in dyslexics compared to typical readers. This pattern suggests a role of theta oscillations in dyslexia and may reflect differences in task engagement between the groups, although robust correlations between MST metrics and performance indices were lacking. (shrink)

BackgroundPregnant people have been overlooked or excluded from clinical research, resulting in a lack of scientific knowledge on medication safety and efficacy during pregnancy. Thus far, both the opportunities to generate evidence-based knowledge beyond clinical trials and the role of pregnant people in changing their status quo have not been discussed. Some scholars have argued that for rare disease patients, for whom, just like pregnant people, a poor evidence base exists regarding treatments, solidarity has played an important role in addressing (...) the evidence gap. This paper explores whether and how the enactment of solidarity among pregnant people can be stimulated to help address the poor evidence base on medications used during pregnancy.MethodWe use the concept of solidarity formulated by Prainsack and Buyx and enrich their concept by providing an account for stimulating the enactment of solidarity. Then we apply this account to the case of pregnant people who use medication.ResultsSolidarity means enacted commitment on the part of an individual to assisting others with whom the person recognizes a similarity in a relevant respect. Although solidarity cannot be imposed, we argue that the empowerment of people is a crucial concept in understanding how solidarity can be stimulated. Empowerment in the context of pregnant people means creating awareness about their status quo, explaining how scientific research can help close the knowledge gap, and how pregnant people can themselves contribute. In particular, how pregnant people can contribute to the collection of health data to strengthen the evidence base for medications used during pregnancy.ConclusionsWe conclude that acting in solidarity can help change the status quo for pregnant people. Furthermore, we argue that the empowerment of pregnant people and other relevant stakeholders is a way to stimulate the enactment of solidarity. The process of empowerment starts by raising awareness about the lack of evidence on medications used during prengnacy and by explaining to pregnant people how they can contribute to changing the way knowledge is being generated by, for example, sharing data on the health effects of medications. (shrink)

Society’s relationship with modern animal farming is an ambivalent one: on the one hand there is rising criticism about modern animal farming; on the other hand people appreciate certain aspects of it, such as increased food safety and low food prices. This ambivalence reflects the two faces of modernity: the negative (exploitation of nature and loss of traditions) and the positive (progress, convenience, and efficiency). This article draws on a national survey carried out in the Netherlands that aimed at gaining (...) a deeper understanding about the acceptance of modern dairy farming in Dutch society. People take two dimensions into account when evaluating different aspects of modern dairy farming: (1) the way living beings are used for production and (2) the way a dairy farm functions as a business. In both these dimensions people appeared to adopt cautious opinions: most people preferred relatively traditional and natural farms and were concerned about the use of nature and treatment of animals in modern production—although this did not imply an outright rejection of modern animal farming. The study also looked for (and sought to explain) differences of opinion between social groups. Besides socio-demographic factors such as age and gender, farming experience and value-orientation (such as socially minded and professional) appeared to be important variables. The values and convictions within modern society can help to explain why some people are greatly concerned about animal welfare while some show less concern. This diversity also helps to explain why general information campaigns are quite ineffective in allaying concerns about modern animal farming. (shrink)

Moral case deliberation (MCD) is a specific form of clinical ethics, aiming to stimulate ethical reflection in daily practice in order to improve the quality of care. This article focuses on the implementation of MCD in nursing homes and the questions how and where to organize MCD. The purpose of this study was to evaluate one way of organizing MCD in two Dutch nursing homes. In both of these nursing homes the MCD groups had a heterogeneous composition and were organized (...) apart from existing institutional communication structures. As part of a naturalistic evaluation, systematic observations, interviews and focus groups were completed. The findings indicate that the heterogeneous composition and MCD meetings separate from existing structures have benefits. However, the participants also reported negative experiences. This gives rise to the question whether a mixed MCD group which meets separately is an effective way to embed MCD as an instrument for reflection on moral issues in daily practice. We conclude that there is no single answer to that question. In the end, the two implementation strategies (i.e. within existing communication structures and a mixed MCD group) can be complementary to each other. (shrink)

As we owe the division of ecology into autecology and synecology to botanists, the arguments for this subdivision and also the definitions and contents of both subsciences as given bySchröter, Flahault &Schröter, Gams andDu Rietz are communicated in full. The same is the case with the division of ecology given by the zoologistsAdams andChapman. Moreover the opinions of these authors in this respect are critisized in detail as well as in their general aspects. This critique is connected with the author's (...) own positive opinion, which is given at the end of the paper, where also the remarks covered by the first two papers of this series are summarised.In ecology as a biological science either the individual or the complex of individuals has to occupy a central position. Therefore science about the environment, especially the abiotic one, as well as science about a definite region or spot of the earth ought not to be incorporated in biology.In autecology the individual occupies a central position, it is one of the subsciences of idiobiology, it is a science about the relations to environment, taken in the broadest sense. Dependent upon the contents of this we have many definitions of ecology, the most important ones being: 1) ecology is a biogeographical subscience; 2) ecology is taken in the sense of ethology; 3) ecology is taken as a science of the teleological relations of the individual to its environment and the objects in it, thus of the non-causal relations, the causal ones being assigned to physiology. These non-causal relations appear under four aspects, all called teleological, i.e. the true purpose-notion, relation in the sense of requirement, that in the sense of wholeness, and of adaptation and the degree of adaptation. Adaptation is taken in a broad sense, covering as well the degree of adaptation , as the latitude of the possibility of adaptation and the degree of variability of the individual to adapt itself. The proposal is made to confine the term autecology to this teleological aspect of the relations of the individual, i.e. of all its characters, not of the epharmonic ones only, to environment.In synecology the complex of individuals, showing direct real connections during individual life, occupies a central position, with equal scientific interest for all members of the complex. Synecology contains all biological scientific contents about this matter. The application ofTschulok's system of subsciences to synecology is critisized and the development of the system of these subsciences is left to its developmental fate in time. Considering the importance of the knowledge of the tendencies of thought for the development of synecology an attempt is made to state those already applied in synecology; author distinguishes the systematical, the mathematical, the causal, the historical, the teleological and the essential tendency of thought. Also the difference in the tendencies of thought shows that autecology and synecology are to be separated in a logical system of biological subsciences.Puisque c'est aux botanistes que nous devons la division de l'écologie en autécologie et synécologie, l'auteur passe en revue tous les arguments qui ont amené les biologistes à faire cette subdivision, ainsi que les définitions de ces deux subsciences et les matières qu'elles comprennent, comme elles sont données parSchröter, Flahault &Schröter, Gams etdu Rietz. Il en fait de même pour la division de l'écologie faite par les zoologistesAdams etChapman. En outre il discute les opinions de ces auteurs sous ce rapport, dans leurs détails aussi bien que dans leurs aspects généraux. Cette discussion est en rapport avec l'opinion positive de l'auteur, qu'il expose à la fin de l'article, où se trouvent résumées également les remarques qui se trouvaient déjà dans les deux premiers articles de cette série.Dans l'écologie, en tant que science biologique, l'individu — ou bien l'ensemble des individus — doit occuper une position centrale. C'est pourquoi ni la science qui concerne le milieu, en particulier le milieu abiotique, ni la science qui se rapporte à une région ou un endroit défini de la terre, ne devrait être incorporée dans la biologie.Dans l'autécologie l'individu occupe une position centrale. Cette science est une des subsciences de l'idiobiologie; elle se rapporte aux relations entre le sujet et son milieu — „milieu” pris dans le sens le plus large du mot. Selon les significations diverses qu'on peut attacher aux termes „relations” et „milieu”, nous avons plusieurs définitions de l'écologie, parmi lesquelles les plus importantes suivent ci-dessous:1)L'écologie est une subscience biogéographique; 2) le terme „écologie” est pris dans le sens d'éthologie; 3) l'écologie est considérée comme la science des relations téléologiques entre l'individu et son milieu et les objets se trouvant dans ce milieu; elle est donc considérée comme la science des relations non-causales, les relations causales étant conférées à la physiologie. Ces relations non-causales se présentent sous quatre aspects, tous appelés téléologiques, c. à. d. la vraie notion de but, les relations dans le sens de besoins, les relations dans le sens de „tout” et les relations dans le sens d'adaptation et de degré d'adaptation.Le mot „adaptation” est pris dans un sens étendu, comprenant aussi bien le degré d'adaptation que l'amplitude de la possibilité d'adaptation et le degré de variabilité dans l'adaptation de l'individu à son milieu. L'auteur propose de restreindre le terme „autécologie” à cet aspect téléologique des relations entre l'individu et son milieu; il s'agit ici, bien entendu, de toutes les qualités de l'individu et non seulement des qualités epharmoniques.Dans la synécologie l'ensemble des individus montrant des rapports directs et réels durant la vie individuelle occupe une position centrale et offre un intérêt scientifique pareil pour tous les membres de l'ensemble. La synécologie comprend tout ce qu'il y a à dire sur cette matière par rapport à la science biologique. L'application du système des subsciences deTschulok à la synécologie est critiquée par l'auteur, qui juge prématuré de s'occuper déjà d'un tel système de subsciences: l'avenir seul nous apprendra quel système se développera ici. Vu l'importance d'une connaissance exacte des différentes tendances de penser pour le développement de la synécologie, l'auteur s'efforce de rassembler celles qui ont déjà été appliquées dans la synécologie; il distingue les tendances de penser systématique, mathématique, causale, historique, téléologique et essentielle . En outre les différences entre ces tendances de penser démontrent, que l'autécologie et la synécologie doivent être séparées dans un système logique de subsciences biologiques. (shrink)

The participation of vulnerable patients in clinical research poses apparent ethical dilemmas. Depending on the nature of the vulnerability, their participation may challenge the ethical principles of autonomy, non-maleficence, or justice. On the other hand, non-participation may preclude the building of a knowledge base that is a prerequisite for defining the optimal clinical management of vulnerable patients. Such clinical uncertainty may also incur substantial economic costs. We present the participation of pre-menopausal women with atrial fibrillation in trials of novel oral (...) anticoagulant drugs as a case study. Due to their non-participation in pivotal trials, it is uncertain whether for them, the risks that are associated with these drugs are outweighed by the advantages compared with conventional treatment. We addressed the question whether research of this new class of drugs in this subgroup would be appropriate from both, an ethical as well an economic perspective. We used the method of specifying norms as a wider framework to resolve the apparent ethical dilemma, while incorporating the question whether research of oral anticoagulants in premenopausal women with atrial fibrillation can be justified on economic grounds. For the latter, the results of a value-of-information analysis were used. Further clinical research on NOACs in premenopausal women with atrial fibrillation can be justified on both, ethical and economic grounds. Addressing apparent ethical dilemmas by invoking a method such as specifying norms can improve the quality of public practical reasoning. As such, the method should also prove valuable to committees that have formally been granted the authority to review trial protocols and proposals for scientific research. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

Introduction: The Dutch Euthanasia Act states that euthanasia is not punishable if the attending physician acts in accordance with the statutory due care criteria. These criteria hold that: there should be a voluntary and well-considered request, the patient’s suffering should be unbearable and hopeless, the patient should be informed about their situation, there are no reasonable alternatives, an independent physician should be consulted, and the method should be medically and technically appropriate. This study investigates whether physicians experience problems with these (...) criteria in medical practice.Methods: In 2006, questionnaires were sent to a random, stratified sample of 2100 Dutch physicians . Physicians were asked about problems in their decision-making related to requests for euthanasia or assisted suicide after enforcement of the 2002 Euthanasia Act.Results: Of all physicians who had received a request for euthanasia or assisted suicide , 25% had experienced problems in the decision-making with regard to at least one of the criteria of due care. Physicians who had experienced problems mostly indicated to have had problems related to evaluating whether or not the patient’s suffering was unbearable and hopeless and whether or not the patient’s request was voluntary or well considered .Discussion: Physicians in The Netherlands most frequently reported problems related to aspects in which they have to evaluate the patient’s subjective perspective. However, it can be questioned whether placing emphasis on these subjective aspects is an adequate fulfilment of the duties imposed on physicians, as laid down in the Dutch Euthanasia Act. (shrink)

Colour has been shown to facilitate the recognition of scene images, but only when these images contain natural scenes, for which colour is ‘diagnostic’. Here we investigate whether colour can also facilitate memory for scene images, and whether this would hold for natural scenes in particular. In the first experiment participants first studied a set of colour and greyscale natural and man-made scene images. Next, the same images were presented, randomly mixed with a different set. Participants were asked to indicate (...) whether they had seen the images during the study phase. Surprisingly, performance was better for greyscale than for coloured images, and this difference is due to the higher false alarm rate for both natural and man-made coloured scenes. We hypothesized that this increase in false alarm rate was due to a shift from scrutinizing details of the image to recognition of the gist of the image. A second experiment, utilizing images without a nameable gist, confirmed this hypothesis as participants now performed equally on greyscale and coloured images. In the final experiment we specifically targeted the more detail-based perception and recognition for greyscale images versus the more gist-based perception and recognition for coloured images with a change detection paradigm. The results show that changes to images are detected faster when image-pairs were presented in greyscale than in colour. This counterintuitive result held for both natural and man-made scenes and thus corroborates the shift from more detailed processing of images in greyscale to more gist-based processing of coloured images. (shrink)

Two decades of research on euthanasia in the Netherlands have resulted into clear insights in the frequency and characteristics of euthanasia and other medical end-of-life decisions in the Netherlands. These empirical studies have contributed to the quality of the public debate, and to the regulating and public control of euthanasia and physician-assisted suicide. No slippery slope seems to have occurred. Physicians seem to adhere to the criteria for due care in the large majority of cases. Further, it has been shown (...) that the majority of physicians think that the euthanasia Act has improved their legal certainty and contributes to the carefulness of life-terminating acts. In 2005, eighty percent of the euthanasia cases were reported to the review committees. Thus, the transparency envisaged by the Act still does not extend to all cases. Unreported cases almost all involve the use of opioids, and are not considered to be euthanasia by physicians. More education and debate is needed to disentangle in these situations which acts should be regarded as euthanasia and which should not. Medical end-of-life decision-making is a crucial part of end-of-life care. It should therefore be given continuous attention in health care policy and medical training. Systematic periodic research is crucial for enhancing our understanding of end-of-life care in modern medicine, in which the pursuit of a good quality of dying is nowadays widely recognized as an important goal, in addition to the traditional goals such as curing diseases and prolonging life. (shrink)

Three arguments are given to show that neural constructivism lacks an essential ingredient to explain cognitive development. Based on results in the theory of adaptive signal analysis, adaptive biological pattern information and self-organization in nonlinear systems of information processing, it is concluded that neural constructivism should be further extended to accommodate the occurrence of phase transitions generating qualitative development in the sense of Piaget.

Some alethic pluralists maintain that there are two kinds of truths operant in our alethic discourse: a realist kind and an anti-realist kind. In this paper, we argue that such a binary conception cannot accommodate certain social truths, specifically truths about race. Most alethic pluralists surprisingly overlook the status of racial truths. Douglas Edwards is, however, an exception. In his version of alethic pluralism—Determination Pluralism—racial truths are superassertible (anti-realist) true rather than correspondence (realist) true. We argue that racial truths exhibit (...) features of both superassertibility (anti-realism) and correspondence (realism). This suggests a fuzzy boundary between realist and anti-realist kinds of truth. There may be a continuum rather than a dichotomy of truths. We conclude by sketching one way for alethic pluralists to accommodate such a notion. (shrink)