It is the intention in this article to explain the electoral stagnation of the Republican People’s Party (Cumhuriyet Halk Partisi, CHP) in the light of the 2015 parliamentary elections in Turkey. Drawing on theories of voting behavior, the article uncovers the organizational shortcomings within the party and the problem of credibility that have emerged as significant impediments to the party in addressing long-term historical-structural issues, mainly the division of Turkish society between the religious periphery and the secular center. Furthermore, the (...) strong identification between the ruling Justice and Development Party (Adalet ve Kalkınma Partisi, AKP) and its partisans have made party-switching difficult, having been achieved, above all, through the provision of economic benefits and public services and the consolidation of party identification through growing polarization and division in Turkish politics. Last but not least, the changes to the political environment between the June 7 and November 1, 2015 elections, pushed stability and security to the top of the agenda, as well as AKP’s electoral adjustments in the run-up to the November 1 elections inhibited any possible flow of votes to the CHP. (shrink)

Objective: To determine cryopreservation-induced alterations in the cytoskeleton of metaphase II mouse oocytes and the implications of these alterations in functionality of the cytoskeleton and polyploidy after fertilization.Design: Comparative study.Setting: Clinical and academic research environment at a medical school teaching hospital.Intervention : Oocytes were frozen using a slow-cooling and slow-thawing protocol in 1.5 M dimethyl sulfoxide and 0.2 M sucrose and were analyzed before and after fertilization.Main Outcome Measure : Cytoskeletal alterations, fertilization, and polyploidy rates.Result : When analyzed immediately after (...) thawing, the oocytes displayed dramatic cytoskeletal alterations. Only slight recovery was observed upon removal of the cryoprotectants. However, incubation after thawing of 1 hour at 37oC completely reestablished a normal microfilament and microtubule pattern while partially restoring normal spindle morphology and chromosome alignment. Accordingly, insemination immediately after removal of cryoprotectants resulted in a significantly decreased fertilization rate and aberrant dynamics of cytoskeleton-dependent events, whereas oocytes inseminated after the post-thaw incubation displayed fertilization rates and cytoskeletal dynamics comparable to those in controls. Cryopreservation did not increase polyspermy but significantly increased digyny when the oocytes were inseminated after the post-thaw incubation. All digynic eggs displayed an abnormal spindle remnant in comparison with diploid or polyspermic eggs.Conclusion : A brief period of incubation after thawing allows recovery and positively affects fertilization and cytoskeletal dynamics. Cryopreservation does not impair the functionality of microfilaments and cytoplasmic microtubules during postfertilization events. Our findings suggest that the increased rate of digyny in cryopreserved oocytes may be related to the spindle disorganization, leading to failure in segregation of the chromosomes, rather than to direct malfunction of the microfilaments in polar body formation. (shrink)

Transoral laser microsurgery applies to the piecemeal removal of malignant tumours of the upper aerodigestive tract using the CO2 laser under the operating microscope. This method of surgery is being increasingly popularised as a single modality treatment of choice in early laryngeal cancers (T1 and T2) and occasionally in the more advanced forms of the disease (T3 and T4), predomi- nantly within the supraglottis. Thomas Kuhn, the American physicist turned philosopher and historian of science, coined the phrase ‘paradigm shift’ in (...) his groundbreaking book The Structure of Scientific Revolutions. He argued that the arrival of the new and often incompatible idea forms the core of a new paradigm, the birth of an entirely new way of thinking. This article discusses whether Steiner and col- leagues truly brought about a paradigm shift in oncological surgery. By rejecting the principle of en block resection and by replacing it with the belief that not only is it oncologically safe to cut through the substance of the tumour but in doing so one can actually achieve better results, Steiner was able to truly revolutionise the man- agement of laryngeal cancer. Even though within this article the repercussions of his insight are limited to the upper aerodigestive tract oncological surgery, his willingness to question other peoples’ dogma makes his contribution truly a genuine paradigm shift. (shrink)

Objective To assess parental permission for a neonate's research participation using the MacArthur competence assessment tool for clinical research (MacCAT-CR), specifically testing the components of understanding, appreciation, reasoning and choice. Study Design Quantitative interviews using study-specific MacCAT-CR tools. Hypothesis Parents of critically ill newborns would produce comparable MacCAT-CR scores to healthy adult controls despite the emotional stress of an infant with critical heart disease or the urgency of surgery. Parents of infants diagnosed prenatally would have higher MacCAT-CR scores than parents (...) of infants diagnosed postnatally. There would be no difference in MacCAT-CR scores between parents with respect to gender or whether they did or did not permit research participation. Participants Parents of neonates undergoing cardiac surgery who had made decisions about research participation before their neonate's surgery. Methods The MacCAT-CR. Results 35 parents (18 mothers; 17 fathers) of 24 neonates completed 55 interviews for one or more of three studies. Total scores: magnetic resonance imaging (mean 36.6, SD 7.71), genetics (mean 38.8, SD 3.44), heart rate variability (mean 37.7, SD 3.30). Parents generally scored higher than published subject populations and were comparable to published control populations with some exceptions. Conclusions The MacCAT-CR can be used to assess parental permission for neonatal research participation. Despite the stress of a critically ill neonate requiring surgery, parents were able to understand study-specific information and make informed decisions to permit their neonate's participation. (shrink)

The last chapter of Politian's first Miscellanea dealt with the amica silentia lunae through which the Greeks sailed back to Troy . He argued that the phrase should not be taken literally, as a statement that Troy fell at the new moon, but in an extended sense, as a poetic indication that the moon had not yet risen when the Greeks set sail. This reading had one merit: it explained how Virgil's moon could be silent while the Greeks were en (...) route but shine during the battle for the city . Yet Politian's effort to identify the phase of the moon described by Virgil was anything but clear: Non igitur aut sera fuerit aut pernox luna, tum nec lunae quidem omnino coitus, sed tempus arbitror potius quamdiu illa non luceret. Accordingly, though his arguments were sometimes repeated by commentators and teachers, they won little assent from scholars who occupied themselves seriously with the passage. In his Adversaria Turnebus took silentia lunae as referring ‘ad noctis taciturnitatem…non ad interlunium’. In the first chapter of his De rebus per epistolam quaesitis Giano Parrasio sharply criticised the fuzziness of Politian's explanation: ‘Ambages istae sunt, ambages’. More important, he quoted a line from the Little Iliad: νξ μν ην μέσση, λαμπρ δ' πέτελλε σελήνη. This he rendered ‘Nox erat intempesta, nitebat et aurea coelo Luna’, and inferred from it that the moon had been up when Troy fell. In his Virgilius collation scriptorum Graecorum illustratus, finally, Fulvio Orsini published a scholium on Euripides' Hecuba, one which quoted both the line from the Little Iliad and an analysis of it by the Peripatetic Callisthenes. He too took the line as refuting Politian. (shrink)

The last chapter of Politian's first Miscellanea dealt with the amica silentia lunae through which the Greeks sailed back to Troy. He argued that the phrase should not be taken literally, as a statement that Troy fell at the new moon, but in an extended sense, as a poetic indication that the moon had not yet risen when the Greeks set sail. This reading had one merit: it explained how Virgil's moon could be silent while the Greeks were en route (...) but shine during the battle for the city. Yet Politian's effort to identify the phase of the moon described by Virgil was anything but clear: Non igitur aut sera fuerit aut pernox luna, tum nec lunae quidem omnino coitus, sed tempus arbitror potius quamdiu illa non luceret. Accordingly, though his arguments were sometimes repeated by commentators and teachers, they won little assent from scholars who occupied themselves seriously with the passage. In his Adversaria Turnebus took silentia lunae as referring ‘ad noctis taciturnitatem…non ad interlunium’. In the first chapter of his De rebus per epistolam quaesitis Giano Parrasio sharply criticised the fuzziness of Politian's explanation: ‘Ambages istae sunt, ambages’. More important, he quoted a line from the Little Iliad: νξ μν ην μέσση, λαμπρ δ' πέτελλε σελήνη. This he rendered ‘Nox erat intempesta, nitebat et aurea coelo Luna’, and inferred from it that the moon had been up when Troy fell. In his Virgilius collation scriptorum Graecorum illustratus, finally, Fulvio Orsini published a scholium on Euripides' Hecuba, one which quoted both the line from the Little Iliad and an analysis of it by the Peripatetic Callisthenes. He too took the line as refuting Politian. (shrink)

Purpose. The purpose of this paper is to study the behaviour of women in extreme conditions, to establish various social roles of women, ways of their adaptation to extreme conditions on the example of Ukrainian anti-Nazi underground during Second World War. Theoretical basis. The authors derive from the fact that historical anhropology is a leading and promising area of historical research. Originality. For the first time, the authors have shown that in conditions of constant stress state and direct threat to (...) life and health, the behaviour of underground women was determined by adequate survival strategies, i.e. by the life circumstances and personal qualities of the underground members. Conclusions. Permanent existence on the verge of life and death often led women to emotional actions, deviant forms of behaviour. Their actions could be controversial, and the motives – confusing. At the same time, the majority of women left in the Soviet underground chose as a strategy of survival the path of confrontation with occupiers, held true to their choices, often showed courage, ingenuity and self-sacrifice. (shrink)

Much has been written about the rights of health-care professionals to conscientiously object. Ironically, there has been no formal discussion as to whether clinical ethicists have the same right. Given that ethicists routinely deal with the same situations and questions that other health-care professionals find morally discomforting, the question as to whether they have the same right is a critical one. We conclude that ethicists should not have the same right to conscientious objection. The role of an ethicist is to (...) competently manage those situations and cases that cause moral discomfort and confusion. By conscientiously objecting, an ethicist would be failing to fulfil their primary function. The same cannot be said as forcefully about other professionals who object. Moreover, ethicists retain the right to conscientious objection to the joining of the discipline in the first place, and also retain the right to exit if they so choose. (shrink)

Lots of Websites offer the possibility to donate human beings. Another problem of ethics of communications.

Technical chronology establishes the structure of calendars and the dates of events; it is, as it were, the foundation of history, particularly ancient history. The chronologer must know enough philology to interpret texts and enough astronomy to compute the dates of celestial phenomena, above all eclipses, which alone provide absolute dates. Joseph Scaliger, so we are told, was the first to master and apply this range of technical skills: Of the mathematical principles on which the calculation of periods rests, the (...) philologians understood nothing. The astronomers, on their side, had not yet undertaken to apply their data to the records of ancient times. Scaliger was the first of the philologians who made use of the improved astronomy of the sixteenth century to get a scientific basis for historical chronology. So Mark Pattison. This verdict can be challenged on a number of grounds. The one relevant at present is simple: Scaliger himself claimed far less. He certainly said that technical chronology had been untouched in modern times — not an entirely fair judgement — but in antiquity it had been practised in exactly the manner he considered proper, or so he believed. In particular he singles out Censorinus, whose De die natali drew extensively on Varro's lost Antiquitates rerum humanarum, books 14–19, for information on chronology. Students of Varro have long appreciated the importance of Censorinus. His dry and compact treatise offers Varronian views on etymology, the human life-span, and the course of history itself, all couched in language so jejune as to suggest that he added little or nothing to what he read. (shrink)

Technical chronology establishes the structure of calendars and the dates of events; it is, as it were, the foundation of history, particularly ancient history. The chronologer must know enough philology to interpret texts and enough astronomy to compute the dates of celestial phenomena, above all eclipses, which alone provide absolute dates. Joseph Scaliger, so we are told, was the first to master and apply this range of technical skills: Of the mathematical principles on which the calculation of periods rests, the (...) philologians understood nothing. The astronomers, on their side, had not yet undertaken to apply their data to the records of ancient times. Scaliger was the first of the philologians who made use of the improved astronomy of the sixteenth century to get a scientific basis for historical chronology. So Mark Pattison. This verdict can be challenged on a number of grounds. The one relevant at present is simple: Scaliger himself claimed far less. He certainly said that technical chronology had been untouched in modern times — not an entirely fair judgement — but in antiquity it had been practised in exactly the manner he considered proper, or so he believed. In particular he singles out Censorinus, whose De die natali drew extensively on Varro's lost Antiquitates rerum humanarum, books 14–19, for information on chronology. Students of Varro have long appreciated the importance of Censorinus. His dry and compact treatise offers Varronian views on etymology, the human life-span, and the course of history itself, all couched in language so jejune as to suggest that he added little or nothing to what he read. (shrink)

This case describes an adolescent in a crisis of a chronic medical condition whose situation is complicated by substance abuse and mental illness. D. Micah Hester provides an analytic approach, teasing apart the multiple layers of medical, developmental, and moral issues at hand and describing possible responses and outcomes. Amy T. Campbell examines existing legal guidelines for adolescent decision making, arguing that greater space exists for clinical discretion in these matters than commonly thought. Cheryl D. Lew discusses the development of (...) agency in adolescent patients, the ideal of autonomous decision making in the context of impairment and chronic illness, and the obligation of healthcare teams to examine an adolescent patient’s decisions in relation to her identity. (shrink)

The framework of Findlay & Walker's target article provides a first attempt to model the saccadic system at all levels. Their scheme is based on two main principles. These are “parallel processing of saccade timing and metrics” and “competitive inhibition through winner-take-all strategies.” In our opinion, however, both concepts are in their strictest sense at odds with the current knowledge of the saccadic system, and need to be refined to make the scheme more relevant.

A new characterization of tabularity in tense logic is established, namely, a tense logic L is tabular if and only if $\mathsf {tab}_n^T\in L$ for some $n\geq 1$. Two characterization theorems for the Post-completeness in tabular tense logics are given. Furthermore, a characterization of the Post-completeness in the lattice of all tense logics is established. Post numbers of some tense logics are shown.

Background: Thrombolytic drugs to treat an acute ischaemic stroke reduce the risk of death or major disability. The treatment is, however, also associated with an increased risk of potentially fatal intracranial bleeding. This confronts the patient with the dilemma of whether or not to take a risk of a serious side effect in order to increase the likelihood of a favourable outcome. Objective: To explore acute stroke patients’ perception of risk and willingness to accept risks associated with thrombolytic drug treatment. (...) Design: Eleven patients who had been informed about thrombolytic drug treatment and had been through the process of deciding whether or not to participate in a thrombolytic drug trial went through repeated qualitative, semistructured interviews. Results: Many patients showed a limited perception of the risks connected with thrombolytic drug treatment. Some perceived the risk as not relevant to them and were reluctant to accept that treatment could cause harm. Others seemed to be aware that treatment would mean exposure to risk. The patients’ willingness to take a risk also varied substantially. Several statements revealed ambiguity and confusion about being involved in a decision about treatment. The patients’ reasoning about risk was put into the context of their health-related experiences and life histories. Several patients wanted the doctor to be responsible for the decisions. Conclusion: Acute stroke patients’ difficulties in perceiving and processing information about risk may reduce their ability to be involved in clinical decisions where risks are involved. (shrink)

Patient competence, defined as the ability to reason, appreciate, understand, and express a choice is rarely discussed in patients with obsessive compulsive disorder, and coercive measures are seldom used. Nevertheless, a psychiatrist of psychologist may doubt whether OCD patients who refuse treatment understand their disease and the consequences of not being treated, which could result in tension between respecting the patient’s autonomy and beneficence. The purpose of this article is to develop a notion of competence that is grounded in clinical (...) practice and corresponds with the experiences of patients with obsessions and/or compulsions. We present a naturalistic case study giving both the patient’s and the therapist’s perspective based on in-depth interviews and a narrative analysis. The case study shows that competence is not merely an assessment by a therapist, but also a co-constructed reality shaped by the experiences and stories of patient and therapist. The patient, a medical student, initially told her story in a restitution narrative, focusing on cognitive rationality. Reconstructing the history of her disease, her story changed into a quest narrative where there was room for emotions, values and moral learning. This fitted well with the therapist’s approach, who used motivational interventions with a view to appealing to the patient’s responsibility to deal with her condition. We conclude that in practice both the patient and therapist used a quest narrative, approaching competence as the potential for practical reasoning to incorporate values and emotions. (shrink)

Objective To determine the attitudes of Egyptian patients regarding their participation in research and with the collection, storage and future use of blood samples for research purposes. Design Cross-sectional survey. Study population Adult Egyptian patients (n=600) at rural and urban hospitals and clinics. Results Less than half of the study population (44.3%) felt that informed consent forms should provide research participants the option to have their blood samples stored for future research. Of these participants, 39.9% thought that consent forms should (...) include the option that future research be restricted to the illness being studied. A slight majority (66.2%) would donate their samples for future genetic research. Respondents were more favourable towards having their blood samples exported to other Arab countries (62.0%) compared with countries in Europe (41.8%, p<0.001) and to the USA (37.2%, p<0.001). Conclusions This study shows that many individuals do not favour the donation of a blood sample for future research. Of those who do approve of such future research, many favour a consent model that includes an option restricting the future research to the illness being studied. Also, many Egyptians were hesitant to have their blood samples donated for genetic research or exported out of the Arab region to the USA and European countries. Further qualitative research should be performed to determine the underlying reasons for many of our results. (shrink)

Background: Discussing treatment risks has become increasingly important in medical communication. Still, despite regulations, physicians must decide how much and what kind of information to present. Objective: To investigate patients’ preference for information about a small risk of a complication of colonoscopy, and whether medical and personal factors contribute to such preference. To propose a disclosure policy related to our results. Design: Vignettes study. Setting: Department of Gastroenterology, Academic Medical Centre, the Netherlands. Patients: 810 consecutive colonoscopy patients. Intervention: A home-sent (...) questionnaire containing three vignettes. Vignettes varied in the indication for colonoscopy, complication severity and level of risk. Patients were invited to indicate their wish to be informed and the importance of such information. In addition, sociodemograhic, illness-related and psychological characteristics were assessed. Main outcome measurements: Wish to be informed and importance of information. Results: Of 810 questionnaires, 68% were returned. Patients generally wished to be informed about low-risk complications, regardless of the indication for colonoscopy or the severity of the complication. The level of risk did matter, though (OR = 2.48, SE = 0.28, p = 0.001). The information was considered less important if done for population screening purposes or diagnosis of colon cancer, if the complication was less severe (bleeding) and if the risk was smaller (0.01% and 0.1%). Patients’ information preference was also related to age, mood and coping style. Limitations: Difficulty of vignettes. Conclusions: Patients generally wish to be informed about all possible risks. However, this might become uninformative. A stepwise approach is suggested. (shrink)