OBJECTIVES: To study the accuracy of reviewing ward notes (chart review) as a measure of the quality of care rendered to patients with "Do Not Resuscitate" (DNR) orders. DESIGN: We reviewed the charts of 19 consecutive, competent inpatients with DNR orders for evidence that the staff addressed a broad range of patient care needs called Concurrent Care Concerns (CCCs), such as withholding treatments other than resuscitation itself, and attention to patient comfort needs. We then interviewed the patient, consultant physician, house (...) officer, and primary nurse and compared the ward notes with the understandings of these staff members. SETTING: The medical service of an urban university medical centre. RESULTS: The average number of documented CCCs addressed per DNR order was 1.1. The ward notes generally agreed with the perceptions of patients, house officers, and nurses (% agreement with notes = 79%, 77%, and 82%; kappa = 0.43, 0.40, 0.50). Consultant physicians' understandings were poorly reflected in the ward notes (% agreement = 59%; kappa = 0.18). They overestimated attention to CCCs compared with the notes (P < 0.0001) and with other observers (P < 0.0001). CONCLUSION: Chart review for attention to CCCs accurately reflects the understandings of patients, house officers, and nurses, but consultant physicians report more attention to CCCs than is recorded in the ward notes or understood by other observers. Better communication regarding end-of-life care plans should be encouraged. (shrink)

The most striking example of Roman intervention in the affairs of mainland Greece between the Achaean and Mithridatic Wars is provided by an inscription now in the Fitzwilliam Museum, Cambridge. This stone bears the text of a letter to the city of Dyme in Achaea from a Roman proconsul named Q. Fabius Maximus, which describes his trial and sentencing of certain men of Dyme whom he had judged responsible for a recent disturbance in that city. One crux to be resolved (...) is chronological: A date of c. 115 b.c. has long been generally accepted, but recently evidence from another, still unpublished inscription has been thought to point to the year 144. Further, the letter of Fabius Maximus has long been held to exemplify the close supervision that most scholars, regardless of their position on the vexed question of Greece's formal status after 146, assume was exercised over Greece by Roman commanders in Macedonia from the time of the Achaean War. The document has also often been cited to bolster the claim that Rome pursued in second-century Greece a conscious policy of suppressing democracy or the political aspirations of the lower class. This is not, of course, the place for reassessment of these old, complex controversies. My purpose here is rather to show that interpretation of the letter of Fabius Maximus has not always been sufficiently mindful of the many obscurities of the text and, consequently, of the events that lie behind it; too often the great lacunae in our knowledge have been filled with assumptions that beg the questions that are under debate. (shrink)

In their simplest form, hybrid languages are propositional modal languages which can refer to states. They were introduced by Arthur Prior, the inventor of tense logic, and played an important role in his work: because they make reference to specific times possible, they remove the most serious obstacle to developing modal approaches to temporal representation and reasoning. However very little is known about the computational complexity of hybrid temporal logics.In this paper we analyze the complexity of the satisfiability problem of (...) a number of hybrid temporal logics: the basic hybrid language over transitive trees; nominal Until logic; and referential interval logic. We discuss the effects of including nominals, the @ operator, the somewhere modality E, and the difference operator D. Adding nominals to tense logic leads for several frame-classes to an increase in complexity of the satisfiability problem from PSPACE to EXPTIME. On transitive trees, however, the satisfiability problem for this language can be decided in PSPACE. Along the way we make a detour through hybrid propositional dynamic logic: we establish upper bounds for a number of temporal logics by generalizing results due to Passy and Tinchev [29] and De Giacomo [16]. We conclude with some remarks on the relevance of our results to description logic, and draw attention to the utility of the spypoint technique for proving upper and lower bounds. (shrink)

In a response to critiques of his On the Postcolony in a 2006 African Identities article, Achille Mbembe declared that the book was written at a time when the study of Africa was caught in a dramatic analytical gridlock. Traditional critical frameworks and discourses on the condition of postcolonial Africa seemed inadequate and ineffectual. Marxian analysis of colonization and its consequences is specifically isolated as one such impotent tool of critical analysis. As an alternative to these “failed” traditional paradigms, Mbembe (...) launches into a deconstructive experimental hermeneutic that leads him to the explication of colonial alterity in libidinal, representational and semiotically analogous language, as exhibited in On the Postcolony. This article challenges the efficacy of this post-structuralist semiotics and phenomenological extrapolations as the proposed way out of his perceived “cul-de-sac” in African postcolonial self-imagination. In particular, his dismissal of Marxian theory is turned... (shrink)

Fundamental problems of the uses of formal techniques and of natural and instrumental practices have been raised again and again these past two decades, in many quarters and from varying viewpoints. We have brought a number of quite basic studies of these issues together in this volume, not linked con ceptually nor by any rigorously defined problematic, but rather simply some of the most interesting and even provocative of recent research accomplish ments. Most of these papers are derived from the (...) Boston Colloquium for the Philosophy of Science during 1973-80, the two exceptions being those of Karel Berka (on scales of measurement) and A. A. Zinov'ev (on a non-tradi tional theory of quantifiers). Just how intriguing these results (or conjectures?) seem to us may be seen from some brief quotations: (1) Judson Webb: ".... the abstract machine concept has many of the appropriate kinds of properties for modelling living, reproducing, rule following, self-reflecting, accident-prone, and lucky creatures... the a priori logical results relevant to the abstract machine concept, above all Godel's, could not conceivably have turned out any better for the mechanist. " (2) M. L. Dalla Chiara: "... modal interpretation (of quantum logic) shows clearly that it possesses a logical meaning which is quite independent of quantum mechanics. " (3) Isaac Levi: (as against Peirce and Popper) "... infallibilism is con sistent with corrigibilism, and a view which respects avoidance of error is an important desideratum for science. (shrink)

I. Introduction Hegel's political philosophy is best understood as being both moderate and critical in character. While the recent scholarship is partially correct in its “centrist-reformist” image of Hegel's political philosophy, I argue that this image is incomplete. Hegel's project in the Philosophy of Right is moderate in the respect that it is a defense of his conceptualization of the modern state—it is the attempt to make explicit the implicit rationality of the modern state form. But his prescient critique of (...) the intractable contradictions of the open capitalist market and his identification of civil society with…. (shrink)

Dans cet article, je reviens sur l’héritage laissé par Karl Marx dans la pensée de Michel Foucault. Organisant l’analyse autour de quelques « oppositions » conceptuelles cruciales – accumulation et discipline, reproduction et biopouvoir, régime de vérité et idéologie, révolution et ascèse –, je tente de mettre au point quatre grands schèmes relationnels susceptibles d’éclairer leurs rapports : la complémentarité, la confrontation productive, le rejet, et la réconciliation. L’objectif de cette analyse est de proposer une alternative à un nombre (...) croissant d’interprétations conservatrices de Foucault en montrant que d’autres grilles de compréhension de son œuvre sont possibles, tout en essayant de mettre en lumière ce que cette lecture « minoritaire » pourrait amener en termes de stratégie et de luttes politiques. (shrink)

This article aims to show the importance of the vampire metaphor to Marx's work. In so doing, it challenges previous attempts to explain Marx's use of the metaphor with reference to literary style, nineteenth-century gothic or Enlightenment rationalism. Instead, the article accepts the widespread view linking the vampire to capital, but argues that Marx's specific use of this link can be properly understood only in the context of his critique of political economy and, in particular, the political (...) economy of the dead. (shrink)