BackgroundObtaining informed consent for intravenous thrombolysis in acute ischemic stroke can be challenging, and little is known about if and how the informed consent procedure is performed by neurologists in clinical practice. This study examines the procedure of informed consent for intravenous thrombolysis in acute ischemic stroke in high-volume stroke centers in the Netherlands.MethodsIn four high volume stroke centers, neurology residents and attending neurologists received an online questionnaire concerning informed consent for thrombolysis with tissue-type plasminogen activator (tPA). The respondents were (...) asked to report their usual informed consent practice for tPA treatment and their considerations on whether informed consent should be obtained.ResultsFrom the 203 invited clinicians, 50% (n = 101) completed the questionnaire. One-third of the neurology residents (n = 21) and 21% of the neurologists (n = 8) reported that they always obtain informed consent for tPA treatment. If a patient is not capable of providing informed consent, 30% of the residents (n = 19) reported that they start tPA treatment without informed consent. In these circumstances, 53% of the neurologists (n = 20) reported that the resident under their supervision would start tPA treatment without informed consent. Most neurologists (n = 21; 55%) and neurology residents (n = 45; 72%) obtained informed consent within one minute. None of the respondents used more than five minutes for informed consent. Important themes regarding obtaining informed consent for treatment were patients’ capacity, and medical, ethical and legal considerations.ConclusionThe current practice of informed consent for thrombolysis in acute ischemic stroke varies among neurologists and neurology residents. If informed consent is obtained, most clinicians stated to obtain informed consent within one minute. In the future, a shortened information provision process may be applied, making a shift from informed consent to informed refusal, while still considering the patient’s capacity, stroke severity, and possible treatment delays. (shrink)

In their introduction to the recent excellent volume Plato & Hesiod, the editors G.R. Boys-Stones and J.H. Haubold observe that when we think about the problematic relationship between Plato and the poets, we tend to narrow this down to that between Plato and Homer. Hesiod is practically ignored. Unjustly so, the editors argue. Hesiod provides a good opportunity to start thinking more broadly about Plato's interaction with poets and poetry, not in the least because the ‘second poet’ of Greece represents (...) a different type of poetry from Homer's heroic epics, that of didactic poetry. What goes for Plato and Hesiod goes for Proclus and Hesiod. Proclus , the productive head of the Neoplatonic school in Athens, took a great interest in poetry to which he was far more positively disposed than Plato had ever been. He wrote, for example, two lengthy treatises in reaction to Socrates' devastating criticism of poetry in the Republic as part of his commentary on that work in which he tries to keep the poets within the Platonic pale. This intriguing aspect of Proclus' thought has, as one might expect, not failed to attract scholarly attention. In Proclus' case too, however, discussions tend to concentrate on his attitude towards Homer . To some extent this is only to be expected, since much of the discussion in the Commentary on the Republic centres on passages from Homer. Proclus did not, however, disregard Hesiod: we still possess his scholia on the Works and Days, now available in a recent edition by Patrizia Marzillo. (shrink)

PurposeThe purpose of this study is to describe the implementation and outcomes of an Eye Movement and Desensitization Reprocessing treatment-program for women with posttraumatic stress disorder after childbirth.MethodsA prospective cohort-study with pre- and post-measurements was carried out in the setting of an academic hospital in the Netherland. Included were women who gave birth to a living child at least 4 weeks ago, with a diagnosis of PTSD, or severe symptoms of PTSD combined with another psychiatric diagnosis. All received up to (...) 8 sessions of EMDR-therapy. The posttraumatic stress disorder Checklist for DSM-5 was administered before and after treatment. Trauma history was assessed before treatment with the Life Events Checklist for the DSM-5, the Childhood Trauma Questionnaire and the Childbirth Perception Scale. Descriptive statistics were used.ResultsForty-four women were referred, 26 met the inclusion criteria. After treatment, none of the women met the criteria for diagnosis of PTSD after on average 5 weekly sessions of EMDR- therapy. These outcomes are promising, as they were achieved in women with relatively high levels of psychiatric comorbidity and high rates of previous mental health treatment.ConclusionImplementing an EMDR-treatment program for women with PTSD after childbirth in the setting of an academic hospital is feasible and effective. Key factors for success include a close collaboration between the relevant hospital departments and a thorough case conceptualization addressing the etiology of the PTSD. (shrink)

Background Genuine uncertainty on superiority of one intervention over the other is called equipoise. Physician-investigators in randomized controlled trials need equipoise at least in studies with more than minimal risks. Ideally, this equipoise is also present in patient-participants. In pediatrics, data on equipoise are lacking. We hypothesize that 1) lack of equipoise at enrolment among parents may reduce recruitment; 2) lack of equipoise during participation may reduce retention in patients assigned to a less favoured treatment-strategy. Methods We compared preferences of (...) parents/patients at enrolment, documented by a questionnaire, with preferences developed during follow-up by an interview-study to investigate equipoise of child-participants and parents in the BeSt-for-Kids-study. This trial in new-onset Juvenile Idiopathic Arthritis-patients consists of three strategies. One strategy comprises initial treatment with a biological disease-modifying-antirheumatic-drug, currently not standard-of-care. Semi-structured interviews were conducted with 23 parents and 7 patients, median 11 months after enrolment. Results Initially most parents and children were not in equipoise. Parents/patients who refused participation, regularly declined due to specific preferences. Many participating families preferred the biological-first-strategy. They participated to have a chance for this initial treatment, and would even consider stopping trial-participation when not randomized for it. Their conviction of superiority of the biological-first strategy was based on knowledge from internet and close relations. According to four parents, the physician-investigator preferred the biological-first-strategy, but the majority stated that she had no preferred strategy. In phase 2, preferences tended to change to the treatment actually received. Conclusions Lack of equipoise during enrolment did not reduce study recruitment, mainly due to the fact that preferred treatment was only available within the study. Still, when developing a trial it is important to evaluate whether the physicians’ research question is in line with preferences of the patient-group. By exploring so-called ‘informed patient-group’-equipoise, successful recruitment may be enhanced and bias avoided. In our study, lack of equipoise during trial-participation did not reduce retention in those assigned to a less favoured option. We observed a change for preference towards treatment actually received, possibly explained by comparable outcomes in all three arms. (shrink)

Chervenak and McCullough, authors of the most acknowledged ethical framework for maternal–fetal surgery, rely on the ‘ethical–obstetrical’ concept of the fetus as a patient in order to determine what is morally owed to fetuses by both physicians and the women who gestate them in the context of prenatal surgery. In this article, we reconstruct the argumentative structure of their framework and present an internal criticism. First, we analyse the justificatory arguments put forward by the authors regarding the moral status of (...) the fetus qua patient. Second, we discuss the internal coherence and consistency of the moral obligations those authors derive from that concept. We claim that some of the dilemmas their approach is purported to avoid, such as the debate about the independent moral status of the fetus, and the foundation of the moral obligations of pregnant women (towards the fetuses they gestate) are not, all things considered, avoided. Chervenak and McCullough construct the obligations of physicians as obligations towards entities with equal moral status. But, at the same time, they assume that the woman has an independent moral status while the moral status of the fetus is dependent on the decision of the woman to present it to a physician for care. According to the logic of their own argumentation, Chervenak and McCullough implicitly admit a different moral status of the woman and the fetus, which will lead to different ascription of duties of the physician than those they ascribed. (shrink)

This article introduces a new hybrid intake procedure developed for posttraumatic stress disorder (PTSD) screening, which combines an automated textual assessment of respondents’ self-narratives and item-based measures that are administered consequently. Text mining technique and item response modeling were used to analyze long constructed response (i.e., self-narratives) and responses to standardized questionnaires (i.e., multiple choices), respectively. The whole procedure is combined in a Bayesian framework where the textual assessment functions as prior information for the estimation of the PTSD latent trait. (...) The purpose of this study is twofold: first, to investigate whether the combination model of textual analysis and item-based scaling could enhance the classification accuracy of PTSD, and second, to examine whether the standard error of estimates could be reduced through the use of the narrative as a sort of routing test. With the sample at hand, the combination model resulted in a reduction in the misclassification rate, as well as a decrease of standard error of latent trait estimation. These findings highlight the benefits of combining textual assessment and item-based measures in a psychiatric screening process. We conclude that the hybrid test design is a promising approach to increase test efficiency and is expected to be applicable in a broader scope of educational and psychological measurement in the future. (shrink)

We apply an online optimization process based on machine learning to the production of Bose-Einstein condensates. BEC is typically created with an exponential evaporation ramp that is optimal for ergodic dynamics with two-body s-wave interactions and no other loss rates, but likely sub-optimal for real experiments. Through repeated machine-controlled scientific experimentation and observations our ’learner’ discovers an optimal evaporation ramp for BEC production. In contrast to previous work, our learner uses a Gaussian process to develop a statistical model of the (...) relationship between the parameters it controls and the quality of the BEC produced. We demonstrate that the Gaussian process machine learner is able to discover a ramp that produces high quality BECs in 10 times fewer iterations than a previously used online optimization technique. Furthermore, we show the internal model developed can be used to determine which parameters are essential in BEC creation and which are unimportant, providing insight into the optimization process of the system. (shrink)

In the present paper I investigate the role that analogy plays in eighteenth-century biology and in Kant’s philosophy of biology. I will argue that according to Kant, biology, as it was practiced in the eighteenth century, is fundamentally based on analogical reflection. However, precisely because biology is based on analogical reflection, biology cannot be a proper science. I provide two arguments for this interpretation. First, I argue that although analogical reflection is, according to Kant, necessary to comprehend the nature of (...) organisms, it is also necessarily insufficient to fully comprehend the nature of organisms. The upshot of this argument is that for Kant our understanding of organisms is necessarily limited. Second, I argue that Kant did not take biology to be a proper science because biology was based on analogical arguments. I show that Kant stemmed from a philosophical tradition that did not assign analogical arguments an important justificatory role in natural science. Analogy, according to this conception, does not provide us with apodictically certain cognition. Hence, sciences based on analogical arguments cannot constitute proper sciences. (shrink)

Are psychiatric disorders natural kinds? This question has received a lot of attention within present-day philosophy of psychiatry, where many authors debate the ontology and nature of mental disorders. Similarly, historians of psychiatry, dating back to Foucault, have debated whether psychiatric researchers conceived of mental disorders as natural kinds or not. However, historians of psychiatry have paid little to no attention to the influence of (a) theories within logic, and (b) theories within metaphysics on psychiatric accounts of proper method, and (...) on accounts of the nature and classification of mental disorders. Historically, however, logic and metaphysics have extensively shaped methods and interpretations of classifications in the natural sciences. This paper corrects this lacuna in the history of psychiatry, and demonstrates that theories within logic and metaphysics, articulated by Christian Wolff (1679-1754), have significantly shaped the conception of medical method and (psychiatric) nosology of the influential nosologist Boissier De Sauvages (1706-1767). After treating Sauvages, I discuss the method of the influential nosologist William Cullen (1710-1790), and demonstrate the continuity between the classificatory methods of Sauvages and Cullen. I show that both Sauvages and Cullen were essentialists concerning medical diseases in general and psychiatric disorders in particular, contributing to the history of conceptions of the ontology and nature of mental disorders. (shrink)

This paper elaborates on conceptual, empirical and practical arguments why corporations need to focus on their social dimensions, in order to further enhance organizational performance. The paper starts with an introduction on the general trend towards inclusiveness and connectedness. It then elaborates on the phase-wise development of cultures and organizational structures. Managing corporate improvement by building cultures of trust is the central focus of this contribution. By showing the cultural dimensions of Great Places to Work and their workplace practices, worthwhile (...) experiences leading to organizational improvement and superior financial performance are demonstrated. (shrink)

This paper analyzes debates on animal language in eighteenth-century German philosophy and science. Adopting a history of ideas approach, I explain how the study of animal language became tied to the investigation into the origin and development of language towards the end of the eighteenth century. I argue that for large parts of the eighteenth century, the question of the existence of animal languages was studied within the context of the philosophical question of whether animals possess reason. In Germany, the (...) debate concerning animal reason was influenced by Christian Wolff and was taken up by diverse thinkers such as Winkler, Meier, and Reimarus. I argue that in the second half of the eighteenth century the study of animal language became more loosely related to the question of whether animals possess reason: animal language was studied not only in light of the debate on animal reason but also because it sheds light on the nature of animals, on the differences and similarities between animals and humans, and on the origin and development of language. This systematic study of animal language coincided with the rise of linguistics, anthropology, and biology as independent sciences. (shrink)

Theurgy, the ritual practice intended to free the descended soul from the body, has been considered an irrational and hence uninteresting part of late Neoplatonism. In this chapter, the author vindicates theurgy by showing that for Proclus there is an intimate relation between philosophy and theurgy. More specifically, he discusses the relevance of theurgy in Proclus’ metaphysics of causation, psychology, theology, and ethics. Theurgical symbols work because they are in fact low immanent forms. We need them, because our souls are (...) entirely descended, and theurgical excellence is the highest virtue. After a discussion of the role of theurgy in Proclus’ reading of the myth of the winged charioteer, the limits of theurgy, and the theurgical practices of purifying the soul from the body and of contemplation, the author ends with a short discussion of hymns as ‘theurgy in action’. (shrink)

Lab experiments on punishment are of limited relevance for understanding cooperative behavior in the real world. In real interactions, punishment is not cheap, but the costs of punishment are of a different nature than in experiments. They do not correspond to direct payments or payoff deductions, but they arise from the repercussions punishment has on social networks and future interactions.

In this interview with Jan Hendrik van den Berg, the Dutch phenomenologist and psychiatrist addresses the origins of his work, his most significant influences, and the purpose of metabletic phenomenology in the modern age. In the course of the interview. Dr. Van den Berg provides a basic overview of his work, and highlights the central finding of his metabletic analyses: a loss of wonder before nature, which results from the more fundamental loss of genuine spirituality in the modern (...) world. (shrink)

The History of Ideas is presently enjoying a certain renaissance after a long period of disrepute. Increasing quantities of digitally available historical texts and the availability of computational tools for the exploration of such masses of sources, it is suggested, can be of invaluable help to historians of ideas. The question is: how exactly? In this paper, we argue that a computational history of ideas is possible if the following two conditions are satisfied: (i) Sound Method . A computational history (...) of ideas must be built upon a sound theoretical foundation for its methodology, and the only such foundation is given by the use of models , i.e., fully explicit and revisable interpretive frameworks or networks of concepts developed by the historians of ideas themselves. (ii) Data Organisation. Interpretive models in our sense must be seen as topic-specific knowledge organisation systems (KOS) implementable (i.e. formalisable) as e.g. computer science ontologies. We thus require historians of ideas to provide explicitly structured semantic framing of domain knowledge before investigating texts computationally, and to constantly re-input findings from the interpretive point of view. In this way, a computational history of ideas maximally profits from computer methods while also keeping humanities experts in the loop. We elucidate our proposal with reference to a model of the notion of axiomatic science in 18th -19th century Europe. (shrink)

This paper studies moral education in Proclus and Iamblichus. The first section analyses Proclus’ theory of moral education and its psychological underpinnings. Especially important in this context is the identification of the faculty of choice with the passive or teachable intellect. The second section investigates the implementation of this theory into practice with the help of Iamblichus’ Letter to Sopater: On Bringing up Children. The final section demonstrates how Proclus’ famous tripartite division of poetry should be understood in the context (...) of his program of moral education. (shrink)

Van den Berg, I.P., Extended use of IST, Annals of Pure and Applied Logic 58 73–92. Internal Set Theory is an axiomatic approach to nonstandard analysis, consisting of three axiom schemes, Transfer , Idealization , and Standardization . We show that the range of application of these axiom schemes may be enlarged with respect to the original formulation. Not only more kinds of formulas are allowed, but also different settings. Many examples illustrate these extensions. Most concern formal aspects of (...) nonstandard asymptotics. (shrink)

Cet article examine les opinions des néoplatoniciens tardifs sur le phénomène social de la philotimia (« amours des honneurs » ; « ambition »). Sur la base du Commentaire de l’Alcibiade de Proclus, on montre que la philotimia est une émotion qui résulte d’une compréhension imparfaite de la vraie nature de l’honneur et du pouvoir. La mauvaise philotimia pousse les ambitieux à poursuivre une carrière politique en quête de pouvoir mondain et de prestige au prix de l’étude de la philosophie. (...) La bonne philotimia, au contraire, peut les pousser à rechercher ce qui est véritablement bien et donc les mettre sur la voie de la philosophie. L’histoire fournit maints exemples de bonne et de mauvaise philotimia. Damascius, dans sa Vie d’Isidore, mobilise des théories de la bonne et de la mauvaise philotimia pour éloigner ses lecteurs de l’arène politique et les conduire vers la poursuite de la philosophie. (shrink)

Selection on grandparental investment is more complex than Coall & Hertwig (C&H) propose. Patterns of investment are subject to an intergenerational conflict over how resources should be distributed to maximize fitness. Grandparents may be selected to distribute resources unevenly, while their descendants will be selected to manipulate investment in their own favor. Here we outline the evolutionary basis of this conflict.

Meta-theories, base-theories and theories of practice in Pratical Theology The problem of meta-theories and base-theories, their interaction and the influence of each on the scientific process, have widely been debated in practical theology. In South Africa two meta-theories namely the system- theory together with the theory that social science is busy with the study of actions, are having the greater deal of attention. The purpose of this article is to point out the fact that an early and absolute choice of (...) particular meta-theories, restricts the work of practical theology because it will influence your base-theories, and can weaken the theological content of practical theology. An attempt is made to offer a model by which the interaction between, meta-theories, base-theories and theories of practice can he understood and which can also help the theologian, busy with practical theology, to steer clear of problems and understand the meta- influences in his own scientific work. (shrink)