Rationale, aims and objectives To compare the pharmacotherapeutic approaches to diabetic hypertension of family physicians (FPs) and general practitioners (GPs). Methods A retrospective prescription-based study was conducted in 15 out of a total of 20 health centres, involving 115 primary care physicians – 77 FPs and 38 GPs, representing 74% of the primary care physicians of Bahrain. Prescriptions were collected during May and June 2000 to comprise a study population of 1266 diabetic-hypertensive patients. Results As monotherapy, angiotensin-converting enzyme (ACE) inhibitors (...) (37.9%) and β-blockers (38.3%) were the most commonly prescribed classes of antihypertensives by FPs and GPs, respectively. Calcium channel blockers (CCBs) were ranked third by both categories of physicians. For two-drug combinations, a β-blocker and an ACE inhibitor was the combination of choice for both physician categories. Patients managed by the FPs were more likely to receive a β-blocker–CCB combination (17.4 vs. 14.9%) or a diuretic–ACE inhibitor combination (16.7 vs. 11.4%) and less likely to receive a β-blocker–diuretic combination (11.8 vs. 16.7%) than those managed by the GPs. The proportion of patients receiving antihypertensive combinations was 40.6 and 38.5% for FPs and GPs, respectively. While the GPs prescribed CCB as a monotherapy to the elderly most often, the FPs choice was a β-blocker. Diuretics were less preferred by both FPs and GPs. β-Blocker–ACE inhibitor was again the most preferred combination of both FPs and GPs. FPs prescribed CCB–β-blocker combinations more often than GPs (P = 0.01), whereas CCB–ACE inhibitor combinations were less preferred (P = 0.09). A trend towards excessive use of short-acting nifedipine as monotherapy for elderly patients, both by FPs and by GPs, was noticed. Glibenclamide, alone or in combination with metformin, was the foremost antidiabetic drug prescribed by FPs and GPs. Middle-aged (45–64 years) patients seen by GPs were more likely to receive glibenclamide than those treated by FPs (P = 0.001) and less likely to receive gliclazide (P = 0.01). Combinations of a β-blocker with either glibenclamide or insulin were prescribed considerably more often by GPs.Conclusions Within the same practice setting, a substantial difference was observed between FPs and GPs in terms of preference for different classes of drugs in the management of diabetic hypertension. The compliance of both FPs and GPs was suboptimal; overall, the compliance of the FPs was closer to the recommended guidelines, however. Educational programmes should specifically address these inadequacies in order to improve the quality of health care. (shrink)

Purpose This paper aims to formalize long-term trajectories of human civilization as a scientific and ethical field of study. The long-term trajectory of human civilization can be defined as the path that human civilization takes during the entire future time period in which human civilization could continue to exist. -/- Design/methodology/approach This paper focuses on four types of trajectories: status quo trajectories, in which human civilization persists in a state broadly similar to its current state into the distant future; catastrophe (...) trajectories, in which one or more events cause significant harm to human civilization; technological transformation trajectories, in which radical technological breakthroughs put human civilization on a fundamentally different course; and astronomical trajectories, in which human civilization expands beyond its home planet and into the accessible portions of the cosmos. -/- Findings Status quo trajectories appear unlikely to persist into the distant future, especially in light of long-term astronomical processes. Several catastrophe, technological transformation and astronomical trajectories appear possible. -/- Originality/value Some current actions may be able to affect the long-term trajectory. Whether these actions should be pursued depends on a mix of empirical and ethical factors. For some ethical frameworks, these actions may be especially important to pursue. (shrink)

A particular thing is nothing but a bundle (a collection) of all its properties. Other than these properties (including spatial, temporal properties), there is nothing. [Space and time, being physical properties, are among the things that have to be constructed as bundles of universals.].

This study described the relationships between academic class and student moral sensitivity and reasoning and between curriculum design components for ethics education and student moral sensitivity and reasoning. The data were collected from freshman (n = 506) and senior students (n = 440) in eight baccalaureate nursing programs in South Korea by survey; the survey consisted of the Korean Moral Sensitivity Questionnaire and the Korean Defining Issues Test. The results showed that moral sensitivity scores in patient-oriented care and conflict were (...) higher in senior students than in freshman students. Furthermore, more hours of ethics content were associated with higher principled thinking scores of senior students. Nursing education in South Korea may have an impact on developing student moral sensitivity. Planned ethics content in nursing curricula is necessary to improve moral sensitivity and moral reasoning of students. (shrink)

Much has been written on the relative merits of different readings of Wittgenstein's Tractatus Logico-Philosophicus. The recent renewal of the debate has almost exclusively been concerned with variants of the ineffabilist (metaphysical) reading of TL-P - notable such readings have been advanced by Elizabeth Anscombe, P. M. S. Hacker and H. O. Mounce - and the recently advanced variants of therapeutic (resolute) readings - notable advocates of which are James Conant, Cora Diamond, Juliet Floyd and Michael Kremer. During this debate, (...) there have been a number of writers who have tried to develop a third way, incorporating what they see as insights and avoiding what they see as flaws in both the ineffabilist and resolute readings. The most prominent advocates of these elucidatory readings of TL-P are Dan Hutto (2003) and Marie McGinn (1999). In this paper we subject Hutto's and McGinn's readings of TL-P to critical scrutiny. We find that in seeking to occupy the middle ground they ultimately find themselves committed to (and in the process commit Wittgenstein to) the very ineffabilism they (and Wittgenstein) are seeking to overcome. (shrink)

In their target article, McKay & Dennett (M&D) conclude that only “positive illusions” are adaptive misbeliefs. Relying on overly strict conceptual schisms (deficit vs. motivational, functional vs. organic, perception vs. belief), they prematurely discount delusions asbiologicallyadaptive. In contrast to their view that “motivation” plays a psychological but not a biological function in a two-factor model of the forming and maintenance of delusions, we propose asingleimpairment in prediction-error–driven (i.e., motivational) learning in three stages in which delusions play a biologically adaptive role.

The imbalance between supply of organs for transplantation and demand for them is widening. Although the current international drive to re-establish procurement via non-heart beating organ donation/donor is founded therefore on necessity, the process may constitute a desirable outcome for patient and family when progression to brain stem death does not occur and conventional organ retrieval from the beating heart donor is thereby prevented. The literature accounts of this practice, however, raise concerns that risk jeopardising professional and public confidence in (...) the broader transplant programme. This article focuses on these clinical, ethical, and legal issues in the context of other approaches aimed at increasing donor numbers. The feasibility of introducing such an initiative will hinge on the ability to reassure patients, families, attendant staff, professional bodies, the wider public, law enforcement agencies, and the media that practitioners are working within explicit guidelines which are both ethically and legally defensible. (shrink)

Legislation that authorises controversial organ procurement strategies but ignores respect for autonomy is flawed in principle and predictably unworkable in practiceThe UK Human Tissue Act 2004,1 designed to regulate all activity involving human tissue, organs, or bodies, was introduced in the House of Commons in December 2003, received Royal Assent on 15 November 2004,2 and has been partially implemented by Commencement Orders from April 2005. The new act, which repeals and replaces the Human Tissue Act 1961, the Anatomy Act 1984, (...) and the Human Organ Transplants Act 1989, has its origins in events of serious public concern, namely the retained organs scandals at Bristol Royal Infirmary3 and the Royal Liverpool Childrens’ Hospital.4 The act is correspondingly dominated by regulation of postmortem examinations and retention of human tissue, with consistent emphasis on the need for fully informed consent. Compliance with these requirements is now mandatory with the threat of up to three years’ imprisonment and/or fines for any deviation.The impact of the original proposals within the bill on research and the clinical practice of pathology have been carefully considered and documented,5 with subsequent amendments to ameliorate professional concerns.6 The act, however, also carries significant implications for medical practice in areas where donor recruitment for transplantation can take place, and representations on these aspects during readings of the bill7 have produced neither clarification, justification, nor amendment within the final legislation.Section 43 will make it lawful for hospital authorities “to take steps for the purpose of preserving the part for use for transplantation and to retain the body for that purpose”. The original explanatory notes for the bill8 while it proceeded through parliament implied that such action, prior to consent to transplantation being sought, was then lawful, clause 44 as section 43 …. (shrink)

"Neuroscience and Philosophy" begins with an excerpt from "Philosophical Foundations of Neuroscience," in which Maxwell Bennett and Peter Hacker question the ...

ch. 1. Ontologii︠a︡ razuma -- ch. 2. Gnoseologii︠a︡ razuma.

This paper examines the deontic logic of the Talmud. We shall find, by looking at examples, that at first approximation we need deontic logic with several connectives: O T A Talmudic obligation F T A Talmudic prohibition F D A Standard deontic prohibition O D A Standard deontic obligation. In classical logic one would have expected that deontic obligation O D is definable by $O_DA \equiv F_D\neg A$ and that O T and F T are connected by $O_TA \equiv F_T\neg (...) A$ This is not the case in the Talmud for the T (Talmudic) operators, though it does hold for the D operators. We must change our underlying logic. We have to regard {O T , F T } and {O D , F D } as two sets of operators, where O T and F T are independent of one another and where we have some connections between the two sets. We shall list the types of obligation patterns appearing in the Talmud and develop an intuitionistic deontic logic to accommodate them. We shall compare Talmudic deontic logic with modern deontic logic. (shrink)

We consider conditionals of the form A ⇒ B where A depends on the future and B on the present and past. We examine models for such conditional arising in Talmudic legal cases. We call such conditionals contrary to time conditionals.Three main aspects will be investigated: Inverse causality from future to past, where a future condition can influence a legal event in the past (this is a man made causality).Comparison with similar features in modern law.New types of temporal logics arising (...) from modelling the Talmudic examples. We shall see that we need a new temporal logic,which we call Talmudic temporal logic with linear open advancing future and parallel changing past, based on two parameters for time. (shrink)

The paper points out that the modern formulation of Bohm’s quantum theory known as Bohmian mechanics is committed only to particles’ positions and a law of motion. We explain how this view can avoid the open questions that the traditional view faces according to which Bohm’s theory is committed to a wave-function that is a physical entity over and above the particles, although it is defined on configuration space instead of three-dimensional space. We then enquire into the status of the (...) law of motion, elaborating on how the main philosophical options to ground a law of motion, namely Humeanism and dispositionalism, can be applied to Bohmian mechanics. In conclusion, we sketch out how these options apply to primitive ontology approaches to quantum mechanics in general. (shrink)

In his last book, David Armstrong sets out his metaphysical system in a set of concise and lively chapters each dealing with one aspect of the world. He begins with the assumption that all that exists is the physical world of space-time. On this foundation he constructs a coherent metaphysical scheme that gives plausible answers to many of the great problems of metaphysics. He gives accounts of properties, relations, and particulars; laws of nature; modality; abstract objects such as numbers; and (...) time and mind. (shrink)

Let A be an algebra. We say that the functions f 1 , . . . , f m : A n → A are algebraic on A provided there is a finite system of term-equalities $${{\bigwedge t_{k}(\overline{x}, \overline{z}) = s_{k}(\overline{x}, \overline{z})}}$$ satisfying that for each $${{\overline{a} \in A^{n}}}$$, the m -tuple $${{(f_{1}(\overline{a}), \ldots , f_{m}(\overline{a}))}}$$ is the unique solution in A m to the system $${{\bigwedge t_{k}(\overline{a}, \overline{z}) = s_{k}(\overline{a}, \overline{z})}}$$. In this work we present a collection of general (...) tools for the study of algebraic functions, and apply them to obtain characterizations for algebraic functions on distributive lattices, Stone algebras, finite abelian groups and vector spaces, among other well known algebraic structures. (shrink)