Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year survival of less than 50% who had advanced gastrointestinal or lung cancer or amyotrophic lateral sclerosis were interviewed. Each patient’s medical record was reviewed at enrollment and at 3 months for evidence of the discussion of patient wishes concerning (...) ventilator support, artificial nutrition and hydration , resuscitation and hospice care. A Kaplan–Meier analysis was also performed and 2-year survival calculated.Results: 60 cancer and 32 ALS patients were enrolled. ALS patients were more likely than cancer patients to have evidence of discussion about their wishes for ventilator support , ANH , DNR and hospice care . At 6 months, 91% of ALS patients were alive compared with 62% of cancer patients; at 2 years, 63% of ALS patients were alive compared with 23% of cancer patients .Conclusions: Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making. (shrink)

This volume "contains eight articles dealing with the intellectual and institutional developments in physics from the mid-1840’s to the mid-1920’s. The primary focus is on the quantum and relativity theories and Einstein’s contributions to these theories. The secondary focus is on thermodynamics and its kinetic theory basis in the nineteenth century." Slightly more than one third of the book is devoted to various aspects of Einstein’s work: M. J. Klein analyzes his difference with Bohr in 1923-1925; R. McCormmach traces the (...) problem area which he extracted from Lorentz’ electron theory in about the first decade of this century; and S. Goldberg considers the British response to his special theory of relativity in 1905-1911. In the editor’s foreword, McCormmach illustrates from the current investigation of Einstein a general thesis about "the limitations of contemporary writing in the history of science." Thus, this anthology may well become a standard secondary source for Einstein scholarship. A fourth of the book has to do with thermodynamics: Y. Elkana follows Helmholtz’ formulation of its first law ; E. E. Daub looks at the evolution of concepts essential to its second law ; and E. W. Garber delineates Clausius’ contribution to its underpinnings. Just two articles are unrelated to these two foci: P. Forman, in the longest paper in the volume, considers Lande’s search for a theory of the anomalous Zooman effect in 1919-1921; and R. Sviedrys, in an exchange with A. Thackray, examines the rise of physical science at Cambridge University during the Victorian era. (shrink)

This massive, expensive tome comprises all the proceedings of the 1970 biennial meeting of the Philosophy of Science Association. Beyond the selection of the papers to be presented at the meeting, there has been no winnowing of the good from the bad. Further, there is no indexing. Thus, the technical philosopher of science, to whose interest the contributed papers in this anthology will appeal, faces the prospect of doing these jobs himself. The symposium papers, which account for a relatively small (...) fraction of this volume, will interest readers of this journal the most. These papers investigate three topics: theoretical entities in statistical explanation; capacities and natures; history of science and its rational reconstruction. (shrink)

The primary purpose of this book "is to analyze and clarify certain fundamental concepts, principles, and procedures in both classical and relativistic mechanics." At the same time, it attempts to provide a grounding in the theory for the philosopher of science who must deal with the sometimes technical literature on the philosophical implications of relativistic mechanics. "This book, then, is an attempt at fundamental philosophic clarification embedded in the format of an introductory work." Its first six chapters deal with the (...) methodological foundations of classical mechanics and electrodynamics, as conceived prior to Einstein. Thus, the next six chapters introduce special relativity in such a way that it is connected with the tradition from which it arose. Although the book is not primarily a historical treatment of the theory, this added perspective is welcome because almost invariably philosophers of relativity portray the theory as if it arose without the intermediary of electrodynamics. (shrink)

Taking the position that scientific hypotheses explain the world and do not merely classify data, the author describes the decline of the Newtonian world picture and the development of a new, "ether-theoretical" view. The nineteenth century founders of electromagnetism—Faraday, Maxwell, Hertz, Lorentz—all tendered theories of a medium, usually called the "ether," which filled the space between any two noncontiguous bodies and transported electromagnetic actions from one to the other. After Einstein profoundly reinterpreted the concept of medium, it came to be (...) called the "field." In giving this history, William Berkson explains what problems each scientist faced and how the process of solving them led to new discoveries. He also draws out the philosophical consequences of the history, especially for the positions of Popper, Meyerson, Agassi and Kuhn. (shrink)

There is currently a debate over whether cognitive architecture is classical or connectionist in nature. One finds the following three comparisons between classical architecture and connectionist architecture made in the pro-connectionist literature in this debate: (1) connectionist architecture is neurally plausible and classical architecture is not; (2) connectionist architecture is far better suited to model pattern recognition capacities than is classical architecture; and (3) connectionist architecture is far better suited to model the acquisition of pattern recognition capacities by learning than (...) is classical architecture. If true, (1)-(3) would yield a compelling case against the view that cognitive architecture is classical, and would offer some reason to think that cognitive architecture may be connectionist. We first present the case for (1)-(3) in the very words of connectionist enthusiasts. We then argue that the currently available evidence fails to support any of (1)-(3). (shrink)

A generally clear and well-written introduction to Thomistic natural theology which, like most such "textbook" treatments, suffers from too much commentary and too little Aquinas. The nature and existence of God are dealt with in some detail, and two interesting sections on "Invalid Reasons for Holding the Existence of God" and "Some Controverted Arguments" are included.--B. P. H.

Data taken by the Mark II detector at the PEP storage ring was used to measure the rate of dilepton production in multihadronic events produced by e+e- annihilation at √s=29 GeV. We determine the probability that a hadron initially containing a b quark decays to a positive lepton to be 0.17-0.08+0.15, with 90% confidence level limits of 0.06 and 0.38. © 1990.

An unorganized but interesting collection of ten papers describing and evaluating the use of computers in legal research and the use of modern behavioral science in analyzing and predicting judicial decisions. The authors are professors of law, lawyers, and social scientists, and include a Soviet scholar writing on cybernetics and Soviet law. Technical descriptions of data recovery systems and technical methods of analyzing judicial decisions alternate with arguments for and against the actual use of such methods and systems by practicing (...) lawyers. All of the technical discussion is within the grasp of the interested lay reader; but the evaluation of these techniques becomes unspecific and polemical at times. The footnotes of many of the papers provide an excellent bibliography.—R. B. P. (shrink)

Correct interpretation of the data from integral laboratory tests, including Thrombin Generation Test, requires biochemistry-based mathematical models of blood coagulation. The purpose of this study is to describe the experimental TGT data from healthy donors and hemophilia A and B patients. We derive a simplified ODE model and apply it to analyze the TGT data from healthy donors and HA/HB patients with in vitro added tissue factor pathway inhibitor antibody. This model allows the characterization of hemophilia patients in the space (...) of three most important model parameters. The proposed approach may provide a new quantitative tool for the analysis of experimental TGT. Also, it gives a reduced model of coagulation verified against clinical data to be used in future theoretical large-scale modeling of thrombosis in flow. (shrink)

Placebo-controlled trials are controversial when individuals might be denied existing beneficial medical interventions. In the case of malaria, most patients die in rural villages without healthcare facilities. An artesunate suppository that can be given by minimally skilled persons might be of value when patients suddenly become too ill for oral treatment but are several hours from a facility that can give injectable treatment for severe disease. In such situations, by default, no treatment is (or can be) given until the patient (...) reaches a facility, making the placebo control design clinically relevant; alternative bioequivalence designs at the facility would misrepresent reality and risk incorrect conclusions. We describe the ethical issues underpinning a placebo-controlled trial in severe malaria. To protect patients and minimise risk, all patients were referred immediately to hospital so that each had a higher chance of prompt treatment through participation. There was no difference between artesunate and placebo in patients who reached clinic rapidly; among those who could not, a single artesunate suppository significantly reduced death or permanent disability, a finding of direct and indirect benefit to patients in participating villages and elsewhere. (shrink)

Containing essays on the nature and scope of rhetoric, as well as philosophical analyses of persuasion and argumentation, this book claims to deal with a "new field of philosophy" in which "the concepts of rhetoric and argumentation, including the rhetoric and argumentation of the philosopher himself, are subjected to philosophical scrutiny." Leaving aside the "newness" of such an endeavor, it is heartening to see new interest in the questions of rhetorical argument. Perhaps analytic philosophers should pay more attention to the (...) history of rhetoric and modern rhetoricians to the new developments in philosophy. This book is a first step in that direction.—B. P. H. (shrink)

One of a series "designed to add to the growing body of historical material reevaluating the culture of Medieval Europe." This volume consists of short, lucid articles which explore some of the historical, philosophical and literary figures and developments of the Middle Ages. A lead article by Laurence K. Shook discusses the nature and value of medieval studies.—B. P. H.

An excellent comparison of the thought of the major figure in the "classic period of Roman Catholic theology" with that of "the central figure of seventeenth century [Protestant] theology." Aquinas's views on creation are succinctly summarized and provide a useful background for the exposition of Gerhard's theology. The author finds the different quality of these two theological outlooks to lie in Aquinas's awareness of man's "richness" and Gerhard's emphasis of man's "inner contradictoriness." That is to say, whereas Aquinas sees the (...) world as "reflecting the abundance of God's resourcefulness and ordering love," Gerhard sees more of creation's inner contradictions: "man trying to save himself though unable to do so...." One hopes that more such comparative studies in Catholic-Protestant thought will be forthcoming.—B. P. H. (shrink)

This is a provocative and important book. Most of its essays by Catholic laymen strongly criticize the Church's traditional stand against "artificial" contraception. The objections against the approved rhythm method, the critical analysis of arguments from "natural law" on theological as well as philosophical grounds, and the attempt to develop a more meaningful Christian approach to sexuality seem certain to raise angry rebuttals from many clergy and a good number of the more conservative laity in the Church. Here we have (...) laymen thinking and arguing in a manner worthy of the "Open Church" foreseen by Pope John and supported by the Second Vatican Council.—B. P. H. (shrink)

Yet another development of the natural theology of Thomas Aquinas aimed at the undergraduate. The approach is traditional and clearly stated. Each chapter begins with an outline and ends with a list of leading ideas and supplementary readings. Judicious use of charts and diagrams helps to clarify the more difficult terms.--B. P. H.

Besides his translation of this classic, the author provides an introduction which serves to situate Galen and his work in ancient thought, an analysis which discusses Galen's sources, and a concise summary of the work itself. This volume should be of value to the modern logician as well as the student of ancient and medieval philosophy.—B. P. H.

According to Lewis the medieval universe, "while unimaginably large, was also unambiguously finite." The earth was believed to be infinitesimally small by cosmic standards and to have a perfect spherical shape containing within it an ordered variety. Man looked at the world and saw a manifestation of Divine Wisdom and of human finitude. It is Lewis's thesis that this model of the universe accounts for the most typical vice as well as the most typical virtue of medieval literature. The vice, (...) "sheer unabashed, prolonged dulness," arises because the writer feels the world has a built-in significance and thus he need not embellish his subject-matter. The virtue, an "absence of strain" whereby the story seems to be telling itself, comes from the author's complete confidence in the intrinsic value of his subject-matter and results in a vividness unrivalled until very recent times. Lewis concludes his admirable book with a warning to his contemporaries not to misunderstand the character of a model nor to assume naively that today's model is necessarily more factual and "true" to reality than that of the Middle Ages.—B. P. H. (shrink)

A superb new translation of the Fioretti which conveys both the humility and the playful humor of St. Francis and his early followers. Also included are the Considerations on the Stigmata, the Life of Brother Juniper, the Life of Brother Egidio, the Second Rule, and the Testament. The translator provides an interesting and illuminating introduction.—B. P. H.

A textbook introduction which borrows heavily from current Existentialist terminology. Each chapter ends with a summary and a list of suggested readings. Although the beginning student's interest may be aroused by this book, it is not made clear what kind of philosophy he is being interested in.—B. P. H.

A massive undertaking which the author hopes will help the reader "to discern the nature of the ills which beset moral philosophy in our time, and above all to recognize, in actu exercito, the philosophical bases of ethics and the value of the primary concepts which it brings into play." Employing what he calls "the method used with such care by Aristotle," Maritain begins with the discovery of ethics by Socrates, moves on to the impact of Christianity upon moral philosophy, (...) the ethics of Kant, and the great "illusion" of post-Kantian dialecticism, and concludes with a telling criticism of so-called existentialist ethics and Bergsonian supra-morality. The style is lively throughout and the general tenor of the book is one of humble yet critical scholarship.—B. P. H. (shrink)

Thirteen essays, both appreciative and informative, on the man and his philosophy. Simon, Collins, Anderson, Ward, and other leading Thomists are represented. They give us a comprehensive picture of Maritain's interests, his importance and his influence.--B. P. H.

Aim: This study explores priority dilemmas in dialysis treatment and care offered elderly patients within the Norwegian public healthcare system.Background: Inadequate healthcare due to advanced age is frequently reported in Norway. The Norwegian guidelines for healthcare priorities state that age alone is not a relevant criterion. However, chronological age, if it affects the risk or effect of medical treatment, can be a legitimate criterion.Method: A qualitative approach is used. Data were collected through semistructured interviews and analysed through hermeneutical content analysis. (...) The informants were five physicians and four nurses from dialysis wards.Findings: Pressing priority dilemmas centre around decision-making concerning withholding and withdrawal of dialysis treatment. Advanced age is rarely an absolute or sole priority criterion. It seems, however, that advanced age appears to be a more subtle criterion in relation with, for example, comorbidity, functional status and cognitive impairment. Nurses primarily prioritise specialised dialysis care and not comprehensive nursing care. The complex needs of elderly patients are therefore often not always met.Conclusions: Clinical priorities should be made more transparent in order to secure legitimate and fair resource allocation in dialysis treatment and care. Difficult decisions concerning withholding or withdrawal of dialysis ought to be openly discussed within the healthcare team as well as with patients and significant others. The biomedical focus and limitations on comprehensive care during dialysis should be debated. (shrink)