Bradford C Bemiss, Chad A WittDepartment of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO, USA: Chronic rejection is a major cause of death after the first year following lung transplantation. Bronchiolitis obliterans is the most common pathologic finding on biopsy, characterized by fibrous granulation tissue, which obliterates the lumen of the bronchiole. Clinically, in the absence of tissue for pathology, BO syndrome refers to a progressive irreversible drop in the forced (...) expiratory volume in 1 second. Recently, a broader definition of chronic rejection, termed "chronic lung allograft dysfunction", has been used to encompass a more inclusive definition of posttransplant dysfunction. Recently, the lung transplant community has come to realize that chronic rejection may be the final common result after repetitive epithelial insults. Acute rejection, infection, and alloreactivity to mismatched HLA antigens are a few of these insults that damage the surface of the bronchioles. Recent evidence of autoimmunity to the normally hidden structural proteins collagen V and K-α1 tubulin have been correlated with a BO phenotype as well, perhaps correlating the epithelial damage with a mechanism for developing BO lesions. Many immunomodulatory medications and treatments have been studied for effectiveness for the treatment of chronic lung allograft dysfunction. New drugs, which more precisely target the immune system, are being developed and tested. Further study is required, but recent advances have improved our understanding of the pathogenesis and potential intervention for this common and deadly complication of lung transplantation.Keywords: lung transplant, bronchiolitis obliterans syndrome, rejection. (shrink)

Chad A Witt, Ramsey R Hachem Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, MO, USA: The role of donor-specific antibodies to human leukocyte antigens and the burden of antibody-mediated rejection in lung transplantation remain enigmatic. Over the past several years, evidence has been emerging that humoral immunity plays an important role in the development of both acute and chronic lung allograft dysfunction. Multiple case reports and case series have (...) identified lung allograft recipients with clinical findings consistent with acute AMR. However, there is currently no widely accepted definition for AMR in lung transplantation, and this has been a significant barrier to furthering our understanding of this form of rejection. Nonetheless, the development of DSA after transplantation has consistently been identified as an independent risk factor for persistent and high-grade acute cellular rejection and CLAD. This has raised the possibility that chronic AMR may be a distinct phenotype of CLAD although evidence supporting this paradigm is still lacking. Additionally, antibodies to lung-restricted self-antigens have been associated with primary graft dysfunction early and the development of CLAD late after transplantation, and emerging evidence underscores significant interactions between autoimmunity and alloimmunity after transplantation. There is currently an active International Society for Heart and Lung Transplantation working group that is developing an operational definition for AMR in lung transplantation. This will be critical to improve our understanding of this form of rejection and conduct clinical trials to identify optimal treatment strategies. This review will summarize the literature on DSA and AMR in lung transplantation and discuss the impact of antibodies to self-antigens on lung allograft dysfunction. Keywords: antibody-mediated rejection, donor-specific antibodies, lung transplantation. (shrink)

Students in an undergraduate legal and ethical issues course continually told the authors that they did not have time to study for the course because they were busy studying for their clinical courses. Faculty became concerned that students were failing to realize the value of legal and ethical concepts as applicable to clinical practice. This led the authors to implement a transformational learning experience in which students applied legal and ethical course content in a high-fidelity human simulation (HFHS) scenario. A (...) preliminary evaluation compared the new HFHS experience with in-person and online student groups using the same case. Based on both student and faculty perceptions, the HFHS was identified as the best of the three approaches for providing a transformational learning experience regarding legal and ethical content. (shrink)

This article provides ethical guidance on using race in health research as a variable or in defining the study population. To this end, a plain, non-exhaustive checklist is provided for researchers and research ethics committees, preceded by a brief introduction on the need for justification when using race as a variable or in defining a study population, the problem of exoticism, that distinctions pertain between race, ethnicity and ancestry, the problematic naming of races, and that race does not serve well (...) as a presumed biological construct in genetic research. (shrink)

This book offers an introduction to the thought of Robert Holcot, a great and influential but often underappreciated medieval thinker. Holcot was a Dominican friar who flourished in the 1330's and produced a diverse body of work including scholastic treatises, biblical commentaries, and sermons. By viewing the whole of Holcot's corpus, John T. Slotemaker and Jeffrey C. Witt provide a comprehensive account of his thought. Challenging established characterizations of him as a skeptic or radical, they show Holcot to be (...) primarily concerned with affirming and supporting the faith of the pious believer. At times, this manifests itself as a cautious attitude toward absolutist claims about the power of natural reason. At other times Holcot reaffirms, in Anselmian fashion, the importance of rational effort in the attempt to understand and live out one's faith. Over the course of this introduction the authors unpack Holcot's views on faith and heresy, the divine nature and divine foreknowledge, the sacraments, Christ, and political philosophy. They also examine Holcot's approach to several important medieval literary genres, including the development of his unique. (shrink)

This article offers an introduction to the question of God’s omnipresence as debated within the late medieval scholastic tradition as seen through the lens of Francis of Meyronnes. In Meyronnes’s commentary on distinction 37 of Peter Lombard’s Sentences, he attempts to categorize the various ways one might prove God’s existence in all things through a four-fold classification. In following his classifications, we are able to look back at some of the historical ways earlier scholastics have attempted to prove God’s omnipresence (...) and follow some of the changes in those approaches as the tradition has developed. Likewise, Meyronnes’s fourth and final classification will point us toward the future. His fourth way—interesting and puzzling in and of itself—offers early hints of future debates about God’s omnipresence and his relationship to place that will emerge in the late 14th century and then again in the 15th, 16th, and 17th centuries. (shrink)

In this article we conclude, via a comparison of the 19th C. scientific publications concerning the Belgian parliament and the state of parliamentological research of the day, that Belgian writers achieved an international standard. In Belgium, as elsewhere in Europe, parliamentology was pursued from the standpoint of various complementary schools of thought. Modern political history provided very detailed information about the functioning of the parliamentary institution; constitutional law investigated the juridical aspects of it ; political science transcended these juridical boundaries (...) and took account of the political aspects as well ; this method was also pursued in the field of political economy which, from a methodological point of view, can be regarded as the fundamental current of parliamentary sociology.It can be asserted that these writers are the founders of modern parliamentology despite the rather weak methodological foundation of their studies, the relative lack of empirical data-collection and the infiuenceof political commitment. As is still the case today, so also in the 19th C, the formal-juridical approach was dominant ; however, it was also insight-fully recognized that the most important problems of power lay in the mutual relations of the members of parliament themselves and in their relation to the majority, the opposition and the executive power. These studies furnish, therefore, very interesting lines of inquiry for the diachronic treatment of the majority of the problems of contemporary parliamentology. (shrink)

Michael Wedin’s Aristotle’s Theory of Substance provides an interpretation of primary substance in Metaphysics Book Z that is compatible with the ontology of the Categories. The incompatibilist position holds that primary substance in the Categories is the concrete, individual substance, like Socrates, whereas the title of primary substance in Metaphysics Z goes to the eidos, the form or the species. Hence, the ontology of the Categories is incompatible with the ontology of Metaphysics Z. One compatibilist strategy argues that the c-substance (...) remains primary substance in Metaphysics Z. Wedin takes another tack. He argues that c-substances are ontologically primary in both texts, and that Metaphysics Z introduces a new kind of priority, explanatory priority, awarded to the form of c-substances. Since c-substances and their forms are prior in different senses, the incompatibility vanishes. Wedin’s claim is stronger than mere compatibilism, however, since what forms explain are basic features of c-substances. Hence, Metaphysics Z is not only compatible with the Categories, “it is a theory about the theory of the Categories”. Wedin argues for what I call strong compatibilism. (shrink)

Our trust in the word of others is often dismissed as unworthy, because the illusory ideal of "autonomous knowledge" has prevailed in the debate about the nature of knowledge. Yet we are profoundly dependent on others for a vast amount of what any of us claim to know. Coady explores the nature of testimony in order to show how it might be justified as a source of knowledge, and uses the insights that he has developed to challenge certain widespread assumptions (...) in the areas of history, law, mathematics, and psychology. (shrink)

Coady explores the challenges that morality poses to politics. He confronts the complex intellectual tradition known as realism, which seems to deny any relevance of morality to politics, especially international politics. He argues that, although realism has many serious faults, it has lessons to teach us: in particular, it cautions us against the dangers of moralism in thinking about politics and particularly foreign affairs. Morality must not be confused with moralism: Coady characterizes various forms of moralism and sketches their distorting (...) influence on a realistic political morality. He seeks to restore the concept of ideals to an important place in philosophical discussion, and to give it a particular pertinence in the discussion of politics. He deals with the fashionable idea of "dirty hands," according to which good politics will necessarily involve some degree of moral taint or corruption. Finally, he examines the controversial issue of the role of lying and deception in politics. Along the way Coady offers illuminating discussion of historical and current political controversies. This lucid book will provoke and stimulate anyone interested in the interface of morality and politics. (shrink)

Political violence in the form of wars, insurgencies, terrorism and violent rebellion constitutes a major human challenge. C. A. J. Coady brings a philosophical and ethical perspective as he places the problems of war and political violence in the frame of reflective ethics. In this book, Coady re-examines a range of urgent problems pertinent to political violence against the background of a contemporary approach to just war thinking. The problems examined include: the right to make war and conduct war, terrorism, (...) revolution, humanitarianism, mercenary warriors, the ideal of peace and the right way to end war. Coady attempts to vindicate the contemporary relevance of the just war tradition to current problems without applying the tradition in a merely mechanical or uncritical fashion. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Philosophy 41.2 (2003) 276-277 [Access article in PDF] Wiep Van Bunge. From Stevin to Spinoza: An Essay on Philosophy in the Seventeenth-Century Dutch Republic. Leiden: Brill, 2001. Pp. xii + 217. Cloth, $80.00 By 1660 there were probably more followers of Descartes in the Dutch Republic, population 1.4 million, than in France, population 20 million. Protestantism and prosperity encouraged high rates of literacy and (...) the universities of Leiden and Utrecht were among the liveliest in the world. This vibrancy infused the metaphors that Descartes put into his great Discours de la methode published first in Leiden in 1637. In it he spoke about the beauty of cities that looked as if they had been built by a single architect and of the freedom to be found among people so busy with their business as to leave thinkers to their pursuits. Indirectly he spoke about his adopted homeland where he found many followers—some more eager than loyal. By the 1640s disputes raged in the Republic and the anti-Cartesian forces were led by the Aristotelian and anti-Copernican Gisbertus Voetius. What has been missing in our scholarship up to now has been any convincing account as to why these disputes occurred, and how they resonated within the Dutch context. Wiep Van Bunge's book takes a big step toward closing that knowledge gap.Van Bunge convincingly argues that the vibrancy of the stadtholder-less period up to 1672 produced a willingness to entertain new ideas. It also did not hurt to have Descartes on the scene and active on behalf of his mechanical philosophy, even to the point of addressing the Utrecht magistrates publicly and asking that his critics be chastised. What is remarkable—especially given the resistance to Descartes seen at Oxford and Cambridge—was the speed with which Cartesian ideas entered the Dutch classrooms where as many as a third of the students came from abroad. Again Van Bunge provides context when he starts with the Dutch engineer Simon Stevin and demonstrates the vitality of mathematics for a commercial society but also for a militant one. (The Netherlands was at war with Spain up to 1609.) A recent exhibition at the J. Paul Getty Museum in Los Angeles, April to July 2002, also illustrates another aspect of mathematics in the Republic. Precisely in the 1630s when Descartes was putting the finishing touches on his Discours, Pieter Saenredam applied geometry to the interiors of the elegant Utrecht churches so as to give his paintings a regularity and precision worthy of the Cartesian dream of order and clarity. The Dutch commitment to discipline and order also made their army one of the most accomplished in the world. It was perhaps over-determined that Descartes, who had trained with it, would find such a sympathetic audience in the Republic.One of the more fascinating aspects of Van Bunge's detailed study, first of Cartesianism and then of Spinozism in the Republic, concerns the political and ideological meanings to be extracted from the new philosophy. Hobbes also finds a place in the narrative, surprisingly taken up by republicans eager to construct a state that could control the passions. Abraham van Berkel, who put Hobbes's Leviathan into Dutch in 1667, gave the allegiance of his text and himself to Jan de Witt and the cause of the regents and the estates. We can only wonder what Hobbes would have made of the association. The republican affiliations of the mechanical philosophy in the Republic provide a distinctively Dutch context to the [End Page 276] political writings of Spinoza, the most famous and outrageous Cartesian of the century. Van Bunge is especially deft in finding Spinozists and providing far more evidence than I could back in 1981 when I argued for a radical enlightenment within the late seventeenth-century Dutch context (see The Radical Enlightenment. Pantheists, Freemasons and Republicans [London: 1981]). None of these positions with their deeply heretical implications could be taken lightly or without danger. Men lost... (shrink)

It is no longer possible to claim that the biological characteristics of the future adult are already determined at conception. After all, a zygote may develop into a hydatidiform mole rather than into a human being. The development of an individual human person is determined by genetically and nongenetically coded molecules within the embryo, together with the influence of the maternal environment. Consequently, it is an error to regard the zygote's chromosomal (and other) DNA as sufficient to determine the uniqueness (...) of the future individual. (shrink)

In the past thirty years, two fundamental issues have emerged in the philosophy of science. One concerns the appropriate attitude we should take towards scientific theories--whether we should regard them as true or merely empirically adequate, for example. The other concerns the nature of scientific theories and models and how these might best be represented. In this ambitious book, da Costa and French bring these two issues together by arguing that theories and models should be regarded as partially rather than (...) wholly true. They adopt a framework that sheds new light on issues to do with belief, theory acceptance, and the realism-antirealism debate. The new machinery of "partial structures" that they develop offers a new perspective from which to view the nature of scientific models and their heuristic development. Their conclusions will be of wide interest to philosophers and historians of science. (shrink)

While people’s lives continue to be put at risk by the dearth of organs available for transplantation, we must give urgent consideration to any option that may make up the shortfall. A market in organs from living donors is one such option. The market should be ethically supportable, and have built into it, for example, safeguards against wrongful exploitation. This can be accomplished by establishing a single purchaser system within a confined marketplace.Statistics can be dehumanising. The following numbers, however, have (...) more impact than most: as of 24th November, during 2002 in the United Kingdom, 667 people have donated organs, 2055 people have received transplants, and 5615 people are still awaiting transplants.1 It is difficult to estimate how many people die prematurely for want of donor organs. “In the world as a whole there are an estimated 700 000 patients on dialysis . . . . In India alone 100 000 new patients present with kidney failure each year”2 . Almost “three million Americans suffer from congestive heart failure . . . deaths related to this condition are estimated at 250 000 each year . . . …. (shrink)

First published in 2002. Routledge is an imprint of Taylor & Francis, an informa company.

This book provides a conceptual basis for recognizing the classroom as an ecology of linguistic and cultural patterns that should be taken into account as part of the teacher's professional decision making. It argues that the orchestration of classroom behaviour cannot be separated from the mental ecology of metaphor and thought patterns that reflect the student's primary culture. Chapters discuss the metaphorical nature of language and thought, primary socilization, nonverbal communication, framing and social control, the classroom as an ecology of (...) power, culturally responsive supervision, and educating teachers for the 21st century - all from a cultural and linguistic point of view. (shrink)

In this volume C.A. (Chet) Bowers, whose pioneering work on education and environmental and sustainability issues is widely recognized and respected around the world, brings together a carefully curated selection of his seminal work on the ideological, cultural, and linguistic roots of the ecological crisis; misconceptions underlying modern consciousness; the cultural commons; a critique of technology; and educational reforms to address these pressing concerns. In the World Library of Educationalists, international scholars themselves compile career-long collections of what they judge to (...) be their finest pieces - extracts from books, key articles, salient research findings, major theoretical and/practical contributions - so the world can read them in a single manageable volume. Readers will be able to follow the themes and strands of their work and see their contribution to the development of a field, as well as the development of the field itself. Contributors to the series include : Michael Apple, James A. Banks, Joel Spring, William F. Pinar, Stephen J. Ball, Elliot Eisner, Howard Gardner, John Gilbert, Ivor F. Goodson, Peter Jarvis. (shrink)

C. A. J. Coady offers to clear up confusion about what terrorism is. His "tactical definition" focuses on terrorist acts as violent attacks upon non-combatants. He discusses what it means to be a non-combatant, considers various philosophical attempts to defend terrorism, and examines the idea of a connection between religion and terrorism.

The Three Papers comprising this series, together with my earlier [34] also published in this journal, constitute an attempt to set out the major issues in the theoretical domain of reduction and to develop a general theory of theory reduction. The fourth paper, [34], though published separately from this trio, is integral to the presentation and should be read in conjunction with these papers. Even so, the presentation is limited in scope – roughly, to intertheoretic reduction among empirical theories – (...) and informal in presentation – not least because a satisfying formal account of theories has yet to be offered. And despite the length, the treatment is still condensed; often corroborating and/or intuitively helpful detail has had to be consigned to footnotes or omitted. I approach the problem from within my own naturalistic realist philosophy of science and formal analysis of abstract hierarchy in theory. The sources for the former are [25], [29], [31], and [32] and those for the latter essentially [27] and [30]. Hierarchical notions played a significant role in the already published [34]. (shrink)

First published in 2002. Routledge is an imprint of Taylor & Francis, an informa company.

Low‐energy, pulsed electromagnetic fields (PEMFs) have reversed therapeutically resistant pathologic processes in the musculo‐skeletal system. Their development as a non‐thermal therapeutic agent is based on 30 years of study of the electro‐biological properties of connective tissues. Specific energy characteristics in applied PEMFs produce selected biological effects by modifying synthetic and other behavioral patterns of target cells; some mechanisms of action are defined. The technology appears safe and effective in clinical treatment of un‐united fractures, avascular necrosis of bone, and chronic, refractory (...) tendinitis. An expanding, rational use in biomedical science is predicted. (shrink)