Copyright © 2015 by the Society of Criti. Objective: Global lung stress varies considerably with low tidal volume ventilation for acute respiratory distress syndrome. High stress despite low tidal volumes may worsen lung injury and increase risk of death. No widely available parameter exists to assess global lung stress. We aimed to determine whether the volume delivered during a recruitment maneuver is inversely associated with lung stress and mortality in acute respiratory distress syndrome. Design: Substudy of an acute respiratory distress (...) syndrome clinical trial on esophageal pressure-guided positive end-expiratory pressure titration. Setting: U.S. academic medical center. Patients: Forty-two patients with acute respiratory distress syndrome in whom airflow, airway pressure, and esophageal pressure were recorded during the recruitment maneuver. Interventions: A single recruitment maneuver was performed before initiating protocol-directed ventilator management. Recruitment maneuvers consisted of a 30-second breath hold at 40 cm H2O airway pressure under heavy sedation or paralysis. VRM was calculated by integrating the flow-time waveform during the maneuver. End-inspiratory stress was defined as the transpulmonary pressure during end-inspiratory pause of a tidal breath and tidal stress as the transpulmonary pressure difference between end-inspiratory and end-expiratory pauses. Measurements and Main Results: VRM ranged between 7.4 and 34.7 mL/kg predicted body weight. Lower VRM predicted high end-inspiratory and tidal lung stress. After adjusting for Pao2/Fio2 and either driving pressure, tidal volume, or plateau pressure and positive end-expiratory pressure, VRM remained independently associated with both end-inspiratory and tidal stress. In unadjusted analysis, low VRM predicted increased risk of death. VRM remained significantly associated with mortality after adjusting for study arm. Conclusions: Low VRM independently predicts high lung stress and may predict risk of death in patients with acute respiratory distress syndrome. (shrink)

Sept cavaliers quittèrent la Ville au crépuscule, face au soleil couchant, par la porte de l'ouest qui n'etait plus guardée. Tête haute, sans se cacher, au contraire de tous ceux qui avaient abandonné la Ville, car ils ne fuyaient pas, ils ne trahissaient rien, espéraient moins encore et se gardaient d'imaginer. Ainsi étaient-ils armés, le coeur et l'âme désencombrés scintillant froidement comme du cristal, pour le voyage qui les attendait. Sur l'ordre du margrave héréditaire, simplement, ils allaient, ils s'étaient mis (...) en mouvement et le plus jeune d'entre eux, qui n'avait pas seize ans, fredonnait une chanson…Seven cavalrymen left the City at dusk, facing the setting sun by the Eastern gate, which was no longer guarded. Head held high, not hiding themselves, contrary to those who had left the City, for they were not escaping, they were not betraying, were hoping even less, and guarded themselves from imagining. Thus they were armed, their unfettered heart and soul sparkling coldly like crystal, for the voyage which awaited them. On the order of the hereditary Margrave, they were simply going, they were setting out, and the youngest of them, who was not yet 16, was humming a song …. (shrink)

When reading Susan Vreeland's novel The Passion of Artemisia, we find ourselves in seventeenth century Renaissance Italy and the social life of Artemisia d'Orazio Gentileschi, a woman painter who was raped, tortured by the Inquisition and due to her fine and original paintings, was the first woman painter to become a member of the famous Accademia del Disegno. In sum, she struggled for her personal and artistic liberation long before anyone in Europe had heard about feminism. Moreover, Artemisia is a (...) timely reminder of how sometimes in the past for Europeans, and more specifically for Italians, Art in general and Painting in particular, was an integral part of a form of life not only for artists but for ordinary people as well. (shrink)

THE OBJECT OF THIS ARTICLE IS TO SHOW THAT SCEPTICISM IS NOT ALWAYS USED TO CHALLENGE BELIEFS: IT IS SOMETIMES USED TO "FOSTER" CERTAIN BELIEFS. GLANVILL’S SCEPTICISM REGARDING OUR KNOWLEDGE OF NATURAL CAUSES IS BASED ON THE WEAKNESS AND LIMITATIONS OF HUMAN UNDERSTANDING. BUT THIS ALLOWS HIM TO ARGUE FOR THE EQUAL POSSIBILITY OF BOTH NATURAL AND NON-NATURAL CAUSES, AND THUS OPENS THE DOOR TO BELIEF IN THE SUPERNATURAL. HUME, HOWEVER, WHOSE SCEPTICISM IS ALSO BASED ON THE LIMITATIONS OF THE (...) UNDERSTANDING, REJECTS ANY EXPLANATION WHICH IS OVER AND ABOVE OUR UNDERSTANDING, THAT IS, EXPLANATIONS IN TERMS OF NON-NATURAL CAUSES. (shrink)

In this important study D. M. Armstrong offers a comprehensive system of analytical metaphysics that synthesises but also develops his thinking over the last twenty years. Armstrong's analysis, which acknowledges the 'logical atomism' of Russell and Wittgenstein, makes facts the fundamental constituents of the world, examining properties, relations, numbers, classes, possibility and necessity, dispositions, causes and laws. All these, it is argued, find their place and can be understood inside a scheme of states of affairs. This is a comprehensive and (...) rigorously this-worldly account of the most general features of reality, argued from a distinctive philosophical perspective, and it will appeal to a wide readership in analytical philosophy. (shrink)

This short novel by the writer S´ndor M´rai, regarded by many as the finest Hungarian writer of our time, was published in 1942 but became known in the West only many years later and was finally translated into English in 2002. Its central subject is the importance and value of friendship between men and love between men and women, involving the three central characters, Henrik, Konrad and Krisztina. The men, who had been friends since their early youth, meet again 41 (...) years later. Although Krisztina, Henrik's wife and Konrad's lover, is long dead, she is fully present in the memory of both. Like Proust's A La Recherche du Temps Perdu, Embers is remembrance of things past, but with a difference. M´rai's novel plays on the contrast between their past friendship and their present broken friendship, and the contrast between Henrik's love for his wife, and her love for Konrad. But whereas Proust's novel is a recapture of the past, M´rai's novel is a recapture of the past through the present. What is left are only embers of friendship and love. (shrink)

The aim of this book is to lay bare the logical flaws in the arguments of those moral philosophers who believe they could make a positive contribution to moral thinking by means of linguistic analysis. By examining three contributions of Urmson, Hare and Toulmin the author shows that meta-ethics or ethics as a second-order activity is an ideal which is very difficult to attain, and if attainable at all would mean the end of ethics as a branch of philosophy.

Mind and Political Concepts offers a descriptive account of the conceptual mind as applied to political philosophy. In an attempt to find the common feature characterizing the conceptual method in political philosophy, this book examines three classical works: Plato's Republic, Thomas Hobbes' Leviathan, and Jean-Jacques Rousseau's Social Contract. It argues that political philosophy can also contribute something to philosophical psychology. This book is comprised of six chapters and begins by tracing the origins of the conceptual method to Plato's general philosophical (...) method. In particular, Plato's views on concepts such as justice, human behavior, and political order in Republic are discussed. The reader is then introduced to Hobbes' Leviathan and his role in the advent of the scientific conceptual method; Rousseau's Social Contract and his analysis of human nature and the state; the structure of a political theory; and the link between the philosophy of mind and psychology. The last chapter considers some modern political theories and shows that, however different their methods and their programs, their notion of the philosopher's participation in political life was dependent on their concept of reason. This monograph will appeal to students and practitioners of philosophy, politics, and psychology. (shrink)