BackgroundAdolescents living with human immunodeficiency virus (HIV) experience challenges, including lack of involvement in their care as well nondisclosure of HIV status, which leads to poor adherence to antiretroviral therapy (ART). Parents have authority over their children, but during adolescence there is an increasing desire for independence. The aim of the study was to explore adolescents’ experience of challenges identified by adolescents ages 10–19 years attending HIV care and treatment at Temeke Regional Referral Hospital in Tanzania. MethodsAn exploratory descriptive qualitative (...) design was employed in the HIV Care and Treatment Centre (CTC) in the Out-Patient Department at the Temeke Regional Referral Hospital in Tanzania with adolescents living with HIV who were 10–19 years of age. A total of 22 adolescents participated in semi-structured face-to-face interviews after parental consent and adolescent assent were obtained. Participants were interviewed about their participation in decisions to be tested for HIV and enrolled in the CTC, concerns surrounding disclosure of their HIV status to the adolescent or to others, stigma and discrimination, and the effect of these challenges on their adherence to medication. All interviews were audio-taped, transcribed verbatim in Swahili, and back-translated to English. Data analysis included both inductive and deductive thematic analysis.ResultsQualitative themes identified included lack of participation in decisions about HIV testing, challenges to enrollment in care and treatment; issues around disclosure of HIV status, such as delays in disclosure to the adolescent and disclosure to other persons and benefits and harms of such disclosures; and factors supporting and interfering with adherence to ART, such as parental support, organizational (clinic) support and problems, and self-stigmatization and shame.ConclusionLack of adolescents’ involvement in their care decision making and delayed disclosure of HIV status to the adolescent were identified concerns, leading to poor adherence to ART among adolescents. Disclosure to others, especially teachers, helped adolescents at school to take their medication properly. Disclosure to others led to stigma and discrimination for some adolescents. More research is needed to better understand the role of disclosure and its benefits and challenges for HIV-positive adolescents in Tanzania. (shrink)

Appearing in English for the first time, Schelling’s 1842 lectures develop the idea that many philosophical concepts are born of religious-mythological notions.

Huck Finn’s emotional responses constitute perfectly good moral reasons not to betray his friend, even though Huck is unable to recognise them as such.

A compilation of all previously published writings on philosophy and the foundations of mathematics from the greatest of the generation of Cambridge scholars that included G.E. Moore, Bertrand Russell, Ludwig Wittgenstein and Maynard Keynes.

We no longer have any texts, any past, but just interpretations of them. The evident multi -interpretability of a text causes it gradually to lose its capacity to function as arbiter in the historical debate. It is necessary to define a new link with the past based on a complete and honest recognition of the position in which we now see ourselves placed as historians. In recent years, many people have observed our changed attitude towards the phenomenon of information. For (...) postmodernism, science and information are independent objects of study which obey their own laws. Language and art are not situated opposite reality but are themselves a pseudo-reality and are therefore situated within reality. Because of the relation between the historiographical view and the language used by the historian to express his view - a relation which nowhere intersects the domain of the past -historiography possesses the same opacity and intensional dimension as art. The essence of postmodernism is precisely that we should avoid pointing out essentialist patterns in the past. There is reason to assume that our relation to the past and our insight into it will in future be of a metaphorical nature rather than a literal one. (shrink)

The defining principle of evolutionary biology is that all species, extant and extinct, evolved from ancient prokaryotic cells. Their initial appearance and adaptive evolution are proposed to have been accompanied by a cellular sentience, by feelings, subjectivity or, in a word, 'consciousness'. Prokaryotic cells, such as archaea and bacteria, have natural unitary, valence-marked 'mental' representations. They process and evaluate sensory information in a context-dependent manner. They learn, establish memories, and communicate using biophysical fields acting on excitable membranes. Symbiotic eukaryotic cells, (...) which evolved much later, initiated a compound cellular subjectivity utilizing 'senomic' and 'ephaptic' principles that evolved into the varieties of consciousness seen in multicellular species. This Cellular Basis of Consciousness (CBC) model provides a novel framework within which to approach fundamental issues such as the origins of life and the emergence of mind. (shrink)

Taking as its point of departure a sharp critique of Rawls's influential A Theory of Justice, this book looks at politics from an aesthetic perspective.

Why are we interested in history at all? Why do we feel the need to distinguish between past and present? In this book, the author argues that the past originates from an experience of rupture separating past and present. Think of the radical rupture with Europe's past that was effected by the French and the Industrial Revolutions. Sublime Historical Experience investigates how the notion of sublime historical experience complicates and challenges existing conceptions of language, truth, and knowledge. These experiences of (...) rupture are paradoxical since they involve both the separation of past and present and, at the same time, the effort to overcome this separation in terms of historical knowledge. The experience unites feelings of loss/pain with those of love/satisfaction, and thus is in agreement with how sublime experience is ordinarily defined. The experience is also precognitive since it precedes historical knowledge. As such it is a challenge to traditional conceptions of the relationship between experience and truth or language. It compels us to disconnect the notions of experience and truth. (shrink)

As the gap between the need for and supply of human organs continues to widen, the aim of securing additional sources of these “gifts of the body” has become a seemingly overriding moral imperative, one that could—and some argue, should—override the widespread ban on organ markets. As a medical practice, organ transplantation entails the inherent risk that one human being, a donor, will become little more than a means to the end of healing for another human being and that he (...) or she will come to have a purely instrumental value. With the establishment of organ markets, not only will the harms of instrumentalization be a reality—the ends of medicine will be further compromised and confused. (shrink)

Introduction: This study, the first of its kind in Iran, was to assess Iranian patients’ preferences for receiving information and participating in decision-making and to evaluate their satisfaction with how medical information is given to them and with their participation in decision-making at present. Method and materials: 299 of 312 eligible patients admitted to general internal medicine or surgery wards from May to December 2006 were interviewed according to a structured questionnaire. The questionnaire contained questions about patients’ preferences regarding four (...) domains of information and their participation in decision-making. Patients’ responses were measured on a visual analogue scale graded from 1 to 10. Results: The mean (SD) score for desire to receive information was 8.88 out of 10 (1.5) and for participation in medical decision-making was 7.75 out of 10 (3). The desire to receive information was greater in women than men (9.0 (1.5) vs 7.8 (1.4), p = 0.025). It was also correlated with their education (r = 0.2, p = 0.001) and their estimation of the severity of their own disease (r = 0.13, p = 0.027). The score for preference to participate in decision-making was higher in women than in men (7.95 (2.8) and 7.0 (3.2), respectively; β = 0.8, p = 0.022) and was negatively correlated with education (r = −0.14, p = 0.015). Discussion: This study shows that Iranian patients are highly interested in receiving information about their condition and participating in clinical decision-making. No predictive variable for such attitudes was found; therefore, the only way for the physician to recognise patients’ desire is to ask them explicitly. (shrink)

The first set of case studies on animal use, this volume offers a thorough, up-to-date exploration of the moral issues related to animal welfare. Its main purpose is to examine how far it is ethically justifiable to harm animals in order to benefit mankind. An excellent introduction provides a framework for the cases and sets the background of philosophical and moral concepts underlying the subject. Sixteen original, previously unpublished essays cover controversies associated with the human use of animals in a (...) broad range of contexts, including biomedical, behavioral, and wildlife research, cosmetic safety testing, education, the food industry, commerce, and animal use as pets and in religious practices. Scientific research is accorded the closest scrutiny. The authors represent a wide range of expertise within their specialized areas of research--physiology, public policy, ethics, philosophy, law, veterinary science, and psychology. The careful analysis of each case makes it possible to elevate the discourse beyond over-simplified positions, and to demonstrate the complexity of the issues. The Human Use of Animals will be welcomed by students and faculty in law, philosophy, ethics, public policy, religion, medicine, and veterinary medicine. It will also interest activists in the animal protection movement, and members of animal protection organizations and Institutional Animal Care and Use Committees. (shrink)

Forgetting has rarely been investigated in historical theory. Insofar as it attracted the attention of theorists at all, forgetting has ordinarily been considered to be a defect in our relationship to the past that should be overcome in one way or another. The only exception is Nietzsche who so provocatively sung the praises of forgetting in his On the Use and Abuse of History . But Nietzsche's conception is the easy victim of a consistent historicism and therefore in need of (...) correction. Four types of forgetting are identified in this essay. Central in the essay's argument is the fourth type. This is the kind of forgetting taking place when a civilization "commits suicide" by exchanging a previous identity for a new one. Hegel's moving account of the conflict between Socrates and the Athenian state is presented as the paradigmatic example of this kind of forgetting. Two conclusions follow from an analysis of this type of forgetting. First, we can now understand what should be recognized as a civilization's historical sublime and how the notions of the historical sublime and of collective trauma are related. Second, it follows that myth and history do not exclude each other; on the contrary, history creates myth. This should not be taken to be a defect of history, for this is precisely how it should be. (shrink)