Transoral laser microsurgery applies to the piecemeal removal of malignant tumours of the upper aerodigestive tract using the CO2 laser under the operating microscope. This method of surgery is being increasingly popularised as a single modality treatment of choice in early laryngeal cancers (T1 and T2) and occasionally in the more advanced forms of the disease (T3 and T4), predomi- nantly within the supraglottis. Thomas Kuhn, the American physicist turned philosopher and historian of science, coined the phrase ‘paradigm shift’ in (...) his groundbreaking book The Structure of Scientific Revolutions. He argued that the arrival of the new and often incompatible idea forms the core of a new paradigm, the birth of an entirely new way of thinking. This article discusses whether Steiner and col- leagues truly brought about a paradigm shift in oncological surgery. By rejecting the principle of en block resection and by replacing it with the belief that not only is it oncologically safe to cut through the substance of the tumour but in doing so one can actually achieve better results, Steiner was able to truly revolutionise the man- agement of laryngeal cancer. Even though within this article the repercussions of his insight are limited to the upper aerodigestive tract oncological surgery, his willingness to question other peoples’ dogma makes his contribution truly a genuine paradigm shift. (shrink)

The coefficients of internal consistency and retest reliability had been rarely investigated within the methodology of dream content analysis. Analyzing a dream series of elderly, healthy persons obtained from weekly telephone interviews, the internal consistency of a series of 20 dreams and retests after 4 or 22 weeks, respectively, had been computed. The findings indicate that dream recall and dream length are quite stable, but dream characteristics such as bizarreness and emotional tone underlie large intraindividual fluctuations. In order to obtain (...) reliable measures for these variables which will be important for correlational studies, including waking-life trait measures, one has to obtain as many dreams as possible (about 20) in a very short time period. Further research is needed to extend the present findings to diary dreams and laboratory dreams. (shrink)

Background: Discussing treatment risks has become increasingly important in medical communication. Still, despite regulations, physicians must decide how much and what kind of information to present. Objective: To investigate patients’ preference for information about a small risk of a complication of colonoscopy, and whether medical and personal factors contribute to such preference. To propose a disclosure policy related to our results. Design: Vignettes study. Setting: Department of Gastroenterology, Academic Medical Centre, the Netherlands. Patients: 810 consecutive colonoscopy patients. Intervention: A home-sent (...) questionnaire containing three vignettes. Vignettes varied in the indication for colonoscopy, complication severity and level of risk. Patients were invited to indicate their wish to be informed and the importance of such information. In addition, sociodemograhic, illness-related and psychological characteristics were assessed. Main outcome measurements: Wish to be informed and importance of information. Results: Of 810 questionnaires, 68% were returned. Patients generally wished to be informed about low-risk complications, regardless of the indication for colonoscopy or the severity of the complication. The level of risk did matter, though (OR = 2.48, SE = 0.28, p = 0.001). The information was considered less important if done for population screening purposes or diagnosis of colon cancer, if the complication was less severe (bleeding) and if the risk was smaller (0.01% and 0.1%). Patients’ information preference was also related to age, mood and coping style. Limitations: Difficulty of vignettes. Conclusions: Patients generally wish to be informed about all possible risks. However, this might become uninformative. A stepwise approach is suggested. (shrink)

Le volume s'enquiert des liens entre l'affectivite et l'activite philosophique. Sur le mode historique et/ou problematique il s'agit de traiter de questions telles que: Y a-t-il une ou des tonalites affectives specifiques a la philosophie: etonnement, angoisse, ennui, serenite, melancolie,...? L'activite philosophique est-elle associee a un deni de l'affectivite et sous quelles formes: nihilisme, detachement, refoulement...? Quel rapport le philosophe noue-t-il a l'ambivalence de l'affect (indecidabilite, double bind,...)? Qu'en est-il de la reception thematique de l'affectivite en philosophie: une philosophie ou (...) une phenomenologie de l'affectivite est-elle possible? Quel statut philosophique pour des sciences nouvelles - les neurosciences -qui pretendent etudier objectivement et techniquement l'affectivit. (shrink)

This study shows how precise simple analytical solutions for the generalized Dirac equation with repulsive vector and attractive energy-dependent Lorentz scalar potentials, position-dependent mass potential, and a tensor interaction term can be obtained within the framework of both similarity transformation and the asymptotic iteration methods. These methods yield a significant improvement over existing approaches and provide more plausible and applicable ways in explaining the pseudospin symmetry’s breaking mechanism in nuclei.

Speeches of the author on theory of knowledge in the context of Islamic philosophy.

One problem of interpreting research on subconscious processing is the possibility that participants are weakly conscious of the stimuli. Here, we compared the fMRI BOLD response in healthy adults to clearly visible single letters with the response to letters presented in the absence of any behavioural evidence of visibility . No letter catch trials served as a control condition. Forced-choice responses did not differ from chance when letter-to-background contrast was low, whereas they were almost 100% correct when contrast was high. (...) A comparison of fMRI BOLD signals for supraliminal and subliminal letters with the control trials revealed a signal increase in left BA 37 . Comparison of supraliminal with subliminal letters showed a significant increase in the right inferior frontal gyrus . Finally, a comparison of subliminal with supraliminal letters showed increases in the left middle temporal gyrus and the right extrastriate cortex. (shrink)

Understanding terrestrial carbon metabolism is critical because terrestrial ecosystems play a major role in the global carbon cycle. Furthermore, humans have severely disrupted the carbon cycle in ways that will alter the climate system and directly affect terrestrial metabolism. Changes in terrestrial metabolism may well be as important an indicator of global change as the changing temperature signal. Improving our understanding of the carbon cycle at various spatial and temporal scales will require the integration of multiple, complementary and independent methods (...) that are used by different research communities. Tools such as air sampling networks, inverse numerical methods, and satellite data allow us to study the strength and location of the global- and continental-scale carbon sources and sinks. Bottom-up studies provide estimates of carbon fluxes at finer spatial scales and examine the mechanisms that control fluxes at the ecosystem, landscape, and regional scales. Bottom-up approaches include comparative and process studies that provide the necessary mechanistic information to develop and validate terrestrial biospheric models. An iteration and reiteration of top-down and bottom-up approaches will be necessary to help constrain measurements at various scales. We propose a major international effort to coordinate and lead research programs of global scope of the carbon cycle. (shrink)

Total quality; commerce; economics; religious aspects; Islam; Islamic ethics.

The present volume draws together original and significant essays from a number of leading authorities which identify areas of the modern criminal law where there are significant conceptual difficulties. The project developed from a series of seminars in Cambridge University, in which leading Anglo-American philosophers, criminal lawyers and legal theorists explored subjects such as attempts, intention, justification, excuses, coercion, complicity, drug-dealing and criminal harm.

لقد خلقت المثنوية تأرجحاً ملازماً في المطارحات الفكرية والنظائر العلمية، أي صراعاً بين النازع الروحي، والعوز المادي. وتوضح لنا أن التذبذب، يميل في أغلب الأحيان إلى صدام بين الروحانية والعلمية. وهذا ما شهدناه بين الدين وفلسفة المنطق، وبين الدين ومكتشفات العلوم الطبيعية، ما جعل الفكر ينشط في توليد قضايا مختلفة في ألوانها وأجناسها وقيمها وأهدافها وطبيعة منجزاتها. وهكذا ينتهي بنا القول إلى أن المثنوية، هي فلسفة المتضاد المثنوي في منظومة القيم المُحدثة بفعل تأملات العقل النظري، والمحور الناظم لبنية النظائر المفترضة (...) في جدلية التغريب التي ساهمت في مأسسة مواريث ثقافة العماء في سائر المطارحات التي تخلّقها العقل الإبداعي. (shrink)