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)

Alzheimer's disease is characterized by plaques of amyloid-beta peptide, cleaved from amyloid-beta protein precursor . Our hypothesis is that lifespan profiles of AD-associated mRNA and protein levels in monkeys would differ from mice and that differential lifespan expression profiles would be useful to understand human AD pathogenesis. We compared profiles of AbetaPP mRNA, AbetaPP protein, and Abeta levels in rodents and primates. We also tracked a transcriptional regulator of the AbetaPP gene, specificity protein 1 , and the beta amyloid precursor (...) cleaving enzyme . In mice, AbetaPP and SP1 mRNA and their protein products were elevated late in life; Abeta levels declined in old age. In monkeys, SP1, AbetaPP, and BACE1 mRNA declined in old age, while protein products and Abeta levels rose. Proteolytic processing in both species did not match production of Abeta. In primates, AbetaPP and SP1 mRNA levels coordinate, but an inverse relationship exists with corresponding protein products as well as Abeta levels. Comparison of human DNA and mRNA sequences to monkey and mouse counterparts revealed structural features that may explain differences in transcriptional and translational processing. These findings are important for selecting appropriate models for AD and other age-related diseases. (shrink)

The notion of form is "the most important notion within the Critique of Aesthetic Judgment". The sensible form involved in aesthetic judgment stands in no clear relation to the formal elements of the Transcendental Aesthetic and Logic—neither to the a priori forms of space and time, nor to the categories. It is held to be the same "kind of form" as the intuitable, "empirical form" mentioned infrequently in the Pure Reason. The author attempts to establish only "what Kant meant" as (...) distinct from its "truth." He lays a bold preparation for "the suggestion... that aesthetic experience is a window, so to speak, into the noumenal world". In Ch. I he accepts a widely-held view that Kant is the discoverer of "philosophical aesthetics" or "the autonomy of the aesthetic realm." His concern is not with this historical question. Nonetheless it may be said that he is not sufficiently aware that the autonomy found in Kant is not in understanding aesthetics as a realm of art, but only in understanding aesthetic judgment in its concern with both art and nature. Accordingly the aesthetic form of objects of art and objects of nature is treated without differentiation. The author is little concerned with form in its relation to natural purposiveness, or with the relation of form in the Aesthetic Judgment to form in the Teleological Judgment. Since nature, at least in certain contexts, supplies a kind of norm for art—a "traditional" element in Kant—the author’s exposition of the manner in which art imitates nature is not entirely satisfactory. In Ch. II, the central issue is whether "individual colors and tones are more than mere sensations". If however each may be understood as "a play of sensations" they can be said to possess a "form" and may enter into aesthetic judgments. The assumption here is that only if the parts of a beautiful thing, e.g., the individual colors of a painting, are beautiful, "can the painting as a whole be a beautiful thing". But this atomistic view of the aesthetic part is subsequently modified. In Ch. III, the imagination is said to "function without the categories" in the synthesis of aesthetic forms. The author must then oppose the view of Kemp Smith and others "that there can be no cognitive awareness or consciousness apart from the categories". He relies especially on the "judgments of perception" of the Prolegomena which "require no pure concept of the understanding". The possibility is not considered that although the imagination may indeed function "autonomously"—without the categories—in the synthesis of aesthetic form, that same synthesis may presuppose a synthesis employing the categories, especially in certain types of aesthetic experience. Some valuable clarifications are achieved of the difficult notions of "play," the harmony of form and cognitive faculties, and the universality of aesthetic judgments. The thesis of Ch. IV is that the object of experience, or the phenomenal object, is not a second object, distinct from the thing-in-itself, but an appearance of the thing-in-itself. Ch. V is devoted to Kant’s theory of art and especially to genius as the productive faculty of aesthetic ideas. The harmony of the faculties of imagination and understanding required of the artistic genius is held to be the same as the harmony which "the work of art itself... arouses in the perceiver of that work of art", but is spontaneous and original in the former case. What would be required of the productive agency in the case of natural objects of aesthetic experience lies outside the range of subject matter chosen. Kant’s view, although not entirely lucid, is that "the standard of fine art must be sought in the supersensible substrate of the artist’s faculties and that the production of the accord of the faculties of understanding and imagination ‘is the ultimate end set by the intelligible basis of our nature'". This prepares the conclusion that "the artist, as creative genius, is he who not only produces but expresses in sensible products, forms which are windows into the supersensible substrate of being". The monograph effectively raises this possibility as a central issue in the discussion of Kant’s aesthetics.—R. K. (shrink)

How many words is a bilingual 2-year-old supposed to know or say in each of her languages? Speech and language therapists or researchers lack the tools to answer this question, because several factors have an impact on bilingual language skills: gender, amount of exposure, mode of acquisition, socio-economic status and the distance between L1 and L2. Unfortunately, these factors are usually studied separately, making it difficult to evaluate their weight on a unique measure of vocabulary. The present study measures the (...) contribution of the following factors to the vocabulary scores of bilingual toddlers: i) gender; ii) sibling ranking; iii) relative amount of exposure to each language; iv) mode of exposure; v) SES; vi) linguistic distance; vii) language spoken between parents. Close to the child’s second birthday, parents of 278 UK-based bilinguals completed successively: a 100-word version of the Oxford-CDI, the CDI in the child’s Additional Language, a family questionnaire, and the Language Exposure Questionnaire. Thirty-six British-English-AL pairs were considered, with languages contrasted on a second-language-learning scale : for example, Dutch and French are close to British-English, while Polish or Cantonese are more distant. Data from the corpus were included in two mixed-effect models, one with the English scores in comprehension as the dependent variable, and the other with production scores. The seven factors listed above were included as predictors. The amount of English exposure was the strongest predictor of comprehension scores = 9.35, p <.005, β = 0.02, t = 3.08, p <.005), followed by the language that parents speak between themselves = 14.94, p <.001, β = 1.37, t = 3.76, p <.0005), linguistic distance = 6.92, p <.01, β = -0.74, t = -2.66, p <.01) and age = 4.86, p <.05, β = 0.55, t = 2.17, p <.05). In production, gender = 13.57, p <.0005, β = -0.91, t = -03.72, p <.0005), amount of exposure to English = 13.57, p <.0005, β = -0.91, t = -03.72, p <.0005), the language that parents speak between themselves = 11.85, p <.005, β = 1.09, t = 3.41, p <.001), and the mother’s occupation = 4.51, p <.05, β = 0.63, t = 2.13, p <.05) were the significant predictors. The more English parents use to address one another, the more English words the child says and understands. This surprising result could be simply explained by the fact that parents who speak English together are also more likely to speak English to their child. The main results of this study is that linguistic distance is a powerful predictor of toddlers’ vocabulary in English, with children learning two close languages growing their vocabulary faster than those learning distant languages. (shrink)

This work has been selected by scholars as being culturally important and is part of the knowledge base of civilization as we know it. This work is in the public domain in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity has a copyright on the body of the work. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and (...) made generally available to the public. To ensure a quality reading experience, this work has been proofread and republished using a format that seamlessly blends the original graphical elements with text in an easy-to-read typeface. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)