A cross-sectional study to ascertain what the Singapore population would regard as material risk in the anaesthesia consent-taking process and identify demographic factors that predict patient preferences in medical decision-making to tailor a more patient-centered informed consent. A survey was performed involving patients 21 years old and above who attended the pre-operative evaluation clinic over a 1-month period in Singapore General Hospital. Questionnaires were administered to assess patients’ perception of material risks, by trained interviewers. Patients’ demographics were obtained. Mann–Whitney U (...) test and Kruskal-Wallis one-way analysis of variance was used. Statistical significance was taken at p < 0.05. Four hundred fourteen patients were eligible of which 26 refused to participate and 24 were excluded due to language barrier. 364 patients were recruited. A higher level of education, being employed and younger age group are factors identified in patients who wanted greater participation in medical decisions. Gender, marital status, type of surgery, and previous surgical history did not affect their level of participation. The complications most patients knew about were Nausea, Drowsiness and Surgical Wound Pain. Patients ranked Heart Attack, Death and Stroke as the most significant risks that they wanted to be informed about in greater detail. Most patients wanted to make a joint decision with the anaesthetist, instead of letting the doctor decide or deciding for themselves. Discussion with the anaesthetist is the preferred medium of communication compared to reading a pamphlet or watching a video. Age and educational level can influence medical decision-making. Despite the digital age, most patients still prefer a clinic consult instead of audio-visual multimedia for pre-operative anaesthetic counselling. The local population appears to place greater importance on rare but serious complications compared to common complications. This illustrates the need to contextualize information provided during informed consent to strengthen the doctor-patient relationship. (shrink)

Live donor kidney transplantation is the best treatment option for most patients with late-stage chronic kidney disease; however, the rate of living kidney donation has declined in the United States. A consensus conference was held June 5-6, 2014 to identify best practices and knowledge gaps pertaining to live donor kidney transplantation and living kidney donation. Transplant professionals, patients, and other key stakeholders discussed processes for educating transplant candidates and potential living donors about living kidney donation; efficiencies in the living donor (...) evaluation process; disparities in living donation; and financial and systemic barriers to living donation. We summarize the consensus recommendations for best practices in these educational and clinical domains, future research priorities, and possible public policy initiatives to remove barriers to living kidney donation. (shrink)

BackgroundPreprint usage is growing rapidly in the life sciences; however, questions remain on the relative quality of preprints when compared to published articles. An objective dimension of quality that is readily measurable is completeness of reporting, as transparency can improve the reader’s ability to independently interpret data and reproduce findings.MethodsIn this observational study, we initially compared independent samples of articles published in bioRxiv and in PubMed-indexed journals in 2016 using a quality of reporting questionnaire. After that, we performed paired comparisons (...) between preprints from bioRxiv to their own peer-reviewed versions in journals.ResultsPeer-reviewed articles had, on average, higher quality of reporting than preprints, although the difference was small, with absolute differences of 5.0% [95% CI 1.4, 8.6] and 4.7% [95% CI 2.4, 7.0] of reported items in the independent samples and paired sample comparison, respectively. There were larger differences favoring peer-reviewed articles in subjective ratings of how clearly titles and abstracts presented the main findings and how easy it was to locate relevant reporting information. Changes in reporting from preprints to peer-reviewed versions did not correlate with the impact factor of the publication venue or with the time lag from bioRxiv to journal publication.ConclusionsOur results suggest that, on average, publication in a peer-reviewed journal is associated with improvement in quality of reporting. They also show that quality of reporting in preprints in the life sciences is within a similar range as that of peer-reviewed articles, albeit slightly lower on average, supporting the idea that preprints should be considered valid scientific contributions. (shrink)

Identity, Morality, and Threat offers a critical examination of the social psychological processes that generate outgroup devaluation and ingroup glorification as the source of conflict. Daniel Rothbart and Karyna Korostelina bring together essays analyzing the causal relationship between escalating violence and opposing images of the Self and Other.

v. 1. Nicomachean ethics. Politics. The Athenian Constitution. Rhetoric. On Poetics.--v. 2. Logic.--v. 3. Physics. Metaphysics. On the soul. Short physical treaties.--v. 4. On the heavens. On generation and corruption. Meteorology. Biological treatises.

Much of the progress in the fields constituting cognitive science has been based upon the use of explicit information processing models, almost exclusively patterned after conventional serial computers. An extension of these ideas to massively parallel, connectionist models appears to offer a number of advantages. After a preliminary discussion, this paper introduces a general connectionist model and considers how it might be used in cognitive science. Among the issues addressed are: stability and noise‐sensitivity, distributed decision‐making, time and sequence problems, and (...) the representation of complex concepts. (shrink)

In this note we present a three-valued intensional logic, which is an extension of both Montague's intensional logic and ukasiewicz three-valued logic. Our system is obtained by adapting Gallin's version of intensional logic (see Gallin, D., Intensional and Higher-order Modal Logic). Here we give only the necessary modifications to the latter. An acquaintance with Gallin's work is pressuposed.

For over a century we have attempted to understand human aesthetic experience using scientific methods. A typical experiment could be described as reductive and quasi-psychophysical. We vary some aspect of the stimulus and systematically measure some aspect of the aesthetic response. The limitations of this approach can be categorized as problems on the Y axis and the X axis. The most enigmatic components of aesthetic experience include inclination to cry, aesthetic rapture, a sense of the sublime, and intense fascination. However, (...) we cannot evoke these 'hot' aesthetic emotions in the lab, at least not with well controlled stimuli on multiple trials. We thus resort to measuring cold, cognitive preference ratings. There are also problems on the X axis. The reductive psychophysical approach explicitly assumes that there are lawful relations between different stimulus dimensions and preferences. It also tacitly assumes that these dimensions are independent and orthogonal. The second assumption is implausible. Whatever stimulus-preference laws we discover are likely to be twisted and modulated when another dimension is added to the stimuli. This 'gestalt nightmare' has long been recognized, but never resolved. This matters, because human aesthetic faculties are probably tuned to the balance and relationship of parts which make up a whole and are indifferent to the parts presented in isolation. I conclude that the future of scientific aesthetics depends on how successfully we can transcend reductive, quasi-psychophysical approaches. (shrink)

A critical appraisal of the theories founded on the theorem of the multiaxial flower , shows an evolution fromWettstein's original version of 1907 to various hypotheses founded on the the same theme and partly derived from the Wettsteinian doctrine. A number of circumstances such as semantic inconsistencies, but principally the choice of inadequate archetypes, prevented the success of the theory of a polystachyous floral region, because the deductions and interpretations emanating from this concept were not sufficiently convincing to defeat the (...) opposed theory of the uniaxial euanthous flower or anthostrobilus hypothesis. Only after the amendation of the theory of a multiaxial reproductive region on the basis of the anthocorm concept can one arrive at a plausible idea of the evolution of the angiospermous flower which is compatible with all aspects of the phylogeny of the Flowering Plants , and with the floral morphology and anatomy of the various kinds of flowers.Eine kritische Bewertung der Theorien die auf dem Theorem der mehrachsigen Blüte gegründet worden sind zeigt die Entwicklung von einer vonWettstein in 1907 vorgeschlagenen Originalversion zu mehreren, teilweise davon abgeleiteten, Theorien über das Thema der Entstehung der Angiospermenblüte. Verschiedene Umstände, wie z.B. semantische Widersprüche, aber in erster Stelle die Wahl eines inadäquaten Prototypus, verhinderten anfänglich den Erfolg der Hypothese eines mehrachsigen Blütenbereiches, weil es den hervorgehenden Schlussfolgerungen und Deutungen zu viel an Ueberzeugungskraft mangelte um die gegnerische Theorie der einachsigen Ranalesblüte oder Anthostrobilushypothese endgültig zu verdrängen. Erst die Ergänzung der Theorie einer vielachsigen Blüte ermöglichte die plausibele Darstellung der Evolution der Angiospermenblüte, welche Erörterung in befriedigender Weise in Uebereinstimmung ist mit allenA spekten der Phylogenie der Blütenpflanzen , und auch mit den morphologischen and anatomischen Verhältnissen bei Blüten jeder Art im Anklang ist.Une évaluation critique des différentes théories fondées sur le théorème de la fleur pluriaxiale montre une évolution qui commence avec une version originale proposée parWettstein en 1907 et qui mène à plusieurs théories, partiellement dérivées de l'idée wettsteinienne, sur le thème de l'origine de la fleur. Quelques circonstances, comme par exemple des contrariétés sémantiques, mais surtout la choix d'un prototype inadéquat, ont prévenu au début le triomphe de l'hypothèse d'une région florale pluriaxiale, puisque les conclusions et les interprétations qui provenaient de cette théorie étaient privées de toute conviction pour suppléer la théorie opposée de la fleur ranalienne et uniaxiale . Une explication recevable de l'évolution de la fleur angiospermique qui harmonise avec tous les aspects de la phylogénie des plantes floriales , et aussi avec les conditions morphologiques et anatomiques de toutes sortes de fleurs, ne gagnait de terrain qu'après le perfectionnement de la théorie de la fleur pluriaxiale. (shrink)

A new criterion is introduced for judging the suitability of various fuzzy logics for practical uncertain reasoning in a probabilistic world and the relationship of this criterion to several established criteria, and its consequences for truth functional belief, are investigated.

Introduction: In The Netherlands, physicians have to be convinced that the patient suffers unbearably and hopelessly before granting a request for euthanasia. The extent to which general practitioners (GPs), consulted physicians and members of the euthanasia review committees judge this criterion similarly was evaluated. Methods: 300 GPs, 150 consultants and 27 members of review committees were sent a questionnaire with patient descriptions. Besides a “standard case” of a patient with physical suffering and limited life expectancy, the descriptions included cases in (...) which the request was mainly rooted in psychosocial or existential suffering, such as fear of future suffering or dependency. For each case, respondents were asked whether they recognised the case from their own practice and whether they considered the suffering to be unbearable. Results: The cases were recognisable for almost all respondents. For the “standard case” nearly all respondents were convinced that the patient suffered unbearably. For the other cases, GPs thought the suffering was unbearable less often (2–49%) than consultants (25–79%) and members of the euthanasia review committees (24–88%). In each group, the suffering of patients with early dementia and patients who were “tired of living” was least often considered to be unbearable. Conclusions: When non-physical aspects of suffering are central in a euthanasia request, there is variance between and within GPs, consultants and members of the euthanasia committees in their judgement of the patient’s suffering. Possible explanations could be differences in their roles in the decision-making process, differences in experience with evaluating a euthanasia request, or differences in views regarding the permissibility of euthanasia. (shrink)

Ausgehend von einer postulierten Abstammung der verschiedenen Gymnospermengruppen und der Angiospermen von Progymnospermen werden die Semophylesen der Samenanlagen und deren „Hüll- und Schutzorganen” eingehend besprochen. Das innere Integument ist phylogenetisch wohl aus verwachsenen sterilen Megasporangien entstanden, das aussere ist das Homologon der Cupula der Samenfarnen und ein Achsengebilde.Die dritte Hülle — die interseminalen Schuppen bei den Bennettiteen, die Chlamys bei den Chlamydospermen, die Fruchtknotenwand bei einigen Angiospermengruppen wie Pandanaceen und Cyperaceen, und der Arillus bei Angiospermen mit karpellaten Gynoezien — ist (...) wahrscheinlich aus reduzierten Samenanlagen hervorgegangen. Die vierte, aus sterilen brakteenartigen Phyllomen entstanden, hat in verschiedenen Kombinationen mit fertilen Achsen, die karpellaten Fruchtknoten der Angiospermen gebildet.Die Herkunft der Blütenpflanzen von chlamydospermen- und bennettiteen-ähnlichen Vorfahren wird sehr wahrscheinlich da Übergänge zwischen den „nackten” Samenanlagen vomGnetum-Typ und sogenannten pseudomonomeren Griffeln von Angiospermen vorliegen.En basant la phylogénie de plusieurs groupes de Gymnospermes et d'Angiospermes sur une descente des Progymnospermes du Devonien Supérieur , les sémophylèses des ovules et de ses couches protectrices ont été discuté.Le tégument interne très probablement représente une groupe de mégasporanges stériles fusés, le tégument externe est l'homologue des cupules des ptéridospermes et d'origine axillaire. La troisième couche — les écailles interséminales chez les Bennettitales, la chlamys chez les Chlamydospermes, le paroi de l'ovaire chez quelques Angiospermes comme les Pandanacées, les Piperacées..., l'arille de l'ovule dans les ovaires carpellaires des Angiospermes — est probablement l'homologue d'un nombre d'ovules steriles. La quatrième couche, constituée de phyllomes steriles, s'est associée avec des axes ovulifères en formant les pistils carpellaires des Angiospermes. L'origine des Angiospermes des ancêtres d'un type Chlamydosperme-Bennettitale est indiqué par la morphologie transitoire de quelques ovaires soi-disant „pseudo-monomères” liant les ovules „nues” du typeGnetum avec les pistils du type des Piperacées, Chloranthacées etc. (shrink)

Ship design needs to respond to and attract an ever more design conscious society. However, little research has been conducted into perceptions of beauty and pleasure and how such perceptions can be usefully absorbed into ship design. Aesthetic consideration, is seen as a distraction from the bespoke nature of the ship design process and is often avoided, second guessed or left for external consultancy. The ship design discipline requires the nurturing of its own aesthetic methods, for future development, and to (...) adapt some of the aesthetic ideals found in architecture, art and design. This paper argues that philosophy can be effective in interpreting what the passenger finds attractive and pleasurable. To illustrate the philosophical approach proposed, the `Elbe SWATH’ and the `Oasis of the Seas’ are investigated and compared using theoretical resources from the culturally focused philosophy of `Functional Beauty’. Conclusions suggest that the interpretation of the end users most valued appreciations can lead to design directives that deliver subjective qualities of beauty - beauty similar to those seen in the pure aims of the Elbe SWATH’s purposeful work craft, or comparable to nature’s beauty and purity in aim. (shrink)

Volume 46, Issue 6, November 2020, Page 727-743.

On the ethics of extending human life: healthy people have a right to carry on livingHumanity has long demonstrated a paradoxical ambivalence concerning the extension of a healthy human lifespan. Modest health extension has been universally sought, whereas extreme health extension has been regarded as a snare and delusion—a dream beyond all others at first blush, but actually something we are better off without. The prevailing pace of biotechnological progress is bringing ever closer the day when humanity will be able (...) to act on the latter view by rejecting a clear and present opportunity for much longer healthy lives. Indeed, some biogerontologists contend that that day has already arrived, to the extent that our hesitation in embarking on a vigorous “war on ageing” is already delaying the point at which a cure for ageing will be developed. Here I consider whether our present caution concerning the wisdom of truly curing ageing is likely to survive the increased scrutiny that it will receive in coming years as a result of these technical advances. I conclude that it will not, because of its irreconcilability with values that are more deeply held by the large majority of humanity than any values that argue against the quest for a cure. I further conclude that all the major current reasons given for not curing ageing are mere crutches to help us cope with the immutability of ageing that we have been brought up to accept. Our failure to set aside such irrationality is already shortening potential longevity—quite probably of those already alive today—to a staggering degree. Once we realise this, our determination to consign human ageing to history will be second …. (shrink)

The different aspects of floral evolution—Angiosperm descent, floral morphology and pollination ecology—are discussed on the basis of the anthocorm theory of the angiospermous flower. Opposed ideas are critically compared and rejected mainly on account of several inconsistencies and flaws in old floral concepts. Floral evolution passed from a very early phase of dicliny, anemophily and aphananthy of the anthocorm to a phase of incipient entomophily soon associated with a partial sex reversal within the anthocorm. This second phase culminated in the (...) monoclinous and primarily zoophilous flower types, whereas other floral types, more particularly the primarily anemophilous, diclinous flowers, are the direct descendants of the anthocorms of the initial phase. The second phase gave rise to at least two morphologically different flower types and two separate semophyletic lines of floral evolution , in each of which the primary zoophily is almost always associated with the development of intrafloral semaphylls usually of androecial derivation. Early flower types were aphananthous and clearly anthocormoid and assumed the morphology and other characteristics of a true flower by contractions, condensations, readjustments, oligomerisations, reductions and modifications leading to the great variety of adaptive floral patterns.Divers aspects de l'évolution de la fleur — à savoir la descendance des Angiospermes, la morphologie de la fleur, et l'écologie de la pollination — sont discutés à partir de l'hypothèse florale de l'anthocorme. Les opinions opposées, après d'être comparées et critisées, sont rejetées principalement à cause des inconséquences et inconsistances des anciens théorèmes morphologiques concernant l'origine de la fleur. L'évolution de la fleur commençait avec une phase d'antan de diclinie, anémophilie et aphananthie, et s'avançait graduellement dans la direction d'une phase entomophilique initiale, bientôt accompagnée d'un renversement de sexe partiel à l'intérieur de l'anthocorm. La deuxième phase culminait vers les types florals monoclines avec zoophilie primaire pendant que des autres types florals, particulièrement les fleurs diclines avec anémophilie primaire, sont les descendants directs du stade initiale de l'anthocorme. A partir de la phase II , au moins deux types florals différents et aussi deux sémophylèses florals séparés se développaient. Dans chacun de ses phases III et III A la zoophilie primaire est presque toujours accouplée avec l'origine des sémaphylles intrafloraux le plus souvent dérivés des étamines. Les anciens types des fleurs ayant été aphanantique et au début encore nettement anthocormoïdes , graduellement prenaient la forme d'une des plusieurs types floraux adaptifs par une contraction de l'axe florale et par l'entassement, l'oligomérisation et la modification des pièces de la fleur.Die drei Aspekte der Evolution der Blüte — die Abstammungsgeschichte der Angiospermen, Blütenmorphologie und Bestäubungsökologie — werden, ausgehend von der Anthokormtheorie der Angiospermenblüte, eingehend besprochen. Entgegengesetzte Meinungen werden kritisch verglichen und hauptsächlich auf Grund mehrerer Strittigkeiten und Fehler der älteren blütenmorphologischen Axiomen abgelehnt. Die Evolution der Blüte fing an mit einer frühen Phase mit Diklinie, Anemophilie und Aphananthie des Anthokorms und schritt allmählich weiter in die Richtung von beginnender Entomophilie, bald mit einer partiellen Geschlechtsinversion innerhalb des Anthokorms zusammengehend. Diese zweite Phase kulminierte in den monoklinen und primär zoophilen Blütentypen, während andere Blütengestalten, besonders die primär anemophilen und diklinen Angiospermenblüten, die unmittelbaren Abkömmlinge der Initialphase des Anthokorms sind. Aus der zweiten Phase entwickelten sich wenigstens zwei morphologisch differenzierte Blütenformen und auch zwei geschiedene Blütensemophylesen , in jeder die primäre Zoophilie fast immer verbunden ist mit der Entwicklung von intrafloralen und meistens von Staubblättern angeleiteten Semaphyllen . Die frühen Blütentypen waren aphanantisch und anfänglich noch deutlich anthokormoid und nahmen allmählich die entgültige Gestalt von einer der vielen adaptiven Blütentypen an durch eine Verkürzung der Blütenachse, und durch ein Zusammendrängen, Oligomerisation und Abänderung der Blütenteile. (shrink)