bluuebunny/crossref_metadata_2025 huggingface dataset:
NICOLAES TULP AND THE GOLDEN AGE OF THE DUTCH REPUBLIC
Authors: Simpson Donald
Published: October 2007

In the seventeenth century, Holland and the allied provinces of the northern Netherlands won final independence from their Spanish overlords and formed a worldwide economic empire. Dutch ships dominated the seas from the Caribbean to Japan and reconnoitred the coasts of Australia and New Zealand. Dutch society was cosmopolitan and supported great painters, philosophers and scientists. In these astonishing years, the physician Nicolaes Tulp [1593–1674] practised medicine in Amsterdam and, in 1641, published a book of his medical observations. This book ran into many editions; the Cowlishaw collection contains one of the last, dated 1716. Tulp is best known as the chief figure in a famous painting by Rembrandt, but his book has been studied by medical historians as a source of early descriptions of cranial surgery, spina bifida, vesical calculi, beriberi and many other conditions. The book is also a mirror of Dutch society in a great period in European history.
WORLD LEADERS SURVIVING SERIOUS ILLNESS: FRANKLIN D. ROOSEVELT AND POPE JOHN PAUL II*
Authors: Kune Gabriel
Published: October 2007

The quality of medical care and the degree of transparency communicated to the world whilst President Franklin D. Roosevelt and Pope John Paul II were seriously ill, as well as the global consequences of critical decisions they made during this time, were examined from published studies and through personal communications. Franklin D. Roosevelt, in his last years, was secretive about his health and, with one exception, was probably given indifferent medical advice, arguably hung on to office too long which, at least for Europe, contributed to some negative outcomes. Pope John Paul II, when quite ill, was open and communicative about his illness, had high‐quality medical and surgical care and, together with his spirited will, greatly contributed to favourable European political outcomes, and to European and world stability.
VARICOSE VEINS: HIPPOCRATES TO JERRY MOORE
Authors: Royle John , Somjen George M.
Published: October 2007

Seven volumes from the Cowlishaw Collection were selected for review. The authors highlight the evolution of treatment of venous diseases from the ancient Greek times to the modern day through the writings of Hippocrates, Ambroise Pare, Richard Wiseman and other famous physicians of the past. An important Australian contribution by Jerry Moore is described in detail. Jerry Moore introduced ‘high ligation’ of the great saphenous vein late in the nineteenth century by modifying Trendelenburg’s original procedure. The operation withstood the test of time and it is performed today according to his recommendations.
IMPOSTURES, DECEPTIONS AND CREDULITY
Authors: Magee Reginald
Published: October 2007

In the Cowlishaw collection of the College Library, there is a little book entitled ‘Sketches of imposture, deception and credulity’. The anonymous author covers a wide range of subjects including some in which there have been deceptions by members of the medical profession or they themselves have been deceived because of their credibility. Several examples have been selected.
Is Charisma Hyper‐Romanticism? Empirical Evidence from New Data and a Meta‐Analysis
Authors: Schyns Birgit , Felfe Jörg , Blank Hartmut
Published: October 2007

In prior research, mixed results were obtained with respect to the relationship between Romance of Leadership and the perception of transformational leadership. In this paper, we first present new studies originating from different contexts (students and employees) and different countries and, second, we meta‐analyse these studies together with prior studies in order to shed light on the relationship between Romance of Leadership and the perception of transformational leadership. In the meta‐analysis, we considered the following moderators: field/employees vs. experimental/student samples, geographical region, and type of assessment of transformational leadership. The results indicate a positive relationship between Romance of Leadership and the perception of transformational leadership. Only the moderating effect of region of origin was significant. In line with social constructivism and information processing approaches of leadership, our results indicate that the perception of leadership comprises more than merely the actual behaviour the leader exhibits.

Des résultats contradictoires ont été obtenus dans le passé en ce qui concerne la relation entre la Romance du Leadership et la perception du leadership transformationnel. Dans cet article, nous présentons d’abord de nouvelles recherches portant sur des populations différentes (des étudiants ou des salariés) provenant de plusieurs pays, puis dans un second temps nous effectuons une méta‐analyse regroupant ces travaux et des études antérieures afin d’y voir plus clair dans la relation entre la Romance du Leadership et la perception du leadership transformationnel. On a, dans la méta‐analyse, pris en considération les variables régulatrices suivantes: l’origine géographique des échantillons d’étudiants (travaux expérimentaux) ou de salariés (enquêtes sur le terrain) et le type d’évaluation du leadership transformationnel. Les résultats vont dans le sens d’une relation positive entre la Romance du Leadership et la perception du leadership transformationnel. Il n’y a que la région d’origine qui présente un effet régulateur significatif. Dans la continuité du constructivisme social et des travaux concevant le leadership comme un traitement de l’information, nos résultats indiquent que la perception du leadership dépasse le comportement observable du leader.
Leaders’ Romantic Conceptions of the Consequences of Leadership
Authors: Schilling Jan
Published: October 2007

By inverting the notion in the romance of leadership literature that extreme results evoke attributions of leadership, the present study investigates the ideas of leaders concerning the content of leadership consequences. To understand the deeper meaning and importance of leadership from the leader's viewpoint, a qualitative approach of data collection and analysis was chosen. Using semi‐standardised interviews, 42 managers were asked about their conceptions of the consequences of positive and negative leadership. The results reveal a wide diversity of consequences of leadership with follower feelings, attitudes, behavior, and organisational results as the main categories. While positive consequences are predominantly moderate in their impact, negative statements more often tend to be extreme. A higher degree of leadership experience is related with an optimistic (i.e. naming more positive aspects), but unromantic (i.e. naming fewer extreme consequences) conception of leadership. Limitations of the present approach and implications for future research on the romance of leadership are discussed.

En inversant la notion relevant de la littérature sur la romance du leadership selon laquelle des résultats exceptionnels provoquent une attribution de leadership, cette recherche porte sur les idées des leaders concernant le contenu des retombées du leadership. Pour comprendre la signification profonde et l’importance du leadership du point de vue du leader, on a choisi un recueil des données et une analyse qualitatives. Dans le cadre d’entretiens semi‐directifs, on a demandéà 42 cadres de parler de leurs conceptions des conséquences du leadership positif et négatif. Les résultats traduisent une grande diversité des conséquences du leadership en ce qui concerne le comportement, les attitudes et les sentiments des collaborateurs ainsi que les suites organisationnelles pour ce qui est des principales rubriques. Alors que les conséquences positives sont généralement modérées dans leur impact, les descriptions négatives tendent plus fréquemment vers le dramatique. Une grande expérience du leadership est en rapport avec une conception optimiste du leadership (c’est‐à‐dire citant davantage de dimensions positives), mais non romantique (c’est‐à‐dire mentionnant moins de conséquences extrêmes). On présente les limites de cette approche et les implications pour de futures recherches sur la romance du leadership.
Prospective evaluation of acute endocrine pancreatic injury as collateral damage of shock‐wave lithotripsy for upper urinary tract stones
Authors: Wendt‐Nordahl Gunnar , Krombach Patrick , Hannak Dieter , Häcker Axel , Michel Maurice Stephan , Alken Peter , Knoll Thomas
Published: October 2007

There has been controversy over whether extracorporeal shock wave lithotripsy (ESWL) can cause damage to the endocrine cells of the pancreas, leading to the later development of diabetes mellitus. Authors from Germany prospectively evaluated acute endocrine pancreatic injury as collateral damage caused by the ESWL for treating upper urinary tract stones. In a careful study they showed that there was no effect on serum levels of variables indicating exocrine and endocrine pancreatic tissue damage, suggesting that the idea that ESWL might lead to future diabetes mellitus is unlikely to be correct.

OBJECTIVE

To detect acute damage to pancreatic cells by extracorporeal shock wave lithotripsy (ESWL), with a focus on endocrine function, as recently the development of diabetes mellitus has been suggested to be a late complication of treatment of upper urinary tract stones, and injury to pancreatic tissue by ESWL, leading to insufficient endocrine function, has been proposed as an explanation of this effect.

PATIENTS AND METHODS

The study included 12 consecutive patients treated with ESWL for proximal ureteric or kidney stones, using a third‐generation electromagnetic lithotripter. To evaluate pancreatic tissue injury caused by ESWL we determined blood variables known to indicate exocrine and endocrine pancreatic cell damage; blood samples were taken before, during, immediately after, and 1 h and 24 h after ESWL to determine the serum levels of amylase, lipase, insulin, glucose, c‐peptide and glucagon. Eight patients treated with ESWL for distal ureteric stones were evaluated in the same way and served as the control group.

RESULTS

Neither the variables indicating islet cell damage (c‐peptide, insulin and glucagon), nor those indicating damage of exocrine pancreatic cells (amylase and lipase) changed significantly over the time course in both groups.

CONCLUSION

We could detect no immediate effect on the serum levels of variables indicating exocrine or endocrine pancreatic tissue damage caused by ESWL for urinary tract stones. The hypothesis that ESWL leads to pancreatic trauma with consecutive development of diabetes mellitus therefore seems unlikely.
Efficacy and complications of intradetrusor injection with botulinum toxin A in patients with refractory idiopathic detrusor overactivity
Authors: Jeffery Stephen , Fynes Michelle , Lee Frank , Wang Kate , Williams Lin , Morley Roland
Published: October 2007

OBJECTIVES

To evaluate the efficacy and complications of botulinum A toxin (Dysport, Ipsen Ltd, Slough, UK) 500 U in refractory idiopathic detrusor overactivity (IDO).

PATIENTS AND METHODS

In a prospective study of 25 patients with refractory IDO, the baseline evaluation included an assessment of symptoms, a 7‐day voiding diary, 24‐h pad test, record of symptoms on a visual analogue scale (VAS) (0–10), the Kings Health Questionnaire (KHQ) and urodynamics. Dysport 500 U was administered at 20 sites in the bladder, sparing the trigone. Patients were followed at 6 weeks and 3, 6 and 9 months; the urodynamic assessment was repeated at 3 months.

RESULTS

Fifteen (63%) patients reported being continent from 1 week after treatment; at 3 months, six (32%) (P = 0.01) patients were still dry, remaining so at 6 months (P = 0.025). Weekly leakage episodes decreased from 5.5 to 1.8 (P = 0.044) at 6 weeks and this was sustained, at 2.7 episodes (P = 0.012), at 9 months. The mean VAS score (0–10) decreased from 8.3 to 5.0 (P = 0.001) at 1 week, to 5.0 at 6 weeks (P = 0.001) and 3 months (P = 0.03) and to 6.1 (P = 0.013) at 6 months. On the KHQ there was a significant improvement in the severity measures domain (P = 0.021) and incontinence impact domain (P = 0.015) up to 9 months. The volume at first desire to void increased from 177 to 251 mL (P = 0.04) at 3 months. At 6 weeks and 3 months, 35% of patients required catheterization, as did 22% at 6 months, but only one at 9 months.

CONCLUSIONS

Intradetrusor Dysport 500 U was associated with significant subjective and objective improvements in refractory IDO. The present patients initially had a significant increase in voiding dysfunction that resolved by 9 months.
Inhibitory effect of sildenafil on the human isolated seminal vesicle
Authors: Gajar Sessin A. , Tano Tania , Resende Ângela C. , Bitencourt José Augusto F. , De Lemos Neto Miguel , Damião Ronaldo , Criddle David N. , Soares de Moura Roberto
Published: October 2007

OBJECTIVE

To investigate the effects of sildenafil on noradrenaline‐ and potassium‐induced contractions of isolated human seminal vesicles (SVs), as premature ejaculation is a relatively common male sexual dysfunction that currently lacks an adequate therapy, and recent in vitro tests showed that sildenafil induces relaxation of rodent isolated SVs, but it is not known whether it also inhibits isolated human SV.

MATERIAL AND METHODS

Isolated strips of human SVs were suspended in an organ bath and cumulative concentration‐response curves to either noradrenaline or KCl were constructed in the presence and absence of sildenafil to evaluate its inhibitory actions.

RESULTS

Sildenafil (25–100 µm) induced concentration‐dependent inhibitory effects on the human SV contracted by either noradrenaline or KCl. These actions of sildenafil do not therefore appear to be mediated via a competitive antagonism of α‐adrenoceptors and are consistent with its recognized ability to inhibit phosphodiesterase‐5.

CONCLUSIONS

The present results show an important inhibitory action of sildenafil in the isolated human SV, supporting the therapeutic indication of this drug for treating premature ejaculation.
Assessment of comparative treatment satisfaction with sildenafil citrate and penile injection therapy in patients responding to both
Authors: Mulhall John P. , Simmons Jennifer
Published: October 2007

Associate Editor

Michael G. Wyllie

Editorial Board

Ian Eardley, UK

Jean Fourcroy, USA

Sidney Glina, Brazil

Julia Heiman, USA

Chris McMahon, Australia

Bob Millar, UK

Alvaro Morales, Canada

Michael Perelman, USA

Marcel Waldinger, Netherlands

OBJECTIVE

To survey patient satisfaction, using validated questionnaires, in a group of men with erectile dysfunction who had used and responded to both sildenafil citrate and intracavernosal injection (ICI) therapy.

PATIENTS AND METHODS

In all, 300 patients on ICI therapy were mailed questionnaire packets containing a survey enquiring about the patients’ medical history, and two sets of the International Index of Erectile Function (IIEF) and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) sexual function surveys. If patients were using sildenafil alternating with ICI they were asked to complete the IIEF and EDITS questionnaires for each therapy. To identify only patients who had an adequate response to each agent, a score of ≥22 on the EF domain of the IIEF for sildenafil and ICI was required for inclusion in the final analysis.

RESULTS

In all, 178 packets were evaluable; 123 men (69%) responded to ICI but not sildenafil, and 11 (6%) responded only to sildenafil and not ICI, leaving 37 patients who responded to both; these patients comprised the study population. There was no difference in EF domain score of the IIEF between the treatments; EDITS scores were significantly higher for ICI therapy than for sildenafil (P < 0.001).

CONCLUSIONS

In patients who alternate the use of sildenafil and ICI therapy, satisfaction appears to be higher with ICI, although the erectogenic performance is similar. This suggests that patient satisfaction does not depend solely on erection performance, and that patients might benefit from various treatment options.
Applying search theory to determine the feasibility of eradicating an invasive population in natural environments
Authors: Cacho Oscar J. , Hester Susan , Spring Daniel
Published: October 2007

The detectability of invasive organisms influences the feasibility of eradicating an infestation. Search theory offers a framework for defining and measuring detectability, taking account of searcher ability, biological factors and the search environment. In this paper, search theory concepts are incorporated into a population model, and the costs of search and control are calculated as functions of the amount of search effort (the decision variable). Simulations are performed on a set of weed scenarios in a natural environment, involving different combinations of plant longevity, seed longevity and plant fecundity. Results provide preliminary estimates of the cost and duration of eradication programs to assist in prioritising weeds for control. The analysis shows that the success of an eradication program depends critically on the detectability of the target plant, the effectiveness of the control method, the labour requirements for search and control, and the germination rate of the plant.
Modelling a mixed system of air pollution fee and tradable permits for controlling nitrogen oxide: a case study of Taiwan*
Authors: Liao Chao‐Ning
Published: October 2007

A mixed‐integer non‐linear programming model that minimises the total regulatory costs of controlling nitrogen oxide is used to investigate how a newly proposed permit trading scheme in Taiwan, which incorporates the features of banking and a non‐one‐to‐one trading ratio, may affect firms’ emission reduction strategies and permit trading decisions. Compared to the previous regulation where only an air pollution fee is used, the new regulation that requires a reduction in emissions by 10 per cent from the emission level in the year 2000 for a 5 year period will increase the costs by 77 per cent, which is equivalent to US$9.87 million. The design of banking and the increasing returns to scale characteristic of pollution control among firms might lead to an uneven reduction in emissions in each year. Setting a lower reservation rate for banking would, however, help maintain a more stable environmental quality without a significant loss to the government in terms of air pollution fee revenue.
THE NOTION OF GIFT‐GIVING AND ORGAN DONATION
Authors: GERRAND NICOLE
Published: October 2007

The analogy between gift‐giving and organ donation was first suggested at the beginning of the transplantation era, when policy makers and legislators were promoting voluntary organ donation as the preferred procurement procedure. It was believed that the practice of gift‐giving had some features which were also thought to be necessary to ensure that an organ procurement procedure would be morally acceptable, namely voluntarism and altruism. Twenty‐five years later, the analogy between gift‐giving and organ donation is still being made in the literature and used in organ donation awareness campaigns. In this paper I want to challenge this analogy. By examining a range of circumstances in which gift‐giving occurs, I argue that the significant differences between the various types of gift‐giving and organ donation makes any analogy between the two very general and superficial, and I suggest that a more appropriate analogy can be found elsewhere.
REASONABLE CARE? SOME COMMENTS ON GILLETT'S REASONABLE CARE
Authors: CRISP ROGER
Published: October 2007

A discussion of some issues from Grant Gillett's book Reasonable Care. At the metaethical level, Gillett's views about the origin, scope and bindingness of morality are outlined and criticised. Against him it is argued that (a) moral capacity does not follow from linguistic ability, (b) things can matter to non‐concept‐users and (c) universalisability arguments fail to show that immorality is irrational. At the first order level, Gillett's arguments against surrogacy and euthanasia are answered.
HEALTH CARE AND THE PRINCIPLE OF FAIR EQUALITY OF OPPORTUNITY
Authors: WILT GERT JAN VAN DER
Published: October 2007

In The Netherlands, the public funding of a number of health care services is controversial. What can we learn from this about the moral concerns that underlie these judgements? And, if there is anything to learn, can we use this improved understanding to scrutinise the adequacy of particular decisions concerning the public funding of health care services? In the present paper, I will analyse three cases: corrective surgey, In Vitro Fertilisation and liver transplantation. I will summarise the arguments that have been used to support or to challenge the public funding of these services. I will then assess the merits of Daniels’fair equality of opportunity account of justice in health care. Can this account improve our understanding of the moral concerns underlying our judgements about the public funding of these services? Can it serve to scrutinise the adequacy of particular decisions that are made concerning the public funding of health care services? My answer to both questions will be a qualified yes. Daniels’account can provide guidance, but not because we can deductively infer from it what is right and what is wrong. Instead, I will argue for a more casuistic use of the concept of fair equality of opportunity.
DESIGNING BABIES: MORALLY PERMISSIBLE WAYS TO MODIFY THE HUMAN GENOME1
Authors: AGAR NICHOLAS
Published: October 2007

My focus in this paper is the question of the moral acceptability of attempts to modify the human genome. Much of the debate in this area has revolved around the distinction between supposedly therapeutic modification on the one hand, and eugenic modification on the other. In the first part of the paper I reject some recent arguments against genetic engineering. In the second part I seek to distinguish between permissible and impermissible forms of intervention in such a way that does not appeal to the therapeutic/eugenic distinction. If I am right much of what we would intuitively call eugenic intervention will be morally acceptable. Central to my argument is an asymmetry in the way genetic engineers can influence a person's capacities on the one hand and life‐goals on the other. Forms of genetic intervention that have a high probability of producing a mismatch of life‐goals and capacities will be ruled out.
BEFORE I WAS AN EMBRYO, I WAS A PRE‐EMBRYO: OR WAS I?
Authors: JONES D. GARETH , TELFER BARBARA
Published: October 2007

Issues surrounding human embryos are poignant and profound. Should research be conducted on them? Should they be discarded? Should they be donated to infertile couples? The Warnock Report was a landmark in providing guidelines limiting experimentation on human embryos to the first 14 days after fertilization, at which time implantation of the embryo is complete and the primitive streak has appeared.2 However, these embryological features were not considered sufficiently distinctive to bestow upon this 14‐day period a separate classification. This situation changed when, in 1986, Anne McLaren suggested the use of the terms ‘pre‐embryo’ or ‘conceptus' to designate “the entire product of the fertilized egg up to the end of the implantation stage” and the term ’embryo‘ for “that small part of the pre‐embryo or conceptus, first distinguishable at the primitive streak stage, that later develops into the foetus.”3

In this paper we look critically at the term ‘pre‐embryo’, and we shall present the case for an alternative set of terms, namely, embryo‐placenta and embryo‐fetus. We consider this latter to be biologically‐based terminology, that does not have any connotation of restricted moral value as the term pre‐embryo does for some.
COMMUNITY‐EQUIPOISE AND THE ETHICS OF RANDOMIZED CLINICAL TRIALS
Authors: GIFFORD FRED
Published: October 2007

This paper critically examines a particular strategy for resolving the central ethical dilemma associated with randomized clinical trials (RCTs) — the “community equipoise” strategy (CE). The dilemma is that RCTs appear to violate a physician's duty to choose that therapy which there is most reason to believe is in the patient's best interest, randomizing patients even once evidence begins to favor one treatment. The community equipoise strategy involves the suggestion that our judgment that neither treatment is to be preferred (that there obtains a state of “equipoise”) is to be assessed according to a community rather than an individual standard. Thus, though a physician may personally believe that there is some reason to prefer one treatment, patients can legitimately be randomized if there remains disagreement in the community of medical professionals. Rationales in favor of this conception include the following: (i) medical knowledge is best understood as residing in the community, (ii) the judgments of others count as evidence, and so should change one's own opinion, (iii) subjects would not be better off outside the trial, and (iv) the point of any trial is the resolution of dispute in the medical community. I critically examine these rationales and argue that they are insufficient. Amongst the problems are tensions between various of these underlying rationales, and important ambiguities in just what the CE criterion is to amount to. Finally, I argue that even if use of CE was justified, it would not justify carrying out RCTs anywhere near long enough to discharge our duty to gain reliable knowledge on which to base safe and effective medical practice. Hence, we need some different justification for carrying out RCTs.
ETHICS IN A BICULTURAL CONTEXT
Authors: CAMPBELL ALASTAIR V.
Published: October 2007

The distinctiveness of Bioethics in New Zealand stems in part from a renewal of emphasis on Maori rights, based on the Treaty of Waitangi, the foundation document of the New Zealand state. Increasingly, committees dealing with health research ethics and with the ethics of assisted reproductive technology have to incorporate Maori values and perspectives.
MORAL EXPERTISE: A PROBLEM IN THE PROFESSIONAL ETHICS OF PROFESSIONAL ETHICISTS
Authors: CROSTHWAITE JAN
Published: October 2007

Philosophers, particularly moral philosophers, are increasingly being involved in public decision‐making in areas which are seen to raise ethical issues. For example, Dame Mary Warnock chaired the ‘Committee of Inquiry into Human Fertilization and Embryology’ in the UK in 1982–4; the Philosophy Department at Auckland was commissioned by the Auckland Regional Authority to report on the ethical aspects of fluoridating the public water supply in 1990; and many of us are serving on ethics committees of various sorts. Not only are philosophers actually being called on or consulted, but many of us would argue that a philosophical contribution in such areas is essential.

The involvement of moral philosophers in public policy decisions raises a question of professional ethics, viz, what role should a philosopher's own moral perspective or judgements play in the advice s/he gives, or contribution s/he makes, to public decision‐making on ethical issues. Like most problems in professional ethics, this prompts reflection on the nature of the profession, and in particular on the expertise we take moral philosophy to offer. It also prompts reflection on how processes of public decision making in ethically problematic areas should be understood. I explore these issues in this paper.
HARD TIMES, HARD CHOICES: FOUNDING BIOETHICS TODAY
Authors: GRACIA DIEGO
Published: October 2007

The discussions of these past twenty years have significantly improved our knowledge about the foundation of bioethics and the meaning of the four bioethical principles with concern to at least three different points: that they are organised hierarchically, and therefore not “prima facie” of the same level; that they have exceptions, and consequently lack of absolute character; and that they are neither strictly deontological nor purely teleological. The only absolute principle of moral life can be the abstract and unconcrete respect of human beings. But when determining the material content of this respect, principles become contingent and relative. Therefore, moral reasoning must have necessarily no less than three moments, one absolute but merely formal, namely respect for all human beings, and the other two relative and material. The first material moment is comprised of the four bioethical principles, divided into two levels, one private, including the principles of autonomy and beneficence, and the other one public, including those of nonmaleficence and justice. The second material moment deals with specific cases, and requires analysis of their context, including their circumstances and consequences. Only when following these steps, and therefore balancing principlism and contextualism, can moral reasoning be correct and complete.
WEIGHTING HEALTH STATES AND STRONG EVALUATION*
Authors: EDGAR ANDREW
Published: October 2007

The problem of public consultation over the allocation of health care resources is addressed by considering the role that quality of life measures, such as QALYs and the Nottingham Health Profile, could play. Such measures are typically grounded in social surveys, and as such may reflect public preferences for health care priorities. Using Charles Taylor's concepts of “weak” and “strong” evaluation, it is suggested that current quality of life measures are inadequate, insofar as they typically presuppose that survey respondents are mere “weak evaluators”, who express only inarticulate preferences. Respondents may, conversely, be understood as strong evaluators, with deeper visions of human nature and the good life informing their health preferences. Space is then created for such respondents to be asked to defend their preferences, and so be encouraged to reflect critically and publicly on the beliefs and prejudices that ground their view of health care priorities.
DEFINING CORE HEALTH SERVICES: THE NEW ZEALAND EXPERIENCE
Authors: CAMPBELL ALASTAIR V.
Published: October 2007

The New Zealand health service has been extensively changed over the past four years, with the introduction of Jour new Regional Health Authorities, required to purchase services on behalf of the Government from a range of providers. In order to ensure fairness across the four regions a Core Services Committee has been set up to define which services must be purchased. However, no clear agreement has emerged about a “core” and no list, either positive (inclusions) or negative (exclusions) has been defined. Instead general criteria have been suggested and steps have been taken to consult the community on their priorities. This paper describes seven workshops run by the author in an effort to discover how the community would reach decisions on the rationing of scare resources. The outcome of these workshops is that there is virtually no community support for an approach based on the social utility of individuals in need.
REPRODUCTIVE TECHNOLOGIES IN DEVELOPING COUNTRIES
Authors: MACKLIN RUTH
Published: October 2007

Are there any ethical concerns about reproductive technologies that are specific or unique to developing countries? Three ethical concerns often mentioned specifically in regard to developing countries are (1), the “overpopulation argument”; (2) the limited resources argument; and (3) the ethical problem of poorly trained practitioners offering their services to unsuspecting and uninformed infertile individuals or couples. Each argument is explored in some detail, with the conclusion that ethical problems do, in fact, exist but are not unique to developing countries. Nevertheless, the difficulties relating to reproductive technologies are likely to be greater in developing countries than in developed ones because of limited resources and a larger number of poor people residing there.
ORGAN TRANSPLANTATION: CONTEMPORARY SUNNI MUSLIM LEGAL AND ETHICAL PERSPECTIVES
Authors: EBRAHIM ABUL FADL MOHSIN
Published: October 2007

The problems that organ transplantation poses to the Muslim mind may be summarized as follows: firstly, a muslim believes that whatever he owns or possesses has been given to him as an amānah (trust) from Alla¯h. Would it not be a breach of trust to give consent for the removal of parts of one's body, while still alive, for transplantation to benefit one's child, sibling or parent? Secondly, the Sharā'ah (Islamic Law) emphasizes the sacredness of the human body. Would it not then be an act of aggression against the human body, tantamount to its mutilation, if organs were to be removed after death for the purpose of transplantation?

In this paper I attempt to illustrate how the Muslim jurists have tried to resolve the dilemma of Muslims by providing them with certain guidlines based on the original sources of Islam, namely, the Qur'n and the Prophetic tradition. In order to assist the followers of other religious traditions to grasp the gravity of the problem posed by organ transplantation to the Muslim mind, I begin by discussing the opinions of Muslim jurists on the issue of utilization of human parts. Thereafter, I touch upon the resolutions taken by the various Islamic Juridical Academies on the issue in question. Finally, I shed light upon the inclusion of organ donation in a Muslim Will and the enforceable nature of such a will
PRESIDENTIAL ADDRESS: IS THE SANCTITY OF LIFE ETHIC TERMINALLY ILL?
Authors: SINGER PETER
Published: October 2007

Our growing technical capacity to keep human beings alive has brought the sanctity of life ethic to the point of collapse. The shift to a concept of brain death was already an implicit abandonment of the traditional ethic, though this has only recently become apparent. The 1993 decision of the British House of Lords in the case of Anthony Bland is an even more decisive shift towards an ethic that does not ask or seek to preserve human life as such, but only a life that is worth living. Once this shift has been completed and assimilated, we will no longer need the concept of brain death. Instead we can face directly the real ethical issue: when may doctors intentionally end the life of a patient?
WHEN DID YOU FIRST BEGIN TO FEEL IT? — LOCATING THE BEGINNING OF HUMAN CONSCIOUSNESS
Authors: BURGESS J. A. , TAWIA S. A.
Published: October 2007

In this paper we attempt to sharpen and to provide an answer to the question of when human beings first become conscious. Since it is relatively uncontentious that a capacity for raw sensation precedes and underpins all more sophisticated mental capacities, our question is tantamount to asking when human beings first have experiences with sensational content. Two interconnected features of our argument are crucial. First, we argue that experiences with sensational content are supervenient on facts about electrical activity in the cerebral cortex which can be ascertained through EEG readings. Second, we isolate from other notions of a‘functioning brain’that which is required to underpin the view that a cortex is functioning in a way which could give rise to rudimentary conscious experiences. We investigate the development in the human fetus of the anatomical and chemical pathways which underpin (immature) cortical activity and the growth and maturation of the electrical circuitry specifically associated with sensational content in adult experience. We conclude (tentatively) that a fetus becomes conscious at about 30 to 35 weeks after conception; an answer based on a careful analysis of EEG readings at various stages of cortical development. Finally, we survey the possible ethical ramifications of our answer.
THE ARGUMENT FROM TRANSFER
Authors: MUNTHE CHRISTIAN
Published: October 2007

Utilitarian arguments on bioethical issues regarding human reproduction typically start with the view that it is wrong, other things being equal, not to procreate when this would have resulted in an additional being with a life worth living. The paper takes this view for granted and examines the common utilitarian claim that overpopulation and destitution in the world mean that, in practice, this obligation to procreate, other things being equal, often turn into a (categorical) obligation not to procreate. A version of this argument is defended— a version called the argument from transfer — according to which, rather than having additional children and care for them in order to make them happy, many people in the West ought to abstain from procreation and take care of destitute children already existing. The reasoning leading up to this conclusion raises some philosophical questions, seldom discussed in connection with bioethics, which indicate that the argument from transfer, although supporting the claim above, cannot neutralise the obligation to create mare happy people as easib as assumed by utilitarians. It is argued that the argument from transfer may place many people facing the choice of procreation in a peculiar moral dilemma.
KILLING, LETTING DIE AND THE BARE DIFFERENCE ARGUMENT
Authors: PERRETT ROYW.
Published: October 2007

I believe that there is no intrinsic moral difference between killing and letting die. That is, there is no difference that depends solely on the distinction between an act and an omission. I also believe that we can reasonably establish this thesis by appeal to the Bare Difference Argument. The form of this argument involves considering two imaginary cases in which there are no morally relevant differences present, save the bare difference that one is a case of killing and one a case of letting die. But in the pair of cases under consideration this bare difference makes no moral difference. Hence it cannot be that the bare difference between killing and letting die is in itself a morally important difference.

Winston Nesbitt has recently argued that the Bare Difference Argument fails because “the examples produced typically possess a feature which makes their use in this context illegitimate, and that when modified to remove this feature, they provide support for the view which they were designed to undermine”. I argue that Nesbitt misunderstands the logic of the Bare Difference Argument and that accordingly his objections are mistaken.
MODIFIED INFORMED CONSENT IN A VIRAL SEROPREVALENCE STUDY IN THE CARIBBEAN
Authors: COX CHERYL , MACPHERSON C.N.L.
Published: October 2007

An unlinked seroprevalence study of HIV and other viruses was conducted on pregnant women on the Caribbean island of Grenada in 1994. Investigators were from both the developed world and the Grenadian Ministry of Health (MOH). There was then no board on Grenada to protect research subjects or review ethical aspects of studies. Nurses from the MOH were asked to verbally inform their patients about the study, md request that patients become subjects of the study and give blood for screening. If consent was given nurses took blood and administered a survey about each subjects’knowledge of HIV transmission routes. Nurses shared a spoken dialect and cultural heritage with prospective subjects and were probably more effective than. foreign researchers at informing subjects. Informed consent was obtained with a simplified consent form supplemented by conversation with each prospective research subject. Facilitating discussion between people with common cultural backgrounds helps apply the Western approach to informed consent to communities in the developing world. Researchers must disclose all information to nurses or other mediators, and ensure that nurses disclose as much information as possible to prospective subjects. So modiJied, informed consent maintains respect for persons and becomes applicable and relevant to various cultures.
PRACTICE GUIDELINES, PATIENT INTERESTS, AND RISKY PROCEDURES
Authors: ROSS ISOBEL A.
Published: October 2007

A clinical scenario is described where an anaesthetist is concerned about the seemingly high risk/benefit ratio relating to laparoscopic versus standard inguinal hernia operations. Some options for further action by the anaesthetist are introduced. The remainder of the paper explores the question of who can legitimately assess the acceptability of risk/benefit ratios, and defends the use of practice guidelines at the expense of so called clinical freedom. It is argued that respect for persons is not breached by limiting the treatment options offered to patients to those therapies which have a‘reasonable’risk/benefit ratio. This‘reasonableness’is context dependent, and should be properly decided by those with expertise in the field.
A Response to M. Stone: ‘How not to Measure the Efficiency of Public Services (And How One Might)’
Authors: Cooper W. W. , Ray Subhash C.
Published: October 2007

This is a response to Stone’s criticisms of the Spottiswoode report to the UK Treasury which was responding to the Treasury’s request for improved methods to evaluate the efficiency and productivity of the 43 police districts in England and Wales. The Spottiswoode report recommended uses of data envelopment analysis (DEA) and stochastic frontier analysis (SFA), which Stone critiqued en route to proposing an alternative approach. Here we note some of the most serious errors in his criticism and inaccurate portrayals of DEA and SFA. Most of our attention is devoted to DEA, and to Stone’s recommended alternative approach without much attention to SFA, partly because of his abbreviated discussion of the latter. In our response we attempt to be constructive as well as critical by showing how Stone’s proposed approach can be joined to DEA to expand his proposal beyond limitations in his formulations.
Objects of Desire, Thought, and Reality: Problems of Anchoring Discourse Referents in Development
Authors: PERNER JOSEF , RENDL BIBIANE , GARNHAM ALAN
Published: October 2007

Abstract:  Our objectives in this article are to bring some theoretical order into developmental sequences and simultaneities in children’s ability to appreciate multiple labels for single objects, to reason with identity statements, to reason hypothetically, counterfactually, and with beliefs and desires, and to explain why an ‘implicit’ understanding of belief occurs before an ‘explicit’ understanding. The central idea behind our explanation is the emerging grasp of how objects of thought and desire relate to real objects and to each other. To capture this idea we make use of the notion of discourse referents, as did Perner and Brandl (2005), to explain the developmental link between understanding beliefs and alternative naming. We present confirming evidence of the prediction from this analysis that children should have comparable problems with understanding identity statements. We explain the precociously correct answers in ‘implicit’ false belief tests based on indirect measures in the following way: From infancy children are able to keep track of other people’s experiences, to reason about counterfactual circumstances, and to reason about goal‐directed (rational) action depending on given circumstances. Indirect tasks reduce the bias to use actual circumstances for reasoning about goal directed action compared to the traditional task, which leads to more correct answers. An emerging metarepresentational understanding helps overcome these biases and enables not only correct action prediction but also the explanation of erroneous actions. The common metarepresentational element explains why false belief tasks and the alternative naming task are mastered at the same time as children understand identity statements.
Object Persistence in Philosophy and Psychology
Authors: SCHOLL BRIAN J.
Published: October 2007

Abstract:  What makes an object the same persisting individual over time? Philosophers and psychologists have both grappled with this question, but from different perspectives—philosophers conceptually analyzing the criteria for object persistence, and psychologists exploring the mental mechanisms that lead us to experience the world in terms of persisting objects. It is striking that the same themes populate explorations of persistence in these two very different fields—e.g. the roles of spatiotemporal continuity, persistence through property change, and cohesion violations. Such similarities may reflect an underlying connection, in that psychological mechanisms of object persistence (especially relevant parts of mid‐level visual object processing) may serve to underlie the intuitions about persistence that fuel metaphysical theories. This would be a way for cognitive science to join these two disparate fields, helping to explain the possible origins and reliability of some metaphysical intuitions, and perhaps leading to philosophical progress.
Evaluation and Proposal for Optimalization of Neurophysiological Tests in Migraine: Part 1—Electrophysiological Tests
Authors: Magis D , Ambrosini A , Bendtsen L , Ertas M , Kaube H , Schoenen J
Published: October 2007

Neurophysiological testing has become a valuable tool for investigating brain excitability and nociceptive systems in headache disorders. Previous reviews have suggested that most neurophysiological tests have limited value for headache diagnosis, but a vast potential for exploring the pathophysiology of headaches, the central effects of certain pharmacological treatments and phenotype-genotype correlations. Many protocols, however, lack standardization. This meta-analytical review of neurophysiological methods in migraine was initiated by a task force within the EUROHEAD project (EU Strep LSHM-CT-2004-5044837-Workpackage 9). Most of the neurophysiological approaches that have been used in headache patients are reviewed, i.e. evoked potentials, nociception-specific blink reflex, single-fibre electromyography, neuroimaging methods (functional MRI, PET, and voxel-based morphometry) and the nitroglycerin attack-provoking test. For each of them, we summarize the results, analyse the methodological limitations and propose recommendations for improved methodology and standardization of research protocols. The first part is devoted to electrophysiological methods, the second to neuroimaging techniques and the NTG test.
Lichen planus patients and stressful events
Authors: Manolache L , Seceleanu‐Petrescu D , Benea V
Published: October 2007

Purpose  To evaluate the possible role of stress before the onset/extension of lichen planus.

Patients and method  Forty‐six outpatients with lichen planus were enrolled. The design was a case‐control study (controls had skin diseases with low psychosomatic component). Stressful situations were evaluated using Holmes and Rahe's social readjustment rating scale.

Results  Lichen planus had an incidence of 0.36% among dermatological conditions. In the lichen planus group, there was a female predominance (76%) and a median age around 50 years. More than 67% of cases experienced at least one stressful event, compared with 21% of controls (χ2 = 17.58, P < 0.001). The odds ratio was 7.44. There was a borderline significant difference in the mean number of stressful events between lichen planus patients and controls (P = 0.06). We divided the situations described by Holmes and Rahe into three categories: family, personal, and job or financial problems. The presence of major life events was significant different in patients and controls (P = 0.005). Family matters were described by 43.6% of lichen planus patients, statistically significant compared with controls (P = 0.002). In almost 25% of cases of lichen planus, ‘the stressful event’ was represented by the illness or death of someone dear. ‘Personal problems’ seemed to be important compared with controls (P = 0.04), exams representing 25% of these matters. There was no difference between the patients and controls regarding the importance of job or financial changes.

Conclusion  Stressful situations, especially related to family, may have a role in the onset and extension of lichen planus lesions.