Search

Editor’s PerspectiveWhat We Already Know about This TopicWhat This Article Tells Us That Is NewBackgroundPostoperative delirium and postoperative cognitive dysfunction share risk factors and may co-occur, but their relationship is not well established. The primary goals of this study were to describe the prevalence of postoperative cognitive dysfunction and to investigate its association with in-hospital delirium. The authors hypothesized that delirium would be a significant risk factor for postoperative cognitive dysfunction during follow-up.MethodsThis study used data from an observational study of cognitive outcomes after major noncardiac surgery, the Successful Aging after Elective Surgery study. Postoperative delirium was evaluated each hospital day with confusion assessment method–based interviews supplemented by chart reviews. Postoperative cognitive dysfunction was determined using methods adapted from the International Study of Postoperative Cognitive Dysfunction. Associations between delirium and postoperative cognitive dysfunction were examined at 1, 2, and 6 months.ResultsOne hundred thirty-four of 560 participants (24%) developed delirium during hospitalization. Slightly fewer than half (47%, 256 of 548) met the International Study of Postoperative Cognitive Dysfunction-defined threshold for postoperative cognitive dysfunction at 1 month, but this proportion decreased at 2 months (23%, 123 of 536) and 6 months (16%, 85 of 528). At each follow-up, the level of agreement between delirium and postoperative cognitive dysfunction was poor (kappa less than .08) and correlations were small (r less than .16). The relative risk of postoperative cognitive dysfunction was significantly elevated for patients with a history of postoperative delirium at 1 month (relative risk = 1.34; 95% CI, 1.07–1.67), but not 2 months (relative risk = 1.08; 95% CI, 0.72–1.64), or 6 months (relative risk = 1.21; 95% CI, 0.71–2.09).ConclusionsDelirium significantly increased the risk of postoperative cognitive dysfunction in the first postoperative month; this relationship did not hold in longer-term follow-up. At each evaluation, postoperative cognitive dysfunction was more common among patients without delirium. Postoperative delirium and postoperative cognitive dysfunction may be distinct manifestations of perioperative neurocognitive deficits.

Background The optimal endoscopic target in early Crohn’s disease (CD) that limits long-term disease complications is unknown. Methods We analysed medical records from patients who had follow-up data since the end of CALM. Patients with Crohn’s disease endoscopic index of severity (CDEIS) scores at the end of CALM were included. The primary outcome was a composite of major adverse outcomes reflecting CD progression: new internal fistula/abscess, stricture, perianal fistula/abscess, CD hospitalisation, or CD surgery since the end of CALM. We compared median CDEIS and per cent improvement from baseline CDEIS. Youden index analysis was used to identify optimal CDEIS cut-off score associated with CD progression. Kaplan–Meier and Cox regression methods were used to compare rates of progression by different CDEIS targets. Multivariable models were adjusted for age, prior surgery, and stricturing behaviour. Results 110 patients with median age 28 (IQR 22–38) years, disease duration 0.2 (0.1–0.5) years, and median follow up of 3.1 (1.9–4.4) years were included. Eleven per cent had a history of stricture, 5.5% history of surgery, and 52% were originally in the tight control arm of the CALM study. Median CDEIS score at end of CALM was 3 (0–5.4) and 32 (29%) patients had disease progression. Baseline median CDEIS score was similar between those with and without progression [10.9 (7.5–15.5) vs. 11.9 (8–17.5)]. Median CDEIS score at the end of CALM was higher among those with progression [1.3 (0–5.1) vs. 4.9 (3–9.1), p < 0.001)]. Patients within higher quartiles of CDEIS score had higher rates of progression over time (Figure 1). Patients without disease progression had a greater median decrease in CDEIS score from baseline to end of CALM [90% (60–100%) vs. 50% (30–80%), p < 0.001]. The optimal CDEIS score cut-off was 2 with sensitivity 84%, specificity 60% and NPV 90% for progression. Patients with CDEIS ≤ 2 had less progression over time compared with patients with > 50% improvement from baseline CDEIS (not reaching CDEIS ≤ 2) and those not meeting either endpoint (Figure 2). On adjusted analysis, CDEIS score ≤ 2 was associated with a decreased risk of progression (aHR 0.23, 95% CI 0.09–0.56). Conclusion In early CD, a CDEIS score ≤ 2 is optimal cut-off associated with a lower risk of disease progression.

Evidence recorded by Natal colonial official James Stuart in conversations with a number of African interlocutors in the early twentieth century suggests that authority over land in the Zulu kingdo...

In this paper I show how what came to be known as “the double law of habit,” first formulated by Joseph Butler in a discussion of moral psychology in 1736, was taken up and developed by medical physiologists William Porterfield, Robert Whytt, and William Cullen as they disputed fundamental questions regarding the influence of the mind on the body, the possibility of unconscious mental processes, and the nature and extent of voluntary action. The paper shows, on a particular topic, the overlap between eighteenth-century philosophical writings on the science of human nature on the one hand, and medical writings and lectures in physiology on the other. Other early modern writers discussed in the paper include René Descartes, Herman Boerhaave and David Hume.

To describe functional recovery after elective surgery and to determine whether improvements differ among individuals who develop delirium.No large studies of older adults have investigated whether delirium influences the trajectory of functional recovery after elective surgery. The prospective observational study assessed this association among 566 individuals aged 70 years and older.Patients undergoing major elective surgery were assessed daily while in hospital for presence and severity of delirium using the Confusion Assessment Method, and their functional recovery was followed for 18 months thereafter. The Activities of Daily Living and Instrumental Activities of Daily Living Scales and the Physical Component Summary of the Short Form-12 were obtained before surgery and at 1, 2, 6, 12, and 18 months. A composite index (standard deviation 10, minimally clinically significant difference 2) derived from these scales was then analyzed using mixed-effects regression.Mean age was 77 years; 58% of participants were women and 24% developed postoperative delirium. Participants with delirium demonstrated lesser functional recovery than their counterparts without delirium; at 1 month, the covariate-adjusted mean difference on the physical function composite was -1.5 (95% confidence interval -3.3, -0.2). From 2 to 18 months, the corresponding difference was -1.8 (95% confidence interval -3.2, -0.3), an effect comparable with the minimally clinically significant difference.Delirium was associated with persistent and clinically meaningful impairment of functional recovery, to 18 months. Use of multifactorial preventive interventions for patients at high risk for delirium and tailored transitional care planning may help to maximize the functional benefits of elective surgery.

Since it is the Understanding that sets Man above the rest of sensible Beings, and gives him all the Advantage and Dominion, which he has over them; it is certainly a Subject, even for its Nobleness, worth our Labour to enquire into. This chapter considers the discerning Faculties of a Man, as they are employed about the Objects, which they have to do with. It is an established Opinion amongst some Men, That there are in the Understanding certain innate Principles. The chapter enquires into the Original of those Ideas, Notions, or whatever else they are called, which a Man observes, and is conscious to himself he has in his Mind; and the ways whereby the Understanding comes to be furnished with them. It endeavours to shew, what Knowledge the Understanding hath by those Ideas; and the Certainty, Evidence, and Extent of it.

Introduction Gary Fuller, Robert Stecker and John P. Wright Selections from Locke's Essay: Epistle to the Reader Book 1: Of Innate Notions Book 2: Of Ideas Book 3: Of Words Book 4: Of Knowledge and Probability Locke and the Ethics of Belief John Passmore Locke on Personal Identity Harold W. Noonan Locke on the Suspense of Desire Vere Chappell Locke and Natural Law Daniel E. Flage Select Bibliography Index

BACKGROUND & AIMS: We investigated the effects of inducing deep remission in patients with early Crohn's disease (CD). METHODS: We collected follow-up data from 122 patients (mean age, 31.2 ± 11.3 y) with early, moderate to severe CD (median duration, 0.2 years; interquartile range, 0.1-0.5) who participated in the Effect of Tight Control Management on CD (CALM) study, at 31 sites, representing 50% of the original CALM patient population. Fifty percent of patients (n = 61) were randomly assigned to a tight control strategy (increased therapy based on fecal level of calprotectin, serum level of C-reactive protein, and symptoms), and 50% were assigned to conventional management. We categorized patients as those who were vs were not in deep remission (CD endoscopic index of severity scores below 4, with no deep ulcerations or steroid treatment, for 8 or more weeks) at the end of the follow-up period (median, 3.02 years; range, 0.05-6.26 years). The primary outcome was a composite of major adverse outcomes that indicate CD progression during the follow-up period: new internal fistulas or abscesses, strictures, perianal fistulas or abscesses, or hospitalization or surgery for CD. Kaplan-Meier and penalized Cox regression with bootstrapping were used to compare composite rates between patients who achieved or did not achieve remission at the end of the follow-up period. RESULTS: Major adverse outcomes were reported for 34 patients (27.9%) during the follow-up period. Significantly fewer patients in deep remission at the end of the CALM study had major adverse outcomes during the follow-up period (P = .01). When we adjusted for potential confounders, deep remission (adjusted hazard ratio, 0.19; 95% confidence interval, 0.07-0.31) was significantly associated with a lower risk of major adverse outcome. CONCLUSIONS: In an analysis of follow-up data from the CALM study, we associated induction of deep remission in early, moderate to severe CD with decreased risk of disease progression over a median time of 3 years, regardless of tight control or conventional management strategy. ispartof: GASTROENTEROLOGY vol:159 issue:1 pages:139-147 ispartof: location:United States status: published

In writing this review I must begin by declaring an interest. In both the books under discussion, my own work, published and unpublished, in the field of the history of southern Africa in the two c...

Endoscopic and deep remission at 1 year prevents disease progression in early Crohn's disease : long-term data from CALM

This paper replies to Peter Millican (Mind, 2009), who argues that Hume denies the possible existence of causal powers which underlie the regularities that we observe in nature. I argue that Hume's own philosophical views on causal power cannot be considered apart from his mitigated skepticism. His account of the origin of the idea of causal power, which traces it to a subjective impression, only leads to what he calls ‘Pyrrhonian scepticism’. He holds that we can only escape such excessive skepticism by way of a natural judgment based on the association of ideas, which forms the basis of what he calls ‘a legitimate ground of Assent’.

(2011). Ideas of Habit and Custom in Early Modern Philosophy. Journal of the British Society for Phenomenology: Vol. 42, Habit, pp. 18-32.

The notion of the “mfecane” was one that existed virtually unchallenged in the imaginations of large numbers of people, including virtually all academic historians of southern Africa, from the late 1960s to the late 1980s. It had three main components: first, that a chain reaction of wars and population movements had swept over much of the eastern half of southern Africa in the 1820s and 1830s; second, that the chain reaction had originally been set in motion by the supposedly explosive expansion of the Zulu kingdom under Shaka; and third, that from these upheavals had emerged a number of new, enlarged states which played a central role in the history of the subcontinent through the rest of the nineteenth century. These ideas had a history that went back to the times of Shaka himself and they had long since achieved the status of unquestioned fact, but they were not elaborated into a coherent book-length account until as recently as 1966. This was in John Omer-Cooper’s well-known The Zulu Aftermath: A Nineteenth-Century Revolution in Bantu Africa, in which, among other things, the plural “wars of Shaka” were relabelled as the singular “mfecane”, and so were rendered into the kind of named “event” that could the more easily be fitted into grand narratives by historians of South Africa. Over the next twenty years The Zulu Aftermath became a very widely influential work of reference. Its basic tenets remained virtually unchallenged until they were confronted head-on in a critique mounted by Rhodes University historian Julian Cobbing.1 The often fierce “mfecane debates” touched off by Cobbing’s intervention are well known and will not be rehearsed here: their main upshot was that the second of the three components identified above – that the upheavals of the 1820s and 1830s had been caused primarily by the expansion of the Zulu kingdom – came to be queried by many historians, including most of those working in the field of Zulu history. Critical engagement with the notion of the mfecane was facilitated by the publication (from 1976 onward) of a series of volumes containing the rich body of historical testimony relating to Zulu history collected by James Stuart in the period 1897 to 1922.3 Debate was further stimulated by the publication of path-breaking studies in the iconography of Shaka by Carolyn Hamilton and Dan Wylie.4 Most recently, Wylie has produced a massive study, based on a critical reading of the evidence in the James Stuart Archive, of what is known of the life and reign of Shaka.5 His findings provide firm support for the view that there is little by way of empirical evidence to support the stereotype that the upheavals of the 1820s and 1830s were caused primarily by the aggressions of Shaka and his armies. In its place is emerging the argument that the deep causes of the upheavals, and of the processes of “state-formation” which they set in train, needed to be looked for in the interactions, from at least the mid-eighteenth century onwards, between African communities and groups of Boer, Kora, Griqua, British and Portuguese traders, raiders and settlers from the Cape and from the subcontinent’s eastern coastlands.

The publication of a new intellectual biography of George Cheyne1 provides a "propitious" occasion for "a thoroughly skeptical review"2 of the question which has long exercised Hume scholars, whether Cheyne was the intended recipient of David Hume's fascinating pie-Treatise Letter to a Physician,3 the letter which describes his own hypochondriacal physical and mental symptoms and gives an account of his early philosophical development.4 Hume's nineteenth-century biographer, John Hill Burton, argued that Hume was probably writing to Cheyne,5 while Ernest Mossner claimed to definitively refute that hypothesis in an article entitled "Hume's Epistle to Dr. Arbuthnot," published in 1944.6 Anita Guerrini's intellectual biography does not discuss Cheyne as a possible recipient of Hume's letter, but she does present a well-rounded picture of this interesting eighteenth-century physician from which we can judge his appropriateness as its addressee. In the following discussion I will make use of the biographical material found in this new biography of Cheyne, as well as other sources, to show that Mossner's arguments are less than definitive, and that it would be wrong to dismiss the possibility that the letter was sent to George Cheyne.7 This is a possibility that, for reasons that I will make clear, makes good biographical and philosophical sense. At the same time, it is important to keep a proper suspense of judgment as Burton did, for the evidence that the letter was either intended for or actually sent to Cheyne is not definitive.

David Hume, a leading figure in the Scottish Enlightenment, contributed significantly to the disciplines of psychology, history, political science and economics—as well as to more theoretical discussions in ethics, aesthetics, epistemology, and philosophy of religion. He was a controversial figure in his own day, mainly because of his criticisms of both natural and revealed religion, and the political views expressed in his History of England (1983). His skeptical arguments concerning induction are still discussed by philosophers interested in probability theory, and his account of the foundations of morality enters into current disputes about the source of moral obligation. In his Treatise of Human Nature (1739–40) Hume set out to found all the other sciences on the science of human nature, and stressed that this science itself must be based on experiment and observation. The basic psychological principle that he sought to establish in his Treatise was that of the association of ideas and impressions. He followed Locke in rejecting innatism and holding that the elemental building blocks of our ideas must be based on experience; however, he argued against Locke that experience cannot supply us with our common sense or scientific conceptions of reality, or the foundations of morality. Rather, the latter arise through irrational processes of the imagination.

Controlled ileal release budesonide and slow release mesalazine are both used to treat mild to moderate active Crohn's disease, although data show that budesonide is more effective in inducing remission. When comparing different treatment options, the effects of agents on health-related quality of life must be considered as well as efficacy. In this study, we sought to compare the effects of budesonide and mesalazine on the health-related quality of life of patients with active Crohn's disease.The study included 182 patients with Crohn's Disease Activity Index scores between 200 and 400. Patients were randomized in a double blind, double dummy, multicenter study to receive 9 mg of budesonide, once daily (n = 93), or 2 g of mesalazine, b.i.d. (n = 89), for 16 wk. Quality of life was assessed at baseline and after 2, 4, 8, 12, and 16 wk of treatment using the Psychological General Well-Being index. In addition, a physician's global evaluation was used to assess how symptoms affected patients' normal activities.Patients treated with budesonide experienced significantly greater improvement in Psychological General Well-Being scores than the group treated with mesalazine after 2, 8, 12, and 16 wk. All components of this index showed greater improvements in the budesonide-treated group than in the mesalazine group at 12 and 16 wk. The physician's global evaluation showed significantly greater improvements in the budesonide group than in the mesalazine group at all visits.Budesonide (9 mg once daily) improves health-related quality of life to a greater extent than mesalazine (2 g b.i.d.) in patients with mild to moderate active Crohn's disease.

The author argues that the core of Hume’s Academic skepticism lies in his commitment to an external world and objective causal powers that are cognitively opaque to human understanding. Three central topics of Hume’s theory of the understanding are discussed—the existence of absolute space, the existence of a world external to our senses, and the existence of objective causal powers. In each case, Hume draws a Pyrrhonian opposition between judgments based on his “Copy Principle” and the “fictions” or “illusions” formed through association of ideas. While he suspends judgment concerning the existence of absolute space, he argues that the association-based beliefs in an external world and objective causal powers are necessary for human life and indispensible in science. In adopting such beliefs about external reality, while at the same time denying their intelligibility, Hume was following ancient Academic skepticism.

Food pesticide residue data are used by the U.S. Environmental Protection Agency (EPA) to determine potential dietary risk from chronic and acute exposures. An acute dietary risk assessment determines the pesticide exposure resulting from a single-day consumption of food, and uses stepwise refinement of residue estimates to better judge actual exposures. All exposure refinements use estimates of the fraction of crops treated and food residues measured increasingly closer to the point of actual food consumption, without changes in the pesticide uses. Exposure distributions at all levels of data refinement were extremely right skewed. At the highest level evaluated, estimated exposures at the 99.9th percentile were 0.00087 mg/kgBW/day compared to 0.2648 mg/kgBW/day at the tolerance level for children 1-6 years, theoretically the highest-exposed population sub-group. The estimated exposure at the 99.9th percentile of the U.S. population was approximately twice the exposure at the 99th percentile and 33 times the exposure at the 90th percentile. This evaluation showed the calculated exposure at the highest tier of assessment was 300 times lower than the tolerance level assessment for children 1-6 years at the 99.9th percentile. Reduction in exposure estimates between these tiers was due to a combination of the following factors: food residue measurements in a specially designed market-basket study, government-sponsored monitoring data, probabilistic methodologies, market share information, and food processing data. This case study demonstrates that an improved understanding of the uncertainties of acute dietary exposure from pesticides is possible by using well-established statistical tools and applying them to comprehensive exposure information, including residue monitoring data, consumption data, and pesticide use information.

Background Crohn's disease is often treated with glucocorticoids or mesalamine. We compared the efficacy and safety of controlled-ileal-release budesonide capsules and slow-release mesalamine tablets in patients with active Crohn's disease affecting the ileum, the ascending colon, or both. Methods In a double-blind, multicenter trial, we enrolled 182 patients with scores of 200 to 400 on the Crohn's Disease Activity Index (with higher scores indicating greater disease activity) and randomly assigned 93 to receive 9 mg of budesonide once daily and 89 to receive 2 g of mesalamine twice daily for 16 weeks. The primary efficacy variable was clinical remission, defined as a score of 150 or less on the Crohn's Disease Activity Index. Results In the analysis of all patients who received at least one dose of study drug, the rates of remission after 8 weeks of treatment were 69 percent in the budesonide group and 45 percent in the mesalamine group (P=0.001); the respective rates after 16 weeks of treatment were 62...

BACKGROUND & AIMS: Tofacitinib, an orally administered Janus kinase inhibitor, blocks signaling through γ-chain-containing cytokines (interleukins 2, 4, 7, 9, 15, and 21). We performed a phase 2 trial to measure its efficacy in patients with moderate-to-severe active Crohn's disease. METHODS: Patients (N = 139; age, ≥18 y) with moderate-to-severe active Crohn's disease were assigned randomly to groups given 1 mg (n = 36), 5 mg (n = 34), or 15 mg (n = 35) tofacitinib or placebo (n = 34), twice daily for 4 weeks, at 48 centers in 12 countries. The primary end point was the proportion of clinical responders at week 4 (decrease from baseline in the Crohn's Disease Activity Index score of ≥70 points [Response-70]). Secondary end points included clinical remission (Crohn's Disease Activity Index score of

All actively metabolizing cells have an electrical potential difference, negative on the interior, across their membranes. This electrochemical potential gradient is generated primarily by proton-pumping ATPases and provides the driving force for the transport of various ionic and neutral solutes. It is a key element in the energy metabolism of cells. Such factors as alteration of transport processes, energy metabolism, cytoplasmic pH, and membrane permeability have a direct effect on the magnitude of the membrane potential. In a brief survey, diclofop-methyl, diclofop, hydroxydiclofop, CGA 82725, haloxyfop-methyl, haloxyfop, bentazon, dinoseb, 4-hydroxy CIPC, and 2-hydroxy CIPC caused rapid depolarizations of the membrane potential of oat coleoptiles. Chlorsulfuron, dimethipin, propham, CIPC, dicamba, alachlor, metolachlor, napthalic anhydride, and paraquat had no measurable effects. The depolarizing effects of diclofop-reported earlier are used to illustrate the methods and interpretation of plant cell membrane potential measurements. Diclofop and diclofop-methyl affect the membrane properties of sensitive plant cells. Diclofop irreversibly depolarized the membrane potential and increased the proton permeability of sensitive cells but not resistant cells. It also increased the ATPase activity of isolated membrane vesicles. The mechanism through which diclofop exerted its effect is not fully understood. The equipment and techniques required for the intercellular recording of membrane potentials and resistance are described as well as the limitations of the techniques. A method not used in herbicide studies but with great potential for studies of herbicide interactions with membranes is patch clamp. A brief introduction to the methods will be given.

Frequent minor side effects are associated with sulfasalazine. The realization that it is the 5-aminosalicylic acid moiety that is the active component of sulfasalazine and that the side effects are probably due to the sulfapyridine has prompted the search for a similar but safer compound. Olsalazine, consisting of two molecules of 5-ASA without sulfasalazine may avoid the problems due to sulfasalazine. One hundred one patients were entered into a double-blind placebo-controlled study of the use of olsalazine (2 g daily) in preventing relapse in patients who had recently recovered from an acute attack of ulcerative colitis. Patients were treated for 12 months. Forty-nine were randomized to olsalazine (39 with limited and 10 with extensive disease) and 52 to placebo (42 with limited and 10 with extensive disease). Life-table analysis showed that the median time to relapse in patients on olsalazine was 342 days, which was significantly longer than the 100 days in the placebo group (P = 0.024). The most important side effect experienced with olsalazine that necessitated withdrawal from the study was "drug-induced diarrhea" in 16% (8/49). There was a similar incidence of minor side effects reported in the two groups, and in no patients were major or dangerous side effects reported. In patients who did not develop diarrhea, olsalazine was well tolerated and successfully prevented rapid relapse in the recently ill patients entered into this study.

The overall problem which dominates Hume's discussion of morals in Book 3 of the Treatise is that of discovering the psychological principles which lie at the root of our moral evaluations. Like Hutcheson, he holds that these evaluations are based on feelings of pleasure and pain. We feel pleasure when we contemplate a “noble and generous action,” and pain or uneasiness when we contemplate “one that is cruel and treacherous” (T3.1.2.2: 470). Our moral evaluations are not inferred from these feelings of pleasure and pain; rather the pleasures and pains constitute our moral evaluations. At the same time, Hume follows Hutcheson in arguing that these pleasures and pains through which we judge characters and actions as moral or immoral are of a particular kind. To convince us that pleasures (and pains) come in different kinds, Hume asks us to reflect on the difference between the pleasure of a fine wine and that of a great piece of music, between that received from inanimate objects and from “the character or sentiments of any person,” and finally the difference between the pleasure received from reflecting on the qualities of someone who serves our self-interest and those of someone who is actually morally virtuous (T3.1.2.4: 472). Moral pleasures and pains are the kind we receive when we consider a character “in general, without reference to our particular interest.” Hume notes that while “the good qualities of an enemy are hurtful to us … [he] may still command our esteem and respect.”

In the title to the second section of Book 3 Hume announces that “Moral distinctions [are] deriv'd from a moral sense” (T3.1.2).The phrase “moral sense” is taken from the philosophies of Francis Hutcheson and Lord Shaftesbury, whose writings Hume had clearly studied very carefully as he was writing Book 3 of the Treatise . However, apart from the title to this section, Hume uses the phrase “moral sense” only one other time in the Treatise , in Book 3, Part 3, where he claims to give his own “explication of the moral sense” (T3.3.1.25: 588). It is never used in his later recasting of his moral theory in the Enquiry Concerning the Principles of Morals . It is true that later in Book 3 of the Treatise he does sometimes use the phrase “sense of morals.” But in the Conclusion to Book 3 of the Treatise he contrasts his own account of the “sense of morals” with the account of “those who resolve the sense of morals into original instincts of the human mind” – an apparent reference to the theory of moral sense of Hutcheson (T3.3.6.3: 619). His own view, he tells us, accounts “for that sense by an extensive sympathy with mankind.” As we have seen in Chapter 1, Hume's personal relations with Hutcheson, which began as he was revising Book 3 for publication, were complex. Hume sought Hutcheson out as an authority who would recommend his philosophy to others.

David Hume's A Treatise of Human Nature (1739–40) presents the most important account of skepticism in the history of modern philosophy. In this lucid and thorough introduction to the work, John P. Wright examines the development of Hume's ideas in the Treatise, their relation to eighteenth-century theories of the imagination and passions, and the reception they received when Hume published the Treatise. He explains Hume's arguments concerning the inability of reason to establish the basic beliefs which underlie science and morals, as well as his arguments showing why we are nevertheless psychologically compelled to accept such beliefs. The book will be a valuable guide for those seeking to understand the nature of modern skepticism and its connection with the founding of the human sciences during the Enlightenment.

REFLECTIONS ON THE ROAD FROM LONDON TO BRISTOL The state of mind of the twenty-two-year-old David Hume as he was jostled up and down in the stagecoach traveling the rough road from London to Bristol in March of 1734 is not difficult to imagine. He had plenty of time on the fifteen-hour-long journey to reflect back on his young life and think about what the future might bring. He must have felt some sadness, having left his family and friends back in Scotland a few weeks earlier. At the same time, Hume was on his way to take up a position with a sugar merchant in Bristol and would have felt the excitement of a young man on a new adventure, traveling alone far from home for the first time in his life. Nevertheless, this was not the life that he had set out for himself five years earlier, and it was with some regrets that he had made this decision. The truth of the matter was that he had made himself ill by the studious way of life that he had adopted, and he had decided to set aside his books and writing for a time until he recovered his health. He believed that this would be best accomplished through an “active” life in business. Thus he was heading toward the major port city of western England to take up a position with a “considerable Trader” to whom he had been recommended.

While medical historians have noted the continuing importance of the soul in seventeenth-century physiology, it is not generally recognized that there were systematic discussions of the role of the physiological soul even after it was banished from science by Descartes and Malebranche. In this paper I analyze important accounts of it by founding members of the Académie des Sciences who were physicians—Cureau de La Chambre and Claude Perrault. Both these thinkers argued that the soul is spread throughout the body and manifests a form of knowledge in all its actions. Cureau was an Aristotelian who argued that all life processes require some form of active imaging on the part of the vegetative or natural faculty. He argued that life processes themselves must be conceived as passionate responses organized through innate patterns built into the organism itself. While the vegetative soul (like the sensitive soul) reasons through a kind of linking of images, it does so without any knowledge of the goal of its actions. Unlike Cureau, his successor Claude Perrault's account of the embodied soul was developed in response to the new physiology of Descartes. Like the latter, he thought that bodily processes must be described in mechanistic terms. However, he rejected the Cartesian theory that the body is an automaton and insisted that the mechanism must be guided by a soul. Perrault argued that this soul is constantly reasoning in order to achieve certain goals. In response to the Cartesian view that the soul is always conscious and aware of its own actions, he gave a systematic account of how such processes become unconscious and why they appear to be determined. Perrault's theory probably influenced Leibniz and, even more significantly, Georg Stahl. In the conclusion to the paper I discuss the importance of Perrault's conception of the embodied soul for eighteenth-century pathology.

Reversibility of a computational method is the ability to execute the method forward as well as backward. Reversible computational methods are generally useful in undoing incorrect computation in a speculative execution setting designed for efficient parallel processing. Here, reversibility is explored of a common component in scientific codes, namely, the Newton-Raphson root-finding method. A reverse method is proposed that is aimed at retracing the sequence of points that are visited by the forward method during forward iterations. When given the root, along with the number of iterations, of the forward method, this reverse method is aimed at backtracking along the reverse sequence of points to finally recover the original starting point of the forward method. The operation of this reverse method is illustrated on a few example functions, serving to highlight the method's strengths and shortcomings.

Extracted from text ... GUIDELINES The South African Gastroenterology Review - August 2003 19 New guidelines published for colorectal cancer screening and surveillance Have you had your screening colonoscopy yet ? will need a full examination of the colon and rectum by colonoscopy or double contrast barium enema if colonoscopy is not available. All persons with increased risk of colon cancer because of a previous history of colorectal cancer, adenomatous polyps or inflammatory bowel disease need colonoscopic surveillance. All providers involved in screening programmes must take responsibility for the clinical evaluation of results obtained and the reminding of patients for the need of ..