Do actions occur inside the body?

The paper offers a critical examination of Jennifer Hornsby's view that actions are internal to the body. It focuses on three of Hornsby's central claims: (P) many actions are bodily movements (in a special sense of the word “movement”) (Q) all actions are tryings; and (R) all actions occur inside the body. It is argued, contra Hornsby, that we may accept (P) and (Q) without accepting also the implausible (R). Two arguments are first offered in favour of the thesis (Contrary-R): that no actions occur inside the body. Three of Hornsby's arguments in favour of R are then examined. It is argued that we need to make a distinction between the causes and the causings of bodily movements (in the ordinary sense of the word “movement”) and that actions ought to be identified with the latter rather than the former. This distinction is then used to show how Hornsby's arguments for (R) may be resisted

Charnel practices in medieval England: new perspectives

Studies of English medieval funerary practice have paid limited attention to the curation of human remains in charnel houses. Yet analysis of architectural, archaeological and documentary evidence, including antiquarian accounts, suggests that charnelling was more widespread in medieval England than has hitherto been appreciated, with many charnel houses dismantled at the sixteenth-century Reformation. The survival of a charnel house and its human remains at Rothwell, Northamptonshire permits a unique opportunity to analyse charnel practice at a medieval parish church. Employing architectural, geophysical and osteological analysis, we present a new contextualisation of medieval charnelling. We argue that the charnel house at Rothwell, a subterranean room constructed during the thirteenth century, may have been a particularly sophisticated example of an experiment born out of beliefs surrounding Purgatory. Our approach enables re-evaluation of the surviving evidence for charnel practice in England and enhances wider narratives of medieval charnelling across Europe

Assessment and treatment of distorted schemas in sexual offenders

The aim of this review is to examine the literature related to the assessment and treatment of sex offenders’ distorted schemas. Where appropriate, the review draws upon current insights from the field of social cognition to aid in the critical evaluation of the findings. First, the review considers the various different methodologies for assessing distorted schemas, discussing their strengths and limitations. Second, the review examines the work related to the treatment of sex offenders’ schemas. Suggestions for future research, and the implications for clinical practice, are highlighted in the article

22q11.2 deletion syndrome

22q11.2 deletion syndrome (22q11.2DS) is the most common chromosomal microdeletion disorder, estimated to result mainly from de novo non-homologous meiotic recombination events occurring in approximately 1 in every 1,000 fetuses. The first description in the English language of the constellation of findings now known to be due to this chromosomal difference was made in the 1960s in children with DiGeorge syndrome, who presented with the clinical triad of immunodeficiency, hypoparathyroidism and congenital heart disease. The syndrome is now known to have a heterogeneous presentation that includes multiple additional congenital anomalies and later-onset conditions, such as palatal, gastrointestinal and renal abnormalities, autoimmune disease, variable cognitive delays, behavioural phenotypes and psychiatric illness - all far extending the original description of DiGeorge syndrome. Management requires a multidisciplinary approach involving paediatrics, general medicine, surgery, psychiatry, psychology, interventional therapies (physical, occupational, speech, language and behavioural) and genetic counselling. Although common, lack of recognition of the condition and/or lack of familiarity with genetic testing methods, together with the wide variability of clinical presentation, delays diagnosis. Early diagnosis, preferably prenatally or neonatally, could improve outcomes, thus stressing the importance of universal screening. Equally important, 22q11.2DS has become a model for understanding rare and frequent congenital anomalies, medical conditions, psychiatric and developmental disorders, and may provide a platform to better understand these disorders while affording opportunities for translational strategies across the lifespan for both patients with 22q11.2DS and those with these associated features in the general population

Adaptive design of a clinical decision support tool: What the impact on utilization rates means for future CDS research

© The Author(s) 2019. OBJECTIVE: We employed an agile, user-centered approach to the design of a clinical decision support tool in our prior integrated clinical prediction rule study, which achieved high adoption rates. To understand if applying this user-centered process to adapt clinical decision support tools is effective in improving the use of clinical prediction rules, we examined utilization rates of a clinical decision support tool adapted from the original integrated clinical prediction rule study tool to determine if applying this user-centered process to design yields enhanced utilization rates similar to the integrated clinical prediction rule study. MATERIALS & METHODS: We conducted pre-deployment usability testing and semi-structured group interviews at 6 months post-deployment with 75 providers at 14 intervention clinics across the two sites to collect user feedback. Qualitative data analysis is bifurcated into immediate and delayed stages; we reported on immediate-stage findings from real-time field notes used to generate a set of rapid, pragmatic recommendations for iterative refinement. Monthly utilization rates were calculated and examined over 12 months. RESULTS: We hypothesized a well-validated, user-centered clinical decision support tool would lead to relatively high adoption rates. Then 6 months post-deployment, integrated clinical prediction rule study tool utilization rates were substantially lower than anticipated based on the original integrated clinical prediction rule study trial (68%) at 17% (Health System A) and 5% (Health System B). User feedback at 6 months resulted in recommendations for tool refinement, which were incorporated when possible into tool design; however, utilization rates at 12 months post-deployment remained low at 14% and 4% respectively. DISCUSSION: Although valuable, findings demonstrate the limitations of a user-centered approach given the complexity of clinical decision support. CONCLUSION: Strategies for addressing persistent external factors impacting clinical decision support adoption should be considered in addition to the user-centered design and implementation of clinical decision support

100 kV Schottky electron gun

We present a comparison between experimental results and computer calculations on a high current, high resolution single lens electrostatic 100 kV Schottky electron gun. One promising application for such an electron gun is for direct electron‐beam patterning of x‐ray masks. The high energy helps provide precise patterning of the thick resist, maintains vertical resist profiles, and minimizes the proximity effect. The gun was designed to operate from 25 to 100 kV, capable of focus at a distance of 145–245 mm with a magnification of 1.15. The emitter, of apex radius ∼0.6 μm operated at 1800 K in the extended Schottky regime, provides an angular intensity of 0.5 mA/sr for an extraction voltage of 5000 V and with a beam limiting aperture of 2.2 mrad, the gun delivers 7 nA of probe current. The gun consists of a replaceable high voltage optic module mounted on a precision insulator with the main acceleration occurring between the exit of the optic module and the grounded anode. A provision is made for alignment of the emitter with respect to the central optical axis of the optic module in a special alignment chamber eliminating the need for high voltage emitter alignment. Final gun alignment is achieved by X–Y motion of the grounded anodeaperture. The gun is constructed to allow ease of replacement of the emitter, the beam defining aperture, and the differential pumping aperture. The beam supply has 10 ppm of ripple while lens supplies have supply, cabling, connectors,insulator, and optic module draw 1 μA of ground leakage current. Pressured SF6 chambers are used for high voltage connector interfaces within the power supply and on the gun

Why the idea of framework propositions cannot contribute to an understanding of delusions

One of the tasks that recent philosophy of psychiatry has taken upon itself is to extend the range of understanding to some of those aspects of psychopathology that Jaspers deemed beyond its limits. Given the fundamental difficulties of offering a literal interpretation of the contents of primary delusions, a number of alternative strategies have been put forward including regarding them as abnormal versions of framework propositions described by Wittgenstein in On Certainty. But although framework propositions share some of the apparent epistemic features of primary delusions, their role in partially constituting the sense of inquiry rules out their role in helping to understand delusions

Novel colours and the content of experience

I propose a counterexample to naturalistic representational theories of phenomenal character. The counterexample is generated by experiences of novel colours reported by Crane and Piantanida. I consider various replies that a representationalist might make, including whether novel colours could be possible colours of objects and whether one can account for novel colours as one would account for binary colours or colour mixtures. I argue that none of these strategies is successful and therefore that one cannot fully explain the nature of the phenomenal character of perceptual experiences using a naturalistic conception of representation

A Phase I Dose Escalation Trial of Gemcitabine with Radiotherapy for Breast Cancer in the Treatment of Unresectable Chest Wall Recurrences

The purpose of this study was to determine the maximum tolerated dose (MTD) of gemcitabine when given concurrently with standard radiotherapy for the treatment of chest wall recurrences, and to compare actuarial rates of local-regional control with those achieved in historical controls. Patients with unresectable chest wall recurrences were enrolled in a phase I trial of concurrent gemcitabine and radiotherapy. Gemcitabine was increased at 150 mg/m 2 /week increments, starting at 300 mg/m 2 /week. Radiotherapy was delivered to the chest wall and regional nodes to a total of 60 to 70 Gy in 2 Gy daily fractions. Treatment toxicity was assessed and a comparison of treatment outcome was performed between study patients and historical groups treated with either radiotherapy alone or excision followed by radiotherapy. The dose-limiting toxicities of neutropenia and thrombocytopenia occurred at the second planned dose of 450 mg/m 2 /week after accrual of only six patients, resulting in a MTD of 300 mg/m 2 /week. Myelosuppression and skin desquamation were commonly observed. Actuarial rates of local-regional control were 100%, 50%, and 90% at 2 years for the gemcitabine with radiotherapy, radiotherapy alone, and excision followed by radiotherapy groups, respectively ( p  = 0.105). The difference among the Kaplan–Meier curves for overall local-regional control was statistically significant at p  = 0.007 in favor of combined gemcitabine and radiotherapy. The MTD of gemcitabine is 300 mg/m 2 /week when gemcitabine is delivered concurrently with radiotherapy for unresectable chest wall failures. This novel approach suggests excellent local-regional control when compared to historical controls. A phase II trial is warranted. Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75565/1/j.1075-122X.2004.21305.x.pd