Creation, Contingency, and Early Modern Science: The Impact of Voluntarist Theology on Seventeenth-Century Natural Philosophy

Could God have made it true that 2 + 2 = 5? Was he bound to make the best of all possible worlds? Is he able at this moment to alter the course of nature, either in whole or in part? Questions like these are often associated with medieval theology, not with early modern science. But science is done by people, and people have not always practiced the rigorous separation of science and theology that has come to characterize the modern world. Although many 17th century scientists sought validity for their work apart from revelation, divorcing science from religion was something they never intended. Indeed most natural philosophers of the scientific revolution assumed without question that the world and the human mind had been created by God. This was no small admission, for it meant that both the manner in which and the degree to which the world could be understood depended upon how God had acted in creating it and how he continued to act in sustaining it. Fifty years ago the late British philosopher M.B. Foster identified two different theologies of creation which differ profoundly in their implications for natural science. Rationalist theology, which assigns to God the activity of pure reason, involves both a rationalist X philosophy of nature and a rationalist theory of knowledge of nature. Voluntarist theology, which attributes to God an activity of will not wholly determined by reason, implies that the products of his creative activity are contingent and can be known only empirically. By a careful analysis of four natural philosophies of the early modern period--those of Galileo, Descartes, Boyle, and Newton--! intend to show that there was indeed a connection between theological voluntarism and empirical science in the 17th century

Prognostic impact of in-hospital hyperglycemia in hospitalized patients with acute heart failure: Results of the IN-HF (Italian Network on Heart Failure) Outcome registry

Objectives: Although diabetes mellitus is frequently associated with heart failure (HF), the association between elevated admission glucose levels and adverse outcomes has not been well established in hospitalized patients with acute HF. Methods: We prospectively evaluated in-hospital mortality, post-discharge 1-year mortality and 1-year re-hospitalization rates in the Italian Network on Heart Failure (IN-HF) Outcome registry cohort of 1776 patients hospitalized with acute HF and stratified by their admission glucose levels (i.e., known diabetes, newly diagnosed hyperglycemia, no diabetes). Results: Compared with those without diabetes (n = 586), patients with either known diabetes (n = 749) (unadjusted-odds ratio [OR] 1.64, 95%CI 0.99\u20132.70) or newly diagnosed hyperglycemia (n = 441) (unadjusted-OR 2.34, 95%CI 1.39\u20133.94) had higher in-hospital mortality, but comparable post-discharge 1-year mortality rates. After adjustment for age, sex, systolic blood pressure, estimated glomerular filtration rate, left ventricular ejection fraction, HF etiology and HF worsening/de novo presentation, the results remained unchanged in patients with known diabetes (adjusted-OR 1.86, 95%CI 1.01\u20133.42), while achieved borderline significance in those with newly diagnosed hyperglycemia (adjusted-OR 1.81, 95%CI 0.95\u20133.45). One-year re-hospitalization rates were lower in patients with newly diagnosed hyperglycemia (adjusted-hazard ratio 0.74, 95%CI 0.56\u20130.96) than in other groups. Conclusions: Elevated admission blood glucose levels are associated with poorer in-hospital survival outcomes in patients with acute HF, especially in those with previously known diabetes. This finding further highlights the importance of tight glycemic control during hospital stay and address the need of dedicated intervention studies to identify customized clinical protocols to improve in-hospital survival of these high-risk patients

Three-dimension structure of ventricular myocardial fibers after myocardial infarction

<p>Abstract</p> <p>Background</p> <p>To explore the pathological changes of three-dimension structure of ventricular myocardial fibers after anterior myocardial infarction in dog heart.</p> <p>Methods</p> <p>Fourteen acute anterior myocardial infarction models were made from healthy dogs (mean weight 17.6 ± 2.5 kg). Six out of 14 dogs with old myocardial infarction were sacrificed, and their hearts were harvested after they survived the acute anterior myocardial infarction for 3 months. Each heart was dissected into ventricular myocardial band (VMB), morphological characters in infarction region were observed, and infarct size percents in descending segment and ascending segment were calculated.</p> <p>Results</p> <p>Six dog hearts were successfully dissected into VMB. Uncorresponding damages in myocardial fibers of descending segment and ascending segment were found in apical circle in anterior wall infarction. Infarct size percent in the ascending segment was significantly larger than that in the descending segment (23.36 ± 3.15 (SD) vs 30.69 ± 2.40%, P = 0.0033); the long axis of infarction area was perpendicular to the orientation of myocardial fibers in ascending segment; however, the long axis of the infarction area was parallel with the orientation of myocardial fibers in descending segment.</p> <p>Conclusions</p> <p>We found that damages were different in both morphology and size in ascending segment and descending segment in heart with myocardial infarction. This may provide an important insight for us to understand the mechanism of heart failure following coronary artery diseases.</p

Hypertriglyceridemia is associated with decline of estimated glomerular filtration rate and risk of end-stage kidney disease in a real-word Italian cohort: Evidence from the TG-RENAL Study

Background: This analysis investigated the role of hypertriglyceridemia on renal function decline and development of end-stage kidney disease (ESKD) in a real-world clinical setting. Methods: A retrospective analysis using administrative databases of 3 Italian Local Health Units was performed searching patients with at least one plasma triglyceride (TG) measurement between 2013 and June 2020, followed-up until June 2021. Outcome measures included reduction in estimated glomerular filtration rate (eGFR) ≥30% from baseline and ESKD onset. Subjects with normal (normal-TG), high (HTG) and very high TG levels (vHTG) (respectively &lt;150 mg/dL, 150-500 mg/dL and &gt;500 mg/dL) were comparatively evaluated. Results: Overall 45,000 subjects (39,935 normal-TGs, 5,029 HTG and 36 vHTG) with baseline eGFR of 96.0 ± 66.4 mL/min were considered. The incidence of eGFR reduction was 27.1 and 31.1 and 35.1 per 1000 person-years, in normal-TG, HTG and vHTG subjects, respectively (P&lt;0.01). The incidence of ESKD was 0.7 and 0.9 per 1000 person-years, in normal-TG and HTG/vHTG subjects, respectively (P&lt;0.01). Univariate and multivariate analyses revealed that HTG subjects had a risk of eGFR reduction or ESKD occurrence (composite endpoint) increased by 48% compared to normal-TG subjects (adjusted OR:1.485, 95%CI 1.300-1.696; P&lt;0.001). Moreover, each 50 mg/dL increase in TG levels resulted in significantly greater risk of eGFR reduction (OR:1.062, 95%CI 1.039-1.086 P&lt;0.001) and ESKD (OR:1.174, 95%CI 1.070-1.289, P = 0.001). Conclusions: This real-word analysis in a large cohort of individuals with low-to-moderate cardiovascular risk suggests that moderate-to-severe elevation of plasma TG levels is associated with a significantly increased risk of long-term kidney function deterioration

Clinical characteristics and course of patients entering cardiac rehabilitation withchronic kidney disease: data from the Italian Survey on Cardiac Rehabilitation(ISYDE)

Purpose: Data from the Italian SurveY on carDiac rEhabilitation (ISYDE-2008) provide insight into the characteristics and clinical course of patients with chronic kidney disease (CKD) admitted to Cardiac Rehabilitation (CR) programs. Methods: Data from 165 CR units were collected online from January 28th to February 10th, 2008. Results: The study cohort consisted of 2281 patients (66.911.8 yrs); 200 (71.312.2 yrs, 66% male) CKD patients and 2081 (66.311.6 yrs, 74% male) non-CKD patients. Compared to non-CKD, CKD patients were older and their admission diagnosis of acute myocardial infarction, myocardial revascularization or heart failure was more frequent. They also showed more cardiac and non cardiac comorbidities, mostly diabetes, chronic obstructive lung disease and cognitive impairment. During the course of CR, CKD patients had reduced access to exercise functional evaluation, more complications (particularly atrial fibrillation, worsening of chronic kidney disease and anaemia) requiring more intense medical treatment, and longer length of in-hospital stay. CKD patients were less likely discharged at home (88% versus 91%, p¼0.05), were more likely transferred to the intensive care units (8% versus 4%, p¼0.005), and had higher death rate during CR programs (2.0% versus 0.5%, p¼0.02). After adjusting for age, ejection fraction, comorbidities (acute myocardial infarction, percutaneous coronary intervention, cardiac surgery, carotid artery critical lesions, peripheral artery disease, respiratory insufficiency, heart failure, diabetes, stroke and cognitive impairment), and complications during CR program (atrial fibrillation and severe ventricular arrhythmias), multivariate logistic analysis showed that heart failure (OR 1.6, 95% CI, 1.1 to 2.4, p¼0.04), respiratory insufficiency (OR 2.4, 95% CI, 1.4 to 4.0, p¼0.0007), and cognitive impairment (OR 4.5, 95% CI, 2.5 to 8.1, p < 0.0001) were significant predictors of death during the CR program in CKD patients. Conclusions: This subanalysis of the ISYDE-2008 survey provided a detailed snapshot of the clinical characteristics, complexity and more severe clinical course of patients admitted to CR presenting with CK

Clinical characteristics and course of patients entering cardiac rehabilitation withchronic kidney disease: data from the Italian Survey on Cardiac Rehabilitation(ISYDE)

Purpose: Data from the Italian SurveY on carDiac rEhabilitation (ISYDE-2008) provide insight into the characteristics and clinical course of patients with chronic kidney disease (CKD) admitted to Cardiac Rehabilitation (CR) programs. Methods: Data from 165 CR units were collected online from January 28th to February 10th, 2008. Results: The study cohort consisted of 2281 patients (66.911.8 yrs); 200 (71.312.2 yrs, 66% male) CKD patients and 2081 (66.311.6 yrs, 74% male) non-CKD patients. Compared to non-CKD, CKD patients were older and their admission diagnosis of acute myocardial infarction, myocardial revascularization or heart failure was more frequent. They also showed more cardiac and non cardiac comorbidities, mostly diabetes, chronic obstructive lung disease and cognitive impairment. During the course of CR, CKD patients had reduced access to exercise functional evaluation, more complications (particularly atrial fibrillation, worsening of chronic kidney disease and anaemia) requiring more intense medical treatment, and longer length of in-hospital stay. CKD patients were less likely discharged at home (88% versus 91%, p¼0.05), were more likely transferred to the intensive care units (8% versus 4%, p¼0.005), and had higher death rate during CR programs (2.0% versus 0.5%, p¼0.02). After adjusting for age, ejection fraction, comorbidities (acute myocardial infarction, percutaneous coronary intervention, cardiac surgery, carotid artery critical lesions, peripheral artery disease, respiratory insufficiency, heart failure, diabetes, stroke and cognitive impairment), and complications during CR program (atrial fibrillation and severe ventricular arrhythmias), multivariate logistic analysis showed that heart failure (OR 1.6, 95% CI, 1.1 to 2.4, p¼0.04), respiratory insufficiency (OR 2.4, 95% CI, 1.4 to 4.0, p¼0.0007), and cognitive impairment (OR 4.5, 95% CI, 2.5 to 8.1, p < 0.0001) were significant predictors of death during the CR program in CKD patients. Conclusions: This subanalysis of the ISYDE-2008 survey provided a detailed snapshot of the clinical characteristics, complexity and more severe clinical course of patients admitted to CR presenting with CKD