Empiricism and Philosophy

Though Quine's argument against the analytic-synthetic distinction is widely disputed, one of the major effects of his argument has been to popularise the belief that there is no sharp distinction between science and philosophy. This thesis begins by distinguishing reductive from holistic empiricism, showing why reductive empiricism is false, refuting the major objections to holistic empiricism and stating the limits on human knowledge it implies. Quine's arguments (and some arguments that have been mistakenly attributed to him) from holism against the analytic-synthetic are considered, and while many of them are found wanting one good argument is presented. Holism does not, however, imply that there is no sharp distinction between science and philosophy, and indeed implies that the distinction between scientific and philosophical disputes is perfectly sharp. The grounds upon which philosophical disputes may be resolved are then sought for and deliniated

[227-POS]: Thromboelastography (TEG((R))) and rotational thromboelastometry (ROTEM((R))) in pregnancy: A systematic review

Item does not contain fulltextOBJECTIVES: To evaluate the current position of thromboelastography (TEG) and rotational thromboelastometry (ROTEM) in clinical obstetric practice. METHODS: A search of the literature was performed on the following databases PubMed MEDLINE, EMBASE and the Cochrane Database of Systematic reviews. All articles published after 1990 until February 2013 and written in English, German, French, Spanish, Italian and Dutch concerning human pregnancies were eligible for inclusion. Eligible papers were subdivided in normal and complicated pregnancy outcomes and processed. RESULTS: 287 articles were found, of which 60 are included in the review. All studies with TEG/ROTEM performed in uncomplicated pregnancies, found significant changes towards a hypercoagulable state, especially in the third trimester. Hypercoagulability was found to persist till at least 3 weeks postpartum. In postpartum hemorrhage FIBTEM-ROTEM correlated well with the measured fibrinogen levels. Although, in severe preeclampsia with low platelets (<100.000/mm(3)) or in HELLP-syndrome changes in TEG/ROTEM associated with hypocoagulability are described, most studies were not able to show any significant differences between healthy pregnant women and women with mild preeclampsia. Miscarriage is associated with hypercoagulable changes in TEG/ROTEM compared to healthy non-pregnant and pregnant women. 26 case reports concerning women with specific coagulation disorders were identified and TEG/ROTEM was used for guiding therapeutic decision making. CONCLUSIONS: In individual women with coagulation disorders TEG/ROTEM can be useful to provide complementary information for "decision-making" and "therapy-guidance". The use of TEG((R)) or ROTEM((R))-analysis in the general obstetric practice, is at this time not recommended. Further research with standardized processing of data is most promising for bedside monitoring and interventions of postpartum hemorrhage. DISCLOSURES: A.C. Bolte: None. F.J. Hermans: None. L.E. Van Rheenen-Flach: None

High positive predictive value (PPV) of cell-free DNA (cfDNA) testing in a clinical study of 10,000 consecutive pregnancies

Background: Cell-free DNA (cfDNA) analysis in maternal blood for the detection of fetal Down syndrome is gradually replacing first trimester screening. We present here a large clinical series of 10,000 consecutive pregnancies. Objectives: To study the reliability of cell-free DNA (cfDNA) analysis in maternal blood for the detection of fetal trisomy 21, 18 and 13 in a clinical setting in 10,000 consecutive pregnancies with variable risk. cfDNA testing has been evaluated in an increasing number of pregnancies mainly at high risk for fetal trisomy, and some studies have suggested that its positive predictive value (PPV) might be lower in low-risk populations. Study design: CfDNA testing using the Harmony™ Prenatal Test was performed in 10,000 consecutive pregnancies with high or low a-priori risk for fetal trisomy 21, 18 and 13. Results: In 147 (1.47%) of the 10,000 pregnancies a high-risk cfDNA testing result indicated trisomy 21 (n=121), trisomy 18 (n=15) or trisomy 13 (n=11). It failed to detect 5 trisomies (2 trisomies 21, 2 trisomies 18, and 1 trisomy 13). Five false-positive results were recorded (4 in the high and 1 in the low risk population). The overall positive predictive value (PPV) was 96%, with a PPV of 96% in the high-risk (>1/200) population and 97% in the low risk (<1/200) population. Conclusions: In this large clinical series of 10,000 consecutive pregnancies, cfDNA testing proved very reliable in detecting fetal trisomy 21, 18 and 13, with a very high PPV both in high and low risk populations