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[Drug addiction and freedom].

The author, in a historical and philosophical approach, analyses the concept of freedom as opposed to slavery. He also refers to the legal and social restrictions and studies the determinism and free will as the causes of human behaviour. Quoting Spinoza, the author states that man accepts the idea of freedom because he realizes the "how" of his options but ignores "why". Without the hypothesis of causality and determinism, there seems to have no science. Without freedom, there seems to be no anthropos man (Jimeno Valdez). The principles of anticausality, of nonreproducibility and of differentiation characterize the human freedom, but are contrary to the way science works. According to the social and political point of view, it was established that the State has the right to oblige and to violently limit freedom. Practically speaking, though, the State is violent just for being the State; the dominant groups are the government because they are and they have been violent. There is a need to limit and to discipline this right of the State of being violent within the dilemma of safety and freedom. By working, the slave avoided the whip. And by doing this, he encouraged the behaviour of the one who whipped him. The non-aversive attitudes limit the freedom in the modern world more and more for they also enchain our will, a rebellion becoming impossible. One is not granted the freedom; it shall be conquered and kept. Freedom, either as a concept or a phenomenon, is always relative. The concept of toxicomania or pharmacodependance is analysed according to the same perspective. The conclusion is that this is always more a problem of the society than of the individual, and this is how it has to be understood and treated. The present world is described as a millenial human culture specifically characterized by eight groups of phenomena: 1. Transport increased human mobility, reduced the relative dimensions of the earth, mixed peoples, compared cultures and created opportunities for conflicts; 2. The means of communication spread information surpassing their own capacity of being formed, they becoming traumatic; 3. The natural energies and electronic computing disturbed the work and comsumption market, man becoming insecure and disposable; 4. The industrial development produced a mass-culture and old time establishment became unreliable; 5. The demographic boom altered the age groups ratio which now presents an excess of children and grandparents with a relative lack of parents; 6. The diffusion of knowledge on human nature; 7. The religions emerged again, even the most primitive, persuading youngsters and governments; 8. The law, institutions and governments did not keep up with the rhythm of the changings and progress. The result was a generalized dissatisfaction.

Freedom↗

Freedom in responsibility: on the relevance of "sin" as a hermeneutic guiding principle in bioethical decision making.

This essay deals with questions of responsibility concerning technology, in particular, gene technology and the special problem of research on embryos. I raise issues concerning the extent of humans' authority to act and the limits of human freedom. In what way is that freedom given, and what kind of responsibility results from it? By discussing various concepts of human freedom in the tradition of European philosophy, as juxtaposed to the Protestant understanding of freedom, this essay discusses the restricting limits, and the obligation to take responsibility. It will turn out that the question concerning freedom cannot be answered without understanding what being human involves. From a Christian perspective, this implies that the foundational relationship between human freedom and sin will be central to an assessment of the human ability to take responsibility. By obliterating the limits of human freedom, sin jeopardizes the very essence of that freedom. The project of taking into account the sinful state of the human condition thus aims at developing a realistic picture of the authority of humans in action, even in view of the human tasks of promoting science and research.

Bioethics↗

Germ-line engineering, freedom, and future generations.

New technologies in germ-line engineering have raised many questions about obligations to future generations. In this article, I focus on the importance of increasing freedom and the equality of freedom for present and future generations, because these two ideals are necessary for a just society and because they are most threatened by the wide-scale privatisation of GLE technologies. However, there are ambiguities in applying these ideals to the issue of genetic technologies. I argue that Amartya Sen's capability theory can be used as a framework to ensure freedom and equality in the use of GLE technology. Capability theory articulates the goal of equalising real freedom by bringing all people up to a threshold of basic human capabilities. Sen's capability theory can clarify the proper moral goal of GLE insofar as this technology could be used to bring people up to certain basic human capabilities, thereby increasing their real freedom. And by increasing the freedom of those who lack basic human capabilities, GLE can aid in decreasing the inequalities of freedom among classes of people.

Ethical Analysis↗

Coordination of mono- and bi-articular muscles in multi-degree of freedom elbow movements.

We investigated the coordination of mono- and bi-articular muscles during movements involving one or more degrees of freedom at the elbow. Subjects performed elbow flexion (or extension) alone, forearm pronation (or supination) alone, and combinations of the two. In bi-articular muscles such as biceps brachii and pronator teres, the amplitude of agonist electromyographic (EMG) activity was dependent on motion in the two degrees of freedom. Agonist burst amplitudes for combined movements were approximately the sum of the agonist burst amplitudes for movements in the individual degrees of freedom. Activity levels in individual degrees of freedom were, in turn, greater than activity levels observed when a muscle acted as agonist in one degree of freedom and antagonist in the other. Other muscles such as triceps, brachialis, and pronator quadratus acted primarily during motion in a single degree of freedom. The relative magnitude and the timing of activity between sets of muscles also changed with motion in a second degree of freedom. These patterns are comparable with those reported previously in isometric studies.

Elbow↗

Long-term outcome of treatment for Ann Arbor Stage I Hodgkin's disease: prognostic factors for survival and freedom from progression.

PURPOSE: The earliest stages of Hodgkin's disease are associated with excellent short-term survival with radiation therapy. This has led to controversies regarding pretreatment evaluation, the extent of irradiation, the role of chemotherapy, and the relative importance of prognostic factors. Long-term results were sought to address these controversies. METHODS AND MATERIALS: A retrospective study was conducted of patients with Stage I Hodgkin's disease treated at the M. D. Anderson Cancer Center from 1967 through 1987. The median age at presentation of 145 patients was 31 years, and the male-to-female ratio was 1.8. Pretreatment evaluation included lymphangiography and bone marrow aspiration and biopsy in all patients. Laparotomy was performed in 101 of the 145 patients (70%). There were 133 patients with supradiaphragmatic presentations; 12 patients had infradiaphragmatic adenopathy. Only five patients had B symptoms (3.5%). Histologic subtypes of the disease included lymphocyte predominance 17.9%, nodular sclerosis 40.7%, mixed cellularity 40.7%, and one unclassified Hodgkin's disease with primary splenic involvement. All patients were treated with radiotherapy, and 16 (11%) also received combination chemotherapy as part of their initial treatment. Radiotherapy techniques included involved/regional field in 49%, extended field in 42.7% (mantle or inverted Y), and subtotal nodal irradiation in 8.3%. Follow-up extended from a minimum of 30-339 months, with a median period of observation of 16.5 years. RESULTS: The median survival was 13.7 years. The 10- and 20-year survival rates were 83% and 66%, respectively. The only factor important for decreased survival was age >40 years at diagnosis (p < 0.0001). Out of 43 deaths, 11 were the result of Hodgkin's disease and the remaining 32 resulted from intercurrent disease, including treatment-related causes. Median freedom from progression was 10.5 years, and the 10- and 20-year freedom from progression were 76% and 69%, respectively. Out of 39 relapses, 5 (13%) occurred beyond 10 years. Women had higher freedom from progression (p = 0.0534) than men. Age, histology, bulk of disease, site of involvement including the mediastinal presentations, and the addition of chemotherapy did not influence the freedom of progression. Although very few patients (12 of 145) received subtotal nodal irradiation, the freedom from progression at 10 years was 91.7% for this group versus 64.7% for the group of patients who were treated with more limited techniques. CONCLUSION: Treatment with radiation therapy for patients with Stage I Hodgkin's disease leads to an excellent outcome, but patients require long-term surveillance as late relapses are not rare. Age is the only factor that affects survival, and gender marginally affects freedom from progression. Subtotal nodal irradiation may improve freedom from progression; further investigation of this treatment is justified.

Adolescent↗

Depolymerization of microtubules increases the motional freedom of molecular probes in cellular plasma membranes.

Depolymerization of microtubules resulted in an increase in the motional freedom of molecular probes in the plasma membranes of Chinese hamster ovary cells expressed by the order parameter, S, measured with two different lipid-soluble spin label probes, 5-doxyl stearic acid and 16-doxyl methylstearate. Treatment with a variety of microtubule-depolymerizing agents, including Colcemid, colchicine, vinblastine, podophyllotoxin, and griseofulvin, all had similar effects on motional freedom of the probes whereas beta-lumicolchicine was inactive. Several independent lines of evidence suggest that these changes in motional freedom of the probes were not the direct result of the interaction of these relatively hydrophobic drugs with the plasma membrane: the effects of the drugs were not immediate; the dose response of the Colcemid effect was the same as the dose response for depolymerization of microtubules; taxol, which stabilizes microtubules but does not affect motional freedom in the membranes, blocked the effect of Colcemid on motional freedom; a mutant cell line which is resistant to colchicine because of reduced uptake of the drug showed no effects of colchicine on probe motional freedom; and a Colcemid-resistant mutant cell line with an altered beta-tubulin showed no effect of Colcemid on motional freedom in the membrane. These results support the hypothesis that microtubules might affect, directly or indirectly, plasma membrane functions.

Animals↗

Stability of sitting postures: the influence of degrees of freedom.

Observational studies of sitting have shown that, during spontaneous sitting, people adopt a variety of postures. Various researchers have formulated theories to explain why people adopt their sitting postures. Branton (1969) hypothesized that there is continual need for postural stability while sitting. Dempster (1955) stated that additional stability could be obtained through temporarily closing chains of body segments, or, in other words, through decreasing the number of degrees of freedom of the body. The present study elaborates on Dempster's theory. The aim of this study was to determine the influence of the degrees of freedom of the body on postural stability in sitting postures. For 21 different sitting postures, the total number of degrees of freedom was determined. Postural sway, a measure for postural stability, was determined using a 3D motion and position measurement system with ten healthy subjects. This study shows that the mean path length at the level of the second thoracic vertebra (PL0.05), a measure derived from postural sway, increases significantly (p < 0.0001) with an increase of the number of degrees of freedom of the body (DoFB). Closer examination of the data showed that a model taking into account only the degrees of freedom of the lumbar and thoracic spine and pelvis seems to be a better predictor of postural sway than the total number of degrees of freedom of the body.

Biomechanical Phenomena↗

The development of the Nucleus Freedom Cochlear implant system.

Cochlear Limited (Cochlear) released the fourth-generation cochlear implant system, Nucleus Freedom, in 2005. Freedom is based on 25 years of experience in cochlear implant research and development and incorporates advances in medicine, implantable materials, electronic technology, and sound coding. This article presents the development of Cochlear's implant systems, with an overview of the first 3 generations, and details of the Freedom system: the CI24RE receiver-stimulator, the Contour Advance electrode, the modular Freedom processor, the available speech coding strategies, the input processing options of Smart Sound to improve the signal before coding as electrical signals, and the programming software. Preliminary results from multicenter studies with the Freedom system are reported, demonstrating better levels of performance compared with the previous systems. The final section presents the most recent implant reliability data, with the early findings at 18 months showing improved reliability of the Freedom implant compared with the earlier Nucleus 3 System. Also reported are some of the findings of Cochlear's collaborative research programs to improve recipient outcomes. Included are studies showing the benefits from bilateral implants, electroacoustic stimulation using an ipsilateral and/or contralateral hearing aid, advanced speech coding, and streamlined speech processor programming.

Acoustic Stimulation↗

Actuarial versus actual freedom from structural valve deterioration with the Carpentier-Edwards porcine bioprostheses.

BACKGROUND: The clinical performance of porcine bioprostheses for valve replacement surgery has been evaluated for over three decades by actuarial analysis as the standard for reporting time-related results. The incidence of structural valve deterioration (SVD) is used for the selection of prostheses for various subsets of patients. Actual or cumulative incidence analysis may provide a superior method to determine durability of bioprostheses. OBJECTIVE: To compare actuarial versus actual methodology in determining the durability of porcine bioprostheses for aortic (AVR) and mitral valve replacement (MVR). PATIENTS AND METHODS: Carpentier-Edwards porcine bioprostheses were implanted between 1975 and 1995 in 2237 AVR and 1582 MVR. The mean age for AVR patients was 65.4+/-12 years and for MVR patients 61.7+/-12 years. The cumulative follow-up for AVR was 14,810 years (mean 6.6+/-4.7) and for MVR 9718 years (mean 6. 1+/-4.5). RESULTS: For AVR the actual freedom from SVD was 87.4+/-2. 0% and 95.6+/-1.8% in those aged 61 to 70 years and more than 70 years, respectively; the actuarial freedom was 75.9+/-4.2% and 82. 3+/-7.9%, respectively. For MVR the actual freedom from SVD was 69. 4+/-2.5% and 92.9+/-1.9% for those aged 61 to 70 years and more than 70 years, respectively; the actuarial freedom was 25.5+/-5.7% and 79. 5+/-6.0%, respectively. Predictors of freedom from SVD for AVR were identified as advancing age, falling into the age groups 61 to 70 and those older than 70 years, and intermediate valve sizes; predictors for MVR were advancing age and age older than 70 years. CONCLUSIONS: Comparison of methods of durability assessment revealed that actual freedom from SVD supports porcine bioprostheses for AVR in patients more than 60 years of age and for MVR in patients more than 70 years of age. This evaluation with experience to 15 years supports the indications for use of porcine bioprostheses.

Aged↗

Academic freedom, analysis, and the Code of Professional Conduct.

Despite nursing's move into higher education, academic freedom has received little attention within the literature. After discussing the concept of academic freedom, this paper argues that there is a potential tension between academic freedom and the requirement to educate student nurses who are fit for practice. One way in which this tension might be revealed is in the marking of student assignments. We ask the question--how should nurse educators mark an essay which is sufficiently analytical but reaches moral conclusions that lie outside the Code of Professional Conduct? We argue that despite an understandable temptation to penalise such an essay, invoking the Code of Professional Conduct to do so, no penalty should be applied, and academic freedom for students within higher education should be encouraged. This is because first, academic freedom is a good in itself especially as it allows unconventional and unpalatable conclusions to be discussed and rebutted, and second, applying a penalty on these grounds is necessarily inconsistent.

Codes of Ethics↗

Self-determination. The tyranny of freedom.

Americans now live in a time and a place in which freedom and autonomy are valued above all else and in which expanded opportunities for self-determination are regarded as a sign of the psychological well-being of individuals and the moral well-being of the culture. This article argues that freedom, autonomy, and self-determination can become excessive, and that when that happens, freedom can be experienced as a kind of tyranny. The article further argues that unduly influenced by the ideology of economics and rational-choice theory, modern American society has created an excess of freedom, with resulting increases in people's dissatisfaction with their lives and in clinical depression. One significant task for a future psychology of optimal functioning is to deemphasize individual freedom and to determine which cultural constraints are necessary for people to live meaningful and satisfying lives.

Depressive Disorder↗

Academic freedom: history, constraints, and recommendations for nursing education.

Nurse faculty members may have a limited awareness of the rights and responsibilities inherent in academic freedom. The author explores the development of academic freedom and those practices in nursing education that have limited nurse educators' academic freedom. Rights and responsibilities of and for faculty and students and constraints to academic freedom are examined. The article closes with recommendations that will help ensure increased awareness of and adherence to the rights and responsibilities of academic freedom.

Curriculum↗

Expressing freedom and taking liberties: the paradoxes of aberrant science.

Complete freedom does not exist, despite people's preparedness to die for it. Scientific freedom is much defended and yet much misunderstood. Scientists have limits imposed on their freedom by the disciplines and discourse communities in which they place themselves. Freedom within these socially constructed constraints needs to be distinguished from taking liberties with the rules and practices that make up these constraints, and validate the activities of special groups within society. Scientists (and the public) perceive taking liberties with science's rules and practices as aberrant science, and they often react punitively. Aberrant science can be broadly examined under four headings: wicked science, naughty science, dysfunctional science, and ideologically unacceptable science. When we examine examples of perceived aberrant science, we find that these categories of "misconduct" are connected and often confused. Scientific freedom needs to be redefined with due regard to current understandings of scientists as human beings facing powerful social pressures to deliver results of a particular kind.

Attitude↗

Freedom and forgiveness.

In the history of philosophy and political thought freedom has meant a number of different things. The author considers several of these meanings and their relevance to psychoanalytic theory. The general argument against freedom that has been mounted in the history of thought, and echoed by Freud, is the thesis of causal determinism; but it is urged here that this in itself is no threat to freedom in the sense of the word required for moral agency: a free choice is one that is caused to some extent by reasons and that is relatively unconstrained both by 'external' and 'internal' forces. Yet because agents are embedded in a causal nexus that includes both the physical world and other people, agency and freedom can be compromised in innumerable ways. Neither freedom nor agency is a condition which we absolutely have or lack, but a matter of degree. Psychoanalytic therapy works toward expanding the capacity for agency and diminishing the constraints of certain internal forces. In the sense defined here, objectivity is an attitude that accepts our embeddedness in the world. With objectivity may come both forgiveness and self-forgiveness, which in turn promote agency.

Citrates↗

Time to pain freedom and onset of pain relief with rizatriptan 10 mg and prescription usual-care oral medications in the acute treatment of migraine headaches: a multicenter, prospective, open-label, two-attack, crossover study.

BACKGROUND: Patients and physicians consider rapid onset of pain relief and pain freedom among the most important attributes of migraine therapy. OBJECTIVE: This study compared the effectiveness of rizatriptan 10 mg and usual-care oral migraine medications in everyday clinical practice settings. METHODS: This was a multicenter, prospective, open-label study. Adult patients treated 2 sequential migraine attacks with rizatriptan 10 mg and a usual-care prescription migraine medication in a crossover manner. Patients chose which medication to take first. They recorded the treatment outcomes using a stopwatch and a treatment diary. End points included time to pain freedom (length of time from dosing to no pain) and time to onset of pain relief (mean time to onset of pain relief and proportion of patients reporting onset of pain relief at 30 minutes), satisfaction with treatment, and medication preference. Information on adverse events was collected through the normal post-marketing reporting mechanism. Comparisons were made using the paired t test and McNemar test for continuous and categorical variables, respectively. A mixed model, accounting for multiple observations per patient, was fitted for the time to pain freedom, controlling for age, sex, treatment period, medication, and headache severity. RESULTS: Of 2346 enrolled patients, 1489 treated 2 migraines in a crossover manner and were included in the analysis (86.8% women, 13.2% men; mean age, 41.7 years). A majority of patients (80.6%) treated both migraines with oral triptans. The most commonly used nontriptans were NSAIDs (5.4%), butalbital-containing combinations (4.3%), and isometheptene (3.4%). Over-the-counter medications were used by 22.3% of patients during rizatriptan-treated attacks and by 28.9% of patients during attacks treated with usual-care medications. The mean time to pain freedom was significantly shorter when an attack was treated with rizatriptan compared with usual-care medications (222 vs 298 minutes, respectively; P<0.001), and the onset of pain relief was significantly more rapid (85 vs 107 minutes; P=0.003), with significant differences noted as early as 15 minutes after dosing (P<0.001). The findings remained similar after adjustment for potential confounding factors. No significant sequence effect was detected. Significantly more patients reported being very satisfied or satisfied with rizatriptan compared with usual-care medications (65.4% vs 57.7%; P<0.001) and preferred rizatriptan (58.0% vs 42.0%; P<0.001). One female patient reported having hives and itchy skin the day after taking rizatriptan; the symptoms subsided after treatment with methylprednisolone. CONCLUSIONS: In this selected population, treatment of a migraine attack with rizatriptan 10 mg was associated with a faster time to pain freedom and onset of pain relief compared with treatment with usual-care oral migraine medications. Patients reported greater satisfaction with and preference for rizatriptan.

Adult↗

A standard definition of disease freedom is needed for prostate cancer: undetectable prostate specific antigen compared with the American Society of Therapeutic Radiology and Oncology consensus definition.

PURPOSE: Freedom from prostate cancer is defined by undetectable prostate specific antigen (PSA) after surgery and the American Society of Therapeutic Radiology and Oncology (ASTRO) criteria are recommended for irradiation. Whether these definitions of disease freedom are comparable was evaluated in this study. MATERIALS AND METHODS: From August 1992 to August 1996 simultaneous irradiation with prostate 125iodine implantation followed by external beam irradiation was performed in 591 consecutive men with stage T1T2NX prostate cancer. All patients had a transperineal implant and none received neoadjuvant hormones. Disease freedom was defined by a PSA cutoff of 0.2 ng./ml. and the ASTRO consensus definition. Median followup was 6 years (range 5 to 8). RESULTS: Of the 591 men in this study 65 had recurrence by ASTRO criteria and 93 had recurrence by a PSA cutoff of 0.2 ng./ml., which was a significant difference (p = 0.001). On multivariate analysis of the factors related to disease-free status the definition of disease freedom, pretreatment PSA and Gleason score were highly significant. Of the 528 men with a minimum 5-year PSA followup the 8-year disease-free survival rate by ASTRO criteria was 99% in those who achieved a PSA nadir of 0.2 ng./ml. and 16% in those with a nadir of 0.3 to 1 ng./ml. Of the 469 disease-free patients by ASTRO criteria with a minimum 5-year followup 455 (97%) achieved a PSA nadir of 0.2 ng./ml. or less. CONCLUSIONS: The definition of freedom from prostate cancer significantly affects treatment results. A standard definition is needed and a PSA cutoff of 0.2 ng./ml. is suggested as the standard for all curative treatments for localized prostate cancer.

Brachytherapy↗

In vivo and noninvasive six degrees of freedom patellar tracking during voluntary knee movement.

OBJECTIVE: The purpose of this study was to investigate in vivo and noninvasively patellar tracking in six degrees of freedom during voluntary knee extension and flexion. DESIGN: Patellar tracking was evaluated in vivo and noninvasively with corroboration using in vivo fluoroscopy and in vitro cadaver measurements. BACKGROUND: Patellofemoral pain is closely related to abnormal patellar tracking and malalignment. However, there is a lack of quantitative and convenient methods to evaluate six degrees of freedom in vivo patellar tracking, partly due to difficulty in evaluating 3-D patellar tracking noninvasively. METHODS: Six degrees of freedom patellar tracking was measured in vivo and noninvasively using a small clamp mounted onto the patella and an optoelectronic motion capture system in 18 knees of 12 healthy subjects during voluntary knee extension and flexion. RESULTS: The patella tracked systematically following a certain pattern during knee extension and flexion. Patellar tracking patterns during knee extension and flexion were not significantly different in the 18 knees tested. When the knee was voluntarily extended from 15 degrees flexion to full extension, the patella was extended 8 degrees, laterally tilted 2 degrees, and shifted 3 mm laterally and 10 mm proximally. The results were consistent with previous in vitro and in vivo studies. CONCLUSION: Six degrees of freedom patellar tracking can be evaluated in vivo and noninvasively within the range of 20 degrees flexion to full knee extension. RELEVANCE: The study provided us quantitative six degrees of freedom information about patellar tracking during knee flexion/extension, which can be used to investigate patellar tracking in vivo and noninvasively in both healthy subjects and patients with patellofemoral disorder and patellar malalignment.

Adult↗

Flexibility and repeatability of finger movements during typing: analysis of multiple degrees of freedom.

The kinematics of the hand and fingers were studied during various keystrokes in typing. These movements were defined by 17 degrees of freedom of motion, and methods were developed to identify simplifying strategies in the execution of the task. Most of the analysis was restricted to the 11 degrees of freedom of the fingers, neglecting thumb and wrist motion. Temporal characteristics of the motion were defined by computing principal components, and it was found that only a few (two to four) principal components were needed to characterize motion of each of the degrees of freedom. Hierarchical relationships among patterns within and between different degrees of freedom were identified using cluster analysis. There was a considerable amount of consistency each time a given keystroke was executed by a subject, and this repeatability may imply a reduction in the number of degrees of freedom independently controlled by the nervous system. However, there also appears to be considerable flexibility in the coordination of the many joints of the hand when examined across different keys and across different subjects.

Biomechanical Phenomena↗