Purpose: The method of diagnosing diabetic retinopathy (DR) through artificial intelligence (AI)-based systems has been commercially available since 2018. This introduces new ethical challenges with regard to obtaining informed consent from patients. The purpose of this work is to develop a checklist of items to be disclosed when diagnosing DR with AI systems in a primary care setting. -/- Methods: Two systematic literature searches were conducted in PubMed and Web of Science databases: a narrow search focusing on DR (...) and a broad search on general issues of AI-based diagnosis. An ethics content analysis was conducted inductively to extract two features of included publications: (1) novel information content for AI-aided diagnosis and (2) the ethical justification for its disclosure. -/- Results: The narrow search yielded n = 537 records of which n = 4 met the inclusion criteria. The information process was scarcely addressed for primary care setting. The broad search yielded n = 60 records of which n = 11 were included. In total, eight novel elements were identified to be included in the information process for ethical reasons, all of which stem from the technical specifics of medical AI. -/- Conclusions: Implications for the general practitioner are two-fold: First, doctors need to be better informed about the ethical implications of novel technologies and must understand them to properly inform patients. Second, patient's overconfidence or fears can be countered by communicating the risks, limitations, and potential benefits of diagnostic AI systems. If patients accept and are aware of the limitations of AI-aided diagnosis, they increase their chances of being diagnosed and treated in time. (shrink)

Artificial intelligence (AI) is expected to revolutionise the practice of medicine. Recent advancements in the field of deep learning have demonstrated success in variety of clinical tasks: detecting diabetic retinopathy from images, predicting hospital readmissions, aiding in the discovery of new drugs, etc. AI’s progress in medicine, however, has led to concerns regarding the potential effects of this technology on relationships of trust in clinical practice. In this paper, I will argue that there is merit to these concerns, (...) since AI systems can be relied on, and are capable of reliability, but cannot be trusted, and are not capable of trustworthiness. Insofar as patients are required to rely on AI systems for their medical decision-making, there is potential for this to produce a deficit of trust in relationships in clinical practice. (shrink)

Diabetes is one of the most common diseases worldwide where a cure is not found for it yet. Annually it cost a lot of money to care for people with diabetes. Thus the most important issue is the prediction to be very accurate and to use a reliable method for that. One of these methods is using artificial intelligence systems and in particular is the use of Artificial Neural Networks (ANN). So in this paper, we used artificial neural networks to (...) predict whether a person is diabetic or not. The criterion was to minimize the error function in neural network training using a neural network model. After training the ANN model, the average error function of the neural network was equal to 0.01 and the accuracy of the prediction of whether a person is diabetics or not was 87.3%. (shrink)

Over the past year, technology companies have made headlines claiming that their artificially intelligent (AI) products can outperform clinicians at diagnosing breast cancer, brain tumours, and diabetic retinopathy. Claims such as these have influenced policy makers, and AI now forms a key component of the national health strategies in England, the United States, and China. While it is positive to see healthcare systems embracing data analytics and machine learning, concerns remain about the efficacy, ethics, and safety of some (...) commercial, AI health solutions. This paper argues that improved regulation and guidance is urgently required to mitigate risks, ensure transparency and best practice, Without this, patients, clinicians, and other stakeholders cannot be assured of an app’s efficacy, and safety. (shrink)

The detection and analysis of misunderstandings are crucial aspects of discourse analysis, and presuppose a twofold investigation of their structure. First, misunderstandings need to be identified and, more importantly, justified. For this reason, a classification of the types and force of evidence of a misunderstanding is needed. Second, misunderstandings reveal differences in the interlocutors’ interpretations of an utterance, which can be examined by considering the presumptions that they use in their interpretation. This paper proposes a functional approach to misunderstandings grounded (...) on presumptive reasoning and types of presumptions, in which incompatible interpretations or interpretative failures are examined as defaults of the underlying interpretative reasoning, caused by overlooked evidence or conflicting presumptions. Moreover, it advances a classification of the types and the probative weights of the evidence that can be used to detect misunderstandings. The proposed methodology and its implications are illustrated through the analysis of doctor–patient communication in diabetes care. (shrink)

Postpartum depression is a major maternal health problem after childbirth. It can start at any time within the first year after delivery and continue for several years. It is characterized by an inability to experience pleasure, anxiety symptoms, panic attacks, spontaneous crying and depressed mood. Some women with postpartum depression even have thoughts of harming their child and self-harm. This study aims to find out the status of postpartum depression and the associated factors among postnatal mothers at the first, fourth (...) and sixth month. This study is a prospective descriptive study, carried out in three major health facilities in Misurata. This study consists of a three-part questionnaire. Part 1 covers the demographic characteristics of the participants, while Part 2 explores the associated risk factors according to the variables used. Part 3 consists of the psychological evaluation of the participants. A hundred mothers (ages between 15 and 43 years) were enrolled in this study. The findings revealed that the prevalence of depression is 60.0% and 22.0% are suffering from borderline depression. Development of depression was strongly correlated with sleeping disturbances, the state of the neonate after birth, excess consumption of stimulants, less weight acceptance by mothers during pregnancy and infant illness. There was a weak relation between depression and delivery state, maternal admission to the hospital during the current pregnancy, and infant gender dissatisfaction. No correlation was found with the development of depression regarding miscarriage, maternal medical problems after delivery, previous child sex, maternal age, education, parity or neonate weight. Thus, this study shows that the chance of having a miscarriage and an unhealthy neonate increases with advanced maternal age. It also shows that caesarean section is associated with bad neonatal outcomes, more weight gain and having gestational diabetes or preeclampsia during pregnancy. Maternal sleeping problems are more pronounced in the first month, attributed to the baby's care, compared with the fourth and sixth months. The study indicates that depression is a common state of psychiatric disorders among Libyan women and should have appropriate attention by physicians and gynecologists. (shrink)

Dharmakīrti’s (c. seventh century) Examination of Relations (Sambandhaparīkṣā) is unique in the Indian Buddhist canon for its being the only extant root text devoted entirely to the topic of the ontological status of relations. But the core thesis of this treatise—that relations are only nominally real—is in prima facie tension with another claim that is central to Dharmakīrti’s epistemology: that there exists some kind of “natural relation” (svabhāvapratibandha) that reliably underwrites inferences. Understanding how Dharmakīrti can consistently rely on natural relations (...) to prop up his presentation of inferential reasoning while at the same time advancing an anti-realist account of relations is critical for making sense of his system of logic and epistemology, which came to be nearly universally adopted in Tibetan Buddhism cutting across traditions. Chomden Rikpé Reldri (1227–1305), who was perhaps the most prolific commentator on logic and epistemology in the history of Tibetan philosophy, composed two texts commenting on the Examination of Relations, neither of which have received any scholarly attention to date. In this paper, I provide an introduction to Chomden Reldri’s two commentaries and consider how they may illuminate Dharmakīrti’s text and also what they reveal about the understanding of Dharmakīrti’s account of relations in early Tibetan scholasticism. I then present a translation of Dharmakīrti’s Examination of Relations together with Chomden Reldri’s commentary, Annotations and Topical Outline of the Examination of Relations (’Brel pa brtag pa’i mchan dang sa bcad gnyis). (shrink)

Postpartum depression is a major maternal health problem after childbirth. It can start at any time within the first year after delivery and continue for several years. It is characterized by an inability to experience pleasure, anxiety symptoms, panic attacks, spontaneous crying and depressed mood. Some women with postpartum depression even have thoughts of harming their child and self-harm. This study aims to find out the status of postpartum depression and the associated factors among postnatal mothers at the first, fourth (...) and sixth month. This study is a prospective descriptive study, carried out in three major health facilities in Misurata. This study consists of a three-part questionnaire. Part 1 covers the demographic characteristics of the participants, while Part 2 explores the associated risk factors according to the variables used. Part 3 consists of the psychological evaluation of the participants. A hundred mothers (ages between 15 and 43 years) were enrolled in this study. The findings revealed that the prevalence of depression is 60.0% and 22.0% are suffering from borderline depression. Development of depression was strongly correlated with sleeping disturbances, the state of the neonate after birth, excess consumption of stimulants, less weight acceptance by mothers during pregnancy and infant illness. There was a weak relation between depression and delivery state, maternal admission to the hospital during the current pregnancy, and infant gender dissatisfaction. No correlation was found with the development of depression regarding miscarriage, maternal medical problems after delivery, previous child sex, maternal age, education, parity or neonate weight. Thus, this study shows that the chance of having a miscarriage and an unhealthy neonate increases with advanced maternal age. It also shows that caesarean section is associated with bad neonatal outcomes, more weight gain and having gestational diabetes or preeclampsia during pregnancy. Maternal sleeping problems are more pronounced in the first month, attributed to the baby's care, compared with the fourth and sixth months. The study indicates that depression is a common state of psychiatric disorders among Libyan women and should have appropriate attention by physicians and gynecologists. (shrink)

Abstract: Heart attacks, or myocardial infarctions, are a leading cause of mortality worldwide. Early prediction and accurate analysis of potential risk factors play a crucial role in preventing heart attacks and improving patient outcomes. In this study, we conduct a comprehensive review of datasets related to heart attack analysis and prediction. We begin by examining the various types of datasets available for heart attack research, encompassing clinical, demographic, and physiological data. These datasets originate from diverse sources, including hospitals, research institutions, (...) and public health agencies. Our analysis aims to identify common features, data quality, and potential biases in these datasets. Next, we explore the predictive modeling techniques employed in heart attack prediction. Machine learning algorithms, such as decision trees, support vector machines, and deep neural networks, have gained prominence in predicting heart attacks. We discuss the strengths and limitations of these methods and highlight recent advancements in predictive modeling. Furthermore, we delve into the critical risk factors associated with heart attacks. Factors such as age, gender, hypertension, diabetes, and cholesterol levels are examined for their significance in predicting cardiac events. We also investigate the role of lifestyle factors, including smoking, diet, and physical activity, in heart attack risk assessment. Additionally, this review addresses the importance of data preprocessing and feature engineering in improving prediction accuracy. Feature selection methods, missing data handling, and data scaling techniques are discussed to enhance the robustness of heart attack prediction models. In conclusion, this comprehensive dataset review provides valuable insights into the state of heart attack analysis and prediction. It serves as a resource for researchers and healthcare professionals seeking to better understand the datasets available for heart attack research and the methods employed for accurate prediction. Ultimately, our efforts in dataset analysis and predictive modeling contribute to the advancement of preventive cardiology and the reduction of heart attack-related morbidity and mortality. (shrink)

Human Aspiration is the first chapter of the magnum opus book "Life Divine". Here in in this chapter Sri Aurobindo one of the most modern prolific philosophers of Renaissance India has highlighted his focal points as to what Man's eternal aspiration has been, that is, God, Light , Freedom & Eternity. Despite technological and scientific advancements, Mans is still thirsty, it is because he aspires for a Divine Life. The article talks about the "Human aspiration" of eternity in details.

The present article intends to discuss the basis of the teleological argument from the work of the Spanish physicist and philosopher Mariano Artigas. After observing the prolific production of many scientists on the subject, we notice that the concept of “finality” must be nuanced. This nuance of the concepct allows to investigate in what ways the empirical sciences and philosophical thought can sustain the “finality” be understood. Then, it demonstrates that the notions of “chance” and “finality” aren’t incompatible, because there (...) is an possible harmonization beetween then. Throughout the process, it is stressed the need to correctly evaluate the advances of the experimental sciences, so as not to extrapolate their own statutes. In the end, having observed how Artigas responds to the question, the author of the article comments on the ethical developments that resonate from the main concept discussed. (shrink)

Guru Gobind Singh was a versatile genius, a unique personality of contrasting qualities of virtue and valour, the spirit of service and sacrifice, solider and scholar. He was not only a great warrior but also a prolific writer and a poet of high calibre. The brief span of forty-two years of his life is vibrant with activity. He wrote in several languages. It is said that fourteen maunds load of manuscripts were lost in Sirsa when the Guru was being pursued (...) from Anandpur to Chamkaur. Fortunately, part of his work survived and they afford a pretty clear view of his aims and ideals. The Guru compiled a variety of poetic compositions, some of which are considered masterpieces of medieval Punjabi poetry and Braj literature. His patronage of poets and scholars at his Darbar contributed a significant addition to the storehouse of Puranic Epics in Indian literature. (shrink)

Diabetes is a major public health issue that affects the nations of our time to a large extent and is described as a non-communicable epidemic. Diabetes mellitus is a common disease where there is too much sugar (glucose) floating around in your blood. This occurs because either the pancreas can’t produce enough insulin or the cells in body have become resistant to insulin. The concentration in this paper is on diagnosis diabetes by designing a proposed expert system. The main goal (...) of this expert system is to get the appropriate diagnosing of the illness, dealing with it quickly, and tips for permanent treatment whenever possible is given out. SL5 object expert system language was used for designing and implementing the proposed expert system. (shrink)

Prolife theorists typically hold to the claim that all human beings possess equal moral status from conception and consequently possess a right to life. This, they believe, entails that abortion is impermissible in all circumstances. Critics characterize this as an extreme anti-abortion position, as it prima facie allows no exceptions, even in cases of rape. Here, I examine whether the prolife claim regarding equal moral status is compatible with a more attractive moderate stance that permits an exception in the case (...) of rape. I show that Judith Jarvis Thomson's analysis of rights can be used to modify the prolife position in this way, but that doing so involves concessions that prolife theorists are unlikely to find acceptable. (shrink)

Opponents of abortion are often described as ‘inconsistent’ (hypocrites) in terms of their beliefs, actions and/or priorities. They are alleged to do too little to combat spontaneous abortion, they should be adopting cryopreserved embryos with greater frequency and so on. These types of arguments—which we call ‘inconsistency arguments’—conform to a common pattern. Each specifies what consistent opponents of abortion would do (or believe), asserts that they fail to act (or believe) accordingly and concludes that they are inconsistent. Here, we show (...) that inconsistency arguments fail en masse. In short, inconsistency arguments typically face four problems. First, they usually fail to account for diversity among opponents of abortion. Second, they rely on inferences about consistency based on isolated beliefs shared by some opponents of abortion (and these inferences often do not survive once we consider other beliefs opponents of abortion tend to hold). Third, inconsistency arguments usually ignore the diverse ways in which opponents of abortion might act on their beliefs. Fourth, inconsistency arguments criticise groups of people without threatening their beliefs (eg, that abortion is immoral). Setting these problems aside, even supposing inconsistency arguments are successful, they hardly matter. In fact, in the two best-case scenarios—where inconsistency arguments succeed—they either encourage millions of people to make the world a (much) worse place (from the critic’s perspective) or promote epistemically and morally irresponsible practices. We conclude that a more valuable discussion would be had by focusing on the arguments made by opponents of abortion rather than opponents themselves. (shrink)

This study employs machine learning to predict diabetes using a Kaggle dataset with 13 features. Our three-layer model achieves an accuracy of 98.73% and an average error of 0.01%. Feature analysis identifies Age, Gender, Polyuria, Polydipsia, Visual blurring, sudden weight loss, partial paresis, delayed healing, irritability, Muscle stiffness, Alopecia, Genital thrush, Weakness, and Obesity as influential predictors. These findings have clinical significance for early diabetes risk assessment. While our research addresses gaps in the field, further work is needed to enhance (...) model generalizability. (shrink)

The diabetic foot is a global threat to public health because it can result in infection and amputation, as well as cause the patient to experience considerable pain and incur financial costs. The condition of patients with diabetic foot in North China is distinguished by more severe local ulcers, a worse prognosis, and a longer duration of disease than that of patients with diabetic foot in the south. Through appropriate preventive measures, the diabetic foot can be (...) effectively avoided. This study assesses the existing knowledge, attitudes and practices associated with diabetic foot prevention among adults with diabetes living in rural areas of North China. (shrink)

Diabetic ketoacidosis is a serious, medical emergency that can be fatal but treatable, we aimed to evaluate the clinical profile of patients admitted with diabetic ketoacidosis. This case series study enrolled 213 non-pregnant adult and adolescent patients admitted with diabetic ketoacidosis at Tripoli Diabetes Hospital from January to September 2023. Demographic data, clinical characteristics, laboratory findings, precipitating factors, and patient outcomes were extracted from medical records and analyzed. Type 1 diabetes mellitus was present in 187 (87.8%) of (...) patients, the age range 11-84 years, (30.26±13.28), with 130 patients ≤30 years old (61.0%), females accounting for 110 of the patients (51.6%), 109 had a diabetes duration of less than 10 years (51.2%). The most common precipitating factor was insulin omission 92 (43.2%) in patients with known diabetes mellitus, whereas, diabetic ketoacidosis as the first presentation of diabetes mellitus in 24 patients (11.7%), systolic blood pressure ranged 50-160 mmHg (112.82±16.19), diastolic blood pressure varied 30-100 mmHg (70.24±11.32). Plasma glucose at presentation ranged 183-1494 mg/dl (462.92±169.85), with Eu-glycemic diabetic ketoacidosis 100-249 mg/dl were in nine patients (4.2%), whereas most of cases (135 patients, 63.4%) present with plasma glucose 250-500 mg/dl, while hyperosmolar status (≥701 mg/dl) were present in 13 patients (6.1%). Venous pH varied from 6.7-7.42 (7.13±0.14), 132 (62.0%) patients presented with pH <7.24, while severe acidosis was pH < 7 in 32 of patients (14.6%), serum bicarbonate with 10.93±4.95, severe (<5 mmol) in 91 patients (42.7%) and moderate (5-10 mmol) were in 79 patients (37.08%). The mean length of hospital stay was 3.33 days, with an average of 2.11 days spent in the high-dependent unit. Serum potassium varied from 2.4-6.7 meq/L with 3.66± 0.63, most common complications of diabetic ketoacidosis treatment were hypokalemia observed in 82 (35.7%) of cases, and hypoglycemia was detected in 41 patients (19.2%). 170 patients were discharged in good condition (79.8%), and 17.8% of patients were transferred to another hospital to receive further management for co-morbid diseases with diabetes after controlling their hyperglycemic crises. The majority of patients presented with the critical status of diabetic ketoacidosis. The findings emphasize the importance of patient education about prevention measures prompt presentation to the hospital, and clinicians' awareness for early and aggressive treatment of hyperglycemic crises. (shrink)

The conventional wisdom about advance care planning holds that the normative force of my prior wishes is simply that they are mine. It is their connection to me that matters. This paper challenges conventional thinking. I propose that the normative force of prior wishes does not depend exclusively on personal identity. Instead, it sometimes depends on a special relationship that exists between a prior, capacitated person and a now incapacitated person. I consider what normative guidance governs persons who stand in (...) a special relationship, and contrast these with the standard model of respect for autonomy. My conclusion is that advance care planning for individuals who have lost decision-making capacity should incorporate the virtues of prudence and integrity, even when one and the same person ceases to exist, and respect for personal autonomy is no longer relevant. (shrink)

Uric acid has increasingly been associated with insulin resistance, hyperinsulinemia, and type 2 diabetes mellitus. Diabetic patients who are hyperuricemic have a risk of developing diabetic complications. Pathogenesis of uric acid may decrease nitric oxide bioavailability in vascular smooth muscle, endothelial cells and direct scavenging of nitric oxide by uric acid. A decrease in endothelial nitric oxide production by uric acid has also been associated with endothelial dysfunction and insulin resistance. This study aims to determine the relationship between (...) uric acid and glucose levels in patients with type 2 diabetes mellitus. The study included 161 Libyan patients (67 males and 94 females) diagnosed with type 2 diabetes mellitus. Both levels of serum uric acid and hemoglobin A1c (HbA1c) were determined. The patients were divided into two groups. The controllable diabetic group with HbA1c of less than 06.0% and the uncontrollable diabetic group with HbA1c of more than 06.0%. Patients who are suffering from type 2 diabetes mellitus without complications were included whereas patients with smoking, alcoholism, nephrotic disease, malignancy, hepatitis, and renal failure or kidney disease were excluded. The mean and standard deviation of uric acid, HbA1c and Pearson correlation coefficient test were considered. In the controllable diabetic group, serum uric acid mean was found to be 4.807±1.39 and HbA1c was found to be 5.032±1.39. In the uncontrollable diabetic group, serum uric acid was 4.897±1.66 and HbA1c was 8.396±1.65. Uric acid level has significantly been correlated with HBA1C in controlled and uncontrolled diabetic patients (p<0.05). In addition, the uric acid level was found to be higher in the uncontrolled diabetic group than that in the controlled group (p<0.05). A possible relationship between serum uric acid and the incidence of type 2 diabetes mellitus was noted. Thus, uric acid can be used as a potential biomarker to indicate impaired glucose metabolism. (shrink)

Vitamin D deficiency and its effect have attracted considerable research interest due to its relation to glucose homeostasis, insulin secretion, sensitivity and synthesis. This study aimed to evaluate vitamin D levels in patients with type II diabetes mellitus aged between 35-65 years and investigate their relations with glycemic control and obesity. The study included 74 Libyan patients with a known history of type II diabetes mellitus (33 males and 41 females). Serum glucose, glycosylated hemoglobin (HbA1c) and vitamin D levels were (...) biochemically estimated in these patients. Further, body mass index (BMI) was calculated for all diabetic patients (weight in kilogram per height in meter square). The mean level of plasma glucose level was 150.58±63.82 mg/dl (mean±SD). The mean of HbA1c level was 7.90±8.48% (mean±SD). The mean level of vitamin D was 22.75±14.97 ng/ml. The mean of BMI was 26.55±4.10 Kg per m2. The findings showed that 58.10% of the cases had vitamin D deficiency (Out of which 24.24% were males and 85.36% were females). This study showed significant differences in glucose, HbA1c, vitamin D and BMI between male and female patients. Moreover, elderly ages for both sexes had adverse effects on vitamin D status. Vitamin D levels have negatively been correlated with levels of glucose, HbA1c and BMI. It is concluded that vitamin D deficiency has an adverse effect on glucose homeostasis in patients with type II diabetes mellitus and this can be a contributing risk factor in complications of type II diabetes mellitus development in Libyan patients. (shrink)

Type 2 diabetes mellites (T2DM) is a common complex disease with multiple factors contributing to its development and progression. Dyslipidemia refers to the abnormality of lipid metabolism, characterized by elevated levels of low-density lipoprotein (LDL), total cholesterol (TC), triglycerides (TG), and decreased levels of high-density lipoprotein (HDL). It is a major risk factor for cardiovascular disease in type 2 diabetic patients. This study aimed to evaluate the diagnostic value of glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG) in predicting (...) the risk of developing diabetic dyslipidemia. 86 clinically diagnosed Libyan patients with type 2 diabetes mellitus (44 males: 42 females), 30 years and 70 years of age were engaged in this study. Levels of HbA1C, blood glucose, TC, TG, LDL, and HDL were performed using a Lntegra Cobas 400+ analyzer. The findings showed that HbA1c exhibits a significant positive correlation with TC and TG with no significant correlation with LDL and HDL levels. Thus, this study suggests that HbA1c can be used as a potential dual marker of glycemic control and dyslipidemia in type 2 diabetes mellitus. (shrink)

Until recently, experimental philosophy has been associated with the questionnaire-based study of intuitions; however, experimental philosophers now adapt a wide range of empirical methods for new philosophical purposes. New methods include paradigms for behavioural experiments from across the social sciences as well as computational methods from the digital humanities that can process large bodies of text and evidence. This book offers an accessible overview of these exciting innovations. The volume brings together established and emerging research leaders from several areas of (...) experimental philosophy to explore how new empirical methods can contribute to philosophical debates. Each chapter presents one or several methods new to experimental philosophy, demonstrating their application in a key area of philosophy and discussing their strengths and limitations. Methods covered include eye tracking, virtual reality technology, neuroimaging, statistical learning, and experimental economics as well as corpus linguistics, visualisation techniques and data and text mining. The volume explores their use in moral philosophy and moral psychology, epistemology, philosophy of science, metaphysics, philosophy of language, philosophy of mind and the history of ideas. Methodological Advances in Experimental Philosophy is essential reading for undergraduates, graduate students and researchers working in experimental philosophy. (shrink)

This paper takes a novel approach to the active bioethical debate over whether advance medical directives have moral authority in dementia cases. Many have assumed that advance directives would lack moral authority if dementia truly produced a complete discontinuity in personal identity, such that the predementia individual is a separate individual from the postdementia individual. I argue that even if dementia were to undermine personal identity, the continuity of the body and the predementia individual’s rights over that body can support (...) the moral authority of advance directives. I propose that the predementia individual retains posthumous rights over her body that she acquired through historical embodiment in that body, and further argue that claims grounded in historical embodiment can sometimes override or exclude moral claims grounded in current embodiment. I close by considering how advance directives grounded in historical embodiment might be employed in practice and what they would and would not justify. (shrink)

In this commentary, I critique three aspects of Emily Walsh's proposal to reduce the moral and legal weight of advance directives: (1) the ambiguity of its initial thesis, (2) its views about the ethics and legality of clinical practice, and (3) its interpretation and application of Ronald Dworkin’s account of advance directives and L.A. Paul's view on transformative experience. I also consider what Walsh’s proposal would mean for people facing the prospect of dementia. I conclude that our reasons to honor (...) many advance directives survive the move to a transformative experience framework. (shrink)

A high level of confidence in the identity of individuals is required to let them die as ordered by an advance directive. Thus, if we are animalists, then we should lack the confidence required to apply lethal advance directives to the cheerfully demented, or so I argue. In short, there is consensus among animalists that the best way to avoid serious objections to their account is to adopt an ontology that denies the existence of brains, hands, tables, chairs, iced-tea, and (...) lemonade. The adoption of such an ontology reduces the justificatory force of commonsense, which is key in arguing that we are animals and that we persist as long as we are biologically alive. With this loss of justification comes the loss of a high level of confidence that Quinn-pre-dementia’s lethal advanced directive applies to Quinn-post-dementia, via identity. If we do not have a high level of confidence that Quinn-pre-dementia’s advanced directive applies to Quinn-post- dementia, then it is not enough (on its own) to let Quinn-post-dementia die. (shrink)

Objectives: This study aimed to fill the gap between Vietnamese diabetic patients' needs and care through a qualitative study asking about their experiences with diabetes and quality of care. -/- Methods: Interviews with five diabetic patients were conducted at a tertiary general hospital located in southern Vietnam. The transcribed data were first subjected to quantitative text analysis using KH Coder to identify major categories of frequently used words, followed by a qualitative analysis of selected cases using the Steps (...) for Coding and Theorization (SCAT) method. -/- Results: The major categories of frequently used words were chronic health conditions, services, facilities, insurance, patient-doctor communication, and medication. SCAT analysis of three selected cases identified six themes: “Disregarding the disease at the early stage,” “Fear of complications,” “Satisfaction with hospital services and medical staff,” “Insurance-related problems,” “Long waiting times,” and “Communication barriers between patients and doctors.” Patients were satisfied with improved hospital facilities and services; however, the overloading of one hospital led to long waiting times and communication difficulties with doctors. Difficulties with health insurance were also observed, and patients were rather passive in disease management and needed to be empowered through improved communication with doctors and other care providers. -/- Conclusion: These findings from our trial of introducing a qualitative study into service evaluation suggest that listening to patients can help health providers learn their perspectives and be more responsive to their needs. (shrink)

Elisabeth Meru, born in Hamburg, is a poetess by heart, a storyteller by nature, a forwarding merchant / financial accountant by training, and a Sikh by choice. She is currently settled in Munich, Germany. During the past three decades, she has authored numerous short stories, articles, and poetic compositions for various newspapers, journals, and radio broadcasts. With over a dozen books, both in English and German languages, to her credit to date, she is a prolific author who specializes in writing (...) on Sikh history, tradition, and culture. Her 24-year-long spiritual quest brought her to the Gurdwara in Munich, wherein she heard Gurbani Kirtan for the first time. Therein she felt as if she had reached home. After continuous devotion and dedication to Sikhi for about seven years, she converted to Sikhism. Due to her love for Sikhi, Punjabi and Punjabiat, she learned Gurmukhi. Her first book in German, “Aus dem Herzen des Sikhismus - Guru Nanak Dev Ji - In deinem stillen Rosengarten” was published in 2009. The English version of the book "From the Heart of Sikhism - Guru Nanak Dev Ji - In your quiet rose garden" was published in 2010. These books describe the legends about the ten Gurus, their wisdom and teachings, and her poems, fables and a fairytale in German style. Elisabeth’s second set of books “Sikhism - Wellspring of Love” (in English) and “Sikhismus - Quell der Liebe” (in German), were published in 2010. This book contains her poems and stories about Sikhism. The stories are rooted in the spirit of fairy tales. Her next book, in German, “Sikhs und Sikhismus: Religion, Riten und der Goldene Tempel ” was published in 2011. In Feb. 2012,she with her team published the German edition of “Guru Granth Sahib Ji Essenz und Sikh Terminologie von A - Z.” It is a must-book for German-speaking Sikhs and all those who want a quick overview of basic terms in Sikhism. Another of her book, in German, “Sikhs ... der Bart ist ab,” was published in 2017. (shrink)

The global production of radioactive wastes is expected to increase in the coming years as more countries have resorted to adopting nuclear power to decrease their reliance on fossil-fuel-generated energy. Discoveries of remediation methods that can remove radionuclides from radioactive wastes, including those discharged to the environment, are therefore vital to reduce risks-upon-exposure radionuclides posed to humans and wildlife. Among various remediation approaches available, microbe-mediated radionuclide remediation have limited reviews regarding their advances. This review provides an overview of the sources (...) and existing classification of radioactive wastes, followed by a brief introduction to existing radionuclide remediation (physical, chemical, and electrochemical) approaches. Microbe-mediated radionuclide remediation (bacterial, myco-, and phycoremediation) is then extensively discussed. Bacterial remediation involves biological processes like bioreduction, biosorption, and bioprecipitation. Bioreduction involves the reduction of water-soluble, mobile radionuclides to water-insoluble, immobile lower oxidation states by ferric iron-reducing, sulfate-reducing, and certain extremophilic bacteria, and in situ remediation has become possible by adding electron donors to contaminated waters to enrich indigenous iron- and sulfate-reducing bacteria populations. In biosorption, radionuclides are associated with functional groups on the microbial cell surface, followed by getting reduced to immobilized forms or precipitated intracellularly or extracellularly. Myco- and phycoremediation often involve processes like biosorption and bioaccumulation, where the former is influenced by pH and cell concentration. A Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis on microbial remediation is also performed. It is suggested that two research directions: genetic engineering of radiation-resistant microorganisms and co-application of microbe-mediated remediation with other remediation methods could potentially result in the discovery of in situ or ex situ microbe-involving radioactive waste remediation applications with high practicability. Finally, a comparison between the strengths and weaknesses of each approach is provided. (shrink)

This book aims to provide a comprehensive analysis of Advanced Persistent Threats (APTs), including their characteristics, origins, methods, consequences, and defense strategies, with a focus on detecting these threats. It explores the concept of advanced persistent threats in the context of cyber security and cyber warfare. APTs represent one of the most insidious and challenging forms of cyber threats, characterized by their sophistication, persistence, and targeted nature. The paper examines the origins, characteristics and methods used by APT actors. (...) It also explores the complexities associated with APT detection, analyzing the evolving tactics used by threat actors and the corresponding advances in detection methodologies. It highlights the importance of a multi-faceted approach that integrates technological innovations with proactive defense strategies to effectively identify and mitigate APT. (shrink)

The fourth amendment to the German Medicinal Products Act (Arzneimittelgesetz) states that nontherapeutic research in incompetent populations is permissible under the condition that potential research participants expressly declare their wish to participate in scientific research in an advance research directive. This article explores the implementation of advance research directives in Germany against the background of the international legal and ethical framework for biomedical research. In particular, it addresses a practical problem that arises from the disclosure requirement for advance research directives. (...) We show that, if the disclosure standard for advance research directives is set at a token level, nontherapeutic research in incompetent populations becomes practically impossible. To resolve this issue, we suggest the disclosure standard be set at a type level. (shrink)

There is a widespread assumption that B-theorists (according to whom there is nothing metaphysically special about the present moment in virtue of which it is present) should interpret the standard tense operators (‘it was the case that’, ‘it will be the case that’) as implicit quantifier-restrictors – so that, for example, an utterance at instant t of the sentence ‘It was the case that there are dinosaurs’ is true just in case there are dinosaurs located at some instant t* earlier (...) than t. However, it is easy to show that this interpretation of the tense operators creates serious problems for B-theorists when combined with certain other relatively uncontroversial B-theoretic assumptions. In this paper, I argue that the best way for B-theorists to respond to these problems is to treat the standard tense operators as redundant when the sentences in their scope are qualitative (i.e. not about any particular individuals). (shrink)

Advance directives typically have two defects. First, most advance directives fail to enable people to effectively avoid unwanted medical intervention. Second, most of them have the potential of ending your life in ways you never intended, years before you had to die.

When medical assistance in dying (MAiD) was legalized in Canada in June 2016, the question of allowing decisionally capable persons to make advance requests in anticipation of later incapacity was reserved for further consideration during the mandatory parliamentary review originally scheduled to begin in June 2020 (but since delayed by COVID-19). In its current form the legislation does not permit such requests, since it stipulates that at the time at which the procedure is to be administered the patient must give (...) “express consent” to receiving it. Since express consent presupposes decisional capacity, this requirement rules out administering MAiD to a patient who has lost capacity. Amendments to the legislation passed by Parliament in March 2021 open the door slightly by allowing advance requests by patients after they have been approved for MAiD, if they fear losing capacity before the procedure can be administered. But this provision would apply only to patients whose natural death was deemed to be “reasonably foreseeable”, and would continue to exclude (a) requests made after diagnosis of a “grievous and irremediable medical condition” but in advance of approval for MAiD, and (b) requests made before such a diagnosis. My aim in this paper is twofold: to explore the ethical and legal issues concerning advance requests for MAiD, and to argue for expanding provision for such requests to include both of these further scenarios. (shrink)

The second volume of “Advancing Uncertain Combinatorics through Graphization, Hyperization, and Uncertainization: Fuzzy, Neutrosophic, Soft, Rough, and Beyond” presents a deep exploration of the progress in uncertain combinatorics through innovative methodologies like graphization, hyperization, and uncertainization. This volume integrates foundational concepts from fuzzy, neutrosophic, soft, and rough set theory, among others, to further advance the field. Combinatorics and set theory, two central pillars of mathematics, focus on counting, arrangement, and the study of collections under defined rules. Combinatorics excels in handling (...) uncertainty, while set theory has evolved with concepts such as fuzzy and neutrosophic sets, which enable the modeling of complex real-world uncertainties by addressing truth, indeterminacy, and falsehood. These advancements, when combined with graph theory, give rise to novel forms of uncertain sets in "graphized" structures, including hypergraphs and superhypergraphs. Innovations such as Neutrosophic Oversets, Undersets, and Offsets, as well as the Nonstandard Real Set, build upon traditional graph concepts, pushing both theoretical and practical boundaries. The synthesis of combinatorics, set theory, and graph theory in this volume provides a robust framework for addressing the complexities and uncertainties inherent in both mathematical and real-world systems, paving the way for future research and application. In the first chapter, “A Review of the Hierarchy of Plithogenic, Neutrosophic, and Fuzzy Graphs: Survey and Applications”, the authors investigate the interrelationships among various graph classes, including Plithogenic graphs, and explore other related structures. Graph theory, a fundamental branch of mathematics, focuses on networks of nodes and edges, studying their paths, structures, and properties. A Fuzzy Graph extends this concept by assigning a membership degree between 0 and 1 to each edge and vertex, representing the level of uncertainty. The Turiyam Neutrosophic Graph is introduced as an extension of both Neutrosophic and Fuzzy Graphs, while Plithogenic graphs offer a potent method for managing uncertainty. The second chapter, “Review of Some Superhypergraph Classes: Directed, Bidirected, Soft, and Rough”, examines advanced graph structures such as directed superhypergraphs, bidirected hypergraphs, soft superhypergraphs, and rough superhypergraphs. Classical graph classes include undirected graphs, where edges lack orientation, and directed graphs, where edges have specific directions. Recent innovations, including bidirected graphs, have sparked ongoing research and significant advancements in the field. Soft Sets and their extension to Soft Graphs provide a flexible framework for managing uncertainty, while Rough Sets and Rough Graphs address uncertainty by using lower and upper approximations to handle imprecise data. Hypergraphs generalize traditional graphs by allowing edges, or hyperedges, to connect more than two vertices. Superhypergraphs further extend this by allowing both vertices and edges to represent subsets, facilitating the modeling of hierarchical and group-based relationships. The third chapter, “Survey of Intersection Graphs, Fuzzy Graphs, and Neutrosophic Graphs”, explores the intersection graph models within the realms of Fuzzy Graphs, Intuitionistic Fuzzy Graphs, Neutrosophic Graphs, Turiyam Neutrosophic Graphs, and Plithogenic Graphs. The chapter highlights their mathematical properties and interrelationships, reflecting the growing number of graph classes being developed in these areas. Intersection graphs, such as Unit Square Graphs, Circle Graphs, and Ray Intersection Graphs, are crucial for understanding complex graph structures in uncertain environments. The fourth chapter, “Fundamental Computational Problems and Algorithms for SuperHyperGraphs”, addresses optimization problems within the SuperHypergraph framework, such as the SuperHypergraph Partition Problem, Reachability, and Minimum Spanning SuperHypertree. The chapter also adapts classical problems like the Traveling Salesman Problem and the Chinese Postman Problem to the SuperHypergraph context, exploring how hypergraphs, which allow hyperedges to connect more than two vertices, can be used to solve complex hierarchical and relational problems. The fifth chapter, “A Short Note on the Basic Graph Construction Algorithm for Plithogenic Graphs”, delves into algorithms designed for Plithogenic Graphs and Intuitionistic Plithogenic Graphs, analyzing their complexity and validity. Plithogenic Graphs model multi-valued attributes by incorporating membership and contradiction functions, offering a nuanced representation of complex relationships. The sixth chapter, “Short Note of Bunch Graph in Fuzzy, Neutrosophic, and Plithogenic Graphs”, generalizes traditional graph theory by representing nodes as groups (bunches) rather than individual entities. This approach enables the modeling of both competition and collaboration within a network. The chapter explores various uncertain models of bunch graphs, including Fuzzy Graphs, Neutrosophic Graphs, Turiyam Neutrosophic Graphs, and Plithogenic Graphs. In the seventh chapter, “A Reconsideration of Advanced Concepts in Neutrosophic Graphs: Smart, Zero Divisor, Layered, Weak, Semi, and Chemical Graphs”, the authors extend several fuzzy graph classes to Neutrosophic graphs and analyze their properties. Neutrosophic Graphs, a generalization of fuzzy graphs, incorporate degrees of truth, indeterminacy, and falsity to model uncertainty more effectively. The eighth chapter, “Short Note of Even-Hole-Graph for Uncertain Graph”, focuses on Even-Hole-Free and Meyniel Graphs analyzed within the frameworks of Fuzzy, Neutrosophic, Turiyam Neutrosophic, and Plithogenic Graphs. The study investigates the structure of these graphs, with an emphasis on their implications for uncertainty modeling. The ninth chapter, “Survey of Planar and Outerplanar Graphs in Fuzzy and Neutrosophic Graphs”, explores planar and outerplanar graphs, as well as apex graphs, within the contexts of fuzzy, neutrosophic, Turiyam Neutrosophic, and plithogenic graphs. The chapter examines how these types of graphs are used to model uncertain parameters and relationships in mathematical and real-world systems. The tenth chapter, “General Plithogenic Soft Rough Graphs and Some Related Graph Classes”, introduces and explores new concepts such as Turiyam Neutrosophic Soft Graphs and General Plithogenic Soft Graphs. The chapter also examines models of uncertain graphs, including Fuzzy, Intuitionistic Fuzzy, Neutrosophic, and Plithogenic Graphs, all designed to handle uncertainty in diverse contexts. The eleventh chapter, “Survey of Trees, Forests, and Paths in Fuzzy and Neutrosophic Graphs”, provides a comprehensive study of Trees, Forests, and Paths within the framework of Fuzzy and Neutrosophic Graphs. This chapter focuses on classifying and analyzing graph structures like trees and paths in uncertain environments, contributing to the ongoing development of graph theory in the context of uncertainty. (shrink)

This fifth volume on Advances and Applications of DSmT for Information Fusion collects theoretical and applied contributions of researchers working in different fields of applications and in mathematics, and is available in open-access. The collected contributions of this volume have either been published or presented after disseminating the fourth volume in 2015 in international conferences, seminars, workshops and journals, or they are new. The contributions of each part of this volume are chronologically ordered. First Part of this book presents some (...) theoretical advances on DSmT, dealing mainly with modified Proportional Conflict Redistribution Rules (PCR) of combination with degree of intersection, coarsening techniques, interval calculus for PCR thanks to set inversion via interval analysis (SIVIA), rough set classifiers, canonical decomposition of dichotomous belief functions, fast PCR fusion, fast inter-criteria analysis with PCR, and improved PCR5 and PCR6 rules preserving the (quasi-)neutrality of (quasi-)vacuous belief assignment in the fusion of sources of evidence with their Matlab codes. Because more applications of DSmT have emerged in the past years since the apparition of the fourth book of DSmT in 2015, the second part of this volume is about selected applications of DSmT mainly in building change detection, object recognition, quality of data association in tracking, perception in robotics, risk assessment for torrent protection and multi-criteria decision-making, multi-modal image fusion, coarsening techniques, recommender system, levee characterization and assessment, human heading perception, trust assessment, robotics, biometrics, failure detection, GPS systems, inter-criteria analysis, group decision, human activity recognition, storm prediction, data association for autonomous vehicles, identification of maritime vessels, fusion of support vector machines (SVM), Silx-Furtif RUST code library for information fusion including PCR rules, and network for ship classification. Finally, the third part presents interesting contributions related to belief functions in general published or presented along the years since 2015. These contributions are related with decision-making under uncertainty, belief approximations, probability transformations, new distances between belief functions, non-classical multi-criteria decision-making problems with belief functions, generalization of Bayes theorem, image processing, data association, entropy and cross-entropy measures, fuzzy evidence numbers, negator of belief mass, human activity recognition, information fusion for breast cancer therapy, imbalanced data classification, and hybrid techniques mixing deep learning with belief functions as well. (shrink)

The third volume of “Advancing Uncertain Combinatorics through Graphization, Hyperization, and Uncertainization: Fuzzy, Neutrosophic, Soft, Rough, and Beyond” presents an in-depth exploration of the cutting-edge developments in uncertain combinatorics and set theory. This comprehensive collection highlights innovative methodologies such as graphization, hyperization, and uncertainization, which enhance combinatorics by incorporating foundational concepts from fuzzy, neutrosophic, soft, and rough set theories. These advancements open new mathematical horizons, offering novel approaches to managing uncertainty within complex systems. Combinatorics, a discipline focused on counting, arrangement, (...) and structure, often faces challenges when uncertainty is present. Set theory, which underpins combinatorial problems, has evolved to tackle these challenges. The introduction of fuzzy and neutrosophic sets has expanded the toolkit for modeling uncertainty by incorporating elements of truth, indeterminacy, and falsehood into decision-making processes. These innovations seamlessly intersect with graph theory, providing new ways to represent uncertain structures through "graphized" forms such as hypergraphs and superhypergraphs. This volume also introduces advanced concepts like Neutrosophic Oversets, Undersets, and Offsets, which push the boundaries of classical graph theory and offer deeper insights into the mathematical and practical challenges posed by real-world systems. By blending combinatorics, set theory, and graph theory, the authors have created a robust framework for addressing uncertainty in both mathematical systems and their real-world applications. This foundation sets the stage for future breakthroughs in combinatorics, set theory, and related fields. Each chapter in this volume contributes both theoretical foundations and practical applications, demonstrating the power of integrating graph theory, set theory, and uncertainty models. The new ideas, algorithms, and mathematical tools presented here will drive the future of combinatorial research and its applications in uncertain environments. In the first chapter, “Introduction to Upside-Down Logic: Its Deep Relation to Neutrosophic Logic and Applications”, the authors present Upside-Down Logic, a novel logical framework that systematically transforms truths into falsehoods and vice versa, based on contextual shifts. Introduced by F. Smarandache, this paper provides a mathematical definition of Upside-Down Logic, including applications related to the Japanese language. The chapter also introduces Contextual Upside-Down Logic, an extension that adjusts logical connectives alongside flipped truth values, as well as Indeterm-Upside-Down Logic and Certain Upside-Down Logic to address indeterminacy. A simple algorithm is also proposed to demonstrate the computational aspects of this logic. In the second chapter, “Local-Neutrosophic Logic and Local-Neutrosophic Sets: Incorporating Locality with Applications”, the authors introduce Local-Neutrosophic Logic and Local-Neutrosophic Sets, which integrate the concept of locality into Neutrosophic Logic. By defining locality as the influence of immediate surroundings on an object or system, this chapter explores how it affects indeterminacy in real-world problems. The paper also examines potential applications and provides mathematical definitions for these new concepts. The third chapter, “A Review of Fuzzy and Neutrosophic Offsets: Connections to Some Set Concepts and Normalization Function”, extends the concept of offsets in uncertain set-theoretic frameworks, such as Fuzzy Sets, Neutrosophic Sets, and Plithogenic Sets. This chapter introduces several advanced types of offsets, including Nonstationary Fuzzy Offset, Multi-valued Plithogenic Offset, and Subset-valued Neutrosophic Offset, offering deeper insights into handling uncertainty in mathematical models. In the fourth chapter, “Review of Plithogenic Directed, Mixed, Bidirected, and Pangene OffGraph”, the authors build upon Plithogenic Graphs to propose extensions such as Plithogenic Directed OffGraph, Plithogenic BiDirected OffGraph, and Plithogenic Mixed OffGraph. These new concepts, including the Plithogenic Pangene OffGraph, are explored in detail, with a focus on their mathematical properties and potential applications in uncertain graph theory. The fifth chapter, “Short Note on Neutrosophic Closure Matroids”, explores the extension of matroid concepts into Neutrosophic and Turiyam Neutrosophic set theories, introducing Neutrosophic closure matroids. This concept integrates uncertainty, indeterminacy, and liberal states into matroid theory, enhancing its applicability in optimization and combinatorial problems. In the sixth chapter, “Some Graph Parameters for Superhypertree-width and Neutrosophic Tree-width”, the authors discuss graph parameters such as Superhypertree-width and Neutrosophic tree-width. These parameters play a crucial role in the study of graph characteristics, particularly in algorithms and real-world applications. The chapter explores the generalization of hypergraphs to SuperHyperGraphs and examines how these concepts extend tree-width parameters within the context of Neutrosophic logic. (shrink)

This paper explores the notion of the self as one of the main obstacles in advancing neuroscience. Some folks argue for strict naturalism in order to study the brain objectively. However, in this process of naturalization, we run the risk of losing key components that make up our experience as human beings, namely emotions, ideas, and values. Therefore, I argue for moderate naturalism in an attempt to reconcile with the self. I reference Immanuel Kant’s moral law theory in order to (...) discuss the ethical implications of following a moderate naturalist view of the self in advancing neuroscience. (shrink)

Background: This study was conducted to measure depression literacy (D-Lit) and mental health literacy (MHL) and to investigate their relationship with psychological status and quality of life among Iranian patients with type 2 diabetes mellitus (T2DM). -/- Methods: This cross-sectional study was conducted in 2021 among 400 patients with T2DM in Iran. Samples were selected using proportional stratified sampling. Data collection tools comprised a demographic questionnaire, measures of MHL and D-Lit, the diabetes quality of life (DQOL) scale, and the DASS-21. (...) After confirming the normality of the data using the Kolmogorov-Smirnov test, parametric statistical tests (such as one-way ANOVA, independent samples t-test, and Chi-Square) were used to investigate the relationship between the variables using SPSS v22 software. The results of continuous quantitative data are reported in the form of means and standard deviations, and qualitative data are reported in the form of absolute and relative frequencies. -/- Results: In this study, 10.25% of the participants (n = 41) had severe depression, while 36.75% (n = 147) experienced severe anxiety. The mean (standard deviation) of MHL was 80.92 (9.16) from 130 points. Of the participants, only 1.7% (n = 7) did not answer any questions correctly on the D-lit scale, and only 5.8% (n = 23) were able to answer 15 questions or more correctly on the D-lit. MHL had a significant negative correlation with depression (r = −0.236), anxiety (r = −0.243), and stress (r = −0.155) (P < 0.001). There was a positive and significant correlation between MHL and D-Lit (r = 0.186) (P < 0.001). D-Lit had a significant negative correlation with depression (r = −0.192), anxiety (r = −0.238), and stress (r = −0.156) (P < 0.001). There was a positive and significant correlation between the ability to recognize disorders (r = 0.163), knowledge of self-treatment (r = 0.154), and DQOL (P < 0.001). Depression (r = −0.251), anxiety (r = −0.257), and stress (r = −0.203) had a significant negative correlation with DQOL (P < 0.001). -/- Conclusion: MHL and D-Lit levels were found to be inadequate in patients with T2DM. These low levels of MHL and D-Lit among patients with T2DM were associated with higher levels of anxiety, depression, and stress, as well as a lower quality of life. Therefore, designing and implementing preventive programs to improve the mental health of patients with T2DM can help prevent mental disorders and ultimately improve their quality of life. (shrink)

The Genetic Ranking Optimization Algorithm (GROA) is used to rank phishing content based on multiple features by optimizing the ranking system through iterative selection and weighting. Dynamic weighting further enhances the process by adjusting the weights of features based on their importance in real-time. This hybrid approach enables the model to learn from the data, improving classification over time. The classification system was evaluated using benchmark phishing datasets, and the results demonstrated a significant improvement in detection accuracy and reduced false (...) positives. (shrink)

Driver drowsiness is a significant factor contributing to road accidents, resulting in severe injuries and fatalities. This study presents an optimized approach for detecting driver drowsiness using machine learning techniques. The proposed system utilizes real-time data to analyze driver behavior and physiological signals to identify signs of fatigue. Various machine learning algorithms, including Support Vector Machines (SVM), Convolutional Neural Networks (CNN), and Random Forest, are explored for their efficacy in detecting drowsiness. The system incorporates an optimization technique—such as Genetic Algorithms (...) (GA) or Particle Swarm Optimization (PSO)—to enhance the accuracy and response time of the detection process. The integration of optimization methods ensures that the model adapts to various driving conditions and individual differences, providing a more reliable and robust detection mechanism. Data from multiple sources, including camera feeds and wearable sensors, are used to train and validate the models, ensuring a comprehensive understanding of drowsiness indicators. (shrink)

Metformin is considered the first-line treatment as a monotherapy for patients with type 2 diabetes mellitus. Emerging evidence suggests that metformin may have a renoprotective role; therefore, understanding the impact of metformin dose and therapy duration on renal function may significantly improve renal outcomes in type 2 diabetes patients. This study aims to investigate the renoprotective effects of metformin by analyzing its dose-dependent impacts on the estimated glomerular filtration rate in patients with type 2 diabetes mellitus. A retrospective cross-sectional study (...) design was used from September 2022 to October 2023. Data from 302 type 2 diabetes patients were collected from patient files at the Benghazi Diabetic Center and the Aljabal Al-Alkdar Diabetic Center, including all with type 2 diabetes mellitus patients on varying doses of metformin. The collected data included age, gender, metformin dose, duration of metformin therapy, urea, and creatinine. Exclusion criteria included patients with significant comorbidities such as chronic kidney disease (other than diabetic nephropathy), liver disease, heart failure, or malignancy; those taking nephrotoxic medications; individuals with recent acute illnesses or surgical procedures; pregnant or lactating women; participants with inadequate medical records; and patients who were non-adherent to metformin therapy. Survival analysis was conducted to evaluate the effect of different metformin doses on the estimated glomerular filtration rate. The study analyzed 302 diabetic patients, of whom 46.0% were male and 54.0% were female. The age was 58.3±11.9 years. The HbA1c was 7.7%±1.3%. The duration of diabetes was 11.4±8.1 years. The creatinine was 1.0±0.9 mg/dL, and the urea was 36.7±23.8 mg/dL. Data analysis revealed a statistically significant difference in survival distribution across the dose groups. Different metformin doses significantly impact the estimated glomerular filtration rate, suggesting that dosage plays a crucial role in maintaining renal function. (shrink)

Monkeypox, an infectious disease caused by the Orthopoxvirus, was identified in humans in 1970. It has recently emerged as a global health concern due to outbreaks beyond its endemic regions in Central and West Africa. This review examines the current state of medical treatments for monkeypox as of 2024, focusing on antiviral agents, immunotherapies, and supportive care measures. Monkeypox manifests with symptoms including fever, rash, and lymphadenopathy, with severe cases more common in immunocompromised individuals. Antiviral therapies such as tecovirimat and (...) brincidofovir are central to treatment strategies, with tecovirimat demonstrating efficacy in alleviating symptoms and reducing viral shedding. Emerging treatment strategies involve novel lipid-based formulations and combination therapies that integrate antivirals with immune-modulating agents. Supportive care remains essential, involving analgesics and antibiotics for secondary infections, while the MVA-BN vaccine plays a critical role in prevention. Research emphasizes the need for a deeper understanding of viral pathogenesis and host immune responses to improve therapeutic and preventive measures. Despite significant advancements, challenges remain, including potential antiviral resistance, disparities in healthcare access, and the necessity for enhanced diagnostic and surveillance capabilities. This review highlights the imperative for ongoing research, international collaboration, and investment in healthcare infrastructure to advance the management and prevention of monkeypox and to prepare for future outbreaks. (shrink)

I present an internal problem for David Lewis’s genuine modal realism. My aim is to show that his analysis of modality is inconsistent with his metaphysics. I consider several ways of modifying the Lewisian analysis of modality, but argue that none are successful. I argue that the problem also affects theories related to genuine modal realism, including the stage theory of persistence and modal fictionalism.

The debate on whether and why misinformation is bad primarily focuses on the spread of false beliefs as its main harm. From the assumption that misinformation primarily causes harm through the spread of false beliefs as a starting point, it has been contended that the problem of misinformation has been exaggerated. Its tendency to generate false beliefs appears to be limited. However, the near-exclusive focus on whether or not misinformation dupes people with false beliefs neglects other epistemic harms associated with (...) it. Specifically, I show that misinformation also causes trouble for the epistemic goods of truth attainment, intellectual autonomy and debate pluriformity. Moreover, for each of these goods, I argue that emphasizing error-avoidance exacerbates, rather than mitigates, the harms caused by misinformation. These oversights and dilemmas show that prioritizing error-avoidance in the fight against misinformation is not a neutral default policy or necessarily a net positive. A shift in focus away from the spread of false beliefs as the main harm of misinformation is needed to better understand and counter its negative effects. (shrink)

The rapid advancement of artificial (computer) intelligence systems (CIS) has generated a means whereby assistive bionic prosthetics can become both more effective and practical for the patients who rely upon the use of such machines in their daily lives. However, de lege lata remains relatively unspoken as to the legal status of patients whose devices contain self-learning CIS that can interface directly with the peripheral nervous system. As a means to reconcile for this lack of legal foresight, this article approaches (...) the topic of CIS-nervous system interaction and the impacts it may have on the legal definition of “persons” under the law. While other literature of this nature centres upon notions of transhumanism or self-enhancement, the approach herein approached is designed to focus solely upon the legal nature of independent CIS actions when operating alongside human subjects. To this end, it is hoped that further discussion on the topic can be garnered outside of transhumanist discourse to expedite legal consideration for how these emerging relationships ought to be received by law-generating bodies internationally. (shrink)

After 41 years from the approval of the first living will law in 1976 in California, on December 22nd 2017 the bill on “Rules on in- formed consent and advance directives” has been approved in Italy. The applicability of the law highlights a lack of a univocal methodol- ogy regarding the recovery process of the patient’s subjective dimension under a testamentary will; so, it seemed useful to highlight the passages that occur between the drafting and the use of an advance (...) directive in an existential phenomenological prospective. Is the individual who freely drafts an A.D., choosing to decide now for the future, the same per- son for which the provisions were outlined? The goal of this paper is to offer an ethical reading of the ontological issue that illness can raises. (shrink)

Hastings Center Report, Volume 52, Issue 1, Page 32-41, January/February 2022.

Advance directives are intended to extend patient autonomy by enabling patients to prospectively direct the care of their future incapacitated selves. There has been much discussion about issues such as whether the future incompetent self is identical to the agent who issues the advance directives or whether advance directives can legitimately secure patient autonomy. However, there is another important question to ask: to what extent and in what conditions is it ethically appropriate for one to limit the liberty or agency (...) of one’s future incompetent self by issuing an advance directive? -/- In this paper, I use a virtue-ethical approach to explore this question, focusing on the case of an advance directive for the future self with moderate dementia. First, I examine virtuous attitudes with regard to autonomy and argue that one can manifest vices or ethically undesirable character traits in trying to intervene in the future self’s life. In particular, I argue that this case can manifest vices such as disdainfulness, intellectual arrogance, and self-dictatorship, which is the vice of trying to control one’s life to an excessive degree, and that a self-dictator fails to give due moral consideration to the future self’s liberty or agency. I then introduce the Daoist idea of wu-wei, which recommends embracement of what happens in one’s life, as one of the possible remedies for the overemphasis on the value of autonomy and control. (shrink)