In this paper I present an argument in favour of a parental duty to use preimplantation genetic diagnosis (PGD). I argue that if embryos created in vitro were able to decide for themselves in a rational manner, they would sometimes choose PGD as a method of selection. Couples, therefore, should respect their hypothetical choices on a principle similar to that of patient autonomy. My thesis shows that no matter which moral doctrine couples subscribe to, they ought to conduct (...) the PGD procedure in the situations when it is impossible to implant all of the created embryos and if there is a significant risk for giving birth to a child with a serious condition. (shrink)

In its recent statement 'Sex Selection and Preimplantation Genetic Diagnosis', the Ethics Committee of the American Society of Reproductive Medicine concluded that preimplantation genetic diagnosis for sex selection for non-medical reasons should be discouraged because it poses a risk of unwarranted gender bias, social harm, and results in the diversion of medical resources from genuine medical need. We critically examine the arguments presented against sex selection using preimplantation genetic diagnosis. We argue that sex selection (...) should be available, at least within privately funded health care. (shrink)

In my previous paper I argued that if in vitro fertilization (IVF) is legal and practiced there is no moral ground to object to legalization of preimplantation genetic diagnosis (PGD). My opponent raises an objection that my paper “fails to address the ethical argumentation of one key opponent of IVF – the Catholic Church”. In this reply I show that her/his thesis that embryos created during IVF are in ‘ethical limbo’ and “fall outside the moral universe of Christian (...) ethics” does not undermine my argumentation and masks the serious problem Catholics have with the moral status of early embryos. (shrink)

Extending the application of preimplantation genetic diagnosis (PGD) to screen embryos for non-medical traits such as gender, height and intelligence, raises serious moral, legal, and social issues. In this paper I consider the possibility of using PGD to select the sexual orientation of offspring. After considering ®ve potential objections, I conclude that parents should be permitted to use PGD to choose the sexual orientation of their children.

The majority of German specialists in reproductive medicine opposes preimplantation sex selection for nonmedical reasons while recommending preimplantation sex selection for medical reasons, e.g. X-linked diseases like haemophilia.

Abstract: This working paper focuses on the question whether there is a therapeutic imperative that, in specific situations, would oblige us to perform genome editing at the germline level in the context of assisted reproduction. The answer to this central question is discussed primarily with reference to specific scenarios where preimplantation genetic diagnosis (PGD) does not represent an acceptable alternative to germline genome editing based on either medical, or ethical, or – from the perspective of the potential parents (...) – moral or religious grounds. This article deals with four different types of case constellations that result from these possible reasons against PGD as well as from the necessity or dispensability of a subsequent “control PGD.” These cases are discussed based on hypotheses concerning contextual factors and theoretical assumptions. In conclusion, we point out that if our assumptions are correct, there is probably no therapeutic imperative for genome editing at the germline level. We draw this rationale from the fact that germline interventions are likely not person-affecting. However, we caution the reader that our result is preliminary and needs to be more carefully examined in future work in light of the bioethical debate and potential objections. -/- // Abstract: Im Zentrum dieses Working Papers steht die Frage, ob es einen therapeutischen Imperativ geben kann, der uns, in bestimmten Situationen, verpflichten würde, eine Genomeditierung (genome editing) auf Keimbahnebene im Rahmen der assistierten Befruchtung vorzunehmen. Die Antwort auf diese zentrale Frage wird insbesondere mit Bezug auf Fälle diskutiert, in denen das Verfahren der Präimplantationsdiagnostik (PID) keine aus entweder medizinischen oder ethischen oder – aus Sicht der potentiellen Eltern – moralischen bzw. religiösen Gründen akzeptable Alternative zu einem Keimbahneingriff darstellt. Die möglichen Gründe gegen die PID sowie die Erforderlichkeit oder Verzichtbarkeit einer nachfolgenden «Kontroll-PID» ergeben vier verschiedene Fallkonstellationen, denen sich der Beitrag zuwendet. Auf Grundlage von Hypothesen zu kontextuellen Faktoren und theoretischen Annahmen diskutieren wir diese Fälle. Im Ergebnis verweisen wir darauf, dass es, wenn unsere Annahmen zutreffen, vermutlich keinen therapeutischen Imperativ zum genome editing auf Keimbahnebene gibt. Dies begründet sich daraus, dass der Keimbahneingriff vermutlich nicht als personenbezogen (person-affecting) zu bezeichnen ist. Wir weisen jedoch darauf hin, dass unser Ergebnis vorläufig ist und unter Berücksichtigung der bioethischen Debatte und möglicher Einwände genauer geprüft werden muss. -/- // Résumé: Ce Working Paper se concentre sur la question de l’existence d’un impératif thérapeutique qui, dans des situations spécifiques, nous obligerait à réaliser une édition du génome au niveau de la lignée germinale dans le cadre de la procréation assistée. Afin de répondre à cette question centrale nous développons quatre scénarios spécifiques dans lesquels le diagnostic préimplantatoire (DPI) ne représente pas une alternative acceptable à l’édition du génome germinal pour des raisons médicales, éthiques ou – du point de vue des futurs parents – morales ou religieuses. Cet article traite de quatre constellations différentes de cas résultant des raisons mises en avant pour s'opposer au DPI ainsi que de la nécessité ou de l’inutilité d’un ultérieur « DPI de contrôle » Ces cas sont discutés sur la base d’hypothèses portant sur les facteurs contextuels et sur les présupposés théoriques. En conclusion, nous soulignons que si nos hypothèses sont correctes, il n’y a probablement aucun impératif thérapeutique justifiant l’édition du génome au niveau de la lignée germinale. Nous arrivons à cette conclusion parce qu’une intervention au niveau de la lignée germinale n’est probablement pas susceptible d’affecter la personne. Cependant, nous mettons en garde le lecteur sur le fait que notre conclusion est préliminaire et qu’elle doit être examinée avec soin dans des futurs travaux instruits par le débat bioéthique et par les éventuelles objections. (shrink)

The book discusses the development of reproductive medicine from the perspective of the parent-child relationship. -/- A könyv a reprodukciós medicina fejlődését vizsgálja a szülői felelősség szempontjából.

In this new post-genomic age of medicine and biomedical technology, there will be novel approaches to understanding disease, and to finding drugs and cures for diseases. Hundreds of new “disease genes” thought to be the causative agents of various genetic maladies will be identified and added to the list of hundreds of such genes already identified. Based on this knowledge, many new genetic tests will be developed and used in genetic screening programs. Genetic screening is the foundation upon which reproductive (...) technologies such as pre-natal diagnosis (PND) and preimplantation genetic diagnosis (PGD) are based. Genetic information arising from the human genome may also be used in attempts to redesign the human genetic inheritance by engineering the human germline (germline engineering). In each of these technologies—PND, PGD, and germline engineering—there are serious ethical and social concerns. Moreover, all three are eugenic in nature because they strive to control which genes are passed down to future generations. The goals of this article are threefold: 1) to introduce the science behind the three technologies; 2) to give a brief overview of eugenics in the past century and show how these genetic technologies are eugenic; and 3) to present a vision of social justice that rejects the genetic determinism upon which eugenics is based and embraces a holistic, ecological view of nature and humanity. (shrink)

Imagine a world where everyone is healthy, intelligent, long living and happy. Intuitively this seems wonderful albeit unrealistic. However, recent scienti c breakthroughs in genetic engineering, namely CRISPR/Cas bring the question into public discourse, how the genetic enhancement of humans should be evaluated morally. In 2001, when preimplantation genetic diagnosis (PGD) and in vitro fertilisation (IVF), enabled parents to select between multiple embryos, Julian Savulescu introduced the principle of procreative bene cence (PPB), stating that parents have the obligations (...) to choose the child that is expected to have the best life. In this paper I argue that accepting the PPB and the consequentialist principle (CP) that two acts with the same consequences are morally on par, commits one to accepting the parental obligation of genetically enhancing one's children. (shrink)

Procreative obligations are often discussed by evaluating only the consequences of reproductive actions or omissions; less attention is paid to the moral role of intentions and attitudes. In this paper, I assess whether intentions and attitudes can contribute to defining our moral obligations with regard to assisted reproductive technologies already available, such as preimplantation genetic diagnosis (PGD), and those that may be available in future, such as reproductive genome editing and ectogenesis, in a way compatible with person‐affecting constraints. (...) I propose the parent–child relationship argument, which is based on the moral distinction between creating and parenting a child. Hence, I first argue that intentions and attitudes can play a role in defining our moral obligations in reproductive decisions involving PGD. Second, I maintain that if we accept this and recognize reproductive genome editing and ectogenesis as person‐affecting procedures, we should be committed to arguing that prospective parents may have moral reasons to prefer reproduction via such techniques than via sexual intercourse. In both cases, I observe an extension of our procreative responsibility beyond what is proposed by the consequentialist person‐affecting morality. (shrink)

Assisted reproductive technologies have greatly increased our control over reproductive choices, leading some bioethicists to argue that we face unprecedented moral obligations towards progeny. Several models attempting to balance the principle of procreative autonomy with these obligations have been proposed. The least demanding is the minimal threshold model (MTM), according to which every reproductive choice is permissible, except creating children whose lives will not be worth living. Hence, as long as the future child is likely to have a life worth (...) living, prospective parents may be allowed to use preimplantation genetic diagnosis (PGD) to select embryos with genetic diseases or disabilities. Assuming a consequentialist person‐affecting view of morality, this paper investigates whether the MTM is an appropriate tool to guide procreative decisions given the continuous development of reproductive genetic technologies. In particular, I consider germline genome editing (GGE) and I argue that its application in human reproduction, unlike PGD, should be conceived as person‐affecting towards future progeny. I claim that even if we assume the plausibility of the MTM within PGD, we are committed to accepting that a greater moral obligation towards progeny should guide procreative decisions if GGE were available. In this case, the MTM should no longer be considered an appropriate instrument to guide procreative choices. Finally, I investigate when we face this greater moral obligation, concluding that it applies only when prospective parents have already engaged in the in vitro fertilization process. (shrink)

Celem artykułu jest krytyka kilku popularnych argumentów przeciwko wykorzystywaniu współczesnych osiągnięć biomedycznych do poprawiania ludzkiej kondycji fizycznej lub umysłowej. Na przykładzie prac Habermasa, Sandela, Fukuyamy omówię trzy argumenty tego typu odwołujące się do: 1) autonomii; 2) życia jako daru; 3) naturalnej równowagi. Na koniec pokażę, że sprzeciw względem niektórych propozycji biomedycznego polepszenia kondycji ludzkiej może być wynikiem swoistego błędu poznawczego, który psychologowie określają jako efekt status quo.

In 2015 the United Kingdom (UK) became the first nation to legalize egg and zygotic nuclear transfer procedures using mitochondrial replacement techniques (MRTs) to prevent the maternal transmission of serious mitochondrial DNA diseases to offspring. These techniques are a form of human germline genetic modification and can happen intentionally if female embryos are selected during the MRT clinical process, either through sperm selection or preimplantation genetic diagnosis (PGD). In the same year, an MRT was performed by a United (...) States (U.S.)-based physician team. This experiment involved a cross-border effort: the MRT procedure per se was carried out in the US, and the embryo transfer in Mexico. The authors examine the ethics of MRTs from the standpoint of genetic relatedness and gender implications, in places that lack adequate laws and regulation regarding assisted reproduction. Then, we briefly examine whether MRTs can be justified as a reproductive option in the US and Mexico, after reassessing their legalization in the UK. We contend that morally inadequate and ineffective regulations regarding egg donation, PGD, and germline genetic modifications jeopardize the ethical acceptability of the implementation of MRTs, suggesting that MRTs are currently difficult to justify in the US and Mexico. In addition to relevant regulation, the initiation and appropriate use of MRTs in a country require a child-centered follow-up policy and more evidence for its safety. (shrink)

Despite the Nazi horrors, in 1953 the new eugenics was founded, when Watson and Crick postulated the double helix of DNA as the basis of chemical heredity. In 1961, scientists have deciphered the genetic code of DNA, laying the groundwork for code manipulation and the potential building of new life forms. After thirty years from the discovery of the DNA structure, the experimenters began to carry out the first clinical studies of human somatic cell therapy. The practice of prenatal genetic (...) tests identifies genes or unwanted genetic markers. Parents can choose to continue pregnancy or give up the fetus. Once the preimplantation genetic diagnosis occurs, potential parents can choose to use in vitro fertilization and then test early embryonic cells to identify embryos with genes they prefer or avoid. Because of concerns about eugenics, genetic counseling is based on a "non-directive" policy to ensure respect for reproductive autonomy. The argument for this counseling service is that we should balance parental autonomy with child's autonomy in the future. Specialists have not yet given a clear answer to the question of whether these practices should be considered eugenic practices, or if they are moral practices. DOI: 10.13140/RG.2.2.28777.95849. (shrink)

By the example of deafness the article examines the ethical problems that arise when preimplantation genetic diagnosis is used for the intentional heredity of genetic defects. In the first two sections the relevant rules of the German Embryo Protection Law and the motives of deaf couples to desire a handicapped child are explained. Subsequently, it is asked whether the positive selection of genetic defects can harm or otherwise wrong the future child. Moreover, a possible duty of prospective parents (...) to prefer an embryo which will most probably experience a higher quality of life is discussed. Finally, the question is raised whether parents have a right to refuse medical treatment that may alleviate their child's handicap. As a result, it is argued that neither a legal ban on the positive selection of handicapped embryos nor compulsory treatment of deaf children are ethically justified. (shrink)

W tekście omawiam tę część internetowej dyskusji, przeprowadzonej w listopadzie 2012 r. na stronie Polskiego Towarzystwa Bioetycznego, która dotyczyła niepewności na temat moralnego statusu embrionów ludzkich. W trakcie dyskusji PTB na temat Stanowiska Komitetu Bioetyki przy Prezydium PAN w sprawie preimplantacyjnej diagnostyki genetycznej (PDG) pojawił się następujący argument: skoro spór o moralny status embrionu jest nierozstrzygalny, to powinniśmy opowiedzieć się przeciwko moralnej dopuszczalności wykonywania PDG na embrionach, a także przeciwko prawnej dopuszczalności tego rodzaju diagnostyki. W tekście omawiam tezy Stanowiska i (...) zdań odrębnych, które wywołały tę część dyskusji, a potem koncentruję się na następujących problemach: (I) dopuszczalność stosowania narzędzi teorii decyzji w debatach etycznych; (II) procedura podejmowania decyzji przez ciała doradcze w sytuacji niepewności moralnej; (III) znaczenie osiągnięć nauk biologicznych przy ustaleniu statusu moralnego embrionu; (IV) możliwość kompromisu w sytuacji pluralizmu wartości; (V) znaczenie statusu moralnego embrionów dla oceny moralnej i prawnej dopuszczalności PDG. (shrink)

Preimplantation genetic testing for polygenic disorders (PGT-P) has been commercially available since 2019. PGT-P makes use of polygenic risk scores for conditions which are multifactorial and are significantly influenced by environmental and lifestyle factors. If current predictions are accurate, then absolute risk reductions range from about 0.02% to 10.1%, meaning that between 10 and 5,000 in vitro fertilization patients would need to be tested with PGT-P to prevent one offspring from becoming affected in the future, depending on the condition (...) and the number of embryos available. Survey and interview data reveal that patients and the public have largely favorable views regarding the use of PGT-P for disease prevention; however, clinicians and professional organizations have many reservations. The use of PGT-P raises multiple social and ethical concerns including the need for adequate counseling, the setting of realistic expectations, the application of distributive justice, the impact of environmental and social determinants of health, and the potential exacerbation of health inequities. Clinicians expressed significant concerns relating to the cost of PGT-P, the potential time-consuming counseling for reproductive endocrinologists and genetic counselors, the intentional creation of supernumerary embryos, and patients’ unrealistic expectations regarding “healthiest disease-free” embryos. Furthermore, current evidence lacks long-term outcome data and generalizability. Prior to offering PGT-P to patients, additional clinical validation studies are needed. Also, ethical and social considerations raised by PGT-P should be carefully delineated. Systemic practices to increase equitable access to unbiased genetic counseling and reproductive services would be desirable prior to the ethical implementation of PGT-P. (shrink)

A diagnostic process is an investigative process that takes a clinical picture as input and outputs a diagnosis. We propose a method for distinguishing diagnoses that are warranted from those that are not, based on the cognitive processes of which they are the outputs. Processes designed and vetted to reliably produce correct diagnoses will output what we shall call ‘warranted diagnoses’. The latter are diagnoses that should be trusted even if they later turn out to have been wrong. Our (...) work is based on the recently developed Cognitive Process Ontology and further develops the Ontology of General Medical Science. It also has applications in fields such as intelligence, forensics, and predictive maintenance, all of which rely on vetted processes designed to secure the reliability of their outputs. (shrink)

A pressing need for interrater reliability in the diagnosis of mental disorders emerged during the mid-twentieth century, prompted in part by the development of diverse new treatments. The Diagnostic and Statistical Manual of Mental Disorders (DSM), third edition answered this need by introducing operationalized diagnostic criteria that were field-tested for interrater reliability. Unfortunately, the focus on reliability came at a time when the scientific understanding of mental disorders was embryonic and could not yield valid disease definitions. Based on accreting (...) problems with the current DSM-fourth edition (DSM-IV) classification, it is apparent that validity will not be achieved simply by refining criteria for existing disorders or by the addition of new disorders. Yet DSM-IV diagnostic criteria dominate thinking about mental disorders in clinical practice, research, treatment development, and law. As a result, the modernDSMsystem, intended to create a shared language, also creates epistemic blinders that impede progress toward valid diagnoses. Insights that are beginning to emerge from psychology, neuroscience, and genetics suggest possible strategies for moving forward. (shrink)

Definitive diagnosis of malaria requires the demonstration through laboratory tests of the presence within the patient of malaria parasites or their components. Since malaria parasites can be present even in the absence of malaria manifestations, and since symptoms of malaria can be manifested even in the absence of malaria parasites, malaria diagnosis raises important issues for the adequate understanding of disease, etiology and diagnosis. One approach to the resolution of these issues adopts a realist view, according to (...) which the needed clarifications will be derived from a careful representation of the entities on the side of the patient which form the ultimate truthmakers for clinical statements. We here address a challenge to this realist approach relating to the diagnosis of malaria, and show how this challenge can be resolved by appeal to Basic Formal Ontology (BFO) and to the Ontology for General Medical Science (OGMS) constructed in its terms. (shrink)

Background: Mint is a grassy, perennial plant, belonging to the oral platoon, fast growing and spreading, its leaves are green in color, fragrant, tart, refreshing, square-shaped leg, bifurcated, erect, ranging in height from (10 - 201 cm). Home to Europe and Asia. The mint plant has many benefits, the most important of which are pain relief, treatment of gallbladder disorders, the expulsion of gases, anti-inflammatory, and relaxing nerves. While the mint plant is the ideal option for the start of gardens, (...) it is prone to some common diseases that affect the plant's growth. Objectives: The main goal of this expert system is to get the appropriate diagnosis of disease and the correct treatment. Methods: In this paper, the design of the proposed Expert System was produced to help Farmers and those interested in agriculture in diagnosing many of the Mint diseases such as Mint rust, Verticillium wilt, Anthracnose, Powdery mildew, Black Stem Rot, Stem and stolon canker, Septoria leaf spot. The proposed expert system presents an overview of mint diseases are given, the cause of diseases outlined and the treatment of disease whenever possible is given out. CLIPS Expert System language was used for designing and implementing the proposed expert system. Results: The proposed Mint diseases diagnosis expert system was evaluated by Agricultural Students at AL Azhar University and some friends interested in agriculture and they were satisfied with its performance. Conclusions: The proposed expert system is very useful for Farmers and those interested in agriculture. (shrink)

In this chapter, our focus is the role played by notions of rationality in the diagnosis of mental disorders, and in the practice of overriding patient autonomy in psychiatry. We describe and evaluate different hypotheses concerning the relationship between rationality and diagnosis, raising questions about what features underpin psychiatric categories. These questions reinforce widely held concerns about the use of diagnosis as a justification for overriding autonomy, which have motivated a shift to mental incapacity as an alternative (...) justification. However, this approach too has recently been criticized from a mental disability rights perspective. Our analysis of the relationship between mental capacity and rationality is used to illuminate these concerns, and to investigate further the relationship between rationality and psychiatric diagnosis. (shrink)

In clinical medicine, a diagnosis can offer an explanation of a patient's symptoms by specifying the pathology that is causing them. Diagnoses in psychiatry are also sometimes presented in clinical texts as if they pick out pathological processes that cause sets of symptoms. However, current evidence suggests the possibility that many diagnostic categories in psychiatry are highly causally heterogeneous. For example, major depressive disorder may not be associated with a single type of underlying pathological process, but with a range (...) of different causal pathways, each involving complex interactions of various biological, psychological, and social factors. This paper explores the implications of causal heterogeneity for whether psychiatric diagnoses can be said to serve causal explanatory roles in clinical practice. I argue that while they may fall short of picking out a specific cause of the patient's symptoms, they can nonetheless supply different sorts of clinically relevant causal information. In particular, I suggest that some psychiatric diagnoses provide negative information that rules out certain causes, some provide approximate or disjunctive information about the range of possible causal processes, and some provide causal information about the relations between the symptoms themselves. (shrink)

In computer science, Artificial Intelligence (AI), sometimes called machine intelligence, is intelligence demonstrated by machines, in contrast to the natural intelligence displayed by humans and other animals. Computer science defines AI research as the study of "intelligent agents": any device that perceives its environment and takes actions that maximize its chance of successfully achieving its goals. Deep Learning is a new field of research. One of the branches of Artificial Intelligence Science deals with the creation of theories and algorithms that (...) allow the machine to learn by simulating neurons in the human body. Most in-depth learning research focuses on finding high-level methods. The strippers analyze a large data set using linear and nonlinear transformations. The method of deep learning is used in the detection of several diseases including blood cell diseases and their classification using the radiography of blood cells to help decision makers to know the type of blood cell and its associated diseases and the results will be presented in detail and discussed. This thesis is using python language and deep learning to detect blood cell diseases and their classifications. The proposed deep learning model was trained, validated and the tested. The accuracy of proposed model was 98.00%. (shrink)

Artificial intelligence (AI) is an area of computer science that emphasizes the creation of intelligent machines or software that work and react like humans. Some of the activities computers with artificial intelligence are designed for include, Speech, recognition, Learning, Planning and Problem solving. Deep learning is a collection of algorithms used in machine learning, It is part of a broad family of methods used for machine learning that are based on learning representations of data. Deep learning is a technique used (...) to produce Pneumonia detection and classification models using x-ray imaging for rapid and easy detection and identification of pneumonia. In this thesis, we review ways and mechanisms to use deep learning techniques to produce a model for Pneumonia detection. The goal is find a good and effective way to detect pneumonia based on X-rays to help the chest doctor in decision-making easily and accuracy and speed. The model will be designed and implemented, including both Dataset of image and Pneumonia detection through the use of Deep learning algorithms based on neural networks. The test and evaluation will be applied to a range of chest x-ray images and the results will be presented in detail and discussed. This thesis uses deep learning to detect pneumonia and its classification. (shrink)

The objective of the paper is to implement and validate diagnosis in the medical field via refined neutrosophic fuzzy logic (RNFL). As such, we have proposed a Max-Min composition (MMC) method in RNFL. This method deals with the diagnosis under certain constraints like uncertainty and indeterminacy. Further, we have considered the diagnosis problems to validate the sensitivity analysis of the novel multi attribute decision-making technique. Finally, we gave the graphical representations and compared the obtained results with other (...) existing measures in refined neutrosophic fuzzy sets. (shrink)

This paper has two objectives 1) to study the influence of digital and new technology on COVID-19 diagnosis and healthcare 2) To propose the integral guideline solutions of the infectious disease for the future. COVID-19 stands for corona (CO), virus (VI), disease (D), or SARS-CoV-2, is a respiratory virus first identified in December 2019 in Wuhan, China(WHO, 2019). It is an epidemiological crisis that caused the deaths and sudden destruction of wealth and health of people around the world. Many (...) countries responded to the crisis with what could only be called urgent prevention and treatment. In the 21st century, our society is based on digital and new technology that can control and prevent the COVID-19 pandemics. However, these ways for solving the problem of COVID-19 pandemics are rising an epistemological crisis too. There are some problems with the COVID-19 diagnosis. From Buddhist philosophy perspective, COVID-19 teaches us the coronavirus is causing us to experience some heightened forms of the three marks of our existence which are the impermanence (aniccā), the suffering (duḥkha), and the non-self (anatta). The establishment of scientific expertise and innovation has shown its value and educating the public about testing, diagnosis, communication, treatment, and vaccine development technology for prevention the of infectious diseases in the future. (shrink)

Patient centred diagnosis is best practised through shared decision making; an iterative dialogue between doctor and patient, whichrespects a patient’s needs, values, preferences, and circumstances. -/- Shared decision making for diagnostic situations differs fundamentally from that for treatment decisions. This has important implications when considering its practical application. -/- The nature of dialogue should be tailored to the specific diagnostic decision; scenarios with higher stakes or uncertainty usually require more detailed conversations.

Brain tumors pose significant challenges in modern healthcare, with accurate and timely diagnosis crucial for determining appropriate treatment strategies. Artificial intelligence has made significant advancements in recent years. Rule-based expert systems (if-then rule-based systems) have emerged as a promising approach for clinical decision-making in brain tumor diagnosis. In this paper, we present "A CLIPS-Based Expert System for Brain Tumor Diagnosis," which leverages a set of 14 if-then rules to diagnose brain tumors with three possible outcomes: 1) Confirm (...) the diagnosis of a brain tumor, 2) Consider the possibility of a brain tumor that has metastasized, and 3) Consider the possibility of a brain tumor. Our expert system offers a user-friendly interface, enabling users to select symptoms and receive a diagnosis based on the provided information. This paper discusses the expert system's development, implementation, and evaluation, highlighting its potential to facilitate brain tumor diagnosis and decision-making in clinical settings. Additionally, we provide a literature review that contextualizes our expert system within the broader landscape of rule-based expert systems for brain tumor diagnosis, examining their effectiveness, limitations, and challenges. (shrink)

We examine two competing solutions to Benardete paradoxes: causal finitism, according to which nothing can have infinitely many causes, and the unsatisfiable pair diagnosis (UPD), according to which such paradoxes are logically impossible and no metaphysical thesis need be adopted to avoid them. We argue that the UPD enjoys notable theoretical advantages over causal finitism. Causal finitists, however, have levelled two main objections to the UPD. First, they urge that the UPD requires positing a ‘mysterious force’ that prevents paradoxes (...) from arising. Since such a force is implausible, the UPD is in trouble. Second, they employ recombination or patchwork principles to argue that paradoxical situations would be possible if causal finitism were false. Since such situations are not possible, causal finitism is true, and so a substantive metaphysical thesis is needed to avoid the paradoxes. We argue that the UPD proponent can successfully respond to these objections. (shrink)

Alasdair MacIntyre’s work in ethics follows in the footsteps of twentieth century efforts to put the ideals of Enlightenment and modernity on trial, and his book After Virtue diagnoses a wide-spread malaise in contemporary moral discourse. As a corrective to this condition, MacIntyre offers a remedy along Aristotelian-Thomistic lines. He specifically conceives of a recovery of these lines that would allow for a common ground in moral debates which would reveal the normative and teleological character of the human good. However, (...) within these pages, I argue that MacIntyre underestimates how his moral corrective is actually a re-inscription of the Enlightenment project, and thus equally doomed to failure. I do this by sketching out three different lines. First, I present MacIntyre’s appraisal of modern moral discourse, which has long since abandoned a reliance on Aristotelian principles of ethics. Second, I outline an informative disjunction MacIntyre sets up between having to choose between a Nietzschean or an Aristotelian model of ethical action. Last, I argue that MacIntyre’s own choice, simultaneously based on, but also diverging from, Aristotle fails because his revamped account of the virtue formation so necessary for modern human flourishing leaves open a space for its development according to contingent histories and traditions, which implies an attenuated account of the virtue ethics he seeks to recover, and vindicates, rather than condemns, the Enlightenment’s attempt to liberate moral theories from its strict teleological forbears. (shrink)

Heart palpitations, while often benign, can sometimes be indicative of severe underlying conditions requiring immediate intervention. Accurate and swift diagnosis thus remains a clinical priority. "A CLIPS-Based Expert System for Heart Palpitations Diagnosis" represents a novel approach to addressing this challenge, harnessing the power of artificial intelligence and rule-based expert systems. Specifically, this system applies a suite of 7 if-then rules to evaluate potential heart palpitations causes and assign one of three outcomes: 1) A confirmed diagnosis of (...) heart palpitations, 2) A suspected link to cardiovascular diseases, and 3) A possible association with anxiety or stress disorders. The expert system offers an intuitive user interface, allowing for seamless symptom input and instant diagnosis based on user-provided information. This paper explores the various phases of this expert system's lifecycle, including design, implementation, and evaluation. Furthermore, the study situates the system within the broader discourse on rule-based expert systems for heart palpitations diagnosis, critically analyzing their efficiency, potential pitfalls, and ongoing challenges. Through this research, the value of integrating rule-based expert systems in clinical diagnostic processes is highlighted, illustrating its capacity to enhance diagnostic accuracy and patient outcomes. (shrink)

Vibration, especially basic vibration, may cause loose contacts, open circuits, or other contact problems, which account for a large proportion of system failure causes. Due to the complexity of the chassis structure used in the biomedical motors, the vibration analysis of a single component cannot solve the vibration problems encountered in the work of the system. Therefore, it is necessary to use system simulation and experiments to monitor and enhance the health of the structure. Finite element method is used to (...) carry out the dynamic analysis from the component to the system, and calculate the natural frequency, modal shape and harmonic response. Then, the effectiveness and accuracy of the analysis results are verified by experiments through simulation and experiments. The results show that the measures taken have effectively reduced the vibration of the chassis equipment and improved its safety for better health safety of patients. There is just a 2% variation between the natural frequencies acquired from the experiment and the simulation computation. In terms of natural frequency, the first 6-order natural frequencies all have errors of less than 10%, and the natural frequency error is comparable to that of fireproof board. (shrink)

Background: When infertility is diagnosed, physicians have the difficult task to break bad news. Their communication skills play a central role in improving patients' coping abilities and adherence to infertility treatments. However, specific guidelines and training courses on this topic are still lacking. The aim of the present study is to provide some practical advice for improving breaking bad news in infertility diagnosis through a systematic literature review of qualitative and quantitative studies. Methods: Electronic searches were performed in the (...) MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Psychology and Behavioral Sciences Collection databases. All articles focusing on the communication of the diagnosis of infertility were included. The main findings of each included article were then summarized. Results: Literature search identified 11,838 references that were screened for eligibility. Full texts of 81 articles were retrieved, and their analysis led to the inclusion of 4 articles, which treated the theme of communication of infertility only partially. The main addressed aspects concerning the communication of the infertility diagnosis were the following: the value that patients give to healthcare professionals' communication skills; the importance of giving clear information on diagnostic procedures and treatments in order to decrease patients' anxiety; and the importance of involving both partners. Conclusions: This review pointed out that the communication of the infertility diagnosis is still underinvestigated. Specific guidelines are currently not available, but other protocols could be used. Taking into account the principal aspects of communication highlighted with this review, in this study, we suggested an adaptation of the original SPIKES protocol that could be used by healthcare professionals for the communication of the infertility status. (shrink)

Abstract: Breast cancer is reported to be the most common cancer type among women worldwide and it is the second highest women fatality rate amongst all cancer types. Notwithstanding all the progresses made in prevention and early intervention, early prognosis and survival prediction rates are still not sufficient. In this paper, we propose an ANN model which outperforms all the previous supervised learning methods by reaching 99.57 in terms of accuracy in Wisconsin Breast Cancer dataset. Experimental results on Haberman’s Breast (...) Cancer Survival dataset show the superiority of proposed method by reaching 88.24 % in terms of accuracy. The results are the best reported ones obtained from Artificial Neural Network using JNN environment without any preprocessing of the dataset. (shrink)

Background: Broccoli is an edible green plant in the cabbage family (family Brassicaceae, genus Brassica) whose large flowering head, stalk and small associated leaves are eaten as a vegetable. A leaf of Broccoli might be affected of Several Diseases descriped in this paper . When symptoms is encountered, it requires some kind of medical care. If appropriate Survival of Broccoli Diseases is not taken quickly, it can lead to Broccoli to die . Objectives: The main goal of this expert system (...) is to get the appropriate diagnosis of disease and the correct treatment. Methods: In this paper the design of the proposed Expert System which was produced to help Farmers in diagnosing many of the broccoli diseases such as : Damping Off,Club root of crucifers or Finger and toe disease,Alternaria leaf spot,Black rot,Downy mildew, and White rust. (shrink)

Migraine is a complex neurological disorder characterized by recurrent moderate to severe headaches, accompanied by additional symptoms such as nausea, sensitivity to light and sound, and visual disturbances. Accurate and timely diagnosis of migraines is crucial for effective management and treatment. However, the diverse range of symptoms and overlapping characteristics with other headache disorders pose challenges in the diagnostic process. In this research, we propose the development of an expert system for migraine diagnosis using artificial intelligence and the (...) CLIPS (C Language Integrated Production System) framework. The expert system utilizes a rule-based inference engine to analyze patient-reported symptoms and provide reliable diagnoses or probability scores indicating the likelihood of migraine. The knowledge base of the expert system is designed based on expert knowledge obtained from medical professionals specializing in migraines. The collected knowledge is translated into a structured format suitable for the CLIPS inference engine, incorporating rules and facts to represent the diagnostic criteria and associated symptoms. The system prompts users to provide relevant information about their symptoms, medical history, and potential triggers. It applies the defined rules and facts to evaluate the likelihood of migraine and generate accurate diagnoses or probability scores. Preliminary evaluation results demonstrate the potential of the expert system as a valuable tool for diagnosing migraines. A dataset of anonymized patient records with confirmed migraine cases was used to test the system. The diagnoses generated by the expert system were compared against the known diagnoses, and a high level of accuracy was observed, with 90% of cases correctly diagnosed as migraines. These results highlight the effectiveness and reliability of the system in assisting medical professionals in the diagnosis of migraines. The proposed expert system offers several advantages for migraine diagnosis. It leverages the collective knowledge and expertise of experienced migraine specialists, providing a standardized and consistent approach to diagnosis. The system can handle large amounts of patient data and effectively analyse complex relationships between symptoms, risk factors, and diagnostic criteria. Furthermore, it offers real-time feedback and recommendations, supporting medical professionals in their clinical decision-making process. Future work involves refining the expert system based on feedback from medical experts, expanding the knowledge base to encompass a wider range of symptoms and risk factors, and conducting further evaluations to enhance its accuracy and applicability in clinical settings. The development of an expert system for migraine diagnosis has the potential to improve the diagnostic process, leading to more effective management and treatment strategies for individuals suffering from migraines. (shrink)

Background: There is no doubt that strawberry diseases are one of the most important reasons that led to the destruction of strawberry plants and their crops. This leads to obvious damage to these plants and they become inedible. Discovering these diseases after a good step for proper and correct treatment. Determining the treatment with high accuracy depends on the method used in the diagnosis. Correctly, expert systems can greatly help in avoiding damage to these plants. The expert system correctly (...) diagnoses strawberry disease to make it easier for farmers to find the right treatment based on the appropriate diagnosis. Objectives: The main goal of this expert system is to get the appropriate diagnosis of disease and the correct treatment. Methods: In this paper the design of the proposed Expert System which was produced to help Farmers and students interested in agriculture strawberry in diagnosing many of the strawberry diseases such as: Leaf Spots, Grey Mold, Red Stele/Red Core, Wilt, Powdery Mildew, Alternaria Spot, Black Root Rot, Anthracnose (black spot), and Angular Leaf Spot. The proposed expert system presents an overview about strawberry diseases are given, the cause of diseases are outlined and the treatment of disease whenever possible is given out. CLIPS language was used for designing and implementing the proposed expert system. Results: The proposed strawberry diseases diagnosis expert system was evaluated by Farmers and they were satisfied with its performance. Conclusions: The Proposed expert system is very useful for Farmers with strawberry problem and students interested in agriculture strawberry. (shrink)

Background: Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home. Depression affects an estimated one in 15 adults (6.7%) in any given (...) year. And one in six people (16.6%) will experience depression at some time in their life. Depression can strike at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime. Objectives: The main goal of this expert system is to get the appropriate diagnosis of disease and the correct treatment and give the appropriate method of treatment through several tips that concern the disease and how to treat it and we will see it through the application on the expert system. Methods: in this paper the design of the proposed Expert System which was produced to help Psychologist in diagnosing depression disease through its symptoms such as: a loss of energy, a change in appetite, sleeping more or less, anxiety, reduced concentration, indecisiveness, restlessness, feelings of worthlessness, guilt or hopelessness and thoughts of self-harm or suicide. The proposed expert system presents an overview about depression disease is given, the cause of diseases is outlined and the treatment of disease whenever possible is given out. SL5 Object Expert System language was used for designing and implementing the proposed expert system. Results: The proposed depression disease diagnosis expert system was evaluated by psychologist students and they were satisfied with its performance. Conclusions: The Proposed expert system is very useful for psychologist, patients with depression and newly graduated psychologist. (shrink)

Background: The castor bean is a large grassy or semi-wooden shrub or small tree. Any part of the castor plant parts can suffering from a disease that weakens the ability to grow and eliminates its production. Therefore, in this paper will identify the pests and diseases present in castor culture and detect the symptoms in each disease. Also images is showing the symptom form in this disease. Objectives: The main objective of this expert system is to obtain appropriate diagnosis (...) of the disease. Methods: In this paper, the expert system is designed for the ability of agricultural engineers to detect and diagnose disease of castor like as: seeding blight, alternaria blight, cercospora leaf spot, powdery mildew and wilt. This system presents the disease symptoms, survival and spread, favorable conditions and image for each disease. Clips and Delphi expert system languages are used for designing and implementing the proposed expert system. Results: The expert system in the diagnosis of castor diseases was assessed by farmers and agricultural engineers and they were satisfied and accepted with its quality of performance. Conclusions: The expert system is easy for farmers and people have experience in the plant of castor to detect and diagnosis the symptoms that may face this plant from several disease. (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)

Background: Arthritis is very common but is not well understood. Actually, “arthritis” is not a single disease; it is an informal way of referring to joint pain or joint disease. There are more than 100 different types of arthritis and related conditions. People of all ages, sexes and races can and do have arthritis, and it is the leading cause of disability in America. More than 50 million adults and 300,000 children have some type of arthritis. It is most common (...) among women and occurs more frequently as people get older. Common arthritis joint symptoms include swelling, pain, stiffness and decreased range of motion. Symptoms may come and go. They can be mild, moderate or severe. They may stay about the same for years, but may progress or get worse over time. Severe arthritis can result in chronic pain, inability to do daily activities and make it difficult to walk or climb stairs. Arthritis can cause permanent joint changes. These changes may be visible, such as knobby finger joints, but often the damage can only be seen on X-ray. Some types of arthritis also affect the heart, eyes, lungs, kidneys and skin as well as the joints. Objectives: The main goal of this expert system is to get the appropriate diagnosis of disease and the correct treatment and give the appropriate method of treatment through several tips that concern the disease and how to treat it and we will see it through the application on the expert system. Methods: in this paper the design of the proposed Expert System which was produced to help Orthopedist in diagnosing Arthritis disease through its symptoms such as: pain on pressure in a joint , Inflammation indicated by joint swelling, Stiffness especially in the morning , Loss of flexibility of joint, Limited, joint movement, Deformity of the joints , Weight loss and fatigue , Non-specific fever and Crepitus. The proposed expert system presents an overview about Arthritis disease is given, the cause of diseases is outlined and the treatment of disease whenever possible is given out. SL5 Object Expert System language was used for designing and implementing the proposed expert system. Results: The proposed Arthritis disease diagnosis expert system was evaluated by Orthopedics students and they were satisfied with its performance. Conclusions: The Proposed expert system is very useful for Orthopedist, patients with arthritis and newly graduated Orthopedics students. (shrink)

There are many eye diseases but the most two common retinal diseases are Age-Related Macular Degeneration (AMD), which the sharp, central vision and a leading cause of vision loss among people age 50 and older, there are two types of AMD are wet AMD and DRUSEN. Diabetic Macular Edema (DME), which is a complication of diabetes caused by fluid accumulation in the macula that can affect the fovea. If it is left untreated it may cause vision loss. Therefore, early detection (...) of diseases is a critical importance. Our main goal is to help doctors detect these diseases quickly before reaching a late stage of the disease. In ophthalmology, optical coherence tomography (OCT) is critical for evaluating retinal conditions. OCT is an imaging technique used to capture high-resolution cross-sections of the retinas of patient. In this thesis, we review ways and techniques to use deep learning classification of the optical coherence tomography images of diseases from which a Retinal is suffering. The models used to improve patient care are (VGG-16, MobileNet, ResNet-50, Inception V3, and Xception) to reduce costs and allow fast and reliable analysis in large studies. The obtained results are encouraging, since the best model ResNet-50 reaching 96.21% of testing accuracy, which is very useful for doctors, to diagnose retinal diseases. (shrink)

In psychiatry some disorders of cognition are distinguished from instances of normal cognitive functioning and from other disorders in virtue of their surface features rather than in virtue of the underlying mechanisms responsible for their occurrence. Aetiological considerations often cannot play a significant classificatory and diagnostic role, because there is no sufficient knowledge or consensus about the causal history of many psychiatric disorders. Moreover, it is not always possible to uniquely identify a pathological behaviour as the symptom of a certain (...) disorder, as disorders that are likely to differ both in their causal histories and in their overall manifestations may give rise to very similar patterns of behaviour. -/- Consider delusions as an example. It wouldn’t be correct to define delusions as those beliefs people form as a result of a neurobiological deficit and a hypothesis-evaluation deficit (as some versions of the two-factor theory of delusions suggest), because for some delusions no neurobiological deficit may be found, and reasoning biases and motivational factors may be contributors to the formation of the delusion (e.g. McKay et al., 2005). Moreover, it would be a mistake to define delusions as symptoms of schizophrenia alone, because they occur also in other disorders, including dementia, amnesia, and delusional disorders. Thus, aetiological considerations may appear in the description and analysis of delusions, but do not feature prominently in their definition. -/- In this paper I argue that the surface features used as criteria for the classification and diagnosis of disorders of cognition are often epistemic in character. I shall offer two examples: confabulations and delusions are defined as beliefs or narratives that fail to meet standards of accuracy and justification. Although classifications and diagnoses based on features of people’s observable behaviour are necessary at these early stages of neuropsychiatric research, given the variety of conditions in which certain phenomena appear, I shall attempt to show that current epistemic accounts of confabulations and delusions have limitations. Epistemic criteria can guide both research and clinical practice, but fail to provide sufficient conditions for the identification of delusions and confabulations, and fail to demarcate pathological from non-pathological narratives or beliefs. -/- Another limitation of current epistemic accounts – which I shall not address here – is the excessive focus on epistemic faults of confabulations and delusions at the expense of their epistemically neutral or advantageous features (see Bortolotti and Cox, 2009). This may lead to a misconception of delusions and confabulations, and to an oversimplification in the assessment of the needs of people who require clinical treatment for their psychotic symptoms. (shrink)

Medical diagnosis has been traditionally recognized as a privileged field of application for so called probabilistic induction. Consequently, the Bayesian theorem, which mathematically formalizes this form of inference, has been seen as the most adequate tool for quantifying the uncertainty surrounding the diagnosis by providing probabilities of different diagnostic hypotheses, given symptomatic or laboratory data. On the other side, it has also been remarked that differential diagnosis rather works by exclusion, e.g. by modus tollens, i.e. deductively. By (...) drawing on a case history, this paper aims at clarifying some points on the issue. Namely: 1) Medical diagnosis does not represent, strictly speaking, a form of induction, but a type, of what in Peircean terms should be called ‘abduction’ (identifying a case as the token of a specific type); 2) in performing the single diagnostic steps, however, different inferential methods are used for both inductive and deductive nature: modus tollens, hypothetical-deductive method, abduction; 3) Bayes’ theorem is a probabilized form of abduction which uses mathematics in order to justify the degree of confidence which can be entertained on a hypothesis given the available evidence; 4) although theoretically irreconcilable, in practice, both the hypothetical- deductive method and the Bayesian one, are used in the same diagnosis with no serious compromise for its correctness; 5) Medical diagnosis, especially differential diagnosis, also uses a kind of “probabilistic modus tollens”, in that, signs (symptoms or laboratory data) are taken as strong evidence for a given hypothesis not to be true: the focus is not on hypothesis confirmation, but instead on its refutation [Pr (¬ H/E1, E2, …, En)]. Especially at the beginning of a complicated case, odds are between the hypothesis that is potentially being excluded and a vague “other”. This procedure has the advantage of providing a clue of what evidence to look for and to eventually reduce the set of candidate hypotheses if conclusive negative evidence is found. 6) Bayes’ theorem in the hypothesis-confirmation form can more faithfully, although idealistically, represent the medical diagnosis when the diagnostic itinerary has come to a reduced set of plausible hypotheses after a process of progressive elimination of candidate hypotheses; 7) Bayes’ theorem is however indispensable in the case of litigation in order to assess doctor’s responsibility for medical error by taking into account the weight of the evidence at his disposal. (shrink)

Background: Obstetrics and gynaecology are many and common, where a woman suffers from problems related to pregnancy or her reproductive organs. Any part of her body may be affected due to some symptoms that are completely related to the reproductive organs when she is in a critical period for her, whether in her menstrual cycle, pregnancy, or disease conditions. The bulk of cases of diseases related to women and childbirth are dealt with great care and special care, as all diseases (...) related to women are considered very sensitive diseases due to the presence of the disease in sensitive and not simple places. A gynaecologist is a specialist in all diseases and problems related to the female sexual organs. They perform regular preventive medical exams, such as cervical smear tests and breast exams. It also provides consultations for women of all ages about the problems of contraception, infertility and menopause. Objectives: The objective of this expert system is to help and facilitate women in diagnosing diseases related to their obstetrics and gynaecology, a simple expert system has been designed consisting of ten various common diseases that affect women whether During or without pregnancy, Methods: In this system, the system consists of a list of some common symptoms, the correct diagnosis adopted for these diseases, and how to treat diseases in the correct way with the help of a consultant obstetrician and gynaecologist, Dr. Fathi Muhammad Al-Habibi, and these diseases are: uterine cancer, cervical cancer, Infertility, double uterus, ectopic pregnancy, endometrial cancer, female sexual dysfunction, endometriosis, faecal incontinence, female infertility, CLIPS Expert System language was used to design and implement the proposed expert system. Results: The proposed ten obstetrics and gynaecology diagnostic expert system was evaluated by medical students and they were satisfied with its performance. Conclusions: The proposed expert system is very useful for obstetricians and gynaecologists, patients with reproductive system problems, and recent graduates. (shrink)

The legacy of the Platonic dialogues may well lie, not in any classical idealist “doctrine of forms,” but in an inquisitive stance towards the puzzle behind any such doctrine—how thought can be about anything at all. This Platonic puzzle may, however, yield a different guise of idealism that is recognizably diagnostic: it aims to dispel our worry about thought’s objectivity as a confusion, engendered by a self-alienation of thought. These themes of diagnosis and idealism resurface in Wittgenstein, who in (...) his treatment of rules calls for an understanding of thought’s normativity from within. This is taken up by Cora Diamond, who urges philosophy to attend to thought’s real needs by exorcizing any desire for agreement with something other than itself. I argue that Wittgenstein and Diamond lead us back to Kant’s idealism, which identifies transcendental realism as the deep-seated prejudice at the root of the puzzle. (shrink)

Vertigo is a common symptom that can result from various underlying diseases and conditions, ranging from benign to severe. Accurate and timely diagnosis of the cause of vertigo is crucial for appropriate management and treatment. In this research, we propose the development of an expert system for vertigo diseases diagnosis, utilizing artificial intelligence (AI) and the proposed Expert System which was produced to help assist healthcare professionals in diagnosing the cause of vertigo based on a patient's symptoms, medical (...) history, and other relevant clinical information. The proposed expert system presents an overview about vertigo diseases are given, the cause of disease is outlined and the treatment or recommendation of disease whenever possible is given out. CLIPS language was used for designing and implementing the proposed expert system. The potential of the proposed expert system lies in its ability to enhance the accuracy and efficiency of vertigo diagnosis, as well as assist in the proper referral and management of patients. (shrink)