Leibniz uses the adjective “blind” in various texts to characterise a type of thought or knowledge. This concept is sometimes associated with the adjective “symbolic”. In his famous 1684 article, ...“Meditationes de cognitione, veritate et ideis”, he introduces the cogitatio caeca vel symbolica as one of the types of knowledge methodically classified in the text. Generally, the focus has been placed on the symbolic nature of this knowledge, since this is seen as a determining element in understanding the Leibnizian theory of knowledge based on the mediation of signs subject to rules of composition. In the background are the various Leibnizian projects of characteristica universalis. This is the angle from which we tend to approach the Leibnizian distinction, contrasting blind or symbolic knowledge, which is essentially mediate in nature, with intuitive knowledge, which depends on immediate vision of its objects. But how are we to accurately interpret the relationship to the act of seeing? Is this act not yet required in the Leibnizian conception of knowledge by signs? In other words, can such knowledge be deployed without the effective act of seeing? If this is the case, it seems that we need to re-examine the “blind” nature of this knowledge in the hope of shedding light on the real conditions of its effectuation, and, ipso facto, on some cognitive properties attributed to sight.
Diagnosing and treating hypertension plays an important role in minimising the risk of cardiovascular disease and stroke. Early and accurate diagnosis of hypertension, as well as regular monitoring, ...is essential to meet treatment targets. In this article, current recommendations for the screening and diagnosis of hypertension are reviewed. The evidence for treatment targets specified in contemporary guidelines is evaluated and recommendations from the USA, Canada, Europe and the UK are compared. Finally, consideration is given as to how diagnosis and management of hypertension might develop in the future.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To measure choroidal thickness (CT) in children of various ages by using spectral optical coherence tomography with enhanced depth imaging and to investigate the association between subfoveal CT and ...ocular axial length, age, gender, weight, and height in children.
Healthy children were prospectively included between May and August 2012. Optical coherence tomography with the enhanced depth imaging system (Spectralis, Heidelberg, Germany) was used for choroidal imaging at nine defined points of the macula of both eyes. Axial length was measured using IOLMaster (Carl Zeiss Meditec, Dublin, CA). Height, weight, and refraction were recorded. Interobserver agreement in readings was also assessed by the Bland-Altman Method.
Three hundred and forty-eight eyes from 174 children aged 3.5 years to 14.9 years were imaged. The mean subfoveal CT in right eyes was 341.96 ± 74.7 µm. Choroidal thickness increased with age (r = 0.24, P = 0.017), height, and weight but not with gender (P > 0.05). It was also inversely correlated to the axial length (r = 0.24, P = 0.001). The nasal choroid appeared thinner than in the temporal area (analysis of variance, P < 0.0001).
In children, CT increases with age and is inversely correlated to axial length. There is a significant variation of CT between children of the same age.
The effective diagnosis and management of hypertension is one of the most important parts of cardiovascular prevention internationally and this is no different in the United Kingdom. Approximately ...14% of the UK population currently receive treatment for hypertension. Recent UK guidelines from the National Institute of Health and Care Excellence have placed greater emphasis on the utilization of out-of-office measurement of blood pressure to more accurately diagnose hypertension.
The aim of the present study was to provide a state-of-the-art review of the evidence for screening, diagnosing, and managing hypertension, as implemented in the United Kingdom, with an emphasis on the role of self-monitored and ambulatory blood pressure monitoring in routine clinical care.
Consideration was given to the use of ambulatory and home monitoring to confirm a diagnosis of hypertension and the use of self-monitoring and self-management to monitor and guide treatment. The evidence for the use of self-monitoring in patients with hypertension was examined, both in isolation, and in combination with lifestyle and treatment interventions.
There is a place for self-monitored blood pressure in specific underresearched populations such as the elderly, specialist conditions, ethnic groups, and during pregnancy and this is discussed here.
The evidence supporting the use of out-of-office monitoring in all aspects of routine clinical care has increased substantially in recent years and is reflected in increased utilization by patients and clinicians alike. Several areas require further research but it is clear that out-of-office monitoring is here to stay and is fast becoming an important part of hypertension management in the United Kingdom.
Background
Having a stroke or transient ischaemic attack increases the risk of a subsequent one, especially with high blood pressure (BP). Home‐based BP management can be effective at maintaining ...optimal BP.
Objective
To describe the optimization of a digital intervention for stroke patients and the value of participant diversity, using the person‐based approach (PBA) and integral patient and public involvement (PPI).
Setting and participants
Stroke patients recruited from primary care and community settings, and health‐care professionals in primary care, in England and Ireland.
Design
Three linked qualitative studies conducted iteratively to develop an intervention using the PBA, with integral PPI.
Intervention
The BP: Together intervention, adapted from existing BP self‐monitoring interventions, is delivered via mobile phone or web interface to support self‐monitoring of BP at home. It alerts patients and their clinicians when a change in antihypertensive medication is needed.
Findings
Feedback from a diverse range of participants identified potential barriers, which were addressed to improve the intervention accessibility, feasibility and persuasiveness. Easy‐to‐read materials were developed to improve usability for patients with aphasia and lower literacy. The importance of including family members who support patient care was also highlighted. Feedback messages regarding medication change were refined to ensure usefulness for patients and clinicians.
Discussion
Input from PPI alongside qualitative research with a diverse study sample allowed the creation of a simple and equitable BP management intervention for stroke patients.
Patient involvement
Two PPI co‐investigators contributed to design, conduct of study, data interpretation and manuscript preparation; community PPI sessions informed early planning. Study participants were stroke patients and family members.
OBJECTIVE:Self-management of hypertension can reduce and control blood pressure (BP) compared with clinic monitoring. However, self-management relies on patients following an algorithm, which may be ...variably adhered to. This study reports fidelity of high-risk patients to the self-management algorithm set by the TASMIN-SR trial.
METHODS:Patients with hypertension, above target clinic BP and one or more of stroke, diabetes, coronary heart disease or chronic kidney disease, were invited to self-monitor following an individualized self-titration algorithm. Home BP readings and medication change details were submitted monthly for 12 months. Readings downloaded from patients’ electronic monitors were compared with written submissions, and protocol fidelity was assessed.
RESULTS:Two hundred and seventy-six patients were randomized to self-management and 225 (82%) completed the required training sessions. Of these, 166 (74%) completed self-management. A total of 11385 (89.6%) submitted readings were accurate compared with corresponding downloaded monitor readings. Mean error rate was 5.2% per patient, which increased with age but not comorbidities. Patients made 475 of 683 (69.5%) algorithm-recommended medication changes, equating to nearly three medication changes per patient. Mean SBP for patients who completed training and made all recommended changes dropped from 141 mmHg (95% CI 138.26–144.46) to 121 mmHg (95% CI 118.30–124.17 mmHg) compared with 129 mmHg (95% CI 125.27–136.73 mmHg) for patients who made none.
CONCLUSION:Most patients randomized to self-management completed training; however, 36% of these had dropped out by 12 months. Self-monitoring was largely undertaken properly and accurately recorded. Fidelity with self-management was associated with lower achieved SBP. Successful implementation of self-management into daily practice requires careful training and should be accompanied by monitoring of fidelity.
In this candid conversation, Toi Derricotte sits down with Claire Schwartz to discuss her journey as a writer, her own creative process, and Cave Canem's emergence as a powerhouse on the literary ...scene.
Dans cet article, nous proposons d’examiner les choix de composition et d’écriture opérés par Émilie du Châtelet dans sa traduction française des Principia Mathematica d’Isaac Newton. En particulier, ...nous nous interrogeons sur la coexistence au sein de cette dernière de deux textes de style mathématique différent que constituent d’une part la traduction proprement dite des démonstrations géométriques des Principia, et d’autre part la « solution analytique » jointe au deuxième tome des Principes mathématiques de la philosophie naturelle. Dans la mesure où l’ensemble des démonstrations géométriques du texte newtonien sont irréductibles à toute forme de « traduction » analytique complète, nous suggérons que la mise en regard du texte newtonien avec sa « Solution analytique » proposée par du Châtelet procède d’une réflexion singulière de sa part sur les principes régissant la philosophie naturelle.
In this article, we propose to question the choices of composition and writing made by E. du Châtelet in her French translation of I. Newton’s Principia Mathematica. In particular, we examine the ...coexistence within the latter of two texts of different mathematical style that constitute on the one hand the actual translation of the geometrical demonstrations of the Principia, and on the other hand the "Solution analytique" attached to the second volume of the Principes mathématiques de la philosophie naturelle. Insofar as all the geometric demonstrations of the Newtonian text are irreducible to any form of complete analytical "translation", we suggest that the confrontation of the Newtonian text with its "analytical solution" proposed by E. du Châtelet proceeds from a personal reflection on her part on the principles governing natural philosophy.
Dans cet article, nous proposons d’examiner les choix de composition et d’écriture opérés par E. du Châtelet dans sa traduction française des Principia Mathematica d’Isaac Newton. En particulier, nous nous interrogeons sur la coexistence au sein de cette dernière de deux textes de style mathématique différent que constituent d’une part la traduction proprement dite des démonstrations géométriques des Principia, et d’autre part la « solution analytique » jointe au deuxième tome des Principes mathématiques de la philosophie naturelle. Dans la mesure où l’ensemble des démonstrations géométriques du texte newtonien sont irréductibles à toute forme de « traduction » analytique complète, nous suggérons que la mise en regard du texte newtonien avec sa « Solution analytique » proposée par E. du Châtelet procède d’une réflexion singulière de sa part sur les principes régissant la philosophie naturelle.
Out-of-office blood pressure (BP) measurement is advocated to confirm hypertension diagnosis. However, little is known about how primary care patients view and use such measurement.
To investigate ...patient experience of out-of-office BP monitoring, particularly home and practice waiting room BP measurement, before, during, and after diagnosis.
A cross-sectional, qualitative study with patients from two UK GP surgeries participating in a feasibility study of waiting room BP measurement.
Interviewees were identified from recent additions to the practice hypertension register. Interviews were recorded, transcribed, and coded thematically.
Of 29 interviewees, 9 (31%) and 22 (76%) had used the waiting room monitor and/or monitored at home respectively. Out-of-office monitoring was used by patients as evidence of control or the lack of need for medication, with the printed results slips from the waiting room monitor perceived to improve 'trustworthiness'. The waiting room monitor enabled those experiencing uncertainty about their equipment or technique to double-check readings. Monitoring at home allowed a more intensive and/or flexible schedule to investigate BP fluctuations and the impact of medication and lifestyle changes. A minority used self-monitoring to inform drug holidays. Reduced intensity of monitoring was reported with both modalities following diagnosis as initial anxiety or patient and GP interest decreased.
Home and practice waiting room measurements have overlapping but differing roles for patients. Waiting room BP monitors may be a useful out-of-office measurement modality for patients unwilling and/or unable to measure and record their BP at home.
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