This book argues that Protestant theological ethics not only reveals basic virtue ethical characteristics, but also contributes significantly to a viable contemporary virtue ethics. Pieter Vos ...demonstrates that post-Reformation theological ethics still understands the good in terms of the good life, takes virtues as necessary for living the good life and considers human nature as a source of moral knowledge. In this book, Protestant theology is approached as an important bridge between pre-modern virtue ethics, shaped by Aristotle and transformed by Augustine of Hippo, and late modern understandings of morality. The volume covers a range of topics, going from eudaimonism and Calvinist ethics to Reformed scholastic virtue ethics and character formation in the work of Søren Kierkegaard. The author focuses particularly on the way in which Protestantism has articulated other-centered virtues from a theology of grace, affirmed ordinary life and emphasized the need of transformation of this life and its orders. Engaging with philosophy of the art of living, Neo-Aristotelianism and exemplarist ethics, he develops constructive contributions to a contemporary virtue ethics. These center around an understanding of moral exemplarity as located in everyday life, a theological perspective on virtuous people showing moral flaws, and an interpretation of the divine law as providing an external reference point for a critical assessment of existing practices.
This paper argues that in Kierkegaard’s works, in his upbuilding discourses and late journal entries in particular, meekness or gentleness (Danish: Sagtmodighed) is presented as a distinctive moral ...and spiritual quality that exhibits a number of characteristics that are usually regarded as attributes of a virtue. Following a “grammatical approach” to what counts as a virtue, rather than a specifically Aristotelian-Thomistic interpretation, it is argued that Kierkegaard presents meekness as an encompassing attitude, a character trait, which can be acquired through imitation of exemplary persons, Christ, in particular, which aims for the good life, is conducive of the good, and is for the benefit of others and the self. It is demonstrated that according to Kierkegaard, meekness differs from other virtues such as courage and patience by its forgiving attitude towards the wrongdoer and nonviolent resistance to injustice and evil. As a virtue that disposes a person to nonviolent resistance, meekness has socio-political implications: injustice is uncovered and criticized for the benefit of “the poor”. A meek person does not confirm the world in its evil, but criticizes it, albeit in a way that is appropriate to meekness, i.e., in a forgiving and nonviolent way.
In many societies all over the world, an increasing polarization between contrasting groups can be observed. Polarization arises when a fear born of difference turns into ‘us-versus-them’ thinking ...and rules out any form of compromise. This volume addresses polarizations within societies as well as within churches, and asks the question: given these dynamics, what may be the calling of the church? The authors offer new approaches to polarizing debates on topics such as racism, social justice, sexuality and gender, euthanasia, and ecology and agriculture in various contexts. They engage in profound theological and ecclesiological reflection, in particular from the Reformed tradition. Contributors to this volume are: Najib George Awad, Henk van den Belt, Nadine Bowers Du Toit, Jaeseung Cha, David Daniels, David Fergusson, Jan Jorrit Hasselaar, Jozef Hehanussa, Allan Janssen, Klaas-Willem de Jong, Viktória Kóczián, Philipp Pattberg, Louise Prideaux, Emanuel Gerrit Singgih, Peter-Ben Smit, Thandi Soko-de Jong, Wim van Vlastuin, Jan Dirk Wassenaar, Elizabeth Welch, Annemarieke van der Woude, and Heleen Zorgdrager.
Various definitions for concussion have been proposed, each having its strengths and weaknesses. We reviewed and compared current definitions and identified criteria necessary for an operational ...definition of sports-related concussion (SRC) in preparation of the 5th Concussion Consensus Conference (Berlin, Germany). We also assessed the role of biomechanical studies in informing an operational definition of SRC.
This is a systematic literature review.
Data sources include MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Clinical Trials and SPORT Discus (accessed 14 September 2016).
Eligibility criteria were studies reporting (clinical) criteria for diagnosing SRC and studies containing SRC impact data.
Out of 1601 articles screened, 36 studies were included (2.2%), 14 reported on criteria for SRC definitions and 22 on biomechanical aspects of concussions. Six different operational definitions focusing on clinical findings and their dynamics were identified. Biomechanical studies were obtained almost exclusively on American football players. Angular and linear head accelerations linked to clinically confirmed concussions demonstrated considerable individual variation.
SRC is a traumatic brain injury that is defined as a complex pathophysiological process affecting the brain, induced by biomechanical forces with several common features that help define its nature. Limitations identified include that the current criteria for diagnosing SRC are clinically oriented and that there is no gold/standard to assess their diagnostic properties. A future, more valid definition of SRC would better identify concussed players by demonstrating high predictive positive/negative values. Currently, the use of helmet-based systems to study the biomechanics of SRC is limited to few collision sports. New approaches need to be developed to provide objective markers for SRC.
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Introduction
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Classifying TBI
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Clinical injury severity
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Focal injury or diffuse injury
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Clinical characteristics
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Coma, confusion and subacute impairments
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Imaging TBI
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Focal and ...diffuse TBI: separate entities?
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Pathophysiological mechanisms of focal injury
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The essentials: glutamate and Ca2+
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Pathophysiological mechanisms of diffuse injury
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A heterogeneous cascade of changes
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After axonal disconnection
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Conclusions
Traumatic brain injury (TBI) is a frequent and clinically highly heterogeneous neurological disorder with large socioeconomic consequences. TBI severity classification, based on the hospital admission Glasgow Coma Scale (GCS) score, ranges from mild (GCS 13–15) and moderate (GCS 9–12) to severe (GCS ≤ 8). The GCS reflects the risk of dying from TBI, which is low after mild (∼1%), intermediate after moderate (up to 15%) and high (up to 40%) after severe TBI. Intracranial damage can be focal, such as epidural and subdural haematomas and parenchymal contusions, or diffuse, for example traumatic axonal injury and diffuse cerebral oedema, although this distinction is somewhat arbitrary. Study of the cellular and molecular post‐traumatic processes is essential for the understanding of TBI pathophysiology but even more to find therapeutic targets for the development of neuroprotective drugs to be eventually used in human beings. To date, studies in vitro and in vivo, mainly in animals but also in human beings, are unravelling the pathological TBI mechanisms at high pace. Nevertheless, TBI pathophysiology is all but completely elucidated. Neuroprotective treatment studies in human beings have been disappointing thus far and have not resulted in commonly accepted drugs. This review presents an overview on the clinical aspects and the pathophysiology of focal and diffuse TBI, and it highlights several acknowledged important events that occur on molecular and cellular level after TBI.
This review presents the current state of the art regarding multiparametric magnetic resonance (MR) imaging of prostate cancer. Technical requirements and clinical indications for the use of ...multiparametric MR imaging in detection, localization, characterization, staging, biopsy guidance, and active surveillance of prostate cancer are discussed. Although reported accuracies of the separate and combined multiparametric MR imaging techniques vary for diverse clinical prostate cancer indications, multiparametric MR imaging of the prostate has shown promising results and may be of additional value in prostate cancer localization and local staging. Consensus on which technical approaches (field strengths, sequences, use of an endorectal coil) and combination of multiparametric MR imaging techniques should be used for specific clinical indications remains a challenge. Because guidelines are currently lacking, suggestions for a general minimal protocol for multiparametric MR imaging of the prostate based on the literature and the authors' experience are presented. Computer programs that allow evaluation of the various components of a multiparametric MR imaging examination in one view should be developed. In this way, an integrated interpretation of anatomic and functional MR imaging techniques in a multiparametric MR imaging examination is possible. Education and experience of specialist radiologists are essential for correct interpretation of multiparametric prostate MR imaging findings. Supportive techniques, such as computer-aided diagnosis are needed to obtain a fast, cost-effective, easy, and more reproducible prostate cancer diagnosis out of more and more complex multiparametric MR imaging data.
Mild traumatic brain injury (mTBI) is a common diagnosis and approximately one third of mTBI patients experience a variety of cognitive, emotional, psychosocial, and behavioral post-concussion ...symptoms. When a cluster of these symptoms persists for more than 3 months they are often classified as post-concussion syndrome (PCS). The objective of this study was to determine prevalence rates, risk factors, and functional outcome associated with PCS 6 months after mTBI, applying divergent classification methods. Follow-up questionnaires at 6 months after mTBI included the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and the Glasgow Outcome Scale Extended (GOSE). The RPQ was analyzed according to different classification methods: the mapped International Classification of Diseases, 10th revision (ICD-10)/Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), the RPQ total score, the RPQ3 and the three-factor model using two different cutoff points (mild or worse and moderate or worse). Our results from a sample of 731 mTBI patients showed that prevalence rates of PCS ranged from 11.4% to 38.7% using divergent classification methods. According to all eight methods, 6.3% (n = 46) of mTBI patients experienced PCS. Applying the divergent classification methods resulted in a different set of predictors being statistically significantly associated with PCS, and a different percentage of overlap with functional impairment, measured with the GOSE. In conclusion, depending on the classification method and rating score used, prevalence rates of PCS deviated considerably. For future research, consensus regarding the diagnostic criteria for PCS and the analysis of the RPQ should be reached, to enhance comparability of studies regarding PCS after mTBI.
In the field of character education role-modelling is advocated as an important pedagogical strategy. It is supposed that students learn from 'significant others' who exemplify important virtues and ...values. However, in these strategies it is not clear what and how students precisely can and should learn from exemplars and how the following of exemplars relates to the educational aim of 'becoming a self.' In this article, it is argued that modelling is only a relevant pedagogical strategy if moral exemplars are somehow related to life in its full extent, including its moral complexities and ambiguities. Understanding moral exemplarity demands not only the reappropriation of an Aristotelian conception of emulation but also an understanding of the typical modern relocation of moral exemplarity in the fullness of life, importantly originating from what Charles Taylor calls the Protestant 'affirmation of ordinary life.' In addition, a distinction is introduced between 'role exemplarity' and 'existential exemplarity.' Based on this distinction it is argued that emulation should not be limited to learning from role models, but should also include something that runs deeper, to the depth of our own subjectivity or self.
•40% of mild traumatic brain injury (mTBI) patients were experiencing post-concussion syndrome (PCS) six months post-injury.•PCS is common following mTBI and patients with PCS have a considerably ...lower health-related quality of life (HRQoL).•Almost half of mTBI patients with PCS were dissatisfied with their functioning.•All RPQ items are significantly negatively correlated with SF-36 domains and the PQoL subscale scores.•Intervention strategies can be targeted better when mTBI patients with PCS are detected shortly after sustaining the injury.
A subset of mild traumatic brain injury (mTBI) patients experience post-concussion symptoms. When a cluster of post-concussion symptoms persists for over three months, it is referred to as post-concussion syndrome (PCS). Little is known about the association between PCS and Health-Related Quality of Life (HRQoL) after mTBI. The aims of this study were to assess the implications of PCS on HRQoL six months after mTBI and the relationship between PCS and HRQoL domains. A prospective observational cohort study was conducted among a sample of mTBI patients. Follow-up postal questionnaires at six months after emergency department (ED) admission included socio-demographic information, the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), and HRQoL measured with the 36-item Short-Form Health Survey (SF-36) and the Perceived Quality of Life Scale (PQoL). In total, 731 mTBI patients were included, of whom 38.7% were classified as suffering from PCS. Patients with PCS had significantly lower scores on all SF-36 domains, lower physical and mental component summary scores and lower mean PQoL scores compared to patients without PCS. All items of the RPQ were negatively correlated to all SF-36 domains and PQoL subscale scores, indicating that reporting problems on any of the RPQ symptoms was associated with a decrease on different aspects of an individuals’ HRQoL. To conclude, PCS is common following mTBI and patients with PCS have a considerably lower HRQoL. A better understanding of the relationship between PCS and HRQoL and possible mediating factors in this relationship could improve intervention strategies, the recovery process for mTBI patients and benchmarking.
Changes in the demographics, approach, and treatment of traumatic brain injury (TBI) patients require regular evaluation of epidemiological profiles, injury severity classification, and outcomes. ...This prospective multicenter study provides detailed information on TBI-related variables of 508 moderate-to-severe TBI patients. Variability in epidemiology and outcome is examined by comparing our cohort with previous multicenter studies. Additionally, the relation between outcome and injury severity classification assessed at different time points is studied. Based on the emergency department Glasgow Coma Scale (GCS), 339 patients were classified as having severe and 129 as having moderate TBI. In 15%, the diagnosis differed when the accident scene GCS was used for classification. In-hospital mortality was higher if severe TBI was diagnosed at both time points (44%) compared to moderate TBI at one or both time points (7-15%, p<0.001). Furthermore, 14% changed diagnosis when a threshold (≥6 h) for impaired consciousness was used as a criterion for severe TBI: In-hospital mortality was<5% when impaired consciousness lasted for<6 h. This suggests that combining multiple clinical assessments and using a threshold for impaired consciousness may improve the classification of injury severity and prediction of outcome. Compared to earlier multicenter studies, our cohort demonstrates a different case mix that includes a higher age (mean=47.3 years), more diffuse (Traumatic Coma Databank TCDB I-II) injuries (58%), and more major extracranial injuries (40%), with relatively high 6 month mortality rates for both severe (46%) and moderate (21%) TBI. Our results confirm that TBI epidemiology and injury patterns have changed in recent years whereas case fatality rates remain high.
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