Evolutionary psychologist Karl Grammer formed a team of researchers to study sexual signals as they occur in a seminatural context: singles bars (Grammer, 1996).

Pożywienie, odzież, mieszkanie, nie są celem samym w sobie: lecz stają się nim, gdy nie rozumiemy czym jest człowiek jako istota psychiczna. Odrodzenie może przyjść tylko wówczas, gdy człowiek, jako jednostka, jasno zrozumie, jakie czynniki ograniczają jego myśl i uczucia. Ograniczenia te sami sobie stwarzamy, bowiem cała nasza umysłowość wciąż dąży do zabezpieczenia się, za pomocą własności, rodziny, idei czy wierzeń. Owo psychologiczne zjawisko nieustannego dążenia do bezpieczeństwa wytwarza konieczność doskonalenia i pomnażania przedmiotów - wytworów myśli i rąk. Przedmioty, podobnie jak imię, rodzina, wiary i przekonania, nabierają ogromnego znaczenia, gdyż w nich szukamy zadowolenia i szczęścia, a gdy nie mogą nam tego dać, myśl stwarza sobie inne, wyższe formy wierzeń i zabezpieczeń się. Ale dopóki wciąż dążymy do własnej ochrony i bezpieczeństwa, na zrozumienie istotnego stosunku człowieka da człowieka nie ma miejsca; stosunek ten sprowadza się wówczas do szukania własnej przyjemności i zadowolenia, a nie jest procesem odkrywania siebie.

Abdominal Pain (acute and chronic)

Subjective

• LOCATION of pain is starting point of abdo pain evaluation

  • 

    • Is it pulm, urinary, or hepatobiliary?

    • UTI/kidney stone → urinalysis

    • colic/fever/steatorrhea/Murphy’s → u/s

  • 

    • If suspected appendicitis, also get urgent surg consult

  • 

    • Not just hx of fever/ds, physical findings too (e.g. distention, tenderness, rectal blood, etc)

• Onset, duration, severity, quality, exacerbating/remitting factors

• Pain relief w/ bowel mvnt, More freq stools w/ onset of pain, Loose stools w/ onset of pain, Passage of mucus, Sensation of incomplete evacuation, abdo distention

  • Manning criteria (3 or more of) for IBS

• Red flags

  • New onset of pain, Change in pain, Altered bowel habits in elderly

    • Check if all 3 are particular to elderly, or just the altered bowel habits

  • Wt loss (GI malignancy)

  • Pain radiating to back (pancreatitis, AAA)

  • Appendicitis (from highest to lowest PPV)

    • RLQ PAIN, pain migration from periumbilical to RLQ, fever, anorexia

  • Pain radiating to groin (testicular torsion, hernia, renal colic)

  • Bleeding per rectum, melena stool (GI bleed, Meckel’s, malignancy in elderly)

  • Anemia

  • Supraclavicular nodes

  • personal/family hx of serious bowel patho

  • Pain waking pt at night

  • Current abx/steroids (can mask peritoneal sx’s)

  • Cardiac hx incl. Afib, HTN (ischemic bowel, AAA, MI)

  • Bowel obstruction (highest to lowest PPV)

    • CONSTIPATION, abdo distention, ↓ pain after vomiting, colic, prev abdo surg

  • Antipsychotic use (ileus, obstruction, toxic megacolon)

  • EtOH (risk factor for p

...

Headache

Adult Headache Algorithm

Subjective

Objective

Plan

...

T HE MODERN U.S. CORPORATION WAS BORN IN A COURT- room in Washington, D.C., on February 2, 1819.

On that day the U.S. Supreme Court established the legal precedent that the property of a corporation, like that of a person, is private and entitled to protection under the U.S. Constitution.

before the 1819 Supreme Court deci- sion, the owners of a corporation were exposed to the possibility that the state could take their business.

If such an act were constitutional, it implied that any state (or the federal government) could, at will, nationalize any corporation.

I have supposed all along, that the passions of love and pride, and those of humility and hatred are similar in their sensations, and that the two former are always agreeable, and the two latter painful. But though this be universally true, it is observable, that the two agreeable, as well as the two painful passions, have some difference, and even contrarieties, which distinguish them.

Nothing invigorates and exalts the mind equally with pride and vanity; though at the same time love or tenderness is rather found to weaken and infeeble it. The same difference is observable betwixt the uneasy passions. Anger and hatred bestow a new force on all our thoughts and actions; while humility and shame deject and discourage us. Of these qualities of the passions, it will be necessary to form a distinct idea. Let us remember, that pride and hatred invigorate the soul; and love and humility infeeble it.

The appetite of generation, when confined to a certain degree, is evidently of the pleasant kind, and has a strong connexion with, all the agreeable emotions. Joy, mirth. vanity, and kindness are all incentives to this desire; as well as music, dancing, wine, and good cheer. On the other hand, sorrow, melancholy, poverty, humility are destructive of it. From this quality it is easily conceived why it should be connected with the sense of beauty.

From these two relations, viz, resemblance and a parallel desire, there arises such a connexion betwixt the sense of beauty, the bodily appetite, and benevolence, that they become in a manner inseparable: And we find from experience that it is indifferent which of them advances first; since any of them is almost sure to be attended with the related affections.

This account of love is not peculiar to my system, but is unavoidable on any hypothesis. The three affections, which compose this passion, are evidently distinct, and has each of them its distinct object. It is certain, therefore, that it is only by their relation they produce each other. But the relation of passions is not alone sufficient. It is likewise necessary, there should be a relation of ideas. The beauty of one person never inspires us with love for another. This then is a sensible proof of the double relation of impressions and ideas. From one instance so evident as this we may form a judgment of the rest.

Of all the immediate effects of pain and pleasure, there is none more remarkable than the WILL; and though properly speaking, it be not comprehended among the passions, yet as the full understanding of its nature and properties, is necessary to the explanation of them, we shall here make it the subject of our enquiry.

It is their constant union alone, with which we are acquainted; and it is from the constant union the necessity arises. If objects had nor an uniform and regular conjunction with each other, we should never arrive at any idea of cause and effect; and even after all, the necessity, which enters into that idea, is nothing but a determination of the mind to pass from one object to its usual attendant, and infer the existence of one from that of the other. Here then are two particulars, which we are to consider as essential to necessity, viz, the constant union and the inference of the mind; and wherever we discover these we must acknowledge a necessity. As the actions of matter have no necessity, but what is derived from these circumstances, and it is not by any insight into the essence of bodies we discover their connexion, the absence of this insight, while the union and inference remain, will never, in any case, remove the necessity.

o this end a very slight and general view of the common course of human affairs will be sufficient. There is no light, in which we can take them, that does nor confirm this principle. Whether we consider mankind according to the difference of sexes, ages, governments, conditions, or methods of education; the same uniformity and regular operation of natural principles are discernible. Uke causes still produce like effects; in the same manner as in the mutual action of the elements and powers of nature.

The skin, pores, muscles, and nerves of a day-labourer are different from those of a man of quality: So are his sentiments, actions and manners. The different stations of life influence the whole fabric, external and internal; and different stations arise necessarily, because uniformly, from the necessary and uniform principles of human nature. Men cannot live without society, and cannot be associated without government. Government makes a distinction of property, and establishes the different ranks of men. This produces industry, traffic, manufactures, law-suits, war, leagues, alliances, voyages, travels, cities, fleets, ports, and all those other actions and objects, which cause such a diversity, and at the same time maintain such an uniformity in human life.

I can imagine only one way of eluding this argument, which is by denying that uniformity of human actions, on which it is founded. As long as actions have a constant union and connexion with the situation and temper of the agent, however we may in words refuse to acknowledge the necessity, we really allow the thing. Now some may, perhaps, find a pretext to deny this regular union and connexion. For what is more capricious than human actions? What more inconstant than the desires of man? And what creature departs more widely, not only from right reason, but from his own character and disposition? An hour, a moment is sufficient to make him change from one extreme to another, and overturn what cost the greatest pain and labour to establish.

His mind runs along a certain train of ideas: The refusal of the soldiers to consent to his escape, the action of the executioner; the separation of the head and body; bleeding, convulsive motions, and death. Here is a connected chain of natural causes and voluntary actions; but the mind feels no difference betwixt them in passing from one link to another; nor is less certain of the future event than if it were connected with the present impressions of the memory and senses by a train of causes cemented together by what we are pleased to call a physical necessity. The same experienced union has the same effect on the mind, whether the united objects be motives, volitions and actions; or figure and motion. We may change the names of things; but their nature and their operation on the understanding never change.

I dare be positive no one will ever endeavour to refute these reasonings otherwise than by altering my definitions, and assigning a different meaning to the terms of cause, and effect, and necessity, and liberty, and chance. According to my definitions, necessity makes an essential part of causation; and consequently liberty, by removing necessity, removes also causes, and is the very same thing with chance. As chance is commonly thought to imply a contradiction, and is at least directly contrary to experience, there are always the same arguments against liberty or free-will. If any one alters the definitions, I cannot pretend to argue with him, until I know the meaning he assigns to these terms.

First, After we have performed any action; though we confess we were influenced by particular views and motives; it is difficult for us to persuade ourselves we were governed by necessity, and that it was utterly impossible for us to have acted otherwise; the idea of necessity seeming to imply something of force, and violence, and constraint, of which we are not sensible.

Few are capable of distinguishing betwixt the liberty of spontaniety, as it is called in the schools, and the liberty of indifference; betwixt that which is opposed to violence, and that which means a negation of necessity and causes.

econdly, There is a false sensation or experience even of the liberty of indifference; which is regarded as an argument for its real existence. The necessity of any action, whether of matter or of the mind, is not properly a quality in the agent, but in any thinking or intelligent being, who may consider the action, and consists in the determination of his thought to infer its existence from some preceding objects: As liberty or chance, on the other hand, is nothing but the want of that determination, and a certain looseness, which we feel in passing or not passing from the idea of one to that of the other. Now we may observe, that though in reflecting on human actions we seldom feel such a looseness or indifference, yet it very commonly happens, that in performing the actions themselves we are sensible of something like it: And as all related or resembling objects are readily taken for each other, this has been employed as a demonstrative or even an intuitive proof of human liberty.

A third reason why the doctrine of liberty has generally been better received in the world, than its antagonist, proceeds from religion, which has been very unnecessarily interested in this question. There is no method of reasoning more common, and yet none more blameable, than in philosophical debates to endeavour to refute any hypothesis by a pretext of its dangerous consequences to religion and morality. When any opinion leads us into absurdities, it is certainly false; but it is not certain an opinion is false, because it is of dangerous consequence. Such topics, therefore, ought entirely to be foreborn, as serving nothing to the discovery of truth, but only to make the person of an antagonist odious. This I observe in general, without pretending to draw any advantage from it. I submit myself frankly to an examination of this kind, and dare venture to affirm, that the doctrine of necessity, according to my explication of it, is not only innocent, but even advantageous to religion and morality.

I define necessity two ways, conformable to the two definitions of cause, of which it makes an essential part. I place it either in the constant union and conjunction of like objects, or in the inference of the mind from the one to the other

Nay I shall go farther, and assert, that this kind of necessity is so essential to religion and morality, that without it there must ensue an absolute subversion of both, and that every other supposition is entirely destructive to all laws both divine and human.