By E. Milten. Luther Seminary.
Conclusion: The skype overcoming signifcant barriers order differin 15 gr amex, including gaining adequate clini- lecture sessions have permitted rapid education and advice over cal training and familiarity with the ultrasound device discount differin line. The fellowship in the southeastern United States was obtained from the leading ul- also needs accreditation by the Ghana College of Physicians cheap differin 15 gr with visa. The trasound device manufacturer purchase differin 15gr otc, Sonosite Fujiflm, during the period training limits of a 1-year fellowship are acknowledged, however it of Jan 2014 to Dec 2015. We included outpatient musculoskeletal is anticipated that, after a decade, trainee experts who meet interna- practices in the southeastern United States, specifcally covering tional standards will build a locally led fully developed residency the states of Georgia, Alabama, Florida, and South Carolina. African governments also need to understand the societal pitals and inpatient services were excluded, as was the purchase of cost of disability and invest in rehabilitation by training rehabilita- used ultrasound devices. Data was collected from the practices on tion team members as well as building more facilities. Ghana, the whether they had received manufacturer training, loaned a device, black star of Africa, has set the pace. Results: Fifty-two outpatient musculoskeletal practices purchased 56 new ultrasound devices during the time period. Fifteen devices (25%) were bought by practices where the physicians had no prior training with 967 ultrasound nor loaned a device before purchase. Residents will learn to work effectively with other as legitimate in order for governments to fund education and de- clinicians to improve the quality of care, health care delivery, learn ploy trained physicians into rehabilitation practice. After a decade about cost-effective care, recognize system error and advocate for of research and experimentation the International Rehabilitation system improvement, learn how to monitor transitions of care, pro- Forum and Komfo Anokye Teaching Hospital in Kumasi, Ghana, viding Effective Handoffs and Safe Discharge Planning. Methods: The team devel- prepare future physicians to be stewards of safe, high quality, high oped a 1-year fellowship for family medicine or internal medicine value, patient centered care and develop a culture of safety and specialists. Journals demonstrate compliance with guidelines by requir- ing authors to register trials before enrolling patients. Reporting guidelines are structured out- tation, Shanghai, China lines for authors to use when describing their methods. There is no review of prospective studies broad range of publications, including those focused on physical that systematically examined the relationship between sedentary therapy, occupational therapy, rehabilitation nursing, speech pathol- behaviors and boenhealth outcomes among graduate students. Trial registration be- cross-sectional study aimed to look for an association in between gan Jan 1, 2016. Material and Methods: editors, authors, and reviewers on how best to apply these guidelines. No gender monly used words that support communication and language learn- differences were found. This review physical activity and sedentary behavior infuence whole body bone aims to evaluate, summarize, and synthesize the data on Malay mass body composition. Frontera4 summarized following its frequency of occurrence, word common- 1 ality and part-of-speech. For statistical analysis, we used the Wilcoxon 971 test and the Mann-Whitney test. As such a long examination session is not practical, it acquisition of knowledge and skills. Participants were assigned alternating 973 roles of hemiplegic individuals, caregivers and heath care providers. Focus domains 1Hospital Rehabilitasi Cheras, Department of Rehabilitation Medi- in the course were hemiplegic shoulder care, transfers, mobility and cine, Cheras, Malaysia activities of daily living. Course survey, pre and post-tests were performed to measure the partici- Introduction/Background: Since the start of Cheras Rehabilitation pants’ level of understanding and overall response. Results: A to- Hospital’s Paediatric Rehabilitation Service in year 2013, many ac- tal of 80 participants enrolled in the course. Majority (80%) of the tivities were conducted for both in- and outpatient to improve the course participants were from the nursing units. One of the annual and post-test questionnaires showed overall increased percentage of activities carried out is the hospital based school holiday programme, level of understanding of hemiplegic care. The programme aims to provide short increased confdence in their practical skills. Incorporating role-play to improve their fne and gross motor skills, mobility and activities as an adjunct to interactive lectures and hands-on demonstration ses- of daily living; also to improve their motivation, behaviour and so- sion was highly evaluated by participants to be an effective learn- cial interaction skills. Conclusion: Experiential Learning is an effective tool with specifc theme was conducted. Hirano2 caregivers agreed that their children learned many skills and more 1Fujita Health University, Occupational Therapy, Toyoake- Aichi, independent after the programme. They felt that the programme was Japan, 2International University of Health and Welfare, Occupa- excellent and would recommend it to other parents. NeuroSpinal Hospital which is private to make the proper database of our patients and their caregivers. It tertiary highly specialized Neuro&Spine surgical referral center af- will lead us to clasify their pattern in the purpose of giving the best ford from A-Z comprehensive (surgical & conservative) manage- rehabilitation approach, including educational program. The highest level of education of parents were School of Business and Leadership, Durban, South Africa college graduate but only in a minor amounts (4. Most of parents were senior high school graduate, Introduction/Background: Globalisation brings new opportunities 37. A followed by speech delay (13%) and global delayed development survival tactic is to have a healthy, engaged and highly produc- (10. Healthy employees are vital to assist in functioning Conclusion: Pediatric patients who came to physical medicine and and competing in the global business environment. Material and Methods: The need to give the suitable educational rehabilitation program to be fol- aim of this study was to understand employees’ awareness, atti- lowed easily by the parents at the hospital and home setting. A probability sample of 301 employees was drawn from a population of 1,314 employees. A further recommendation is that times when services are Dubai, United Arab Emirates offered should be extended. Hope for further re- Frontières, Trauma, Brussels, Belgium, 3Médecins Sans Frontières, covery was the greatest perceived barrier to community reintegra- Trauma, Luxembourg, Luxembourg tion. So practitioner account for prognosis exactly and counsel the length Introduction/Background: Considering the needs and benefts for of hospital stay early. Within those centers, physiotherapists are 1National Rehabilitation Hospital, Rehabilitation, Yangon, Myan- part of a multidisciplinary team, which also comprises surgeons, mar Burma medical doctors,nurses, mental health counsellors and hygiene promotion professionals, in the common objective to offer the best Introduction/Background: Objectives of this study are to describe possible care for the trauma patients and optimize their recovery. It is a tertiary level teaching hospital scores for patients with upper limb and lower limb trauma, admit- and 50 bedded hospital. Multiple needs of the end of both in-and outpatient-based physiotherapy were collect- disable person could be met by multi-disciplinary team approach. Material score improved from 32 to 34 (6%) for inpatients and from 43 to and Methods: P&O workshop provides various types of Prosthesis 49 (14%), or up to almost complete regain of functionality, for out- and there are three phases of amputee management. In 2012, total amputees are 237, 366 score was observed for inpatients and outpatients respectively, and amputees in 2014 and in 2015, there are 556 amputees. Most of a functional recovery of 16% and 29% (up to a mean score of them are males and between 20 to 50 years. Associations with the cause of trauma and with congenital and acquired such as occupational accidents, mine in- different interventions were also observed. Conclusion: A marked juries, road traffc accidents, diabetes mellitus, peripheral vascular success of the physiotherapy in these resource-poor, violent set- diseases and malignancies. Results: The workload of P&O work- tings was noted for both pain reductionand functionalrecovery in shop is increasing year by year because of more and more injuries. Mapping of the associations There are only 10 P&O technicians in Myanmar and P&O services between patient characteristicsand functional evolution/outcomes are available at National Rehabilitation Hospital, Defense Services will allow tailoring of the physical rehabilitation protocols. So, ulations and protocols, and to assess the validity and sensitivity of our visions are to do the mobile team services for P&O application the different scoring systems. Rahman1 Medicine, Seoul, Republic of Korea 1Bangabandhu Sheikh Mujib Medical University, Physical Medi- cine and Rehabilitation, Dhaka, Bangladesh Introduction/Background: To ascertain the factors infuencing community reintegration of patients with acquired disabilities Introduction/Background: Disasters result in signifcant numbers who were given rehabilitation in post-acute rehabilitation center of disabling impairments. Material and Methods: A sample of 96 individu- Floods and cyclones killed millions of people in Bay of Bengal dur- als with acquired disabilities who admitted to National rehabilita- ing last centuries. Non-compliant building collapse had times follow-up survey by telephone interview and retrospective major casualties during recent past. Inadequate preparedness and insuffcient ily member care-giver and better functional state had signifcantly equipment for rescue are major causes of death and disability. Among the reason review intends to emphasize the need of health related rehabilitation for prolonged hospitalization, hope for further recovery was of disaster victims at low resource setting in Bangladesh. Conclusion: and Methods: We have gone through the recent events of natural dis- Family member care-giver has a positive impact on reintegration. On the contrary, the burden obstructs the nursing management 2010–2015 of government of Bangladesh to see the by family member.
Exenatide decreases glucagon secretion order on line differin, slows gastric emptying purchase differin with paypal, reduces food intake purchase differin 15gr overnight delivery, and promotes b-cell proliferation purchase 15gr differin otc. Sitagliptin is the first in a new class of antidiabetic agents that act by inhibiting dipeptidyl peptidase 4, a serine protease. In monotherapy or in combination with metformin, sitagliptin decreased fasting and post- prandial plasma glucose concentrations and plasma HbA1c concentration. Amylin is a polypeptide stored and secreted by b-cells of the pancreas, and it acts in concert with insulin to reduce blood sugar. Pramlintide acts to slow gastric emptying, decrease glucagon secretion, and decreases appetite. Structure and synthesis (1) Glucagon is a single-chain polypeptide of 29 amino acids produced by the a cells of the pancreas. Chapter 10 Drugs Acting on the Endocrine System 243 (3) Secretion of glucagon is inhibited by elevated plasma glucose, insulin, and somatostatin. Glucagon rapidly increases blood glucose in insulin-induced hypoglycemia if hepatic glycogen stores are adequate. The adverse effects of glucagon are minimal; there is a low incidence of nausea and vomiting. Diazoxide is a nondiuretic thiazide that promptly increases blood glucose levels by direct inhibition of insulin secretion. Calcium is the major extracellular divalent cation, primarily (40%–50%) existing as free ion- 2+ 2+ ized Ca (the biologically active fraction). Approximately 40% of serum Ca is bound to plasma proteins, especially albumin, with the remaining 10% complexed to such anions as citrate. This is mediated by cytokines produced by osteoblasts that regulate the number and activity of osteoclasts. Infrequent adverse effects include dizziness, depression, pain, headache, and leg cramps. Calcitonin is a 32-amino acid peptide secreted by perifollicular cells of the thyroid gland in response to elevated plasma Ca2+. Gastrin, glucagon, cholecystokinin, and epi- nephrine can also increase calcitonin secretion. Pharmacologic properties (1) Synthetic salmon calcitonin (Fortical, Miacalcin) differs from human calcitonin at 13 of 32 amino acids and has a longer half-life. Therapeutic uses (1) Calcitonin reduces hypercalcemia due to Paget disease, hyperparathyroidism, idio- pathic juvenile hypercalcemia, vitamin D intoxication, osteolytic bone disorders, and osteoporosis. The calciferols, vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol), are secosteroid members of the steroid hormone family. Synthesis (1) Vitamin D3 is produced in the skin from cholesterol; this synthesis requires exposure to ultraviolet light. It is 4 approved to treat hyperparathyroidism in patients with renal failure who are on dialysis. Compared with 1,25-D3, it binds with low af- finity to the serum vitamin D-binding globulin. Vitamin D and vitamin D metabolites are used to treat hypocalce- mia caused by a number of diseases, including vitamin D deficiency (nutritional rick- ets), hypoparathyroidism, renal disease, malabsorption, and osteoporosis. For this reason, the drug has been successfully used in the treatment of certain leukemias. Bisphosphonates (P-C-P) are analogues of pyrophos- phate (P-O-P) that bind directly to hydroxyapatite crystals in bone and impair reabsorption. Recommen- dation is to administer on an empty stomach with a full glass of water and remain stand- ing for 30 minutes. Aminobisphosphonates (1) Mechanism of action is inhibition of farnesyl diphosphate synthase, part of the choles- terol biosynthetic pathway. This impairs posttranslational modification of a number of regulator proteins critical for osteoclast function including Ras, Rho, and Rac. Uses (1) Paget disease—given orally, clinical symptoms improve relatively slowly (1–3 months) 2+ (2) Effective in 60%–70% of cases; normalization of serum Ca levels in 2–8 days (3) Heterotopic ossification (4) Aminobisphosphonates are approved for the prevention of osteoporosis e. When used for prolonged periods (years), etidronate can interfere with mineralization of bone (osteomalacia). Cinacalcet is approved for use in patients with hyperparathyroidism secondary to renal disease. Thiazide diuretics reduce the renal excretion of Ca and the incidence of kidney stone for- mation in patients with idiopathic hypercalciuria. Calcium supplements are available in a variety of Ca2+ concentrations and in parenteral and oral formulations. Calcium supplements are useful as dietary supplements for the treatment or prevention of osteoporosis and for the immediate treatment of acute hypocalcemia and hypocalcemic tetany. Retinol (vitamin A) is a prohormone that is converted by intracellular enzymes to activate the active agents all-trans-retinoic acid and 9-cis-retinoic acid. The retinoid receptors are members of the nuclear receptor family and act by modulating transcription of specific genes. Retinoids are morphogens, playing important roles during embryonic development, including the regulation of cellular proliferation and differentiation, and the modulation of immune function and cytokine production. They cause severe fetal malformations and must be used with extreme caution in females of childbearing age. Tretinoin is all-trans-retinoic acid, a naturally occurring metabolite of vitamin A. Oral administration is associated with a syndrome of hypervitamino- sis A, which includes headache, fever, bone pain, nausea, vomiting, and rash. Isotretinoin is an oral agent used for the treatment of severe acne and the symptomatic man- agement of keratinization disorders. It reversibly reduces the size of sebaceous glands and hence the production of sebum. Adverse effects of isotretinoin include inflammation of mucous membranes (most often the lips), rash, and alopecia. Reti- noids tend to inhibit lipoprotein lipase, which leads to an increase in serum triglycerides. Acitretin is an oral agent approved for the treatment of psoriasis and other disorders of kerati- nization. In addition, acitretin has been studied in cutaneous T-cell lymphoma and for the pre- vention of skin cancers following solid organ transplantation. It is a topical cream approved for use in the skin disorders associated with Kaposi syndrome. The most common adverse effects seen with tazarotene are skin related: rash, desquamation, and pruritus. Adapalene is a topical retinoid-like drug for the treatment of mild-to-moderate acne vulgaris. Bexarotene is a synthetic oral and topical rexinoid with selectivity for the retinoid X-receptor. It is used in the treatment of cutaneous T-cell lymphoma, Kaposi sarcoma, and breast and lung cancers. Its major adverse effects are hyperlipidemias, both hypertriglyceridemia and hypercholestero- lemia. A 36-year-old woman complains of hot (B) Levonorgestrel flashes, feelings of weakness, and increased (C) Raloxifene appetite. You observe that she is tachycardic (D) Calcitriol and has a prominent pulse pressure. A patient who has recently undergone a kid- Which of the following would be the most ney transplant is immunosuppressed with dexa- appropriate treatment for this patient? Besides the necessary (B) Liotrix treatment of the trauma, which of the following (C) Thyrotropin a actions would be necessary? A male patient is diagnosed with a large, be- formin, but her fasting glucose levels remain nign prostatic mass, and he has the urge to uri- above 100 mg/dL. He returns to your office 3 days (A) Increase insulin secretion later complaining that his urge to urinate has (B) Decrease glucocorticoid levels increased, not decreased. These studies (D) Prostatic resistance to leuprolide indicate an advanced case of osteosarcoma. A 16-year-old female patient enters your der- she becomes unresponsive and moribund.
Furthermore proven 15 gr differin, Diocles and Praxagoras are the only doctors from the period concerned of whom we know some of the therapeutic measures they took in case the disease occurred discount differin 15 gr amex. The authors of On the Sacred Disease and On Breaths restrict themselves to some very general remarks on curing the dis- ease (by restoring the balance between the four primary qualities hot buy generic differin 15 gr on-line, cold order differin overnight, dry and wet; curing it by means of contrasting qualities). Diocles, on the other hand, is known to have based his treatment on the type of cause he established for the disease: purgative measures to remove phlegma, walking 36 ‘Anonymus Parisinus’ 3 (published by I. Heart, brain, blood, pneuma 135 and carrying around for those who contracted the disease due to their phys- ical constitution, bleeding for those who contracted it by eating meat or due to dipsomania. On the other hand, Caelius Aurelianus is a sufﬁciently uncongenial informant for us to assume that Diocles provided more than just some vague indications. The examples given show how each of the authors mentioned arrives at a different explanation of epilepsy, based on an a priori view on the physical aspects of cognitive processes, and how in their opinion the empirically perceptible symptoms of the disease can be ﬁtted into this explanation. There is no empirical veriﬁcation of such presuppositions in the modern sense of the word, apart from a rather haphazard use of empirical facts (yet not discovered in any targeted way), employed in the author’s own defence or in his criticism of rival views. Much has been written about the reasons for this scientiﬁc attitude; in this respect it should be noted that systematic attempts at falsifying theories by gathering counter-examples in empirical reality were the exception rather than the rule in antiquity. For this reason the encephalocentric view on the location of the mind needed quite some scientiﬁc and rhetorical force to secure its position in the debate. However, it is unlikely that the form in which this collection has come down to us dates back to Aristotle. Jackson (1986) 31–3; Klibansky, Panowsky and Saxl (1964) 15–40 [and (1990) 55–91]; Muri (¨ 1953) 21–38; Pigeaud (1978) 23–31; Pigeaud (1981a) 122–38; Pigeaud (1984) 501–10; Pigeaud (1988a); Simon (1978) 228–37; Tellenbach (1961) 1–15 [and Rutten (¨ 1992); Roussel (1988)]. Signiﬁcantly, these writings do refer to the so-called constitutional type of ‘the melancholic’ (ho melancholikos), yet without providing clarity on the underlying physiological theory, and in any case it is nowhere related to a bodily ﬂuid called ‘black bile’. The problem is that, on the one hand, this step was sup- posedly ﬁrst made in Aristotle’s school (according to Jouanna (1975) 296), whereas on the other hand the Aristotelian use of ‘the melancholics’ as an established term seems to suggest that this step had already been taken. I say ‘seems’, for it is by no means certain that Aristotle actually associated the term ho melancholikos with this ‘constitutional type’ and its afﬁliated theory of the four humours. Aristotle on melancholy 141 seems to mean virtually the same as manikos (‘mad’) or mainesthai (‘be mad’). This ﬁrst of all requires an analysis of all occurrences of the words melancholikos and melaina chole¯(sections 2 and 3) and an analysis of the role Aristotle assigns to (black) bile in human physiology (section 4). The results will enable us to gain a better insight into the relationship be- tween Aristotle and the Hippocratic theory of humours. In the second part of this chapter (sections 5–7) I will discuss the theory set out in Pr. This will also reveal the philosophical signiﬁcance of the issue of melancholy: for Aristotle seems to use melan- cholics to illustrate the role played by the human phusis, both in the sense of ‘natural predisposition’ and of ‘physiological constitution’, in the moral, sensitive and intellectual behaviour of man, namely what the Problemata text calls the ‘character-affecting aspect’ (to ethopoion¯ )ofphusis. Proof of this is that certain people are disturbed by the fact that if they are unable to recollect something, despite making a strong effort, the process of recollecting continues even after they stop making the effort. The cause of this disorder is that just as someone who throws something is unable to bring the thrown object to a halt, the process of recollection causes a bodily 12 Muri (¨ 1953) 34; Flashar (1966) 37–8; Klibansky et al. For the historical background to this use of the term, as well as the origin of the notion ‘black bile’, see also Kudlien (1967a) 75–88 and (1973) 53–8. The subject of parenocle±n is nmnhsiv (this refers to the pqov mentioned in line 25); oÅdn ¨tton belongs to namimnhskesqai. The ‘disturbance’ (parenocle±n) does not so much consist in the fact that these people are unable to remember something in particular (for how could this be an indication that memory is a physiological process? The disorder manifests itself particularly in people whose region of sensory perception is surrounded by moisture, ‘for once moisture is set in motion, it does not readily stop moving until the sought object is found and the movement has taken a straight course’. Melancholics are mentioned here in the context of a discussion of the bodily (physiological) aspect of recollection. Their characteristic feature is their disorder14 in the process of recollection, in that they are unable to con- trol this process. As causes for the disorder Aristotle ﬁrst mentions the special movement by images (phantasmata) and secondly moisture (hugrotes¯ ) lo- cated around the aisthetikos topos¯ , the heart. Although it remains uncertain whether this sentence refers to melancholics, the structure of the argument seems to indicate that this moisture is the physiological cause of the previ- ously mentioned special affection by images. In 457 a 25 he discusses people with prominent blood vessels who, as a result of this width of their vessels (poroi), are not much given to sleep. Aristotle subsequently18 states that melancholics are not prone to sleep (hupnotikoi¯ ) either, for their inner parts are chilled, which results in limited ‘evaporation’ of food (according to Aristotle, this ‘evaporation’, anathumiasis, is the cause of sleep). This is also the reason why melancholics are on the one hand good eaters, yet on the other hand they are spare; their 14 On (par)enocle±n see On Divination in Sleep (De divinatione per somnum, Div. With regard to the complication that in Greek medicine melancholics were usually associated with dryness, I endorse Sorabji’s solution (1972a, 113): black bile is of course a liquid (cf. In this passage melancholics are not characterised by the fact that they are particularly moist but by the fact that there is moisture around their heart (as is occasionally the case with other people), namely black bile. For the tendency in this chapter of the Problemata to take certain features, which Aristotle occasionally mentions in relation to melancholy, as part of a more fundamental basis of the melancholic nature, see n. Aristotle on melancholy 143 body is in such a condition (diakeitai) that it seems as if they have not had any food at all:19 ‘for black bile is cold by nature and therefore chills the nutritive region (threptikos topos) of the body as well as any other parts that may contain this residue’. First of all, it should be noted that Aristotle speaks not only of melancholics but also of ‘black bile’ (melaina chole¯): underlying his use of the term hoi melancholikoi is a physiological concept that recognises black bile as a distinct ﬂuid (i. The text implies that black bile is cold by nature and has a chilling effect on its environment. Cold as a natural elementary quality of black bile corresponds to the Hippocratic characterisation of black bile as dry and cold (see Flashar (1966) 39), although the phrase ‘naturally’ seems to leave open the possibility of heating. At ﬁrst there seems to be considerable discrepancy between the two writings: whilst melancholics are presented as an example of people with clear and prophetic dreams in On Divination in Sleep (Div. Closer analysis of the relevant passages should reveal whether they are indeed inconsistent. To start with the passages in On Divination in Sleep, at the beginning of chapter 2 (463 b 12ff. For this reason dreams are not divine, albeit beyond human control, for nature is beyond human control 19 See Pr. The only explanation for this is that these dreams are not sent by a god, but it is in the nature (phusis) of garrulous and melancholic people to see all kinds of images (in their dreams), as these people are subject to a large number and variety of movements, which cause them to chance upon ‘images similar to events’ (omo©oiv qewrmasin). Their good fortune in this respect can be compared to that of people who in a game of chance have a better chance of winning because they just keep trying. Aristotle speaks here of people with a ‘garrulous and melancholic nature’ (llov kaª melagcolik jÅsiv),24 who apparently serve as an example of the general rule that ‘quite common’ people (pnu eÉtele±v nqrwpoi) have prophetic dreams. Melancholics are therefore implicitly contrasted with the group of ‘the best and most intelligent’ (see 462 b 21–2), for these would typically be expected to be the recipients of divine provision, if any such thing exists. This rather obscure passage is made even more difﬁcult to interpret, as the explanation it gives for the prophetic dreams of melancholics seems to differ considerably from the one given in 463 b 17ff. This ability is based on a similarity (homoiotes¯ ) between the objects concerned. A further factor is the strength and intensity (sphodrotes¯ ) of their imagination, which prevents the process 23 For a discussion of the numerous difﬁculties involved in the interpretation of this paragraph see van der Eijk (1994) 289–301 [see also ch. For other interpretations of this passage see Barra (1957) 75–84; Boyance(´ 1936) 192; Croissant (1932) 36;Detienne (´ 1963) 140–69; Effe (1970) 82 n. Aristotle on melancholy 145 of association from being disturbed by other bodily movements. The eu- thuoneiria of melancholics (referred to here as eustochia, ability to make the right conjecture, which suggests a greater degree of activity)27 seems to be based on the ability to ‘perceive similarities’ (tv ¾moi»thtav qewre±n); on other occasions Aristotle relates this ability to a special natural disposi- tion (phusis or euphuia) and considers it an important principle for poetry and philosophy. In this passage Aristotle brackets melancholics together with the feverish and the intoxicated as examples of people who see confused and monstrous images in their sleep and whose dreams themselves are not coherent (oÉk rrwmna). The cause of this blurriness is that all these affec- tions contain air (pneumatÛdh) and therefore produce much movement and confusion. Yet even if this interpretation of euthuoneiros is adopted, it remains impos- sible to square Aristotle’s remark in Insomn. The ‘daemonic’ nature of the effect of the human phusis actually consists in the fact that it escapes rational control, i. See below (section 6) for the signiﬁcance of this principle in Aristotle’s views on cognitive psychology.