BackgroundThe Patient-Centered Outcomes Research Institute is obligated to peer review and to post publicly “Final Research Reports” of all funded projects. PCORI peer review emphasizes adherence to PCORI’s Methodology Standards and principles of ethical scientific communication. During the peer review process, reviewers and editors seek to ensure that results are presented objectively and interpreted appropriately, e.g., free of spin.MethodsTwo independent raters assessed PCORI peer review feedback sent to authors. We calculated the proportion of reports in which spin was identified during (...) peer review, and the types of spin identified. We included reports submitted by April 2018 with at least one associated journal article. The same raters then assessed whether authors addressed reviewers’ comments about spin. The raters also assessed whether spin identified during PCORI peer review was present in related journal articles.ResultsWe included 64 PCORI-funded projects. Peer reviewers or editors identified spin in 55/64 submitted research reports. Types of spin included reporting bias, inappropriate interpretation, inappropriate extrapolation of results, and inappropriate attribution of causality. Authors addressed comments about spin related to 47/55 of the reports.Of 110 associated journal articles, PCORI comments about spin were potentially applicable to 44/110 articles, of which 27/44 contained the same spin that was identified in the PCORI research report. The proportion of articles with spin was similar for articles accepted before and after PCORI peer review.DiscussionJust as spin is common in journal articles and press releases, we found that most reports submitted to PCORI included spin. While most spin was mitigated during the funder’s peer review process, we found no evidence that review of PCORI reports influenced spin in journal articles. Funders could explore interventions aimed at reducing spin in published articles of studies they support. (shrink)

The last decade has seen an explosion of research on the gut microbiota—the trillions of microorganisms that colonize the human gut. It is now clear that interindividual diversity in microbiota composition plays an important role in determining susceptibility to a wide variety of diseases. However, identifying the precise changes in microbiota composition that play causal roles has remained a largely unrealized goal. Here, we propose that functional classifications of microbes based on their interactions with and effects on the host—particularly the (...) host immune system—will illuminate the role of the microbiota in shaping human physiology. We outline the benefits of “functional” classification compared to phylogenetic classifications, and review current efforts at functional classification of the microbiota. Finally, we outline a theoretical framework for classifying host-microbiota interactions. Future advances enabling broader functional classifications of the microbiota promise to revolutionize our understanding of the role of gut microbes in health and disease. Functional classifications of the human microbiota reveal previously hidden patterns and will be key to cracking the microbiota composition code. This figure shows a theoretical comparison between phylogenetic classification and functional classification of a host-associated microbial community. (shrink)

Mirrored-self misidentification is the delusional belief that one's own reflection in the mirror is a stranger. In two experiments, we tested the ability of hypnotic suggestion to model this condition. In Experiment 1, we compared two suggestions based on either the delusion's surface features (seeing a stranger in the mirror) or underlying processes (impaired face processing). Fifty-two high hypnotisable participants received one of these suggestions either with hypnosis or without in a wake control. In Experiment 2, we examined the extent (...) to which social cues and role-playing could account for participants' behaviour by comparing the responses of 14 hypnotised participants to the suggestion for impaired face processing (reals) with those of 14 nonhypnotised participants instructed to fake their responses (simulators). Overall, results from both experiments confirm that we can use hypnotic suggestion to produce a compelling analogue of mirrored-self misidentification that cannot simply be attributed to social cues or role-playing. (shrink)

The American public has increasingly identified health care as a key issue of concern. In order to address the multiple problems relating to the access and affordability of health care, President Obama and federal lawmakers across the political spectrum continue to call for major health reform. In any debate on health reform, a predictable set of complex policy, management, economic, and legal issues is likely to be raised. Due to the diverse interests involved, these issues could lead to a series (...) of high-stakes policy debates. Therefore, it is critical that advocates of reform strategies anticipate such issues in order to decrease the likelihood that legally resolvable questions become barriers to substantive health reform. In an effort to frame and study legal challenges and solutions in advance of the heat of political debate, the O’Neill Institute for National and Global Health Law at Georgetown University and the Robert Wood Johnson Foundation have crafted the “Legal Solutions in Health Reform” project. (shrink)

Traditionally, psychoanalytically oriented clinicians have eschewed a direct focus on symptoms, viewing it as superficial turning away from underlying psychopathology. But this assumption is an artifact of a dated classical approach; it should be reexamined in the light of contemporary relational thinking. So argues Mary Connors in _Symptom-Focused Dynamic Psychotherapy_, an integrative project that describes cognitive-behavioral techniques that have been demonstrated to be empirically effective and may be productively assimilated into dynamic psychotherapy. What is the warrant for symptom-focused interventions in (...) psychodynamic treatment? Connors argues that the deleterious impact of symptoms on the patient's physical and emotional well being often impedes psychodynamic engagement. Symptoms associated with addictive disorders, eating disorders, OCD, and posttraumatic stress receive special attention. With patients suffering from these and other symptoms, Connors finds, specific cognitive-behavior techniques may relieve symptomatic distress and facilitate a psychodynamic treatment process, with its attentiveness to the therapeutic relationship and the analysis of transference-countertransference. Connors' model of integrative psychotherapy, which makes cognitive-behavioral techniques responsive to a comprehensive understanding of symptom etiology, offers a balanced perspective that attends to the relational embeddedness of symptoms without skirting the therapeutic obligation to alleviate symptomatic distress. In fact, Connors shows, active techniques of symptom management are frequently facilitative of treatment goals formulated in terms of relational psychoanalysis, self psychology, intersubjectivity theory, and attachment research. A discerning effort to enrich psychodynamic treatment without subverting its conceptual ground, _Symptom-Focused Dynamic Psychotherapy_ is a bracing antidote to the timeworn mindset that makes a virtue of symptomatic suffering. (shrink)

The authors of the Target article, Shen and colleagues (2024) argue that there is a need for an ethical framework to help analyze when it is appropriate to return individualized research results (I...

Despite spending more on health care than every other industrialized country, the U.S. ranks 37th in health outcomes. These differences cannot be explained away with differences in age and income, or even with quality of care. And, the rate of growth in health care spending in the U.S. continues to increase. The share of the Gross Domestic Product attributable to health care grew from 9% in 1980 to more than 17% in 2011. Health care costs are projected to account for (...) more than one-fifth of our economy by 2021. Despite spending more and more, the U.S. does not have better health outcomes than other countries. Worse, our increasing spending is largely attributable to preventable conditions. More than 85 cents of every dollar spent on health in the U.S. are spent on the treatment and management of chronic diseases, such as those caused by preventable conditions related to obesity and tobacco use. (shrink)

PurposeEven low intensity exercise bouts of at least 15 min can improve feelings of energy and reduce systolic blood pressure. However, little is known about the psychological outcomes of briefer exercise bouts, particularly for modes of exercise that are more intense than level walking, and readily available to many working adults. This study assessed the effects of a 4-min bout of stair walking on FOE and feelings of fatigue.MethodsThirty-six young adult participants were randomized to either stair walking or seated control (...) groups. All participants walked on level-ground from a laboratory to a nearby stairwell and were seated for 4 min before beginning their experimental condition. Stair-walking participants walked up and down one flight of 16 stairs at their own pace for 4 min, while control participants remained seated during that time. Participants walked back to the laboratory for post-condition assessments. Measures of blood pressure, heart rate, rated perceived exertion, and the intensity of feelings of mental energy, mental fatigue, physical energy, and physical fatigue were assessed pre-and post-condition. Separate one-way ANOVAs were conducted on change scores for all variables.ResultsThe stair climbing group experienced significant increases in heart rate [F = 13.167, p < 0.001] and RPE [F = 93.844, p < 0.001] that were not observed in the seated control group. Four minutes of self-paced stair climbing resulted in small changes and non-significant differences within and between groups in blood pressure as well as FOE and FOF.ConclusionAlthough a 4-min self-paced exercise bout can convey short-term physiological health benefits, a 4-min bout of self-paced indoor stair walking in a stairwell was insufficient to lower blood pressure or change subjective FOE and fatigue in a sample that exhibited better than typical FOE and FOF at the pre-test. (shrink)

Despite a recent wave in global recognition of the rights of transgender and gender-diverse populations, referred to in this text by the umbrella label of trans*, international law continues to presume a cisgender binary definition of gender — dismissing the lived realities of trans* individuals throughout the world. This gap in international legal recognition and protection has fundamental implications for health, where trans* persons have been and continue to be subjected to widespread discrimination in health care, longstanding neglect of health (...) needs, and significant violations of bodily autonomy. (shrink)

When ethics committees are consulted about patients who have or need court-appointed guardians, they lack empirical evidence about several common issues, including the relationship between guardianship and prolonged, potentially medically unnecessary hospitalizations for patients. To provide information about this issue, we conducted quantitative and qualitative analyses using a retrospective cohort from Veterans Healthcare Administration. To examine the relationship between guardianship appointment and hospital length of stay, we first compared 116 persons hospitalized prior to guardianship appointment to a comparison group (n (...) = 348) 3:1 matched for age, diagnosis, date of admission, and comorbidity. We then compared 91 persons hospitalized in the year following guardianship appointment to a second matched comparison group (n = 273). Mean length of stay was 30.75 days (SD = 46.70) amongst those admitted prior to guardianship, which was higher than the comparison group (M = 7.74, SD = 9.71, F = 20.75, p. (shrink)

The current work builds a definition of irritability from both academic definitions and lay perspectives. In Study 1, a quantitative content analysis of academic definitions resulted in eight main content categories (i.e., behaviour, emotion or affect, cognition, physiological, qualifiers, irritant, stability or endurance, and other). In Study 2, a community sample of 39 adults participated in qualitative interviews. A deductive thematic analysis resulted in two main themes. The first main theme dealt with how participants positioned irritability in relation to other (...) negative states. The second dealt with how participants constructed irritability as both a loss of control and as an experience that should be controlled. The discussion integrates the findings of both studies and provides a concise, but comprehensive definition. (shrink)

Justifying involuntary psychiatric treatment on the basis of a judgment that a person lacks capacity is usually expressed in terms of a person’s ability to make a decision about his or her health and treatment. Typically, this relates to the ability to refuse treatment. Exactly what “capacity” means, however, and how one determines when another individual lacks capacity, or lacks sufficient capacity, in this context is particularly controversial, with the United Nations Committee on the Rights of Persons with Disabilities insisting (...) that involuntary treatment be abandoned altogether and capacity tests avoided.Capacity is a concept that has multiple meanings and applications across different disciplines and... (shrink)

INTRODUCTION: MOORE AND METAPHYSICS In the course of this book I will make frequent use of the word 'metaphysics'. Indeed I will maintain that that word ...

We are currently facing global healthcare crisis that has placed unprecedented stress on healthcare workers as a result of the coronavirus disease 2019. It is imperative that we develop novel tools to assist healthcare workers in dealing with the significant additional stress and trauma that has arisen as a result of the pandemic. Based in research on the effects of immersive environments on mood, a neuroscience research laboratory was rapidly repurposed using commercially available technologies and materials to create a nature-inspired (...) relaxation space. Frontline healthcare workers were invited to book 15-min experiences in the Recharge Room before, during or after their shifts, where they were exposed to the immersive, multisensory experience 496 Recharge Room users completed a short survey about their experience during an unselected, consecutive 14-day period. Average self-reported stress levels prior to entering the Recharge Room were 4.58/6. After a single 15-min experience in the Recharge Room, the average user-reported stress level was significantly reduced 1.85/6. Net Promoter Score for the experience was 99.3%. Recharge Rooms such as those described here produce significant short-term reductions in perceived stress, and users find them highly enjoyable. These rooms may be of general utility in high-stress healthcare environments. (shrink)

We propose a friendly amendment to integrative experiment design (IED), adversarial-collaboration IED, that incentivizes research teams from competing theoretical perspectives to identify zones of the design space where they possess an explanatory edge. This amendment is especially critical in debates that have high policy stakes and carry a strong normative-political charge that might otherwise prevent free exchange of ideas.

The Morality of Happiness By Julia Annas, Oxford University Press, 1993. Pp. x + 502. ISBN 0–19–507999‐X. £45.00 (hbk), £13.99 (pbk).Dimensions of Creativity By Margaret A. Boden (ed.) MIT Press, 1994. Pp. 242. ISBN 0–262–02368–7. £24.95.Thomas Hobbes and the Science of Moral Virtue By David Boonin‐Vail, Cambridge University Press, 1994. Pp. 219. ISBN 0–521–46209–6. £37.50.Reason and Rhetoric in the Philosophy of Hobbes By Quentin Skinner, Cambridge University Press, 1996. Pp. 477. ISBN 0–521–55436–5. £35.00.Being and the Between By William Desmond, State (...) University of New York Press, 1995. Pp. 557. ISBN 0–7914–2271–2. $19.95.Perplexity and Ultimacy By William Desmond, State University of New York Press, 1995. Pp. 263. ISBN 0–7914–2387–5. $19.95.Evidence and Inquiry: Towards Reconstruction in Epistemology By Susan Haack, Blackwell Publishers, 1994. Pp. x + 259. ISBN 0–631–19679‐X/£14.99 (pbk).Kant's Intuitionalism: A Commentary on the Transcendental Aesthetic By Lorne Falkenstein, University of Toronto Press, 1996. Pp. xvii + 465. ISBN 0–8020–2973–6. $70.00.The Metaphysics of Free Will By John Martin Fischer, Blackwell, 1995. Pp. ix + 273. ISBN 1–55786–8573. £14.99.Identification Papers By Diana Fuss, Routledge, 1995. Pp. 179. ISBN 0–415–90886–8. $16.95.Rorty and Pragmatism: The Philosopher Responds to his Critics Edited by Herman J. Saatkamp, Jr., Vanderbilt University Press, 1995. ISBN 0–8265–1263–1 $24.95.Nietzsche's French Legacy: a Genealogy of Poststructuralism By Alan D. Schrift, Routledge, 1995. Pp. xviii + 198. ISBN 0–415–91146‐X. £40.00.Causal Cognition ‐ A Multidisciplinary Debate Edited by Dan Sperber, David Premack, and Ann James Premack, Clarendon Press, 1995. Pp. 670. ISBN 0–19–852314–9. £00.00. (shrink)

The “scarred villain” trope, where facial differences like scars signify moral corruption, is ubiquitous in film (e.g., Batman’s The Joker). Strides by advocacy groups to undermine the trope, however, suggest cinematic representations of facial differences could be improving with time. This preregistered study characterized facial differences in film across cultures (US vs. India) and time (US: 1980-2019, India: 2000-2019). Top-grossing films by country and decade were screened for characters with facial differences. We found that the scarred villain trope has actually (...) worsened with time, although in tandem with progress in also representing non-villainous characters with facial anomalies. Country of origin did not predict the presence of facial differences in villains or heroes. “Action” and “fantasy” movies were the most likely genres to depict villains with facial differences. Finally, villains’ facial differences crossed more facial subunits and were more likely to involve lips, chin, and mandible than when present in heroes. Our findings underscore the need for critical reflection on the role of cultural practices—even when seemingly innocuous—in shaping and maintaining negative biases against already stigmatized groups. (shrink)

In the late spring of 400 b.c.e., when the Ten Thousand were encamped outside the city of Cotyora, Xenophon addressed the soldiers gathered in assembly in order to defend himself against accusations that he was planning to lead them on a colonizing expedition to the land of the Phasis river. Having demonstrated that he was not misleading the soldiers by proving that he could not hope to deceive them into travelling east, Xenophon then moved on to what he presented as (...) a more serious matter for the assembled mercenaries: the problem of growing indiscipline in the army, and its consequences. Xenophon illustrated the extent of the problem by describing to the men two incidents in detail. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS 533 Le Cristologie contemporanee e le loro posizioni fondamentali al vaglio della dottrina di S. Tommaso. By DANIEL 0Ls, O.P., Studi Tomi· stici, 39. Citta Del Vaticano: Liberia Editrice Vaticana, 1991. Pp. 198 + 13. 25,000 Lire. The author's purpose in this compact but highly informative volume is to confront some of the more fundamental positions of current chris· tology with the christology of Aquinas, with the (...) further intention of deepening our appreciation of St. Thomas's thought (pp. 6 and 193). Ols is aware that, in speaking generically of " contemporary christology," he is entering into discussion with a large number of authors whose viewpoints often differ significantly from one another. He cites writers as diverse as Rahner, Schillebeeckx, Sobrino, and Duquoc, for example. Cognizant of the differences among them, he nonetheless sees points of convergence. There is, he says, a certain " negative unity " among them in that each holds himself at a certain distance from the doctrine of Chalcedon and from the " christology from above " which traditionally has been taken as proceeding from the Chalcedonian defi· nition of faith. (One of the reasons for using St. Thomas as interlocutor with the modern christologies is Aquinas's own development of such a "christology from above.") Along with this negative unity, there is another aspect that links the disparate modern christologies. Ols is aware that, in speaking generically of " contemporary christain anthropological focus which sees as normative " not the revealed message, but the ones to whom the message is directed" (p. 8). In developing his thesis, Ols in fact leaves to one side most of the major modern writers on christology and limits himself to a systematic analysis of the christologies of Rahner (especially as found in Foundations of Christian Faith and in A New Christology, which Rahner wrote with William Thiising) and Schillebeeckx. In five chapters (pp. 15-76) Ols examines the relevant points of the theology of each man and then separately contrasts the results with the theology of Aquinas. The examination of Rahner's thought is done not without a certain sympathy. Ols notes points of convergence between the transcendental Thomism of Rahner and the actual thought of Aquinas. There is a certain a priori methodology in both men, and there are similarities between Rahner's transcendental approach and Thomas's thought on the " natural desire" for the Beatific Vision. The harmonies, however, are often more apparent than real, says Ols; this is especially so in a point central to the Rahnerian anthropology: Rahner's a priori definition of man as the being capable of union with the deity. This capability Rahner equates with the Scholastic notion of potentia obedientalis. In fact, claims Ols, Rahncr is using the terminology in an equivocal sense 534 BOOK REVIEWS and means something quite different from what Aquinas meant by it. For Rahner, the obediential potency "is objectively identical with the essence of man" (p. 30, quoting from Rahner's Foundations); for Aquinas the obediential potency is nature's openness to being used by the Creator as He wills. As a result of the differences, the Incarnation, for Rahner, can be deduced as a possibility from the very nature of man; for Thomas, even the possibility can only be known retrospectively once the Incarnation has happened. The different starting points reflect different epistemologies: the one starts from man's potentialities and moves out toward the world and God; the other works from the world and God to understand man's possibilities. Thus, for the Thomist " a posteriori reflection on the convenience " of the Incarnation there is substituted the Rahnerian " a priori reflection on the deducibility of the Incarnation " (p. 53). Without going deeply into a philosophical critique of Rahner-Cornelio Fabro has already done that-Ols con· tends that this difference is due to the fact that Rahner's theology " is radically dependent on an idealistic thought-pattern which represents a mortal danger for theology" (p. 56). E. Schillebeeckx's thought likewise suffers, says Ols, from the influence of philosophical idealism. What is central to Schillebeeckx's christology is the " concrete experience of the primitive Christian community " (p. 71, quoting Schillebeeckx's Jesus). Consequently, what we find in... (shrink)

In 1942, replying to a criticism put to him by Langford, G. E. Moore confessed that he was unable to solve the paradox of analysis. But while conceding inability to solve the puzzle Moore offered the following suggestion, which he did not further develop: I think that, in order to explain the fact that, even if ‘To be a brother is the same thing as to be a male sibling’ is true, yet nevertheless this statement is not the same as (...) the statement ‘To be a brother is to be a brother’, one must suppose that both statements are in some sense about the expressions used as well as about the concept of being a brother. But in what sense they are about the expressions used I cannot see clearly; and therefore I cannot give any clear solution to the puzzle. (shrink)