This work offers an analysis of all the legal and moral issues surrounding humanitarian intervention: the deaths of innocent persons and the Doctrine of Double Effect Governmental legitimacy - The Doctrine of Effective Political Control; UN Charter and evaluation of the Nicaragua ruling; The Morality of not intervening; US-led invasion of Iraq; Humanitarian intervention authorised by the UN Security Council - Iraq, Somalia, Haiti, Rwanda, and Bosnia among others highlight NATO's intervention in Kosovo; The Nicaragua Decision; and The precedents of (...) Panama, Liberia and Sierra Leone. The book's features include: a new framework based on the doctrine of double effect; basic principles of international ethics; outline of the moral argument for humanitarian intervention; explores the morality and legality of military action to end tyranny or anarchy; arguments in a much more detailed and complete fashion than in previous editions; in-depth examination of philosophy of international law; the relationship between custom and moral theory; new discussion of the question of right authority; and a full analysis of recent interventions in Kosovo and Iraq. book addresses a broad interdisciplinary audience of international lawyers, philosophers, and political scientists. In this new edition, the author responds to critics while updating the discussion in the light of the momentous events that took place at the beginning of the new millennium. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Update on Waiving Informed Consent in Emergency ResearchCharles R. McCarthyMadam: The closing statement of my article on Waiving Informed Consent in Emergency Research published in the June 1995 issue of the Kennedy Institute of Ethics Journal was: "No doubt we shall hear more of this issue."Indeed, we have heard much more on this issue. (1) In May 1995, after my article had already gone to press, the Food (...) and Drug Administration (FDA) and the National Institutes of Health (NIH) jointly published a report on the Public Forum on Informed Consent in Clinical Research Conducted in Emergency Circumstances. (2) On July 26, 1995, the Department of Health and Human Services (HHS) published in the Federal Register a Notice of Action Related to Emergency Research Activity (60 FR 38353-54). This action constituted a waiver of the requirement to obtain prior informed consent from subjects, as required by the Department's Regulations for the Protection of Human Subjects (45 CFR 46), for one specific NIH-funded project under strictly defined circumstances. (3) On September 21, 1995, FDA published a proposed rule to amend its current informed consent regulations (21 CFR 50) to permit harmonization of federal policies on emergency research and to reduce confusion as to when such research can proceed without obtaining prior informed consent from research subjects. The proposed regulation provides a narrow exception to the requirement for obtaining and documenting informed consent from each human research subject.The HHS waiver (a harbinger of a proposed amendment to its regulations) and the FDA proposed rule are intended to be harmonized so that an Institutional Review Board (IRB) in compliance with one set of regulations relative to the waiver of informed consent will be, ipso facto, in compliance with the other set of regulations.In brief: The FDA proposed amendments will allow an IRB to waive informed consent in emergency situations when:1. The human subjects are in a life threatening condition;2. Obtaining informed consent is not feasible because: (i) the subjects will not be able to provide consent because of their medical condition, (ii) the intervention must be administered before consent from legally authorized representatives is feasible, (iii) there is no reasonable way to identify prospectively the individuals likely to become eligible for the research because the emergence of the condition to be studied cannot be predicted reliably in particular individuals; [End Page 385]3. The opportunity to participate is in the interest of the subjects because: (i) a life threatening situation necessitates intervention, (ii) the risk of the intervention is reasonable in the light of what is known about the medical condition and the patient, the risks and benefits of current therapy, if any, and what is known about the risks and benefits of the proposed intervention or activity;4. The research could not practicably be carried out without the waiver;5. Additional protection of the rights and welfare of the subjects will be provided including, at least: (i) consultation (which may include consultation carried out by the IRB itself) with representatives of the communities from which the subjects will be drawn, (ii) public disclosure prior to commencement of the study sufficient to describe the study and its risks and benefits, (iii) public disclosure of sufficient information following completion of the study to apprise the community and researchers of the study and its results, and (iv) the establishment of an independent data and safety monitoring board;6. The IRB has reviewed and approved an informed consent document for use with subjects or legal representatives in situations in which obtaining such consent may be feasible for some subjects.The preamble to the proposed amendments to the regulations and the amendments themselves contain much more information than is presented here. Readers are therefore encouraged to study the proposals carefully. The public comment period ended November 6, and the FDA is expected to issue a final rule in 1996.Charles R. McCarthyKennedy Institute of Ethics Georgetown University Washington, DCCopyright © 1995 The Johns Hopkins University Press... (shrink)

Somalia, Haiti, Bosnia, and Kosovo. All are examples where humanitarian intervention has been called into action. This timely and important new volume explores the legal and moral issues which emerge when a state uses military force in order to protect innocent people from violence perpetrated or permitted by the government of that state. Humanitarian intervention can be seen as a moral duty to protect but it is also subject to misuse as a front for imperialism without regard to international law. (...) In Humanitarian Intervention, the contributors explore the many questions surrounding the issue. Is humanitarian intervention permitted by international law? If not, is it nevertheless morally permissible or morally required? Realistically, might not the main consequence of the humanitarian intervention principle be that powerful states will coerce weak ones for purposes of their own? The current debate is updated by two innovations in particular, the first being the shift of emphasis from the permissibility of intervening to the responsibility to intervene, and the second an emerging conviction that the response to humanitarian crises needs to be collective, coordinated, and preemptive. The authors shed light on the timely debate of when and how to intervene and when, if ever, not to. Contributors: Carla Bagnoli, Joseph Boyle, Anthony Coates, Thomas Franck, Brian D. Lepard, Catherine Lu, Pratap Bhanu Mehta, Terry Nardin, Thomas Pogge, Melissa S. Williams, and Kok-Chor Tan. (shrink)

Background and ObjectivesUp to 10% of fathers experience perinatal depression, often accompanied by anxiety, with a detrimental impact on the emotional and behavioural development of infants. Yet, few evidence-based interventions specifically for paternal perinatal depression or anxiety exist, and few depressed or anxious fathers engage with support. This mini-review aims to build on the evidence base set by other recent systematic reviews by synthesising more recently available studies on interventions for paternal perinatal depression and anxiety. Secondarily, we also aimed to (...) identify useful information on key implementation strategies, if any, that increase the engagement of men.MethodsWe drew upon three major previous systematic reviews and performed an updated search of PubMed/Medline; Psycinfo; Cochrane Database; Embase and Cinahl. The search was limited to trials, feasibility studies or pilot studies of interventions published between 2015 and 2020 that reported on fathers' perinatal mental health. We included psychological, educational, psychosocial, paternal, couple-focused, or group therapies, delivered face-to-face, via telephone and/or online that reported on either paternal depression, anxiety or both.ResultsEleven studies satisfied search criteria. The majority were randomised controlled trials. Most interventions incorporated counselling, therapy or psychoeducation and took an indirect approach to perinatal mental health through antenatal or postnatal education and were couple-focused. No studies reported a presence of diagnosed depression or anxiety at baseline, although five studies reported a positive effect on sub-threshold symptoms.DiscussionThere was some evidence that these approaches may be useful in the initial engagement of fathers with perinatal supports and improve depression and anxiety scores. No studies targeted the explicit treatment of clinically depressed or anxious men, and this remains the most substantial gap in the peer-reviewed evidence base. Our results highlight the need to deliver perinatal interventions specifically designed for men and evaluate them in populations with clinical levels of depressive and anxious symptomatology. (shrink)

Records the papers and commentaries, with an edited discussion, presented at an international consultation convened by the Council for International Organizations of Medical Sciences (CIOMS) to guide revision of the CIOMS International Ethical Guidelines for Biomedical Research Involving Human Subjects. The Guidelines, first issued in 1982 and then revised in 1993, are being updated and expanded to address a number of new and especially challenging ethical issues. These include issues raised by international collaborative trials of drugs in developing countries, especially (...) expensive drugs, and the use of placebo controls in randomized clinical trials. Others arise from the complexity of research in human genetics, including stem-cell research, and in reproductive biology. Throughout, particular attention is given to the difficult questions that arose during the heated debate over trials in developing countries, of short-duration zidovudine (AZT) therapy to reduce perinatal transmission of HIV. The International Ethical Guidelines for Biomedical Research Involving Human Subjects set out a code of research ethics that is widely used by ethical review committees and other bodies responsible for reviewing and overseeing the ethical design of studies and conduct of research. The revision of the Guidelines is being coordinated by CIOMS, in collaboration with WHO. The consultation centered on seven specially commissioned papers, authored by international experts that explore some of the more difficult issues in depth. Each is followed by an invited commentary, often expressing opposing views, and a summary of the issues or conclusions that emerged during the subsequent debate. The first paper, on justice in international research, deals with the question of whether proposals for research to be conducted in a developing country should make provision for future access of the population involved to the interventions under investigation. Also considered are questions that arise when research uses populations in developing countries to investigate interventions that will be of exclusive benefit to the industrialized world. Case studies of recent drug trials and their research protocols are discussed to illustrate circumstances in which use of populations in developing countries is justified or constitutes exploitation. Ethical challenges of the randomized controlled trial are considered in the second paper, which includes a discussion on the equitable distribution of benefits and risks, the use of placebo for controls, and the obligation to ensure that the participation of controls does not compromise their medical care or endanger their health. A paper on informed consent in international health research considers how cultural factors influence communication and language in the informed-consent process and respect for privacy and confidentiality in the research. Subsequent papers address issues in genetics research and reproductive biology, including the moral status of fetuses and the use of embryos in research, and examine the contribution which international human rights instruments can make in the application of the general principles of ethics to research involving human subjects. The final paper gives an overview of capacity building and the role of communities in international biomedical research. (shrink)

Rumination is associated with psychological adjustment and WM capacity. Studies have shown that psychological interventions such as expressive writing can reduce negative rumination and improve WM capacity. The present study investigated the effect of positive rumination training in expressive writing on psychological adjustment and WM updating. Within an experimental design, positive rumination was manipulated for 10 participants who were maladaptive ruminators in an experiment using a five week training compared to the control group with 9 participants. Results revealed significant enhancement (...) of psychological adjustment and the response time (RT) of WM updating in the experimental group but not in the control group. The two groups did show signifcant difference of all the outcomes in pretest. But the experimental group showed significantly better oucomes than the control group in posttest. The results indicate that positive rumination training in expressive writing is effective and rumination has a causal influence on WM updating capacity. (shrink)

As interpersonal, racial, social, and international conflicts intensify in the world, it is important to safeguard the mental health of individuals affected by them. According to a Buddhist notion “if you want others to be happy, practice compassion; if you want to be happy, practice compassion,” compassion practice is an intervention to cultivate conflict-proof well-being. Here, compassion practice refers to a form of concentrated meditation wherein a practitioner attunes to friend, enemy, and someone in between, thinking, “I’m going to help (...) them.” The compassion meditation is based on Buddhist philosophy that mental suffering is rooted in conceptual thoughts that give rise to generic mental images of self and others and subsequent biases to preserve one’s egoism, blocking the ultimate nature of mind. To contextualize compassion meditation scientifically, we adopted a Bayesian active inference framework to incorporate relevant Buddhist concepts, including mind, compassion, aggregates, suffering, reification, conceptual thoughts, and superimposition. In this framework, a person is considered a Bayesian Engine that actively constructs phenomena based on the aggregates of forms, sensations, discriminations, actions, and consciousness. When the person embodies rigid beliefs about self and others’ identities and the resulting ego-preserving bias, the person’s Bayesian Engine malfunctions, failing to use prediction errors to update prior beliefs. To counter this problem, after recognizing the causes of sufferings, a practitioner of the compassion meditation aims to attune to all others equally, friends and enemies alike, suspend identity-based conceptual thoughts, and eventually let go of any identity-grasping belief and ego-preserving bias that obscure reality. We present a brain model for the Bayesian Engine of three components: Relation-Modeling, Reality-Checking, and Conflict-Alarming, which are subserved by the Default-Mode Network, Frontoparietal Network and Ventral Attention Network, and Salience Network, respectively. Upon perceiving conflicts, the strengthening or weakening of ego-preserving bias will critically depend on whether the SN up-regulates the DMN or FPN/VAN, respectively. We propose that compassion meditation can strengthen brain regions that are conducive for suspending prior beliefs and enhancing the attunements to the counterparts in conflicts. (shrink)

Postoperative complications of extracting impacted third molar teeth often include pain, trismus, and facial swelling. Recent studies have explored the application of dexamethasone to lessen this inflammation following surgery. We used a systematic review and meta-analysis in this investigation to assess the efficacy of dexamethasone. in reducing postoperative complications. Article searches were conducted using PRISMA guidelines in four electronic databases: Web of Science, PubMed, Embase, and Google Scholar. The keywords were selected according to the data search strategy. The PICO framework (...) (Population, Intervention, Comparison, Outcome) was used to organize this systematic review and using SIGN (Scottish Intercollegiate Guidelines Network) bias assessment. The study used a visual analog scale to assess postoperative pain. The dose of dexamethasone used varied between 8 mg, 1 ml intravenously and 0.3 mg/kg. The results showed variations in the duration of analgesic use and the number of analgesic tablets required. Overall, the use of dexamethasone after third molar surgery was shown to reduce edema and trismus. However, the response to pain reduction was variable. This study concludes that intramuscular, pterygomandibular injection, sublingual, and submucosal administration of dexamethasone can produce better therapeutic effects than conventional postoperative care for extraction of impacted third molar teeth. In particular, During the healing phase swelling, trismus and edema are significantly reduced. (shrink)

Background. In some organisations, traumatic events via direct or indirect exposure are routine experiences. A NICE review (2005; updated in December 2018) of Post-Traumatic Stress Disorder (PTSD) management in primary and secondary care did not address early interventions for trauma in emergency response organisations. Aims. This scoping review was designed to identify previous research which evaluated the use of early interventions following exposure to primary or secondary trauma, to report on the effectiveness of early interventions models. Method. A scoping review (...) was conducted to examine early interventions for trauma with staff in roles potentially exposed to trauma including: emergency response, military and humanitarian aid. Relevant data was extracted from included studies and outcomes were assessed using meta-ethnography. Results. Fifty studies of mixed quality met the inclusion criteria for this review. Synthesis of study outcomes found that early interventions help emergency responders to manage post-incident trauma when they: are delivered in a manner that respects distinct organisational culture; are supported by organisations and senior management, and; harness existing social cohesion and peer support systems within teams. Conclusions. This review demonstrates that early interventions support emergency responders following exposure to trauma when: tailored to the needs of the population, are supported by the host organisation, and harness existing social cohesion and peer support processes within a team or unit. We identify a number of recommendations for the delivery and evaluation of early interventions for psychological trauma in emergency response organisations. (shrink)

Generalisation in evaluative conditioning occurs when the valence acquired by a conditional stimulus (CS), after repeated pairing with an unconditional stimulus (US), spreads to stimuli that are similar to the CS (generalisation stimuli, GS). CS evaluations can be updated via CS instructions that conflict with prior conditioning (negative conditioning + positive instruction). We examined whether CS instructions can update GS evaluations after conditioning. We used alien stimuli where one alien (CSp) from a fictional group was paired with pleasant US (...) images and another alien (CSu) from a different group was paired with unpleasant US images. The other members from the two groups were used as GSs. After conditioning, participants received negative CSp instructions and positive CSu instructions. In Experiment 1, explicit and implicit GS evaluations were measured before and after the instructions. In Experiment 2, we used a between-participants design where one group received positive/negative CS instructions while a control group received neutral instructions. In both experiments, the positive/negative CS instructions caused a reversal of explicit GS evaluations and an elimination of implicit GS evaluations. The findings suggest that generalised evaluations can change after CS instructions which may have implications for interventions aimed at reducing negative group attitudes. (shrink)

Cognitive control processes, such as updating task-relevant information while switching between multiple tasks, are substantially impaired in older adults. However, it has also been shown that these cognitive control processes can be improved by training interventions, e.g., by training in task switching. Here, we applied an event-related potential approach to identify whether a cognitive training improves task-preparatory processes such as updating of relevant task goals. To do so, we applied a pretest-training-posttest design with eight training sessions. Two groups of older (...) adults were either trained in task switching or in performing single tasks and we compared their performance to a group of untrained younger adults. To foster cue updating in the treatment group, we applied a cue-based switching task in which the two task cues were randomly selected prior to target presentation so that participants had time to prepare for the upcoming task. In contrast, the control group also received task cues but those were redundant as only one task had to be performed. We also examined whether training in cue updating during task switching can be transferred to a similar cognitive control task measuring updating of context information, namely a modified version of the AX-Continuous Performance Task. The results revealed training-specific improvements in task switching, that is, a larger improvement in blocks requiring switching in comparison to single tasks at the behavioral level. In addition, training specific-effects were also found at the neuronal level. Older adults trained in cue updating while switching showed a reduction in mixing costs in the cue-related P3, indicating an improvement in preparatory updating processes. Additionally, P3 topography changed with training from a very broad to a parietally focused scalp distribution similar to the one found in younger adults. However, we did not obtain training-specific improvements in context updating in the AX-CPT neither at the behavioral level nor at the neuronal level. Results are discussed in the context of the ongoing debate on whether transfer of cognitive training improvements is possible. (shrink)

Rotating shifts are common among nurses to ensure continuity of care. This scheduling system encompasses several adverse health and performance consequences. One of the most injurious effects of night-time shift work is the deterioration of sleep patterns due to both circadian rhythm disruption and increased sleep homeostatic pressure. Sleep problems lead to secondary effects on other aspects of wellbeing and cognitive functioning, increasing the risk of errors and workplace accidents. A wide range of interventions has been proposed to improve the (...) sleep quality of nurses and promote an increase in attention levels. In recent years, particular attention has been paid to individual and environmental factors mediating the subjective ability to cope with sleep deprivation during the night shift. Given the predictive role of these factors on the negative impact of a night shift, an individualized intervention could represent an effective countermeasure by ensuring suitable management of shift schedules. Therefore, the aims of this mini-review are to: provide an updated overview of the literature on sleep problems in night shift nurses and their adverse consequences; and critically analyze the psychosocial factors that mediate the negative impact of shift work with the ultimate goal of defining an effective countermeasure based on an individualized approach. (shrink)

This Article explores three theories of humanitarian intervention that appear in, or are inspired by, the writings of Hugo Grotius. One theory asserts that natural law authorizes all states to punish violations of the law of nations, irrespective of where or against whom the violations occur, to preserve the integrity of international law. A second theory, which also appears in Grotius’s writings, proposes that states may intervene as temporary legal guardians for peoples who have suffered intolerable cruelties at the hands (...) of their own state. Each of these theories has fallen out of fashion today based on skepticism about their natural law underpinnings and concerns about how they have facilitated Western colonialism. As an alternative, this Article outlines a third theory that builds upon Grotius’s account of humanitarian intervention as a fiduciary relationship, while updating Grotius’s account for the twenty-first century. According to this new fiduciary theory, when states intervene to protect human rights abroad they exercise an oppressed people’s right of self-defense on their behalf and may use force solely for the people’s benefit. As fiduciaries, intervening states bear obligations to consult with and honor the preferences of the people they seek to protect, and they must respect international human rights governing the use of force within the affected state. By clarifying the respective responsibilities of the Security Council and individual states for humanitarian intervention, the fiduciary theory also lends greater coherency to the international community’s “responsibility to protect” human rights. (shrink)

Objectives: Technology can assist and support both people with dementia and caregivers. Recently, technology has begun to embed remote components. Timely with respect to the pandemic, the present work reviews the most recent literature on technology in dementia contexts together with the newest studies about technological support published until October 2020. The final aim is to provide a synthesis of the timeliest evidence upon which clinical and non-clinical decision-makers can rely to make choices about technology in the case of further (...) pandemic waves.Methods: A review of reviews was performed alongside a review of the studies run during the first pandemic wave. PsycInfo, CINAHL, and PubMed-online were the databases inspected for relevant papers published from January 2010.Results: The search identified 420 articles, 30 of which were reviews and nine of which were new studies meeting the inclusion criteria. Studies were first sorted according to the target population, then summarized thematically in a narrative synthesis. The studies targeting technologies for PWD were categorized as follows: monitoring and security purposes, sustaining daily life, and therapeutic interventions. Each category showed potential benefits. Differently, the interventions for caregivers were classified as informative, psycho-education programs, psychosocial-supportive, therapeutic, and cognitive/physical training. Benefits to mental health, skills learning, and social aspects emerged.Conclusions: The evidence shows that technology is well-accepted and can support PWD and caregivers to bypass physical and environmental problems both during regular times and during future pandemic waves. Nevertheless, the lack of a common methodological background is revealed by this analysis. Further and more standardized research is necessary to improve the implementation of technologies in everyday life while respecting the necessary personalization. (shrink)

The transport sector is one of the largest sources of greenhouse gas emissions in New Zealand. To address this issue, the government is planning a set of actions to be implemented in the next 15 years. One of these actions deals with transport emissions and targets for a reduction in light vehicle travel. However, to achieve this goal, there is a need for both an updated assessment of effective interventions and an analysis of their relevance and applicability to the New (...) Zealand context. This report seeks to close the gap by conducting a narrative literature review of a collection of existing literature, supplemented with some targeted searches. With the focus on evidence relevant to New Zealand’s largest and fastest growing urban environments, the report identified 24 publicly available research outputs from around the world (mainly from Western European countries). The papers assessed differ not only in the type of research method and analysis applied but also the form of intervention (s) evaluated, the duration of the intervention and follow-up periods, the characteristics of the population groups or intervention sites studied, the measures, results and metrics relevant to New Zealand, and the outcomes of the interventions. Although these differences may represent a challenge in terms of comparability and transferability, they also provide opportunities and lessons for policy-and decision-makers. Finally, the report discusses the implications of the review and its findings and provides some directions and recommendations for future research, policy and practice for the measurement and evaluation of interventions. (shrink)

BackgroundComorbidity between diabetes mellitus and depression is highly prevalent. The risk of depression in a person with diabetes is approximately twice that of a person without this disease. Depression has a major impact on patient well-being and control of diabetes. However, despite the availability of effective and specific therapeutic interventions for the treatment of depression in people with diabetes, 50% of patients do not receive psychological treatment due to insufficient and difficult accessibility to psychological therapies in health systems. The use (...) of information and communication technologies has therefore been proposed as a useful tool for the delivery of psychological interventions, but it continues to be a field in which scientific evidence is recent and controversial. This systematic review aims to update the available information on the efficacy of psychological interventions delivered through ICTs to improve depressive symptomatology in patients with diabetes.MethodsA systematic review of the literature was performed following the PRISMA guidelines and using MEDLINE, Embase, PubMed, Web of Science, PsycINFO, Scopus, and Cochrane Library databases to search for randomized clinical trials of eHealth treatments for patients with diabetes and comorbid depression from 1995 through 2020. In addition, studies related to follow-up appointments were identified. Inclusion criteria were as follows: randomized clinical trials ; patients with type 1 and type 2 diabetes; adult population over 18 years of age; presence of depressive symptomatology assessed with standardized instruments; treatments for depression based on established psychotherapeutic techniques and principles; delivered through eHealth technologies. We did not limit severity of depressive symptomatology, delivery setting or comparison group. Two coauthors independently reviewed the publications identified for inclusion and extracted data from the included studies. A third reviewer was involved to discuss discrepancies found. The PEDro scale was used to assess the quality of the RCTs. No meta-analysis of the results was performed. The protocol used for this review is available in PROSPERO.ResultsThe initial search identified 427 relevant scientific publications. After removing duplicates and ineligible citations, a total of 201 articles were analyzed in full text. Ten articles met the criteria of this review and were included, obtaining very good scientific quality after evaluation with the PEDro scale. The main results show that the eHealth psychological intervention for depression in patients with diabetes showed beneficial effects both at the end of treatment and in the short and long term for the improvement of depressive symptomatology. The methodology used was very heterogeneous. However, all studies were based on cognitive-behavioral tools and used standardized assessment instruments to evaluate depressive symptomatology or diagnosis of MDD. Glycemic control was assessed by glycosylated hemoglobin, but no benefits were found in improving glycemic control. Only four studies included psychoeducational content on diabetes and depression, but none used tools to improve or enhance adherence to medical prescriptions or diabetes self-care.ConclusionsICT-based psychological interventions for the treatment of depression in people with diabetes appear to be effective in reducing depressive symptomatology but do not appear to provide significant results with regard to glycemic control. Nonetheless, the scientific evidence reported to date is still very limited and the methodology very diverse. In addition, no studies have implemented these systems in routine clinical practice, and no studies are available on the economic analysis of these interventions. Future research should focus on studying and including new tools to ensure improvements in diabetes outcomes and not only on psychological well-being in order to advance knowledge about these treatments. Economic evaluations should also be undertaken to analyze whether these treatment programs implemented using eHealth technologies are cost-effective. (shrink)

Levy (2021 Levy, N. (2021). Bad beliefs: Why they happen to good people. Oxford University Press.[Crossref], [Google Scholar]) argues that bad beliefs predominately stem from automatic (albeit rational) updating in response to testimonial evidence. To counteract such beliefs, then, we should focus on ridding our epistemic environments of misleading testimony. This paper responds as follows. First, I argue that the suite of automatic processes related to bad beliefs extends well beyond the deference-based processes that Levy identifies. Second, I push back (...) against Levy’s claim that bad beliefs stem from wholly rational processes, suggesting that, in many cases, such processes are better characterized as arational. Finally, I note that Levy is too quick to dismiss the role that individuals can play in cleaning up their own epistemic environments, and I suggest one route through which this is possible. (shrink)

The prevalence of fear of movement in persistent pain ranges from 50 to 70%, and it may hinder the subsequent rehabilitation interventions. Therefore, the evaluation of fear of movement/injury plays a crucial role in making clinical treatment decisions conducive to the promotion of rehabilitation and prognosis. In the decision-making process of pain treatment, the assessment of fear of movement/injury is mainly completed by scale/questionnaire. Scale/questionnaire is the most widely used instrument for measuring fear of movement/injury in the decision-making process of (...) pain treatment. At present, the most commonly used scale/questionnaire are the Tampa Scale for Kinesiophobia, the Fear-Avoidance Beliefs Questionnaire, the Kinesiophobia Causes Scale, the Athlete Fear-Avoidance Questionnaire, and the Fear-Avoidance Components Scale. In order to provide necessary tools and references for related research and rehabilitation treatment, this descriptive review is designed as an introduction to the background and content, score system, available language versions, variants of the original questionnaire, and psychometric properties of these scales/questionnaries. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Oldest and Most Respected Uniform in the World1Zelig R. Weinstein“And all the peoples of the earth shall see that the name of the LORD is called upon thee; and they shall be afraid of thee.”(Deuteronomy 28:10)Rabbi Eliezer the Great says that this verse alludes to the Tefillin Shel Rosh, the small leather box containing Biblical verses that are worn by Jewish men on their head. During Talmudic times (...) and for centuries after, devout Jewish men would wear Tefillin the entire day. This practice is now only rarely seen. Since the 1960s, there has been a resurgence of public display of one’s adherence to traditional Jewish practices. It is increasingly common to see Jewish men wearing a yarmulke at work and in public spheres. There are perhaps thousands of Jewish doctors who don’t hesitate to wear their yarmulke in their places of practice–hospital, clinic, private practice.In the 1980s I joined the staff of the Department of Radiology at the Bethesda Naval Hospital as the Director of Neuroradiology and Interventional Radiology. As the hospital’s Neuroradiologist I presented the radiological findings for the cases presented at the bimonthly “brain cutting” sessions. These sessions were well attended by staff, residents and medical students from the Departments of Neurosurgery, Neurology, Neuropathology and Radiology. I was the only traditional Orthodox Jew at the hospital, clearly recognizable as such by the yarmulke I always wore (very unusual in the early 1980s). My yarmulke would provoke occasional good–natured kidding particularly from the neurosurgery staff and residents. [End Page 212]During one of these sessions, kidding about my yarmulke from a small group of residents was reaching a crescendo. The kidding came to a sudden halt when the Chief Resident of Neuro-surgery, a born and bred Louisianan, demanded everyone’s attention. When it quieted down he very sternly ordered everyone to carefully look at their uniforms. Everyone seemed perplexed but all followed suit. Almost a half–minute passed before the Chief Resident, with his thick Southern drawl, spoke. “Our [naval] uniforms are, at most, a couple of hundred years old.” He then pointed toward my yarmulke and said: “Dr. Weinstein’s uniform is thousands of years old and a lot more respected than our uniforms.”This was my initiation into the alluring, usually positive and unexpected fascination and respect that my obvious religiosity had on my patients, their families and my many colleagues during the almost seven years I spent at Bethesda.The story I will tell is very poignant. It involved the family of one of the most senior Chief Petty Officers of the United States Navy.Late one Sunday evening, I received a call from the Chief Resident, Dr. Steve Henning, informing me that the family matriarch had been admitted to Bethesda with relatively acute onset of significant neurological findings. The emergent workup confirmed the presence of a large mass, a meningioma, of the frontal lobe region with significant surrounding edema and mass effect. Neurosurgery requested embolization of the feeding vessels prior to surgery. The interventional procedure and possible serious complications were fully explained to the patient, her husband and her two daughters. Consent was signed and early Monday morning the patient was brought to Special Procedures to have the tumor embolized.Prior to the procedure I introduced myself to the patient’s family and spoke to them about the procedure. The patient’s husband and two daughters, one of whom was an active duty Navy nurse the other a minister of a fundamentalist church in the South, were very attentive and expressed concern about the procedure and its outcome. I tried to reassure them and told them I would speak to them during and after the procedure.All went well. Medically, the patient did well during and after the procedure. She was discharged from our care to neurosurgery. The patient and her family thanked us.After the patient left the Special Procedures area the Chief Technologist, Al, approached me and very cryptically asked if I was aware of what happened when the Chief Resident, Dr. Henning, spoke with the patient and family the night before. I was puzzled and replied, no. He... (shrink)

The International Commission on Radiological Protection — whose regularly updated recommendations are routinely adopted as law throughout the globe — recently issued the first-ever ICRP protections for the environment. These draft 2005 proposals are significant both because they offer the commission’s first radiation protections for any non-human parts of the planet and because they will influence both the quality of radiation risk assessment and environmental protection, as well as the global costs of nuclear-weapons cleanup, reactor decommissioning and radioactive waste management. (...) This piece argues that the 2005 recommendations are scientifically and ethically flawed, or gray, in at least three respects: first, in largely ignoring scientific journals while employing mainly “gray literature;” second, in relying on non-transparent dose estimates and models, rather than on actual radiation measurements; and third, in ignoring classical ethical constraints on acceptable radiation risk. (shrink)

Although an invasive medical intervention, Deep Brain Stimulation (DBS) has been regarded as an efficient and safe treatment of Parkinson’s disease for the last 20 years. In terms of clinical ethics, it is worth asking whether the use of DBS may have unanticipated negative effects similar to those associated with other types of psychosurgery. Clinical studies of epileptic patients who have undergone an anterior temporal lobectomy have identified a range of side effects and complications in a number of domains: psychological, (...) behavioural, affective and social. In many cases, patients express difficulty adjusting from being chronically ill to their new status as ‘treated’ or ‘seizure free’. This postoperative response adjustment has been described in the literature on epilepsy as the ‘Burden of Normality’ (BoN) syndrome. Most of the discussion about DBS postoperative changes to self is focused on abnormal side effects caused by the intervention (ie, hypersexuality, hypomania, etc). By contrast, relatively little attention is paid to the idea that successfully ‘treated’ individuals might experience difficulties in adjusting to becoming ‘normal’. The purpose of this paper is (1) to articulate the postoperative DBS psychosocial adjustment process in terms of the BoN syndrome, (2) to address whether the BoN syndrome illustrates that DBS treatment poses a threat to the patient’s identity, and (3) to examine whether the current framework for rehabilitation after DBS procedures should be updated and take into account the BoN syndrome as a postoperative self-change response. (shrink)

With the increasing prevalence of Internet usage, Internet-Delivered Psychological Treatment (IDPT) has become a valuable tool to develop improved treatments of mental disorders. IDPT becomes complicated and labor intensive because of overlapping emotion in mental health. To create a usable learning application for IDPT requires diverse labeled datasets containing an adequate set of linguistic properties to extract word representations and segmentations of emotions. In medical applications, it is challenging to successfully refine such datasets since emotion-aware labeling is time consuming. Other (...) known issues include vocabulary sizes per class, data source, method of creation, and baseline for the human performance level. This paper focuses on the application of personalized mental health interventions using Natural Language Processing (NLP) and attention-based in-depth entropy active learning. The objective of this research is to increase the trainable instances using a semantic clustering mechanism. For this purpose, we propose a method based on synonym expansion by semantic vectors. Semantic vectors based on semantic information derived from the context in which it appears are clustered. The resulting similarity metrics help to select the subset of unlabeled text by using semantic information. The proposed method separates unlabeled text and includes it in the next active learning mechanism cycle. Our method updates model training by using the new training points. The cycle continues until it reaches an optimal solution, and it converts all the unlabeled text into the training set. Our in-depth experimental results show that the synonym expansion semantic vectors help enhance training accuracy while not harming the results. The bidirectional Long Short-Term Memory (LSTM) architecture with an attention mechanism achieved 0.85 Receiver Operating Characteristic (ROC curve) on the blind test set. The learned embedding is then used to visualize the activated word's contribution to each symptom and find the psychiatrist's qualitative agreement. Our method improves the detection rate of depression symptoms from online forum text using the unlabeled forum texts. (shrink)

Extensively updated to include clinical findings over the last two decades, this third edition of A Practitioner's Guide to Rational-Emotive Behavior Therapy reviews the philosophy, theory, and clinical practice of Rational Emotive Behavior Therapy. This model is based on the work of Albert Ellis, who had an enormous influence on the field of psychotherapy over his 50 years of practice and scholarly writing. Designed for both therapists-in-training and seasoned professionals, this practical treatment manual and guide introduces the basic principles of (...) rational-emotive behavior therapy, explains general therapeutic strategies, and offers many illustrative dialogues between therapist and patient. The volume breaks down each stage of therapy to present the exact procedures and skills therapists need, and numerous case studies illustrate how to use these skills. The authors describe both technical and specific strategic interventions, and they stress taking an integrative approach. The importance of building a therapeutic alliance and the use of cognitive, emotive, evocative, imaginal, and behavioral interventions serves as the unifying theme of the approach. Intervention models are presented for the treatment of anxiety, depression, trauma, anger, personality disorders, and addictions. Psychologists, clinical social workers, mental health counselors, psychotherapists, and students and trainees in these areas will find this book useful in learning to apply rational-emotive behavior therapy in practice. (shrink)

ABSTRACT I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments. INTRODUCTION In contrast to the classic model of randomized-control trials, often with a large number of (...) subjects enrolled, precision medicine attempts to optimize therapeutic outcomes by focusing on the individual.[i] A recent publication highlights the strengths and weakness of both traditional evidence-based medicine and precision medicine.[ii] Plus, it outlines a tension in the shift from evidence-based medicine’s inductive reasoning style (the collection of data to postulate general theories) to precision medicine’s abductive reasoning style (the generation of an idea from the limited data available).[iii] The paper’s main example is the application of precision medicine for the treatment of cancer.[iv] I argue that this examination and appreciation for the shift to abductive reasoning should be extended to the intersection of neuroscience and novel brain-computer interfaces too. As the name suggests, brain-computer interfaces are a significant advancement in neurotechnology that directly connects someone’s brain to external or implanted devices.[v] Among the various kinds of brain-computer interfaces, adaptive deep brain stimulation devices require numerous personalized adjustments to their settings during the implantation and computation stages in order to provide adequate relief to patients with treatment-resistant disorders. What makes these devices unique is how adaptive deep brain stimulation integrates a sensory component to initiate the stimulation. While not commonly at the level of sophistication as self-supervising or generative large language models,[vi] they currently allow for a semi-autonomous form of neuromodulation. This paper highlights the implications of applying abductive reasoning to personalized implantable neurotechnologies. Then, it explores whether abductive reasoning is sufficient to justify insurance coverage for devices absent widespread clinical trials, which are better applied to one-size-fits-all treatments.[vii] ANALYSIS I. The State of Precision Medicine in Oncology and the Epistemological Shift While a thorough overview of precision medicine for the treatment of cancer is beyond the scope of this article, its practice can be roughly summarized as identifying clinically significant characteristics a patient possesses (e.g., genetic traits) to land on a specialized treatment option that, theoretically, should benefit the patient the most.[viii] However, in such a practice of stratification patients fall into smaller and smaller populations and the quality of evidence that can be applied to anyone outside these decreases in turn.[ix] As inductive logic helps to articulate, the greater the number of patients that respond to a particular therapy the higher the probability of its efficacy. By straying from this logical framework, precision medicine opens the treatment of cancer to more uncertainty about the validity of these approaches to the resulting disease subcategories.[x] Thus, while contemporary medical practices explicitly describe some treatments as “personalized”, they ought not be viewed as inherently better founded than other therapies.[xi] A relevant contemporary case of precision medicine out of Norway focuses on the care of a patient with cancer between the ventricles of the heart and esophagus, which had failed to respond to the standard regimen of therapies over four years.[xii] In a last-ditch effort, the patient elected to pay out-of-pocket for an experimental immunotherapy (nivolumab) at a private hospital. He experienced marked improvements and a reduction in the size of the tumor. Understandably, the patient tried to pursue further rounds of nivolumab at a public hospital. However, the hospital initially declined to pay for it given the “lack of evidence from randomised clinical trials for this drug relating to this [patient’s] condition.”[xiii] In rebuttal to this claim, the patient countered that he was actually similar to a subpopulation of patients who responded in “open‐label, single arm, phase 2 studies on another immune therapy drug” (pembrolizumab).[xiv] Given this interpretation of the prior studies and the patient’s response, further rounds of nivolumab were approved. Had the patient not had improvements in the tumor’s size following a round of nivolumab, then pembrolizumab’s prior empirical evidence in isolation would have been insufficient, inductively speaking, to justify his continued use of nivolumab.[xv] The case demonstrates a shift in reasoning from the traditional induction to abduction. The phenomenon of ‘cancer improvement’ is considered causally linked to nivolumab and its underlying physiological mechanisms.[xvi] However, “the weakness of abductions is that there may always be some other better, unknown explanation for an effect. The patient may for example belong to a special subgroup that spontaneously improves, or the change may be a placebo effect. This does not mean, however, that abductive inferences cannot be strong or reasonable, in the sense that they can make a conclusion probable.”[xvii] To demonstrate the limitations of relying on the abductive standard in isolation, commentators have pointed out that side effects in precision medicine are hard to rule out as being related to the initial intervention itself unless trends from a group of patients are taken into consideration.[xviii] As artificial intelligence (AI) assists the development of precision medicine for oncology, this uncertainty ought to be taken into consideration. The implementation of AI has been crucial to the development of precision medicine by providing a way to combine large patient datasets or a single patient with a large number of unique variables with machine learning to recommend matches based on statistics and probability of success upon which practitioners can base medical recommendations.[xix] The AI is usually not establishing a causal relationship[xx] – it is predicting. So, as AI bleeds into medical devices, like brain-computer interfaces, the same cautions about using abductive reasoning alone should be carried over. II. Responsive Neurostimulation, AI, and Personalized Medicine Like precision medicine in cancer treatment, computer-brain interface technology similarly focuses on the individual patient through personalized settings. In order to properly expose the intersection of AI, precision medicine, abductive reasoning, and implantable neurotechnologies, the descriptions of adaptive deep brain stimulation systems need to deepen.[xxi] As a broad summary of adaptive deep brain stimulation, to provide a patient with the therapeutic stimulation, a neural signal, typically referred to as a local field potential,[xxii] must first be detected and then interpreted by the device. The main adaptive deep brain stimulation device with premarket approval, the NeuroPace Responsive Neurostimulation system, is used to treat epilepsy by detecting and storing “programmer-defined phenomena.”[xxiii] Providers can optimize the detection settings of the device to align with the patient’s unique electrographic seizures as well as personalize the reacting stimulation’s parameters.[xxiv] The provider adjusts the technology based on trial and error. One day machine learning algorithms will be able to regularly aid this process in myriad ways, such as by identifying the specific stimulation settings a patient may respond to ahead of time based on their electrophysiological signatures.[xxv] Either way, with AI or programmers, adaptive neurostimulation technologies are individualized and therefore operate in line with precision medicine rather than standard treatments based on large clinical trials. Contemporary neurostimulation devices are not usually sophisticated enough to be prominent in AI discussions where the topics of neural networks, deep learning, generative models, and self-attention dominate the conversation. However, implantable high-density electrocorticography arrays (a much more sensitive version than adaptive deep brain stimulation systems use) have been used in combination with neural networks to help patients with neurologic deficits from a prior stroke “speak” through a virtual avatar.[xxvi] In some experimental situations, algorithms are optimizing stimulation parameters with increasing levels of independence.[xxvii] An example of neurostimulation that is analogous to the use of nivolumab in Norway surrounds a patient in the United States who was experiencing both treatment-resistant OCD and temporal lobe epilepsy.[xxviii]Given the refractory nature of her epilepsy, implantation of an adaptive deep brain stimulation system was indicated. As a form of experimental therapy, her treatment-resistant OCD was also indicated for the off-label use of an adaptive deep brain stimulation set-up. Another deep brain stimulation lead, other than the one implanted for epilepsy, was placed in the patient’s right nucleus accumbens and ventral pallidum region given the correlation these nuclei had with OCD symptoms in prior research. Following this, the patient underwent “1) ambulatory, patient-initiated magnet-swipe storage of data during moments of obsessive thoughts; (2) lab-based, naturalistic provocation of OCD-related distress (naturalistic provocation task); and (3) lab-based, VR [virtual reality] provocation of OCD-related distress (VR provocation task).”[xxix] Such signals were used to identify when to deliver the therapeutic stimulation in order to counter the OCD symptoms. Thankfully, following the procedure and calibration the patient exhibited marked improvements in their OCD symptoms and recently shared her results publicly.[xxx] In both cases, there is a similar level of abductive justification for the efficacy of the delivered therapy. In the case study in which the patient was treated with adaptive deep brain stimulation, they at least had their neural activity tested in various settings to determine the optimum parameters for treatment to avoid them being based on guesswork. Additionally, the adaptive deep brain stimulation lead was already placed before the calibration trials were conducted, meaning that the patient had already taken on the bulk of the procedural risk before the efficacy could be determined. Such an efficacy test could have been replicated in the first patient’s cancer treatment, had it been biopsied and tested against the remaining immunotherapies in vitro. Yet, in the case of cancer with few options, one previous dose of a drug that appeared to work on the patient may justify further doses. However, as the Norwegian case presents, corroboration with known responses to a similar drug (from a clinical trial) could be helpful to validate the treatment strategy. (It should be noted that both patients were resigned to these last resort options regardless of the efficacy of treatment.) There are some elements of inductive logic seen with adaptive deep brain stimulation research in general. For example, abductively the focus could be that patient X’s stimulation parameters are different from patient Y’s and patient Z’s. In contrast, when grouped as subjects who obtained personalized stimulation, patients X, Y, and Z demonstrate an inductive aspect to this approach’s safety and/or efficacy. The OCD case holds plenty of abductive characteristics in line with precision medicine’s approach to treating cancer and as more individuals try the method, there will be additional data. With the gradual integration of AI into brain-computer interfaces in the name of efficacy, this reliance on abduction will continue, if not grow, over time. Moving forward, if a responsive deep brain stimulation treatment is novel and individualized (like the dose of nivolumab) and there is some other suggestion of efficacy (like clinical similarities to other patients in the literature), then it may justify insurance coverage for the investigative intervention, absent other unrelated reasons to deny it. III. Ethical Implications and Next Steps While AI’s use in oncology and neurology is not yet as prominent as its use in other fields (e.g., radiology), it appears to be on the horizon for both.[xxxi] AI can be found in both the functioning of the neurotechnologies as well as the implementation of precision medicine. The increasing use of AI may serve to further individualize both oncologic and neurological therapies. Given these implications and the handful of publications cited in this article, it is important to have a nuanced evaluation of how these treatments, which heavily rely on abductive justification, ought to be managed. The just use an abductive approach may be difficult as AI infused precision medicine is further pursued. At baseline, such technology relies on a level of advanced technology literacy among the general public and could exclude populations who lack access to basic technological infrastructure or know-how from participation.[xxxii] Even among nations with adequate infrastructure, as more patients seek out implantable neurotechnologies, which require robust healthcare resources, the market will favor patient populations that can afford this complex care.[xxxiii] If patients already have the means to pay for an initial dose/use of a precision medicine product out of pocket, should insurance providers be required to cover subsequent treatments?[xxxiv] That is, if a first dose of a cancer drug or a deep brain stimulator over its initial battery life is successful, patients may feel justified in having the costs of further treatments covered. The Norwegian patient’s experience implies there is a precedent for the idea that some public insurance companies ought to cover successful cancer therapies, however, insurance companies may not all see themselves as obligated to cover neurotechnologies that rely on personalized settings or that are based on precision/abductive research more than on clinical trials. CONCLUSION The fact that the cases outlined above rely on abductive style of reasoning implies that there may not be as strong a justification for coverage by insurance, as they are both experimental and individualized, when compared to the more traditional large clinical trials in which groups have the same or a standardized protocol (settings/doses). If a study is examining the efficacy of a treatment with a large cohort of patients or with different experimental groups/phases, insurance companies may conclude that the resulting symptom improvements are more likely to be coming from the devices themselves. A preference for inductive justification may take priority when ruling in favor of funding someone’s continued use of an implantable neurostimulator. There are further nuances to this discussion surrounding the classifications of these interventions as research versus clinical care that warrant future exploration, since such a distinction is more of a scale[xxxv] than binary and could have significant impacts on the “right-to-try” approach to experimental therapies in the United States.[xxxvi] Namely, given the inherent limitations of conducting large cohort trials for deep brain stimulation interventions on patients with neuropsychiatric disorders, surgically innovative frameworks that blend abductive and inductive methodologies, like with sham stimulation phases, have traditionally been used.[xxxvii] Similarly, for adaptive brain-computer interface systems, if there are no large clinical trials and instead only publications that demonstrate that something similar worked for someone else, then, in addition to the evidence that the first treatment/dose worked for the patient in question, the balance of reasoning would be valid and arguably justify insurance coverage. As precision approaches to neurotechnology become more common, frameworks for evaluating efficacy will be crucial both for insurance coverage and for clinical decision making. ACKNOWLEDGEMENT This article was originally written as an assignment for Dr. Francis Shen’s “Bioethics & AI” course at Harvard’s Center for Bioethics. I would like to thank Dr. Shen for his comments as well as my colleagues in the Lázaro-Muñoz Lab for their feedback. - [i] Jonathan Kimmelman and Ian Tannock, “The Paradox of Precision Medicine,” Nature Reviews. Clinical Oncology 15, no. 6 (June 2018): 341–42, https://doi.org/10.1038/s41571-018-0016-0. [ii] Henrik Vogt and Bjørn Hofmann, “How Precision Medicine Changes Medical Epistemology: A Formative Case from Norway,” Journal of Evaluation in Clinical Practice 28, no. 6 (December 2022): 1205–12, https://doi.org/10.1111/jep.13649. [iii] David Barrett and Ahtisham Younas, “Induction, Deduction and Abduction,” Evidence-Based Nursing 27, no. 1 (January 1, 2024): 6–7, https://doi.org/10.1136/ebnurs-2023-103873. [iv] Vogt and Hofmann, “How Precision Medicine Changes Medical Epistemology,” 1208. [v] Wireko Andrew Awuah et al., “Bridging Minds and Machines: The Recent Advances of Brain-Computer Interfaces in Neurological and Neurosurgical Applications,” World Neurosurgery, May 22, 2024, S1878-8750(24)00867-2, https://doi.org/10.1016/j.wneu.2024.05.104. [vi] Mark Riedl, “A Very Gentle Introduction to Large Language Models without the Hype,” Medium (blog), May 25, 2023, https://mark-riedl.medium.com/a-very-gentle-introduction-to-large-language-models-without-the-hype-5 f67941fa59e. [vii] David E. Burdette and Barbara E. Swartz, “Chapter 4 - Responsive Neurostimulation,” in Neurostimulation for Epilepsy, ed. Vikram R. Rao (Academic Press, 2023), 97–132, https://doi.org/10.1016/B978-0-323-91702-5.00002-5. [viii] Kimmelman and Tannock, 2018. [ix] Kimmelman and Tannock, 2018. [x] Simon Lohse, “Mapping Uncertainty in Precision Medicine: A Systematic Scoping Review,” Journal of Evaluation in Clinical Practice 29, no. 3 (April 2023): 554–64, https://doi.org/10.1111/jep.13789. [xi] Kimmelman and Tannock, “The Paradox of Precision Medicine.” [xii] Vogt and Hofmann, 1206. [xiii] Vogt and Hofmann, 1206. [xiv] Vogt and Hofmann, 1206. [xv] Vogt and Hofmann, 1207. [xvi] Vogt and Hofmann, 1207. [xvii] Vogt and Hofmann, 1207. [xviii] Vogt and Hofmann, 1210. [xix] Mehar Sahu et al., “Chapter Three - Artificial Intelligence and Machine Learning in Precision Medicine: A Paradigm Shift in Big Data Analysis,” in Progress in Molecular Biology and Translational Science, ed. David B. Teplow, vol. 190, 1 vols., Precision Medicine (Academic Press, 2022), 57–100, https://doi.org/10.1016/bs.pmbts.2022.03.002. [xx] Stefan Feuerriegel et al., “Causal Machine Learning for Predicting Treatment Outcomes,” Nature Medicine 30, no. 4 (April 2024): 958–68, https://doi.org/10.1038/s41591-024-02902-1. [xxi] Sunderland Baker et al., “Ethical Considerations in Closed Loop Deep Brain Stimulation,” Deep Brain Stimulation 3 (October 1, 2023): 8–15, https://doi.org/10.1016/j.jdbs.2023.11.001. [xxii] David Haslacher et al., “AI for Brain-Computer Interfaces,” 2024, 7, https://doi.org/10.1016/bs.dnb.2024.02.003. [xxiii] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 103–4; “Premarket Approval (PMA),” https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpma/pma.cfm?id=P100026. [xxiv] Burdette and Swartz, “Chapter 4 - Responsive Neurostimulation,” 104. [xxv] Burdette and Swartz, 126. [xxvi] Sean L. Metzger et al., “A High-Performance Neuroprosthesis for Speech Decoding and Avatar Control,” Nature 620, no. 7976 (August 2023): 1037–46, https://doi.org/10.1038/s41586-023-06443-4. [xxvii] Hao Fang and Yuxiao Yang, “Predictive Neuromodulation of Cingulo-Frontal Neural Dynamics in Major Depressive Disorder Using a Brain-Computer Interface System: A Simulation Study,” Frontiers in Computational Neuroscience 17 (March 6, 2023), https://doi.org/10.3389/fncom.2023.1119685; Mahsa Malekmohammadi et al., “Kinematic Adaptive Deep Brain Stimulation for Resting Tremor in Parkinson’s Disease,” Movement Disorders 31, no. 3 (2016): 426–28, https://doi.org/10.1002/mds.26482. [xxviii] Young-Hoon Nho et al., “Responsive Deep Brain Stimulation Guided by Ventral Striatal Electrophysiology of Obsession Durably Ameliorates Compulsion,” Neuron 0, no. 0 (October 20, 2023), https://doi.org/10.1016/j.neuron.2023.09.034. [xxix] Nho et al. [xxx] Nho et al.; Erik Robinson, “Brain Implant at OHSU Successfully Controls Both Seizures and OCD,” OHSU News, accessed March 3, 2024, https://news.ohsu.edu/2023/10/25/brain-implant-at-ohsu-successfully-controls-both-seizures-and-ocd. [xxxi] Awuah et al., “Bridging Minds and Machines”; Haslacher et al., “AI for Brain-Computer Interfaces.” [xxxii] Awuah et al., “Bridging Minds and Machines.” [xxxiii] Sara Green, Barbara Prainsack, and Maya Sabatello, “The Roots of (in)Equity in Precision Medicine: Gaps in the Discourse,” Personalized Medicine 21, no. 1 (January 2024): 5–9, https://doi.org/10.2217/pme-2023-0097. [xxxiv] Green, Prainsack, and Sabatello, 7. [xxxv] Robyn Bluhm and Kirstin Borgerson, “An Epistemic Argument for Research-Practice Integration in Medicine,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 43, no. 4 (July 9, 2018): 469–84, https://doi.org/10.1093/jmp/jhy009. [xxxvi] Vijay Mahant, “‘Right-to-Try’ Experimental Drugs: An Overview,” Journal of Translational Medicine 18 (June 23, 2020): 253, https://doi.org/10.1186/s12967-020-02427-4. [xxxvii] Michael S. Okun et al., “Deep Brain Stimulation in the Internal Capsule and Nucleus Accumbens Region: Responses Observed during Active and Sham Programming,” Journal of Neurology, Neurosurgery & Psychiatry 78, no. 3 (March 1, 2007): 310–14, https://doi.org/10.1136/jnnp.2006.095315. (shrink)

With new technologies come new ethical challenges. Often, we can apply previously established principles, even though it may take some time to fully understand the detail of the new technology - or the questions that arise from it. The International Commission on Radiological Protection, for example, was founded in 1928 and has based its advice on balancing the radiation exposure associated with X-rays and CT scans with the diagnostic benefits of the new investigations. They have regularly updated their advice as (...) evidence has accumulated and technologies have changed,1 and have been able to extrapolate from well-established ethical principles. Other new technologies lend themselves less well to off-the-peg ethical solutions. In several articles in this edition the ethical challenges associated with the use of artificial intelligence in medicine are addressed. Although multiple ethical codes and guidelines have been written on the use and development of AI, Hagendorf noted that many of them reiterated a ‘ deontologically oriented, action-restricting ethic based on universal abidance of principles and rules’. 2 Applying pre-existing ethical frameworks to artificial intelligence is problematic for several reasons. In particular, AI has two characteristics which are very different from the current clinical practice on which traditional medical ethics are based: 1. The so called ‘black box’ of deep learning, whereby a deep neural network is trained to iteratively adapt to make …. (shrink)

This paper seeks to understand the treatment effect of Prescription Drug Monitoring Programs on opioid prescription rates. Using county-level panel data on all opioid prescriptions in the U.S. between 2006 and 2015, we investigate whether state interventions like PDMPs have heterogeneous treatment effects at the sub-state level, based on regional and temporal variations in policy design, extent of urbanization, race, and income. Our models comprehensively control for a set of county and time fixed effects, countyspecific and time-varying demographic controls, potentially (...) endogenous time-series trends in prescription rates, and other state-level opioid interventions such as Naloxone Access and Good Samaritan laws, Medicaid expansion, and the provision of Methadone Assistance Treatment. We find that PDMPs are only effective in reducing prescription rates if they obligate doctors to check for patients' history prior to filling out a prescription, but the frequency at which a state requires its PDMP to be updated is irrelevant to its effectiveness. Moreover, the significant treatment effects of PDMPs are almost exclusively driven by urban and predominantly white counties, with the relatively more affluent regions showing greater responsiveness than their less affluent counterparts. (shrink)

Now in its fourth edition, Rational Diagnosis and Treatment: Evidence-Based Clinical Decision - Making is a unique book to look at evidence-based medicine and the difficulty of applying evidence from group studies to individual patients._ The book analyses the successive stages of the decision process and deals with topics such as the examination of the patient,_the reliability of clinical data, the logic of diagnosis, the fallacies of uncontrolled therapeutic experience and the need for randomised clinical trials and meta-analyses. It is (...) the main theme of the book that, whenever possible, clinical decisions must be based on the evidence from clinical research, but the authors also explain the pitfalls of such research and the problems involved in applying evidence from groups of patients to the individual patient._ For this new edition, the sections on placebo and meta-analysis and on alternative medicine have been thoroughly updated, and there is more focus on insufficient reporting of harms of interventions. The sections on different research designs describe advantages and limitations, and the increased medicalisation and the effects of cancer screening on health people are noted. A section on academic freedom when clinicians collaborate with industry and ghost authors is added._ This essential reference work integrates the science and statistical approach of evidence-based medicine with the art and humanism of medical practice; distinguishing between data, sets of data, knowledge and wisdom, and their application. Such an intellectually challenging book is ideal for both medical students and doctors who require theoretical and practical clinical skills to help ensure that they apply theory in practice. (shrink)

To give substance to the rhetoric of ‘learning health systems’, a variety of novel trial designs are being explored to more seamlessly integrate research with medical practice, reduce study duration and reduce the number of participants allocated to ineffective interventions. Many of these designs rely on response adaptive randomisation. However, critics charge that RAR is unethical on the grounds that it violates the principle of equipoise. In this paper, I reconstruct critiques of RAR as holding that it is inconsistent with (...) five important ethical principles. I then argue that these criticisms rest on a faulty view of equipoise encouraged by the idea that a RAR study models the beliefs of a single rational agent about the relative merits of the interventions being studied. I outline a view in which RAR models an idealised health system in which diverse communities of fully informed experts shrink or grow as their constituent members update their expert opinions in light of reliable medical evidence. I show how a proper understanding of clinical equipoise can reconcile this conception of RAR with these five ethical principles. This analysis removes an in-principle objection to RAR and sheds important light on the relationship between clinical equipoise and transient diversity in the scientific community. (shrink)

Adopting a broadly compatibilist approach, this volume's authors argue that the behavioral and mind sciences do not threaten the moral foundations of legal responsibility. Rather, these sciences provide fresh insight into human agency and updated criteria as well as powerful diagnostic and intervention tools for assessing and altering minds.

BackgroundYouth substance use is a public health problem globally, where alcohol is one of the drugs most consumed by children, and youth prevention is the best intervention for drug abuse.ObjectiveReview the latest evidence of alcohol use prevention programs in empirical research, oriented to all fields of action among children and youth.MethodsA narrative and critical review was carried out within international databases in August 2021 and was limited to empirical studies that appeared in the last five years. A flow diagram was (...) used according to the PRISMA statements. Empirical research articles in English with RCTs and quasi-experimental design that included alcohol, children, and young people up to 19 years of age were included. The authors examined the results and conceptual frameworks of the Prevention programs by fields of action.ResultsTwenty-two articles were found from four fields of action: school, family, community, and web-based, representing 16 alcohol prevention programs. School-based alcohol prevention programs are clinically relevant [Theory of Planned Behavior, Refuse, Remove, Reasons, Preventure, The GOOD Life, Mantente REAL, Motivational Interviewing, Primavera, Fresh Start, Bridges/Puentes], they are effective in increasing attitudes and intentions toward alcohol prevention behavior, while decreasing social norms and acceptance of alcohol, reducing intoxication, and increasing perceptions with regards to the negative consequences of drinking.DiscussionThis narrative and critical review provides an updated synthesis of the evidence for prevention programs in the school, family, community, and web-based fields of action, where a more significant number of programs exist that are applied within schools and for which would have greater clinical relevance. However, the prevention programs utilized in the other fields of action require further investigation. (shrink)

B a c k g r o u n d. Considering a scientific truth as a process is connected with the understanding a concrete truth as unity of absolute and relative moments of such process. Beginning by Hegel, truth was regarded as linear process with final point of its development. It was absolute truth, as return of absolute idea to itself in absolute spirit by Hegel. It was the third world by Popper as the world of objective truth. Ukrainian philosopher (...) Pavlo Kopnin opened development of truth for future, eliminating from it the final point in his materialistic interpretation of the truth as a process. However, such process was still regarded as linear process. It was natural for the stage of linear science. As I have already wrote (Dobronravova, 2017), modern stage of nonlinear science actualizes the considering of a scientific truth as nonlinear process. In situation of many variants of nonlinear dynamics the understanding of concrete truth needs to be updated. Such updating is the goal of the article. M e t h o d s. Dialectic method in addition to scientific realism is the most natural approach to research the modern nonlinear science. Methodologic conception of genetic constructivism by V. Stepin is foundation to consider the relations between theoretical and empirical levels of nonlinear knowledge. Criticism of correspondent conception of truth in internal realism by H.Putnam is initiative position in looking for right epistemolology of nonlinear science. Concrete truth as nonlinear process means the description of real nonlinear dynamics with knowledge about a choice, made by a self-organizing system between alternatives in bifurcation point. Nonlinear theories reconstruct few options of further development for nonlinear system. To explain a real situation in certain moment of such development means to describe the real choices by system in points of branching the possibilities. It means that nonlinear science becomes historical one that describes irreversible change of events. Methodologically it means the restriction for claim to repeat the results of empirical checking the predictions of theory, because of choice by chance in bifurcation points. This claim can work for nonlinear medium if different options can be realized in it simultaneously (like Benar's cells in layer of heated liquid or different parties in democratic societies). Otherwise things are going in the situations of historical kind, where the irreversible choice between alternatives has place (like historical choice between right-hand and left-hand traffic in different countries). Repetitions in empirical checking the predicted variants are not possible in principle because of random nature of choice in bifurcation points. R e s u l t s. Non-linear physical theories are descriptive, just like biological, geological and geographic theories. So arrogant condemnation of such theories by physicists and philosophers of science who took physics as a sample in many previous years founded on misunderstanding the specificity of different kinds of theories and their objects. Logical structure of explanation and prediction are not the same in non-linear theories. Non-linear theory can predict a set of possibilities but not the realization of certain one in certain moment. Concrete truth can be justified if human intervention provides the realization of special condition to choose selected variant. C o n c l u s i o n s. We have to understand that such task is more complicated, if we take into account the quantitative way to solve the nonlinear equations. The chain of iterations in approximate solution of such equations can rather give computer simulation of non-linear dynamics. Exact prediction with iteration formula of each next step of unfolding non-linear dynamics, does not guarantee the long scale prediction of complex nonlinear system state. It does not mean that knowledge we got about nonlinear phenomena are not useful for human practice. Thus, the change of dimension in fractal structures of "noise" in cardiograms lets to admit the first signs of heart illness and to cure heart in time. Meteorologists can warn pilots about oncoming storm, defining speed of rising flows in atmosphere by fractal dimension of pictures on the screen of radar. Those are the predictions in nonlinear science. Are they the proofs of concrete truth? Perhaps, yes, they are if we recall old formulation about practice as criteria of truth. (shrink)

This paper argues that the interventionist account of causation faces a dilemma concerning macroscopic causation – i.e., causation by composite objects. Interventionism must either require interventions on a composite object to hold the behavior of its parts fixed, or allow such interventions to vary the behavior of those parts. The first option runs the risk of making wholes causally excluded by their parts, while the second runs the risk of mistakenly ascribing to wholes causal abilities that belong to their parts (...) only. Using as starting point Baumgartner’s well-known argument that interventionism leads to causal exclusion of multiply realized properties, I first show that a similar interventionist exclusion argument can be mounted against the causal efficacy of composite objects. I then show that Woodward’s (2015) updated interventionist account (explicitly designed to address exclusion worries) avoids this problem, but runs into an opposite issue of over-inclusion: it grants to composites causal abilities that belong to their parts only. Finally, I examine two other interventionist accounts designed to address Baumgartner’s argument, and show that when applied to composites, they too fall on one horn (exclusion) or the other (over-inclusion) of the dilemma. I conclude that the dilemma constitutes an open and difficult issue for interventionism. (shrink)

Prenatal ultrasound use is skyrocketing despite limited evidence of improved outcomes. One factor driving this trend is the widely recognized psychological appeal of real-time fetal imaging. Meanwhile, considering imperfect safety evidence, U.S. professional guidelines dictate that prenatal ultrasound—a screening test—should be governed by expected clinical benefits—an opportunity for intervention. However, when women’s healthcare professionals themselves are pregnant, their access to ultrasound technology permits informal, personal use that may deviate from standard-of-care, e.g., for reassurance. Highlighting a poignant case wherein a pregnant (...) obstetrician’s personal ultrasound use had unforeseen negative consequences, we explore this issue within context of professional ethics and informal medical care. We discuss how women’s health professionals’ self-care may influence and inform prenatal care at large. We advocate curtailing informal prenatal ultrasound use, but also potentially broadening accepted indications for or relaxing proscriptions against ultrasounds for patients. Further research and updated, evidence-based, ethically-sound guidelines are needed. (shrink)

Cities are conspicuous among settlements because of their bulk and pace: Venice, Paris, or New York. Each is distinctive, but all share a social structure that mixes systems, their members, and a public regulator. Cities alter this structure in ways specific to themselves: orchestras play music too elaborate for a quartet; city densities promote collaborations unachievable in simpler towns. Cities, Real and Ideal avers with von Bertalanffy, Parsons, Simmel, and Wirth that a theory of social structure is empirically testable and (...) confirmed. It proposes a version of social justice appropriate to this structure, thereby updating Marx s claim that justice is realizable without the intervention of factors additional to society s material conditions.". (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Critical Piety: Our Urgent Need to Recover an Ancient VirtueMary Nickel (bio)But, you see, if you eats these dinners and don’t cook ’em, if you wears these clothes and don’t buy or iron them, then you might start thinking that the good fairy or some spirit did all that. They asked a little white girl in this family I used to work for who made her cake at one (...) of her little tea parties. She said she made it and then she hid her face and said the good fairies made it. Well, you are looking at that good fairy. Black folks don’t have no time to be thinking like that. If I thought like that, I’d burn cakes and scorch skirts. But when you don’t have anything else to do, you can think like that. It’s bad for your mind, though.—Rosa Wakefield1There has been a lamentable trend, in the age since the Great Awakenings, to use the word “piety” as a synonym for “devoutness.” Piety, to the contemporary ear, conjures a sense of personal religious feeling and practice. For example, Saba Mahmood’s distinguished text, Politics of Piety, has as its theme the individual agency of women in Islamic societies. Meanwhile, untold books in the field of religious studies simply use “piety” as a stand-in for “religion.”2 This use of the term is not limited to the academic study of religion; recently, one liberation theologian has even demanded that we move, in the words of the title of his book, Beyond Piety.3 The thesis of that book rests on the premise that piety is altogether private, and insufficiently materially productive.4 [End Page 5]According to the ancients, though, piety is neither of these things. Piety, for Cicero, motivates the pious to “render kind offices and loving service to one’s kin and country.”5 As such, the ancient virtue of piety is fundamentally public, insofar as it pertains to one’s public tribute to her kin and fellow citizens. Furthermore, piety is productive, insofar as it motivates the pious to accomplish good things on behalf of her kin and fellow citizens. The ancient virtue therefore involves the near inverse of what the modern term suggests today.6 Where contemporary uses of the word “piety” are often preceded by the word “personal,” the ancients would have been bewildered by such a formulation.This essay does not dare try to account for how the ancient virtue of piety disintegrated to the point of becoming a matter of private religious practice. For those who are interested in that topic, many historians (and non-historians) offer various narratives to explain that trajectory.7 However, I will refrain from so doing. Instead, in what follows, I seek to illuminate the ancient virtue of piety, and show why we need so urgently to recover it. Piety, the ancients believed, is the virtuous act of acknowledging those things that make our lives possible.Furthermore, I will also update the ancient virtue, so to speak, to situate it in our modern context. That requires three substantial interventions. First, I show that piety must be comprehensive and even prospective. That is: not only ought we to be grateful for those who have made our lives possible up to and including the present moment, but we ought also to be grateful for those whose future work will sustain our continued wellbeing. Second, I show that piety must not only be symbolic or expressive, but also material. However, I do [End Page 6] not intend to neglect the importance of expressive piety. Third, I concentrate on the appropriate means for acknowledging those sources of our being that are not altogether (or at all) commendable. Finally, I offer some reflections on what this meditation on piety might tell us about contemporary American society, including two policy proposals regarding public education and paid family leave.I. Piety, Ancient and ModernPremodern Piety. It can take some effort to comprehend what pietas meant to the ancients, especially given the modern connotations associated with its contemporary English cognate. It takes even more to grasp how central this virtue... (shrink)

Badiou has said that his entire philosophical project stems from the need to “update” the traditional philosophical categories of Truth, Being, the Infinite and the Universal in the wake of the 19th Century German mathematician Georg Cantor’s explication of transfinite set theory. In his essay, “What is Love?”, he provides an account of one of the ways in which a post-Cantorian reconfiguration of the ontological status of the category of Woman might operate. This is given in the form of (...) a postscript subtitled “The Feminine Position and Humanity” wherein he gives Lacan’s conception of supplementary feminine jouissance “an extra turn of the screw”. This essay draws on Badiou’s reconfiguration of the philosophical category of Woman to examine the implications of another postscript, that which abruptly concludes the 2003 novel Elizabeth Costello by J. M. Coetzee. It reads Coetzee’s invention of the “Letter of Elizabeth, Lady Chandos” with recourse to Lacanian psychoanalytic theory and on through the ontological reconfiguration of the philosophical category of Woman demonstrated by Badiou. It argues that Coetzee assembles, through the intervention of the postscript, a situation that “makes it possible to argue”, along with Badiou, that, for the woman position, love knots together the four types of truths – Politics, Art, Science, and Love (2008, 196). (shrink)

COVID-19 is reducing the ability to perform surgical procedures worldwide, giving rise to a multitude of ethical, practical and medical dilemmas. Adapting to crisis conditions requires a rethink of traditional best practices in surgical management, delving into an area of unknown risk profiles. Key challenging areas include cancelling elective operations, modifying procedures to adapt local services and updating the consenting process. We aim to provide an ethical rationale to support change in practice and guide future decision-making. Using the four principles (...) approach as a structure, Medline was searched for existing ethical frameworks aimed at resolving conflicting moral duties. Where insufficient data were available, best guidance was sought from educational institutions: National Health Service England and The Royal College of Surgeons. Multiple papers presenting high-quality, reasoned, ethical theory and practice guidance were collected. Using this as a basis to assess current practice, multiple requirements were generated to ensure preservation of ethical integrity when making management decisions. Careful consideration of ethical principles must guide production of local guidance ensuring consistent patient selection thus preserving equality as well as quality of clinical services. A critical issue is balancing the benefit of surgery against the unknown risk of developing COVID-19 and its associated complications. As such, the need for surgery must be sufficiently pressing to proceed with conventional or non-conventional operative management; otherwise, delaying intervention is justified. For delayed operations, it is our duty to quantify the long-term impact on patients’ outcome within the constraints of pandemic management and its long-term outlook. (shrink)

In light of the Fourth Industrial Revolution, the intervention of artificial intelligence in commercial transactions has expanded, and it has not remained a mere subject or subject of the contract, whether it is a material or moral product, but has gone beyond that to have a fundamental and effective role in concluding the contract as an electronic agent that makes the contract automated and concluded in whole or in part in an automated manner without human intervention. The UAE legislator was (...) interested in regulating its use, whether under the Electronic Transactions Law of 2006 and the current one of 2021, and referred to this possibility under the Trade through Modern Technology Law of 2023; It considers it an information program that represents the original principal and bears the effects of the transaction concluded with the intervention of artificial intelligence despite not granting the electronic agent legal personality. The integration of artificial intelligence and modern technology into commercial transactions has profoundly transformed the landscape of commercial law. Artificial intelligence techs, including natural language processing and machine learning algorithms, are increasingly utilized for contract formation, risk assessment, and dispute resolution. Such technologies enhance efficiency, decreases human error, and advance transactional processes, offering substantial advantages for businesses and consumers. Modern technology, consists of digital currencies, smart contracts, and blockchain, has further revolutionized commercial transactions through offering unprecedented levels of security, transparency, and automation. Blockchain technology warrants irreversible and provable records, while smart contracts perform automatically when predefined conditions are met. This minimizes the need for intermediaries and enhancing integrity of the transactions carried out. Additionally, this paper addresses the legal and regulatory responses to these technological advancements. Jurisdictions across the world are grappling with the need to update existing laws or come up with new ones in order to address the challenges posed by AI and modern tech in commerce. The dynamic nature of technology calls for a flexible and adaptive legal approach in order to make sure that commercial laws remains to be relevant and effective. (shrink)

This article evaluates New Zealand’s Medicines Amendment Bill 2011. This Bill is currently before Parliament and will amend the Medicines Act 1981. On June 20, 2011, the Australian and New Zealand governments announced their decision to proceed with a joint scheme for the regulation of therapeutic products such as medicines, medical devices, and new medical interventions. Eventually, the joint arrangements will be administered by a single regulatory agency: the Australia New Zealand Therapeutic Products Agency. The medicines regulations in Australia and (...) New Zealand will be updated as part of this process. The Medicines Amendment Bill addresses some of the well-recognised deficiencies in the Medicines Act 1981. However, a comprehensive overhaul of the Act is not being undertaken. I argue that repealing and replacing the Medicines Act 1981 would be preferable and advisable, given the number of legal difficulties with the Act and, in particular, where it does not align with equivalent current international law. (shrink)

This chapter aims to shed light on the normative questions raised by medical imaging (MI), paving the way for interdisciplinary dialogue and further philosophical exploration. MI comprises noninvasive techniques aimed at visualizing internal human body structures to aid in explanation, diagnosis, and monitoring of health conditions. MI requires interpretation by specialized professionals, and is routinely employed across medical disciplines. It is entrenched in clinical guidelines and therapeutic interventions. Moreover, it is a dynamic research field, witnessing ongoing technological advancements. After surveying (...) philosophical issues arising from MI, which are relatively unexplored, the chapter focuses on the epistemology of diagnostic imaging. Specifically, it delves into what constitutes an image as evidence and how radiological procedures generate knowledge. The discussion dissects three facets of the radiological process: image interpretation, radiological reporting, and semantic analysis. Each facet carries distinct epistemic implications, as errors can manifest in various ways, affecting the acquisition of patient-relevant knowledge. (shrink)

Our understanding of the complexity of the oral biome and of the role of the various constituent bacteria in the aetiology of dental disease is growing. Probiotics and their relationship with prebiotics, as well as other microbiome‐based interventions, could be useful in preventing and treating dental disease and in promoting oral health. However, given the promise and early stage of this treatment approach, there are also a number of ethical, social and regulatory issues associated with innovative probiotic therapy. In this (...) article, a brief update is given on contemporary theories of the aetiology and management of the two commonest dental diseases, and on the roles of pre‐ and probiotics and oral biome transplant in the management of these diseases. The focus is primarily on four core issues: informed consent, risk–benefit assessment, how to determine suitable healthy donors, and commercialization and regulation. We discuss the safety and benefits of oral probiotics, not only concerning the products and quality control during their manufacture, but also regarding the depth of public knowledge about this topic. We point out that the requirement of listing ingredients honestly might be insufficient, and that the prevalent rhetoric of ‘natural’ and ‘organic’ as well as some health claims in the translational, innovative probiotic industry and markets are themselves misleading and should be carefully scrutinized. Finally, we suggest an ethical imperative to find a balance between scientific research and industry, and public health in the regulation of probiotics. (shrink)

In the context of a didactic for learning and updating the texts and classical languages, this work proposes a translation and interpretation of the philosophical and political sense of the fable The Aged Horse of Babrius. The translation follows the Greek version of Crusius and the Gredos edition, while the interpretation is based on the philosophical and political reflections of Cicero and Plutarch in On old Age and Whether an old man should engage in plublic affairs. These reflections can also (...) be seen from a statistical analysis of Long-Lived Men of Lucian of Samosata. Thus, the meaning of the fable says that young statesmen should avoid becoming the next useless politicians or “old horses” of the State. This reflection contributes today to weigh the political participation of young people and updates the civic importance of the elderly in their intervention on public affairs. (shrink)

Kalle Pihlainen’s book reworks seven essays published over the last dozen years. Pihlainen’s Preface and Hayden White’s Foreword articulate a cri de cœur. Both fear that something important has been missed. White’s Foreword somewhat cryptically characterizes Pihlainen’s book as “metacritical,” and locates Pihlainen in the role of being a “serious reader” for the community of theorists of history. What does it mean to be a “serious” reader? White never says. But following White’s hint, Pihlainen can be read as updating Marx’s (...) conception of the task of unmasking sources of alienation by focusing on the reasons for the estrangement of histories from a wider audience. For him, “the core case is that the ‘historical’ nature of history itself needs to be acknowledged”. It remains unacknowledged so long as the source of meaning in history continues to be displaced. For even those who emphasize narrative form tend to talk as if meanings were imposed by some factor other than human intervention, as if form magically imbues content with significance. But this is one more symptom, if such is needed, of collective bad faith, a denial that only people make meaning. By taking disembodied literary forms as repositories of significance, responsibility for meaning is once again deflected or deferred. In this key regard, Pihlainen’s claim to place “decided emphasis on its [historical theory’s] ethical-political momentum” signals that the issues he intends to foreground are not epistemological or discursive. Pihlainen rightly suspects that all the talk of “narrativism” and “discourse” serves only to evade confronting the truly difficult moral and political challenges that writing represents. His various chapters identify these evasions and the challenges that remain. (shrink)

We consider the peculiarity of unique events, such as those of a natural, evolutionary, and social nature. In particular, we consider unique social events that have had either the claim or the vocation of being salvific for humanity, such as the introduction over time of the Torah, Hinduism, Buddhism, Christianity, and Islam. We question how the claimed, general salvific vocation contrasts, or is inconsistent with, the non-retroactive temporality and locality of such events, which could not have happened otherwise. This undeclared (...) and philosophically unsolved inconsistency then reappears in subsequent cultural contradictions and inadequacies, political and social allowances such as, for instance, homo-centrism and a pathological relation with Nature. In the case of Christianity, this inconsistency is represented by the painting reproduced in the article, a work in which the excluded humans and other living beings are represented as astonished by the occurrence in this moment, and in such an unnatural context. Furthermore, we consider the original understanding as related to concepts of classical physics, or of such concepts naively adopted within the texts considered sacred. However, in some religions, such as Christianity, the inconsistency is theologically solved. We stress the need to update the ancient original elementary, naïve, pre-classic philosophical and conceptual frameworks used so that these alleged inconsistencies and contradictions may be not only theologically solved, but also conceptually solved in more complex understandings of the world, for example, considering relativistic time, long-range interdependence, quantum entanglement, and theories of the universe. Without this update, the unique saving events can affect only religiously, that is, optionally, on the scientific and philosophical conceptions used. Without this adjustment, homo-centrist illusion and egoism prevail as the natural, linear consequential attitude without raising these questions. It rather assumes that the intervention is for involved human beings, and moreover for those who have had and are lucky enough to receive and practice it, ignoring the enormous inconsistency within the message itself, and its presumed general and available salvific nature. This requires theological, philosophical, and scientific interdisciplinarity. The theme concerns inconsistencies within and superficiality of the narratives and their treatment of the unique, salvific events, without any reference to possible general and retroactive effects of how these events are represented in the painting. We conclude that the subject should be debated by taking into account contemporary understandings, such as relativistic space and time, quantum physics, and of the universe, with new philosophical and anthropological approaches. This should be a matter of responsible philosophical and theological interdisciplinary debate involving science, suitable to establish new understandings. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Utopia and the Contemporary British Novel by Caroline EdwardsMark SchmittCaroline Edwards. Utopia and the Contemporary British Novel. Cambridge: Cambridge University Press, 2021. 277 pp. Paperback, ISBN 9781108712392.The development of the novel as a literary form is closely linked to the representational mode of realism and how it can convey the human experience of time. That the novel distinguishes itself substantially from earlier forms of literature in how it (...) attempts to capture temporality through means of literary realism has been acknowledged ever since Ian Watt’s The Rise of the Novel (1957). As such, the novel form underwent dramatic changes throughout the periods of modernity and postmodernity, with modernist and postmodernist techniques of representation mirroring shifts in the temporal experience. But how can the contemporary novel—a category itself loaded with implication and definitional problems—of the twenty-first century confront the particular representational challenges of its time? This is the question that Caroline Edwards addresses in her study Utopia and the Contemporary British Novel. Edwards is concerned with the wider repercussions of the post-postmodernist notion of the Fukuyaman thesis of the “end of history” and the profound challenges to this thesis in the face of the post-9/11 unfolding of the twenty-first century. The temporal experience of this century is marked by what Edwards calls “non-contemporaneity,” that is, a “political, and even ontological uncertainty” (9). In the context of contemporary literature, the resulting “temporal disjointedness that marks our experience in the twenty-first century” has “given rise to different expressions of the unevenness of the contemporary, at the level of novelistic structure, prose style, generic sampling and non-mimetic interventions into otherwise realist narratives and juxtaposed timescales” (9). The notion of non-contemporaneity is drawn from Ernst Bloch’s concept of Ungleichzeitigkeit, which Edwards considers to be “productive to thinking about the complexity of [End Page 595] utopian times and the different kinds of pasts and futures that circulate within our own present moment of contemporaneity, which is inescapably non-contemporaneous with itself ” (30). Edwards considers this noncontemporaneity as a prevalent temporal register in contemporary British fiction that speak to the crises of temporality associated with a range of political, social, and economic events and processes that have marked the first decades of the twenty-first century. The seemingly natural unfolding of the “the linear progressive time of neoliberalism” (8), what Mark Fisher has called “capitalist realism,” has increasingly been put into question, not least due to the 2008 Global Financial Crisis (158). Similarly, Edwards identifies the 2016 Brexit referendum as symptomatic of a nationalism that must, following Michael Gardiner, always appear to be “out of time” (8). Such crises are thus indicative of anachronistic unevenness and conflicting temporalities. Consequently, a literary fiction that wants to adequately represent these struggles with temporality cannot confine itself to the pitfalls of literary realism, but it would be equally ill-suited by resorting to postmodernist metafiction and irony. Rather, as Edwards contends, the twenty-first-century fictions that she discusses attempt to complicate realist modes by using disruptive and experimental narrative techniques that amount to “non-mimetic experiments with narrative voice and structure” and “delinearised” temporalities (4). With this approach, Edwards argues, these texts interrogate the present as unstable.The four main chapters of Edwards’s book proceed by first establishing the dominant philosophical and theoretical concepts underlying her hypothesis. Chapter 2 (“Reading Fictions of the Not Yet”) is a theoretical and methodological chapter and offers an in-depth engagement with theories of temporality and narratology. Edwards’s aim here is to advocate for an updating of conventional narratology to account for the multilayered narrative experiments with time since modernism and especially in contemporary fiction. Her approach to theorization and analysis is inspired by Elizabeth Freeman’s Time Binds: Queer Temporalities, Queer Histories (2010) in the decision to focus on close readings of a small number of primary texts and read them as texts or aesthetic artifacts that develop “theories of their own” (29). The chapter offers an in-depth engagement with Bloch’s philosophy of utopianism and his concept of Ungleichzeitigkeit.Another cornerstone for Edwards’s theory and method is the work of... (shrink)

The purpose of this article is to inquire into the concepts of history and technique proposed in the philosophy of Xavier Zubiri to show the link that emerges. We show how history, as a capacitation process, is involved with technique as the inventionof physic realities. This way to be involved is due human animal, to be in reality, hasintervene on it; this intervention is historical and, at the same time, the technique, because by modifying the physical world from the invention (...) of realities, the humananimal is reciprocally modifying itself by updating its capacities. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:LettersMaxwell J. Mehlman, Susan R. Massey, Ronald M. Green, and Fred RosnerPhysicians and the Allocation of Scarce ResourcesMadam: We read with interest Dr. Pellegrino's commentary on our article in the December 1994 issue of the Kennedy Institute of Ethics Journal, and commend him for pointing out so well the different ways that law and ethics approach the issue of physician allocation of scarce resources.We wish to make one clarification. (...) Dr. Pellegrino states that we propose that fiduciary duties be abolished. Quite the contrary, our position is that fiduciary obligations are essential to the maintenance of trust—which we believe to be an efficient as well as an ethical element of the patient-provider relationship. If fiduciary duties are undercut, as we pointed out they are by the Oregon Medicaid legislation, then some other method of promoting trust must be established, and, as we point out in the article, it is difficult to identify what that method could be.Maxwell J. MehlmanandSusan R. MasseyThe Law Medicine CenterArter & HaddenCase Western Reserve UniversityCleveland, OHSchool of LawCleveland, OHReport of the Human Embryo Research PanelMadam: In the December 1994 issue of the Kennedy Institute of Ethics Journal, I reported on the controversy surrounding the work of the NIH Human Embryo Research Panel and the conclusions reached in its report, which was formally presented to NIH Director Harold Varmus on September 27, 1994. At that time, the report was to be reviewed by the Advisory Committee to the Director (ACD) until its next meeting in early December. I am writing to update your readers on the fate of the Panel's report.On the morning of December 2, 1994, following a previous afternoon of animated discussion, the ACD unanimously accepted the Report of the Human Embryo Research Panel. Panel members and members of the NIH staff who were present and had worked for nearly a year on the Report were gratified by this vote of confidence and by the strong support of NIH Director Harold Varmus.We had little time to enjoy this success. Within a matter of hours, the White House issued a press release in which President Clinton thanked the committee for its work and then, in a remark overruling one of the key recommendations in our report, stated: "I do not believe that federal funds should be used to support the creation of human embryos for research purposes, and I have directed that NIH not allocate any resources for such research." [End Page 83]As a Panel member and active participant in that day's events, my initial response was one of shock. I was particularly distressed that the President and his advisors chose a moment so late in the process to make their views known. Why had we worked for months, I asked, without a word of concern from the White House? Although Panel members were guided primarily by our perceptions of the ethical and scientific issues involved, some were close to the political realities of Washington and would have introduced these concerns into the Panel's deliberations.Within a matter of days, my own sense of outrage had diminished. First of all, it was clear that whatever the personal sources of the President's objections to the Panel's recommendations, this high level political intervention was inevitable. Less than a month before, on November 8, with the election of a majority House and Senate, the political environment for embryo research had changed dramatically. The previous June, 32 congressmen, most of them members of a minority Republican party, had signed a letter protesting the Panel's work. Now, one of the signers of that letter, Newt Gingrich, was destined to be Speaker of the House.Second, it became clear that the damage was not total. The President has forbidden NIH to support work involving the deliberate creation of embryos for research. Without exception, members of the Panel had come to the conclusion that some development of "research embryos" must be permitted to reduce the risks of new assisted reproductive technologies, to enhance scientific knowledge, and to develop new therapies for a range of serious diseases. All these... (shrink)