BackgroundHIV cure research involving cell and gene therapy has intensified in recent years. There is a growing need to identify ethical standards and safeguards to ensure cell and gene therapy (CGT) HIV cure research remains valued and acceptable to as many stakeholders as possible as it advances on a global scale.MethodsTo elicit preliminary ethical and practical considerations to guide CGT HIV cure research, we implemented a qualitative, in-depth interview study with three key stakeholder groups in the United States: (1) biomedical (...) HIV cure researchers, (2) bioethicists, and (3) community stakeholders. Interviews permitted evaluation of informants’ perspectives on how CGT HIV cure research should ethically occur, and were transcribed verbatim. We applied conventional content analysis focused on inductive reasoning to analyze the rich qualitative data and derive key ethical and practical considerations related to CGT towards an HIV cure.ResultsWe interviewed 13 biomedical researchers, 5 community members, and 1 bioethicist. Informants generated considerations related to: perceived benefits of CGT towards an HIV cure, perceived risks, considerations necessary to ensure an acceptable benefit/risk balance, CGT strategies considered unacceptable, additional ethical considerations, and considerations for first-in-human CGT HIV cure trials. Informants also proposed important safeguards to developing CGT approaches towards an HIV cure, such as the importance of mitigating off-target effects, mitigating risks associated with long-term duration of CGT interventions, and mitigating risks of immune overreactions.ConclusionOur study identified preliminary considerations for CGT-based HIV cure across three key stakeholder groups. Respondents identified an ideal cure strategy as one which would durably control HIV infection, protect the individual from re-acquisition, and eliminate transmission to others. Known and unknown risks should be anticipated and perceived as learning opportunities to preserve and honor the altruism of participants. Preclinical studies should support these considerations and be transparently reviewed by regulatory experts and peers prior to first-in-human studies. To protect the public trust in CGT HIV cure research, ethical and practical considerations should be periodically revisited and updated as the science continues to evolve. Additional ethics studies are required to expand stakeholder participation to include traditionally marginalized groups and clinical care providers. (shrink)

Interpersonal sensitivity, particularly threat of potential exclusion, is a critical condition in borderline personality disorder (BPD) which impairs patients’ social adjustment. Current evidence-based treatments include group components, such as mentalization-based group therapy (MBT-G), in order to improve interpersonal functioning. These treatments additionally focus on the therapeutic alliance since it was discovered to be a robust predictor of treatment outcome. However, alliance is a multidimensional factor of group therapy, which includes the fellow patients, and may thus be negatively affected by the (...) exclusion-proneness of BPD patients. The aim of this pilot study was to examine the predictive value of threat of social exclusion for the therapeutic alliance in MBT-G. In the first part of the study, social exclusion was experimentally induced in 23 BPD inpatients and 28 healthy subjects using the Cyberball paradigm, a virtual ball tossing game. The evoked level of threat was measured with the Need-Threat Scale (NTS) which captures four dimensions of fundamental human needs, i. e. the need for belongingness, for self-esteem, for control, and for a meaningful existence. In the second part of the study, therapeutic alliance was measured on three dimensions, the therapists, the fellow patients and the group as a whole, using the Group-Questionnaire (GQ-D). BPD patients scored higher in their level of threat according to the NTS in both, the inclusion and the exclusion condition. The level of threat after exclusion predicted impairments of the therapeutic alliance in MBT-G. It was associated with more negative relationships, lower positive bonding and a lower positive working alliance with the fellow patients and lower positive bonding to the group as a whole whilst no negative prediction of the alliance to the therapists was found. Consequently, our translational study design has shown that Cyberball is an appropriate tool to use as an approach for clinical questions. We further conclude that exclusion-proneness in BPD is a critical feature with respect to alliance in group treatments. In order to neutralize BPD patients’ exclusion bias, therapists may be advised to provide an “inclusive stance”, especially in initial sessions. It is also recommendable to strengthen patient to patient relations. (shrink)

›Bottom-up‹ und ›top-down‹ sind heutzutage gängige Methodenbezeichnungen in allen Bereichen der Wissenschaft. Dennoch sind beide Methoden keine Entdeckung der Moderne, sondern wurden unter Begriffen wie beispielsweise ›Auf-‹ und ›Abstieg‹, ›Induktion‹ und ›Deduktion‹ in der Wissenschaftsgeschichte häufig verwendet, um komplexe Wissensbestände vollständig aufzuarbeiten und zu strukturieren. Paradigmatisch für eine derartige Aufarbeitung stehen die mittelalterliche Summa und das neuzeitliche System. Aktuellen Studien zufolge hat aber bereits Dionysius Areopagita in der Spätantike eine derartige Summe verfasst, während in der Neuzeit erst J. G. Fichtes (...) Wissenschaftslehre (1804) allen Systemansprüchen genügen konnte. Daher beschäftigt sich die vorliegende Studie mit den Auf- und Abstiegsmethoden bei Dionysius und Fichte, ihrer antiken Vorgeschichte und kontrastiert ihre Methoden mit der aktuellen Wissenschaftsphilosophie. Dabei zeigt sich, dass beide Autoren bei der Aufstiegs- bzw. bottom-up-Methode bislang unberücksichtigte Strategien zur Lösung des Induktionsproblems anwenden. (shrink)

As readers of Theoretical Medicine and Bioethics undoubtedly know, edited books can be highly uneven in their quality, with some chapters excelling in content, depth, and readability while others languish in mediocrity. Volumes in an annually issued series run an even greater risk of suffering the plague of inferiority, especially after many years of fame and success. End-of-Life Ethics: A Case Study Approach clearly overcomes these maladies and provides readers with an excellent collection of well-written, thought-provoking essays.The Hospice Foundation of (...) America launched its annual bereavement teleconference two decades ago, publishing a book each year to accompany that educational event. Dubbed the “Living with Grief” series, every volume includes chapters written by a diversity of clinicians and scholars in the care of the dying and bereaved. The series has been unique in its approach to bridge scholarly understandings with practical clinical application.This volume takes a unique .. (shrink)

“Dialectic” has been a matter of growing interest in contemporary philosophy. The present article analyzes dialectical methods and positions them by reference to two paradigmatic texts of German idealism and analytic philosophy, i.e. J.G. Fichte’s Science of Knowing (1804) and J. McDowell’s Mind and World. Both dialectical approaches will be interpreted with regard to their contribution in the debate on reductionism and anti-reductionism: both Fichte and McDowell claim that philosophical positions and logical terms stand in a dualistic relationship to one (...) another, on the one hand, but are separated by a gulf, on the other. I will argue that for McDowell dialectic seems to be an alternative to one-sided reductionisms as well as to normal anti-reductionistic holism. Furthermore, for Fichte dialectic is an adequate method for describing the relationship of reductionism and anti-reductionism itself. Both see in dialectic a technique for bridging the gulf between binary opposite terms of logic as well as mutually exclusive positions, such as mind and world, subject and object, or idealism and realism. (shrink)

Some theorists, worried about liberalism’s potential as a foundation for public health ethics, suggest that republicanism provides a better background of justification for public health policies, interventions, etc. In this article, this suggestion is put to the test, and it is argued that (i) contemporary (civic) republicanism and liberalism are not nearly as opposed as it is sometimes suggested, and that (ii) the kind of republicanism which one leading scholar in the field, Bruce Jennings, as an alternative to liberalism, (...) does not reflect the contemporary understanding of republicanism as held by, e.g. Phillip Pettit et al. (shrink)

Social inequalities in health in the UK persist despite attempts to reduce them. We argue that work and pensions constitutes an area of intervention where there is potential to make change happen. We propose that workers who are exposed to significant health risks through their occupation should be allowed to draw their state pension earlier, based on a minimum number of years in the workforce. We model this proposal on similar policies in other European countries. In our modification, the pension (...) age and the retirement age would be separated, such that workers can receive a state pension whether or not they choose to continue working. This arrangement may encourage workers either to reduce their working hours or to change to less demanding or harmful work. The health of these workers would thereby benefit from reduced exposure to a harmful work environment, reduced stress and more opportunities for rest and relaxation. However, it has also been suggested that retirement is bad for mental health. In response, our proposal enables workers to phase in full retirement over a period of part-time work, and we believe that this would counter any potential negative effects on health caused by retirement. (shrink)

The texts collected in this volume, which was originally published in 1969, contain Herder's most original and stimulating ideas on politics, history and language. They had for the most part not been previously available in English. In his introduction, Professor Barnard analyses the basic premises of Herder's political thought against the background of the Enlightenment. He examines Herder's concepts of language, community and culture, his theory of historical interaction, and his approach to the problem of change and progress. Finally, he (...) provides a brief comparative analysis of traditionalist thought following the French Revolution, showing how substantive writers like Burke differed from Herder despite the close similarity of political vocabulary. (shrink)

The first English translation of Fichte’s second set of 1804 lectures on the Wissenschaftslehre.

The reception history of the French Revolution in France and England is well documented among Anglophone scholars; however, the debate over the Revolution in Germany is much less well known. Fichte's Contribution played an important role in this debate. Presented here for the first time in English, Fichte's work provides a distinctive synthesis of Locke's "possessive individualism," Rousseau's general will, and Kant's moral philosophy. This eclectic blend results in an unusual rights theory that at times veers close to a form (...) of anarchism. Written in 1792–93, just before Fichte moved to Jena to develop his philosophical system in a series of works—above all the Wissenschaftslehre of 1794—the Contribution provides invaluable insight into Fichte's early development. In addition, Fichte's work predates much of Kant's political philosophy, and can shed light on the rich dialogue in German political thought in the 1790s. (shrink)

International array of contributors, bringing together both traditional and more recent approaches to provide valuable insights into the poets’ use of language.Covers authors from Lucilius to Juvenal.Of the peoples of ancient Italy, only the Romans committed newly composed poems to writing, and for 250 years Latin-speakers developed an impressive verse literature.The language had traditional resources of high style, e.g., alliteration, lexical and morphological archaism or grecism, and of course metaphor and word order; and there were also less obvious resources in (...) the technical vocabularies of law, philosophy and medicine.The essays in this volume show how the poets in the classical period combined these elements, and so created a poetic medium that could comprehend satire, invective, erotic elegy, drama, lyric, and the grandest heroic epos. (shrink)

It is proved that the relevance logic \ has no structurally complete consistent axiomatic extension, except for classical propositional logic. In fact, no other such extension is even passively structurally complete.

The practice of covertly administering medication is controversial. Although condemned by some as overly paternalistic, others have suggested that it may be acceptable if patients have permanent mental incapacity and refuse needed treatment. Ethical, legal, and clinical considerations become more complex when the mental incapacity is temporary and when the medication actually serves to restore autonomy. We discuss these issues in the context of a young man with schizophrenia. His mother had been giving him antipsychotic medication covertly in his soup. (...) Should the doctor continue to provide a prescription, thus allowing this to continue? We discuss this case based on the “four principles” ethical framework, addressing the conflict between autonomy and beneficence/non-maleficence, the role of antipsychotics as an autonomy restoring agent, truth telling and the balance between individual versus family autonomy. (shrink)

It is shown that an approach to quantum phenomena in which charged particles are treated as macroscopically extended periodic disturbances in a nonlinear c-number field, interacting with each other via massless excitations of that field, leads almost uniquely to the five basic equations of classical electrodynamics: the Lorentz force law and Maxwell's equations. The fundamental electromagnetic quantity in this approach is the 4-vector potential Aα—interpreted absolutely as a measure of the local shift of each particle off its mass shell—rather than (...) theE andB fields, and it thus provides a new viewpoint on the questions of Aharonov-Bohm phase shifts, the existence of magnetic monopoles, and the role of gauge invariance. (shrink)