Based on the findings about the importance of social support network in the success of treatment and long term recovery, this article will provide an insight of the successful elements in addiction individual and group counseling interaction through which addicts manage to overcome the denial of addiction, to accept the recovery program, to go through the stages of recovery, and to identify appropriate research methods for understanding the phenomenon of interaction in recovery from addictions. (...) This exploratory study will attempt to identify an innovative perspective of the aspects pertaining to the recovery from addiction which are susceptible to be disclosed primarily by using methods inspired by the analysis of interactions. The method used in research is qualitative focus group with addictions counsellors and people in recovery, working in a counseling center. Using the application of ELAN software to annotate and transcribe interactions from the video and audio recordings, it will situate the research on addiction and recovery from addiction in the larger field of investigations on communication processes in human interactions in various cultural, social and professional contexts. (shrink)

In the literature on the recovery of societies from natural disasters, a dominant theme is the importance of pursuing and achieving sustainable recovery. Sustainability implies that recovery efforts should aim to (re-) build, maintain, and, if possible, enhance the quality of life of members of the disaster-stricken community in the short and long term. In this paper, we propose a capabilities-based approach to recovery and argue that it provides important theoretical resources for better realizing (...) this ideal of sustainability in practice. From a capabilities-based approach, the societal impact of a disaster is measured in terms of its impact on selected capabilities of individuals within society. Capabilities are constitutive elements of well-being and capture the valuable doings and beings individuals can achieve or become (e.g., being adequately nourished, and being sheltered). A proposed Disaster Impact Index (DII), we argue, can capture the societal impact of a disaster by measuring its impact on the well-being of individuals, as gauged by the changes in individuals’ capabilities. We discuss how to measure this impact in practice. Also, a proposed Disaster Recovery Index (DRI) measures the current level of individuals’ capabilities. It can provide important information on the degree to which capabilities have been restored and enhanced by comparing the DRI against a benchmark, or level of capabilities attainment, toward which recovery processes should strive. We argue that the DII and DRI provide critical information for policy- and decision-makers to use in order to practically implement the principles of sustainable recovery. Both can be used in the process of predisaster planning for recovery and in the period of recovery itself. (shrink)

An increasing number of research teams are investigating the efficacy of brain-computer interface (BCI)-mediated interventions for promoting motor recovery following stroke. A growing body of evidence suggests that of the various BCI designs, most effective are those that deliver functional electrical stimulation (FES) of upper extremity (UE) muscles contingent on movement intent. More specifically, BCI-FES interventions utilize algorithms that isolate motor signals—user-generated intent-to-move neural activity recorded from cerebral cortical motor areas—to drive electrical stimulation of individual muscles or muscle synergies. (...) BCI-FES interventions aim to recover sensorimotor function of an impaired extremity by facilitating and/or inducing long-term motor learning-related neuroplastic changes in appropriate control circuitry. We developed a non-invasive, electroencephalogram (EEG)-based BCI-FES system that delivers closed-loop neural activity-triggered electrical stimulation of targeted distal muscles while providing the user with multimodal sensory feedback. This BCI-FES system consists of three components: (1) EEG acquisition and signal processing to extract real-time volitional and task-dependent neural command signals from cerebral cortical motor areas, (2) FES of muscles of the impaired hand contingent on the motor cortical neural command signals, and (3) multimodal sensory feedback associated with performance of the behavioral task, including visual information, linked activation of somatosensory afferents through intact sensorimotor circuits, and electro-tactile stimulation of the tongue. In this report, we describe device parameters and intervention protocols of our BCI-FES system which, combined with standard physical rehabilitation approaches, has proven efficacious in treating UE motor impairment in stroke survivors, regardless of level of impairment and chronicity. (shrink)

The frequency and severity of natural disasters and extreme weather events are increasing, taking a dramatic economic and relational toll on the communities they strike. Given the critical role that entrepreneurship plays in a community’s viability, it is necessary to understand how small business owners respond to these events and move forward over time. This study explores the long-term dynamics and trajectory of individuals within the broader business community following a natural disaster, paying particular attention to the influence (...) of social identity. Results suggest that the community identity changes over the course of recovery and rebuilding, underscoring the need for a holistic approach so that intervening agencies can achieve the sustainable economic recovery desired. (shrink)

Customers complain because they want to be treated fairly by the company when a service failure occurs. The role of perceived complaint justice and its relation to customer satisfaction has been discussed and researched. However, a static view is mostly adopted in previous literature. We argue that satisfaction is cumulative and both prior satisfaction and post-recovery satisfaction should be looked at in relation to complaint justice in the context of service recovery. This study attempts to fill the gap (...) by investigating the mediating role of justice in the relationship between prior satisfaction and post-recovery satisfaction (both with the recovery and with the organization) and examining the mediating role of post-recovery satisfaction in the relationship between the dimensions of justice and customer retention. Hypotheses were tested using a sample of 200 customers that had service failure experience at Chinese restaurants in Hong Kong. Justice dimensions (distributive justice, procedural justice, and interactional justice) were found to fully mediate the relationship between prior satisfaction and satisfaction with recovery. All dimensions, except the interactional justice, were also found to be partial mediators in the relationship between prior satisfaction and post-recovery satisfaction with organization. Findings also revealed the mediating roles of two post-recovery satisfaction variables in transferring the justice dimensions into behavioral intention, with the two variables playing almost opposite roles. Discussion and recommendations are provided for future development and improvement in building long-term relationship with customers. (shrink)

In modern mental health care, ‘recovery’ does not necessarily mean the same thing for clinicians, service users, and survivor groups. This divergence is especially stark where self-injury is concerned. For clinicians, recovery often refers to cessation of self-injury; for those with lived experience, self-harm may be a temporary or long-term method of navigating trauma and distress. This article explores how the survivor-led model, which regards self-injury as an understandable reaction to distress, poverty, abuse, and discrimination emerged (...) from second-wave feminism, the survivor movement, and the growth of grassroots mental health groups in the 1980s. We focus on Bristol Crisis Service for Women (BCSW), a peer-led listening service for women who self-injure, founded in 1986. We begin with the history of BCSW and how experiences of their founders and users caused them to advocate for a different model of self-injury. We then situate BCSW’s approach to self-harm and recovery within the frame of women’s mental health activism. Finally, we explore how BCSW and its allies criticised existing psychiatric paradigms of self-harm, showing how the individualised medical model was rooted in gendered stereotypes that failed to recognise the real-world concerns of many women. We argue that it remains important to see self-harm not as an individual health concern, but in relation to the structural and practical issues affecting users and survivors. Within BCSW, a peer-led service, experience of self-injury became not a deficit but a useful asset in supporting other women, indicating that recovery itself could be both collective and non-linear. (shrink)

ObjectiveTo investigate the short-term effect of music therapy combined with binaural frequency difference therapy on patients with consciousness disorder.Materials and methodsNinety patients with definite diagnosis of disorders of consciousness were selected. These patients were randomly divided into control group, experiment 1 group and experiment 2 group, with 30 patients in each group. The control group was treated with routine clinical treatment and rehabilitation. In experiment 1 group, music therapy was added to the control group. In experimental group 2, music (...) therapy combined with binaural α frequency difference therapy was added to the control group. All patients were assessed before and after 30 treatments. The assessment items included Glasgow Coma Scale, Coma Recovery Scale revised, electroencephalogram, upper somatosensory evoked potential, and brainstem auditory evoked potential.ResultsBefore treatment, there were no significant differences in GCS score, CRS-R score, USEP, BAEP, and EEG scores among the three groups. After 30 times of treatment, GCS score, CRS-R score, USEP, BAEP, and EEG scores in 3 groups were significantly higher than those before treatment. And the consciousness rate of experimental group 2 was better than experimental group 1, experimental group 1 was better than the control group and the difference was statistically significant.ConclusionMusic therapy combined with binaural α frequency difference therapy is more effective in stimulating DOC patients. (shrink)

In this paper we argue that the protocols of subjects recalling the names of their high school classmates, as well as an army of traditional memory phenomena, can be understood from an information processing analysis which interprets retrieval as a problem‐solving process. This characterization of retrieval focuses on the reconstructive and recursive nature of the process of remembering. Retrieval is viewed as a process in which some information about a target item is used to construct a description of the item (...) and this description is used in attempts to recover new fragments of information. A new description i s formed and the process continues recursively. Three subprocesses are identified: FIND A CONTEXT, in which a proper environment for conducting a search i s established: SEARCH, in which bits and pieces of information appropriate to the context are recovered until an adequate description can be formed within the search context; and VERIFY, in which recovery information is checked for consistency.From the perspective this characterization, we examine the protocols of subjects asked to think aloud while recalling the names of their classmates. Subjects' retrievals continued for a surprisingly long period and were characterized by the phenomena of overshoot, systematic hypothesizing, fabrications, establishment of search contexts, self‐corrections, and the use of a number of basic search strategies. The view of memory as a problem‐solving process not only leads us to the identification of these phenomena but also to a framework for a coherent interpretation for them. (shrink)

An alternative to objectifying approaches to understanding Post-traumatic Stress Disorder grounded in hermeneutic phenomenology is presented. Nurses who provided care for soldiers injured in the Iraq and Afghanistan wars, and sixty-seven wounded male servicemen in the rehabilitation phase of their recovery were interviewed. PTSD is the one major psychiatric diagnosis where social causation is established, yet PTSD is predominantly viewed in terms of the usual neuro-physiological causal models with traumatic social events viewed as pathogens with dose related effects. Biologic (...) models of causation are applied reductively to both predisposing personal vulnerabilities and strengths that prevent PTSD, such as resiliency. However, framing PTSD as an objective disease state separates it from narrative historical details of the trauma. Personal stories and cultural meanings of the traumatic events are seen as epiphenomenal, unrelated to the understanding of, and ultimately, the therapeutic treatment of PTSD. Most wounded service members described classic symptoms of PTSD: flashbacks, insomnia, anxiety etc. All experienced disturbance in their sense of time and place. Rather than see the occurrence of these symptoms as decontextualized mechanistic reverberations of war, we consider how these symptoms meaningfully reflect actual war experiences and sense of displacement experienced by service members. (shrink)

ABSTRACTWhen in emotional distress, people often turn to others for social support. A general distinction has been made between two types of support that are differentially effective: Whereas socio-affective support temporarily alleviates emotional distress, cognitive support may contribute to better long-term recovery. In the current studies, we examine what type of support individuals seek. We first confirmed in a pilot study that these two types of support can be reliably distinguished. Then, in Study 1, we experimentally tested (...) participants’ support evaluations in response to different emotional situations using a vignette methodology. Findings showed that individuals perceived any type of reaction that included socio-affective support as preferable. The evaluation of cognitive support, however, was dependent on the specific emotion: Unlike worry and regret, anger and sadness were characterised by a strong dislike for purely cognitive support. Using different materials, Study 2 replicated these findin... (shrink)

Creating focal lesions in primary visual cortex (V1) provides an opportunity to study the role of extra-geniculo-striate pathways for activating extrastriate visual cortex. Previous studies have shown that more than 95% of neurons in macaque area V2 and V3 stop firing after reversibly cooling V1 [1,2,3]. However, no studies on long term recovery in areas V2, V3 following permanent V1 lesions have been reported in the macaque. Here we use macaque fMRI to study area V2, V3 activity (...) patterns from 1 to 22 months after lesioning area V1. We find that visually driven BOLD responses persist inside the V1-lesion projection zones (LPZ) of areas V2 and V3, but are reduced in strength by ,70%, on average, compared to prelesion levels. Monitoring the LPZ activity over time starting one month following the V1 lesion did not reveal systematic changes in BOLD signal amplitude. Surprisingly, the retinotopic organization inside the LPZ of areas V2, V3 remained similar to that of the non-lesioned hemisphere, suggesting that LPZ activation in V2, V3 is not the result of input arising from nearby (non-lesioned) V1 cortex. Electrophysiology recordings of multi-unit activity corroborated the BOLD observations: visually driven multi-unit responses could be elicited inside the V2 LPZ, even when the visual stimulus was entirely contained within the scotoma induced by the V1 lesion. Restricting the stimulus to the intact visual hemi-field produced no significant BOLD modulation inside the V2, V3 LPZs. We conclude that the observed activity patterns are largely mediated by parallel, V1-bypassing, subcortical pathways that can activate areas V2 and V3 in the absence of V1 input. Such pathways may contribute to the behavioral phenomenon of blindsight. (shrink)

:Long-term patient outcomes after severe brain injury are highly variable, and reliable prognostic indicators are urgently needed to guide treatment decisions. Functional neuroimaging is a highly sensitive method of uncovering covert cognition and awareness in patients with prolonged disorders of consciousness, and there has been increased interest in using it as a research tool in acutely brain injured patients. When covert awareness is detected in a research context, this may impact surrogate decisionmaking—including decisions about life-sustaining treatment—even though the (...) prognostic value of covert consciousness is currently unknown. This paper provides guidance to clinicians and families in incorporating individual research results of unknown prognostic value into surrogate decisionmaking, focusing on three potential issues: Surrogate decisionmakers may misinterpret results; Results may create false hope about the prospects of recovery; There may be disagreement about the meaningfulness or relevance of results, and appropriateness of continued care. (shrink)

This book supports the emerging field of vascularized composite allotransplantation for face and upper-limb transplants by providing a revised, ethically appropriate consent model which takes into account what is actually required of facial and upper extremity transplant recipients. In place of consent as permission-giving, waiver, or autonomous authorization, this book imagines consent as an ongoing mutual commitment, i.e. as covenant consent. The covenant consent model highlights the need for a durable personal relationship between the patient/subject and the care provider/researcher. Such (...) a relationship is crucial given the recovery period of 5 years or more for VCA recipients. The case for covenant consent is made by first examining the field of vascularized composite allotransplantation, the history and present understandings of consent in health care, and the history and use of the covenant concept from its origins through its applications to health care ethics today. This book explains how standard approaches to consent are inadequate in light of the particular features of facial and upper limb transplantation. In contrast, use of the covenant concept creates a consent model that is more appropriate ethically for these very complex surgeries and long-term recoveries. (shrink)

ABSTRACT Objective: To contrast relief efforts for the 26 December 2004 tsunami with current global HIV/aids relief efforts and analyse possible reasons for the disparity. Methods: Literature review and ethical analysis. Results: Just over 273,000 people died in the tsunami, resulting in relief efforts of more than US$10 bn, which is sufficient to achieve the United Nation’s long‐term recovery plan for South East Asia. In contrast, 14 times more people died from HIV/aids in 2004, with UNAIDS predicting (...) a US$8 bn funding gap for HIV/aids in developing nations between now and 2007. This disparity raises two important ethical questions. First, what is it that motivates a more empathic response to the victims of the tsunami than to those affected by HIV/AIDS? Second, is there a morally relevant difference between the two tragedies that justifies the difference in the international response? The principle of justice requires that two cases similarly situated be treated similarly. For the difference in the international response to the tsunami and HIV/aids to be justified, the tragedies have to be shown to be dissimilar in some relevant respect. Are the tragedies of the tsunami disaster and the HIV/aids pandemic sufficiently different, in relevant respects, to justify the difference in scope of the response by the international community? Conclusion: We detected no morally relevant distinction between the tsunami and the HIV/aids pandemic that justifies the disparity. Therefore, we must conclude that the international response to HIV/aids violates the fundamental principles of justice and fairness. (shrink)

A question arising from the COVID-19 crisis is whether the merits of cases for climate policies have been affected. This article focuses on carbon pricing, in the form of either carbon taxes or emissions trading. It discusses the extent to which relative costs and benefits of introducing carbon pricing may have changed in the context of COVID-19, during both the crisis and the recovery period to follow. In several ways, the case for introducing a carbon price is stronger during (...) the COVID-19 crisis than under normal conditions. Oil costs are lower than normal, so we would expect less harm to consumers compared to normal conditions. Governments have immediate need for diversified new revenue streams in light of both decreased tax receipts and greater use of social safety nets. Finally, supply and demand shocks have led to already destabilized supply-side activities, and carbon pricing would allow this destabilization to equilibrate around greener production for the long-term. The strengthening of the case for introducing carbon pricing now is highly relevant to discussions about recovery measures, especially in the context of policy announcements from the European Union and United States House of Representatives. Key Policy Insights: • Persistently low oil prices mean that consumers will face lower pain from carbon pricing than under normal conditions. • Many consumers are more price-sensitive during the COVID-19 context, which suggests that a greater relative burden from carbon prices would fall upon producers as opposed to consumers than under normal conditions. • Carbon prices in the COVID-19 context can introduce new revenue streams, assisting with fiscal holes or with other green priorities. • Carbon pricing would contribute to a more sustainable COVID-19 recovery period, since many of the costs of revamping supply chains are already being felt while idled labor capacity can be incorporated into firms with lower carbon-intensity. (shrink)

The ethics of long-term Extracorporeal Membrane Oxygenation (ECMO) use, especially when organ recovery appears highly unlikely and the patient does not qualify for organ transplantation, are compli...

Grafts of embryonic neural tissue into the brains of adult patients are currently being used to treat Parkinson's disease and are under serious consideration as therapy for a variety of other degenerative and traumatic disorders. This target article evaluates the use of transplants to promote recovery from brain injury and highlights the kinds of questions and problems that must be addressed before this form of therapy is routinely applied. It has been argued that neural transplantation can promote functional (...) class='Hi'>recovery through the replacement of damaged nerve cells, the reestablishment of specific nerve pathways lost as a result of injury, the release of specific neurotransmitters, or the production of factors that promote neuronal growth. The latter two mechanisms, which need not rely on anatomical connections to the host brain, are open to examination for nonsurgical, less intrusive therapeutic use. Certain subjective judgments used to select patients who will receive grafts and in assessment of the outcome of graft therapy make it difficult to evaluate the procedure. In addition, little long-term assessment of transplant efficacy and effect has been done in nonhuman primates. Carefully controlled human studies, with multiple testing paradigms, are also needed to establish the efficacy of transplant therapy. (shrink)

Acute starvation can have long-term consequences that are mediated through epigenetic change. Some of these changes are affected by the activity of AMP-activated protein kinase, a master regulator of cellular energy homeostasis. In Caenorhabditis elegans, the absence of AMPK during a period of starvation in an early larval stage results in developmental defects following their recovery on food, while many of them become sterile. Moreover, the loss of AMPK during this quiescent period results in transgenerational phenotypes that (...) can become progressively worse with each successive generation. Our recent data describe a chromatin-based mechanism of how AMPK mediates adjustment to acute starvation in the germ cells, however, the heritable aspect of this AMPK mutant phenotype remains unresolved. Here, we explore how AMPK might affect this process and speculate how the initial transcription that occurs in the germ cells may adversely affect subsequent germline gene expression and/or genomic integrity. AMPK protects germ cell integrity during acute starvation by blocking inappropriate transcription. How these aberrant transcripts cause transgenerational defects is unclear. AMPK likely regulates germline integrity at multiple levels through several targets. The authors speculate here how AMPK disruption during starvation could result in the observed defects seen at each generation. (shrink)

The conventional discourse on existential risks (x-risks) from AI typically focuses on abrupt, dire events caused by advanced AI systems, particularly those that might achieve or surpass human-level intelligence. These events have severe consequences that either lead to human extinction or irreversibly cripple human civilization to a point beyond recovery. This decisive view, however, often neglects the serious possibility of AI x-risk manifesting gradually through an incremental series of smaller yet interconnected disruptions, crossing critical thresholds over time. This paper (...) contrasts the conventional decisive AI x-risk hypothesis with what I call an accumulative AI x-risk hypothesis. While the former envisions an overt AI takeover pathway, characterized by scenarios like uncontrollable superintelligence, the latter suggests a different pathway to existential catastrophes. This involves a gradual accumulation of AI-induced threats such as severe vulnerabilities and systemic erosion of critical economic and political structures. The accumulative hypothesis suggests a boiling frog scenario where incremental AI risks slowly undermine systemic and societal resilience until a triggering event results in irreversible collapse. Through complex systems analysis, this paper examines the distinct assumptions differentiating these two hypotheses. It is then argued that the accumulative view can reconcile seemingly incompatible perspectives on AI risks. The implications of differentiating between the two types of pathway—the decisive and the accumulative—for the governance of AI as well as long-term AI safety are discussed. -/- . (shrink)

A variety of studies show that parental absence early in life leads to deleterious effects on the developing CNS. This is thought to be largely because evolutionary-dependent stimuli are necessary for the appropriate postnatal development of the young brain, an effect sometimes termed the “experience-expectant brain,” with parents providing the necessary input for normative synaptic connections to develop and appropriate neuronal survival to occur. Principal among CNS systems affected by parental input are the monoamine systems. In the present study,N= 434 (...) rhesus monkeys (233 males, 201 females) were reared in one of two conditions: as mother-reared controls (MR;n= 269) or without adults with 24-h access to same-aged peers (PR;n= 165). When subjects were six-months-old, they underwent a separation paradigm involving 4, sequential, four-day social separations from their mothers or peers, with each separation followed by three-day reunions with their mothers or their peers. Prior to the separation paradigm, baseline cisternal CSF samples were obtained, as well as at the end of each the four social separations, and after final separation, during a recovery period. CSF was assayed for concentrations of monoamine metabolites and a blood sample was genotyped for the serotonin transporter (5-HTT) genotype. Replicating earlier landmark findings, PR subjects with thesallele exhibited lower baseline concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA), when compared to PR subjects homozygous for theLallele. MR subjects were undifferentiated by genotype. PR subjects exhibited lower CSF 5-HIAA concentrations during baseline, but higher CSF 5-HIAA during social separations, when compared to MR subjects. There were rearing effects for the dopamine metabolite homovanillic acid (HVA) and for the norepinephrine metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG), with PR subjects showing higher HVA and lower MHPG when compared to MR subjects. These findings indicate that there are long-term deficits in the response of monoamines following early maternal absence. The results of this study confirm and extend earlier findings that early parental absence has deleterious consequences for the development of the monoamine systems, and that these consequences are modulated by the 5-HTT genotype. (shrink)

Throughout this paper PJ Kearney attempts to balance the risks and benefits of different approaches in paediatric oncology. Decisions have to be considered both in the short and the long term. Where religious beliefs, such as those held by Jehovah's Witnesses in relation to blood transfusions, conflict with normal medical practice the decision is often removed from the doctor, parents or patient to the courts. This sort of solution can be counter-productive, especially as good health care and subsequent (...) recovery rely, to a large extent, on good relationships between and among the parties concerned. Destruction of these relationships, for whatever reason, often has a detrimental effect on the patient, in whose best interest everyone believes they are acting. (shrink)

Patients with strokes to the Anterior Communicating Artery pose an important challenge to rehabilitation teams due to a particular mix of cognitive and behavioral impairments. These deficits often compromise engagement with rehabilitation, learning and generalization. The goal of this article is to describe the long-term presentation of a patient with an ACoA stroke as well as her rehabilitation needs and the many challenges experienced by the rehabilitation team when attempting to facilitate functional, vocational and psychosocial recovery. Based (...) on this case, and the existing literature, a neuropsychological rehabilitation framework to understand and address the specific problems and needs of this population is proposed. This framework demands rehabilitation teams to consider: the slow pattern of recovery of this population, the interaction between cognitive and behavioral impairments, the relevance of physical and social environments, the value of personal projects and the need to include psychological and relational interventions. (shrink)

In Bulgaria, integrating technology and innovation is crucial for advancing sustainable healthcare disaster management, enhancing disaster response and recovery, and minimizing long-term environmental and social impacts. The purpose of the study is to assess the impact of modern technological innovations on the effectiveness of disaster management in health care in Bulgaria with a focus on Health Information Systems (HIS), Telemedicine, Telehealth, e-Health, Electronic Health Records, Artificial Intelligence (AI), Public Communication Platforms, and Data Security and Privacy. These innovations, (...) when integrated effectively, can significantly strengthen Bulgaria's preparedness and response capabilities, improving efficiency and reducing the environmental footprint of disaster interventions. Collaboration with technology experts, research institutions, and international organizations is essential for successful implementation. The research aims to assess how these technologies can enhance disaster management efficacy, adopting a methodical approach using Systematic Literature Reviews (SLRs). Systematic Literature Reviews (SLRs) utilize precise criteria for research selection and evaluation to reduce bias, systematically compiling and analyzing data from various studies to offer evidence-based insights. They are crucial for uncovering research gaps, indicating areas needing further exploration. Findings highlight the transformative potential of technology integration in streamlining communication, data management, and operational efficiency. The study underscores the urgent need for an integrated approach and a culture of innovation within the healthcare sector, emphasizing ongoing assessment and adaptation of technology-based strategies. While acknowledging limitations and calling for further research, the study provides valuable insights into Bulgaria's healthcare disaster management strategies and sets the stage for future investigations to refine and expand upon these strategies. It advocates for a strategic framework guiding the efficient integration of technology into disaster management, aiming for resilient and patient-centric healthcare systems. (shrink)

Patients in a vegetative state/ unresponsive wakefulness syndrome (VS/UWS) pose ethical dilemmas to those involved. Many conflicts occur between professionals and families of these patients. In the Netherlands physicians are supposed to withdraw life sustaining treatment once recovery is not to be expected. Yet these patients have shown to survive sometimes for decades. The role of the families is thought to be important. The aim of this study was to make an inventory of the professional perspective on conflicts in (...) long-term care of patients in VS/UWS. A qualitative study of transcripts on 2 Moral Deliberations (MD’s) in 2 cases of patients in VS/UWS in long-term care facilities. Six themes emerged: 1) Vision on VS/UWS; 2) Treatment and care plan; 3) Impact on relationships; 4) Feelings/attitude; 5) Communication; 6) Organizational aspects. These themes are related to professionals and to what families had expressed to the professionals. We found conflicts as well as contradictory feelings and thoughts to be a general feature in 4 of these themes, both in professionals and families. Conflicts were found in several actors: within families concerning all 6 themes, in nurse teams concerning the theme treatment and care plan, and between physicians concerning all 6 themes. Different visions, different expectations and hope on recovery, deviating goals and contradictory feelings/thoughts in families and professionals can lead to conflicts over a patient with VS/UWS. Key factors to prevent or solve such conflicts are a carefully established diagnosis, clarity upon visions, uniformity in treatment goals and plans, an open and empathic communication, expertise and understanding the importance of contradictory feelings/thoughts. Management should bridge conflicts and support their staff, by developing expertise, by creating stability and by facilitating medical ethical discourses. Shared compassion for the patient might be a key to gain trust and bridge the differences from non-shared to shared decision making. (shrink)

Hand function improvement in stroke survivors in the chronic stage usually plateaus by 6 months. Brain-computer interface (BCI)-guided robot-assisted training has been shown to be effective for facilitating upper-limb motor function recovery in chronic stroke. However, the underlying neuroplasticity change is not well understood. This study aimed to investigate the whole-brain neuroplasticity changes after 20-session BCI-guided robot hand training, and whether the changes could be maintained at the 6-month follow-up. Therefore, the clinical improvement and the neurological changes before, immediately (...) after, and 6 months after training were explored in 14 chronic stroke subjects. The upper-limb motor function was assessed by Action Research Arm Test (ARAT) and Fugl-Meyer Assessment for Upper-Limb (FMA), and the neurological changes were assessed using resting-state functional magnetic resonance imaging. Repeated-measure ANOVAs indicated that long-term motor improvement was found by both FMA (F[2,26]= 6.367,p= 0.006) and ARAT (F[2,26]= 7.230,p= 0.003). Seed-based functional connectivity analysis exhibited that significantly modulated FC was observed between ipsilesional motor regions (primary motor cortex and supplementary motor area) and contralesional areas (supplementary motor area, premotor cortex, and superior parietal lobule), and the effects were sustained after 6 months. The fALFF analysis showed that local neuronal activities significantly increased in central, frontal and parietal regions, and the effects were also sustained after 6 months. Consistent results in FC and fALFF analyses demonstrated the increase of neural activities in sensorimotor and fronto-parietal regions, which were highly involved in the BCI-guided training.Clinical Trial Registration:This study has been registered atClinicalTrials.govwith clinical trial registration number NCT02323061. (shrink)

What I have tried to do here is to provide a historical example of the interdependence between nature and culture that is one of the themes of this conference. To sum up: Scientific descriptions of the world emerge out of a complex interaction between nature, economic production, and the legal system. “Science” consists of a struggle among scientists, and between scientists and citizens, over what counts as “reality.” Lawmaking, in turn, consists of a struggle between people who want to allocate (...) access to resources for particular purposes, whether for commercial use, recreational use, or “natural” uses. Production, for its part, is a complicated function of technology, the sociology of user groups, the structure of legal entitlements to access, and the availability of resources. Nature, finally, is at any point, to no small degree, the product of past and present human impacts on it — which impacts, in turn, are determined in no small way by the sociology and the legal structure of the market.Each process takes place in continual conversation with all the others. As John Muir put it, “When we try to pick out anything by itself, we find it hitched to everything else in the universe.”45 Historically, resource managers have gotten into trouble when they have unconsciously assumed that such is not the case — yet such, assumptions are powerful because they are made instinctively, unthinkingly, at the level of people's basic understanding of the world and their place in it. Lots of them persist.On the other hand, in a few experimental cases in the United States and Canada where government and users have shared power and responsibility for resources management, including long-range planning for recovery and enhancement, here have been some notable improvements. The strategy goes under the name of “co-management” and involves negotiated agreements for shared decision-making between central authority and local groups. Typically, both government and industry resist such arrangements because they involve restructuring the power relations between different sectors in the industry; the result is that the few experiments in co-management that we have seen in the United States have come in areas, typically fisheries and wildlife, where the resource is in serious crisis and all of the parties to the agreement have had to abandon the positions they held previously.Examples of successful co-management regimes include those among American tribes in the Pacific Northwest, among commercial salmon fishers in Alaska, and in a project to rehabilitate the clam industry in New Jersey. Government employees and local groups share responsibility for gathering scientific data about the resources, for developing plans to manage them, and for enforcing regulations. Successful experiments at co-management seem to generate better scientific data about their resources than traditional management regimes do; they significantly reduce enforcement costs; and they enhance the economic power of the resource users. Most importantly, they nurture among the user groups a sense of control over their own destinies, and a willingness to share both costs and benefits of managing the resources rationally and to develop lasting, stable mechanisms for conflict resolution. The process is both democratic and ecologically rational. The key is to link the day-to-day work of producers to their long-range interests as residents in their communities and as working parts of the ecological systems in which they live.45At a minimum, it is clear that objective certainty about the state of the resources or the likely effect of whatever regulations we do impose is simply not attainable. This is partly because of the important role that random shocks play in the environment (and should play in our thinking about it), and also because of the sheer complexity of the system in which we are embedded. There will always be something that even the most complete model leaves out; and in any event the total system of ecology, production, and management will change every time something changes in any part of it.The policy lesson to be derived from all of this, finally, is that what we ought to sustain when we approach conservation problems is not the size of a particular resource, or even the prosperity of a particular harvesting group, but the long-term health of the interaction between nature, the economy, and the political system. We can recognize that the balance of the system, our attempted insurance against an uncertain future, democracy among user groups, and our moral duty to avoid extinguishing species — all of these things being difficult to quantify — do play integral roles in the conversation between nature and humankind, and perhaps more significant roles than the more objective measures to which we usually look for guidance. We can recognize, as John Muir did, that because everything in the universe is hitched to everything else, every step we take will change the total system in some way. When we make choices, then, we can keep an eye on what kind of conversation we want to have with the rest of Creation and make our choices accordingly. *** DIRECT SUPPORT *** A8402064 00014 *** DIRECT SUPPORT *** A8402064 00015. (shrink)

Current management of people with prolonged disorders of consciousness is failing patients, families and society. The causes include a general lack of concern, knowledge and expertise; a legal and professional framework which impedes timely and appropriate decision-making and/or enactment of the decision; and the exclusive focus on the patient, with no legitimate means to consider the broader consequences of healthcare decisions. This article argues that a clinical pathway based on the principles of the English Mental Capacity Act 2005 and using (...) time-limited treatment trials could greatly improve patient management and reduce stress on families. There needs to be early and continuing use of formal best interests meetings, starting between 7 and 21 days after onset of unconsciousness. The treatment options need to evolve as the clinical state and prognosis becomes more certain. A formal discussion of treatment withdrawal should occur when the upper bound of predicted recovery falls below a level the patient would have considered acceptable, and it should always be discussed when the condition is considered permanent. Any decision to stop treatment should be contingent on a formal second opinion from an independent expert who should review the clinical situation and expected prognosis, but not the best interests decision. The article also asks how, if at all, the adverse effects on the family and the resource implications of long-term care of people left in a prolonged state of unconsciousness should be incorporated in the process. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Disability Embodied: Narrative Exploration of the Lives of Two Brothers Living with Traumatic Brain InjuryDouglas E. KiddAny discussion of personal experiences with disability, inevitably lead me to recall the experiences of my brother, Richard Kidd. An examination of our journeys clearly illustrates the term disability. More so, our stories reveal the outcome of severe physical impairment dictates the limits of personal agency and autonomy. Perhaps an obvious conclusion, (...) but exploration of our experience is useful as we provide living testimony to eventualities that could similarly occur to others. In order to provide context for discussion of our disabilities, I will briefly recall how we acquired our traumatic brain injuries (TBI), as well as how our brain injuries are expressed. The article will demonstrate that due to the severity of the brain damage he acquired, Richard is entirely subject to the whim of the society he encounters, and thus disabled. The article will also discuss how the disabling attitudes I have encountered sought to diminish my humanity.Richard KiddRichard’s descent into impairment began in the early evening hours of December 31, 1987. As a pedestrian, Richard attempted to cross a street in Indianapolis, when a car without using headlights, slammed into him. In addition, the driver fled the scene of the accident. After stabilizing from the initial trauma—multiple compound fractures to both legs and severe brain injury—Richard spent approximately ten months in coma. After emerging from coma, Richard underwent months of therapy. Albeit with consistent direction from others, therapy enhanced Richard’s ability to hold a cup and use a spoon. These were significant victories for Richard and signaled the beginning of his recovery. However, within two years of his accident, monies ended for rehabilitation and Richard entered into custodial care at his first nursing facility. As time passed, his daily interactions with poorly supervised, unskilled, and underpaid nursing facility employees with little time to work with Richard meant it was more cost efficient for staff to simply spoon–feed Richard. Consequently, Richard lost the ability to participate in an aspect of his self–care. Richard’s humanity took years to gradually erode, but due to the severity of his impairments, he became viewed by those he encountered as an object of treatment, or reservoir of pain and pity, rather than an individual worthy of respect. Accordingly, [End Page 199] Richard became viewed as other. Thus began Richard’s descent into disability.A complete lack of dental care for decades provides a good example of Richard’s treatment as other. Richard’s experience also demonstrates that desensitized members of the medical, dental, and long–term care professions sometimes precipitate grave circumstances. The combination of an inattention to his needs and his limited ability to participate with his self–care meant that Richard typically went without dental treatment. His quality of life diminished further when aides at a nursing facility dropped him. During the fall, Richard’s face smashed into the floor and several teeth were shattered. More than a decade passed before Richard finally received follow–up dental treatment—that day nearly cost him his life. Due to prolonged neglect, all of Richard’s teeth required extraction. I do not question the dental surgeon’s assessment of Richard’s teeth. I am certain that all of his teeth needed to be removed; but Richard’s sedentary lifestyle meant that he had limited ability to cope with the trauma associated with having 24 teeth removed in one session. I feel certain the dental surgeon assumed Richard was like most other patients and could handle the stress associated with the procedures. However, Richard could not cope with trauma and blood loss the extractions produced. What is worse than the dental surgeon’s assessment of Richard’s ability to withstand surgery is the post–op personnel decision to discharge him to home, shortly after surgery. The nursing facility was ill–equipped to cope with the extent of the blood loss that ensued and soon Richard began to aspirate on his own blood. Accordingly, Richard was sent to the hospital where he proceeded to slip into coma. Richard remained in a coma for approximately four days and in hospital... (shrink)

Miguel is an eighteen‐year‐old male transferred to Alamo Hospital for antivenom treatment after a rattlesnake bite while sleeping on railroad tracks. His “coyote,” an individual who guides undocumented people across the U.S. border from Mexico, dropped him off at a clinic. By the time Miguel was transferred from the clinic to Alamo, he was in complete paralysis and at risk for heart failure, requiring ventilator support to breathe. A person who receives treatment for a snake bite within one to two (...) hours has a 99 percent chance of recovery, but for Miguel, at least fifteen hours had already passed. A hospital ethicist at Alamo contacted the Mexican consulate, and together they arranged for Miguel's father to come to Alamo and make decisions for him. His physicians have determined that he is in a persistent vegetative state and can no longer benefit from hospital treatment. However, no long‐term care facility will accept him. Miguel is undocumented and unfunded. Miguel's father wishes to take his son home, but the cost of transporting him is high,and their home state in Mexico has no ventilator available for him and no consistent supply of electricity to run it. What should the hospital do? (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Living Organ Donors’ Stories: (Unmet) Expectations about Informed Consent, Outcomes, and CareElisa J. Gordon, Symposium EditorKeywordsEthics, informed consent, kidney, liver, living donor, narrative, transplantationLiving donor organ transplantation has become standard treatment for patients with end-stage kidney or end-stage liver disease. Live donors comprised approximately 5,769 (34%) and 247 (4%) of all kidney and liver transplants in 2011, respectively (OPTN/UNOS). The reasons why people donate, the perception that donating does (...) not entail a decision per se, and the attendant fears and anxieties living donors feel about donating, have all been previously well investigated (Lennerling, Forsberg, Meyer, & Nyberg, 2004; Papachristou, Walter, Frommer, & Klapp, 2010). But much less is known about how donors experienced the overall donation process including the donor evaluation, preparation, appreciation of risks, decision-making, informed consent, post-operative, recovery processes, and the impact of donating on all aspects of their life, from their point of view. Thus, a narrative approach is essential for gaining insights into these less well known phenomena.There is good reason to remain concerned about the safety and ethical basis of living donation considering that living donors undergo serious health risks for no direct medical benefit to themselves (Ethics Committee of the Transplantation Society, 2004; Laird, 2012; Neergaard, 2011; Ratner & Sandoval, 2010; Shelton, 2011). The situation raises serious ethical questions specifically about nonmaleficence and informed consent, and more broadly about using people as a means to an end. The absence of long-term information may not undermine a willing donor’s commitment to save a loved one’s life, but is certainly cause for concern among transplant clinicians who want to be sure to disclose information that may be material for donors in order to provide adequate informed consent. In other words, the disjuncture between what transplant clinicians find important to disclose to donors and what prospective donors need to know—which follows along the lines of what Elliot Mishler referred to as the ‘voice of medicine’ versus the ‘voice of the lifeworld’(1984)—seems to complicate donors’ preparation for donation. Donors’ stories are important for addressing these concerns by identifying risks that typically do not get reported in the scientific literature—perhaps owing to a different [End Page 1] conceptualization of what should be construed as noteworthy risks—as well as by demonstrating how personal situations can enhance or detract from the experience overall.This issue of Narrative Inquiry in Bioethics (NIB) affords a unique entrée into both the often heard and unheard stories of living organ donors. A set of topical areas were presented for the authors’ consideration that relate to the donation process in general and the informed consent process more specifically: whether donors were prepared to donate; comprehended what they were told; could have understood the process better, as well as, the impact of donation on health, employment, finances, and personal relationships (Table 1). When soliciting donors’ stories, every effort was made to include a full range of experiences—both good and bad—from a variety of donors: kidney donation, liver donation, adult-to-adult and adult-to-child donation, related, unrelated, directed and anonymous (also known as ‘altruistic’ or ‘good Samaritan’ donors), paired chain exchange, and list exchange (Table 2)—in order to present a balanced perspective on live donation. Additionally, this issue includes a full breadth of stories about the donor experience, ranging from positive to mixed to negative (Table 3). While donors were given tremendous leeway in what stories they told, they were asked to focus their narratives on the lesser known dimensions of donation—the experience of it. While additional stories from liver donors would have helped to underscore common concerns among liver donors, we only received a few. Some of the donors are themselves health care professionals, active in the United Network for Organ Sharing (UNOS) or their local OPO, or have leveraged their experiences to help others by becoming a donor buddy or donor advocate. Given that we received more stories than Click for larger view View full resolutionTable 1.Topical areas to address[End Page 2] Click for larger view View full resolutionTable 2.Forms of Living Donation Click for larger view View... (shrink)

Given the long-standing controversy about whether the brain-dead should be considered alive in an irreversible coma or dead despite displaying apparent signs of life, the ethical and policy issues posed when family members insist on continued treatment are not as simple as commentators have claimed. In this article, we consider the kind of policy that should be adopted to manage a family's insistence that their brain-dead loved one continues to receive supportive care. We argue that while it would be (...) ethically inappropriate to continue to devote scarce acute care resources to such patients in a hospital setting, it may not be ethically inappropriate for patients to receive these resources in certain other settings. Thus, if a family insists on continuing to care for their brain-dead loved at their home, we should not, from a policy perspective, interfere with the family's wishes. We also argue that healthcare professionals should make some effort to facilitate the transfer of brain-dead patients to these other settings when families insist on continued treatment despite being informed about the lack of any potential for recovery of consciousness. Our arguments are strengthened by the fact that patients in a persistent vegetative state, who, when correctly diagnosed, also have no potential for recovery of consciousness, are routinely transferred from hospitals to nursing homes or long-term care facilities where they continue to be ventilated, tube fed and to receive other supportive care. We also briefly explore the question of who should be responsible for the costs of such treatment at the long-term care facility. (shrink)

Dysfunctional customer behavior is common in service settings. For frontline employees, negative encounters can cause short-term despondency or have profound, long-term psychological effects that often result in both direct and indirect costs to service firms. Existing research has explored the influence of dysfunctional customer behavior on employee emotions, but it has not fully investigated the psychological mechanism through which customer misbehavior transforms into employee responses. To maintain service quality and employee well-being, it is important to understand the (...) impact of customer misconduct on employee emotions and its effect on subsequent service behavior. To assess the process through which dysfunctional customer behavior manifests as negative emotions in frontline service employees, and the influence of negative employee emotions on their prosocial service behavior, we surveyed 185 frontline banking service employees. We sought information on service employee experiences, attitudes, and feelings regarding dysfunctional customer behaviors, the perceived level of supervisor support, and employee prosocial service behavior intentions. Structural equation modeling and hierarchical linear modeling were used for statistical analysis and hypothesis verification. Results indicate that dysfunctional customer behavior has a positive relationship with bank service employee negative emotions and a negative influence on employee prosocial service behavior. The study found that negative emotions fully mediated the relationship between dysfunctional customer behavior and prosocial service behavior. The moderating role that perceived supervisor support plays on the relationships between dysfunctional customer behavior and negative emotion was also investigated. The results show that perceived supervisor support moderates the relationship between dysfunctional customer behavior and negative employee emotions. Finally, the study provides bank managers with effective strategies to assist frontline employees to manage and deter dysfunctional customer behavior, and presents employees with internal recovery strategies when encountering dysfunctional customer behavior. (shrink)

In all fields of clinical medicine, there is an increasing awareness that outcome must be assessed in terms of quality of life and cost effectiveness, rather than merely length of survival. This is especially the case when considering decompressive craniectomy for severe traumatic brain injury. The procedure itself is technically straightforward and involves temporarily removing a large section of the skull vault in order to provide extra space into which the injured brain can expand. A number of studies have demonstrated (...) many patients going on to make a good long-term functional recovery, however, this is not always the case and a significant number survive but are left with severe neurocognitive impairment. Unfortunately, many of these patients are young adults who were previously fit and well and are, therefore, likely to spend many years in a condition that they may feel to be unacceptable, and this raises a number of ethical issues regarding consent and resource allocation. In an attempt to address these issues, we have used the analytical framework proposed by Jonsen, that requires systematic consideration of medical indications, patient preferences, quality of life and contextual features. (shrink)

This volume illustrates the central importance of diversity of human values throughout healthcare. The readings are organized around the main stages of the clinical encounter from the patient's perspective. They run from staying well and 'first contact' through to either recovery or to long-term illness, death and dying.

In cases of depression where linguistic meaning has collapsed, there is good reason to believe that a long-term strategy for recovery must include rehabilitating the depressive person's capacity for meaningful speech. This requires that the patient participate actively in interpreting her own pain. In this essay, I argue that medical diagnosis can tempt patients, particularly women, to circumvent this process of interpretation. To explain this danger, I draw on Julia Kristeva's clinical analyses of depression and recent studies (...) on the correlation between depression and self-silencing. (shrink)

Given the long‐standing controversy about whether the brain‐dead should be considered alive in an irreversible coma or dead despite displaying apparent signs of life, the ethical and policy issues posed when family members insist on continued treatment are not as simple as commentators have claimed. In this article, we consider the kind of policy that should be adopted to manage a family's insistence that their brain‐dead loved one continues to receive supportive care. We argue that while it would be (...) ethically inappropriate to continue to devote scarce acute care resources to such patients in a hospital setting, it may not be ethically inappropriate for patients to receive these resources in certain other settings. Thus, if a family insists on continuing to care for their brain‐dead loved at their home, we should not, from a policy perspective, interfere with the family's wishes. We also argue that healthcare professionals should make some effort to facilitate the transfer of brain‐dead patients to these other settings when families insist on continued treatment despite being informed about the lack of any potential for recovery of consciousness. Our arguments are strengthened by the fact that patients in a persistent vegetative state, who, when correctly diagnosed, also have no potential for recovery of consciousness, are routinely transferred from hospitals to nursing homes or long‐term care facilities where they continue to be ventilated, tube fed and to receive other supportive care. We also briefly explore the question of who should be responsible for the costs of such treatment at the long‐term care facility. (shrink)

Research suggests that stress has immediate and long-term effects on attention and memory. Rather than disrupting memory formation and consolidation, acute stress has been shown to shift attention processes resulting in a tradeoff between prioritized and nonprioritized information. Both arousal and stress result in cognitive and neurobiological shifts that often support memory formation. When an acute stressor occurs, it can distort immediate attentional focus, increasing processing for high-priority features while reducing processing for extraneous features. The downstream cognitive consequences (...) for this shift in attention are better memory for some features and poorer memory for others when compared to conditions of low stress. However, individual differences (e.g., sex, age, basal stress response, and stress reactivity) all impact the relationship between the acute stress response and memory. Although acute stress generally benefits memory formation, we suggest that forgetting and later recovery of stressful memories can better be understood by examining factors that influence the subjective experience of stress and stress reactivity. (shrink)

Background Female genital mutilation and circumcision (FGM/C) practices present physicians in Germany with numerous challenges. One possible intervention is elective clitoral reconstruction for esthetic and physiological recovery after FGM/C. Even if the study situation regarding the results achieved by clitoral reconstruction is controversial, the range of reconstruction options is increasing. Arguments The aim of this study is to critically examine the epistemic and ethical dimensions of the interdisciplinary debate on clitoral reconstruction that has arisen over the last 20 years. (...) It is intended to provide orientation in the complex field in which cultural, gender-specific, sexual, and psychosocial factors interact with anatomical–physiological knowledge and the lack thereof. The analysis shows the ambivalent role of evidence claims and promises in relation to clitoral reconstruction. Conclusions Difficulties in testing and comparing existing surgical procedures and in the use of standardized questioning tools demonstrate how essential cultural competence and diversity awareness are in dealing with those affected. The prima facie correct argument of insufficient evidence on the efficacy, comparability, and long-term consequences of reconstruction procedures proves to be problematic for ethical and epistemic reasons. In order to generate valid and useful data on sexuality, body perception, pain, and pleasure before and after clitoral reconstruction, survey modalities that address the culturally heterogeneous target group of women with FGM/C are needed. Cultural competence and sensitivity in medicine are also urgently needed for target group-oriented education and counseling as a prerequisite for self-determined decisions for/against clitoral reconstruction. (shrink)

This article explores the theological themes prevalent in the language of anorexia nervosa by briefly exploring extant literature in the field before reporting on the author’s qualitative fieldwork with Christian women with anorexia nervosa. Sufferers, both those from religious and non-religious backgrounds, often convey their understanding of their illness in theological and moral language, using terms such as ‘sin’ and ‘sacrifice’. The use of theological frameworks on ‘Pro-Ana’ internet forums is also considered. The article concludes by considering the implications of (...) this use of theological language for pastoral and chaplaincy care, and argues that highly skilled mental health chaplains would be of benefit to treatment models for anorexia nervosa and that community church leaders can pay a crucial role in long-lasting recovery, particularly for anorexic women who profess a Christian faith. (shrink)

Despite having paved the way for face, womb and penis transplants, hand transplantation today remains a small hybrid of reconstructive microsurgery and transplant immunology. An exceptionally limited patient population internationally complicates medical researchers’ efforts to parse outcomes “objectively.” Presumed functional and psychosocial benefits of gaining a transplant hand must be weighed in both patient decisions and bioethical discussions against the difficulty of adhering to post-transplant medications, the physical demands of hand transplant recovery on the patient, and the serious (...) class='Hi'>long-term health risks of immunosuppressant drugs. This paper relates five narratives of hand transplantation drawn from an oral history project to show how narrative methods can and should inform ethical evaluations and the clinical process of hand transplantation. The interviews with patients and their partners analyzed here lead us to suggest that qualitative accounts of patient experiences should be used to complement clinical case studies reported in medical journals and to help develop instruments to assess outcomes more systematically. (shrink)

Jonas, sixty-four, had never had a problem with the police and was reputed to be polite and calm. How then to explain the sudden outburst of violence when, on a given night, he shot a rifle at police officers? No one was harmed, but the perpetrator was arrested. It was in prison, a few hours after the incident, that Englebert, at the time a prison psychologist, met him. Englebert was also able to interview some of Jonas's family and friends, all (...) of whom were astonished by the event. This book, written by Englebert in collaboration with philosopher Grégory Cormann, analyzes the case not so much to find an ultimate explanation for Jonas's act as to show the variety of ways in which one can frame the man and his actions.The most common way of framing the event, the one most of Jonas's acquaintances have employed, is to link the violence with madness, but temporary insanity is not really an explanation. To say that Jonas went mad is no more than saying that his violence was incomprehensible. Still, to assert that he was mad when he fired the rifle qualifies as an interpretation in that it splits the act from the rest of the man's life. By insisting on that separation, kin and friends unburden themselves of any feelings of guilt they may experience at not having been able to prevent the act.Jonas's wife has another version of the event. She connects it with the recent death of his mother. Jonas was very close to his mother: he had dined with her every night of his life, even after his marriage thirty years before she died. Indeed even after her death, a month before the episode with the police, he had continued to go every night to her house. He wanted to carry on his lifelong habit, without change. A dispute about the house with his twenty-year-old son led to the encounter with the police: Jonas had added to his will a provision that his son would inherit the house but would be prohibited from ever selling it. The son found this prohibition unacceptable, and their argument came rapidly to blows. Out of fear, Jonas's wife called the police. Jonas went to the attic and brought down his late father's rifle. The son fled, but Jonas remained on the doorstep, waiting for the police.All the data presented in this book appear to confirm that Jonas suffered from a “major depressive disorder with melancholic features,” characterized by strong attachment to order and regularity. In this interpretation, the shot was a desperate act, aimed somehow at precluding change. Hence the act marked not a break in the man's life but signaled continuation of a long-term disorder.Englebert and Cormann, however, advance a third version—the most audacious, the most original. They compare the shot (a moment of high excitation) to the electroconvulsive therapy sometimes used to treat manic depression. It seems that electroshock produces a temporary disruption in the brain that is followed by a higher neuroplasticity that can help patients to recover. By putting himself in a perilous situation, Jonas produced an excitation that could disrupt his neural circuitry. In the authors’ interpretation, the act suggests neither temporary insanity nor the symptom of a long-term illness, but a first step toward recovery. The rifle was an improvised instrument for self-treatment.The book reflects Jean-Paul Sartre's claim according to which “it is perhaps sufficient to seek the explanation for a crime in the social situation and the criminal's psychopathic makeup, but only a poet can elucidate its human meaning.” Englebert and Cormann prove to be poets by showing how Jonas could free himself from self-bondage. (shrink)

A slight stabilization of some macroeconomic indicators Ukraine in conditions of long-term preservation of structural imbalances in the domestic economy against the background of global economic recovery, reduce consumer demand in the global markets combined with the devaluation of the hryvnia no reason to conclude that ensure the sustainability of enterprises to the likely financial and economic turmoil. Given this situation, the article identifies the main problems of accounting of foreign exchange transactions in Ukraine through the prism (...) of foreign software security. At present actualized issue integration into the European economic space, which leads to aggravation of the issue of financial payments in foreign currency and their reflection in the accounting business. Stand unstable economic situation in the domestic market of Ukraine leads the majority of domestic enterprises to shift to foreign markets. Foreign trade enterprises directly related to the riskiness and exposure to foreign shocks her, so constantly need to monitor the status of foreign security. Based on empirical research using the software package MS Excel, articles in the research and forecasting of external economic security of Ukraine and brought a further increase of this indicator in a strategic perspective. However, foreign financial and payment transactions engaged in enterprise involving consideration of exchange rate fluctuations, in which there are exchange differences significantly affect the financial results of the company. In order to improve the accounting currency transactions in the context of foreign trade enterprises proposed harmonization of national and international accounting systems using international standards in national accounting system and financial reporting. (shrink)

The 1960s was a decade dedicated to experimentation within the Kennedy and Johnson administrations. Americans witnessed many significant changes and advancements in those ten short years, including the first man on the moon, a war in Vietnam, and successes in the automobile industry. Probably the most important of these changes was the War on Poverty, introduced by John Fitzgerald Kennedy and continued by Lyndon Baines Johnson and subsequent administrations. This paper examines the creation of a new class of reliance on (...) government handouts, as well as a misallocation of resources.Poverty was a well-known tragedy in third world countries. It was hard to believe that the United States, a leading nation of the world, was hit just as badly as those other countries. In fact, many Americans denied the problem for fear of the reaction from the rest of the world. In reality, though, many American families were struggling every day to provide food, shelter, and education for their children. Once this devastating misfortune was acknowledged, Kennedy dedicated his 1960 campaign to the New Frontier, which would encourage Americans to regain faith in their country by implementing programs to eradicate poverty. To succeed, Kennedy knew that the key to recovery centered on education. Improved education would provide the youth with better job opportunities, which would increase productivity, and therefore decrease poverty. Unfortunately, Kennedy was unable to follow through with his plans. After he was assassinated, Johnson took office ready to expand on Kennedy’s drafted plan. He wanted to look at poverty in a more positive way, as an opportunity to effectively change society. Continuing with Kennedy’s ideas, Johnson felt this change would best be accomplished through publics works programs. In his State of the Union Address, Johnson declared a “war on poverty” in which he would provide Americans with the tools needed to escape the world of poverty and make a living for themselves.Under the provision of the Office of Economic Opportunity, created specifically to abolish poverty, programs were created to begin the process of recovery. Community action programs, the Jobs Corps, and Head Start are just three programs put into action to improve the status of the poor. Job training and education were the main functions of these programs, but the effectiveness is heavily debated amongst historians.Though many claim that the War on Poverty was indeed successful, evidence shows otherwise. In viewing statistics from Congressional Records and other government documents, it is clear that the short-term effects were not worth the long-term consequences, and had the problem of poverty been left to the natural market, the issue would have been solved much more sufficiently. (shrink)

Background Female genital mutilation and circumcision (FGM/C) practices present physicians in Germany with numerous challenges. One possible intervention is elective clitoral reconstruction for esthetic and physiological recovery after FGM/C. Even if the study situation regarding the results achieved by clitoral reconstruction is controversial, the range of reconstruction options is increasing. Arguments The aim of this study is to critically examine the epistemic and ethical dimensions of the interdisciplinary debate on clitoral reconstruction that has arisen over the last 20 years. (...) It is intended to provide orientation in the complex field in which cultural, gender-specific, sexual, and psychosocial factors interact with anatomical–physiological knowledge and the lack thereof. The analysis shows the ambivalent role of evidence claims and promises in relation to clitoral reconstruction. Conclusions Difficulties in testing and comparing existing surgical procedures and in the use of standardized questioning tools demonstrate how essential cultural competence and diversity awareness are in dealing with those affected. The prima facie correct argument of insufficient evidence on the efficacy, comparability, and long-term consequences of reconstruction procedures proves to be problematic for ethical and epistemic reasons. In order to generate valid and useful data on sexuality, body perception, pain, and pleasure before and after clitoral reconstruction, survey modalities that address the culturally heterogeneous target group of women with FGM/C are needed. Cultural competence and sensitivity in medicine are also urgently needed for target group-oriented education and counseling as a prerequisite for self-determined decisions for/against clitoral reconstruction. (shrink)

AimThe functional prognosis of patients after coma following either cardiac arrest or acute structural brain injury is often uncertain. These patients are associated with high mortality and disability. N20 and N70 somatosensory evoked potentials are used to predict prognosis. We evaluated the utility of SSEP as an early indicator of long-term prognosis in these patients.MethodsThis was a retrospective cohort study of patients admitted to the intensive care unit with a diagnosis of coma after CA or ABI. An SSEP (...) study was performed, including N20 and N70 at 24–72 h, after coma onset. Functional recovery was assessed 6–12 months later using the modified Glasgow scale. The study was approved by our local research ethics committee.ResultsIn the CA and ABI groups, the absence of N20 or N70 was a strong indicator of poor outcome. Conversely, the presence of N70 was an indicator of a good outcome.ConclusionSomatosensory evoked potentials are useful early prognostic markers with high specificity and sensitivity. Moreover, N70 has additional potential value for improving the prediction of good long-term functional outcomes.Clinical Trial Registration:[https://clinicaltrials.gov/], identifier [2018/01/001]. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Prelude to Tackling Contemporary Crises: William James and a Psychological Springboard to Political ChangePaul Croce (bio)“That selective industry of the mind,... incessantly deciding, among many things,... which ones for it shall be realities.”—William James, 1892 (PBC, 167)“[N]either the whole of truth, nor the whole of good, is revealed to any single observer.”—William James, 1899 (TT, 149)The modern world has witnessed tremendous increases in prosperity, and that material abundance has (...) spurred great achievements. But these successes have also brought enormous and troubling side effects. Climate change, biodiversity loss, social inequality, and more problems have grown into crises with potential to challenge the achievements themselves. Alongside these challenges, many outstanding proposals have also emerged for dealing with our present crises. The crises and the insights for addressing them are in a harrowing competition, reminiscent of what H. G. Wells called “a race between education and catastrophe.” During recent chapters of this contest, especially in the United States, sound suggestions for halting or reversing environmental deterioration and for reducing class and racial inequities have gained some public and political support but have also met considerable resistance.1 While direct work to [End Page 26] address the crises is important, those efforts can be supported with understanding of the people and ideologies resisting that work. In fact, neglect of these impediments, which can further enable them to reduce abilities or willingness to address problems or even notice them, may be the biggest crisis of all.Just as medication can directly heal an illness while rest and self-care can build up general strength to support recovery, so coping with crises calls for both grappling with them directly and also consideration of the impediments that reduce the strength of those steps toward social healing. The inquiry here serves as a complement to sound proposals for immediate action by diagnosing what has hindered their realization. Outcries against injustice and creative interventions address the acute conditions of current crises, while cultural assessments of ways those responses gain or lose attention serve as prescriptions for addressing the chronic conditions that have exacerbated the crises through distraction. As with medical issues, long-term and preventive care of chronic problems can support acute treatment, even as they do not displace the need for immediate action.This article confronts a puzzle about why so many people do not pay attention to such large problems in nature and society and what steps can be taken to bridge that divide between the committed and the distracted. The emphasis here on attention shifts focus away from ideological differences and toward the values selections that drive the ideological differences. This article portrays James’s own path as he learned from differences before explaining how his theories offer insights on how selective choices shape the assumptions supporting ideologies that so often form into hostile contrasts.2 In addition to these alerts about the challenges of disagreement, he also presents methods to encourage listening across differences for chances to turn some of those commitments into constructive possibilities rather than treating them as reasons [End Page 27] to fight. These ways to evaluate cultural and political debates and increase understanding about selective choices can shed light on how so many people have been unwilling or unable to pay attention to the mounting problems, and through encouragement of more listening with respect, these methods can encourage more support for addressing the crises themselves.I. Jamesian Ways to Listen Across DifferencesCharles Taylor calls William James (1842–1910) “our great philosopher of the cusp.” This brief, elegant expression depicts a borderland thinker adept at mediating contrasting ideas. James’s often-difficult experiences in development toward that way of thinking and that reputation provide more depth about the contrasts that he experienced on the way toward his creative syntheses in psychology and philosophy.3 His wrestling with different interpretations serves as a microcosm for the challenges and rewards of listening for potential insights on each side of even hostile contrasts. He designed deliberate ways to reckon with differences, considering each to be a partial yet valuable window into the human condition. In his youth, he was torn between the competing perspectives of religious thought... (shrink)

The Iowa Gambling Task (IGT) is widely used to study decision‐making within healthy and psychiatric populations. However, the complexity of the IGT makes it difficult to attribute variation in performance to specific cognitive processes. Several cognitive models have been proposed for the IGT in an effort to address this problem, but currently no single model shows optimal performance for both short‐ and long‐term prediction accuracy and parameter recovery. Here, we propose the Outcome‐Representation Learning (ORL) model, a novel (...) model that provides the best compromise between competing models. We test the performance of the ORL model on 393 subjects' data collected across multiple research sites, and we show that the ORL reveals distinct patterns of decision‐making in substance‐using populations. Our work highlights the importance of using multiple model comparison metrics to make valid inference with cognitive models and sheds light on learning mechanisms that play a role in underweighting of rare events. (shrink)

High noise levels may have an adverse effect on the normal cochlea function and lead to significant hearing loss. Clinically, exposure to high intensity impulse noise produces a wide range of audiometric effects which may result in long term or even irreversible symptoms. Nevertheless, there is sometimes a spontaneous rebound recovery of the auditory function. This phenomenon was previously studied in the vision, another sensory function. It was called the visual survival attractor.In view of the importance that (...) the sensory organs have for the brain, and in particular in its function of recognising and dealing with its environment, it was interesting to know whether this survival attractor concept already described for vision occurs more generally in all the sensory functions. With this in mind we present here the results of a new study, this time on hearing. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Extramarital Contraception in the Catholic Faith:A Call to Action from a Physician and EthicistCara BuskmillerIntroductionDefinitionsBefore proceeding to a discussion of extramarital contraception, it is relevant to lay a foundation of definitions and limitations of this essay. Here, "sex" and "sexual act" will refer to acts of penile–vaginal intercourse and acts meant to lead to such intercourse, respectively. Other acts which are rightly called "sexual" are not relevant to this (...) essay, as the focus here is on encounters that could result in fertilization.The traditional natural law theory with its analysis of object, intention, and circumstances is at play in this essay, with a hylomorphic understanding of nature and ethics. In this understanding of ethics, the names of many acts include not only an object but an intention and circumstances (e.g., murder specifies an illegal type of killing with premeditation). Likewise, "contraception" here refers to the use of any drug or device which temporarily lowers fertility (object), to prevent fertilization (intention) due to presumed-fertile sex (circumstance). Such drugs or devices are called "contraceptives" in this essay. In this essay, "contraception" is not committed solely by intending to avoid fertilization, so acts such as trying to avoid fertilization by timing sex during infertile parts of a menstrual cycle are not contraception, and the pastoral term "contraceptive mindset" does not apply. "Contraception" is also not solely defined by the use of particular medical products, since the intention to avoid fertilization is part of the definition in this essay. Thus, [End Page 1245] prescribing or taking a birth control pill for polycystic ovarian syndrome, in the words of Pope St. Paul VI in his 1968 landmark encyclical Humanae Vitae (HV), is not at all illicit, here because such treatment is not contraception, and the problems of contraception do not apply (§15)."Marriage" in this essay refers principally to sacramental matrimony, made by the consent of a baptized man and a baptized woman.1 Civil marriage, cohabitation, long-term affairs, sex in dating, short-term hookups, prostitution, and sexual assault represent a spectrum of falling away from matrimony. This essay assumes that matrimony is God's one true plan for sex, fertilization, and childrearing. This essay also makes heavy use of the Scholastic-personalist perspective of HV on the unitive and procreative dimensions of sex. As sexual relationships "fall away" from matrimony, they lose resemblance to these dimensions."Consent" is here defined as a free act in which a person agrees to do, accept, or reject something.2 Consent is an act of the will, and it may be partial or total. Only when consent is total is a person held fully responsible for his or her actions; for example, only when consent is total can a person commit a mortal sin. Consent is different from assent, which is not of the will, but of the mind.3 In this paper, sex without consent is termed "sexual assault"—the status of the act as an assault is solely determined by consent. These definitions allow for a sexual assault in which a victim withholds consent and yet does not resist an attack,4 which is different from past legal and colloquial definitions.5 This definition also allows for assault victims that have positive emotional responses to or physical arousal from an attack. These responses from a victim do not make the assault consensual or desired, [End Page 1246] and in fact make post-traumatic recovery more difficult.6 Simply put, consent is of the will, and this is not diminished by whether the body follows suit; this differs from some legal definitions of consent in canon law, where the will of the person agreeing to a contract is signified by externals, even if there was no intention to fulfill the duties of the contract.7 Consent will be central to this essay, since it helps make the spectrum of relationships that "fall away" from marriage intelligible in two sets: one with consent, and one without."Intellectual disability" in medical and ethical literature refers to a large spectrum of differences in mental and behavioral performance, but this essay is only considering intellectually disabled persons who would be unable to... (shrink)

This narrative symposium brings to light the extreme difficulties faced by parents of children diagnosed with brain tumors. NIB editorial staff and narrative symposium editors, Gigi McMillan and Christy A. Rentmeester, developed a call for stories that was distributed on several list serves and posted on Narrative Inquiry in Bioethics’ website. The call asks parents to share their personal experience of diagnosis, treatment, long–term effects of treatment, social issues and the doctor–patient–parent dynamic that develops during this process. Thirteen (...) stories are found in the print version of the journal and an additional six supplemental stories are published online only through Project MUSE. One change readers may notice is that the story authors are not listed in alphabetical order. The symposium editors had a vision for this issue that included leading readers through the timeline of this topic: diagnosis–treatment–acute recovery–recurrence–treatment (again)– acute recovery (again)– long-term quality of life– (possibly) end of life. Stories are arranged to help lead the reader through this timeline. Gigi McMillan is a patient and research subject advocate, co-founder of We Can, Pediatric Brain Tumor Network, as well as, the mother of a child who suffered from a pediatric brain tumor. She also authored the introduction for this symposium. Christy Rentmeester is an Associate Professor of Health Policy and Ethics in the Creighton University School of Medicine. She served as a commentator for this issue. Other commentators for this issue are Michael Barraza, a clinical psychologist and board member of We Can, Pediatric Brain Tumor Network ; Lisa Stern, a pediatrician who has diagnosed six children with brain tumors in her 20 years of practice; and Katie Rose, a pediatric brain tumor patient who shares her special insights about this world. (shrink)