Rationale, aims and objectives To compare the pharmacotherapeutic approaches to diabetic hypertension of family physicians (FPs) and general practitioners (GPs). Methods A retrospective prescription-based study was conducted in 15 out of a total of 20 health centres, involving 115 primary care physicians – 77 FPs and 38 GPs, representing 74% of the primary care physicians of Bahrain. Prescriptions were collected during May and June 2000 to comprise a study population of 1266 diabetic-hypertensive patients. Results As monotherapy, angiotensin-converting enzyme (ACE) inhibitors (...) (37.9%) and β-blockers (38.3%) were the most commonly prescribed classes of antihypertensives by FPs and GPs, respectively. Calcium channel blockers (CCBs) were ranked third by both categories of physicians. For two-drug combinations, a β-blocker and an ACE inhibitor was the combination of choice for both physician categories. Patients managed by the FPs were more likely to receive a β-blocker–CCB combination (17.4 vs. 14.9%) or a diuretic–ACE inhibitor combination (16.7 vs. 11.4%) and less likely to receive a β-blocker–diuretic combination (11.8 vs. 16.7%) than those managed by the GPs. The proportion of patients receiving antihypertensive combinations was 40.6 and 38.5% for FPs and GPs, respectively. While the GPs prescribed CCB as a monotherapy to the elderly most often, the FPs choice was a β-blocker. Diuretics were less preferred by both FPs and GPs. β-Blocker–ACE inhibitor was again the most preferred combination of both FPs and GPs. FPs prescribed CCB–β-blocker combinations more often than GPs (P = 0.01), whereas CCB–ACE inhibitor combinations were less preferred (P = 0.09). A trend towards excessive use of short-acting nifedipine as monotherapy for elderly patients, both by FPs and by GPs, was noticed. Glibenclamide, alone or in combination with metformin, was the foremost antidiabetic drug prescribed by FPs and GPs. Middle-aged (45–64 years) patients seen by GPs were more likely to receive glibenclamide than those treated by FPs (P = 0.001) and less likely to receive gliclazide (P = 0.01). Combinations of a β-blocker with either glibenclamide or insulin were prescribed considerably more often by GPs.Conclusions Within the same practice setting, a substantial difference was observed between FPs and GPs in terms of preference for different classes of drugs in the management of diabetic hypertension. The compliance of both FPs and GPs was suboptimal; overall, the compliance of the FPs was closer to the recommended guidelines, however. Educational programmes should specifically address these inadequacies in order to improve the quality of health care. (shrink)

The COVID-19 pandemic has resulted in more than 524 million cases and 6 million deaths worldwide. Various drug interventions targeting multiple stages of COVID-19 pathogenesis can significantly reduce infection-related mortality. The current within-host mathematical modeling study addresses the optimal drug regimen and efficacy of combination therapies in the treatment of COVID-19. The drugs/interventions considered include Arbidol, Remdesivir, Interferon and Lopinavir/ritonavir. It is concluded that these drugs, when administered singly or in combination, reduce the number of infected cells and viral load. (...) Four scenarios dealing with the administration of a single drug, two drugs, three drugs and all four are discussed. In all these scenarios, the optimal drug regimen is proposed based on two methods. In the first method, these medical interventions are modeled as control interventions and a corresponding objective function and optimal control problem are formulated. In this framework, the optimal drug regimen is derived. Later, using the comparative effectiveness method, the optimal drug regimen is derived based on the basic reproduction number and viral load. The average number of infected cells and viral load decreased the most when all four drugs were used together. On the other hand, the average number of susceptible cells decreased the most when Arbidol was administered alone. The basic reproduction number and viral load decreased the most when all four interventions were used together, confirming the previously obtained finding of the optimal control problem. The results of this study can help physicians make decisions about the treatment of the life-threatening COVID-19 infection. (shrink)

Pancreatitis is a complex, progressively destructive inflammatory disorder. Alcohol was long thought to be the primary causative agent, but genetic contributions have been of interest since the discovery that rare PRSS1, CFTR and SPINK1 variants were associated with pancreatitis risk. We now report two associations at genome-wide significance identified and replicated at PRSS1-PRSS2 and X-linked CLDN2 through a two-stage genome-wide study. The PRSS1 variant likely affects disease susceptibility by altering expression of the primary trypsinogen gene. The CLDN2 risk allele is (...) associated with atypical localization of claudin-2 in pancreatic acinar cells. The homozygous CLDN2 genotype confers the greatest risk, and its alleles interact with alcohol consumption to amplify risk. These results could partially explain the high frequency of alcohol-related pancreatitis in men. © 2012 Nature America, Inc. All rights reserved. (shrink)

The Greeks and Romans have been charged with destroying the ecosystems within which they lived. In this book, however, M. D. Usher argues rather that we can find in their lives and thought the origin of modern ideas about systems and sustainability, important topics for humans today and in the future. With chapters running the gamut of Greek and Roman experience – from the Presocratics and Plato to Roman agronomy and the Benedictine Rule – Plato's Pigs brings together unlikely bedfellows, (...) both ancient and modern, to reveal surprising connections. Lively prose and liberal use of anecdotal detail, including an afterword about the author's own experiments with sustainable living on his sheep farm in Vermont, add a strong authorial voice. In short, this is a unique, first-of-its-kind book that is sure to be of interest to anyone working in Classics, environmental studies, philosophy, ecology, or the history of ideas. (shrink)

AimsThis study evaluates a protocol for early, routine ethics consultation for patients on extracorporeal membrane oxygenation to support decision-making in the context of clinical uncertainty with the aim of mitigating ethical conflict and moral distress.MethodsWe conducted a single-site qualitative analysis of EC documentation for all patients receiving ECMO support from 15 August 2018 to 15 May 2019. Detailed analysis of 20 ethically complex cases with protracted ethics involvement identifies four key ethical domains: limits of prognostication, bridge to nowhere, burden of (...) treatment and system-level concerns. There are three subthemes: relevant contextual factors, the role of EC and observed outcomes. Content analysis of transcripts from interviews with 20 members of the multidisciplinary ECMO team yields supplemental data on providers’ perceptions of the impact of the early intervention protocol.ResultsLimited outcome data for ECMO, unclear indications for withdrawal, adverse effects of treatment and an obligation to attend to programme metrics present significant ethical challenges in the care of this patient population. Upstream EC mitigates ethical conflict by setting clear expectations about ECMO as a time limited trial, promoting consistent messaging among multiple services and supporting surrogate decision-makers. When ECMO becomes a ‘bridge to nowhere’, EC facilitates decision-making that respects patient values yet successfully sets limits on non-beneficial use of this novel therapy.ConclusionData from this study support the conclusion that ECMO poses unique ethical challenges that necessitate a standardised protocol for early, routine EC—at least while this medical technology is in its nascent stages. (shrink)

Adolescence is an important yet vulnerable period of transition from childhood to adulthood. An increasing number of studies support the traditional Catholic view, which sees teens as prone to making poor decisions when influ­enced by emotions or peer pressure but capable of thriving when guided by parents and religion. However, newer policies of medical societies undermine the traditional supports of family and faith with a permissive approach toward sexual exploration. To counter this unhealthy trend, which seems to be based more (...) on postmodern ideology than robust science, Catholic physicians should become experts in adolescent behavior and sexual health. Physicians should be sensitive to opposing viewpoints but participate only in treatments which are ethical and beneficial for their patients. Specifically, Catholic physicians must avoid contraceptives, abortion, and “gender-affirming” therapies. By using good science and emulating the models of service, Socratic dialogue, and accompaniment, physicians can guide adolescents toward a virtuous, healthy adulthood. (shrink)

In this paper, I am going to explore an alternative explanation of causation in Graham Priest’s modal meinongianism. Priest proposes an understanding of causation, which is either too confusing, or against the metaphysical core of modal meinongianism. In his proposals, causation is discussed in the context of defining purely fictional and abstract objects, by using a counterfactual approach. In this case, causation is understood as an existence-entailing relation. I will argue that such an account of causation proves ineffective. Instead, I (...) will give another interpretation for causation, which is based on Peter Menzies and Huw Price’s version of agency theory of causation. My interest in studying such a particular subject is to find an answer which is to be used in a further research. The end result of my work will be the fact that causation as agency can, at best, be useful in understanding intentional acts, but not suitable for explaining what it means for a particular object to causally interact with us. (shrink)

First paragraph: Ernst von Glasersfeld's contributions to the LANA Project (the Language Analogue Project) were very important to its seven years of success, 1971--1977, during which the effort was led by the senior author of this paper... Indeed, his contributions have helped perpetuate research into the language skills of apes and sea mammals to this day. Ernst was a member of the original team of 1970 that formulated the proposal to the National Institutes of Health for four years' funding to (...) develop a computer-monitored keyboard-situation appropriate to research on the language skills of which the great apes might be capable. (shrink)

Attention and consciousness are two distinct neural processes which are intricately intertwined. However, there is asymmetry in the distribution of attentional abilities across the two hemispheres. The right hemisphere is asserted to be dominant for attentional abilities. Research suggests that the ventral frontoparietal cortex of the right hemisphere is dominant for exogenous attentional abilities, attention is phylogenetically more primitive than endogenous attention, and, compared to the left hemisphere, the right hemisphere is more adept at abilities and functions that are of (...) more primitive origin. This review explores the attentional abilities of the mute right hemisphere, the extent to which these may affect consciousness, and whether the unilateral dominance of the exogenous network influences consciousness. (shrink)

This article is about an intervention introducing prehistoric life in primary education. Its objectives were to foster openness and interest for prehistory and archaeology, as well as content knowledge and conceptual learning with a focus on four main facets: basic knowledge about prehistoric life; conceptual learning/change regarding prehistory; learning about archaeologists and archaeology as a scientific discipline; and learning about interactions of archaeology and other disciplines. Students participated in two workshops about the creation of a prehistoric object, highlighting the close (...) interaction between the natural sciences and humanities within archaeology. The workshop emphasised dialogue between students, teachers and researchers, as well as active participation by the students. The educational effects of the workshops were studied using a pre-post design. Results show that the workshops had sizeable positive effects on both affective and cognitive variables. The appreciation of the workshops ranged from ≈ 70 to 90% for interest, perceived educational value and further aspects. We also found a positive impact of the intervention on cognitive variables, e.g. for several elements of key knowledge about prehistory. Regarding conceptual learning, we found improved understanding of the link between climate change and long-term changes in wildlife in a given area. A positive impact was also found for the understanding of archaeology encompassing both humanities and the natural sciences. No differences of the various outcomes were found between girls and boys; the workshops appear suitable for both genders. We conclude with a discussion of the interpretation of our findings, of some limitations and possible improvements, and of future perspectives, in particular for further classroom implementation. (shrink)

This book studies the interfaces of ethics, economics, and politics. Public policy issues involve all three of these subjects. Although it may be seen as suggesting the nucleus of a joint university course, the book is accessible to and should interest all those concerned with political decisions. Any such decision needs a criterion for judging whether one action or outcome is better than another. Even a dictator must to some extent be concerned about the economic welfare of the citizens; and (...) a democratic government more so. But how is a person's economic welfare to be judged? Furthermore, any political decision affects the economic welfare of different people differently. How then is the welfare of a community to be judged? This is an ethical question. Underlying any coherent public policy there must be a relevant moral code. (shrink)