Ensuring that life-saving antimicrobials remain available as effective treatment options in the face of rapidly rising levels of antimicrobial resistance will require a massive and coordinated global effort. Setting a collective direction for progress is the first step towards aligning global efforts on AMR. This process would be greatly accelerated by adopting a unifying global target — a well-defined global target that unites all countries and sectors. The proposed pandemic instrument — with its focus on prevention, preparedness and response — (...) represents an ideal opportunity to develop and adopt a unifying global target that catalyzes global action on AMR. We propose three key characteristics of a unifying global target for AMR that — if embedded within the pandemic preparedness instrument — could rally public support, funding, and political commitment commensurate with the scale of the AMR challenge. (shrink)

Background The American Association of Medical Colleges has called for incorporation of the health humanities into medical education, and many medical schools now offer formal programs or content in this field. However, there is growing recognition among educators that we must expand beyond empathy and wellness and apply the health humanities to questions of social justice – that is, critical health humanities. In this paper we demonstrate how this burgeoning field offers us tools for integrating social justice into medical education, (...) utilizing the frameworks of critical consciousness and structural competency. Practice of health humanities Critical health humanities can be applied at multiple levels of learners, and in a variety of contexts. We are two physician-writers who have developed several educational programs that demonstrate this. We taught a seminar that introduced first-year and second-year undergraduates to concepts such as social determinants of health, intergenerational trauma, intersectionality, resilience, and cross-cultural care through works of fiction, poetry, film, podcasts, stand-up comedy, and more. Through creative projects and empathic reflection, students engaged with the complexities of structural forces that create and maintain health disparities. Medical students in their clinical years can engage in critical health humanities learning experiences as well. We teach several multidisciplinary electives that address social (in)justice in medicine, as well as mentor fourth-year students engaged in independent electives that foster critical awareness around health equity and ethics. Beyond the classroom, we have actively engaged in critical health humanities practices through story slams, literary journal clubs, conference presentations, and Grand Rounds. Through these activities we have included learners at GME and CME levels. These examples also demonstrate how community engagement and multidisciplinary partnerships can contribute to the practice of critical health humanities. Conclusion In this paper, we explore the growing field of critical health humanities and its potential for teaching health equity through narrative practices. We provide concrete examples of educational activities that incorporate critical consciousness and structural competency – frameworks we have found useful for conceptualizing critical health humanities as a pedagogical practice. We also discuss the strengths and challenges of this work and suggest future directions. (shrink)

In fungi, cell fusion between genetically unlike individuals triggers a cell death reaction known as the incompatibility reaction. In Podospora anserina, the genes controlling this process belong to a gene family encoding STAND proteins with an N‐terminal cell death effector domain, a central NACHT domain and a C‐terminal WD‐repeat domain. These incompatibility genes are extremely polymorphic, subject to positive Darwinian selection and display a remarkable genetic plasticity allowing for constant diversification of the WD‐repeat domain responsible for recognition of non‐self. Remarkably, (...) the architecture of these proteins is related to pathogen‐recognition receptors ensuring innate immunity in plants and animals. Here, we hypothesize that these P. anserina incompatibility genes could be components of a yet‐unidentified innate immune system of fungi. As already proposed in the case of plant hybrid necrosis or graft rejection in mammals, incompatibility could be a by‐product of pathogen‐driven divergence in host defense genes. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Après avoir présenté les grandes lignes de la réflexion phénoménologique de Wittgenstein en 1929 et son abandon de Vidée d'un langage phénoménologique, je montre qu'il fait face à un dilemme à propos de la notion de règle. Si on regarde l'expression symbolique d'une règle sous le mode physicaliste, on ne peut pas voir le lien entre celle-ci et ses applications. Comment peut-elle, de par elle-même, servir de guide à nos actions ? Il faut une intention, une interprétation, ce qui fait (...) de la règle un objet phénoménologique. L'abandon du langage phénoménologique doit cependant forcer Wittgenstein à reconnaître qu'une règle en tant qu'objet phénoménologique ne peut pas être comparée à ou être utilisée pour déclencher une action qui se déroule dans le monde physique. Je montre que c'est en tentant de sortir de ce dilemme que Wittgenstein en viendra aux conceptions exposées dans ses remarques sur « suivre une règle ». J'examine en dernier lieu quelques conséquences de cette interprétation sur celle de la philosophie des mathématiques de Wittgenstein.After presenting a broad sketch of Wittgenstein's phenomenology; in 1929, and of his abandonment of the idea of a phenomenological language, it is shown that the notion of a rule left him with a dilemma, if the symbolical expression of a rule is understood in a physicalist mode, one cannot see the link between it and its applications. How could it, of itself guide our actions? One needs an intention or interpretation, thus turning the rule into a phenomeno/ogica I object. The abandonment ofthe p he nojne no logical language must have foiled Wittgenstein to recognize that a rule, qua phenomenological object, cannot be compared to or used to trigger an action in the physical world. It is then shown how Wittgenstein reached, while trying to solve this dilemma, the conception of rules presented in the remarks on 'following a rule". Lastly, some of the consequences of this new reading on the interpretation of Wittgenstein's philosophy of mathematics are examined. (shrink)

It is demonstrated on the basis of the Dirac equation that quarks cannot be confined by a vector gluon potential of the form(r/r 0)a or[ln(r/r 0]a, a>0, if the quark-gluon interaction conserves parity. In order to confine quarks with the parity-conserving interaction, the effective gluon potential must be a pseudovector or a scalar. These are shown in a simple Yang-Mills field with theSU(2) group.

In the framework of population dynamics, we start from the logistic equation describing the evolution of one species with limited food supply. A split device allows us to consider the population as two sub-populations x and y evolving analogously. The dynamical system has a one-parameter family of equilibria which is structurally unstable. Then small perturbations of the system (describing functional or ethological differentiations between the sub-species) lead in general to a new system involving a fast and a slow dynamics with (...) a finite number of equilibria. In simple situations where the differentiation is clearly either an advantage or an inconvenience for one of the subspecies, the stable equilibrium amounts to extinction of the disadvantaged subspecies (elementary Darwinism). Oppositely more complex differentiations (involving both advantages and inconveniences) often lead to stable equilibria with well-defined non zero proportions of the sub-populations (preservation of the biodiversity). Other examples are concerned with symbiosis-like differentiations, leading to preservation, whereas the opposite case (mutual nuisances) has an unstable equilibrium and lead to extinction of one or the other subspecies according to the initial conditions. The case of a scission into three subspecies is more rich in consequences. In certain cases, predator-prey relations lead to auto-organization phenomena with stable diversity-preserving diversity. Cases of instability are also possible, leading to orbits tending towards a poly-cycle.This implies some kind of pseudo-extinction: this amounts to “pseudo-periodic-like” orbits with “pseudo-periods” larger and larger, tending to infinity; each pseudo-period contains parts where one of the sub-populations practically vanish. Other non-linear perturbations lead to stable orbits. (shrink)

This article describes key paradigms employed to assess deception and reviews the main neuroscience-based technologies that have been employed to investigate the neural correlates of deception: electroencephalography, functional magnetic resonance imaging, and transcranial direct current stimulation. Any potential use of neuroscience-based methods to detect deception in real-life situations requires successful classification in single subjects. It describes findings on the single subject performance of these methods and addresses the effects of two factors that are problematic for all deception detection methods, the (...) potential use of countermeasures, strategies used by subjects to defeat the deception detection tests, and the potential role of false memories and of incidental encoding. It briefly outlines some of the ethical issues associated with these technologies to detect deceptive behavior. (shrink)

J P White; Indoctrination, Journal of Philosophy of Education, Volume 4, Issue 1, 30 May 2006, Pages 107–120, https://doi.org/10.1111/j.1467-9752.1970.tb00429.x.

Biomedical research has a strong impact on a country’s scientific-technological and socioeconomic development. It can make a significant contribution at three different levels: promotion of public health; the exchange of knowledge within the scientific community; and economic/ financial profitability. Africa only attracts ~3.3% of the world’s clinical research. This small proportion is due to, among several factors, the absence of two fundamental aspects: specific robust legislation and capacity for regulatory and ethical evaluation. There are five Portuguese- speaking African countries – (...) Angola, Cabo Verde, Guinea-Bissau, Mozambique and São Tomé and Príncipe. Despite presenting different degrees of clinical research development, these countries show a common serious insufficiency in the minimum conditions necessary for hosting, collaborating or leading biomedical research projects. These countries are also excluded from the support of international organisations for capacity building because of the language barrier. The Biomedical Ethics and Regulatory Capacity Building Partnership for Portuguese-Speaking African Countries project has developed methods to build capacity and partnership through research on national law, comparisons with international standards and by issuing recommendations at a national level. Through collaborative intensive training, trainees are taught to become educators at a national level. This, in turn, creates a sustainable impact at country level. BERC-Luso is a pioneering project, owing to a combination of innovative features. The partnership project: was developed exclusively in Portuguese; involves a large number of African countries, and national and international institutions; has been further enhanced by the diversity and complementarity of its action plans; and has also benefited from a broad participatory methodology based on resolution of recipients’ problems by the recipients themselves. It thus stands out as a model for similar future projects. (shrink)

During the 1970s, prenatal screening technologies were in their infancy, but were being swiftly harnessed to uncover and prevent spina bifida. The historical rise of this screening process and prevention programme is analysed in this paper, and the role of ethical debates in key studies, editorials and letters reported in the Lancet, and other related texts and governmental documents between 1972 and 1983, is considered. The silence that surrounded rigorous ethical debate served to highlight where discussion lay—namely, within the justifications (...) offered for the prevention of spina bifida, and the efficacy and benefits of screening. In other words, the ethical justification for screening and prevention of spina bifida, when the authors are not explicitly interested in ethics, is considered. These justifications held certain notions of disability as costly to society, with an imperative to screen and prevent spina bifida for the good of the society. (shrink)