The concept of quality of life is the basis for a new paradigm of clinical medicine. Its assessment is considered to be an important instrument in determining disease severity and effectiveness of different treatment modalities. Our studies are devoted to the problem of diabetes complications especially anemia in patients with diabetic kidney disease. Anemia in subjects with diabetic nephropathy may result from various pathogenic factors including erythropoietin deficiency, iron deficiency, vitamin B12 and/or folate deficiencies, the effects of proinflammatory (...) cytokines etc. Diabetic patients with anemia are at increased risk of cardiovascular accidents and death. The aim of this study was to assess the influence of anemia on the quality of life of patients with early stages of diabetic nephropathy. We investigated 127 patients with type 2 diabetes mellitus and early diabetic nephropathy. Anemia was defined according to the World Health Organization criteria. Anemic patients were divided into three groups according to the stage of chronic kidney disease. Patients’ quality of life was assessed with SF-36 health survey. Anemic patients had lower scores of physical role functioning and emotional role functioning as compared to the patients with normal hemoglobin level, irrespective of the stage of chronic kidney disease. Patients with anemia and chronic kidney disease stage 3 had lower scores of general health perceptions, physical functioning, bodily pain, vitality and mental health than patients in the non-anemic group. Social role functioning was similar in anemic and non-anemic patients. The possible mechanisms and implications of the above mentioned findings are discussed with a medical and humanitarian perspective. The directions of further studies are proposed. (shrink)

Hurricane Katrina offered a revealing snapshot of the historical vulnerability that New Orleans and Gulf Coast residents have long experienced and continue to face. In particular, population groups with special health needs—those suffering from debilitating chronic diseases—were among those most at risk during the storm. Focusing specifically on diabetic evacuees during and after Katrina, this essay examines how the lack of planning during the disaster led to diminished access to dialysis as well as poor food and inadequate insulin management (...) in evacuation shelters. In so doing, it underscores the strong links between disasters and public health concerns such as elevated risks for complications, emergency room visits, hospitalizations, and reduced life expectancy for individuals with diabetes. As the case of Katrina powerfully illustrates, populations suffering from chronic diseases like diabetes suffer disproportionately from disasters and other disruptive events. (shrink)

Diabetic ketoacidosis is a serious, medical emergency that can be fatal but treatable, we aimed to evaluate the clinical profile of patients admitted with diabetic ketoacidosis. This case series study enrolled 213 non-pregnant adult and adolescent patients admitted with diabetic ketoacidosis at Tripoli Diabetes Hospital from January to September 2023. Demographic data, clinical characteristics, laboratory findings, precipitating factors, and patient outcomes were extracted from medical records and analyzed. Type 1 diabetes mellitus was present in 187 (87.8%) of (...) patients, the age range 11-84 years, (30.26±13.28), with 130 patients ≤30 years old (61.0%), females accounting for 110 of the patients (51.6%), 109 had a diabetes duration of less than 10 years (51.2%). The most common precipitating factor was insulin omission 92 (43.2%) in patients with known diabetes mellitus, whereas, diabetic ketoacidosis as the first presentation of diabetes mellitus in 24 patients (11.7%), systolic blood pressure ranged 50-160 mmHg (112.82±16.19), diastolic blood pressure varied 30-100 mmHg (70.24±11.32). Plasma glucose at presentation ranged 183-1494 mg/dl (462.92±169.85), with Eu-glycemic diabetic ketoacidosis 100-249 mg/dl were in nine patients (4.2%), whereas most of cases (135 patients, 63.4%) present with plasma glucose 250-500 mg/dl, while hyperosmolar status (≥701 mg/dl) were present in 13 patients (6.1%). Venous pH varied from 6.7-7.42 (7.13±0.14), 132 (62.0%) patients presented with pH <7.24, while severe acidosis was pH < 7 in 32 of patients (14.6%), serum bicarbonate with 10.93±4.95, severe (<5 mmol) in 91 patients (42.7%) and moderate (5-10 mmol) were in 79 patients (37.08%). The mean length of hospital stay was 3.33 days, with an average of 2.11 days spent in the high-dependent unit. Serum potassium varied from 2.4-6.7 meq/L with 3.66± 0.63, most common complications of diabetic ketoacidosis treatment were hypokalemia observed in 82 (35.7%) of cases, and hypoglycemia was detected in 41 patients (19.2%). 170 patients were discharged in good condition (79.8%), and 17.8% of patients were transferred to another hospital to receive further management for co-morbid diseases with diabetes after controlling their hyperglycemic crises. The majority of patients presented with the critical status of diabetic ketoacidosis. The findings emphasize the importance of patient education about prevention measures prompt presentation to the hospital, and clinicians' awareness for early and aggressive treatment of hyperglycemic crises. (shrink)

BackgroundImportant sex and gender differences have been found in research on diabetes complications and treatment. Reporting on whether and how sex and gender impact research findings is crucial for developing tailored diabetes care strategies. To analyze the extent to which this information is available in current diabetes research, we examined original investigations on diabetes for the integration of sex and gender in study reporting.MethodsWe examined original investigations on diabetes published between January 1 and December 31, 2015, in the top five (...) general medicine journals and top five diabetes-specific journals (by 2015 impact factor). Data were extracted on sex and gender integration across seven article sections: title, abstract, introduction, methods, results, discussion, and limitations.ResultsWe identified 155 original investigations on diabetes, including 115 randomized controlled trials (RCTs) and 40 observational studies. Sex and gender were rarely incorporated in article titles, abstracts and introductions. Most methods sections did not describe plans for sex/gender analyses; 47 (30.3%) articles described plans to control for sex/gender in the analysis and 12 (7.7%) described plans to stratify results by sex/gender. While most articles (151, 97.4%) reported the sex/gender of study participants, only 10 (6.5%) of all articles reported all study outcomes separately by sex/gender. Discussion of sex-related issues was incorporated into 21 (13.5%) original investigations; however, just 1 (0.6%) discussed gender-related issues. Comparison by journal type (general medicine vs. diabetes specific) yielded only minor differences from the overall integration results. In contrast, RCTs performed more poorly on multiple sex/gender assessment metrics compared to observational studies.ConclusionsSex and gender are poorly integrated in current diabetes original investigations, suggesting that substantial improvements in sex and gender data reporting are needed to inform the evidence to support sex- and gender-specific diabetes care. (shrink)

MENDENHALL TJ, BERGE JM, HARPER P, GREENCROW B, LITTLEWALKER N, WHITEEAGLE S and BROWNOWL S. Nursing Inquiry 2010; 17: 359–372 The Family Education Diabetes Series (FEDS): community‐based participatory research with a midwestern American Indian communityIndigenous people around the globe tend to struggle with poorer health and well‐being than their non‐indigenous counterparts. One area that this is especially evident is in the epidemic of diabetes in North America’s American Indians (AIs) – who evidence higher prevalence rates and concomitant disease‐related complications than (...) any other racial/ethnic group. As researchers and AI communities work together to transcend conventional top‐down, service‐delivery approaches to care, community‐based participatory research is beginning to show promise as a way to partner contemporary biomedical knowledge with the lived‐experience, wisdom, and customs of Indigenous people. This study describes the Family Education Diabetes Series (FEDS) as an example of such effort, and highlights pilot findings assessing its value and impact across key diabetes‐relevant variables. Following 36 intervention participants across baseline, 3‐month, and 6‐month time periods, data show significant improvements in weight, blood pressure, and metabolic control (A1c). Strengths and limitations of this investigation are presented, along with suggestions about how to further advance and empirically test the work across other Indigenous communities. (shrink)

Introduction: Early recognition of prediabetes may prevent progression to diabetes, yet not all adults are aware of their prediabetes risk. To reach all adults unaware of their risk, additional risk assessment strategies are warranted. Objectives: The objective of this study was to evaluate the potential scope of benefit from prediabetes risk assessment in the dental care setting and to identify characteristics of dental patients likely to unknowingly have prediabetes or diabetes. Methods: Data from 10,472 adults in the National Health and (...) Nutrition Examination Survey from 2013 to 2014 and 2015 to 2016 were analyzed for associations among prediabetes/diabetes risk factors, health care use, and hemoglobin A1C levels according to chi-square tests and multivariate logistic regression. Results: A total of 7.73% of US adults had seen a dentist but not a medical provider in the past 12 mo. The composition of this subpopulation was significantly different from that who saw a medical provider, in ways that might affect their diabetes risk. In addition, 31.27% of this subpopulation would be identified as being at high risk for prediabetes according to the CDC Prediabetes Screening Test, and 15.83% had hemoglobin A1C levels indicative of undiagnosed prediabetes or diabetes. Screening in a dental setting would have the highest odds of identifying someone unaware of his or her diabetes risk among those who were non-White, obese, or ≥45 y old. Conclusion: Extrapolation from this analysis indicates that screening for prediabetes at dental visits has the potential to alert an estimated 22.36 million adults of their risk for prediabetes or diabetes. Incorporating prediabetes or diabetes risk assessment into routine dental visits may enable 1) those with prediabetes to take action to decrease their risk of developing diabetes and 2) those with diabetes to engage in treatment to decrease their risk of diabetes-related complications. Knowledge Transfer Statement: Screening for prediabetes and diabetes during dental visits has the potential to raise patients’ awareness of diabetes risk and prevent prediabetes from progressing to diabetes. For some patients, the dental visit may be the only point of contact with the health care system, which heightens the importance of including diabetes risk assessment for patient well-being. (shrink)

Diabetes is a chronic and systemic disease that has reached epidemic proportions. An estimated 17 million Americans have diabetes, and an additional 16 million individuals are considered to have pre-diabetes. Studies have shown that timely screening and referral are necessary to maintain healthy blood glucose levels and slow the progression of diabetes-related complications. Furthermore, lifestyle changes can prevent or delay the onset of Type 2 diabetes for high-risk individuals.The Division of Diabetes Translation at the Centers for Disease Control and Prevention (...) undertook an analysis of diabetes-related legislation across the nation. More specifically, state laws, rules and regulations mandating health insurance coverage for diabetes-related supplies and services were examined according to Sample Purchasing Specifications for Services Related to Diabetes—an evidence-based model of standards of care for persons with diabetes. (shrink)

Adenosine transport in cultured human umbilical vein endothelial cells (HUVEC) was characterized and shown to be mediated by a single facilitated diffusion mechanism. Initial rates of adenosine influx at 22 degrees C were saturable [apparent Michaelis constant, 69 +/- 10 mu M; maximum velocity (V-max), 600 +/- 70 pmol.10(6) cells(-1).s(-1)] and inhibited by nitrobenzylthioinosine (NBMPR). Formycin B had an unusually high affinity [inhibitory constant K-i), 18 +/- 4.3 mu M], whereas inosine had a low affinity (K-i, 440 +/- 68 mu (...) M) and nucleobases were without effect on adenosine influx. The number of transporters (1.2 x 10(6) sites/cell) was estimated by NBMPR equilibrium binding (apparent dissociation constant, 0.11 +/- 0.01 nM; maximum binding, 2.0 +/- 0.15 pmol/10(6) cells). In addition, we compared these endothelial cells with those obtained from cords from pregnancies complicated by diabetes (HUVEC-D), since embriopathy may occur in these conditions. HUVEC-D exhibited a 2.3-fold reduction in both the V-max for adenosine influx and the maximum number of NBMPR binding sites (260 +/- 40 pmol.10(6) cells(-1).s(-1) and 0.86 +/- 0.08 pmol/10(6) cells, respectively). However, the turnover number for each nucleoside transporter in normal and diabetic HUVEC was similar (approximate to 300 adenosine molecules/s). Adenosine metabolism at 10 mu M in HUVEC-D was modified compared with normal cells. Intracellular phosphorylation (> 90%) was the predominant pathway in normal HUVEC, whereas in HUVEC-D, substantial levels of adenine and adenosine were detected. The present results demonstrate therefore the downregulation of the NBMPR-sensitive nucleoside transporter and changes in adenosine metabolism in HUVEC from diabetic pregnancies. (shrink)

Diabetes has been associated with affective disorders which complicate the management of the disease. Emotional intelligence, or the ability to perceive, facilitate, understand, and regulate emotions, has shown to be a protective factor of emotional disorders in general population. The main objective of this study was to systematically review the role of the EI construct in Type 1 and Type 2 diabetics and to observe how EI is related to biological and psychological variables. Comprehensive searches were conducted in PubMed, Scopus, (...) PsycInfo, and Cochrane without time limitations, for studies examining the link between diabetes and EI. A total of 12 eligible studies were selected according to the inclusion criteria. We divided the results into four sections: EI and hemoglobin glycosylated, EI training effects, differences in EI between persons with diabetes and without diabetes, and EI and psychological adjustment and well-being. The results showed negative correlations between EI and HbA1c, positive effects of EI training on quality of life, anxiety, and glycemic control, no differences in EI between people with diabetes and healthy individuals, and, finally, negative correlations between EI and different psychological variables such as diabetes-related anxiety and distress, and positive correlations with quality of life, well-being, and marital satisfaction. This systematic review offers a starting point for a theoretical and practical understanding of the role played by EI in the management of diabetes and reveals that EI is a promising protective factor for biological and psychological variables in this population. (shrink)

Cardiovascular disease is a major complication of type 2 diabetes mellitus. In addition to traditional risk factors, psychological determinants play an important role in CVD risk. This study applied Deep Neural Network to develop a CVD risk prediction model and explored the bio-psycho-social contributors to the CVD risk among patients with T2DM. From 2017 to 2020, 834 patients with T2DM were recruited from the Department of Endocrinology, Affiliated Hospital of Harbin Medical University, China. In this cross-sectional study, the patients' (...) bio-psycho-social information was collected through clinical examinations and questionnaires. The dataset was randomly split into a 75% train set and a 25% test set. DNN was implemented at the best performance on the train set and applied on the test set. The receiver operating characteristic curve analysis was used to evaluate the model performance. Of participants, 272 were diagnosed with CVD. The developed ensemble model for CVD risk achieved an area under curve score of 0.91, accuracy of 87.50%, sensitivity of 88.06%, and specificity of 87.23%. Among patients with T2DM, the top five predictors in the CVD risk model were body mass index, anxiety, depression, total cholesterol, and systolic blood pressure. In summary, machine learning models can provide an automated identification mechanism for patients at CVD risk. Integrated treatment measures should be taken in health management, including clinical care, mental health improvement, and health behavior promotion. (shrink)

Type 2 diabetes mellitus (T2DM) is a multifaceted chronic condition characterized by insulin resistance and hyperglycemia. This review synthesizes evidence on the influence of lifestyle factors such as diet, physical activity, and stress on the development and progression of T2DM. It highlights the intricate relationship between obesity, insulin resistance, and β-cell dysfunction, with a particular focus on the role of psychological stress in exacerbating disease outcomes. Through the analysis of recent studies, the review explores how lifestyle interventions, including dietary changes, (...) exercise, and stress management, can improve glycemic control and reduce complications. This comprehensive review underscores the need for integrated, personalized management strategies in T2DM care, emphasizing the importance of addressing both physiological and psychological factors to optimize outcomes and prevent complications. (shrink)

Lower plasma levels of high-density lipoproteins in adolescents with type 2 diabetes have been associated with a higher pulse wave velocity, a marker of arterial stiffness. Evidence suggests that HDL proteins or particle subspecies are altered in T2D and these may drive these relationships. In this work, we set out to reveal any specific proteins and subspecies that are related to arterial stiffness in youth with T2D from proteomics data. Plasma and PWV measurements were previously acquired from lean and T2D (...) adolescents. Each plasma sample was separated into 18 fractions and evaluated by mass spectrometry. Then, we applied a validated network-based computational approach to reveal HDL subspecies associated with PWV. Among 68 detected phospholipid-associated proteins, we found that seven were negatively correlated with PWV, indicating that they may be atheroprotective. Conversely, nine proteins show positive correlation with PWV, suggesting that they may be related to arterial stiffness. Intriguingly, our results demonstrate that apoA-I and histidine-rich glycoprotein may reverse their protective roles and become antagonistic in the setting of T2D. Furthermore, we revealed two arterial stiffness-associated HDL subspecies, each of which contains multiple PWV-related proteins. Correlation and disease association analyses suggest that these HDL subspecies might link T2D to its cardiovascular-related complications. (shrink)

Compliance is a key concept in health care and affects all areas of health care including diabetes. Non-compliance has previously been a label attached to many patients without much thought having been given to the causes of poor compliance. Over the last few decades there has been a large volume of research focusing on compliance that has exposed the multitude of factors affecting compliance. Even the definition is not clear cut and so comparability between studies is not without difficulties. A (...) better understanding of the factors affecting compliance, including the doctor/patient relationship, has allowed the evolution of “concordance”. Concordance views the patient as being the equal of the healthcare provider and as having a right to make informed decisions. In a condition such as diabetes, which has many potential long term complications, it is vital that concordance is embraced in the healthcare system in order to improve care. (shrink)

Children diagnosed with type 1 diabetes mellitus (T1DM) are at risk for neurocognitive sequelae, including impaired attention functioning. The specific nature of the cognitive deficit varies; current literature underscores early age of diabetes diagnosis and increased disease duration as primary risk factors for this neurocognitive decline. Forty-three children with T1DM were evaluated for Attention Deficit/Hyperactivity Disorder (ADHD) symptomatology using the MOXO continuous performance test (MOXO-CPT) performed during a routine outpatient evaluation. The study cohort demonstrated a significant decline in all four (...) domains of attention functioning. The effect was most pronounced with early age at T1DM diagnosis, a longer disease duration and with poorer glycemic control (represented by higher HbA1c values). With increased disease duration (of 5 plus years), acute hyperglycemia was associated with inattention in the real-time setting. These findings highlight the need for routine screening of neurocognitive function in children with T1DM so that early intervention can be employed during this crucial period of cognitive development. (shrink)

Gestational Diabetes Mellitus (GDM) is a collection of symptoms that arise in pregnant women caused by an increase in blood glucose levels due to a progressive decrease in insulin secretion, variables that influence the incidence of gestational diabetes include age, history of diabetes mellitus, can occur at any time, but this disease usually begins to attack in the 24th week of pregnancy. The prevalence of Gestational Diabetes Mellitus in Indonesia is still relatively small, namely around 3-5%, but this figure could (...) be higher because cases of GDM are rarely detected. Even though it can heal on its own, that doesn't mean gestational diabetes is not dangerous. If not treated properly, this disease can increase the risk of the baby being born with excess weight, being born prematurely, or being born with low blood sugar or hypoglycemia. For pregnant women, gestational diabetes has the potential to cause complications, such as preeclampsia and hypertension. In Indonesia, all pregnant women are recommended to undergo DMG screening. However, not many pregnant women do this. The aim of this research is to determine the relationship between the perceptions of pregnant women and the behavior of early detection of Gestational Diabetes Mellitus at the Plumbon health center, Indramayu Regency in 2024. This research is quantitative research with a cross-sectional study design. The respondents in this study were 107 pregnant women who lived in the working area of the Plumbon Health Center, Indramayu Regency and used health services at the health center in 2024. Samples were taken using the Accidental Sampling technique, a technique for determining samples based on chance, namely any patient who happened to meet the researcher. and data were analyzed univariate and bivariate. The results of the research show that the characteristics of respondents, namely age, education, employment and income, do not have a significant relationship with early detection behavior of GDM, however, the perception of pregnant women with behavior of early detection of Gestational Diabetes Mellitus has a significant relationship as does mother's knowledge of early detection of Gestational Diabetes Mellitus. have a significant relationship. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Lisa’s StoryLisa P. (wife of patient) and Jeanne KerwinMy husband suffered from sudden onset of heart failure with a very low ejection fraction and was on IV Milrinone at the age of 47. One of the most powerful things he told me was that he was not afraid to die and therefore did not want to move forward with Milrinone. He eventually “did it for the kids.” After the (...) Milrinone drip was no longer working, he was offered an LVAD (left ventricular assist device) to keep him alive. He refused, but the doctor again convinced him to “do it for your kids” and said, “we put these devices in 80-year-olds.” He did not have time to explore any other options and reluctantly accepted the LVAD. It was implanted in May of 2014 in a very long and complicated surgery with a long and difficult recovery. He was in the hospital for a long time, and then he refused to go to rehab upon discharge, making it difficult for our family to manage, as he was extremely weak and needed care of his wound dressing. He worried about the financial [End Page 7] impact of a heart transplant and the medications required, as we were already struggling with the medical bills. He refused to have more surgery with the potential complications and never agreed to get on the transplant waiting list.After the implanted LVAD, my husband was not able to do most of what he loved in life. He couldn’t work (he was a truck driver), he couldn’t go fishing or swimming in the ocean, he couldn’t go hunting and fishing, and his overall physical condition was so poor that he couldn’t cook, garden and, most aggravating to him, he could not take a regular hot shower. The LVAD had to be covered with plastic in order to avoid getting the drive-line area wet, so bathing was a complicated process. He had trouble with stairs, had neuropathic pain in his legs from diabetes, and because of the pain medications, he felt cloudy and dizzy and slept most of the day in his recliner. I took care of him, even after I had to go back to work, and at the same time, I managed our two children (ages 9 and 12 at the time of LVAD).After almost two years of living with the LVAD, multiple hospitalizations for GI bleeds then seizures, more medications, and weekly blood draws for INR1, my husband requested that the LVAD be de-activated and that he be allowed to die of his heart failure. He described his life as “miserable.” He watched as his misery impacted his children and me. He suffered daily and had none of the joys that made life worth living for him. When we approached the cardiac team that implanted and monitored his LVAD with his request, they said “no.” They would not de-activate the LVAD because it was working. It was keeping him alive and he had no other terminal illness. His palliative doctor, who was treating his pain, also heard his request and told us to call for an “ethics consult” to determine if he would be “allowed” to have the LVAD de-activated. We got the number and called on March 31, 2016.At the time of the call to Ethics, we had no idea what “Ethics” was, other than a general definition of the word ethics as in professional behaviors and such. We did not know what to expect but we called. We would never have known to call “Ethics” if the palliative doctor had not advised us to do so, and my husband might have suffered a longer, more painful life both mentally and physically prolonged by the LVAD.We explained the request to the ethics consultant. She listened to my husband describe his daily living and his dissatisfaction with the quality of his life, his physical and emotional suffering, and his wish to rid himself of the LVAD and allow nature to take its course. There was actually no decision to be made on his part. He had already made up... (shrink)

Species evolve, very slowly, through selection of genes which give rise to phenotypes well adapted to their environments. The cultures, including the languages, of human communities evolve, much faster, maintaining at least a minimum level of adaptedness to the external, non- cultural environment. In the phylogenetic evolution of species, the transmission of information across generations is via copying of molecules, and innovation is by mutation and sexual recombination. In cultural evolution, the transmission of information across generations is by learning, and (...) innovation is by sporadic invention or borrowing from other cultures. This much is the foundational bedrock of evolutionary theory. But things get more complicated; there can be gene-culture co-evolution. Prior to the rise of culture, the physical environment is the only force shaping biological evolution from outside the organism, and cultures themselves are clearly constrained by the evolved biological characteristics of their members. But cultures become part of the external environment, and influence the course of biological evolution. For example, altruistic cultures with developed medical knowledge reduce the cost to the individual of carrying genes disposing to certain pathologies (such as diabetes); and such genes become more widespread in the populations maintaining such cultures. Assortative mating can affect biological evolution, and particular cultures may influence the factors which are sorted for in mating. (For a careful discussion of the effects of cultural evolution on natural selection, see Cavalli-Sforza and Bodmer, 1971:774- 804). This paper examines mechanisms involved in the co-evolution of a biological trait, the critical period for language acquisition, and a property of human cultures, the size of their languages. A gene/culture interaction will be shown that can be described as a kind of symbiosis, but perhaps more aptly as an `arms race'. In this introduction, we will sketch the basic mechanics of the interaction in very broad terms; the rest of the paper will explain and justify the details. The implications of our model for second language acquisition are given toward the end of the paper. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Positive Change in Perception and Care for a Difficult PatientMelissa CavanaughIf you asked any healthcare professional if they had ever cared for a difficult patient, I am certain the answer would be a resounding "Yes!" I have encountered many over my forty-two years as an RN. The story of Ms. E. is one of exceptional challenge and, I hope, success.I met Ms. E. in 2012 when I took a (...) nursing position in an outpatient primary care Geriatric Clinic. The clinic was located within an inner city, Level 1 Trauma health system whose mission is to care for the underserved. This organization had cared for the most vulnerable in the area for decades. The clinic model is unique in that it provides a "one-stop shop" for the common medical needs of the older adult. Other specialties, including podiatry, rheumatology, dementia care, and stroke, held appointments in this clinic area. The supporting staff team members assisted in each of these clinics, leading them to interact with the same patients frequently.Most of my previous experiences had been in inpatient units with a quick turnover of patients. There was no time or need to develop a long-term relationship with the patients in these settings. However, the comprehensive services found in this clinic coupled with the low staff turnover, led to a stable group of seniors receiving care in this office. Many of these individuals had been attending this clinic for over twenty years.I heard about Ms. E. before I ever met her. She was well known to the clinic team as a "problem" patient. The general response when she was on the schedule was eye rolling and audible moans. I soon learned that in addition to her scheduled visits, she would randomly appear outside the full glass interior doors. She would hover in the area, tapping on the glass to get the attention of a staff member. She did not hesitate to interrupt staff and other patients to make her needs known when she was in the exam room hallway. Often team members would scatter and hide to avoid dealing with her. If she was not in the building, she was on the triage line with a question or physical complaint. To complicate matters even further, her husband was our patient as well, and they always attended appointments together.Ms. E. suffered from common geriatric chronic diseases such as hypertension, diabetes, and osteoarthritis. Her morbid obesity complicated her diagnoses. Though she was able to safely ambulate with an assistive device such as a cane or walker, she routinely used a motorized chair. She and her husband admitted visiting fast food restaurants often even though they had met with a dietician for counseling on several occasions. They often requested help obtaining medications, yet related stories about visiting the local casino. Ms. E. spoke with a small, weak voice that added to the countenance of helplessness and pity. Unfortunately, these behaviors of noncompliance, attention seeking, and dependency on others extended to her immediate community, and she is estranged from family and friends who may have been a source of support to her. [End Page E1]Ms. E.'s appointments were scheduled at the end of the day due to the expectation and pattern of the extended time they would take. No matter her expressed concerns or needs, our recommendations and interventions were never enough. She continually questioned the assessment information and did not want to accept the education and orders given as the correct response to her problems. As one can see, her appointments could be exhausting!Ms. E. certainly deserved the best and most comprehensive care available from our team. Developing a more therapeutic relationship for her within the clinic became a priority for me. However, it was a daunting task to provide this level of care and to convince her that she deserved and was receiving such care. She presented a laundry list of characteristics that could lead to biases from the staff. Overcoming such individual biases toward her may be a barrier as well. These included her obesity, her lack of initiative, her self-centered behaviors, and her constant need for attention.As healthcare professionals... (shrink)

The procurement of fetal tissue for transplantation may promise great benefit to those suffering from various pathologies, e.g., neural disorders, diabetes, renal problems, and radiation sickness. However, debates about the use of fetal tissue have proceeded without much attention to ethical theory and application. Two broad moral questions are addressed here, the first formal, the second substantive: Is there a framework from other moral paradigms to assist in ethical debates about the transplantation of fetal tissue? Does the use of fetal (...) tissue entail cooperation in abortion? To answer these questions I develop a theoretical framework by combining the paradigm of just-war reasoning with canons governing the use of cadaverous tissue. The kinds of safeguards provided by this paradigm allow fetal tissue to be procured without the taint of association with abortion. Central to solving the problem of cooperation is the distinction between intending and foreseeing a moral misdeed. Fetal researchers may foresee fetal death in elective abortions without intending such deaths to occur. Thus, even those who object unequivocally to elective abortion may condone the procurement of fetal tissue, if sufficient reason exists. Keywords: fetal tissue, casuistry, prima facie duties, just-war tenets, complicity CiteULike Connotea Del.icio.us What's this? (shrink)

Nicotinamide adenine dinucleotide (NAD+) biosynthetic pathway, mediated by nicotinamide phosphoribosyltransferase (NAMPT), a key NAD+ biosynthetic enzyme, plays a pivotal role in controlling many biological processes, such as metabolism, circadian rhythm, inflammation, and aging. Over the past decade, NAMPT‐mediated NAD+ biosynthesis, together with its key downstream mediator, namely the NAD+‐dependent protein deacetylase SIRT1, has been demonstrated to regulate glucose and lipid metabolism in a tissue‐dependent manner. These discoveries have provided novel mechanistic and therapeutic insights into obesity and its metabolic complications, such (...) as insulin resistance, an important risk factor for developing type 2 diabetes and cardiovascular disease. This review will focus on the importance of adipose tissue NAMPT‐mediated NAD+ biosynthesis and SIRT1 in the pathophysiology of obesity and insulin resistance. We will also critically explore translational and clinical aspects of adipose tissue NAD+ biology. (shrink)

Bowel necrosis is a commonly observed condition in elderly patients with longstanding diabetes. In such condition, intestinal resection is usually performed for the removal of the gangrenous part. Post-surgical dietary management after bowel resection poses several challenges for the health care team. The case presented in this study is that of an elderly diabetic male who developed acute renal failure as a result of neglect in post-surgical feeding after intestinal resection. After the intervention by a trained dietitian, a transitional (...) diet was planned and successfully executed, resulting in reversal of acute renal failure, dehydration, and post-surgical stress. Several complications including hepatic dysfunction and mouth ulcers were resolved through well-planned transitional diet. The patient was finally discharged in a stable health condition and was regularly followed up for any nutritional or medical issues. Neglects in nutritional care of patients can have severe implications including development of medical complications, resulting in increased length of hospital stay, augmenting the disease stress of the patient and family, and finally the preventable drainage of several human and monetary resources. Therefore, recognition of nutritional intervention as an important part of in-hospital health care may have social as well as economic impacts. (shrink)

RD, a 32-year-old male, was admitted to the hospital with hypoxic COVID pneumonia–a potentially life-threatening condition characterized by dangerously low levels of oxygen in the body- during one of the pandemic’s surges. While RD’s age gave the clinical team hope for his prognosis, his ability to recover was complicated by his being unvaccinated and having multiple comorbidities, including diabetes and obesity. His condition worsened to the point that he required extracorporeal membrane oxygenation (ECMO), a machine that maintains the functioning of (...) a person’s heart and lungs. -/- Given its scarcity–only 264 of the over 6,000 hospitals in the United States offer ECMO, according to the Extracorporeal Life Support Organization–as well as its high cost and the inadequate supply of staff required to maintain it, ECMO primarily serves as a bridge to support critically ill patients until they can receive an organ transplant or implanted medical device. For RD, ECMO was started to support him until he could be evaluated for, and possibly receive, a bilateral lung transplant. Despite its intended use as a treatment of last resort, some patients can remain on ECMO for weeks or months. And some are awake, alert, and capable of medical decision-making. -/- RD was one such patient. However, the transplant evaluation committee ruled out RD’s candidacy for bilateral lung transplantation, based on his poor potential for recovery and a lack of family and friends to provide post-transplant support. This determination raised the prospect of continued ECMO treatment being a bridge to nowhere. But RD was comfortable on ECMO and wanted to remain in the ICU. The ICU intensivist contacted the ethics consult service with questions about whether continued ECMO support was medically and ethically inappropriate. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:What, Exactly, Does the Madperson Lack?Sofie Jeppsson, PhD (bio)Justin garson has already received well-earned recognition for his Madness: A philosophical exploration (2022), in which he distinguishes the view of madness as a dysfunction from madness as a strategy—a distinction that cuts across traditional distinctions between, for example, biological/neurological and psychological/social views. On the dysfunction view, going mad might be comparable to something like having an asthma attack or, more (...) long-term, developing type 1 diabetes. If the trachea closes up and prevents air from passing through, that is a dysfunction in the breathing apparatus. If the islets of Langerhans in the pancreas cease to produce insulin, making the person dependent on insulin shots to stay alive, that is a dysfunction. On the strategy view, going mad is rather like getting a fever when already infected with some pathogen. Given that you have the pathogen reproducing inside you, a rising body temperature provides a strategy (although not, of course, something the ill person chose) to keep the reproduction rate down, thus giving the immune system a better chance at vanquishing the infection. That does not mean that fevers are harmless—if a fever becomes high enough, it might itself do damage to the body. Still, it is a strategy, not a mere dysfunction. Analogously, on the Madness as strategy view, going mad might help a person deal with old traumas or an ongoing terrible situation, even as the madness may also be damaging in itself.In this paper, Garson introduces us to another interesting distinction: between seeing madness as a lack of reason, or as a perversion of or difference in reason. Garson writes that present-day psychiatry tends to see madness as a lack, whereas the late modern thinkers conceived of it as a perversion of reason. The late moderns clearly saw madness as something negative, but if we retain something like their basic view, merely change our evaluation from the negative perversion to the more neutral difference, we have a better basis for regarding Madness as a complicated and problematic but still cherished identity, and for Mad Pride.This is another interesting distinction well worth calling attention to. I’m uncertain how well the J.C.A. Heinroth example works—the text cited seems to show that he had a Madness as strategy view, but is it a Madness as a different kind of reason view?—but the other examples work better. Nevertheless, I want to push back a little against the claim that present-day psychiatry and philosophy of psychiatry tend to regard madness as a lack of something whereas the early moderns saw it as a difference. (Just a friendly little push, mind you, but still.)Arthur Wigan’s description of two brains, one functional and one dysfunctional, still seems to posit a lack of proper function in one of them. Sure, he does not say that the madperson lacks as much as the [End Page 313] idiot, who has two dysfunctional brains whereas the madperson has one functional and one dysfunctional. Still, there’s a lack. This two-brain picture also has its modern analogues: It brings to mind (albeit in a less biologically concrete and reified form) much psycho-educational material on, for example, how to live with bipolar disorder, according to which a supposed sane and rational part of the psychiatric patient’s mind should learn to handle and control the other, mad part (e.g., Miklowitz, 2012).According to John Locke, madpeople reason just fine, but they start from false premises. Is not this, too, something that madpeople are supposed to lack? Correct and realistic premises to start from? Locke writes that madpeople have “taken their fancies for realities,” but “make right deductions from them.” Moreover, Locke’s theory is reminiscent of modern bottom-up theories like Brendan Maher’s (1999)—madpeople have bizarre experiences on the basis of which they form bizarre beliefs, but we need not postulate that they suffer from any problems with, for example, reasoning and drawing inferences to explain why they believe what they do. Theorists who instead argue for a top-down or two-factor account of why madpeople stick... (shrink)

Diabetes is one of the most common diseases worldwide where a cure is not found for it yet. Annually it cost a lot of money to care for people with diabetes. Thus the most important issue is the prediction to be very accurate and to use a reliable method for that. One of these methods is using artificial intelligence systems and in particular is the use of Artificial Neural Networks (ANN). So in this paper, we used artificial neural networks to (...) predict whether a person is diabetic or not. The criterion was to minimize the error function in neural network training using a neural network model. After training the ANN model, the average error function of the neural network was equal to 0.01 and the accuracy of the prediction of whether a person is diabetics or not was 87.3%. (shrink)

Diabetes is a major public health issue that affects the nations of our time to a large extent and is described as a non-communicable epidemic. Diabetes mellitus is a common disease where there is too much sugar (glucose) floating around in your blood. This occurs because either the pancreas can’t produce enough insulin or the cells in body have become resistant to insulin. The concentration in this paper is on diagnosis diabetes by designing a proposed expert system. The main goal (...) of this expert system is to get the appropriate diagnosing of the illness, dealing with it quickly, and tips for permanent treatment whenever possible is given out. SL5 object expert system language was used for designing and implementing the proposed expert system. (shrink)

The global “diabetes monitoring devices market size” is expected to rise owing to increasing awareness about the self-management of diabetes. Fortune Business Insights in a report, titled “Diabetes Monitoring Devices: Global Market Analysis, Insights and Forecast, 2019-2026” offers valuable insights into the market, highlighting opportunities and threats alike. The global market is expected to yield huge profits facilitated by remarkable developments in diabetes management. As per the International Diabetes Foundation (IDF), the number of people suffering from diabetes was 415 million (...) in 2015 and is expected to reach 642 million by the year 2040. The rising prevalence of diabetes across the globe is a major factor driving the market. (shrink)

Purpose: The method of diagnosing diabetic retinopathy (DR) through artificial intelligence (AI)-based systems has been commercially available since 2018. This introduces new ethical challenges with regard to obtaining informed consent from patients. The purpose of this work is to develop a checklist of items to be disclosed when diagnosing DR with AI systems in a primary care setting. -/- Methods: Two systematic literature searches were conducted in PubMed and Web of Science databases: a narrow search focusing on DR and (...) a broad search on general issues of AI-based diagnosis. An ethics content analysis was conducted inductively to extract two features of included publications: (1) novel information content for AI-aided diagnosis and (2) the ethical justification for its disclosure. -/- Results: The narrow search yielded n = 537 records of which n = 4 met the inclusion criteria. The information process was scarcely addressed for primary care setting. The broad search yielded n = 60 records of which n = 11 were included. In total, eight novel elements were identified to be included in the information process for ethical reasons, all of which stem from the technical specifics of medical AI. -/- Conclusions: Implications for the general practitioner are two-fold: First, doctors need to be better informed about the ethical implications of novel technologies and must understand them to properly inform patients. Second, patient's overconfidence or fears can be countered by communicating the risks, limitations, and potential benefits of diagnostic AI systems. If patients accept and are aware of the limitations of AI-aided diagnosis, they increase their chances of being diagnosed and treated in time. (shrink)

Pre-diabetes is a risk factor for the development of diabetes, not a disease in its own right. The prevalence increases with age and reaches nearly 50% of those aged over 75 years in the USA. While lifestyle modification and treatment are likely to benefit those with many years of life ahead of them, they are unlikely to benefit patients with a limited life expectancy. Despite this, some very elderly patients in the UK and elsewhere are being labelled as pre-diabetic. (...) While ideal practice would be to carefully consider the impact of any potentially abnormal blood test before it is taken, this is not always possible in routine practice. In this paper, we discuss a pragmatic, ethical approach for clinicians managing pre-diabetic blood tests in very elderly patients. We argue that a ‘see-saw’ model of paternalism should be used in deciding which patients to inform that they can be labelled as pre-diabetic. Those patients that may benefit from the label should be informed, and those that will not, should not. Where the benefits/drawbacks are unclear, the result and its potential significance should be discussed in depth with the individual patient. We do not advocate withholding information from any patient. Instead we suggest clinicians use individual patient circumstances to contextualise the relevance of pre-diabetes to the patient and consider the benefits and drawbacks before informing them. This approach has the potential to be used for other pre-conditions and risk factors in addition to pre-diabetes. (shrink)

This article studies the phenomenology of chronic illness in light of phenomenology’s insights into ecstatic temporality and freedom. It shows how a chronic illness can, in lived experience, manifest itself as a disturbance of our usual relation to ecstatic temporality and thence as a disturbance of freedom. This suggests that ecstatic temporality is related to another sort of time—“provisional time”—that is in turn rooted in the body. The article draws on Merleau-Ponty’s Phenomenology of Perception and Heidegger’s Being and Time , (...) shedding light on the latter’s concept of ecstatic temporality. It also discusses implications for self-management of chronic illness, especially in children. (shrink)

In this article, we investigate the role of scientific and patient narratives on perceptions of the medical debate around gestational diabetes testing. Among medical scientists, we show that the narrative surrounding GDM testing affirms that future research and data will lead to medical consensus. We call this narrative trajectory the “deferred quest.” For patients, however, diagnosis and their subsequent discovery that biomedicine does not speak in one voice ruptures their trust in medical authority. This new distrust creates space for patients (...) to develop a Frankian quest narrative where they become the protagonist in their story. Additionally, across these different narratives, we observe how character is constructed and employed to negotiate trust. We conclude that healthcare providers should assess the narrative trajectory adopted by patients after diagnosis. Also, we suggest that providers acknowledge the lack of medical consensus to their patients. This veracity would foster women’s sense of trust in their provider as well as allow women to be active interlocutors in a debate that ultimately plays out in their deliberation about their body, pregnancy, and risk. (shrink)

Objective Diabetes is a global public health concern. Management of diabetes depends on successful implementation of strategies to alleviate decline in executive functions (EFs), a characteristic of diabetes progression. In this review, we describe recent research on the relationship between diabetes and EF, summarize the existing evidence, and put forward future research directions and applications. Methods Herein, we provide an overview of recent studies, to elucidate the relationship between DM and EF. We identified new screening objectives, management tools, and intervention (...) targets for diabetes management. We also discuss the implications for clinical practice. Results In both types 1 and 2 diabetes mellitus (DM), hyperglycemia substantially impairs EF in people of all age groups and ethnicities. Hypoglycemia can similarly impair EF. Interestingly, a decline in EF contributes to DM progression. Glucose dysregulation and EF decline exacerbate each other in a vicious cycle: poor blood glucose control, impaired EF, diabetes management task failure, then back to poor blood glucose control. Many pathophysiological indexes (e.g., obesity, metabolic index, inflammatory and immune factors), neuropsychological indexes (e.g., compliance, eating habits, physical exercise, sleep, and depression), and genetic factors are changed by this pathological interaction between DM and EF. These changes can provide insight into the pathophysiological mechanisms of diabetes-related EF decline. Conclusion Further studies, including large-scale prospective and randomized controlled trials, are needed to elucidate the mechanism of the interaction between diabetes and EF and to develop novel strategies for breaking this cycle. (shrink)

In Complicity and the Rwandan Genocide ( 2010b ), Larry May argues that complicity can be the basis for criminal liability if two conditions are met: First, the person’s actions or inactions must contribute to the harm in question, and secondly, the person must know that his actions or inactions risk contributing to this harm. May also states that the threshold for guilt for criminal liability is higher than for moral responsibility. I agree with this latter claim, but I think (...) that it casts doubt on May’s account of criminal liability, particular in so-called performance cases in which low-level participants merely fail to help. This is because it is far from clear that passive non-helpers are morally responsible for their participation in widespread harms. Situationism purports to show that passive bystanders typically are not morally responsible for their role in such harms, because they were behaving reasonably subject to the constraints they faced. In this paper, I assess this claim, and defend it on the basis of O. W. Holmes’ standard of the reasonable person as a guide to judging criminal complicity. Finally, I provide a situationist account of the Rwandan genocide, which focuses on the systemic causes and primary perpetrators of the genocide, rather than low-level participants. (shrink)

We live in a morally flawed world. Our lives are complicated by what other people do, and by the harms that flow from our social, economic and political institutions. Our relations as individuals to these collective harms constitute the domain of complicity. This book examines the relationship between collective responsibility and individual guilt. It presents a rigorous philosophical account of the nature of our relations to the social groups in which we participate, and uses that account in a discussion of (...) contemporary moral theory. Christopher Kutz shows that the two prevailing theories of moral philosophy, Kantianism and consequentialism, both have difficulties resolving problems of complicity. He then argues for a richer theory of accountability in which any real understanding of collective action not only allows but demands individual responsibility. (shrink)

Peter French’s and Steven Ratner’s thoughtful comments are helpful in advancing the analysis we offered in our book On Complicity and Compromise. Inevitably, there are areas of disagreement and bones to pick. However, our primary concern in this reply will be to press, with their assistance, the more positive agenda.

Christopher Kutz has written an excellent book: part metaphysics, part ethical theory, and part legal philosophy. The aim of the book, as is clear from the title, is to examine and defend the idea of complicity, that is, the responsibility of individuals for their participation in collective harms. While there has not been a lot of philosophical work on this topic, there has been some good work, and Kutz is responsive to most of it. But basically, this book strikes out (...) on its own, building a conception of complicity from an analysis of collective action and individual intention. The cornerstone of the analysis is the idea that individuals should be responsible for what they participate in, regardless of whether the participation makes a causal difference for the outcome. (shrink)

When the 2022 FIFA Men’s World Cup was awarded to Qatar, it raised a number of moral concerns, perhaps the most prominent of which was Qatar’s woeful record on human rights in the arena of migrant labour. Qatar’s interest in hosting the event is aptly characterised as a case of ‘sportswashing’. The first aim of this paper is to provide an account of the nature of sportswashing, as a practice of using an association with sport, usually through hosting an event (...) or owning a club (such as Newcastle United, owned by Saudi Arabia), to subvert the way that others attend to a moral violation for which the sportswashing agent is responsible. This may be done through distracting away from wrongdoing, minimising it, or normalising it. Second, we offer an account of the distinctive wrongs of sportswashing. The gravest moral wrong is the background injustice which sportswashing threatens to perpetuate. But the distinctive wrongs of sportswashing are twofold: first, it makes participants in sport (athletes, coaches, journalists, fans) complicit in the sportswasher’s wrongdoing, which extends a moral challenge to millions of people involved with sport. Second, sportswashing corrupts valuable heritage associated with sporting traditions and institutions. Finally, we examine how sportswashing ought to be resisted. The appropriate forms of resistance will depend upon different roles people fill, such as athlete, coach, journalist, fan. The basic dichotomy of resistance strategies is to either exit the condition of complicity, for example by refusing to participate in the sporting event, or to modify one’s engagement with the goal of transformation in mind. We recognize this is difficult and potentially burdensome: sports are an important part of many of our lives; our approach attempts to respect this. (shrink)

Medical complicity in torture is prohibited by international law and codes of professional ethics. But in the many countries in which torture is common, doctors frequently are expected to assist unethical acts that they are unable to prevent. Sometimes these doctors face a dilemma: they are asked to provide diagnoses or treatments that respond to genuine health needs but that also make further torture more likely or more effective. The duty to avoid complicity in torture then comes into conflict with (...) the doctor’s duty to care for patients. Sometimes the right thing for a doctor to do requires complicity in torture. Whether this is the case depends on: the expected consequences of the doctor’s actions; the wishes of the patient; and the extent of the doctor’s complicity with wrongdoing. Medical associations can support physicians who face this dilemma while maintaining a commitment to clear principles denouncing torture. (shrink)

The Rwandan genocide of 1994 occurred due to widespread complicity. I will argue that complicity can be the basis for legal liability, even for criminal liability, if two conditions are met. First, the person’s actions or inactions must be causally efficacious at least in the sense that had the person not committed these actions or inactions the harm would have been made significantly less likely to occur. Second, the person must know that her actions or inactions risk contributing to a (...) harmful enterprise, and must intend that these actions or inactions risk making this contribution. But it is not part of this analysis that the defendant must intend the harmful result. I explore the boundaries between legal and moral complicity and end with a discussion of how the analysis defended in the paper affects such questions as how many people in Rwanda should be prosecuted for the genocide which occurred due to widespread complicity. (shrink)

Complicity marks out a way that one person can be liable to sanctions for the wrongful conduct of another. After describing the concept and role of complicity in the law, I argue that much of the motivation for presenting complicity as a separate basis of criminal liability is misplaced; paradigmatic cases of complicity can be assimilated into standard causation-based accounts of criminal liability. But unlike others who make this sort of claim I argue that there is still room for genuine (...) complicity in the law and in morality. In defending this claim, I sketch an approach to complicity which grounds our liability for what others do not in our causal relation to their actions but in our “agency-relations” with others. In such cases, one agent can be liable for the wrongs of second agent to the extent that first authorizes the second to act at her behest. This approach fills the gap where standard causation-based accounts of complicity fail – especially in where several agents cooperatively contribute to an overdetermined harm. (shrink)

Insulin‐dependent diabetes mellitus (IDDM) is an autoimmune disease whose etiology is complex. Both genetic susceptibility, which is polygenic, and environmental factors, including virus infections, appear to be involved in the development of IDDM. In this review, we have tried to balance the discussion of diabetes by examining both immunological and virological perspectives. Several mouse models, including viral and non‐viral models, have been used to study diabetes. For this review, we include lessons gleaned from the non‐obese diabetic (NOD) mouse and (...) from mouse models of coxsackievirus‐ and encephalomyocarditis‐virus‐induced diabetes. Finally, we present a multi‐stage model in which several viral infections, including the coxsackieviruses, are postulated to play a role in the autoimmune destruction of pancreatic beta cells. (shrink)

Background: Diabetes mellitus (DM) is a noncommunicable disease that stills being a burden in health system. Some trace minerals such as selenium and zinc was postulated having role in blood and insulin regulation in Type 2 Diabetes Mellitus. The objective of this study is conducted to determine the level of selenoium and zinc serum in Type 2 Diabetes Mellitus patient, and its correlation with glycemic control parameter. Methods: A cross sectional study was conducted at Abdul Moeloek and Hasan Sadikin Hospital (...) from endocrinology outpatient clinic from october to december 2022 with random sampling. Patient was tested for glycated albumin, fasting blood glucose, and glycated hemoglobin as marker od glycemic control Data then analyzed descriptively and underwent bivariate analysis with Spearman Rank Correlation. Results: Low level of Zinc, but with normal level of selenium was found among research subject. Bivariate analysis between the variables showed that there is positive, weak, and insignificant correlation of zinc and selenium with fasting blood glucose, HbA1C, and glycated albumin. (Selenium with HbA1C: r:0,131, p:0.099, Selenium with FBG: r:0,135, p:0.092, Selenium with glycated albumin: r: 0.084, p:0,223, Zinc with HbA1C: r:0.069, p:0,389, Zinc with FBG: r:0,084, r:0,544, Zinc with glycated albumin: r:0.007, p:0,920) Conclusion: There is a positive, weak, and insignificant correlation of serum selenium and zinc with glycemic control parameters. (shrink)

Jeff McMahan famously defends a moral inequality of combatants, where liability to be attacked and potentially killed in war, should be grounded in the individual combatant’s moral responsibility for posing an unjust threat. In a response, Seth Lazar shows that McMahan’s criterion for liability leads to an unacceptable dilemma between “contingent pacifism” and “total war”, i.e. between war being practically infeasible, or implausibly many civilians being legitimate targets. The problem is that McMahan grounds liability mainly in the individual’s causal responsibility (...) for posing an unjust threat, but where a large proportion of combatants and civilians are approximately equally causally responsible. Recently, Saba Bazargan has come to the aid of McMahan by injecting an alternative supplementary criterion for liability, namely the individual’s complicity in a group act. This criterion is supposed to uphold the noted moral inequality, while avoiding the responsibility dilemma, by grounding moral incrimination in the individual’s participatory intention, instead of her causal contribution. I argue that the complicity account fails to resolve the dilemma. It fails because complicity grounded in a causally inert participatory intention is insufficient for liability. Further, I show why this reveals a deeper problem with the complicity account itself, namely that though it purports to ground incrimination non-causally, it fails to do so to any serious extent. (shrink)

This paper considers some aspects of the morality of complicity, understood as participation in the wrongs of another. The central question is whether there is some way of participating in the wrongs of another other than by making a causal contribution to them. I suggest that there is not. In defending this view I encounter, and resist, the claim that it undermines the distinction between principals and accomplices. I argue that this distinction is embedded in the structure of rational agency.

Intersectoral collaboration (IC) plays a significant role in the delivery of diabetes care and treatment of patients with type 2 diabetes (DM2), as the treatment and care of these patients take place in both primary care and specialist settings. The collaboration involves a large number of actors from primary and secondary healthcare sectors, who are expected to fulfil various roles when they engage in IC. We explored the actors' roles by applying the framework of positioning theory with the aim of (...) revealing seemingly embedded understandings of such roles. The empirical data consisted of individual and focus group interviews. Our results indicate that naturalised understandings of the roles of actors interact with the way in which health professionals, patients, managers and relatives strive to develop IC that aims to help and guide patients who live with DM2. (shrink)