Reconstructive allografts using Vascularized Composite Allotransplantation are providing individuals living with upper limb loss and facial disfigurement with new opportunities for a sensate, esthetically acceptable, and functional alternative to current treatment strategies. Important research attention is being paid to how best to assess and screen candidates for VCA, measure optimal patient outcomes, and support patient adherence to lifelong behaviors and medical regimens. Far less attention, however, has been dedicated to the team science required for these complex VCA teams to form, (...) prepare, and provide the highest quality clinical and psychosocial care to those receiving VCA. VCA teams are unique in that they require specialized team members whose scope of practice may not otherwise overlap. The team also needs to constantly negotiate balancing patient safety with multiple risks throughout the transplant process. This study aimed to elucidate the team science needed for this highly innovative and complex area of medicine. Using in-depth qualitative interviews with 14 VCA team members and observations at team meetings, we found that careful consideration of team composition, team structure, and organizational commitment influences team performance and patient outcomes, but that to be efficient and truly effective, teams need to commit to developing processes that foster collaboration. These processes are action-oriented, strategic and interpersonal. Dedication and commitment to team science allows teams to manage conflict under stress and exercise ways to leverage strengths to provide optimal performance or patient psychosocial and clinical outcomes. This study can provide insight into quality improvement efforts for VCA teams and guidance for other transplant programs that wish to consider expansion into VCA. (shrink)

The goals of vascular composite allotransplantation for hand are to maximize functional status and psychosocial wellbeing and to improve quality of life. Candidates are carefully vetted by transplant programs through an extensive evaluation process to exclude those patients with contraindications and to select those that are most likely to attain functional or quality of life benefit from transplant. Patient choice for any treatment, however, requires that candidates be able to understand the risks, benefits, and alternatives before choosing to proceed. This (...) study aimed to understand patients’ knowledge and perceptions about treatment options for hand loss, including hand transplant. This study will be used to inform a standardized education approach and develop conversation aids for use by clinicians and patients throughout the treatment decision process. Ten individuals who had experienced hand amputation or had congenital limb loss were interviewed to better understand previous and current decisions about treatment, experiences in adjusting to their treatment, and perceptions about hand VCA. From this qualitative interview data, four findings emerged: knowledge and education around VCA as a treatment option; adaptation of individuals with limb loss; fear of risk associated with transplantation; issues of aging and overuse injuries to existing limbs. Results suggests that there is opportunity for expanding education about all treatment options for patients with new loss, long-term loss, and congenital limb loss. Establishing a baseline of knowledge about all options–prosthetics, rehabilitative strategies, and VCA—can help patients evaluate their values and goals of treatment. Issues associated with aging, including overuse and injury, and adaptability over the life course should be included in considerations about treatment choices. Data indicate the need for routinely assessing patient preferences about treatment choice so patients can plan for their future as they adapt and age and as technology for treatments change. To assure that thorough information is provided for current and future decision-making, education about treatment choices and selection procedures for VCA should be standardized. (shrink)

This article shows how there is a great kinship between Polanyi's thought and that of Bernard Haring, "the father of modern moral theology" in the Roman Catholic Church. Haring advocated an ethics of personal responsibility that calls for an epistemology such as Polanyi developed for history and social sciences in The Study of Man.

A crisis continues to brew within the pharmaceutical research and development (R&D) enterprise: productivity continues declining as costs rise, despite ongoing, often dramatic scientific and technical advances. To reverse this trend, we offer various suggestions for both the expansion and broader adoption of modeling and simulation (M&S) methods. We suggest strategies and scenarios intended to enable new M&S use cases that directly engage R&D knowledge generation and build actionable mechanistic insight, thereby opening the door to enhanced productivity. What M&S requirements (...) must be satisfied to access and open the door, and begin reversing the productivity decline? Can current methods and tools fulfill the requirements, or are new methods necessary? We draw on the relevant, recent literature to provide and explore answers. In so doing, we identify essential, key roles for agent-based and other methods. We assemble a list of requirements necessary for M&S to meet the diverse needs distilled from a collection of research, review, and opinion articles. We argue that to realize its full potential, M&S should be actualized within a larger information technology framework—a dynamic knowledge repository—wherein models of various types execute, evolve, and increase in accuracy over time. We offer some details of the issues that must be addressed for such a repository to accrue the capabilities needed to reverse the productivity decline. (shrink)

This article shows how there is a great kinship between Polanyi's thought and that of Bernard Haring, "the father of modern moral theology" in the Roman Catholic Church. Haring advocated an ethics of personal responsibility that calls for an epistemology such as Polanyi developed for history and social sciences in The Study of Man.

Because Bertrand Russell adopted much of the logical symbolism of Peano, because Russell always had a high regard for the great Italian mathematician, and because Russell held the logicist thesis so strongly, many English-speaking mathematicians have been led to classify Peano as a logicist, or at least as a forerunner of the logicist school. An attempt is made here to deny this by showing that Peano's primary interest was in axiomatics, that he never used the mathematical logic developed by him (...) for the reduction of mathematical concepts to logical concepts, and that, instead, he denied the validity of such a reduction. (shrink)

The mental health of young people is a growing public health concern. With socio-emotional difficulties in youth often resulting in psychiatric disorders later in life and most with mental health conditions rather stabilizing in time, it is essential to support healthy socio-emotional development. With a comprehensive definition of mental health, since emotion regulation plays a critical role in prevention, it becomes imperative to better understand how children effectively manage their emotions from an early age. Determining effective use of ER skills (...) relies on adequate measurements. Typical methods of data collection in children present consistent shortcomings. This review addresses research findings considering the suitability of the late positive potential measured through electroencephalogram as a neural indicator of ER in children and youth. There is growing evidence, as reported in this review, that indicates that the late positive potential may be a reliable neural indicator of children's cognitive reappraisal abilities more specifically. Results generally suggest that the late positive potential amplitudes are sensitive to directed reappraisal in children. However, given the scant research, questions remain regarding developmental trends, methodology, interindividual variability, reappraisal of various stimuli, and how the late positive potential may relate to more traditional measures of ER. Directions for future research are provided, which are expected to address unanswered research questions and fill literature gaps. Taken together, the findings reviewed indicate that the late positive potential is generally sensitive to directed cognitive reappraisal in children and that there is promise of establishing this neural marker as an indicator of ER. (shrink)

Secondary education around the world has been significantly disrupted by covid-19. Students have been forced into new ways of independent learning, often using remote technologies, but without the social nuances and direct teacher interactions of a normal classroom environment. Using data from the School Attitudes Survey—which surveys students regarding the perceived level of difficulty, anxiety level, self-efficacy, enjoyability, subject relevance, and opportunities for creativity with regards to each of their school subjects—this study examines students' responses to this disruption from two (...) very different schools with two very different experiences of the pandemic. This paper reports on the composite attitudinal profiles of students in the senior secondary levels at each school. The findings challenged our expectation that the increased difficulty and anxiety caused by the disruption would reduce perceived opportunities for creativity. Indeed, our analyses showed that the students at both schools demonstrated generally positive attitudes toward their learning and strongly associated opportunities for creativity with other attitudinal constructs including enjoyability, subject relevance, and self-efficacy. These complex associations made by the students appear to have buffered the impacts of the disruption, and they may even have supported creative resilience. (shrink)

Bioethics conjures images of dramatic healthcare challenges, yet everyday clinical ethics issues unfold regularly. Without sufficient ethical awareness and a relevant working skillset, clinicians can feel ill-equipped to respond to the ethical dimensions of everyday care. Bioethicists were interviewed to identify the essential skills associated with everyday clinical ethics and to identify educational case scenarios to illustrate everyday clinical ethics. Individual, semi-structured interviews were conducted with a convenience sample of bioethicists. Bioethicists were asked: (1) What are the essential skills required (...) for everyday clinical ethics? And (2) What are potential educational case scenarios to illustrate and teach everyday clinical ethics? Participant interviews were analyzed using qualitative content analysis. Twenty-five (25) bioethicists completed interviews (64% female; mean 14.76 years bioethics experience; 80% white). Five categories of general skills and three categories of ethics-specific skills essential for everyday clinical ethics were identified. General skills included: (1) Awareness of Core Values and Self-Reflective Capacity; (2) Perspective-Taking and Empathic Presence; (3) Communication and Relational Skills; (4) Cultural Humility and Respect; and (5) Organizational Understanding and Know-How. Ethics-specific skills included: (1) Ethical Awareness; (2) Ethical Knowledge and Literacy; and (3) Ethical Analysis and Interaction. Collectively, these skills comprise a Toolbox of Everyday Clinical Ethics Skills. Educational case scenarios were identified to promote everyday ethics. Bioethicists identified skills essential to everyday clinical ethics. Educational case scenarios were identified for the purpose of promoting proficiency in this domain. Future research could explore the impact of integrating educational case scenarios on clinicians’ ethical competencies. (shrink)

Clinical ethics consultants face a wide range of ethical dilemmas that require broad knowledge and skills. Although there is considerable overlap with the approach to adult consultation, ethics consultants must be aware of differences when they work with infant, pediatric, and adolescent cases. This article addresses unique considerations in the pediatric setting, reviews foundational theories on parental authority, suggests practical approaches to pediatric consultation, and outlines current available resources for clinical ethics consultants who wish to deepen their skills in this (...) area. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Mismapping the Underworld: Daring and Error in Dante’s ‘Comedy’Edward Donald KennedyMismapping the Underworld: Daring and Error in Dante’s ‘Comedy,’ by John Kleiner; 182 pp. Stanford: Stanford University Press, 1994, $32.50.Critics once emphasized the unity and apparent perfection of Dante’s Divine Comedy. In Mismapping the Underworld, John Kleiner emphasizes instead the imperfections, the inconsistencies, and inaccuracies in Dante’s work both to give a more accurate assessment of Dante’s artistry (...) and, as he remarks, to help readers “learn to enjoy” the imperfections (p. 2).The five chapters of the book are devoted to various cruces in the Vita nuova and the Comedy. The first chapter considers numerology in the Vita nuova: pointing out that scholars’ arguments for that work’s numerological symmetry have been flawed, Kleiner asks if Dante had as much “passion for order” as scholars have assumed. The second chapter, from which the title of the book is taken, considers earlier scholars’ attempts to draw accurate maps of Dante’s vision of Hell and inaccuracies and inconsistencies in that vision. Probably not many readers, for example, have realized that Satan, partially buried in the ice of Cocytus at the bottom of Hell, must be about 2,500 feet tall, if one calculates his height from the evidence Dante has given us, and even the part of his body extending above the ice must approximate “the height of the World Trade Center.” One must then ask how Dante, the narrator in the poem, is able to give such detailed descriptions of the tormented bodies of Cassius, Brutus, and Judas dangling from Satan’s mouth: “at their height they should be as insignificant a sight as a trio of deluded tourists waving from the top of the Empire State Building” (p. 44). One of the reasons why scholars have attempted to map the underworld so precisely is, as Kleiner points out, that Dante makes it seem so much more concrete than the “dreamlike” surface of earth. (Here C. S. Lewis may have taken a clue from Dante, in his notion that the concrete belongs to Heaven, that things on earth are only “shadowlands.”)The third chapter concerns Dante’s reputation as a student of classical literature. Here, focusing on two cantos of the Inferno and the Purgatorio, Kleiner considers Dante’s inaccurate citations from Virgil, Statius, and other [End Page 415] classical writers and his intentional use of “masterful distortions” to create the effect he wanted. In the fourth chapter, Kleiner discusses Dante’s use of scientific material, such as his precise description of the duration of a lunar eclipse that no one on earth would have been able to gauge and his design of an impossible experiment concerning reflected light. The final chapter associates Dante’s interest in Geryon, the monster who appears in Canto 16 of the Inferno, with the medieval fascination with the grotesque. Moreover, the Ovidian allusions in this canto, Kleiner believes, make the encounter with Geryon a meditation on poetry and show “fiction’s proximity to fraud, its perilous attractiveness, and its susceptibility to perversion” (p. 132). Thus the Geryon episode represents Dante’s concern with the dangers inherent in reading, dangers depicted earlier in the Inferno in, for example, the Francesca and Paolo episode of Canto V, in which the lovers had been seduced into committing adultery after reading the story of Lancelot and Guinevere. In such episodes, Dante reminds us of the power a writer has over his readers and of his duty not to use that power irresponsibly.Because of the post-Renaissance emphasis on the importance of unity in a work of art and the later emphasis on realism, earlier critics naturally emphasized the unity and consistency of Dante’s work. A great work, they assumed, had to have these qualities. As Kleiner’s book reminds us, however, earlier writers did not always prize them as highly as modern critics do, and some inconsistencies and errors (some deliberate, some not) seem to have been acceptable. Inaccurate citations of classical works are due in part to the fact that medieval writers often knew earlier works only from commonplace books and in part to... (shrink)

Childhood & philosophy é uma revista que está esperando por nascer pelo menos desde que Sócrates ocupou um lugar singular na pólis do século v a. C. e fundou uma disciplina. A concepção dessa revista se sustenta, muito mais tarde, no providencial encontro histórico entre a educação da infância e a filosofia. esse encontro, por sua vez, teve que esperar pelas proféticas declarações de Rousseau no Emílio, enviadas qual um manuscrito posto numa garrafa à revolução iminente e também pelo lento (...) desenvolvimento, ao longo dos séculos XIX e XX, de um tipo de adulto realmente capaz de ouvir as crianças, senão de escutá-las. Para isso foi necessária a desconstrução romântica de tal adulto vivamente esclarecido quem, devemos admitir, fez possível a revolução. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Invention of Greek Ethnography from Homer to Herodotusby Joseph E. SkinnerRebecca F. KennedyJ osephE. S kinner. The Invention of Greek Ethnography from Homer to Herodotus. Greeks Overseas. Oxford: Oxford University Press, 2012. xii + 343 pp. Numerous black-and-white figs. Cloth, $85.In his welcome book on the invention of ethnography, Skinner challenges the focus in mainstream scholarship on the Greek prose genre that was first defined by Jacoby (...) in his influential Die Fragmente der griechischen Historiker(discussed in detail, 30–34) and on a notion that the “Greekness” the genre embodies was [End Page 287]supposedly invented in the fifth century as a response to the Persian wars. Skinner also advocates a break from the structuralist frameworks favored by scholars such as F. Hartog and E. Hall. Thus, the book has two distinct focuses. First, Skinner seeks to demonstrate that the origins of the prose genre can be found in other literary genres, sub-literary engagements, and material artifacts that should be considered as part of the “thought-world from which the early prose accounts emerged” (17). Second, Skinner shows that structuralist binaries are not the best method for understanding ethnographic thinking and frames his study instead with the discourse theories found in the works of historian J. Clifford and anthropologist/sociologist P. Bourdieu that emphasize “practice” and process. Skinner argues that the genre of Greek ethnography is not synonymous with the practice of Greek identity nor can any functional, homogenous Greek identity claim to be embedded within the genre (18). Rather, he emphasizes the “ethnographic concerns” of the Greeks and attempts to contextualize the emergence of the prose genre by exploring evidence of ethnographic “practice” in the material of everyday life. Ethnographic thought is further defined as positioning in relation to both non-Greeks and other Greeks. Although the title of the book suggests that the timeframe of the study includes evidence from Homer down to the time of Herodotus’ Histories(ca. 430 b.c.e.), most of the evidence he musters comes from the archaic period with occasional recourse to Pindar and the historical fragments of the post–Persian war period. This fits in with a secondary aim of the book to show that the Persian wars did not serve as the impetus for ethnographic thinking or for the emergence of a notion of “Greekness,” a position emphasized most vigorously by J. Hall.Chapter 1 is a long and dense explanation of Skinner’s theoretical approach and the debates among which Skinner situates his study. Despite a number of scholarly efforts over the last decade or so in rethinking identity and ethnicity in antiquity, it is still necessary to combat the ghosts of Jacoby and the structuralists, and Skinner musters a theoretically equipped army for the battle. He finds inherently problematic Jacoby’s “invention” of genres and our adherence to them (a legacy from the earlier academic enterprise, especially in Germany, of prioritizing and ranking ancient cultures based on their “firsts”). Structuralist views are represented by Edith Hall’s Inventing the Barbarian(Oxford 1989), one of the most influential voices in the study of ancient ethnicity. Although she is prominent throughout the book, Skinner ironically never addresses the fact that Hall’s own evidence is the performative, public practice of Athenian drama. Hall herself, although a structuralist, reflects in choice of evidence the type of discursive practice Skinner himself wishes to invoke (in fact, he entirely excludes drama from his evidence). Skinner’s theoretical apparatus is complex and rarely appears explicitly in later chapters (except in the conclusion).In “Populating the Imaginaire” (chap. 2), Skinner catalogues some foreign and/or mythical peoples whom the Greeks deployed in their texts and art as part of their process of self-identification. The peoples discussed are, as Skinner admits, selective, but I could not find a principle behind the selection. The discussion of the Cyclopes is restricted to Homer, and the Arimaspians make a brief appearance. [End Page 288]The Scythians, Amazons, Lydians, Egyptians, and Ethiopians receive extensive treatment in text and iconography (although his presentation of Archaic literary representations of Thrace is slightly abbreviated). Also included are the Pelasgians and peoples of... (shrink)

Single units that are not related to the desired task can become related to the task by conditioning their firing rates. We theorized that, during conditioning of firing rates to a tone, (a) unrelated single units would be recruited to the task; (b) the recruitment would depend on the phase of the task; (c) tones of different frequencies would produce different patterns of single unit recruitment. In our mute locked-in participant, we conditioned single units using tones of different frequencies emitted (...) from a tone generator. The conditioning task had three phases: Listen to the tone for 20 s, then silently sing the tone for 10 s, with a prior control period of resting for 10 s. Twenty single units were recorded simultaneously while feedback of one of the twenty single units was made audible to the mute locked-in participant. The results indicate that (a) some of the non-audible single units were recruited during conditioning, (b) some were recruited differentially depending on the phase of the paradigm (listen, rest, or silent sing), and (c) single unit firing patterns were specific for different tone frequencies such that the tone could be recognized from the pattern of single unit firings. These data are important when conditioning single unit firings in brain-computer interfacing tasks because they provide evidence that increased numbers of previously unrelated single units can be incorporated into the task. This incorporation expands the bandwidth of the recorded single unit population and thus enhances the brain-computer interface. This is the first report of conditioning of single unit firings in a human participant with a brain to computer implant. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Sextus Empiricus: Against the Grammarians (Adversus Mathematicos I)George A. KennedyD[avid] L. Blank, trans. Sextus Empiricus: Against the Grammarians (Adversus Mathematicos I). With an introduction and commentary. Oxford: Clarendon Press, 1998. lvi + 436 pp. Cloth, $105. (Clarendon Later Ancient Philosophers).Sextus was a Greek physician whose "empirical" medical studies seem to have led him to an enthusiastic commitment to what he calls "Pyrrhonian" skepticism, though it perhaps has rather (...) little debt to Pyrrho, who lived in the fourth century B.C. When and where Sextus himself lived and worked is unknown: certainly during the time of the Roman Empire, probably in the second, possibly in the third century, maybe in Alexandria, or Rome, or elsewhere. His extensive writings are a major source for the skeptical tradition in ancient philosophy--a kind of anti-foundationalism that has some appeal in our own age--but their importance goes beyond that, since Sextus explicates in detail the dogmas and theories he seeks to counteract. Against the Grammarians, as Blank notes, is second only to the textbook attributed to Dionysius Thrax for information on the teaching of grammar and is important for knowledge of Epicureanism as well.Blank's introduction, translation (the Greek text is not included), and line-by-line commentary (the first ever published) is a work of great learning and, I would think, of great patience. The volume as a whole greatly facilitates understanding of Sextus, his sources, and the traditions to which he subscribed or which he resisted. Blank has adopted "expertise" as a translation for the somewhat troublesome word techne, and "expert" for technites. This seems a reasonable rendering of Sextus' usage. What he attacks is not grammar (or, in subsequent books, rhetoric and the other arts) as practiced in ordinary life, but the claims to expert, scientific knowledge on the part of doctrinaire teachers of the arts, as well as some physicians and philosophers.This leads us, however, to a general problem in Sextus' writings. At the beginning of Against the Grammarians (chapters 5-7) (and elsewhere) he claims to have discovered difficult problems in the claims of specialists in philosophy and the arts which lead him to suspension of judgment. He will attempt "without any spirit of competitiveness to select and put the effective arguments against the liberal studies." Implicitly, an equal amount might be said in their defense. In what follows, however, he repeatedly claims to have "demolished" dogmas, leading to what has been called "negative dogmatism," the dogmatic denial of dogma. Blank devotes a section of his introduction to this problem, concluding that Sextus' intent throughout is in fact "equipollence." That is probably what Sextus himself would claim. Assuming it is, Sextus must, however, be charged with the fault of expressing himself poorly, for he repeatedly exults at his conclusive refutations of the claims of others.Throughout the work Blank strives, often with considerable success, to provide a sympathetic explanation and logical justification for Sextus' arguments, [End Page 166] many of which may initially strike a reader as blatant sophistries. Sextus was no fool, but he had blind spots and obsessions--infinite regress being one--and he often fails to take into account lines of argument obvious to a modern reader. Blank's objectivity does not extend to blanket approval of all of Sextus' arguments; indeed, he criticizes and even rejects the validity of arguments on a number of occasions. His treatment can be described as generally even-handed, but giving his author the benefit of the doubt more often than I would be inclined to do.Blank's extended introduction considers what is known about Sextus' life and works; the history of attacks on the arts, which go back to the fifth century b.c.; evidence for empiricist attacks on grammar; Against the Grammarians in relation to the other writings of Sextus; and negative dogmatism; then a few concluding remarks on the translation. Both here and in the commentary he convincingly demonstrates that Sextus' primary source is a lost Epicurean treatise--something like the writings of Zeno of Sidon, the teacher of Philodemus, though Blank stops short of claiming Zeno as the source. This Epicurean work contained a detailed attack... (shrink)