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)

BackgroundSelf-prescribing and prescribing to personal contacts is explicitly discouraged by General Medical Council guidelines.AimsThis study examines how widespread the practice of self-prescribing and prescribing to personal contacts is.MethodsA 16-item questionnaire was distributed via an online forum comprising 4445 young medical doctors (representing 20% of all Irish registered doctors), which asked respondents about previous prescribing to themselves, their families, friends and colleagues, including the class of medication prescribed. Demographic details were collected including medical grade and specialty.ResultsA total of 729 responses were (...) obtained, the majority of which were from young non-consultant hospital doctors from a range of specialties. Two-thirds of respondents had self-prescribed, over 70% had prescribed to family, and nearly 60% had prescribed to a friend or colleague. Older doctors were more likely to self-prescribe (χ2=17.51, p<0.001). Interns being less likely to self-prescribe was not unexpected (χ2=69.55, p<0.001), while general practitioners (GPs) and paediatricians were more likely to self-prescribe (χ2=13.33, p<0.001;χ2=11.35, p<0.001). GPs, paediatricians and hospital medicine specialties were more likely to prescribe to family (χ2=5.19, p<0.05;χ2=8.38, p<0.05;χ2=6.17, p<0.05) and surgeons were more likely to prescribe to friends (χ2=15.87, p<0.001). Some 3% to 7% who had self-prescribed had prescribed an opiate, benzodiazepine or psychotropic medication. Male doctors, anaesthetists and surgeons were more likely to self-prescribe opioids (χ2=7.82, p<0.01;χ2=7.31, p<0.01;χ2=4.91, p<0.05), while those in hospital medicine were more likely to self-prescribe psychotropic medications (χ2=5.47, p<0.05).ConclusionPrescribing outside the traditional doctor-patient relationship is widespread despite clear professional guidance advising against it. (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)

Pictures are tactile as well as visual. Outline pictures stand for the same kinds of surface features in touch and vision. Vantage point geometry is used by blind and sighted perceivers in pictures. Limits of pictures may be comparable for the blind and sighted, and transcended in useful ways. Introduction In keeping with a conference on the multimodality of human communication, the purpose of this paper is to show that some aspects of pictures are tangible as well as visual. Many (...) means of communication are often considered to be exclusively visual or auditory, but the exclusionary view requires radical revision, the evidence from pictures tells us. (shrink)

This Is A New Release Of The Original 1911 Edition.

In the face of limited time and escalating impacts, some scientists and politicians are talking about attempting "grand technological interventions" into the Earth’s basic physical and biological systems ("geoengineering") to combat global warming. Early ideas include spraying particles into the stratosphere to block some incoming sunlight, or "enhancing" natural biological systems to withdraw carbon dioxide from the atmosphere at a higher rate. Such technologies are highly speculative and scientific development of them has barely begun. -/- Nevertheless, it is widely recognized (...) that geoengineering raises critical questions about who will control planetary interventions, and what responsibilities they will have. Central to these questions are issues of justice and political legitimacy. For instance, while some claim that climate risks are so severe that geoengineering must be attempted, others insist that the current global order is so unjust that interventions are highly likely to be illegitimate and exacerbate injustice. Such concerns are rarely discussed in the policy arena in any depth, or with academic rigor. Hence, this book gathers contributions from leading voices and rising stars in political philosophy to respond. It is essential reading for anyone puzzled about how geoengineering might promote or thwart the ends of justice in a dramatically changing world. (shrink)

Edible insects are a potentially less burdensome source of proteins on the environment than livestock for a majority of rural consumers. Hence, edible insects are a timely idea to address the challenges of the supply side to sustainably meet an increasing demand for food. The objective of this paper is twofold. The first is to identify and compare rural-households’ intentions to consume insect-based foods among households drawn from two regions in Kenya—one where consumption of insects is common and the other (...) where the practice is uncommon. The second is to explore consumers’ trust in sources of information regarding quality and appropriateness of food items. The study employed an extended theory of planned behaviour and involved 432 participants. Results indicate that rural households have positive intentions to consume insect-based foods and those intentions are higher for individuals who are more familiar with the practice. Results also show that information sources from industry are more trusted than those from the media. Further, the study revealed that control variables such as perceived availability of insect-based foods and their level of fit with the culinary practices have a higher influence on consumption intentions than general attitudes. In addition, age of the respondent, gender, household size and level of formal education, significantly influence the consumption intentions. The study discusses the implications of these findings in the development of sustainable agri-food systems. (shrink)

Friedrich Nietzsche (1844-1900) has had a profound impact on our way of life. Among other things, he was a philosopher, a poet, and a scholar. Unfortunately, he suffered from poor health, which caused him to resign from his position as the Chair of Classical Philology, which he held at the age of 24. At 44, he was so ill that his mother, and then his sister had to care for him until his death at the page of 55. Nietzsche wrote (...) on numerous subjects, but is commonly associated with nihilism, critiques of Christian morality, and his strong opposition to anti-Semitism and nationalism. There was a brief time when his sister reworked his manuscripts to favor Nazi ideology, but the correct manuscripts were uncovered. Many scholars have written about Nietzsche. J. M. Kennedy was the pen name for John McFarland, who wrote extensively on Nietzsche. He also wrote on education, philology and war. This new edition is dedicated to Daniel Gutierrez Sandoval and Emma Norman, who have had different views of Nietzsche. Please note that this is a reprint of the original version, and has a few small blemishes. (shrink)

Mark Johnson argues in favour of embodied experience as the basis for knowledge. An important implication of his analysis is that these experiences instigate pervasive metaphorical systems. Johnson 's argument involves reductionist problems, chicken-and-egg problems and, at times, unclear criteria for what counts as a basic experience and a metaphor.

Usain Bolt’s Lightning Bolt pose, one arm highly extended to one side, suggests action. Likewise, static pictures of animals, legs extended, show animation. We tested a new cue for motion perception—extension—and in particular extension of dancer’s legs. An experiment with pictures of a dancer finds larger angles between the legs suggest greater movement, especially with in-air poses and in lateral views. Leg positions graded from simply standing to very difficult front and side splits. Liking ratings were more related to Difficulty (...) ratings than Movement ratings. (shrink)

Amy Herzog 'Reassessing the Aesthetic: Cinema, Deleuze, and the Art of Thinking' _Film-Philosophy_, Deleuze Special Issue vol. 5 no. 40, November 2001.

Informed by the critical humanisms of Hannah Arendt, Frantz Fanon, and Paul Gilroy, the authors argue for an orientation to teaching and learning that troubles the continuing effects of dehumanizing race logic. Reflecting on Paul Haggis's Oscar award winning film Crash from 2004, they suggest that the metaphor of racial 'crashing' captures what happens when we act out from experiences of racial injury instead of being touched by it. They propose a psychoanalytic pedagogy of emotions as a method for reading (...) representation beyond the limits of detached rational critique. Learning from the affect of racial injury as it is made manifest in representation, they suggest, is an important ethical starting point for generating new insights into what it might mean to live within and beyond contemporary legacies of racial hatred. (shrink)

Recent work on receptor molecules and cells used prototypical sweet, salty, sour, bitter, and umami stimuli. Labeled-line coding was supported, but it remains possible that the molecules and cells could respond to other tastants. Studies with other tastants are needed. The sensory message might contain two codes – one for attraction or aversion, the other, across-fiber patterning of stimulus quality.

We propose that in pictures both the extended limbs of actors and the ground are involved in gestalts for movement. Limbs extend to suggest more motion literally when a dancer is in air and refer to a canonical pose when on the ground. A running pony’s curled limbs off the ground depict fast action literally. A horse’s flying-gallop off the ground suggests speedy motion metaphorically. Cast shadows indicate the actor’s location with respect to the ground. We consider extended and curled (...) limbs, on-ground and off, in literal and metaphoric pictures. (shrink)

BackgroundThe ARRIVE (Animal Research: Reporting of In Vivo Experiments) guidelines are widely endorsed but compliance is limited. We sought to determine whether journal-requested completion of an ARRIVE checklist improves full compliance with the guidelines.MethodsIn a randomised controlled trial, manuscripts reporting in vivo animal research submitted to PLOS ONE (March–June 2015) were randomly allocated to either requested completion of an ARRIVE checklist or current standard practice. Authors, academic editors, and peer reviewers were blinded to group allocation. Trained reviewers performed outcome adjudication (...) in duplicate by assessing manuscripts against an operationalised version of the ARRIVE guidelines that consists 108 items. Our primary outcome was the between-group differences in the proportion of manuscripts meeting all ARRIVE guideline checklist subitems.ResultsWe randomised 1689 manuscripts (control: n = 844, intervention: n = 845), of which 1269 were sent for peer review and 762 (control: n = 340; intervention: n = 332) accepted for publication. No manuscript in either group achieved full compliance with the ARRIVE checklist. Details of animal husbandry (ARRIVE subitem 9b) was the only subitem to show improvements in reporting, with the proportion of compliant manuscripts rising from 52.1 to 74.1% (X2 = 34.0, df = 1, p = 2.1 × 10−7) in the control and intervention groups, respectively.ConclusionsThese results suggest that altering the editorial process to include requests for a completed ARRIVE checklist is not enough to improve compliance with the ARRIVE guidelines. Other approaches, such as more stringent editorial policies or a targeted approach on key quality items, may promote improvements in reporting. (shrink)