Social contracts are the mechanisms by which society legitimizes professions and grants them authority and autonomy to carry out their functions. The nursing profession is currently renegotiating its contract with society in a manner which clearly reflects a change from physician dominance, and emphasis on illness care to increased independent and autonomous functioning within a newly developing framework of nursing science which emphasizes health care. In return for their services, nurses are also negotiating for those benefits which historically they have (...) not received. These include legitimization of their newly acquired autonomous role functions, and adequate reimbursement mechanisms and structures. When the contemporary role of the nurse is fully legitimzed, the impact on contemporary society and health care is likely to be enormous. (shrink)

Significant associations have been found between specific human leukocyte antigen (HLA) alleles and organ transplant rejection, autoimmune disease development, and the response to infection. Traditional searches for disease associations have conventionally measured risk associated with the presence of individual HLA alleles. However, given the high level of HLA polymorphism, the pattern of amino acid variability, and the fact that most of the HLA variation occurs at functionally important sites, it may be that a combination of variable amino acid sites shared (...) by several alleles (shared epitopes) are better descriptors of the actual causative genetic variants. Here we describe a novel approach to genetic association analysis in which genes/proteins are broken down into smaller sequence features and then variant types defined for each feature, allowing for independent analysis of disease association with each sequence feature variant type. We have used this approach to analyze a cohort of systemic sclerosis patients and show that a sequence feature composed of specific amino acid residues in peptide binding pockets 4 and 7 of HLA-DRB1 explains much of the molecular determinant of risk for systemic sclerosis. (shrink)

The theories or programs of research described in the chapters of this book move beyond the traditional evaluation model of prejudice, drawing on a broad range of theoretical ancestry to develop models of why, when, and how differentiated reactions to groups arise, and what their consequences might be. The chapters have in common a re-focusing of interest on emotion as a theoretical base for understanding differentiated reactions to, and differentiated behaviors toward, social groups. The contributions also share a focus on (...) specific interactional and structural relations among groups as a source of these differentiated emotional reactions. The chapters in the volume thus reflect a theoretical shift from an earlier emphasis on knowledge about ingroups and outgroups to a new perspective on prejudice in which socially-grounded emotional differentiation becomes a basis for social regulation. (shrink)

Bioethical decision‐making in pediatrics diverges from similar decisions in other medical domains because the young child is not an autonomous decision‐maker, while the teen is developing—and should be encouraged to develop—autonomy and decisional capacity. Thus the balance between autonomy and beneficence is fundamentally different in pediatrics than in adult medicine. While ethical dilemmas that reflect these fundamental issues are common, many pediatric physician and nursing training programs do not delve into the issues or offer specific training about how to deal (...) with borderline cases.To meet this need, the Children's Mercy Bioethics Center in Kansas City, Missouri, created a program specifically dedicated to serving practicing, experienced pediatric health professionals. Our students come from various professional disciplines: they are doctors, nurses, social workers, chaplains, lawyers, psychologists, counselors, and hospital administrators practicing in pediatrics. (shrink)

Over-time variability characterizes not only individual-level emotions, but also group-level emotions, those that occur when people identify with social groups and appraise events in terms of their implications for those groups. We discuss theory and research regarding the role of emotions in intergroup contexts, focusing on their dynamic nature. We then describe new insights into the causes and consequences of emotional dynamics that flow from conceptualizing emotions as based in group membership, and conclude with research recommendations.

We respond to a Letter to the Editor regarding "Principlism and contemporary ethical considerations for providers of transgender health care." We address criticisms by Castle & Klein (2024) of blatant fatphobia related to the ethical elements concerning BMI restrictions for gender-affirming surgery. Our response corrects several mischaracterizations of the article and clarifies our position. My co-authors and I remain focused on advocating for patient-centered, ethically sound, evidence-based, and equitable healthcare policies.

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)

We report the identification of a recurrent, 520-kb 16p12.1 microdeletion associated with childhood developmental delay. The microdeletion was detected in 20 of 11,873 cases compared with 2 of 8,540 controls and replicated in a second series of 22 of 9,254 cases compared with 6 of 6,299 controls. Most deletions were inherited, with carrier parents likely to manifest neuropsychiatric phenotypes compared to non-carrier parents. Probands were more likely to carry an additional large copy-number variant when compared to matched controls. The clinical (...) features of individuals with two mutations were distinct from and/or more severe than those of individuals carrying only the co-occurring mutation. Our data support a two-hit model in which the 16p12.1 microdeletion both predisposes to neuropsychiatric phenotypes as a single event and exacerbates neurodevelopmental phenotypes in association with other large deletions or duplications. Analysis of other microdeletions with variable expressivity indicates that this two-hit model might be more generally applicable to neuropsychiatric disease. © 2010 Nature America, Inc. All rights reserved. (shrink)

DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers can freely discuss current and emerging deep brain stimulation technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in (...) its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year’s meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury. (shrink)

Illness narratives invite practitioners to understand how biomedical and traditional health information is incorporated, integrated, or otherwise internalized into a patient’s own sense of self and social identity. Such narratives also reveal cultural values, underlying patterns in society, and the overall life context of the narrator. Most illness narratives have been examined from the perspective of European-derived genres and literary theory, even though theorists from other parts of the globe have developed locally relevant literary theories. Further, illness narratives typically examine (...) only the experience of illness through acute or chronic suffering (and potential recovery). The advent of biomedical disease prevention methods like post- and pre-exposure prophylaxis (PEP and PrEP) for HIV, which require daily pill consumption or regular injections, complicates the notion of an illness narrative by including illness prevention in narrative accounts. This paper has two aims. First, we aim to rectify the Eurocentrism of existing illness narrative theory by incorporating insights from African literary theorists; second, we complicate the category by examining prevention narratives as a subset of illness narratives. We do this by investigating several narratives of HIV prevention from informants enrolled in an HIV prevention trial in Kenya and Uganda in 2022. (shrink)

Background Individuals who were maltreated during childhood are faced with increased risks for developing various psychological symptoms that are particularly resistant to traditional treatments. This pilot study investigated the effects of a mindfulness based behavioral intervention for young adults with a childhood maltreatment history. Methods This study looked at self-report psychological questionnaires from 20 subjects (5 males) before and after a mindfulness-based behavioral intervention, compared to 18 subjects (6 males) in the waiting list control group (age range 22–29); all subjects (...) experienced mild-to-moderate childhood maltreatment. We analyzed changes in stress, anxiety, depression, mindfulness and self-compassion related to the intervention with linear mixed effects models; we also analyzed the relationships among questionnaire score changes with partial correlation analyses and mediation analysis. Results Linear mixed effects model analyses revealed significant group by time interaction on stress ( p p p p p p r = 0.578, p = 0.001), which negatively correlated with changes in depression ( r = −0.374, p = 0.05) and anxiety ( r = −0.395, p p r = −0.674, p r = −0.580, p r = −0.544, p Conclusion Our results suggest that, to some extent, the mindfulness-based intervention can be helpful for improving self-compassion and psychological health among young adults with a childhood maltreatment history. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT02447744. (shrink)

Plasminogen activator inhibitor‐1 (PAI‐1) is a physiological inhibitor of urokinase (uPA), a serine protease known to promote cell migration and invasion. Intuitively, increased levels of PAI‐1 should be beneficial in downregulating uPA activity, particularly in cancer. By contrast, in vivo, increased levels of PAI‐1 are associated with a poor prognosis in breast cancer. This phenomenon is termed the “PAI‐1 paradox”. Many factors are responsible for the upregulation of PAI‐1 in the tumor microenvironment. We hypothesize that there is a breast cancer (...) predisposition to a more aggressive stage when PAI‐1 is upregulated as a consequence of Metabolic Syndrome (MetS). MetS exerts a detrimental effect on the breast tumor microenvironment that supports cancer invasion. People with MetS have an increased risk of coronary heart disease, stroke, peripheral vascular disease and hyperinsulinemia. Recently, MetS has also been identified as a risk factor for breast cancer. We hypothesize the existence of the “PAI‐1 cycle”. Sustained by MetS, adipocytokines alter PAI‐1 expression to promote angiogenesis, tumor‐cell migration and procoagulant microparticle formation from endothelial cells, which generates thrombin and further propagates PAI‐1 synthesis. All of these factors culminate in a chemotherapy‐resistant breast tumor microenvironment. The PAI‐1 cycle may partly explain the PAI‐1 paradox. In this hypothesis paper, we will discuss further how MetS upregulates PAI‐1 and how an increased level of PAI‐1 can be linked to a poor prognosis. BioEssays 29:1029–1038, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

Traditional accounts hold that reference consists in a relation between the mind and an object; the relation is effected by a mental act and mediated by internal mental contents (internal representations). Contemporary theories as diverse as Fodor’s [Fodor, J.A., 1987. Psychosemantics: The Problem of Meaning in the Philosophy of Mind. MIT Press, Cambridge, MA] language of thought hypothesis, Dretske’s [Dretske, F., 1988. Explaining Behaviour: Reasons in a World of Causes. MIT Press, Cambridge, MA] informational semantics and Millikan’s [Millikan, R.G., 1984. (...) Language, Thought and Other Biological Categories: New Foundations for Realism. MIT Press, Cambridge, MA] teleosemantics share this act– content–object picture (which was also held by several early modern philosophers, in particular Locke). The core of the traditional view is the thesis that reference and intentionality are relational (‘thesis RR’). Although deeply problematic, RR is entrenched also in psychology, linguistics, cognitive science and Artificial Intelligence. Using for the most part arguments employed by Wittgenstein, we mount a case against RR and advance a deflationary account of reference and intentionality according to which neither is relational. (shrink)

Saeculum: Gedenkschrift für Heinrich Otten anlässlich seines 100. Geburtstags. Edited by Andreas Müller-Karpe; Elisabeth Rieken; and Walter Sommerfeld. Studien zu den Boǧazköy-Texten, vol. 58. Wiesbaden: Harrassowitz Verlag, 2015. Pp. xi + 316, illus. €84.

Childbearing is an increasingly complicated matter, which has evolved significantly over the past several decades. Treatment options for infertility have expanded. Prenatal testing and treatment have led to an evolution in obstetrical decision-making, wherein the risks and benefits to the fetus and future child are better understood and more strongly considered in medical management of the pregnant woman. Obstetrics appears to be increasingly interventional; one in three babies in the United States is now born by cesarean section. Neonatal intensive care (...) has markedly improved outcomes for premature babies. A pregnant woman may now be presented with many options— obstetrician or midwife, home or hospital delivery, choices among prenatal testing and monitoring, early induction of labor, cesarean delivery. Health care professionals face similar decisions with regard to what they recommend and the boundaries of safe and responsible care they should make available. Preterm Babies, Fetal Patients, and Childbearing Choices, by John D. Lantos and Diane S. Lauderdale, provides an excellent overview of the available information relevant to these questions. (shrink)

It is not widely realised that Turing was probably the first person to consider building computing machines out of simple, neuron-like elements connected together into networks in a largely random manner. Turing called his networks 'unorganised machines'. By the application of what he described as 'appropriate interference, mimicking education' an unorganised machine can be trained to perform any task that a Turing machine can carry out, provided the number of 'neurons' is sufficient. Turing proposed simulating both the behaviour of the (...) network and the training process by means of a computer program. We outline Turing's connectionist project of 1948. (shrink)

One of the most enduring criticisms of John Dewey's political thought is that it is unsuspicious of power. This essay responds to this critique by advancing the claim that power is an integral but implicit element of Dewey's conception of human experience. Given Dewey's indirect treatment of power, this essay has two primary tasks. First, it reconstructs and develops an explicit conception of power for Deweyan pragmatism. Second, it evaluates the extent that Dewey's political and social philosophy is able to (...) criticize power relations. Taken together, I aim to provide a more coherent and realistic defense of the political dimensions of Dewey's democratic theory. This defense moves Deweyan pragmatism toward a democratic politics that neither elides conflict nor evades power. (shrink)