This article presents the Pilgrimage Model as a template for educators wishing to lead students on site-specific studies of engaged learning. During the 2015–2016 academic year, a group of Georgeto...

Large-scale sequencing tests, including whole-exome and whole-genome sequencing, are rapidly moving into clinical use. Sequencing is already being used clinically to identify therapeutic opportunities for cancer patients who have run out of conventional treatment options, to help diagnose children with puzzling neurodevelopmental conditions, and to clarify appropriate drug choices and dosing in individuals. To evaluate and support clinical applications of these technologies, the National Human Genome Research Institute and National Cancer Institute have funded studies on clinical and research sequencing under (...) the Clinical Sequencing Exploratory Research program as well as studies on return of results. Most of these studies use sequencing in real-world clinical settings and collect data on both the application of sequencing and the impact of receiving genomic findings on study participants. They are occurring in the context of controversy over how to obtain consent for exome and genome sequencing. (shrink)

This is the second paper in a two-part series describing subject and family perspectives from the CENTURY-S (CENtral Thalamic Deep Brain Stimulation for the Treatment of Traumatic Brain InjURY-Safety) first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury (msTBI). To participate, subjects were independently assessed to formally establish decision-making capacity to provide voluntary informed consent. Here, we report on post-operative interviews conducted after a successful trial of thalamic stimulation. All five msTBI subjects met (...) a pre-selected primary endpoint of at least a 10% improvement in completion time on Trail-Making-Test Part B, a marker of executive function. We describe narrative responses of subjects and family members, refracted against that success. Interviews following surgery and the stimulation trial revealed the challenge of adaptation to improvements in cognitive function and emotional regulation as well as altered (and restored) relationships and family dynamics. These improvements exposed barriers to social reintegration made relevant by recoveries once thought inconceivable. The study’s success sparked concerns about post-trial access to implanted devices, financing of device maintenance, battery replacement, and on-going care. Most subjects and families identified the need for supportive counseling to adapt to the new trajectory of their lives. (shrink)

This is the first article in a two-part series describing subject and family perspectives from the central thalamic deep brain stimulation for the treatment of traumatic brain injury using the Medtronic PC + S first-in-human invasive neurological device trial to achieve cognitive restoration in moderate to severe traumatic brain injury, with subjects who were deemed capable of providing voluntary informed consent. In this article, we report on interviews conducted prior to surgery wherein we asked participants about their experiences recovering from (...) brain injury and their perspectives on study enrollment and participation. We asked how risks and benefits were weighed, what their expectations and fears were, and how decisions were reached about trial participation. We found that informed consent and enrollment decisions are fraught. Subjects and families were often split, with subjects more focused on putative benefits and families concerned about incremental risk. Both subjects and families viewed brain injury as disruptive to personal identity and relationships. As decisions were made about study enrollment, families struggled with recognizing the re-emergent agency of subjects and ceding decision-making authority to subjects who had previously been dependent upon them for protection and guidance. Subjects and family members reported a hope for the relief of cognitive disabilities, improved quality of life, normalization of interpersonal interactions, and a return to work or school as reasons for study participation, along with altruism and a desire to advance science. Despite these aspirations, both subjects and families appreciated the risks of the intervention and did not suffer from a therapeutic misconception. A second essay to be published in the next issue of Cambridge Quarterly of Healthcare Ethics—Clinical Neuroethics will describe interviews conducted after surgery, the effects of cognitive restoration for subjects, families, and challenges presented to the social structures they will call upon to support them through recovery. This subsequent article will be available online prior to its formal publication in October 2023. (shrink)

BackgroundChildhood adversity is linked to adverse health in adulthood. One posited mechanistic pathway is through physiological responses to acute stress. Childhood adversity has been previously related to both exaggerated and blunted physiological responses to acute stress, however, less is known about the psychological mechanisms which may contribute to patterns of physiological reactivity linked to childhood adversity.ObjectiveIn the current work, we investigated the role of challenge and threat stress appraisals in explaining relationships between childhood adversity and cortisol reactivity in response to (...) an acute stressor.MethodsUndergraduate students completed an online survey that included general demographic information and the Risky Families Questionnaire 24 h before a scheduled lab visit. In the lab, a research assistant collected a baseline salivary cortisol sample. Following the baseline period, participants were read instructions for the Trier Social Stress Test, a validated psychological lab stressor. Next, they completed a challenge vs. threat task appraisal questionnaire and completed the speech and math portion of the TSST. Twenty minutes following the start of the TSST, a second salivary sample was collected to measure changes in salivary cortisol following the TSST.ResultsLinear regression analyses adjusted for age, sex, childhood socioeconomic status, and baseline cortisol levels, showed childhood adversity associated with changes in cortisol levels [B = –0.29 t = –2.35, p = 0.02, R2=0.07]. Linear regression analyses controlling for age, sex, and childhood SES showed childhood adversity associated with both challenge [B = –0.52 t = –5.04, p < 0.001, R2=0.24] and threat [B = 0.55 t = 5.40, p < 0.001, R2=0.27] appraisals. Significant indirect effects of childhood trauma on cortisol reactivity were observed through challenge appraisals [B = –0.01 ], and threat appraisals [B = –0.01 ].ConclusionChildhood adversity may contribute to blunted cortisol reactivity, a pattern of response which is linked to obesity, addiction, and other behavior-related diseases. Our findings suggest that this relationship is in part a product of stress appraisals. (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)

Australia is currently experiencing a prolonged period of water scarcity that is challenging a diverse range of water-dependent activities ranging from household gardening to horticultural production to the viability of riverine ecosystems. The political and ecological importance of water in Australia is not, however, only a recent phenomenon. For the majority of Australia’s settled history, water politics, economics, culture and engineering have reflected and embodied a dynamic relationship between Australian hydrology and Australian society. This essay examines that relationship by first (...) reviewing the work of the Australian historical geographer, Emeritus Professor J. M. Powell. For 40 years Powell has been writing about the process of natural resource appraisal and management in Australia and he has been Australia’s leading authority on the role of water in that process for most of that time. The essay then argues for an extension of Powell’s work by applying the insights provided by the scholars Karl Wittfogel, Donald Worster and Eric Swyngedouw. Their work, it is argued, suggests the possibility of a more nuanced understanding of water in Australia than that currently offered by the majority of the Australian literature, and ultimately provides some tools for thinking ourselves out of the current water crisis. (shrink)

Spatial relations are central to geometrical thinking. With respect to the classical elementary geometry of Euclid’s Elements, a distinction between co-exact, or qualitative, and exact, or metric, spatial relations has recently been advanced as fundamental. We tested the universality of intuitions of these relations in a group of Senegalese and Dutch participants. Participants performed an odd-one-out task with stimuli that in all but one case display a particular spatial relation between geometric objects. As the exact/co-exact distinction is closely related to (...) Kosslyn’s categorical/coordinate distinction, a set of stimuli for testing all four types was used. Results suggest that intuitions of all spatial relations tested are universal. Yet, culture has an important effect on performance: Dutch participants outperformed Senegalese participants and stimulus layouts affect the categorical and coordinate processing in different ways for the two groups. Differences in level of education within the Senegalese participants did not affect performance. (shrink)

Annotation. Against the background of Aristotle's Nicomachean Ethics. Bradley provides a detailed differentiation between Aristotle's and Aquinas's view on moral principles and the end of man.

The problem of 'no fault' compensation for patients who suffer adverse effects as a result of their participation in clinical trials is discussed in the light of the guidelines issued by the Association of the British Pharmaceutical Industry (ABPI) and our recent experiences in reviewing protocols submitted to the local ethics of surgical research sub-committee. We have found a variety of qualifications being applied by pharmaceutical firms which are not in the spirit of the guidelines, let alone the interests of (...) the patient, and we suggest a means whereby the patients can be assured of fair treatment in the event of 'no fault' injury. (shrink)

The foreskin in small boys causes much anxiety in our society. It develops during the second half of gestation, and in premature infants may appear relatively deficient. By term, however, it has grown and protruded to well beyond the glans penis. The inner layer of the foreskin is densely adherent to the surface of the glans and cannot be retracted until it is fully separated, which occurs during the first few years of life. Prior to that time the distal opening (...) of the foreskin is narrow, but because of its adherence there is no significant pocket under the skin to allow accumulation of urine or debris. Later in childhood, after the foreskin is fully separated, urine and dirt can accumulate between the foreskin and the glans, leading to infection and inflammation . With recurrent balanitis, and/or tearing of the delicate foreskin, phimosis or scarring may constrict the distal foreskin.Circumcision has a long history in ancient societies of the Middle East, and is likely to have arisen as an early public health measure for preventing recurrent balanitis, caused by sand accumulating under the foreskin. Circumcision is a major part of the ritual for such religions as Judaism, Christianity, and Islam, and it is probably no accident that all of these arose in the Middle East. By contrast, in religions arising outside the arid Middle East , there is no ritual circumcision. In aboriginal society in Australia, circumcision is practised also.The importance of preventing recurrent balanitis and secondary phimosis in arid, sandy regions was confirmed by the Australian army medical corps in two world wars. During both wars, Australian soldiers were stationed in North Africa and the Middle East, and the incidence of recurrent balanitis caused by sand under the foreskin reached “epidemic” proportions, leading to large numbers …. (shrink)

Society in the Self: A Theory of Identity in Democracy shows how society is working in the deeper regions of self and identity. This book is an exploration of the democratic potentials of self and identity in a globalizing and localizing society.

In Poetics chapter 9, Aristotle famously claims that poetry is more philosophical than history. What does this mean? I argue that he is talking about the metaphysics of events. Poets seek causal coherence among the events in their stories. Historians must report what happened whether or not the events of history exhibit causal coherence. This makes the poet's job more philosophical than the historian's, for the poet is seeking a unified plot -- an action-type -- that serves as the backbone (...) of the story he is trying to tell. The poet's final script is a token of an Aristotelian universal, the universal being an action-type that could have been fleshed out in many different ways, although with similar characters. Hence, the poet shows us what he thinks it is likely or necessary for agents of different types to do in the circumstances that confront them. Aristotelian mimesis, on this account, is the poetic representation of "one action," that is, of one action-type. (shrink)

The first to focus exclusively on implicit memory research, this book documents the proceedings of a meeting held in Perth, Australia where leading researchers ...

Depuis 1996, plusieurs équipes sont au travail pour achever la traduction liturgique de l’Ancien Testament. Au moment où le chantier est en voie d’achèvement, un ouvrier de la première heure présente ici l’entreprise à travers le cas particulier du livre de Tobie, qui a été traduit sur frais nouveaux pour l’usage liturgique. La traduction liturgique ne prétend pas surclasser les traductions existantes, mais occupe un créneau qui lui est propre: celui de la proclamation publique.