The regulation of narcotic medications used in narcotic addiction treatment is unique in medical therapeutics. Physicians who want to use narcotics for this indication must obtain a separate annual registration from the Drug Enforcement Administration. Annual registration is contingent on compliance with both the DEA's security regulations as well as treatment regulations jointly promulgated by the Food and Drug Administration and the National Institute on Drug Abuse.During the last decade, a number of events have occurred that persuaded NIDA that it (...) is time to reevaluate the current method by which the Department of Health and Human Services regulates methadone treatment. As a result of research during the past twenty years, we have learned about the effective components of methadone treatment. In comparison to other available treatment modalities for opioid addiction, methadone treatment is uniquely effective when administered by well-trained medical staffs. (shrink)

Empirical ethics research is increasingly valued in bioethics and healthcare more generally, but there remain as yet under-researched areas such as pharmacy, despite the increasingly visible attempts by the profession to embrace additional roles beyond the supply of medicines. A descriptive and critical review of the extant empirical pharmacy ethics literature is provided here. A chronological change from quantitative to qualitative approaches is highlighted in this review, as well as differing theoretical approaches such as cognitive moral development and the four (...) principles of biomedical ethics. Research with pharmacy student cohorts is common, as is representation from American pharmacists. Many examples of ethical problems are identified, as well as commercial and legal influences on ethical understanding and decision making. In this paper, it is argued that as pharmacy seeks to develop additional roles with concomitant ethical responsibilities, a new prescription is needed for empirical ethics research in pharmacy—one that embraces an agenda of systematic research using a plurality of methodological and theoretical approaches to better explore this under-researched discipline. (shrink)

Do UK community pharmacists encounter the high drama dilemmas of the medical ethics literature or is a 'morality of the mundane' more appropriate? This paper presents the findings of a qualitative study that asked a sample of UK pharmacists to describe their ethical issues and to establish whether these were ethical dilemmas as understood philosophically or ethical problems of a more legal or emotional nature. It emerged that although many pharmacists referred to 'dilemmas', these were often problems involving a conflict (...) between an ethical value and a legal or procedural issue and often arose in the routine minutiae of dispensing prescriptions and selling medicines. Such ethical problems remained of concern for pharmacists and the commercial environment, corporate pharmacy ownership and pharmacists' subordination to doctors, all precipitated ethical problems. Law and ethics appeared to be understood synonymously but this may reflect a modernity that increasingly brackets out ethical experiences by encouraging reliance upon law and procedure. (shrink)

Background: Increasing interest in empirical ethics has enhanced understanding of healthcare professionals’ ethical problems and attendant decision-making. A four-stage decision-making model involving ethical attention, reasoning, intention and action offers further insights into how more than reasoning alone may contribute to decision-making.Aims: To explore how the four-stage model can increase understanding of decision-making in healthcare and describe the decision-making of an under-researched professional group.Methods: 23 purposively sampled UK community pharmacists were asked, in semi-structured interviews, to describe ethical problems in their work (...) and how they were resolved. Framework analysis of transcribed interviews utilised the four decision-making stages, together with constant comparative methods and deviant-case analysis.Results: Pharmacists were often inattentive and constructed problems in legal terms. Ethical reasoning was limited, but examples of appeals to consequences, the golden rule, religious faith and common-sense experience emerged. Ethical intention was compromised by frequent concern about legal prosecution. Ethical inaction was common, typified by pharmacists’ failure to report healthcare professionals’ bad practices, and ethical passivity emerged to describe these negative examples of the four decision-making stages. Pharmacists occasionally described more ethically active decision-making, but this often involved ethical uncertainty.Discussion: The four decision-making stages are a useful tool in considering how healthcare professionals try to resolve ethical problems in practice. They reveal processes often ignored in normative theories, and their recognition and the emergence of ethical passivity indicates the complexity of decision-making in practice. Ethical passivity may be deleterious to patients’ welfare, and concerns emerge about improving pharmacists’ ethical training and promoting ethical awareness and responsibility. (shrink)

Despite the known positive effects of acute exercise on cognition, the effects of a competitive team sport match are unknown. In a randomized crossover design, 20 female and 17 male field hockey players completed a battery of cognitive tests prior to, at half-time, and immediately following a competitive match ; with effect sizes presented as raw ES from mixed effect models. Blood samples were collected prior to and following the match and control trial, and analyzed for adrenaline, noradrenaline, brain derived (...) neurotrophic factor, cathepsin B, and cortisol. The match improved response times for a simple perception task at full-time and response times on the complex executive function task improved at half-time. Working memory declined at full-time on the match. The change in working memory was negatively correlated with increases in cortisol, as was the change in simple perception response time and the change in noradrenaline concentration. This study is the first to highlight the effects a competitive hockey match can have on cognition. These findings have implications for performance optimization, as understanding the influence on specific cognitive domains across a match allows for the investigation into strategies to improve these aspects. (shrink)

Live donor kidney transplantation is the best treatment option for most patients with late-stage chronic kidney disease; however, the rate of living kidney donation has declined in the United States. A consensus conference was held June 5-6, 2014 to identify best practices and knowledge gaps pertaining to live donor kidney transplantation and living kidney donation. Transplant professionals, patients, and other key stakeholders discussed processes for educating transplant candidates and potential living donors about living kidney donation; efficiencies in the living donor (...) evaluation process; disparities in living donation; and financial and systemic barriers to living donation. We summarize the consensus recommendations for best practices in these educational and clinical domains, future research priorities, and possible public policy initiatives to remove barriers to living kidney donation. (shrink)

Human societies are extraordinarily cooperative compared to those of most other animals. In the vast majority of species, individuals live solitary lives, meeting to only to mate and, sometimes, raise their young. In social species, cooperation is limited to relatives and (maybe) small groups of reciprocators. After a brief period of maternal support, individuals acquire virtually all of the food that they eat. There is little division of labor, no trade, and no large scale conflict. Communication is limited to a (...) small repertoire of self-verifying signals. No one cares for the sick, or feeds the hungry or disabled. The strong take from the weak without fear of sanctions by third parties. Amend Hobbes to account for nepotism, and his picture of the state of nature is not so far off for most other animals. In contrast, people in even the simplest human societies regularly cooperate with many unrelated individuals. Human language allows low-cost honest communication of virtually unlimited complexity. The sick are cared for, and sharing leads to substantial flows of food from the middle aged to the young and old. Division of labor and trade are prominent features of every historically known human society, and archaeology indicates that they have a long history. Violent conflict among sizable groups is common. In every human society, social life is regulated by commonly held moral systems that specify the rights and duties of individuals enforced, albeit imperfectly, by third party sanctions. (shrink)

Peter Abelard (1079–1142 ce) was the most wide‐ranging philosopher of the twelfth century. He quickly established himself as a leading teacher of logic in and near Paris shortly after 1100. After his affair with Heloise, and his subsequent castration, Abelard became a monk, but he returned to teaching in the Paris schools until 1140, when his work was condemned by a Church Council at Sens. His logical writings were based around discussion of the “Old Logic”: Porphyry's Isagoge, aristotle'S Categories and (...) On Interpretation and boethius'S textbook on topical inference. They comprise a freestanding Dialectica (“Logic”; probably c.1116), a set of commentaries (known as the Logica [Ingredientibus], c. 1119) and a later (c. 1125) commentary on the Isagoge (Logica Nostrorum Petititoni Sociorum or Glossulae). In a work Abelard called his Theologia, issued in three main versions (between 1120 and c.1134), he attempted a logical analysis of trinitarian relations and explored the philosophical problems surrounding God's claims to omnipotence and omniscience. The Collationes (“Debates,” also known as “Dialogue between a Christian, a Philosopher and a Jew”; probably c.1130) present a rational investigation into the nature of the highest good, in which the Christian and the Philosopher (who seems to be modeled on a philosopher of pagan antiquity) are remarkably in agreement. The unfinished Scito teipsum (“Know thyself,” also known as the “Ethics”; c.1138) analyses moral action. (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)

The US neutrino community gathered at the Workshop on the Intermediate Neutrino Program at Brookhaven National Laboratory February 4-6, 2015 to explore opportunities in neutrino physics over the next five to ten years. Scientists from particle, astroparticle and nuclear physics participated in the workshop. The workshop examined promising opportunities for neutrino physics in the intermediate term, including possible new small to mid-scale experiments, US contributions to large experiments, upgrades to existing experiments, R&D plans and theory. The workshop was organized into (...) two sets of parallel working group sessions, divided by physics topics and technology. Physics working groups covered topics on Sterile Neutrinos, Neutrino Mixing, Neutrino Interactions, Neutrino Properties and Astrophysical Neutrinos. Technology sessions were organized into Theory, Short-Baseline Accelerator Neutrinos, Reactor Neutrinos, Detector R&D and Source, Cyclotron and Meson Decay at Rest sessions.This report summarizes discussion and conclusions from the workshop. (shrink)

Despite a large and multifaceted effort to understand the vast landscape of phenotypic data, their current form inhibits productive data analysis. The lack of a community-wide, consensus-based, human- and machine-interpretable language for describing phenotypes and their genomic and environmental contexts is perhaps the most pressing scientific bottleneck to integration across many key fields in biology, including genomics, systems biology, development, medicine, evolution, ecology, and systematics. Here we survey the current phenomics landscape, including data resources and handling, and the progress that (...) has been made to accurately capture relevant data descriptions for phenotypes. We present an example of the kind of integration across domains that computable phenotypes would enable, and we call upon the broader biology community, publishers, and relevant funding agencies to support efforts to surmount today's data barriers and facilitate analytical reproducibility. (shrink)

Pickering & Garrod (P&G) argue that contemporary models of language use are inadequate. This has resulted largely because of an experimental focus on monologue rather than dialogue. I agree with the need for increased experimentation that focuses on the interplay between production and comprehension. However, I have some concerns about the Interactive Alignment model that the authors propose.

© 2015, Springer-Verlag Berlin Heidelberg.Genetic studies have identified single nucleotide polymorphisms associated with the risk of prostate cancer. It remains unclear whether such genetic variants are associated with disease aggressiveness. The NCI-SPORE Genetics Working Group retrospectively collected clinicopathologic information and genotype data for 36 SNPs which at the time had been validated to be associated with PC risk from 25,674 cases with PC. Cases were grouped according to race, Gleason score and aggressiveness. Statistical analyses were used to compare the frequency (...) of the SNPs between different disease cohorts. After adjusting for multiple testing, only PC-risk SNP rs2735839 was significantly and inversely associated with aggressive and high-grade disease in European men. Similar associations with aggressive and high-grade disease were documented in African-American subjects. The G allele of rs2735839 was associated with disease aggressiveness even at low PSA levels in both European and African-American men. Our results provide further support that a PC-risk SNP rs2735839 near the KLK3 gene on chromosome 19q13 may be associated with aggressive and high-grade PC. Future prospectively designed, case-case GWAS are needed to identify additional SNPs associated with PC aggressiveness. (shrink)

Contractualism conceives of firm-stakeholder relations as cooperative schemes for mutual benefit. In essence, contractualism holds that these schemes, as well as the normative principles that guide and constrain them, are ultimately ratified by the consent and endorsement of those subject to them. This paper explores the empirical validity of a contractualist perspective on firm-stakeholder relations. It first develops a typology of firm-stakeholder contracting problems. It subsequently confronts this typology with empirical data collected in an interview study of concrete stakeholder management (...) practices, involving in-depth research interviews with forty-four managers working in the Dutch financial services industry. The findings of this theory-building study suggest that there are limits to the applicability of the contract model in the context of stakeholder management, and that disregarding either the model or its limitations may lead to highly ineffective firm-stakeholder relations. (shrink)

Spatial evolutionary game theory explains how cooperative traits can survive the intense competition in biological systems. If the spatial distribution allows cooperators to interact with each other frequently, the benefits of cooperation will outweigh the losses due to exploitation by selfish organisms. However, for a cooperative behavior to get established in a system, it needs to be found initially in a sufficiently large cluster to allow a high frequency of intracooperator interactions. Since mutations are rare events, this poses the question (...) of how cooperation can arise in a biological system in the first place. We present a simple model which captures two concepts from genetics that can explain how evolution overcomes the emergence problem. The first concept is, often in nature, a gene may not express its phenotype except under specific environmental conditions, rendering it to be a “silent” gene. The second key idea is that a neutral gene, one that does not harm or improve an organism’s survival chances, can still spread through a population if it is physically near to another gene that is positively selected. Through these two ideas, our model offers a possible solution to the fundamental problem of emergence of cooperation in biological systems. (shrink)

When individuals learn from what others tell them, the information is subject to transmission error that does not arise in learning from direct experience. Yet evidence shows that humans consistently prefer this apparently more unreliable source of information. We examine the effect this preference has in cases where the information concerns a judgment on others’ behaviour and is used to establish cooperation in a society. We present a spatial model confirming that cooperation can be sustained by gossip containing a high (...) degree of uncertainty. Accuracy alone does not predict the value of information in evolutionary terms; relevance, the impact of information on behavioural outcomes, must also be considered. We then show that once relevance is incorporated as a criterion, second-hand information can no longer be discounted on the basis of its poor fidelity alone. Finally we show that the relative importance of accuracy and relevance depends on factors of life history and demography. (shrink)

Governments must keep agricultural systems free of pests that threaten agricultural production and international trade. Biosecurity surveillance already makes use of a wide range of technologies, such as insect traps and lures, geographic information systems, and diagnostic biochemical tests. The rise of cheap and usable surveillance technologies such as remotely piloted aircraft systems presents value conflicts not addressed in international biosurveillance guidelines. The costs of keeping agriculture pest-free include privacy violations and reduced autonomy for farmers. We argue that physical and (...) digital privacy in the age of ubiquitous aerial and ground surveillance is a natural right to allow people to function freely on their land. Surveillance methods must be co-created and justified through using ethically defensible processes such as discourse theory, value-centred design and responsible innovation to forge a cooperative social contract between diverse stakeholders. We propose an ethical framework for biosurveillance activities that balances the collective benefits for food security with individual privacy: establish the boundaries of a biosurveillance social contract; justify surveillance operations for the farmers, researchers, industry, the public and regulators; give decision makers a reasonable measure of control over their personal and agricultural data; and choose surveillance methodologies that give the appropriate information. The benefits of incorporating an ethical framework for responsible biosurveillance innovation include increased participation and accumulated trust over time. Long term trust and cooperation will support food security, producing higher quality data overall and mitigating against anticipated information gaps that may emerge due to disrespecting landholder rights. (shrink)

We present a theoretical and an empirical challenge to Cushman's claim that rationalization is adaptive because it allows humans to extract more accurate beliefs from our non-rational motivations for behavior. Rationalization sometimes generates more adaptive decisions by making our beliefs about the world less accurate. We suggest that the most important adaptive advantage of rationalization is instead that it increases our predictability as potential partners in cooperative social interactions.

The relevance of nonlinear dynamics to calcium metabolism led us to reevaluate the role of Ca-regulating hormones in Ca homeostasis. We suggest that, firstly, the main Ca metabolic functions in rat-bone and gut - are organized as dynamic entities able to generate various temporal expressions, including self-oscillating patterns and, secondly, Ca homeostasis results from interaction between both metabolic and hormonal oscillators. Following this schema, a major role for the hormonal system, with its circadian pattern, could be to act directly on (...) metabolic functions or indirectly through feeding behaviour, in order to optimize, coordinate and synchronize the Ca fluxes at ECF level. (shrink)

Background If trials of therapeutic interventions are to serve society's interests, they must be of high methodological quality and must satisfy moral commitments to human subjects. The authors set out to develop a clinical - trials compendium in which standards for the ethical treatment of human subjects are integrated with standards for research methods. Methods The authors rank-ordered the world's nations and chose the 31 with >700 active trials as of 24 July 2008. Governmental and other authoritative entities of the (...) 31 countries were searched, and 1004 English-language documents containing ethical and/or methodological standards for clinical trials were identified. The authors extracted standards from 144 of those: 50 designated as ‘core’, 39 addressing trials of invasive procedures and a 5% sample of the remainder. As the integrating framework for the standards we developed a coherent taxonomy encompassing all elements of a trial's stages. Findings Review of the 144 documents yielded nearly 15 000 discrete standards. After duplicates were removed, 5903 substantive standards remained, distributed in the taxonomy as follows: initiation, 1401 standards, 8 divisions; design, 1869 standards, 16 divisions; conduct, 1473 standards, 8 divisions; analysing and reporting results, 997 standards, four divisions; and post-trial standards, 168 standards, 5 divisions. Conclusions The overwhelming number of source documents and standards uncovered in this study was not anticipated beforehand and confirms the extraordinary complexity of the clinical trials enterprise. This taxonomy of multinational ethical and methodological standards may help trialists and overseers improve the quality of clinical trials, particularly given the globalisation of clinical research. (shrink)

Interactions with global markets offer development opportunities for Indigenous communities. They also place pressure on the natural resources that communities depend upon for their livelihood and, in many cases, their political and cultural autonomy. These markets often interact with family-based enterprises embedded within commons, with important implications for the social relationships and shared territorial resources that characterise such regimes. In this paper, we analyse the relationships that exist between commons, global markets, and small-scale family enterprises, using the case of mezcal (...) production—an alcoholic beverage made from agave—in an Indigenous community in Oaxaca, Mexico. Most mezcal production is organized at the family level; yet the raw materials and inputs necessary for making mezcal are held communally and regulated by locally-crafted institutions. Empirical data show that as family enterprises engage with an emergent global market for mezcal, the commons become essential for not only protecting territorial resources but also maintaining a degree of autonomy from powerful global markets and value chains. However, this requires substantial investment in monitoring and enforcement, and for community members to value sustainable commons management over short-term economic self-interest. To seek autonomy while participating in global markets, producer families also join together to develop cooperative strategies to access markets on better terms. (shrink)

Open peer commentary on the article “Exploration of the Functional Properties of Interaction: Computer Models and Pointers for Theory” by Etienne B. Roesch, Matthew Spencer, Slawomir J. Nasuto, Thomas Tanay & J. Mark Bishop. Upshot: Artificial life computer simulations hold the potential for demonstrating the kinds of bottom-up, cooperative, self-organizing processes that underlie the self-construction of observer-actors. This is a worthwhile, if limited, attempt to use such simulations to address this set of core constructivist concerns. Although we concur with much (...) of the philosophical perspective in the target article, we take issue with some of the implied positions related to dynamical systems, sensorimotor contingency theory, and neural information processing. Ideally, we would like to see computational approaches more directly address adaptive, constructive processes and mechanisms operant in minds and brains. This would entail using tasks that are more relevant to the psychology of human and animal learning than performing digit sums or sorts. It also could involve relating the dynamics of agents more explicitly to ensembles of communicating neural assemblies. (shrink)

For families all over the world, going through a pandemic has presented a number of challenges. In particular, social distancing measures involving the closure of schools and day care centers, as well as increasing work hours at home, made parents face very demanding situations. However, we know little about whether parents’ burnout levels are influenced by the age of their children. This study sought to determine whether levels of parental burnout are higher in families with at least one child under (...) the age of four than in families with older children. The second goal was to explore whether having children under 4 years of age moderates the relationship between parental cooperation and PB. A cross-sectional study was conducted with a sample of 651 participants since May 18th until August 27th, 2020. The main results showed that child age is a predictor of PB. Besides, having a child aged 0–4 years old moderates the relationship between parental cooperation and PB. Finally, it was found that in cases where there was at least one child under 4 years of age in the family, with one of the partners who worked remotely, the respondent’s PB rose by 7.9 points. The implications of these results with respect to the consideration of children’s ages in the different parental scenarios were discussed. (shrink)

In this article the perspective shifts to the “upstream” end of the agricultural knowledge and information system (AKIS). Because knowledge policy and strategic decision-making are not the prerogative of the public sector, organizations such as cooperative unions and multinational companies are included. After considering the influence of the changing environment on the nature of the AKIS, the role of knowledge management and policy in the emerging knowledge and information market is examined. Special attention is given to public and private R&D. (...) The article then looks where information technology (IT) fits in and what considerations determine strategic investment in IT projects and sustained services. Some of the European experiences with this strategic investment are evaluated. (shrink)