Patient portals are poised to transform health communication by empowering patients with rapid access to their own health data. The 21st Century Cures Act is a US federal law that, among other provisions, prevents health entities from engaging in practices that disrupt the exchange of electronic health information—a measure that may increase the usage of patient health portals. Caregiver access to patient portals, however, may lead to breaches in patient privacy and confidentiality if not managed properly through proxy accounts. We (...) present an ethical framework that guides policy and clinical workflow development for healthcare institutions to support the best use of patient portals. Caregivers are vital members of the care team and should be supported through novel forms of health information technology (IT). Patients, however, may not want all information to be shared with their proxies so healthcare institutions must support the development and use of separate proxy accounts as opposed to using the patient’s own account as well provide controls for limiting the scope of information displayed in the proxy accounts. Lastly, as socioeconomic barriers to adoption of health IT persist, healthcare providers must work to ensure multiple streams of patient communication, to prevent further propagating health inequities. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Knowing the EastPatti M. MarxsenKnowing the East. By Paul Claudel. Translated by James Lawler. Princeton, NJ: Princeton University Press, 2004. 136 pp.Fifty years after his death, Paul Claudel (1868–1955) is remembered for many things. Not only was he a major twentieth-century poet and playwright, he was an astute observer of Dutch, Spanish, and Japanese art. Not only was he the brother of sculptor Camille Claudel, he was a (...) diplomat who lived for nearly twenty years in Asia, including a stint as the French ambassador to Japan (1921–1927). When he was elected as a member of the Académie Française in 1946 at nearly 80 years of age he quipped, "For an academic, that is puberty." He died at 87, having lived large in two centuries and on three continents.Following an adolescence marked with indifference toward religion, Claudel experienced a profound conversion to Catholicism during a Christmas night service at Notre Dame Cathedral in Paris at the age of 18. With Christianity at the center of his universe and under the influence of Symbolist poets Rimbaud and Mallarmé, he developed a response to the world that was at once poetic and spiritual. Through his poetry, plays, and essays, he insisted on a fundamental unity between matter and spirit, a harmonious and vast universe into which the human mind could enter. And, at least for him, the point of entry was the portal of the Church. He struggled at times, but never lost sight of his faith. For all this, he is often credited with the revival of French Catholicism in the wake of WWI. After all, if Paul Claudel could take religion seriously and find meaning in it, pourquoi pas the rest of us?The facts of his extraordinary biography form a peculiar background to the recent translation by James Lawler of Claudel's collection of prose poems titled Knowing [End Page 229] the East. First published in 1946 as Connaissance de l'est, these sixty-one texts were written between 1895 and 1905 during Claudel's first visits to China and Japan as a young vice-consul stationed in Shanghai. He was twenty-six and still finding his poetic voice. And though his stance in the world is decidedly Christian, the content of this intriguing work reveals an inner dialogue with Buddhist ideas of interconnection, harmony, the ongoing quest for a higher life condition, and the overwhelming impact of nature in the lives of mere humans.In "Pagoda," Claudel describes a seven-story Chinese pagoda as it "amplifies and multiplies the roof, exaggerates the horned corners that rise with an elegant surge, and turns their curves upward to the sky." This form that "does away with walls" and concentrates on the uplifting roof creates a space where "Buddha, Prince of Peace, dwells inside with all the gods." In this architecture he reads a structuring of physical and spiritual space, a kind of never ending upward movement divided into "the seven mystical heavens." The culminating effect is the heavenly achievement of the unknowable. And so, after going as far as he can go into the world of the spirit, he ends this prose poem with an abrupt return to temporal reality. "I have no more to say of the Pagoda. I do not know its name."Elsewhere, in "The Wanderer," he turns his sense of awe toward nature. "Every tree has its personality, every small beast its role, every voice its part in the symphony," he writes. "As one understands music, so I understand nature, like a detailed narrative of proper names; as my walk and the day advance, so does the elaboration of the doctrine." The "doctrine," it seems, is the idea of dependent origination, the interrelation of all life that springs from a single source. In the last line, he states, "I understand the world's harmony. When will I grasp its melody?"In "The Temple of Consciousness" Claudel climbs "the black rock's vertical wall, and only at this late afternoon hour do I know myself to be on the right track." Below, he observes golden rice fields. Ahead there is an "old stairway overlaid with hoary moss... (shrink)

Increasing numbers of health organisations are offering some or all of their patients access to the visit notes housed in their electronic health records. In some countries, including Sweden and the USA, this innovation is advanced with patients using online portals to access their clinical records including the visit summaries written by clinicians. In many countries, patients can legally request copies of their records; however, open notes are different because this innovation offers patients rapid, real-time access via electronic devices. In (...) this brief report, we explore what open notes might mean for placebo use in clinical care. Survey research into patient access to their clinical notes shows that increased transparency enhances patients’ understanding about their medications and augments engagement with their care. We reflect on the consequences of access for placebo prescribing, particularly for the common practice of deceptive placebo use, in which patients are not aware they are being offered a placebo. In addition, we explore how open notes might facilitate placebo and nocebo effects among patients. Bridging placebo studies with medical ethics, we identify a range of empirical research gaps that now warrant further study. (shrink)

The article "The relevance of anger, anxiety, gender and race in investment decisions", written by Daniel M. V. Bernaola · Gizelle D. Willows and Darron West, was originally published online on the publisher’s internet portal on 21 October 2020.

Funding organizations around the world are adopting open science policies, resulting in a pressing need for open science programs. In response to the 2011 decadal survey, NASA sought to expand and accelerate omics research, releasing its GeneLab Strategic Plan in 2014. GeneLab is an open science data repository and analysis portal for spaceflight and space-relevant omics data. GeneLab’s output has been outstanding, but its full potential as a way to transform space biology has not yet been achieved. NASA should pursue (...) the development of GeneLab as an open science platorm in earnest. (shrink)

Digital health includes applications for smartphones and smart speakers as well as more traditional ways to access health information electronically, such as through your health care provider's online web‐based patient portal. As the number of digital health offerings—such as smartphone health trackers and web‐based patient portals—grows, what benefit do ethics, or bioethics, perspectives bring to digital health product development? For starters, the field of bioethics is concerned about issues of social justice, including equitable benefit and minimization and fair distribution of (...) the burden of harms. Researchers who employ user‐centered design methods should consider what digital health applications and products would look like if issues like equity and accessibility were foregrounded throughout design and development. One group whose needs are often neglected in the design of digital health products is older adults. Many people anticipate that the digital divide among older adults will close as the current generation of tech‐savvy consumers ages up. But since technology is constantly evolving, this divide may be constantly recreated. As bioethics moves ever further into the technology era, I want it to be mindful of the creation of digital health care disparities. (shrink)

It weighs in at a bit more than five pounds; its dimensions demand a cradle. Yet this book is a handsome and welcome achievement despite its bulk. Its reproduction of the 1922 text, its maps and photos of 1904 Dublin; its list of minor characters in Ulysses; its bibliography of scholarship, both old and new; its timeline of Joyce's life, and its exemplary detailed annotations of the text: everything, harvested from the best sources, has been brought together to create the (...) largest volume dedicated to Joyce scholarship ever produced—a book that celebrates the first printing of Joyce's masterpiece. Given its weight and size, its classroom utility is likely limited; given its monumentality, it is a proper hundred-year tribute.What is wholly original about the book's contents are the essays that preface each of the eighteen episodes of the masterpiece. That Joycean scholarship grows upon itself is amply demonstrated by the sophistication and weight of learning the eighteen writers can now display. Almost fifty years have passed since Clive Hart and David Hayman edited a volume with a similar aim. Each of the new essays reveals just how much more there is now to know and say about Ulysses, how much more there is to praise in how Joyce conceived the book, how much more there is to teach, and how unlikely it is that Joycean scholarship will ever be diminished in either its curiosity or its energy. Given the increasing complexity and density of such accumulated knowledge, it is a pleasure to witness the economy and precision shown by so many of the writers. In particular, Robert Spoo's writing about “Nestor,” Maud Ellmann's writing about “Lotus Eaters,” and Vicki Mahaffey's writing about “Nausicaa” demonstrate how concision can make for valuable illumination.But there is a problem with where these essays are positioned. Coming before each of the episodes they introduce, they might condition the mind of a reader new to Ulysses to look upon those episodes as no more than demonstrations of what the scholars think. Catherine Flynn, the book's editor, emphasizes the need of such professional interpretation when she describes the plight of anyone “struggling through Ulysses” and “the key challenges facing the reader.” She is right about how hard it is for any new reader to “get” the book, but the placement of the essays is at odds with her claim that “grappling with the novel's challenges, the reader is pushed toward one of the most important rewards of reading Ulysses: thinking independently.” The prefaces may well impede the reader from thinking independently.Professor Flynn's focus on challenge and difficulty is widely shared throughout the Joycean community and has become a fundamental preoccupation in Joyce scholarship. Taking Joyce's mastery as a given, many Joyceans assume a Talmudic stance in believing, to quote Spinoza, that “the intellectual love of a thing consists in understanding its perfections.” Facing the formidable Joyce, they turn and turn again to explication. They subscribe to the dictum that the youthful Joyce himself, perhaps self-mockingly, set down: “A man of genius makes no mistake. His errors are volitional and are the portals of discovery.” But is Ulysses free of error?Fritz Senn, writing about “Ithaca,” does not put himself in opposition to Joyce but in opposition to the presumed inerrancy of Joyce. He argues that the episode displays a troubling disjunction between what Joyce intended to do in the episode and what he did. Joyce told his friend Frank Budgen that in the episode “not only will the reader know everything and know it in the baldest and coldest way, but Bloom and Stephen thereby become heavenly bodies, wanderers like the stars at which they gaze.” But readers do not, indeed, get to know all they should, or see all they should see. Senn notes that they “learn next to nothing about Bloom's mother, his birthday, or the exact nature of his father's suicide, although they do learn a lot about such things as the junk in a drawer, the Dublin water supply system, and the addresses of Dublin shops.” Senn asks: “What does the meeting of the two characters amount to? Will it change Stephen so that he might become the author of the book he is in? Does Bloom find a son? Does he become the father that Stephen is supposed to be looking for? The impassive episode does not seem to answer, or to care.” But these are questions about which many a reader might care.Joyce named “Ithaca” as his favorite among the episodes. Senn demonstrates by his care and attentiveness that he too admires it. But by not limiting himself to dutiful reverence, he instead critically examines the Joycean text. His tribute to Joyce is both unsparing and generous.Equally attentive and yet incisive is Katherine O'Callaghan in her examination of “Sirens.” She recognizes the experimental daring of Joyce's strategy of “conveying music through language” in that episode. But her analysis, as penetrating as it is learned, does not leave the reader persuaded that the episode is entirely successful. As she observes, “the reluctance of the musical art to bend to the critical written voice” is a “stumbling block.”Another problematic experiment, “Oxen of the Sun,” which Joyce himself described as “the most difficult episode... both to interpret and to execute,” presents its commentator, Sarah Davison, with the task of explaining how its grandiose mixture of parody, plagiarism, and sheer celebration of myriad English prose styles over the centuries can function without, as she says, “wrongfooting and dissatisfying readers” who assume that the episode “enacts a historical progression only to find themselves disorientated by so many different echoes and cadences.”Were Joycean scholars more devoted to critical judgment than to explication—even when they are faced with the spectacular imposition of genius—the common reader would more likely find fellowship, and less intimidation, when reading a book that is not a sacred text but a human document, written with the extraordinary self-imposed challenges, as well as the problematic results, that only a most extraordinary human could make. (shrink)

The article Deflating the "DBS causes personality changes" bubble, written by Frederic Gilbert, J. N. M. Viaña and C. Ineichen, was originally published electronically on the publisher’s internet portal on 19 June 2018 without open access.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Shinto: The Way Home: Dimensions of Asian SpiritualityJason M. WirthShinto: The Way Home: Dimensions of Asian Spirituality. By Thomas P. Kasulis. Honolulu: University of Hawai'i Press, 2004. Pp. xx + 184.Thomas P. Kasulis wrote his fine new book Shinto: The Way Home: Dimensions of Asian Spirituality as the result of a promise made over a glass of scotch to Henry Rosemont, who is currently editing a series of (...) volumes highlighting various Asian spiritual traditions. These volumes promise to be strong, advanced introductions, and it is already clear that they should be seriously considered as introductory texts for courses in the Asian spiritual traditions. However, feeling "queasy" about his promise, Kasulis confessed that he was "primarily trained as a scholar of Japanese philosophy and there is simply not that much Shinto philosophy to write about" (p. xvi). Yet it appears that the scotch did not inspire frivolous behavior. The book is written by someone who has much love-perhaps even a pure heart and mind (makoto no kokoro)-for the Japanese spiritual heritage, and hence it makes an outstanding introduction to the basics of the Shinto tradition and its many practices. "Reading this book should help readers begin, not end, their study of Shinto" (p. xvii).Kasulis argues that Shinto is for the most part not a religion in the conventional Western sense. In fact, the Japanese word for "religion," shūkyō, is a neologism to designate the teachings (kyō) that comprise a shū, that is, a "discrete religious community with common practices and teachings" (p. 30). Yet Shinto operates in the background for most Japanese people, and so does not necessarily originate or result [End Page 358] in a clearly articulated doctrinal position. It comprises part of the cultural ambiance of Japanese life. It shapes the Japanese wedding ceremony and governs the Japanese relationship to rice (including sake).More significantly, it helps ritualistically inculcate the rudiments of what might be called something like a deep ecology. Certain remarkable locations in nature, certain foci that are spectacularly aberrant or startlingly exceptional, are marked off by a sacred portal (torii) or rope (shimenawa). They are designated as places of awe and wonder, as places inhabited by the kami (gods). In this way, a Shinto ecological aesthetic contrasts directly with a classical Western sense of beauty. The latter is achieved when an object is in maximum proximity to its idea-when it deviates as little as possible from its inherent nature. In Shinto the kami are present in an awesome deviation from the norm (as in a gnarled pine or a wondrously twisted rock).Yet Shinto does not necessarily ghettoize the sacred space, truncating it from its circulation with all of nature. Rather, sacred spots (like sacred practices) are isolated in order to serve as an opening into nature as sacred. They are sacred portals to the sacredness of the whole-"they are holographic entry points for experiencing kami everywhere" (p. 23). Kasulis traces these themes from Japanese prehistory, including their eventual appropriation in the early-eighth-century chronicles the Kojiki and the Nihonshoki, both of which were commissioned by imperial decree. Furthermore, there was much in Shinto that was compatible with the emergence of Buddhism in Japan. The latter helped Shinto remain dynamic and nondogmatic (p. 93), and Shinto helped make some of the more difficult aspects of esoteric Buddhism (Shingon and Tendai) more accessible to commoners (p. 99).However, in the isolationism of the Tokugawa period, Shinto was slowly wrested from its ensconcement in Japanese Buddhism. The influences of Neo-Confucianism and the Japanese code of the warrior (bushidō), the demilitarization of Buddhist monasteries, the relegation of monasteries to census taking, and other measures helped the Tokugawa clan consolidate their own power and enervate Buddhism's hold on Japan. Shinto itself would have to be freed from its Buddhist housing. The most fateful instance of this purification process transpired inadvertently with Motoori Norinaga (1730-1801) and the dawning of the kokugaku or "native studies" movement. Norinaga spent more than three decades deciphering and annotating the linguistic labyrinth of the Kojiki. Yet this was not a mere scholastic exercise. Norinaga assigned the Kojiki the status of scripture... (shrink)

In many countries, including patients are legally entitled to request copies of their clinical notes. However, this process remains time-consuming and burdensome, and it remains unclear how much of the medical record must be made available. Online access to notes offers a way to overcome these challenges and in around 10 countries worldwide, via secure web-based portals, many patients are now able to read at least some of the narrative reports written by clinicians (‘open notes’). However, even in countries that (...) have implemented the practice many clinicians have resisted the idea remaining doubtful of the value of opening notes, and anticipating patients will be confused or anxious by what they read. Against this scepticism, a growing body of qualitative and quantitative research reveals that patients derive multiple benefits from reading their notes. We address the contrasting perceptions of this practice innovation, and claim that the divergent views of patients and clinicians can be explained as a case of epistemic injustice. Using a range of evidence, we argue that patients are vulnerable to (oftentimes, non-intentional) epistemic injustice. Nonetheless, we conclude that the marginalisation of patients’ access to their health information exemplifies a form of epistemic exclusion, one with practical and ethical consequences including for patient safety. (shrink)

A landslide inventory is a detailed register of the spatial distribution, geometry, and attributes of landslides and is essential for landslide hazard analysis, risk management, regional planning, and land use management and development, especially in landslide-prone regions. However, the development of a national landslide inventory is time-consuming and costly. Accordingly, most developing countries, including Sri Lanka, have basic landslide databases, which identify the location, date, and time of occurrence on a point map. This study, therefore, aimed to introduce a new (...) method to report landslide information via a mobile application based on a participatory approach with information recorded in a web portal called the participatory landslide inventory. Twenty-one landslide site locations and their attributes were captured on the PLI web portal using the PLI mobile app. The system administrator then demarcated the landslide boundaries and performed geometrical calculations for each landslide to complete the inventory. Finally, the landslide information was published through the PLI web portal. The PLI is an effective and efficient tool for developing a landslide inventory economically. (shrink)

During the set-up phase of an international study of genetic influences on outcomes from sepsis, we aimed to characterise potential differences in ethics approval processes and outcomes in participating European countries. Between 2005 and 2007 of the FP6-funded international Genetics Of Sepsis and Septic Shock project, we asked national coordinators to complete a structured survey of research ethic committee approval structures and processes in their countries, and linked these data to outcomes. Survey findings were reconfirmed or modified in 2017. Eighteen (...) countries participated in the study, recruiting 2257 patients from 160 ICUs. National practices differed widely in terms of composition of RECs, procedures and duration of the ethics approval process. Eight countries used a single centralised process for approval, seven required approval by an ethics committee in each participating hospital, and three required both. Outcomes of the application process differed widely between countries because of differences in national legislation, and differed within countries because of interpretation of the ethics of conducting research in patients lacking capacity. The RECs in four countries had no lay representation. The median time from submission to final decision was 1.5 months; in nine approval was received within 1 month; six took over 6 months, and in one 24 months; had all countries been able to match the most efficient approvals processes, an additional 74 months of country or institution-level recruitment would have been available. In three countries, rejection of the application by some local RECs resulted in loss of centres; and one country rejected the application outright. The potential benefits of the single application portal offered by the European Clinical Trials Regulation will not be realised without harmonisation of research ethics committee practices as well as national legislation. (shrink)

Rita Bottino,1 Santosh Nagaraju,2 Vikas Satyananda,2 Hidetaka Hara,2 Martin Wijkstrom,2 Massimo Trucco,1 David KC Cooper2 1Institute of Cellular Therapeutics, Allegheny Health Network, 2Thomas E Starzl Transplantation Institute, Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA: Diabetes mellitus is increasing worldwide. Type 1 diabetes can be treated successfully by islet allotransplantation, the results of which are steadily improving. However, the number of islets that can be obtained from deceased human donors will never be sufficient to cure more than a very (...) small percentage of patients who might benefit from transplantation. Although there are some differences in glucose metabolism between pigs and humans, the use of pigs could provide an unlimited supply of islets, and the insulin produced would undoubtedly control glucose levels. Transplantation of islets into the portal vein results in islets residing in the liver; however, an early inflammatory response and rejection remain problematic, even when the recipient is receiving immunosuppressive therapy. In the long term, immunosuppressive drugs may exhibit toxicities to patients and specifically harm the islet cells. In contrast, encapsulation techniques provide islets with a physical barrier that prevents antibodies binding to the islet graft while still allowing insulin to be released into the recipient's circulation; in theory, patients receiving encapsulated grafts might not require exogenous immunosuppressive therapy. Nonhuman primates with encapsulated pig islet transplants have remained insulin-independent for several weeks, but long-term efficacy remains uncertain. Furthermore, techniques are now available to knock out genes from the pig and/or insert human genes, thus rendering the antigenic structure of pigs closer to that of humans, and providing protection from the human immune response. Islet transplantation from genetically engineered pigs has been followed by insulin independence in a small number of nonhuman primates for greater than 1 year. Neonatal islets have some advantages over adult islets in that they are easier to isolate and culture, and have the ability to proliferate during the first few months after transplantation. In 2009, the International Xenotransplantation Association set up a group to encourage and advise on clinical trials of pig islet xenotransplantation; this group's guidelines are discussed. Clinical trials of encapsulated pig islets are already under way. Keywords: diabetes, islets, pancreatic, pig, xenotransplantation. (shrink)

Straipsnyje aptariami Vilniaus miesto policijos 2010 ir 2011 m. registruotų įvykių geografinių tyrimų, atliktų Vilniaus universitete 2011–2012 m., rezultatai. Apie šimtą tūkstančių įvykių per metus buvo lokalizuoti pagal nurodytus jų adresus ir klasifikuoti pagal veikos pobūdį. ArcGIS 10 programinės įrangos įrankiais atlikta bendra ir skirtingų tipų įvykių pasiskirstymo laike analizė rodo, kad daugiausia įvykių mieste įvyksta pirmojoje tamsaus paros meto pusėje. Tik vagystės ir plėšimai daugiausia vyksta dieną. Sudaryti apibendrinti labai tikslūs įvykių tankio žemėlapiai atskleidžia įvykių koncentraciją miesto centre ir (...) daugiabučių namų rajonuose, dažnai aplink prekybos ir pramogų centrus. 2010 ir 2011 m. įvykių tankio branduoliai lokalizuoti vienodai, nors 2011 m. įvykių tankis branduoliuose pastebimai didesnis. Vagysčių ir plėšimų procentinė dalis pasiskirsčiusi kitaip nei bendras įvykių tankis: ji didžiausia Šnipiškių, Verkių ir Žvėryno seniūnijose. Smurtiniai nusikaltimai didžiausią dalį sudaro Panerių ir Rasų seniūnijose. Įvykių žemėlapiai geriau atskleidžia bendras ir atskirų tipų nusikalstamumo tendencijas, padeda stebėti jų pokyčius ir planuoti prevencijos priemones. Jie viešai skelbiami Lietuvos erdvinės informacijos portale www.geoportal.lt. (shrink)

According to the standard analysis of degree questions, the logical form of a degree question contains a variable that ranges over individual degrees and is bound by the degree question operator how. In contrast with this, we claim that the variable bound by the degree question operator how does not range over individual degrees but over intervals of degrees, by analogy with Schwarzschild and Wilkinson's proposal regarding the semantics of comparative clauses. Not only does the interval-based semantics predict the existence (...) of certain readings that are not predicted under the standard view, it is also able, together with other natural assumptions, to account for the sensitivity of degree questions to negative islands, as well as for the fact, uncovered by Fox and Hackl, that negative islands can be obviated by some properly placed modals. Like Fox and Hackl, we characterize negative island effects as arising from the fact that the relevant question, due to its meaning alone, can never have a maximally informative answer. Contrary to Fox and Hackl, however, we do not need to assume that scales are universally dense, nor that the notion of maximal informativity responsible for negative islands is blind to contextual parameters. (shrink)

This paper examines the deontic logic of the Talmud. We shall find, by looking at examples, that at first approximation we need deontic logic with several connectives: O T A Talmudic obligation F T A Talmudic prohibition F D A Standard deontic prohibition O D A Standard deontic obligation. In classical logic one would have expected that deontic obligation O D is definable by $O_DA \equiv F_D\neg A$ and that O T and F T are connected by $O_TA \equiv F_T\neg (...) A$ This is not the case in the Talmud for the T (Talmudic) operators, though it does hold for the D operators. We must change our underlying logic. We have to regard {O T , F T } and {O D , F D } as two sets of operators, where O T and F T are independent of one another and where we have some connections between the two sets. We shall list the types of obligation patterns appearing in the Talmud and develop an intuitionistic deontic logic to accommodate them. We shall compare Talmudic deontic logic with modern deontic logic. (shrink)

We motivate and introduce a new method of abduction, Matrix Abduction, and apply it to modelling the use of non-deductive inferences in the Talmud such as Analogy and the rule of Argumentum A Fortiori. Given a matrix $${\mathbb {A}}$$ with entries in {0, 1}, we allow for one or more blank squares in the matrix, say a i,j =?. The method allows us to decide whether to declare a i,j = 0 or a i,j = 1 or a i,j =? (...) undecided. This algorithmic method is then applied to modelling several legal and practical reasoning situations including the Talmudic rule of Kal-Vachomer. We add an Appendix showing that this new rule of Matrix Abduction, arising from the Talmud, can also be applied to the analysis of paradoxes in voting and judgement aggregation. In fact we have here a general method for executing non-deductive inferences. (shrink)

Attention and consciousness are two distinct neural processes which are intricately intertwined. However, there is asymmetry in the distribution of attentional abilities across the two hemispheres. The right hemisphere is asserted to be dominant for attentional abilities. Research suggests that the ventral frontoparietal cortex of the right hemisphere is dominant for exogenous attentional abilities, attention is phylogenetically more primitive than endogenous attention, and, compared to the left hemisphere, the right hemisphere is more adept at abilities and functions that are of (...) more primitive origin. This review explores the attentional abilities of the mute right hemisphere, the extent to which these may affect consciousness, and whether the unilateral dominance of the exogenous network influences consciousness. (shrink)

Although activated spinal cord glia contribute importantly to neuropathic pain, how nerve injury activates glia remains controversial. It has recently been proposed, on the basis of genetic approaches, that toll-like receptor 4 may be a key receptor for initiating microglial activation following L5 spinal nerve injury. The present studies extend this idea pharmacologically by showing that TLR4 is key for maintaining neuropathic pain following sciatic nerve chronic constriction injury. Established neuropathic pain was reversed by intrathecally delivered TLR4 receptor antagonists derived (...) from lipopolysaccharide. Additionally, -naltrexone, -naloxone, and -naloxone, which we show here to be TLR4 antagonists in vitro on both stably transfected HEK293-TLR4 and microglial cell lines, suppressed neuropathic pain with complete reversal upon chronic infusion. Immunohistochemical analyses of spinal cords following chronic infusion revealed suppression of CCI-induced microglial activation by -naloxone and -naloxone, paralleling reversal of neuropathic pain. Together, these CCI data support the conclusion that neuron-to-glia signaling through TLR4 is important not only for initiating neuropathic pain, as suggested previously, but also for maintaining established neuropathic pain. Furthermore, these studies suggest that the novel TLR4 antagonists -naloxone and -naloxone can each fully reverse established neuropathic pain upon multi-day administration. This finding with -naloxone is of potential clinical relevance. This is because -naloxone is an antagonist that is inactive at the -opioid selective receptors on neurons that produce analgesia. Thus, these data suggest that -opioid antagonists such as -naloxone may be useful clinically to suppress glial activation, yet -opioid agonists suppress pain. (shrink)

What makes the words we speak mean what they do? Possible-worlds semantics articulates the view that the meanings of words contribute to determining, for each sentence, which possible worlds would make the sentence true, and which would make it false. M. J. Cresswell argues that the non-semantic facts on which such semantic facts supervene are facts about the causal interactions between the linguistic behaviour of speakers and the facts in the world that they are speaking about, and that the kind (...) of causation involved is best analysed using David Lewis's account of causation in terms of counterfactuals. Although philosophers have worked on the question of the connection between meaning and linguistic behaviour, it has mostly been without regard to the work done in possible-world semantics and Language in the World is a book-length examination of this problem. (shrink)

The considerable attention to financial interests in clinical research has focused mostly on academic medical centers, even though the majority of clinical research is conducted in community practice settings. To fill this gap, this article maps the practices and policies in 73 community hospitals and several hundred specialized facilities around the country for reviewing clinical investigators’ financial relationships with research sponsors. Community hospitals face a substantially different mix of issues than academic medical centers do because their physician researchers are usually (...) not employees, and more of their studies are later-phase, multicenter trials. Accordingly, community physicians stand to benefit personally from per capita payments, but they tend to have less direct influence over research findings when compared with their academic peers. These and other contrasts require separate guidance for community-based organizations that takes into account their particular needs, circumstances, and institutional capacities. (shrink)

The history of moral dilemma theory often ignores the medieval period, overlooking the sophisticated theorizing by several thinkers who debated the existence of moral dilemmas from 1150 to 1450. In this book Michael V. Dougherty offers a rich and fascinating overview of the debates which were pursued by medieval philosophers, theologians and canon lawyers, illustrating his discussion with a diverse range of examples of the moral dilemmas which they considered. He shows that much of what seems particular to twentieth-century moral (...) theory was well-known long ago - especially the view of some medieval thinkers that some forms of wrongdoing are inescapable, and their emphasis on the principle 'choose the lesser of two evils'. His book will be valuable not only to advanced students and specialists of medieval thought, but also to those interested in the history of ethics. (shrink)