The resurgence of tuberculosis in the United States is due, in part, to the dismantling of large-scale treatment systems that were a critical part of the disease control effort for the better part of the twentieth century. As the number of cases grows, clinicians, politicians, public health officials and community advocates have grappled with the difficult problem of building systems to care for infected people that are consonant with current knowledge and beliefs about quality care. As an example, the United (...) Hospital Fund’s 1992 report, The Tuberculosis Revival: Individual and Societal Obligations in a Time of AIDS, discussed policies to guarantee adequate treatment that protects patients’ civil rights, needs for special facilities for care of TB patients, and the special problems faced by infected prisoners. This thoughtful report highlighted many areas of social policy that require further examination. (shrink)

Understanding of the λ model has greatly increased in recent years as evidenced by most of the commentaries. Some commentators underscored the potential of the model to integrate aspects of different sensorimotor systems in the production of movement. Other commentators focused on not-yet-fully-developed parts of the model. A few persisted in misunderstanding some of its basic concepts, and on these grounds they reject it. In responding to commentaries we continue to elaborate on some fundamental points of the model, especially control (...) variables, the idea of movement production by shifting the positional frame of reference and the hypothesis of biomechanical correspondence in motor control. We also continue to develop our ideas on the intrinsic generation of the frame of reference associated with external space and utilized for the control of arm movement and locomotion. The dynamic principles underlying the model are discussed in light of the dynamical systems approach. (shrink)

A hypothesis about sensorimotor integration (the λ model) is described and applied to movement control and kinesthesia. The central idea is that the nervous system organizes positional frames of reference for the sensorimotor apparatus and produces active movements by shifting the frames in terms of spatial coordinates. Kinematic and electromyographic patterns are not programmed, but emerge from the dynamic interaction among the system s components, including external forces within the designated frame of reference. Motoneuronal threshold properties and proprioceptive inputs to (...) motoneurons may be cardinal components of the physiological mechanism that produces positional frames of reference. The hypothesis that intentional movements are produced by shifting the frame of reference is extended to multi-muscle and multi-degrees-of-freedom systems with a solution of the redundancy problem that allows the control of a joint alone or in combination with other joints to produce any desired limb configuration and movement trajectory. The model also implies that for each motor behavior, the nervous system uses a strategy that minimizes the number of changeable control variables and keeps the parameters of these changes invariant. Examples are provided of simulated kinematic and electromyographic signals from single- and multi-joint arm movements produced by suggested patterns of control variables. Empirical support is provided and additional tests of the model are suggested. The model is contrasted with others based on the ideas of programming of motoneuronal activity, muscle forces, stiffness, or movement kinematics. (shrink)

The basic concepts of motor control formulated in our target article were derived from specific experiments, a fact which is disregarded in Dalenoort's comments. A purely academic approach to motor control may not result in a clearer understanding of control concepts.

The cerebellum probably obeys the rules of sensorimotor integration common in the nervous system. One such a rule is formulated: the nervous system organizes spatial frames of reference for the sensorimotor apparatus and produces voluntary movements by shifting their origin points. We give examples of spatial frames of reference for different single- and multi-joint movements including locomotion and also illustrate that the process of motor development and learning may depend critically on the formation of appropriate frames of reference and the (...) organism's ability to manage them. We suggest that a solution to the problem of sensorimotor integration may not be trivial and may actually change the mental and experimental paradigms used in the understanding of the cerebellum and other brain structures, [HOUK et al.; SIMPSON et al.; SMITH; TIIACH]. (shrink)

We apply a cognitive modeling approach to the problem of measuring expertise on rank ordering problems. In these problems, people must order a set of items in terms of a given criterion (e.g., ordering American holidays through the calendar year). Using a cognitive model of behavior on this problem that allows for individual differences in knowledge, we are able to infer people's expertise directly from the rankings they provide. We show that our model-based measure of expertise outperforms self-report measures, taken (...) both before and after completing the ordering of items, in terms of correlation with the actual accuracy of the answers. These results apply to six general knowledge tasks, like ordering American holidays, and two prediction tasks, involving sporting and television competitions. Based on these results, we discuss the potential and limitations of using cognitive models in assessing expertise. (shrink)

This article presents evidence supporting the claim that ethical reasoning is a skill that can be taught and assessed. We propose a working definition of ethical reasoning as 1) the ability to identify, analyze, and weigh moral aspects of a particular situation, and 2) to make decisions that are informed and warranted by the moral investigation. The evidence consists of a description of an ethical reasoning education program—Ethical Reasoning in Action —designed to increase ethical reasoning skills in a variety of (...) situations and areas of life. ERiA is housed at a public, major comprehensive U.S. university—James Madison University—and assessment of the program focuses on interventions delivered prior to and during orientation for incoming first-year students. Findings indicate that the interventions measurably enhance the ability of undergraduate students to reason ethically. ERiA’s competency-targeted program and positive student learning outcomes offers a promising model for higher education ethics programs seeking to connect classroom learning in ethics to decision-making in everyday life. (shrink)

Now in its fourth edition, Rational Diagnosis and Treatment: Evidence-Based Clinical Decision - Making is a unique book to look at evidence-based medicine and the difficulty of applying evidence from group studies to individual patients._ The book analyses the successive stages of the decision process and deals with topics such as the examination of the patient,_the reliability of clinical data, the logic of diagnosis, the fallacies of uncontrolled therapeutic experience and the need for randomised clinical trials and meta-analyses. It is (...) the main theme of the book that, whenever possible, clinical decisions must be based on the evidence from clinical research, but the authors also explain the pitfalls of such research and the problems involved in applying evidence from groups of patients to the individual patient._ For this new edition, the sections on placebo and meta-analysis and on alternative medicine have been thoroughly updated, and there is more focus on insufficient reporting of harms of interventions. The sections on different research designs describe advantages and limitations, and the increased medicalisation and the effects of cancer screening on health people are noted. A section on academic freedom when clinicians collaborate with industry and ghost authors is added._ This essential reference work integrates the science and statistical approach of evidence-based medicine with the art and humanism of medical practice; distinguishing between data, sets of data, knowledge and wisdom, and their application. Such an intellectually challenging book is ideal for both medical students and doctors who require theoretical and practical clinical skills to help ensure that they apply theory in practice. (shrink)

In this book G. W. Leibniz presents not only his reflections on predestination and election but also a more detailed account of the problem of evil than is found in any of his other works apart from the _Theodicy_. Surprisingly, his _Dissertation on Predestination and Grace_ has never before been published in any form. Michael J. Murray's project of translating, editing, and providing commentary for the volume will therefore attract great interest among scholars and students of Leibniz's philosophy and theology. (...) Leibniz addresses such topics as free will, moral responsibility, divine causation, justice, punishment, divine foreknowledge, and human freedom, revealing crucial aspects of the genesis of his mature metaphysics and the theological motivations behind it. (shrink)

Contemporary medical education must train skilled and compassionate health care professionals who are rigorous in their approach to patient care and their pursuit of knowledge and solutions. Problem-based learning has been widely introduced, but there is no evidence that it leads to better outcomes than more traditional programs, and fundamental gaps in conceptual knowledge may result. Recently, emphasis has been placed on a solid grounding in underlying concepts combined with a systems-based approach, and ability to transfer information and solve problems. (...) Integrating traditional scientific and clinical disciplines with progressive and continuous assessment, may be a better means of achieving the combined aims of clinically relevant curriculum design, vertical integration of medical knowledge, and facilitation of the continuum of training. Being adaptable and flexible, cognisant of costs, and driven by evidence are key features of delivering medical education and contemporary medical practice. Educational research should lead to continuous improvement, but innovation without evaluation and attention to costs may create as many, or more, problems as are solved. (shrink)

Anastasia G. Yangaki Amphores crétoises : le cas d'Éleutherna p. 503-523 L'étude des amphores crétoises de la période paléochrétienne mises au jour sur le site d'Éleutherna, dans la région de Mylopotamos, enrichit considérablement notre connaissance des amphores de production crétoise identifiées à la suite des recherches récentes sur plusieurs sites de la Méditerranée. Cet article tend à préciser la datation précédemment proposée pour certains types déjà connus. Il présente un groupe uniforme d'amphores à l'intérieur du type initial, produit par un (...) nouvel atelier, et révèle plusieurs types nouveaux à Éleutherna, utilisés surtout à la fin de la période protobyzantine et même au cours du VIIIe siècle ; parmi ces derniers, on signale les types qui imitent des formes d'amphores importées sur l'île. Des analyses chimiques ont permis d'ajouter le site d'Éleutherna ou la région de Mylopotamos au nombre des centres de fabrication d'amphores crétoises. (shrink)