In this paper, we consider ethical issues related to the treatment of posttraumatic stress disorder (PTSD) in combat zones, via exposure therapy. Exposure-oriented interventions are the most well-researched behavioral treatments for PTSD, and rigorous studies across contexts, populations, and research groups provide robust evidence that exposure therapy for PTSD is effective and can be widely disseminated. Clinical procedures for Prolonged Exposure therapy, a manualized exposure-oriented protocol for PTSD, are reviewed, and we illustrate the potential benefits, as well as the potential (...) difficulties, associated with providing this treatment in combat zones. Several ethical considerations are identified: (1) Assuming successful treatment, is it ethical to send individuals with a known risk of developing PTSD back into combat? (2) If treatment is unsuccessful in theater (perhaps due to the confounding factor of ongoing danger), could that impact treatment effectiveness for soldiers who attempt therapy again post-deployment? (3) If the military finds combat-zone treatment effective and useful in maintaining an efficient work force, will treatment become mandatory for those diagnosed with PTSD? (4) What unintended consequences might be associated with large-scale dissemination of exposure therapy in or near combat, outside of mental health care infrastructures? (5) How would genetic variations known to be associated with PTSD risk influence decisions regarding who receives treatment or returns to combat? We conclude with a review of the personal and societal costs associated with not providing evidence-based PTSD treatments wherever possible. (shrink)

Treatment of military-related posttraumatic stress disorder is a major public health care concern. Since 2001 over 2.5 million troops have been deployed to Iraq or Afghanistan, many of whom have experienced direct combat and sustained threat. Estimates of PTSD rates related to these wars range from 8% to over 20%, or 192,000 to 480,000 individuals. Already, nearly 250,000 service members of Operations Enduring Freedom, Iraqi Freedom, and New Dawn have sought VA health care services for PTSD. This recent increased need (...) for mental health services comes in addition to the ongoing needs of Vietnam-era and other veterans who continue to suffer from PTSD. PTSD is related to high co-morbidities of other mental health difficulties, poorer physical health status, and increased medical care utilization. Such high demand for services is an important contributor to the large cost associated with combat-related PTSD. Accordingly, promoting successful, cost-effective treatment strategies for PTSD is a chief public health care priority. (shrink)

Volume 19, Issue 10, October 2019, Page 68-70.

The medical drama and its central character, the doctor-hero have been a mainstay of popular television. House M.D. offers a new (and problematic) iteration of the doctor-hero. House eschews the generic conventions of the “television doctor” by being neither the idealized television doctor of the past, nor the more recent competent but often fallible physicians in entertainment texts. Instead, his character is a fragmented text which privileges the biomedical over the personal or emotional with the ultimate goal of scientifically uncovering (...) and resolving instances of disease. This article examines the implicit and explicit messages in House M.D. and critically analyzes both the show and its lead character in relation to the traditional medical drama genre that highlights the “doctor-hero” as the central character. While at first House seems to completely violate narrative and generic norms, ultimately the program provides a new form that reinforces the presence of the doctor-hero, but highlights House’s character as the central figure who is personally and interpersonally problematic but biomedically effective. (shrink)

Biological ontologies are used to organize, curate, and interpret the vast quantities of data arising from biological experiments. While this works well when using a single ontology, integrating multiple ontologies can be problematic, as they are developed independently, which can lead to incompatibilities. The Open Biological and Biomedical Ontologies Foundry was created to address this by facilitating the development, harmonization, application, and sharing of ontologies, guided by a set of overarching principles. One challenge in reaching these goals was that the (...) OBO principles were not originally encoded in a precise fashion, and interpretation was subjective. Here we show how we have addressed this by formally encoding the OBO principles as operational rules and implementing a suite of automated validation checks and a dashboard for objectively evaluating each ontology’s compliance with each principle. This entailed a substantial effort to curate metadata across all ontologies and to coordinate with individual stakeholders. We have applied these checks across the full OBO suite of ontologies, revealing areas where individual ontologies require changes to conform to our principles. Our work demonstrates how a sizable federated community can be organized and evaluated on objective criteria that help improve overall quality and interoperability, which is vital for the sustenance of the OBO project and towards the overall goals of making data FAIR. Competing Interest StatementThe authors have declared no competing interest. (shrink)

Affective variables have been shown to impact working memory and cognitive control. Theoretical arguments suggest that the functional impact of emotion on cognition might be mediated through shifting action dispositions related to changes in motivational orientation. The current study examined the effects of positive and negative affect on performance via direct manipulation of motivational state in tasks with high demands on cognitive control. Experiment 1 examined the effects of monetary reward on task-switching performance, while Experiment 2 examined the effects of (...) both rewards and punishments on working memory, using primary (liquid) reinforcers. In both experiments, dissociable trial-by-trial and contextual (block-related) enhancements of cognitive control during task performance were observed in relationship to motivational incentive value. Performance enhancements were equivalent in the reward and punishment conditions, but were differentially impacted by individual difference measures of trait reward and punishment sensitivity. Together, the results suggest both common and specific mechanisms by which approach and avoidance motivational states influence cognitive control, via activation of reward and punishment processing systems. (shrink)

We sought to assess formally the extent to which different control and elimination strategies for human African trypanosomiasis Trypanosoma brucei gambiense would exacerbate or alleviate experiences of societal disadvantage that traditional economic evaluation does not take into account. Justice-enhanced cost-effectiveness analysis is a normative approach under development to address social justice considerations in public health decision-making alongside other types of analyses. It aims to assess how public health interventions under analysis in comparative evaluation would be expected to influence the clustering (...) of disadvantage across three core dimensions of well-being: agency, association and respect. As a case study to test the approach, we applied it to five strategies for Gambiense HAT control and elimination, in combination with two different other evaluations: a cost-effectiveness analysis and a probability of elimination analysis. We have demonstrated how JE-CEA highlights the ethical importance of adverse social justice impacts of otherwise attractive options and how it indicates specific modifications to policy options to mitigate such impacts. JE-CEA holds promise as an approach to help decision makers and other stakeholders consider social justice more fully, explicitly and systematically in evaluating public health programs. (shrink)

Clinical ethics consultants face a wide range of ethical dilemmas that require broad knowledge and skills. Although there is considerable overlap with the approach to adult consultation, ethics consultants must be aware of differences when they work with infant, pediatric, and adolescent cases. This article addresses unique considerations in the pediatric setting, reviews foundational theories on parental authority, suggests practical approaches to pediatric consultation, and outlines current available resources for clinical ethics consultants who wish to deepen their skills in this (...) area. (shrink)

Background In February, 2015, the Supreme Court of Canada struck down the ban on medical assistance in dying. In June, 2016, the federal government passed Bill C-14, permitting MAiD. Current medical students will be the first physician cohort to enter a system permissive of MAiD, and may help to ensure equitable access to care. This study assessed medical student views on MAiD, factors influencing these views, and opportunities for medical education. Methods An exploratory cross-sectional survey was developed and distributed to (...) medical students across all years of a three-year Canadian undergraduate medical program. The investigators administered the survey to participants during academic sessions from November to December, 2015. Analysis of the results included summary descriptive statistics, Pearson’s chi-square test of independence to identify differences between participants by year of study, logistic regression to identify factors that influence students’ stances on MAiD, and Wilcoxon signed rank test to measure changes in student support for MAiD and comfort discussing MAiD. Results There were 405 participants for a response rate of 87%. The majority of students supported the Supreme Court’s decision, 61% would provide the means for a patient to end their life, and 38% would personally administer a lethal medication. Students who were more willing to provide the means for MAiD found medical education/clinical experience and patient autonomy to be important contributors to their stances on MAiD. Those students who were less willing to provide the means for MAiD found religious/spiritual beliefs and teachings, as well as concern about potential negative consequences, to be important contributors to their stances on MAiD. Educational training desired by participants included medicolegal, communication skills, technical skills, and religious. Conclusions Medical students generally supported and would provide the means for MAiD to patients. They also indicated a desire for directed medical education on MAiD. (shrink)

The tropical lowlands of southern Mexico and Central America are composed of a complex mosaic of landscapes that presented a variety of possibilities and challenges to the subsistence practices of the ancient Maya. The Yalahau Regional Human Ecology Project has been investigating ancient Maya agricultural practices and use of resources in a unique fresh-water wetland zone located in the northeast corner of the Yucatán Peninsula. While containing only a sparse population today, the Yalahau region once supported numerous Maya communities and (...) civic-ceremonial centers, particularly during the Late Preclassic and Early Classic periods, between approximately 100 B.C. and A.D. 450. Our investigations have developed evidence that the ancient Maya manipulated and cultivated the wetland landscape of the region, used soil or algae from the wetlands to enrich upland garden plots, and cultivated trees within their communities. We suggest that the study of ancient Maya agricultural practices can contribute to sustainable development of the area today and in the future. (shrink)

Few studies have examined how trait emotion dysregulation relates to momentary affective experiences and the emotion regulation strategies people use in daily life. In the current study, 112 c...

Some books are like parents, grandparents or old friends. They have been with us from our earliest days and one treats them almost with familiarity. They belong to one's youth and the recognition that they have been around for months and years keeps company with surprise. For philosophers such a book is A. J. Ayer's Language, Truth and Logic, first published over fifty years ago in 1936. There is a sense in which a similar point may be made about some (...) individuals, but discretion and good manners should deter us from succumbing to the philosophical disease of pressing an analogy too far. Suffice it to say that over a period during which most English speaking philosophers were content to work within a context which was significantly influenced by Ayer's clear and cajoling formulation of a twentieth century of empiricism, F. C. Copleston provided one of the few distinctive alternative philosophical perspectives on major metaphysical questions. This essay will reflect upon the influence of Ayer's Language, Truth and Logic some fifty years after its publication, upon the philosophical discussion of religion and theological questions. (shrink)

Symposium discussion on Todd Moody's `Conversations with Zombies' , by Owen Flanagan, Thomas Polger, Daniel C. Dennett, Guven Guzeldere, Jaron Lanier, John McCarthy, Selmer Bringsjord, Mary Midgley, Avshalom C. Elitzur, Keith Chandler, David Hodgson and Charles T. Tart, with response from Todd C. Moody.

Singing and praying in the words of biblical men and women is basic to sacramental mimesis, i.e., Christian imitation of the actions of the saints with the intention of thereby opening themselves to grace. This evidence counters the “voiceless victim” paradigm prevalent in much feminist scholarship. In pre-Christian Jewish liturgy, the song of Miriam after the Crossing of the Red Sea was already important in the annual celebration of the Passover. Jesus emphasized the spiritual equality of the sexes in his (...) teaching and ministry, and this led to increased visibility for women in Christian tradition: Susanna was the first of at least eight women interpreted as types of Christ. She was presented this way even within the synoptic Gospels themselves [see “Aneboesen phone megale: Susanna and the Synoptic Passion Narratives,” forthcoming in Gregorianium]. Moreover, the practice of presenting examples from both sexes in sermons and church decoration was so pervasive as to constitute a pastoral program of the Church. Such balanced representation of the sexes is found in both texts and art. The linguistic range of the evidence for the singing of women’s words includes Greek, Latin, Coptic, Syriac, Slavonic, and German. The artworks depicting women are from throughout the Christian world, including Dura Europos, Jerusalem, Egypt, Ethiopia, Cyprus, Syria, Armenia, Italy, France, Belgium, Germany. More than twenty biblical women are treated in the essay. Women’s words, quoted from the biblical record or imaginatively supplied, became the prayer of the whole congregation. Miriam’s words remain focal universally on Holy Saturday. The acclamations of Elizabeth and of the Virgin Mary became prominent early in both East and West . Both Byzantine and Gregorian chant commemorated them and other women such as Eve, Esther, Judith, Sarah , Susanna, Martha of Bethany, the Samaritan woman, the Canaanite woman, the woman with the ointment, the Samaritan woman, the ten virgins of the parable , and especially the Holy Women at the Tomb . Their proclamation of the Lord’s rising became particularly important in Byzantine resurrection hymns used at Easter and year-round. With four other first-century female saints– Junia, Mariamne, Photina and Thecla– Mary Magdalene was deemed ἰσαπόστολος “equal to the apostles,” because the angel commissioned her to announce the Lord’s Resurrection to the disciples. Martha’s profession of faith is the fullest recorded in the Gospels and became the basis for a Byzantine communion prayer . Repeatedly, one finds that women’s words were sung at important Sunday feasts and during Holy Week. In Gregorian chant their words were sung over the course of several days. Susanna’s words are readily found in fifty Gregorian chant manuscripts from the ninth through fifteenth centuries, used in cathedrals, in monasteries and other religious houses, and in parish churches; an appendix lists these manuscripts. Throughout the continent–in Italy, Austria, Slovenia, Germany, Switzerland, France, The Netherlands, England, Wales–the varied communities of the church sang Susanna’s words. Moreover, her words as mediated through Gregorian chant were quoted by Bernard of Clairvaux in a sermon and by Hermann of Scheda in his account of his conversion from Judaism. These men used Susanna’s words to evoke her as a type of Christ and thereby to seek to be like him themselves. That is, they experienced sacramental mimesis through singing women’s words. (shrink)

Assuming that future experiments confirm Aspect's discovery of nonlocal interactions between quantum pairs of correlated particles, we analyze the constraints imposed by the EPR reasoning on the said interactions. It is then shown that the nonlocal relativistic quantum potential approach plainly satisfies the Einstein causality criteria as well as the energy-momentum conservation in individual microprocesses. Furthermore, this approach bypasses a new causal paradox for timelike separated EPR measurements deduced by Sutherland in the frame of an approach by means of (...) space-time zigzags with advanced potentials. It is finally demonstrated that this inherent quantum causal direct interaction establishes permanent EPR correlations which are always restricted to spacelike separations and are instantaneous only in the center-of-mass rest frame of the two-particle system. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:An Unconscious Dimension of Thinking, Situations, and La Vida:Reflections on Bethany Henning's Dewey and the Aesthetic UnconsciousGregory Pappasthis book is doing different related and valuable things. First, Bethany Henning explores a neglected dimension of Dewey's thought. In particular, the book inquires into the dimension of the unconscious and tries to develop what she considers an "implicit" "theory of the unconsciousness" or of the "aesthetic unconscious" in Dewey's (...) philosophy. Then, based on all of the above, it provides a diagnosis and possible solution to a problem with philosophers and with American culture.The neglected dimension of Dewey's thought that Henning explores highlights the ways in which Dewey foresaw what feminist thinkers have said, and recent scientific accounts of human life and thinking are confirming: What we "feel" (what is "qualitative," "ineffable," and "noncognitive") is key to how to think and how to live (guidance and meaning). It has therefore been puzzling to me (along with John McDermott, Tom Alexander, Mark Johnson, and a few others) why even Dewey scholarship has to a large extent neglected exploring this aspect of his thought. Frustrated with Bertrand Russell, Dewey says that "Mr. Russell has not been able to follow the distinction I make between the immediately had material of non-cognitively experienced situations and the material of cognition—a distinction without which my view cannot be understood" (LW 14:33; emphasis added).More importantly, by neglecting this insight and these aspects of his thought, we have failed to utilize one of the most important resources to diagnose sociopolitical-moral problems today! This is what I have been trying to do in recent years, and I see Dr. Henning as trying to do the same. She is not just providing a theory of the unconscious for the sake of speculation, but she does so with instrumental intent, in the hope that it will help us better approach a concrete social-cultural problem we suffer in our society, a topic to which I will return. [End Page 84]My reading of Dewey and the Aesthetic Unconscious has provoked a few questions:(a). Is there, in Dewey, a conception of aesthetic and religious experience that can be understood as an "implicit theory of the unconscious"?(b). Even if there is one, do we need one? For what purpose?(c). What would we miss if we were to say what needs to be said and explored by Henning by using different terms/concepts and avoiding the possible misunderstanding and dangers of making reference to "the unconscious"?(d). Would Henning agree that the problematic aversion or repression in American culture that concerns us is more than that of the unconscious, the qualitative, body, and nature that form the focus of her book?(e). Henning agrees that we need more than art and "deep" psychology to ameliorate the problems that concern us. What is this "more"? How?In regard to (b), I can think of one good purpose, which Henning develops in Dewey and the Aesthetic Unconscious: to engage in a dialogue with psychoanalysis and contemporary philosophies that draw from psychoanalysis and feminism (e.g., Kristeva) or, in general, other academics concerned with the same problems. I also wondered as I was reading the book why Henning does not put Carl Jung in dialogue with Dewey as well, just as a matter of curiosity. But I wonder, if we need to develop a "theory of the unconsciousness" or of the "aesthetic unconsciousness" to both make a contribution to the "depth" of lived experience (La Vida) and also deal with the social-cultural problems that concern us.There are dangers with talking about or making reference to "the" unconsciousness or "the" aesthetic unconsciousness and theorizing about them. The problem is that it comes across as a noun, and not as way of participating in La Vida or nature, that is continuous in a significant way with what is more conscious and more cognitive: we are at any time more or less conscious. But Henning seems aware of all of this. She is careful enough to make clear that she is acknowledging continuity, but I confess to "feeling" uncomfortable sometimes with her reference to that... (shrink)