Genomic research—including whole genome sequencing and whole exome sequencing—has a growing presence in contemporary biomedical investigation. The capacity of sequencing techniques to generate results that go beyond the primary aims of the research—historically referred to as “incidental findings”—has generated considerable discussion as to how this information should be handled—that is, whether incidental results should be returned, and if so, which ones.Federal regulations governing most human subjects research in the United States require the disclosure of “the procedures to be followed” in (...) the research as part of the informed consent process. It seems reasonable to assume—and indeed, many commentators have concluded—that genomic investigators will be expected to inform participants about, among other procedures, the prospect that incidental findings will become available and the mechanisms for dealing with them. Investigators, most of whom will not have dealt with these issues before, will face considerable challenges in framing meaningful disclosures for research participants.To help in this task, we undertook to identify the elements that should be included in the informed consent process related to incidental findings. We did this by surveying a large number of genomic researchers (n = 241) and by conducting in‐depth interviews with a smaller number of researchers (n = 28) and genomic research participants (n = 20). Based on these findings, it seems clear to us that routine approaches to informed consent are not likely to be effective in genomic research in which the prospect of incidental findings exists. Ensuring that participants’ decisions are informed and meaningful will require innovative approaches to dealing with the consent issue. We have identified four prototypical models of a consent process for return of incidental findings. (shrink)

Specialists and primary care physicians play an integral role in treating the twin epidemics of pain and addiction. But inadequate access to specialists causes much of the treatment burden to fall on primary physicians. This article chronicles the differences between treatment contexts for both pain and addiction — in the specialty and primary care contexts — and derives a series of reforms that would empower primary care physicians and better leverage specialists.

(No abstract is available for this citation).

In the maximal form of indirect development found in many taxa of marine invertebrates, embryonic cell lineages of fixed fate and limited division capacity give rise to the larval structures. The adult arises from set‐aside cells in the larva that are held out from the early embryonic specification processes, and that retain extensive proliferative capacity. We review the locations and fates of set‐aside cells in two protostomes, a lophophorate and a deuterostome. The distinct adult body plans of many phyla develop (...) from homologous set‐aside cells within homologous larvae. We argue that the stocks from which these phyla arose utilized these respective larvae, and the diversity of their adult body plans reflects diverse pattern formation processes executed in their set‐aside cell populations. Chordates and arthropods develop directly, but share adult characters with indirectly developing phyla. Thus the deuterostome and protostome stocks that were ancestral to chordates and arthropods, respectively, also utilized maximal indirect development. (shrink)

This article investigates the potential of fMRI to test assumptions about different components in models of complex cognitive tasks. If the components of a model can be associated with specific brain regions, one can make predictions for the temporal course of the BOLD response in these regions. An event‐locked procedure is described for dealing with temporal variability and bringing model runs and individual data trials into alignment. Statistical methods for testing the model are described that deal with the scan‐to‐scan correlations (...) in the errors of measurement of the BOLD signal. This approach is illustrated using a “sacrificial” ACT‐R model that involves mapping 6 modules onto 6 brain regions in an experiment from Ravizza, Anderson, and Carter (in press) concerned with equation solving. The model's visual encoding predicted the BOLD response in the fusiform gyrus, its controlled retrieval predicted the BOLD response in the lateral inferior prefrontal cortex, and its subgoal setting predicted the BOLD response in the anterior cingulate cortex. On the other hand, its motor programming failed to predict anticipatory activation in the motor cortex, its representational changes failed to predicted the pattern of activity in the posterior parietal cortex, and its procedural component failed to predict an initial spike in caudate. The results illustrate the power of such data to direct the development of a theory of complex problem solving, both at the level of a specific task model as well as at the level of the cognitive architecture. (shrink)

BackgroundResponsive neurostimulation has been utilized as a treatment for intractable epilepsy. The RNS System delivers stimulation in response to detected abnormal activity, via leads covering the seizure foci, in response to detections of predefined epileptiform activity with the goal of decreasing seizure frequency and severity. While thalamic leads are often implanted in combination with cortical strip leads, implantation and stimulation with bilateral thalamic leads alone is less common, and the ability to detect electrographic seizures using RNS System thalamic leads is (...) uncertain.ObjectiveThe present study retrospectively evaluated fourteen patients with RNS System depth leads implanted in the thalamus, with or without concomitant implantation of cortical strip leads, to determine the ability to detect electrographic seizures in the thalamus. Detailed patient presentations and lead trajectories were reviewed alongside electroencephalographic analyses.ResultsAnterior nucleus thalamic leads, whether bilateral or unilateral and combined with a cortical strip lead, successfully detected and terminated epileptiform activity, as demonstrated by Cases 2 and 3. Similarly, bilateral centromedian thalamic leads or a combination of one centromedian thalamic alongside a cortical strip lead also demonstrated the ability to detect electrographic seizures as seen in Cases 6 and 9. Bilateral pulvinar leads likewise produced reliable seizure detection in Patient 14. Detections of electrographic seizures in thalamic nuclei did not appear to be affected by whether the patient was pediatric or adult at the time of RNS System implantation. Sole thalamic leads paralleled the combination of thalamic and cortical strip leads in terms of preventing the propagation of electrographic seizures.ConclusionThalamic nuclei present a promising target for detection and stimulation via the RNS System for seizures with multifocal or generalized onsets. These areas provide a modifiable, reversible therapeutic option for patients who are not candidates for surgical resection or ablation. (shrink)

An obligation may take either of two forms, each form being reported in a different way. For example, when we report the obligation of parents to care for their children, if it is the moral obligation we mean, we will say ‘Parents ought to look after their children’ but if we mean the legal obligation, we will say ‘Parents have to look after their children’. The law specifies that people shall do thus and so, not that they ought to do (...) thus and so. (shrink)

Objective: To determine whether the marks in the third year Objective Structured Clinical Examination were affected by the collusion reported by the students themselves on an electronic discussion board.Design: A review of the student discussion, examiners’ feedback and a comparison of the marks obtained on the 2 days of the OSCE.Participants: 255 third year medical students.Setting: An OSCE consisting of 15 stations, administered on three sites over 2 days at a UK medical school.Results: 40 students contributed to the discussion on (...) the electronic discussion board. The main points raised were perceived inequity between students who did, or did not, have prior knowledge of the station content, and the lack of honesty and professionalism of their peers. Most contributors claimed to have received, or knew of others receiving, prior knowledge, but none confessed to passing on information. No significant difference was observed in the overall mark for the OSCE on day 1 ) and day 2 ). On day 2, marks were considerably greater for four stations and markedly lower for three stations. It was not obvious why collusion should affect these station marks. A clear indication of the effects of collusion could only be obtained from a single subsection of an individual station where 82 students on day 2 incorrectly gave the diagnosis from day 1.Conclusion: Marks do not provide a sound inference of student collusion in an OSCE and may mask the aspects of professional development of students. (shrink)

Excessive prescribing of pain medications after surgery has contributed to the epidemic of opioid misuse and diversion in the United States. Pain specialists may be particularly well situated to address these issues. We describe an attempt to reverse the trend at an orthopedic surgical hospital by implementing a peri-operative assessment and treatment service which minimizes preoperative opioid use, when necessary implements addiction treatment, and encourages early tapering from opioids.

Reply to a commentary by Felicitas Holzer and Ignacio Mastroleoon “Models of Consent to Return of Incidental Findings in Genomic Research.”.

In this 1970 introduction to philosophy Mr Taylor concentrates on two central topics - explanation and meaning. He takes the argument far enough to acquaint the reader first-hand with the methods and approach of analytical philosophy, and yet because of the scope of these two topics he is able to introduce many of the traditional philosophical problems in epistemology, metaphysics, ethics, aesthetics, and logic. By this approach he avoids the dangers both of superficiality and of undue technicality. Philosophers are concerned (...) to analyse and describe certain concepts and modes of argument, not to establish facts or conclusions of any sort that can be tested by formal demonstration or controlled observation; their findings cannot be conveniently categorized or graded into a comprehensive and progressive course of studies. Mr Taylor meets this difficulty with his extended discussions of specific topics and questions which have implications over the whole subject. (shrink)

In saying ‘N knows that p’, where the supposed knowing is gained through rational reflection (the paradigm form of knowing, conceptually), I endorse N’s belief as rationally held, and hence correct (the ‘RhCB’ analysis). We understand this ‘hence’ not as ‘hence, infallibly’ but as ‘hence in fact’– a reliability reading, not implying infallibility (cf. the use of ‘hence’ to attribute non‐deterministic causation). The false appearance of inconsistency in our taking knowing to require an infallible guarantee of correctness while regularly attributing (...) knowledge where we lack an absolute guarantee arises from misreading of the ‘hence’ as implying infallibility, partly due to the mistaken assumption that ‘know’ functions purely descriptively. Though aware that rationality may occasionally fail to ensure correctness, we accept it as sufficing to yield knowledge wherever it does not fail – a consistent non‐infallibilist understanding of what knowing requires. (shrink)

. As Gregory Peterson's book Minding God illustrates, an ongoing encounter between theology and the cognitive sciences can provide rich insights to both disciplines. Similarly, reflection on recent advances in pain research can prove to be fertile ground in which further theological insights might take root. Pain researchers remind us that pain is both a sensory and an emotional experience. The emotional component of pain is critically important for the clinical management of people in pain, as it serves a communicative (...) function-human connection occurs more readily through the expression of and response to emotion than through the sterile exchange of "objective" descriptions of sensory phenomena. But emotion, pain and communication also figure prominently in Christian theology. For example, doctrines of incarnation and eschatology raise questions about suffering, healing, and hope as well as about the nature of the divine-human relationship. In addition, there seems to be scientific evidence for (admittedly subtle) gender differences in the perception of and response to pain. Several feminist theologians have noted that a habitual theological emphasis on God's rationality tends to reinforce masculine images of God and demeans the validity of emotion in the divine-human relationship. Potential theological implications of the emotional and communicative aspects of pain and how this might affect women's religious experience-with a particular focus on Teresa of Avila-are explored. (shrink)

Among moral rules, Some are seen as having inherent moral authority, Others as sustained by our decision and conceivably susceptible of replacement "salva moralitate". But how can a "chosen" rule have moral authority? one familiar (utilitarian) way: the rule is justified by the supposed consequences of having it not by its content: its authority for us derives from our (revisable) factual judgments as to these consequences. This article seeks to explore another way: we (individual or community) adopt a rule as (...) a symbolic way of expressing a moral conviction. The impulsion here may be to express our conviction to others; or to ourselves--To realize the theoretical conviction in our living (as such a conviction demands of us). Rules justified in terms of "respect for life" are sustained as symbolic rules. Other examples of such rules are considered, Along with questions about the practice of adopting rules as symbols. (shrink)