Multimodal prehabilitation is increasingly recognized as an important component of the pre-operative pathway in oncology. It aims to optimize physical and psychological health through delivery of a series of tailored interventions including exercise, nutrition, and psychological support. At the core of this prescription is a need for considerable health behavior change, to ensure that patients are engaged with and adhere to these interventions and experience the associated benefits. To date the prehabilitation literature has focused on testing the efficacy of devised (...) exercise and nutritional interventions with a primary focus on physiological and mechanistic outcomes with little consideration for the role of behavioral science, supporting individual behavior change or optimizing patient engagement. Changing health behavior is complex and to maximize success, prehabilitation programs should draw on latest insights from the field of behavioral science. Behavioral science offers extensive knowledge on theories and models of health behavior change to further advance intervention effectiveness. Similarly, interventions developed with a person-centered approach, taking into consideration individual needs and preferences will increase engagement. In this article, we will provide an overview of the extent to which the existing prehabilitation literature incorporates behavioral science, as well as studies that have explored patient's attitudes toward prehabilitation. We will go on to describe and critique ongoing trials in a variety of contexts within oncology prehabilitation and discuss how current scientific knowledge may be enhanced from a behavioral science perspective. We will also consider the role of “surgery schools” and detail practical recommendations that can be embedded in existing or emerging clinical settings. (shrink)

This study investigated how problem solvers get into and out of a state of impasse while solving difficult problems. 47 participants had to decipher the secret method behind 33 magic tricks while r...

Paragraph 12 of the revised International Code of Medical Ethics (ICoME) states that ‘the physician should strive to practise medicine in ways that are environmentally sustainable with a view to minimising environmental health risks to current and future generations.’1 This emphasis on environmental sustainability is in line with popular discourse as well growing scholarly attention in medical ethics for healthcare’s contribution to climate change. Recent research analyses, for instance, the ‘greening’ of informed consent and related bioethical principles.2 3 It is (...) unclear what the duty of practising sustainable healthcare means at the level of doctor–patient interaction. Parsa-Parsi et al flag the potential conflict in the ICoME’s provisions if ‘the actions of physicians are influenced by environmental considerations to the detriment of patients’ (p. 2), noting that the ICoME does not provide a handhold to improve understanding of such tensions. The code ‘does not go into extensive detail, does not include comprehensive explanations nor any rules or guidance on how to reconcile its principles when they conflict’ (p. 4). For Parsa-Parsi et al, not codes, but textbooks have a crucial role to play in resolving this conflict. It is rife that professional codes can lead to internal inconsistencies and …. (shrink)

In the present study, we explored the effects of high arousal on cognitive performance when facing a situation of risk. We also investigated how these effects are moderated by either positive or ne...

The diverse and paradoxical nature of globalization processes has given rise to new social constellations that shape transnational, national and local spaces. The historicity of identities, their past and present conditions, the changes they went through, the ways they influence the feeling of full membership in a community and the differentiation derived from cultural diversity and pluralism underscore the need for revisiting theoretical explorations. This paper addresses past and present social, cultural and religious processes in an era of transformations derived (...) from the complexity of today’s interconnected world and on the light of historical encounters. The need for revising the singularity of social and cultural trajectories and the religious trends gravitating in society is approached through snapshots of a twofold historical encounter: between Modernity and Latin America, and between Judaism and Modernity. Both express entrenched dilemmas of the binaries periphery-center and universal-particular. While one of them raised the issue of the dominant program of Modernity as a Western project, the other was entailed in the assumptions of one hegemonic religious constellation. (shrink)

Multiple authorship is the universal solution to multi-tasking in the sciences. Without a team, each with their own set of expertise, and each involved mostly in complementary ways, a research project will likely not advance quickly, or effectively. Consequently, there is a risk that research goals will not be met within a desired timeframe. Research teams that strictly scrutinize their modus operandi select and include a set of authors that have participated substantially in the physical undertaking of the research, in (...) its planning, or who have contributed intellectually to the ideas or the development of the manuscript. Authorship is not an issue that is taken lightly, and save for dishonest authors, it is an issue that is decided collectively by the authors, usually in sync with codes of conduct established by their research institutes or national ministries of education. Science, technology and medicine publishers have, through independent, or sometimes coordinated efforts, also established their own sets of guidelines regarding what constitutes valid authorship. However, these are, for the greater part, merely guidelines. A previous and recent analysis of authorship definitions indicates that the definitions in place regarding authorship and its validity by many leading STM publishers is neither uniform, nor standard, despite several of them claiming to follow the guidelines as set forward by the International Committee of Medical Journal Editors or ICMJE. This disparity extends itself to ghost and guest authorship, two key authorship-related issues that are examined in this paper to assess the extent of discrepancies among the same set of STM publishers and what possible influence they might have on publishing ethics. (shrink)

Most departments in any field of science that have a sound academic basis have discussion groups or journal clubs in which pertinent and relevant literature is frequently discussed, as a group. This paper shows how such discussions could help to fortify the post-publication peer review movement, and could thus fortify the value of traditional peer review, if their content and conclusions were made known to the wider academic community. Recently, there are some tools available for making PPPR viable, either as (...) signed or anonymous comments, or in a hybrid format. Thus, limited platforms are currently in place to accommodate and integrate PPPR as a supplement to traditional peer review, allowing for the open and public discussion of what is often publicly-funded science. This paper examines ways in which the opinions that emerge from journal clubs or discussion groups could help to fortify the integrity and reliability of science while increasing its accountability. A culture of reward for good and corrective behavior, rather than a culture that protects silence, would benefit science most. (shrink)

Die Beiträge dieses Buches unternehmen den Versuch, Praktische Philosophie in Begriffen einer negativistischen Sozialphilosophie zu rekonstruieren, die ein breites Spektrum von Phänomenen negativer Sozialität in ihrem eigenen Recht beschreibt und dabei davon ausgehen muss, dass sich diese Phänomene nicht in einer voll integrierten Gemeinschaft oder Gesellschaft aufheben lassen. Eine solche Sozialphilosophie geht den Gründen für die Irreduziblität des Negativen einerseits auf einer begrifflichen Ebene, andererseits aber auch in konkreten historisch-sozialphilosophischen, lexikalisch angeordneten Analysen nach. Getragen sind die Analysen von der Überzeugung, (...) dass ohne „Reibung“ an diesen Phänomenen auch ein Leben im Zeichen des Guten oder Gerechten jeglichen Halt an einem leibhaftigen In-der-Welt-Sein verlieren muss. Wir sind nicht nur unaufhebbarer Negativität ausgesetzt, sondern müssen auch verstehen, wie das der Fall ist, und welche Spielräume des Verhaltens sich uns darin eröffnen. (shrink)

TPPP/p25 is a recently discovered, unstructured protein involved in brain function. It is found predominantly in oligodendrocytes in normal brain but is enriched in neuronal and glial inclusions of Parkinson's disease and other synucleinopathies. Its physiological function seems to be the dynamic stabilization of microtubular ultrastructures, as well as the projections of mature oligodendrocytes and ciliary structures. We reappraise the earlier belief that TPPP/p25 is a brain‐specific protein. We have identified and cloned two shorter (N‐terminal‐free) homologs of TPPP/p25 that behave (...) differently from each other and from TPPP/p25. Two unique cell models have been established and used to study the effect of the unstructured protein on the energy metabolism and the formation of pathological aggregates. Our data suggest that the intracellular level of TPPP/p25 influences the cell differentiation, proliferation and the formation of protein aggregates, and consequently, the etiology of central nervous system diseases. (shrink)

This study examines processes through which social personae are conveyed by male Japanese students at a public university in Yokohama. Focusing on the frame-setting function of first person pronominals in contexts where there is no intra/inter speaker variation in the choice of FPP, this paper analyzes how speakers manage identity-associated discursive alignments related to a shared Okinawa prefecture background. The common experience of being from Okinawa prefecture and attending university far from home is the primary reason that these speakers are (...) close friends. However, analysis reveals speakers’ continual and active contention and re-formulation of this shared ‘Okinawan-ness’ and the personae to which it is linked. In particular, FPPs are implicated in speakers’ discussion of heterogeneity and/or local differences with respect to their Okinawa prefecture background. Strategic use of FPPs thus emerges as a salient tactic for speakers’ active negotiation of conversation relevant personae categories even in interactional contexts without variation. (shrink)

This article takes the interlinkages between law and politics as its starting point. It analyzes recent changes in the legislative style of education governance in Sweden as not only a spec...

This article takes the interlinkages between law and politics as its starting point. It analyzes recent changes in the legislative style of education governance in Sweden as not only a species of crisis management, but also a long-term response to a series of tensions arising out of the push toward what has been identified as ‘juridification’ in many Western nations—the reliance on law and judicial means for addressing core moral predicaments, public policy questions, and political controversies. The article outlines the (...) notion of juridification at a theoretical level and highlights juridification processes and their possible ramifications on education. It argues that recent changes in the legislative style of education governance in Sweden not only reveal much about the commitments and implicit assumptions of modern regulatory and evaluative regimes, but also reflect the general impact of the rationalization of social and political life on the organization of government. The article provides a case with which to examine some of the theoretical underpinnings and implicit conceptual assumptions of modern regulatory and evaluative regimes as well as educational institutions’ relationships with the State. It shows that regulatory frameworks define the conceptualizations of what educational institutions do and thus of what actually gets done. (shrink)

According to estimates more than 400 biobanks currently operate across Europe. The term ‘biobank’ indicates a specific field of genetic study that has quietly developed without any significant critical reflection across European societies. Although scientists now routinely use this phrase, the wider public is still confused when the word ‘bank’ is being connected with the collection of their biological samples. There is a striking lack of knowledge of this field. In the recent Eurobarometer survey it was demonstrated that even in (...) 2010 two-thirds of the respondents had never even heard about biobanks. The term gives the impression that a systematic collection of biological samples can constitute a ‘bank’ of considerable financial worth, where the biological samples, which are insignificant in isolation but are valuable as a collection, can be preserved, analysed and put to ‘profitable use’. By studying the practices of the numerous already existing biobanks, the authors address the following questions: to what extent does the term ‘biobank’ reflect the normative concept of using biological samples for the purposes of biomedical research? Furthermore, is it in harmony with the so far agreed legal–ethical consensus in Europe or does it deliberately pull science to the territory of a new, ambiguous commercial field? In other words, do biobanks constitute a medico-legal fiction or are they substantively different from other biomedical research protocols on human tissues? (shrink)

BackgroundBreakthroughs in animal studies make the topic of human application of ectogenesis for medical and non-medical purposes more relevant than ever before. While current data do not yet demonstrate a reasonable expectation of clinical benefit soon, several groups are investigating the feasibility of artificial uteri for extracorporeal human gestation.Main textThis paper offers the first comprehensive and up to date discussion of the most important pros and cons of human ectogenesis in light of clinical application, along with an examination of crucial (...) ethical (and legal) issues that continued research into, and the clinical translation of, ectogenesis gives rise to. The expected benefits include advancing prenatal medicine, improving neonatal intensive care, and providing a novel pathway towards biological parenthood. This comes with important future challenges. Prior to human application, important questions have to be considered concerning translational research, experimental use of human fetuses and appropriate safety testing. Key questions are identified regarding risks to ectogenesis’ subjects, and the physical impact on the pregnant person when transfer from the uterus to the artificial womb is required. Critical issues concerning proportionality have to be considered, also in terms of equity of access, relative to the envisaged application of ectogenesis. The advent of ectogenesis also comes with crucial issues surrounding abortion, extended fetal viability and moral status of the fetus.ConclusionsThe development of human ectogenesis will have numerous implications for clinical practice. Prior to human testing, close consideration should be given to whether (and how) ectogenesis can be introduced as a continuation of existing neonatal care, with due attention to both safety risks to the fetus and pressures on pregnant persons to undergo experimental and/or invasive procedures. Equally important is the societal debate about the acceptable applications of ectogenesis and how access to these usages should be prioritized. It should be anticipated that clinical availability of ectogenesis, possibly first as a way to save extremely premature fetuses, may spark demand for non-medical purposes, like avoiding physical and social burdens of pregnancy. (shrink)

The centrality of trust in traditional doctor–patient relationships has been criticized as inordinately paternalistic, yet in today's discussions about medical ethics—mostly in response to disruptive innovation in healthcare—trust reappears as an asset to enable empowerment. To turn away from paternalistic trust‐based doctor–patient relationships and to arrive at an empowerment‐based medical model, increasing reference is made to the importance of nurturing trust in technologies that are supposed to bring that empowerment. In this article we stimulate discussion about why the move towards (...) patient empowerment may not be able to keep clear of the criticism of trust in traditional patient–doctor relationships. First, we explore how such a shift in trust dynamics might corrode patient empowerment in the name of patient empowerment. Second, we examine how a translocation of trust may at best push the “trust issue” elsewhere and at worst make it harder to evaluate trustworthiness. (shrink)

This paper proposes an integrated account of the etiology of OCD that accommodates both dysfunctional cognitions and sensorimotor features of compulsive action. It is argued that cognitive/metacognitive theories do not aspire to address all obsessive-compulsive phenomenal properties and that empirical evidence concerning some of these requires the incorporation of motor deficits as an independent factor in a plausible conception of OCD. The difference in agency attribution between obsessive-compulsive persons and schizophrenia patients with delusions of control is also accounted for in (...) terms of bottom-up processes. (shrink)

In this paper, we aim to stimulate ethical debate about the morally relevant connection between ectogenesis and the foetus as a potential beneficiary of treatment. Ectogenesis could facilitate foetal interventions by treating the foetus independently of the pregnant woman and provide easier access to the foetus if interventions are required. The moral relevance hereof derives from the observation that, together with other developments in genetic technology and prenatal treatment, this may catalyse the allocation of a patient status to the foetus. (...) The topic of foetal medicine is of growing interest to clinicians, and it also deserves due attention from an ethical perspective. To the extent that these developments contribute to the allocation of a patient status to the foetus, normative questions arise about how moral responsibilities towards foetal interests should be balanced against the interests of the pregnant woman. We conclude that, even if ectogenesis could facilitate foetal therapy, it is important to remain sensitive to the fact that it would not circumvent the key ethical concerns that come with in utero foetal treatment and that it may even exacerbate potential conflicts between directive treatment recommendations and the pregnant woman's autonomous decision to the contrary. (shrink)

People who are involuntarily childless need to use assisted reproductive technologies if they want to have a genetically related child. Yet, from an ethical point of view it is unclear to what extent assistance to satisfy this specific desire should be warranted. We first show that the subjectively felt harm due to the inability to satisfy this reproductive desire does not in itself entail the normative conclusion that it has to be met. In response, we evaluate the alternative view according (...) to which the satisfaction of this desire is regarded as a way to meet one’s presumed intermediate need for parenthood. This view presupposes that parenthood is one of those general categories of experiences and activities that contribute an irreplaceable value to people’s lives, but the central difficulty is to find those characteristics that mark out parenthood as an irreplaceable constituent of a valuable life. We go on to argue, however, that even if one assumes that parenthood is such an irreplaceable constituent that makes life more valuable, this does not necessarily entail a moral duty to satisfy the desire for genetic parenthood. We conclude that there is a pro tanto obligation to help people conceive a genetically related child (if this is what they prefer), but that this can be outweighed by other moral considerations, such as safety and justice concerns. (shrink)

The implementation of care robotics in care settings is identified by some authors as a disruptive innovation, in the sense that it will upend the praxis of care. It is an open ethical question whether this alleged disruption will also have a transformative impact on established ethical concepts and principles. One prevalent worry is that the implementation of care robots will turn deception into a routine component of elderly care, at least to the extent that these robots will function as (...) simulacra for something that they are not (i.e. human caregivers). At face value, this may indeed seem to indicate a concern for how this technology may upend existing practices and relationships within a care setting. Yet, on closer inspection, this reaction may rather point to a rediscovery and a revaluation of a particularly well-entrenched value or virtue, i.e. veracity. The virtue of veracity is one of the values that is mobilized to argue against a substitution of human caregivers (while a combination of care robots and human caregivers is much more accepted). The subject of this paper is to explore how the moral panic surrounding care robots should not so much be interpreted as an anticipated and probable disruptor in a care setting, but rather as a sensitizing – in a way conservationist – argument that identifies veracity as an established value that is supposed to be protected and advanced in present day and future care settings. (shrink)

The dominant philosophical conceptions of obsessive-compulsive behavior present its subject as having a deficiency, usually characterized as volitional, due to which she lacks control and choice in acting. Compulsions (mental or physical) tend to be treated in isolation from the obsessive thoughts that give rise to them. I offer a different picture of compulsive action, one that is, I believe, more faithful to clinical reality. The clue to (most) obsessive-compulsive behavior seems to be the way obsessive thoughts, which are grounded (...) in an irrational cognitive style in matters of risk, danger, and responsibility, motivate compulsions through bizarre means–end reasoning. I show that the patient with obsessive-compulsive disorder (OCD) is not weak and passive with regard to the compulsive act; rather, the act is voluntary and regarded by the patient as an instrument of control. I also defend the idea that OCD-related cognitions are either beliefs or mental states with relevantly similar functional roles. (shrink)

Gervain et al. discuss both behavioral and neurophysiological AGL studies that investigate rule and structure learning processes in infants. The paper provides an overview of all the major AGL paradigms used to date to investigate infant learning abilities at the level of morpho‐phonology and syntax from a very early age onwards. Gervain et al. also discuss the implications of the results for a general theory of natural language acquisition.

A part of relativistic dynamics is axiomatized by simple and purely geometrical axioms formulated within first-order logic. A geometrical proof of the formula connecting relativistic and rest masses of bodies is presented, leading up to a geometric explanation of Einstein’s famous E = mc 2. The connection of our geometrical axioms and the usual axioms on the conservation of mass, momentum and four-momentum is also investigated.

People have various desires, but it is a contested moral issue when a desire becomes of such importance that it legitimizes a moral claim on others. This paper explores how the normative significance of desire satisfaction can be assessed and argues that a normatively significant desire can constitute a pro tanto obligation to help satisfy it. The paper presents a framework that relates the normative significance of a given desire to the general goal of living a reasonably valuable life and (...) inquires how the latter can be given determinate content without excluding a heterogeneity of the personal good. The paper contends that the set of possibly normatively significant desires is thus restricted by considerations about intelligibility, adequacy, and replaceability, which are mediated by societal background theories. (shrink)

Die ursprüngliche ethische und gesellschaftliche Situation des Menschen in einer seiner frühen Schriften untersuchend sagt Fichte über die französische Revolution, dass das Sittliche dahingehend zu unterscheiden sei, ob es sich auf die Geisteswelt beziehe oder auf gesellschaftliche Verhältnisse.

Die ursprüngliche ethische und gesellschaftliche Situation des Menschen in einer seiner frühen Schriften untersuchend sagt Fichte über die französische Revolution, dass das Sittliche dahingehend zu unterscheiden sei, ob es sich auf die Geisteswelt beziehe oder auf gesellschaftliche Verhältnisse.

In this paper, by applying a feminist bioethical perspective, we identify a new form of medical paternalism that still shapes contemporary legal policies on human egg cryopreservation performed without medical reasons. The fear of negligent, careless women who opt to delay their pregnancy for mere convenience is a widely known gender biased stereotype. Nevertheless, the opinions and judgments of medical professionals on this issue have not yet been sufficiently explored by in-depth research. In this essay, therefore, first we look at (...) the broader bioethical, legal, and social aspects of human egg cryopreservation. In the second part of the paper we discuss a unique qualitative study conducted with professionals working at Hungarian IVF clinics. We argue, based on a bioethical analysis of the collected data, that when new reproduction technologies provide opportunities for women to widen their range of reproductive choices, the traditional forms of medical paternalism can be reinforced by gendered paternalism, as well. We identify several elements of gendered paternalism that characterized the attitudes of the IVF staff and discuss the professionals’ resistance to elective egg freezing and vitrification of eggs for the future. We conclude by suggesting directions for future policy. Although we focus on the Hungarian case in this paper, we are aware that similar attitudes can be observed in some other countries where this technology has become available and requested by women, but where they also face difficulties in their access to it. (shrink)

Gervain et al. discuss both behavioral and neurophysiological AGL studies that investigate rule and structure learning processes in infants. The paper provides an overview of all the major AGL paradigms used to date to investigate infant learning abilities at the level of morpho‐phonology and syntax from a very early age onwards. Gervain et al. also discuss the implications of the results for a general theory of natural language acquisition.

In this study, we directly contrast two approaches that have been proposed to explain the SNARC effect. The traditional direct mapping account suggests that a direct association exists between the position of a number on the mental number line and the location of the response. On the other hand, accounts are considered that propose an intermediate step in which numbers are categorized as either small or large between the number magnitude and the response representations. In a magnitude comparison task, we (...) departed from the usual bimanual left/right response dimension and instead introduced the unimanual close/far dimension. A spatial-numerical association was observed: small numbers were associated with a close response, while large numbers were associated with a far response, regardless of the movement direction (left/right). We discuss why these results cannot be explained by assuming a direct mapping from the representation of numbers on a mental number line to response locations and discuss how the results can be explained by the alternative accounts. (shrink)