Capitalizing on the hype surrounding stem cell research, numerous clinics around the world offer “stem cell therapies” for a variety of medical conditions. Despite questions about the safety and efficacy of these interventions, anecdotal evidence suggests a relatively large number of patients are traveling to receive these unproven treatments — a practice called “stem cell tourism.” Because these unproven treatments pose risks to individual patients and to legitimate translational stem cell research, stem cell tourism has generated substantial policy concern and (...) inspired attempts to reduce these risks through the development of guidelines for patients and medical practitioners. This paper examines the roles and responsibilities of physicians in patients' home countries with respect to patients' decisions to try unproven stem cell therapies abroad. Specifically, it examines professional guidance from two organizations — the American Medical Association and the International Society for Stem Cell Research — and assesses physicians' professional and legal obligations to patients considering unproven stem cell therapies. Then, drawing on qualitative interviews conducted with patients who traveled abroad for unproven stem cell treatments, it explores the roles that physicians actually play in patients' decisions and compares these actual roles with their professional and legal responsibilities. The paper concludes with a discussion of strategies to help improve the guidance physicians provide to patients considering unproven treatments. (shrink)

Stem cell science, using both embryonic and a variety of tissue-specific stem cells, is advancing rapidly and offers promise to improve medical care in the future. Yet, with the notable exception of hematopoietic stem cell transplantation, a long-established approach to treating certain cancers of the blood system, this promise is long term and most stem cell research focuses on basic scientific questions or the collection of pre-clinical data. Although some clinical trials are underway, most are focused on safety, and novel (...) effective therapy is likely a long way off. Despite the preliminary nature of most stem cell research, however, numerous clinics around the world offer stem cell “therapies” to patients today outside the context of a clinical trial. Although the number of patients who have received these stem cell-based interventions is unknown, anecdotal reports suggest a substantial population of patients is willing to try them, despite unresolved questions about their safety and efficacy. (shrink)

We explored the effects of resilience in the healthcare setting during the COVID-19 pandemic in Germany. Our study sheds light on the cross-level effects of resilience in hospitals and thus responds to calls to research this empirically. In a cross-sectional study design, the perceptions of resilience of employees in hospitals and of transformations at the individual, team, and organizational level were analyzed. An online survey was conducted in summer 2020 in Germany in which 1,710 healthcare workers completed a self-report questionnaire. (...) Results indicate that resilience is both a highly interrelated construct on the individual and organizational level and also positively linked to perceptions of transformation as an indicator for demonstration of resilience. We also found a partial mediation effect of organizational resilience and team efficacy, respectively, on the relationship between individual resilience and perceived transformation on the individual and organizational level as well as a full mediation on the team level. The study highlights the interdependence of individual and organizational resilience and its impact on perceived transformation in German hospitals during the COVID-19 pandemic. Whereas team efficacy is crucial for performance in regular work operations, during a pandemic the organizational level becomes more relevant. Theoretical and practical implications are discussed. (shrink)

Evolutionary change is opportunistic, but its course is strongly constrained in several fundamental ways. These constraints (historical/phylogenetic, functional/adaptive, constructional/morphogenetic) and their dynamic relationships are discussed here and shown to constitute the conceptual framework of Constructional Morphology. Notwithstanding recent published opinions which claim that the discovery of constraints renders Neodarwinian selection theory obsolete, we regard the insights of Constructional Morphology as being entirely consistent with this theory. As is shown here in the case of the Hyracoidea, formal analysis of the constraints (...) which have framed the evolution of various characters extends our understanding of the evolution of a taxon. (shrink)

Ecologists are challenged by the need to bridge and synthesize different approaches and theories to obtain a coherent understanding of ecosystems in a changing world. Both food web theory and regime shift theory shine light on mechanisms that confer stability to ecosystems, but from different angles. Empirical food web models are developed to analyze how equilibria in real multi-trophic ecosystems are shaped by species interactions, and often include linear functional response terms for simple estimation of interaction strengths from observations. Models (...) of regime shifts focus on qualitative changes of equilibrium points in a slowly changing environment, and typically include non-linear functional response terms. Currently, it is unclear how the stability of an empirical food web model, expressed as the rate of system recovery after a small perturbation, relates to the vulnerability of the ecosystem to collapse. Here, we conduct structural sensitivity analyses of classical consumer-resource models in equilibrium along an environmental gradient. Specifically, we change non-proportional interaction terms into proportional ones, while maintaining the equilibrium biomass densities and material flux rates, to analyze how alternative model formulations shape the stability properties of the equilibria. The results reveal no consistent relationship between the stability of the original models and the proportionalized versions, even though they describe the same biomass values and material flows. We use these findings to critically discuss whether stability analysis of observed equilibria by empirical food web models can provide insight into regime shift dynamics, and highlight the challenge of bridging alternative modelling approaches in ecology and beyond. (shrink)

This chapter argues that the objection that Socrates makes against diviners, poets, and rhapsodies having knowledge is an example of what has come to be known as an opacity objection: that is, some aspect of what would be required for them to know is unrecognised by them. This chapter contends that the opacity is of a different kind than what contemporary epistemologists have considered, and claims that Socrates’ specific version should have a place in contemporary theory of knowledge.

Nanomedicine is yielding new and improved treatments and diagnostics for a range of diseases and disorders. Nanomedicine applications incorporate materials and components with nanoscale dimensions where novel physiochemical properties emerge as a result of size-dependent phenomena and high surface-to-mass ratio. Nanotherapeutics and in vivo nanodiagnostics are a subset of nanomedicine products that enter the human body. These include drugs, biological products, implantable medical devices, and combination products that are designed to function in the body in ways unachievable at larger scales. (...) Nanotherapeutics andin vivonanodiagnostics incorporate materials that are engineered at the nanoscale to express novel properties that are medicinally useful. These nanomedicine applications can also contain nanomaterials that are biologically active, producing interactions that depend on biological triggers. Examples include nanoscale formulations of insoluble drugs to improve bioavailability and pharmacokinetics, drugs encapsulated in hollow nanoparticles with the ability to target and cross cellular and tissue membranes and to release their payload at a specific time or location, imaging agents that demonstrate novel optical properties to aid in locating micrometastases, and antimicrobial and drug-eluting components or coatings of implantable medical devices such as stents. (shrink)

Large-scale sequencing tests, including whole-exome and whole-genome sequencing, are rapidly moving into clinical use. Sequencing is already being used clinically to identify therapeutic opportunities for cancer patients who have run out of conventional treatment options, to help diagnose children with puzzling neurodevelopmental conditions, and to clarify appropriate drug choices and dosing in individuals. To evaluate and support clinical applications of these technologies, the National Human Genome Research Institute and National Cancer Institute have funded studies on clinical and research sequencing under (...) the Clinical Sequencing Exploratory Research program as well as studies on return of results. Most of these studies use sequencing in real-world clinical settings and collect data on both the application of sequencing and the impact of receiving genomic findings on study participants. They are occurring in the context of controversy over how to obtain consent for exome and genome sequencing. (shrink)

This article demonstrates the potential of using hierarchical Bayesian methods to relate models and data in the cognitive sciences. This is done using a worked example that considers an existing model of category representation, the Varying Abstraction Model (VAM), which attempts to infer the representations people use from their behavior in category learning tasks. The VAM allows for a wide variety of category representations to be inferred, but this article shows how a hierarchical Bayesian analysis can provide a unifying explanation (...) of the representational possibilities using 2 parameters. One parameter controls the emphasis on abstraction in category representations, and the other controls the emphasis on similarity. Using 30 previously published data sets, this work shows how inferences about these parameters, and about the category representations they generate, can be used to evaluate data in terms of the ongoing exemplar versus prototype and similarity versus rules debates in the literature. Using this concrete example, this article emphasizes the advantages of hierarchical Bayesian models in converting model selection problems to parameter estimation problems, and providing one way of specifying theoretically based priors for competing models. (shrink)

This article asks under what circumstances controversial technologies would be considered seriously for remediation instead of being rejected out of hand. To address this question, the authors developed a conceptual framework called public acceptability of controversial technologies. PACT considers site-specific, decision-oriented dialogues among the individuals and groups involved in selecting or recommending hazardous waste remediation technologies. It distinguishes technology acceptability, that is, a willingness to consider seriously, from technology acceptance, the decision to deploy. The framework integrates four dimensions: an acceptability (...) continuum that underlies decision-oriented dialogues among individuals and constituency groups, the attributes of these individuals and groups, the attributes of the technology at issue, and the community context—social, institutional, and physical. This article describes and explores PACT as a tool for understanding and better predicting the acceptability of controversial technologies. (shrink)

Nurse Ethicists bring a unique perspective to clinical ethics consultation. This perspective provides an appreciation of ethical tensions that will exist beyond the consult question into the moral space of patient care. These tensions exist even when an ethically preferable plan of action is identified. Ethically appropriate courses of action can still lead to moral dilemmas for others. The nurse ethicist provides a lens well suited to identify and respond to these dilemmas. The nurse–patient relationship is the ethical foundation of (...) nursing practice and this relational ontology is well suited to addressing ethical dilemmas that exist prior to and beyond the initial consult question. This paper will describe one nurse ethicist’s phronetic and pragmatic approach to a clinical ethics consult elucidated through feminist ethics and systems thinking. This paper will describe the theoretical basis for this method, present a case, and describe how this consultation approach provides a rich analysis based around relationships and responsibilities that also highlights the important ethical tensions within the social structure that exists around the patient and continue after the consult question is answered. (shrink)

Nijhawan's theory rests on the assumption that transient signals compete with predictive signals to generate the visual percept. We describe experiments that show that this assumption is incorrect. Our results are consistent with an alternative theory that proposes that vision is instead postdictive, in that the perception of an event is influenced by occurrences after the event.

A fundamental question in biology is whether phenotypes can be predicted by ecological or genomic rules. At least five cases of convergent evolution of the crab‐like body plan (with a wide and flattened shape, and a bent abdomen) are known in decapod crustaceans, and have, for over 140 years, been known as “carcinization.” The repeated loss of this body plan has been identified as “decarcinization.” In reviewing the field, we offer phylogenetic strategies to include poorly known groups, and direct evidence (...) from fossils, that will resolve the history of crab evolution and the degree of phenotypic variation within crabs. Proposed ecological advantages of the crab body are summarized into a hypothesis of phenotypic integration suggesting correlated evolution of the carapace shape and abdomen. Our premise provides fertile ground for future studies of the genomic and developmental basis, and the predictability, of the crab‐like body form. (shrink)

The neonatologist was describing the dire situation, the complexity of the fetus's anomalies, and the options—comfort care, some resuscitation—and finished by saying, “We would not recommend ECMO …” “We would not recommend” is a curious phrase. There is something ambiguous, very nebulous about it, something passive, noncommittal, maybe even deflective. As a bioethics researcher, I wondered how this phrase is interpreted, how it influences parents' moral deliberation over their options.

Navigating tragic circumstances in pediatrics requires consideration of parental grief responses. We meet parents where they are, not where we might want them to be. Different parents grieve differ...

Caruso Brown brings forward an argument that clinicians and ethicists have a duty to consider decision-makers marginalized by hierarchical structures. The author presents a pragmatic approac...

© 2015 Elsevier Inc.Postnatal organogenesis occurs in an immune competent environment and is tightly controlled by interplay between positive and negative regulators. Innate immune cells have beneficial roles in postnatal tissue remodeling, but roles for the adaptive immune system are currently unexplored. Here we show that adaptive immune responses participate in the normal postnatal development of a non-lymphoid epithelial tissue. Since the mammary gland is the only organ developing predominantly after birth, we utilized it as a powerful system to study (...) adaptive immune regulation of organogenesis. We found that antigen-mediated interactions between mammary antigen-presenting cells and interferon-γ -producing CD4+ T helper 1 cells participate in MG postnatal organogenesis as negative regulators, locally orchestrating epithelial rearrangement. IFNγ then affects luminal lineage differentiation. This function of adaptive immune responses, regulating normal development, changes the paradigm for studying players of postnatal organogenesis and provides insights into immune surveillance and cancer transformation. Plaks et al. (shrink)

In his Philosophical Inquiry concerning Human Liberty (1717), the English deist Anthony Collins proposed a complete determinist account of the human mind and action, partly inspired by his mentor Locke, but also by elements from Bayle, Leibniz and other Continental sources. It is a determinism which does not neglect the question of the specific status of the mind but rather seeks to provide a causal account of mental activity and volition in particular; it is a ‘volitional determinism’. Some decades later, (...) Diderot articulates a very similar determinism, which seeks to recognize the existence of “causes proper to man” (as he says in the Réfutation d’Helvétius). The difference with Collins is that now biological factors are being taken into account. Obviously both the ‘volitional’ and the ‘biological’ forms of determinism are noteworthy inasmuch as they change our picture of the nature of determinism itself, but my interest here is to compare these two determinist arguments, both of which are broadly Spinozist in nature – and as such belong to what Jonathan Israel called in his recent book “the radical Enlightenment,” i.e. a kind of underground Enlightenment constituted by Spinozism – and to see how Collins’ specifically psychological vision and Diderot’s specifically biological vision correspond to their two separate national contexts: determinism in France in the mid-1750s was a much more medico-biological affair than English determinism, which appears to be on a ‘path’ leading to Mill and associationist psychology. (shrink)

The COVID-19 pandemic has raised a host of ethical challenges, but key among these has been the possibility that health care systems might need to ration scarce critical care resources. Rationing p...

Ce livre étudie, à travers une série d'épisodes allant de la philosophie des Lumières à notre époque, le problème du matérialisme dans l'histoire de la philosophie et l’histoire des sciences. Comment comprendre les spécificités de l’histoire du matérialisme, des Lumières à nos jours, au sein de la grande histoire de la philosophie et de l’histoire des sciences ? Quelle est l’actualité de l’opposition classique entre le corps et l’esprit ? Qu’est-ce que le rire ou le rêve peuvent nous apprendre du (...) matérialisme ? En traversant l’histoire de ce concept jusqu’à l’émergence d’un « nouveau matérialisme » contemporain, l’ouvrage vise à revitaliser le matérialisme et sa lecture. -/- . (shrink)

The pandemic creates unprecedented challenges to society and to health care systems around the world. Like all crises, these provide a unique opportunity to rethink the fundamental limiting assumptions and institutional inertia of our established systems. These inertial assumptions have obscured deeply rooted problems in health care and deflected attempts to address them. As hospitals begin to welcome all patients back, they should resist the temptation to go back to business as usual. Instead, they should retain the more deliberative, explicit, (...) and transparent ways of thinking that have informed the development of crisis standards of care. The key lesson to be learned from those exercises in rational deliberation is that justice must be the ethical foundation of all standards of care. Justice demands that hospitals take a safety‐net approach to providing services that prioritizes the most vulnerable segments of society, continue to expand telemedicine in ways that improve access without exacerbating disparities, invest in community‐based care, and fully staff hospitals and clinics on nights and weekends. (shrink)

Le concept d' Umwelt est souvent considéré comme l'équivalent allemand du concept français de « milieu ». En revenant sur l' apparition du concept scientifique d' Umwelt au début du XXe siècle, nous souhaitons mettre en évidence sa genèse polémique et le fait qu'il est, contre toute attente, le résultat d'un rejet du concept de milieu. Pour le géographe F. Ratzel et le biologiste J. von Uexküll, ce concept était en effet indissociable de la théorie de Taine. Beaucoup trop déterministe (...) à leurs yeux, elle renforçait le monisme matérialiste qui se développait alors en Allemagne et auquel ils souhaitaient mettre un terme. (shrink)

Growth mindset is an important aspect of children’s socioemotional development and is subject to change due to environmental influence. Orchestral music education may function as a fertile context in which to promote growth mindset; however, this education is not widely available to children facing economic hardship. This study examined whether participation in a program of orchestral music education was associated with higher levels of overall growth mindset and greater change in levels of musical growth mindset among children placed at risk (...) by poverty. After at least 2 years of orchestral participation, students reported significantly higher levels of overall growth mindset than their peers; participating students also reported statistically significant increases in musical growth mindset regardless of the number of years that they were enrolled in orchestral music education. These findings have implications for future research into specific pedagogical practices that may promote growth mindset in the context of orchestral music education and more generally for future studies of the extra-musical benefits of high-quality music education. (shrink)

Christliche Ethik in der technischen Welt.--Kybernetik und christliches Ethos.--Christliche Anthropologie und biologische Zukunft des Menschen.--Die Stadt als Ort der Utopie.--Christliche Zukunftshoffnung und rationale Zukunftsplanung.--Verantwortung für die Folgen der Freiheit, theologische Überlegungen zum Thema Umweltschutz.

L’histoire de l’importation du terme de « sociologie » dans l’espace germanophone n’est pas celle d’une appropriation heureuse et spontanée. Il a été le plus souvent évité ou utilisé entre guillemets. Pour comprendre ce rapport passionné à la « sociologie », cet article propose une enquête de sémantique historique transnationale qui part d’un relevé bibliométrique des titres de livres incluant ce terme, publiés en allemand jusqu’en 1908 (création de la « société allemande de sociologie »). Comte y apparaît comme un (...) spectre qu’on cherche à repousser. Les connotations socialistes françaises et la proximité imaginée entre la sociologie et les sciences de la nature expliquent la méfiance au long cours des savants germanophones à l’égard de ce label. (shrink)