In lieu of an abstract, here is a brief excerpt of the content:Decision-Making as a Broader ConceptJacinta O. A. Tan (bio), Anne Stewart (bio), and Tony Hope (bio)KeywordsCompetence, decision-making, capacity, anorexia nervosa, autonomy, values, identityWe thank Demian Whiting for the thoughtful critique of aspects of our paper (Tan et al. 2006a). A primary aim of our research was to provide empirical grounds on which to stimulate discussion about the nature of decision-making capacity (DMC). Whiting criticizes in particular the concept of (...) 'pathological values' that we suggested might be relevant in the assessment of DMC and in the related issue of deciding when a patient's refusal of beneficial treatment should be overridden.Whiting's central concern is with DMC. Whiting argues that the absence of pathological values should not be a criterion for DMC. We are unclear whether he is also arguing that pathological values do not provide a reason of any kind for overriding treatment refusal. At the end of the paper he writes: "we cannot justify compulsory treatment of patients who have pathological values... on the grounds that these patients lack DMC" (2009, XX). This seems to leave open the possibility that we may be able to justify compulsory treatment of patients who have pathological values on grounds other than that they lack DMC. As we wrote in our response to the discussants of our original paper, "The primary issue for us is whether the reasons for refusal to which we draw attention provide grounds for overriding refusal, and if they do how they can be characterized in such a way as to avoid the ever-present danger of simply overriding autonomy in a patient's best interests" (Tan et al. 2006b, 300).In deciding on whether to use compulsory treatment, there are other relevant factors that may need to be considered, such as the seriousness of the decision, which determines the threshold for competence. However, in this response we consider three issues. First, we argue that the current concept of DMC is by no means so clear cut or generally agreed upon as Whiting implies, and that some of the lack of clarity relates to pathological values. Second, that the concept of DMC is itself dependent on accounts of autonomy, and that it is plausible that pathological values can affect autonomy. Third, we directly consider the question of whether a coherent account of pathological values might be given based on a concept of authenticity.The Current Criteria for DMCWhiting argues that the current criteria for DMC are correct and that an additional criterion along the lines of absence of pathological values should not be added. This argument assumes that there is a clear and agreed understanding of the current criteria. We believe this is not the case for three reasons.(i) Whiting begins his account of DMC by saying that it is normally taken to include: "(1) [End Page 345] understanding (and appreciation)" (2009, 341). Already there is an area of dispute, and the use of parentheses reflects this. The concept of 'appreciation' was developed by Grisso and Applebaum (Grisso, Appelbaum, and Hill-Fotouhi 1997). It is not included in either English common law development, for example (ReC), nor in the criteria specified in the Mental Capacity Act 2005. More important, Grisso and Appelbaum in their comment on our original paper (2006) argue that our work advances thinking about 'appreciation' rather than requiring that we add new elements. The implication is that they believe that what we have called pathological values are relevant to the assessment of capacity and are already included in an account of capacity that incorporates the criterion of 'appreciation.' In our response, we argued that pathological values are not entirely captured within the account of appreciation that Grisso and Appelbaum had previously given. We do not want to revisit that issue here, but the point of relevance is that on one view (that of Grisso and Appelbaum) pathological values are already included in the current criteria for DMC as part of the concept of appreciation, whereas on Whiting's view they are not.(ii) Even if there were agreement over the wording and concepts relevant to DMC there is a further important issue: how are those concepts... (shrink)

Capacity and competence in the field of child and adolescent psychiatry are complex issues, because of the many different influences that are involved in how children and adolescents make treatment decisions within the setting of mental health. This article will examine some of the influences which must be considered, namely: developmental aspects, the paradoxical relationship between the need for autonomy and participation and the capacity of children, family psychiatry, and the duty of care towards children and adolescents. The legal frameworks (...) relevant to consideration of consent and competence will be briefly considered, as well as some studies of children's consent, participation and competence. A case vignette will be used as a focus to consider the complexity of the issue of competence in child and adolescent psychiatry, in the particular mental disorder of anorexia nervosa. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Studying Penguins to Understand BirdsJacinta O. A. Tan (bio), Anne Stewart (bio), Ray Fitzpatrick (bio), and Tony Hope (bio)Keywordsanorexia nervosa, treatment decision-making, competence, valuesWe are grateful to Grisso, Appelbaum, Charland, and Vollmann for their thoughtful commentaries on our paper. We would like to respond by picking up on some of the points they make, although we do not address all the issues raised.Our general aims in the paper are (...) less immediately pragmatic than are the central concerns of Grisso and Appelbaum. Our interest is primarily in a number of ethical, and related conceptual, issues that arise from empirical data. In the long run, of course, we believe that these ethical and conceptual issues are important to the care of people with mental disorders, but our focus is philosophical.Our central interest is what justifies overriding treatment refusal. We are unhappy with a "status" approach according to which, for example, the mere fact that a person suffers a mental disorder provides grounds for overriding her wishes. Such an approach, it seems to us, fails to identify reasons, and discriminates against those with mental disorder, a view shared by the Law Commission (The Law Commission 1995). We are, on the other hand, attracted by the approach that grounds any overriding of treatment refusal on lack of capacity (or competence) to make treatment decisions. The concept of capacity has been well developed through legal cases and conceptual analysis, not least by Grisso and Appelbaum themselves. We were struck, however, first through clinical experience, and subsequently from the pilot study reported in our paper, that many patients with anorexia nervosa who refuse treatment do not necessarily lack capacity, using the current criteria, and yet show features or give reasons that raise serious doubts as to whether it is right to respect their refusal of treatment.To avoid reliance on a "status" approach, the issue with which we are grappling is whether the concept of capacity (and therefore lack of capacity) can be developed to encompass some of our findings, and whether it is ethically right to do so. Charland makes the important point that the concept of competence, or capacity, has both a descriptive and a prescriptive component. It is for this reason that the question of whether, for example, we should extend the criteria for capacity is part of the question of when it is morally right to override treatment refusal.Grisso and Appelbaum suggest that our work advances "our thinking about appreciation, rather than requiring that we add new elements" (2006, 297). From our perspective, and at this stage, it is a secondary issue whether we are suggesting a development of appreciation, or a new element (e.g., "pathological values"). The primary issue for us is whether the reasons for refusal to which we draw attention provide grounds for overriding refusal, and if they do how they can be characterized in [End Page 299] such a way as to avoid the ever-present danger of simply overriding autonomy in a patient's best interests.We chose to study anorexia nervosa for various reasons, but we expect that the issues raised have a more general relevance (such as to substance abuse and impulse control disorders as Grisso and Appelbaum and Charland suggest). We do not expect the results to be relevant to all, or even most, mental disorders. Our main interest is not the specific management of people with anorexia, but how the data challenge, and help to develop, the concept of capacity, and the ethical analysis of overriding patient refusal of treatment. Our paper aims to address what we understand Charland to be referring to by the "pretheoretical desiderata" (2006, 283) of the concept of capacity. One reason why we chose anorexia as the focus of this work is because it is different from many mental disorders in the issues that it raises. In this it is, perhaps, rather like studying penguins to better understand the concept of bird just because penguins, although clearly birds, have unusual features.We agree, therefore, with Grisso and Appelbaum's caution that it would be unwise to jump in and change the MacCAT-T on the basis of the results... (shrink)

Differences in guidance from various organisations is preventing uniform standards of practiceThe emphasis in medical law and ethics on protecting the patient’s right to choose is at an all time high. Apart from circumscribed situations, for instance where the Mental Health Act 19831 is applicable, the only justification for medically treating an adult patient against his or her wishes is on the basis of common law, using the principle of best interests, and only when he or she lacks capacity to (...) refuse treatment. As a result, it is important that clinicians should be able to assess capacity to refuse treatment. Given that judgements of incapacity involve deciding that a person does not have the ability to refuse treatment, a great deal of care needs to go into the assessment and characterisation of incapacity.There is divergence between the characterisation of capacity that is used by the courts and that which is recommended by the British Medical Association . The BMA usefully expands on the first element of capacity as set out in the standard legal definition of capacity in the Re C judgment2 but ignores the other two elements. By doing this, the BMA makes it unclear whether it is rejecting these as relevant to capacity; it also misses the opportunity to expand on these elements in a clinically useful way.We will begin with a description of the BMA’s advice3 and the standard English legal definition of capacity.2,4 Then we will show that there are important discrepancies between these two sources of advice. We think that the BMA ought to clarify its position on capacity in order to safeguard the interests of physicians, healthcare workers, and patients.THE RE C TESTMr C was a patient in a psychiatric secure hospital who had chronic paranoid schizophrenia with …. (shrink)

This paper explores the ethical and conceptual implications of the findings from an empirical study (reported elsewhere) of decision-making capacity in anorexia nervosa. In the study, ten female patients aged thirteen to twenty-one years with a diagnosis of anorexia nervosa, and eight sets of parents, took part in semistructured interviews. The purpose of the interviews was to identify aspects of thinking that might be relevant to the issue of competence to refuse treatment. All the patient-participants were also tested using the (...) MacArthur Competence Assessment Tool—Treatment test of competence. This is a formalized, structured, interviewer-administered test of competence, which is a widely accepted clinical tool for determining capacity. The young women also completed five brief, self-administered questionnaires to assess their levels of psychopathology. The issues identified from the interviews are described under two headings: difficulties with thought processing and changes in values. The results suggest that competence to refuse treatment may be compromised in people with anorexia nervosa in ways that are not captured by traditional legal approaches. (shrink)

As leadership discourses in higher education are increasingly being mediated online, texts previously reserved for staff are now being made available in the public domain. As such, these texts become accessible for study, critique and evaluation. Additionally, discourses previously confined to the written domain are now increasingly multimodal. Thus, an approach is required that is capable of relating detailed, complex multimodal discourse analyses to broader sociocultural perspectives to account for the complex meaning-making practices that operate in online leadership discourses. For (...) this purpose, a digital multimodal discourse approach is proposed and illustrated via a small-scale case study of the online leadership discourse of an Australian university. The analysis of two short video texts demonstrates how a digital multimodal discourse perspective facilitates the identification of key multimodal systems used for meaning-making in online communication, how meaning arises through combinations of semiotic choices, and how the results of multimodal discourse analysis using digital technology can reveal larger sociocultural patterns – in this case, divergent leadership styles and approaches as reflected in online discourse, at a time of immense change within the higher education sector. (shrink)

Deep Brain Stimulation is currently being investigated as an experimental treatment for patients suffering from treatment-refractory AN, with an increasing number of case reports and small-scale trials published. Although still at an exploratory and experimental stage, initial results have been promising. Despite the risks associated with an invasive neurosurgical procedure and the long-term implantation of a foreign body, DBS has a number of advantageous features for patients with SE-AN. Stimulation can be fine-tuned to the specific needs of the particular patient, (...) is relatively reversible, and the technique also allows for the crucial issue of investigating and comparing the effects of different neural targets. However, at a time when DBS is emerging as a promising investigational treatment modality for AN, lesioning procedures in psychiatry are having a renaissance. Of concern it has been argued that the two kinds of interventions should instead be understood as rivaling, yet “mutually enriching paradigms” despite the fact that lesioning the brain is irreversible and there is no evidence base for an effective target in AN. We argue that lesioning procedures in AN are unethical at this stage of knowledge and seriously problematic for this patient group, for whom self-control is particularly central to wellbeing. They pose a greater risk of major harms that cannot justify ethical equipoise, despite the apparent superiority in reduced short term surgical harms and lower cost. (shrink)

It feels like there’s two of you inside—like there’s another half of you, which is my anorexia, and then there’s the real K [own name], the real me, the logic part of me, and it’s a constant battle between the two. The anorexia almost does become part of you, and so in order to get it out of you I think you do have to kind of hurt you in the process. I think it’s almost inevitable. We came to the (...) concept of authenticity belatedly, one might say. We had been talking to people who had a diagnosis of anorexia nervosa about their experiences of living with their condition, and though we had not raised issues of authenticity or identity ourselves, they often did. They struggled with questions of .. (shrink)

Contemporary diagnostic criteria for anorexia nervosa explicitly refer to affective states of fear and anxiety regarding weight gain, as well as a fixed and very strong attachment to the pursuit of thinness as an overarching personal goal. Yet current treatments for that condition often have a decidedly cognitive orientation and the exact nature of the contribution of affective states and processes to anorexia nervosa remains largely uncharted theoretically. Taking our inspiration from the history of psychiatry, we argue that conceptualizing anorexia (...) nervosa as a passion is a promising way forward in both our understanding and treatment of that condition. Building on the theory of the passions elaborated by Théodule Ribot, the founder of scientific psychology in France, we argue that there is convincing empirical evidence in defense of the empirical hypothesis that anorexia nervosa is a passion in Ribot’s specific, technical sense. We then explore the implications of this finding for current approaches to treatment, including cognitive–behavioral therapy, and clinical and ethical issues associated with treatment refusals. (shrink)

We are grateful for these two insightful commentaries, which both see novelty and value in the manner in which we invoke the hypothesis that anorexia nervosa is a passion, to help explain data from the Anorexia Experiences Study, which provides the basis of our inquiry. In this response, we wish to clarify and elaborate on our hypothesis; in particular, the difference between passions and moods, the manner in which our hypothesis touches on issues of authenticity and identity, and the compelling (...) parallel with addiction. We also wish to emphasize that, in proposing the hypothesis that anorexia nervosa is a passion, our primary aim is not so much to exclude or replace alternative theoretical approaches. Our focus, really, is to argue that the hypothesis that anorexia nervosa is a passion adds something rich and unique to our current understanding of that condition, which is not fully or adequately captured by alternative accounts... (shrink)

International education is impacted by multiple discourses, in particular the discourse of university as an educational institution responsible for producing and curating knowledge for the public good, pursuing truth and transforming student life, and the neoliberal marketing discourse which portrays the university as a business organization providing a service for international students as customers/consumers. Following a multimodal discourse analytic perspective, this study examines ‘Why Choose’ webpages of one British and two Australian universities to identify how the apparently conflicting higher education (...) and neoliberal marketing discourses are managed in the interdiscursive space using language, images and videos. The results reveal that ‘Why Choose’ webpages are hybrid texts where the discourse of higher education is upheld in relation to the neoliberal marketing discourse through multimodal strategies of accentuation, infusion and progression. The study argues for the necessity of undertaking a multimodal discourse approach to understand how various positions are negotiated interdiscursively in online media. (shrink)

This study takes a systemic functional multimodal social semiotic approach to the analysis and discussion of image and text relations in two sets of data. First, patterns of contextualisation of images and text in the online magazines Dabiq and Rumiyah produced by the Islamic extremist organisation which refers to itself as Islamic State are examined. The second data set consists of a sample of texts from Western online news and blog sites which include recontextualisations of images found in the first (...) data set. A sample of examples of the use and re-use of images is discussed in order to identify patterns of similarity and difference when images and text are recontextualised. It is argued that the ISIS material tends to foreground the interpersonal metafunction in combination with the textual metafunction, while the other data set tends to foreground the ideational metafunction. These inferences indicate that further exploration of a larger data set is worth pursuing. Such studies would provide deeper insights helping to distinguish between online material which supports terrorism and that which opposes it, as well as facilitating the further development of multimodal social semiotic approaches to image and text relations. (shrink)

This paper uses a social semiotic perspective to analyze Donald Trump’s domination of media coverage of the US presidential campaign from 16 June 2015, when he announced his candidacy for nomination as the Republican candidate until 8 November 2016, when he was elected as President of the United States. The paper argues that one of the keys to Donald Trump’s domination of media coverage was that, in presenting himself and his agenda, he foregrounded interpersonal meaning by making himself the focus (...) of attention of the campaign through strategies that invaded various semiotic spaces to form a “sub-semiosphere” of Trump dogma. The effects of this were that what he did and what he said captured the majority of media attention at the expense of his opponents, enabling him to win the election, despite his complete lack of background experience as a politician. (shrink)

Incidence and prevalence rates of dengue have increased over the years, and the disease is quickly becoming cause for concern within the public health community. Globally, 128 countries and slightly under four billion people are at risk of contracting dengue. In Sri Lanka, more than half of dengue cases originate in Colombo, which in previous years, used a manual pen-and-paper data management system, which meant that it was not possible to obtain or provide up-to-date information about the severity and spread (...) of dengue. In 2015, two versions of a mobile application called Mo-Buzz Dengue were developed and launched in Colombo, Sri Lanka in order to overcome the challenges of the traditional management system by capitalizing on the rising affordability and ubiquity of mobile phone technology. To keep up with the dynamic nature of disease outbreaks, real-time data need to be visualized in a manner which facilitates discerning and comprehending these patterns. Hence, we used health maps in Mo-Buzz to effectively present this information. The first version of Mo-Buzz was for public health inspectors, digitized data management as well as provided educational materials. The second version of Mo-Buzz was a source of information for the general public, a crowdsourcing platform to provide information relating to dengue transmission, and for health authorities to alert users to dengue-specific developments in their area. This paper illustrates the design considerations of the Mo-Buzz disease surveillance system for the general public. A draft scaled-down version of the PHI system was used to obtain feedback and make incremental design enhancements. Additionally, similar health maps were evaluated in terms of capability and usability. These findings were applied to identify future enhancements to the health map of Mo-Buzz Dengue. (shrink)

ABSTRACTThis study examines the types of verbal, pictorial, and multimodal metaphors in the genre of sex education picture books for young children in Mainland China. Although being an educational discourse genre that is essentially concerned with transmitting scientific facts, sex education picture books employ a range of metaphors that categorize and construe the biological knowledge of human reproduction in a way that not only facilitates young children’s understanding of scientific concepts but also instills in them particular values and moralities that (...) are socioculturally conditioned. An examination of the source domains from which the metaphors are drawn and the target domains onto which the metaphors are mapped reveals three types of metaphor, namely, personification, domestication, and cross-experience metaphors. The analysis of seven sex education picture books for pre-school children suggests that these types of metaphor are used purposefully for addressing pedagogical as well as ideological con... (shrink)

Este artículo presenta una lectura crítica de un trabajo central de Axel Honneth desde la teoría de la sujeción de Judith Butler. Intenta mostrar que, por la ausencia en su escrito de una consideración sobre el poder, el pensador alemán no logra cumplir satisfactoriamente su objetivo propuesto de enfrentar las posturas que cuestionan el potencial crítico del reconocimiento. La hipótesis que aquí se maneja es que esa ausencia está ligada a su definición del reconocimiento como lo contrario de las prácticas (...) de dominio o sometimiento. Ahora bien, Honneth afirma que el escepticismo de esas posturas respecto del reconocimiento se basa en la idea de que toda praxis recognoscente reproduce de alguna manera el orden social dominante. El presente trabajo se propone entonces, cuestionar esta aseveración del autor advirtiendo que un análisis sobre el modo en que el poder actúa en las prácticas cotidianas de reconocimiento no necesariamente conlleva una renuncia de la función crítica del concepto para la teoría social. Más bien, como sugiere la noción butleriana (y foucaultiana) de crítica, sólo enmarcando al reconocimiento en el horizonte normativo que lo delimita puede convertirse en la base de la indagación social. (shrink)

Editors Wanda Teays, John-Stewart Gordon, and Alison Dundes Renteln have assembled the works of an interdisciplinary, international team of experts in bioethics into a comprehensive, innovative and accessible book. Topics covered range from torture and lethal injection to euthanasia, sex selection, vulnerable human subjects, to health equity, safety and public health, and environmental disasters like Bhopal, Fukushima, and more.

Bone marrow is the main site for hematopoiesis in adults. It acts as a niche for hematopoietic stem cells (HSCs) and contains non‐hematopoietic cells that contribute to stem cell dormancy, quiescence, self‐renewal, and differentiation. HSC also exist in resting spleen of several species, although their contribution to hematopoiesis under steady‐state conditions is unknown. The spleen can however undergo extramedullary hematopoiesis (EMH) triggered by physiological stress or disease. With the loss of bone marrow niches in aging and disease, the spleen as (...) an alternative tissue site for hematopoiesis is an important consideration for future therapy, particularly during HSC transplantation. In terms of harnessing the spleen as a site for hematopoiesis, here the remarkable regenerative capacity of the spleen is considered with a view to forming additional or ectopic spleen tissue through cell engraftment. Studies in mice indicate the potential for such grafts to support the influx of hematopoietic cells leading to the development of normal spleen architecture. An important goal will be the formation of functional ectopic spleen tissue as an aid to hematopoietic recovery following clinical treatments that impact bone marrow. For example, expansion or replacement of niches could be considered where myeloablation ahead of HSC transplantation compromises treatment outcomes. (shrink)

In an attempt to learn from COVID-19, this essay features six responses to the question: what did COVID-19 teach us, expose in us, or purge out of us when it comes to spiritual formation in Christ? Each response was written independently of the others by one of the coauthors. Diane J. Chandler focuses in on how COVID-19 exposed grievous inequities for ethnic groups in the American church and broader society. Kelly M. Kapic reminds us of the goodness of human finitude (...) and how COVID restrictions have forced many of us to embrace our limitations. Siang-Yang Tan reflects on eight lessons he has learned during this pandemic year in his role shepherding a local church. James C. Wilhoit calls us to consider the structures that are needed for local church leadership to make wise and godly decisions in times of crisis. Richard Peace draws our attention to what might be learned from the forced monasticism brought about by COVID-19 quarantines. Finally, Ruth Haley Barton pauses to consider the interdependence of human life that has been dramatically illustrated by this pandemic. While these six responses certainly do not exhaust all there is for the church to learn from COVID, we present them in the spirit of “O Lord, teach us what we do not see” and hope they will inspire your own reflections. (shrink)

In schools, trustworthiness is a foundational value taught to students through values education as well as the school activities, ethos and climate. A key determining factor for the establishment o...

PurposeThe purpose of this study was to introduce an orthogonal experimental design to improve the efficiency of building and optimizing models for freezing of gait prediction.MethodsA random forest model was developed to predict FOG by using acceleration signals and angular velocity signals to recognize possible precursor signs of FOG. An OED was introduced to optimize the feature extraction parameters.ResultsThe main effects and interaction among the feature extraction hyperparameters were analyzed. The false-positive rate, hit rate, and mean prediction time were 27%, (...) 68%, and 2.99 s, respectively.ConclusionThe OED was an effective method for analyzing the main effects and interactions among the feature extraction parameters. It was also beneficial for optimizing the feature extraction parameters of the FOG prediction model. (shrink)

The purpose of the article is to reveal the anthropologization of Dasein-psyche’s being by methods of neurophilosophy. The anthropologization of Dasein-psyche’s being by methods of neurophilosophy allows considering the noogenesis from the perspective of philosophical traditions, which is much richer in comparison with the history of scientific knowledge about the psychology of meanings. The being of Dasein-psyche in the meaning of "philosopher’s soul" was firstly mentioned by Plato in "Phaedo". The anthropologization of Dasein-psyche’s being reveals the ontological orientation and limits (...) of the being of Dasein-psyche within the being of Dasein-the-One, as well as the intellect, knowledge and techne, as the arete existentials. Theoretical basis of the study is built on Heidegger’s fundamental ontology and methods of neurophilosophy. Originality lies in exploring Dasein-psyche through the neurophilosophical approach. In the context, Dasein-psyche is revealed as a part of the whole or the image, created from Dasein-Y-Matter as a paradigm. It is formed by the factors and causes of complication, as well as by the experience of being of the previous states of matter. Conclusions. In conclusion, the anthropologization of Dasein-psyche’s being by methods of neurophilosophy allows considering the noogenesis from the perspective of philosophical traditions. The essence of a person is revealed as the arete existentials, which require further rethinking and clarification. (shrink)

Maternal opioid use during pregnancy is a growing national problem and can lead to newborns developing neonatal opioid withdrawal syndrome soon after birth. Recent data demonstrates that nearly every 15 min a baby is born in the United States suffering from NOWS. The primary treatment for NOWS is opioid replacement therapy, commonly oral morphine, which has neurotoxic effects on the developing brain. There is an urgent need for non-opioid treatments for NOWS. Transcutaneous auricular neurostimulation, a novel and non-invasive form of (...) electrostimulation, may serve as a promising alternative to morphine. tAN is delivered via a multichannel earpiece electrode worn on and around the left ear, targeting two cranial nerves—the vagus and trigeminal nerves. Prior research suggests that auricular neurostimulation exerts an anxiolytic effect on the body by releasing endogenous opioids and reduces withdrawal symptoms in adults actively withdrawing from opioids. In this first-in-human prospective, open-label trial, we investigated tAN as an adjuvant to morphine therapy in eight infants >33 weeks gestational age suffering from NOWS and receiving oral morphine treatment. Infants received tAN for 30 min 1 h before receiving a morphine dose. tAN was delivered at 0.1 mA below perception intensity at two different nerve targets on the ear: Region 1, the auricular branch of the vagus nerve; and Region 2, the auriculotemporal nerve. tAN was delivered up to four times daily for a maximum of 12 days. The primary outcome measures were safety [heart rate monitoring, Neonatal Infant Pain Scale, and skin irritation] and morphine length of treatment. tAN was well-tolerated and resulted in no unanticipated adverse events. Comparing to the national average of 23 days, the average oral morphine LOT was 13.3 days and the average LOT after tAN initiation was 7 days. These preliminary data suggest that tAN is safe and may serve as a promising alternative adjuvant for treating NOWS and reducing the amount of time an infant receives oral morphine. (shrink)

Estudio sistemático sobre la imagen y sus complejas relaciones con el lenguaje verbal, partiendo de una crítica al logocentrismo en su vertiente racionalista -que reduce el conocimiento y el pensamiento al discurso lingüístico- para desembocar en una teoría de la representación. El autor sostiene que la imagen va más allá de la representación al tornarse presencia, basándose en el examen de pensadores clásicos y teóricos actuales que han abordado cuestiones afines. Propone una teoría de la imagen que no se ciñe (...) sólo a lo visual, sino que reconoce las dimensiones no visuales de lo imaginal: "el principal objetivo de este libro es contribuir a la construcción de una filosofía de la imagen. Hoy en día es ya una necesidad urgente contar con un aparato conceptual que nos permita afrontar las distintas modalidades de lo imaginal, que aparecen en ámbitos tan diversos como la intimidad psicológica, la ciencia, la filosofía, la comunicación masiva, la religión, la educación, la propaganda o el arte". (shrink)

The factors responsible for the return of fertility post-partum have not been very clearly defined. Several previous studies have reported apparently major differences between populations in the duration of infertility associated with lactation. However, these differences may be related to the differences in study designs.

The work is carried out in line with the Russian dialectology of the German language. Its relevance comes from the fact that it is devoted to one of the territorial forms of German, which was never before linguistically studied. The authors of the paper conducted the field work in the territory of Novosibirsk region and collected data that allow analyzing the language situation of the Germans residing there. In the proposed article, the first results of this analysis are presented, which (...) give an idea of the main social and linguistic characteristics of the native forms of the German language in Novosibirsk region. In particular, the main components of the linguistic situation of the ethnoterritorial community under consideration are identified, the communicative power of each component is described, and the dialect identification of the native forms of the German language in the surveyed region is carried out. When modeling the language situation of the Germans of Novosibirsk region, the phenomena caused by interlingual contacting are emphasized. The authors show that on the territory of Novosibirsk region there are German idioms long staying outside the main continuum of German language and representing unique language formations. These language formations show signs of West Central German, and also includes phenomena caused by language interference. The simulated language situation is characterized as unbalanced - the demographic and communicative capacities of German dialects in the region under consideration are much lower than those of languages with majority status. It is noted that the demographic and communicative capacities of the described territorial forms of German language are in the process of a rapid decline. (shrink)

Prior research has examined value antecedents to sustainable consumption, including religious or cultural values. We bridge together these usually separated bodies of literature to provide an ethically-based examination of both religious and cultural values in one model to understand what drives sustainable consumption as well as outcomes on consumer well-being. In doing so, we also fulfill calls for more research on socio-demographic antecedents to ethical consumption, particularly in the domain of sustainable consumption. We examine this relationship using data from the (...) religiously and culturally diverse country of Singapore, collected from a door-to-door, representative sample utilizing numerous quality control techniques. Our path analysis and logical follow-up tests reveal that both religious and cultural values influence sustainable consumption, and then sustainable consumption positively influences consumer well-being. Implications are provided for consumer ethics, business’ ethical practices, and belief congruence theory. (shrink)

In recent decades, attempts to create and argue a new ontology of existence that could provide a robust alternative to the mainstream physicalist metaphysics have been made in science and philosophy. A new book by Bernardo Kastrup, a well-known specialist in the field of philosophy of mind and neuroscience of consciousness, offers the author's conceptually clear and rigorous formulation of the philosophical system. The author proves that appearance and reality in ontology are fundamentally experiential. A universal phenomenal consciousness is the (...) sole ontological primitive, which patterns of excitation constitute existence, and a human being is dissociated mental complexes of this universal consciousness, surrounded like islands by the ocean of its mentation. Kastrup’s idea of the World has an idealist ontological underpinning. The author contrasts his vision of the world with the existing ideas of the world perception, such as physicalism, microexperientialism and cosmopsychism. The quality of the argument, which is given in the book, suggests the revival of the philosophy of idealism as the next paradigm, according to which a form of universal mind will be viewed as nature's sole fundamental entity. (shrink)

Estamos a un año del cincuentenario de la aparición formal de la bioética en el escenario científico global. El afortunado neologismo usado por Potter en 1970 para vincular las ciencias experimentales con las ciencias humanísticas, creando un enfoque interdisciplinar indispensable -esencia de la bioética-, el cual pretende recuperar el liderazgo de la filosofía -particularmente de la ética- a fin de orientar apropiadamente los desarrollos de las ciencias prácticas en boga, como la biología, la ecología, la química, la cibernética, las nuevas (...) biotecnologías, la biomedicina, siempre con respeto de la dignidad del ser humano y su entorno. Es necesario estar alerta a ciertas tendencias actuales guiadas principalmente por intereses económicos y posverdad, corrientes transhumanistas que parecieran dar un nuevo giro copernicano en la reflexión científico-filosófica, en donde la esencia del ser humano pareciera esfumarse y quedar al libre arbitrio de las ciencias cibernéticas. ¿Qué hacer entonces? El reto que se vislumbra en el horizonte es volver a descubrir una racionalidad que la sustente, o como Potter decía en 1970: "El conocimiento de cómo utilizar el conocimiento" ¿Qué tan cerca está esta nueva ciencia de alcanzar las metas que su fundador Van Rensselaer Potter propuso para unir las ciencias experimentales con las ciencias humanísticas? ¿La biología con la filosofía, y a su vez destacar la urdimbre jurídica que de manera natural brota ante problemáticas y retos tan relevantes en el ámbito clínico, como son los que aborda y atiende la bioética como ciencia? En este contexto la bioética surge como una disciplina con un especial interés por discernir en esta multitud de nuevas posibilidades lo que es ético de lo que no lo es, lo que humaniza de lo que degrada, lo correcto de lo incorrecto, lo que concuerda con el respeto a la dignidad de las personas o no. De ahí el interés en aportar un conjunto de escritos científicos acerca de sus fundamentos y principales aplicaciones, tanto para personal de salud, alumnos de pregrado y posgrado, docentes, como a quienes pertenecen a comités hospitalarios: abogados, filósofos, representantes religiosos, así como profesionales de otros ámbitos, incluidas la investigación y la práctica clínica, que les permita tomar las decisiones correctas, dentro del marco del derecho sanitario vigente de nuestro país y conforme a los tratados internacionales de los que México es parte. El libro tiene como objetivo presentar a los estudiantes, docentes, investigadores y profesionales de distintas carreras, interesados en este ámbito, los fundamentos antropológicos y humanísticos de la novedosa y polémica ciencia de la bioética, sus campos de aplicación, los dilemas que suelen presentarse, así como algunas propuestas de solución de casos clínicos concretos por un grupo interdisciplinar de académicos de prestigiadas instituciones educativas de nuestro país. (shrink)

La admirable riqueza cultural y artística del Renacimiento esconde una desoladora miseria y aquella "edad de la abundancia" contrasta con una inmensa pobreza. Lejos de ser una broma o una pesadilla, la celebrada Utopía de Tomás Moro fue antes que nada un desafío insoslayable, pues proponía que ninguna sociedad merece tal nombre si tolera la miseria de un solo pobre. Rico y pobre explora la cuestión en ese libro de 1516 y en otros del escritor londinense para concluir con un (...) esbozo de su vida a la luz de la pobreza como virtud indispensable y libertadora. He aquí un hombre afortunado que no fue indiferente ante el infortunio de tantos y que vio en la humanitas la virtud por excelencia que lleva a una constante atención y cuidado del prójimo. Inspirado por un cambio de actitud en su época, así como por su fe cristiana y la mejor tradición estoica, mostró una robusta preocupación sobre el tema subrayando el valor social que debe tener toda riqueza, tanto a nivel estatal como individual, destacando la grave obligación cívica de los ricos y la necesidad que tienen todos, ricos y pobres, de empeñarse en la práctica de cierto desprendimiento y generosidad si no quieren mermar su propia humanidad y fallecer en su avaricia. La percepción de la miseria había cambiado de tal manera que su remedio ya no podía estar en una u otra limosna en plazas e iglesias, sino en la acción bien pensada y perentoria de todo gobierno que se tenga por justo. Sir Tomás Moro, privilegiado desde la cuna y seguro en su trabajo profesional, vio la pobreza de tantos como un desastre social, pero uno que, al mismo tiempo, debería llevar a todo ser humano a ver en el desprendimiento y generosidad una excelencia o virtud que alumbra la "otra" libertad, y tan íntima y valiosa que en su caso brilló aun en la prisión y ante el horror de una muerte injusta y atroz." -- Page 4 of cover. (shrink)