Port-wine birthmarks (PWBs) are caused by somatic, mosaic mutations in the G protein guanine nucleotide binding protein alpha subunit q (GNAQ) and are characterized by the formation of dilated, dysfunctional blood vessels in the dermis, eyes, and/or brain. Cutaneous PWBs can be treated by current dermatologic therapy, like laser intervention, to lighten the lesions and diminish nodules that occur in the lesion. Involvement of the eyes and/or brain can result in serious complications and this variation is termed Sturge-Weber syndrome (SWS). (...) Some of the biggest hurdles preventing development of new therapeutics are unanswered questions regarding disease biology and lack of models for drug screening. In this review, we discuss the current understanding of GNAQ signaling, the standard of care for patients, overlap with other GNAQ-associated or phenotypically similar diseases, as well as deficiencies in current in vivo and in vitro vascular malformation models. (shrink)

This article integrates research on gendered organizations and the work-family interface to investigate an innovative workplace initiative, the Results-Only Work Environment, implemented in the corporate headquarters of Best Buy, Inc. While flexible work policies common in other organizations “accommodate” individuals, this initiative attempts a broader and deeper critique of the organizational culture. We address two research questions: How does this initiative attempt to change the masculinized ideal worker norm? And what do women’s and men’s responses reveal about the persistent ways (...) that gender structures work and family life? Data demonstrate the ideal worker norm is pervasive and powerful, even as employees begin critically examining expectations regarding work time that have historically privileged men. Employees’ responses to ROWE are also gendered. Women are more enthusiastic, while men are more cautious. Ambivalence about and resistance to change is expressed in different ways depending on gender and occupational status. (shrink)

This article examines the unique disadvantages experienced by Black people and other people of color with substance use disorder in health care, and argues that an intersectional approach to enforcing disability rights laws offer an opportunity to ameliorate some of the harms of oppression to this population.

Meat is a multi-billion-dollar industry that relies on people performing risky physical work inside meat-processing facilities over long shifts in close proximity. These workers are socially disempowered, and many are members of groups beset by historic and ongoing structural discrimination. The combination of working conditions and worker characteristics facilitate the spread of SARS-CoV-2, the virus that causes COVID-19. Workers have been expected to put their health and lives at risk during the pandemic because of government and industry pressures to keep (...) this “essential industry” producing. Numerous interventions can significantly reduce the risks to workers and their communities; however, the industry’s implementation has been sporadic and inconsistent. With a focus on the U.S. context, this paper offers an ethical framework for infection prevention and control recommendations grounded in public health values of health and safety, interdependence and solidarity, and health equity and justice, with particular attention to considerations of reciprocity, equitable burden sharing, harm reduction, and health promotion. Meat-processing workers are owed an approach that protects their health relative to the risks of harms to them, their families, and their communities. Sacrifices from businesses benefitting financially from essential industry status are ethically warranted and should acknowledge the risks assumed by workers in the context of existing structural inequities. (shrink)

In this essay, we consider a set of related questions concerning the role and nature of money, the working of markets, and the relationship between forms of social organization and money. Among other things, we speculate that efforts to purge the neo-classical theory of markets of the phenomenon of false trading have been misguided in the sense that they fail to grasp the dependence of a market system on the existence of some false trading.

Many philosophers believe that there is a causal condition on perception, and that this condition is a conceptual truth about perception. A highly influential argument for this claim is based on intuitive responses to Gricean style thought experiments. Do the folk share the intuitions of philosophers? Roberts et al. (2016) presented participants with two kinds of cases: Blocker cases (similar to Grice’s case involving a mirror and a pillar) and Non-Blocker cases (similar to Grice’s case involving a clock and brain (...) stimulation). They found that a substantial minority agreed that seeing occurs in the Non-Blocker cases, and that in the Blocker cases significantly less agreed that seeing occurs. They thus hypothesized that folk intuitions better align with a no blocker condition than with a causal condition. This paper continues this line of enquiry with two new experiments. The paper investigates the generality and robustness of Roberts et al.’s findings by expanding the sense modalities tested from only vision to audition and olfaction as well. The paper also uses Gricean style thought experiments as a case study for investigating the “reflection defense” against the negative project in experimental philosophy. Our results replicate and extend Roberts et al.’s study and support their hypothesis that folk intuitions better align with a no blocker condition. They also provide an empirical reason to doubt the reflection defense. (shrink)

Prescription opioid policies too often reflect over a century's worth of moralizing about the nature of opioid use disorder, the value of pain, and the meaning of suffering. The social and legal penalties to prescribers run in one direction—avoid overprescribing, however defined, at all costs. The lack of shared definitions is problematic for formulating and evaluating opioid policy. For example, the variant definitions of “misuse,” “abuse,” and “addiction” complicate estimates of morbidity. There are also no widely accepted definitions of misprescribing (...) and overprescribing. I offer here a modest attempt at the categorization of misprescribing: inadvertent overprescribing, corrupt overprescribing, qualitative overprescribing, quantitative overprescribing, multiclass overprescribing, and underprescribing. (shrink)

This chapter contains sections titled: A Brave New (Sexual) World The Original Study “Let's get this party started”: How Friends with Benefits Relationships Were Established “Is this a good idea?” Motivations and Barriers to Friends with Benefits Relationships “How does it feel?” Emotions Associated with Friends with Benefits Relationships “Can we make this work?” Rules for Maintaining Friends with Benefits Relationships “Was it good for you?” Outcomes of Friends with Benefits Relationships “So, what do you think?” Friends' Reactions to Friends (...) with Benefits Relationships Friends with Benefits Relationships: The Good, the Bad, and the Ugly. (shrink)

Considers the social and political significance of Kristeva’s oeuvre.

Earp et al. provide a robust justification for the decriminalization of drugs based on the systemic racism that fuels the “war on drugs” and the ongoing harms of drug policies to individuals...

Randomized controlled trial trial designs exist on an explanatory-pragmatic spectrum, depending on the degree to which a study aims to address a question of efficacy or effectiveness. As conceptualized by Schwartz and Lellouch in 1967, an explanatory approach to trial design emphasizes hypothesis testing about the mechanisms of action of treatments under ideal conditions, whereas a pragmatic approach emphasizes testing effectiveness of two or more available treatments in real-world conditions. Interest in, and the number of, pragmatic trials has grown substantially (...) in recent years, with increased recognition by funders and stakeholders worldwide of the need for credible evidence to inform clinical decision-making. This increase has been accompanied by the onset of learning healthcare systems, as well as an increasing focus on patient-oriented research. However, pragmatic trials have ethical challenges that have not yet been identified or adequately characterized. The present study aims to explore the views of key stakeholders with respect to ethical issues raised by the design and conduct of pragmatic trials. It is embedded within a large, four-year project that seeks to develop guidance for the ethical design and conduct of pragmatic trials. As a first step, this study will address important gaps in the current empirical literature with respect to identifying a comprehensive range of ethical issues arising from the design and conduct of pragmatic trials. By opening up a broad range of topics for consideration within our parallel ethical analysis, we will extend the current debate, which has largely emphasized issues of consent, to the range of ethical considerations that may flow from specific design choices. Semi-structured interviews with key stakeholders, across multiple jurisdictions, identified based on their known experience and/or expertise with pragmatic trials. We expect that the study outputs will be of interest to a wide range of knowledge users including trialists, ethicists, research ethics committees, journal editors, regulators, healthcare policymakers, research funders and patient groups. All publications will adhere to the Tri-Agency Open Access Policy on Publications. (shrink)

An inordinate number of low wage workers in essential industries are Black, Hispanic, or Latino, immigrants or refugees — groups beset by centuries of discrimination and burdened with disproportionate but preventable harms during the COVID-19 pandemic.

1The opinions contained in this article are those of the authors and should not be construed as policies of the American Medical Association.

The past two decades of psychoanalytic discourse have witnessed a marked transformation in the way we think about women and gender. The assignment of gender carries with it a host of assumptions, yet without it we can feel lost in a void, unmoored from the world of rationality, stability and meaning. The feminist analytic thinkers whose work is collected here confront the meaning established by the assignment of gender and the uncertainty created by its absence. The contributions brought together in (...) _Psychoanalytic Reflections on a Gender-free Case_ address a cross-section of significant issues that have both chronicled and facilitated the changes in feminist psychoanalysis since the mid 1980s. Difficult issues which have previously been ignored are considered first. The book goes on to address family perspectives as they interact and shape the child’s experience of growing up male or female. Other topics covered are the authority of personal agency as influenced by the language and theory of patriarchy, male-centred concepts that consistently define women as inferior, and the concept of gender as being co-constructed within a relationship. The gender-free case presented here will fascinate all psychoanalysts interested in exploring ways of grappling with the elusive nature of gender, as well as those studying gender studies. (shrink)

DBS Think Tank IX was held on August 25–27, 2021 in Orlando FL with US based participants largely in person and overseas participants joining by video conferencing technology. The DBS Think Tank was founded in 2012 and provides an open platform where clinicians, engineers and researchers can freely discuss current and emerging deep brain stimulation technologies as well as the logistical and ethical issues facing the field. The consensus among the DBS Think Tank IX speakers was that DBS expanded in (...) its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. After collectively sharing our experiences, it was estimated that globally more than 230,000 DBS devices have been implanted for neurological and neuropsychiatric disorders. As such, this year’s meeting was focused on advances in the following areas: neuromodulation in Europe, Asia and Australia; cutting-edge technologies, neuroethics, interventional psychiatry, adaptive DBS, neuromodulation for pain, network neuromodulation for epilepsy and neuromodulation for traumatic brain injury. (shrink)

The standard, non‐repeated prisoner's dilemma poses no true dilemma about rationality, we argue. What the prisoners ought rationally to do, unless they are selfless, depends on the relationship of trust that they have or lack with one another. This helps to diffuse the apparent conflict between individual and collective rationality. If the prisoners have reason to trust one another, pursuing a joint strategy would be rational for them. In the absence of trust, pursuing an individual strategy would be rational. The (...) solution that is supposed to be puzzling – because each prisoner confessing is worse for both than the alternative on which both remain silent – is simply the rational solution for persons who have no reason to trust one another. Philosophers have been misled by the apparent availability of the better alternative. Collective rationality is not relevant for persons who do not stand in a trusting relationship. When they do, there is no unresolved conflict between their individual and collective points of view.1. (shrink)

With the growth of precision medicine research on health data and biospecimens, research institutions will need to build and maintain long-term, trusting relationships with patient-participants. While trust is important for all research relationships, the longitudinal nature of precision medicine research raises particular challenges for facilitating trust when the specifics of future studies are unknown. Based on focus groups with racially and ethnically diverse patients, we describe several factors that influence patient trust and potential institutional approaches to building trustworthiness. Drawing on (...) these findings, we suggest several considerations for research institutions seeking to cultivate long-term, trusting relationships with patients: Address the role of history and experience on trust, engage concerns about potential group harm, address cultural values and communication barriers, and integrate patient values and expectations into oversight and governance structures. (shrink)

The gap between the number of organs available for transplant and the number of individuals who need transplanted organs continues to increase. At the same time, thousands of transplantable organs are needlessly overlooked every year for the single reason that they come from individuals who were declared dead according to cardio pulmonary criteria. Expanding the donor population to individuals who die uncontrolled cardiac deaths will reduce this disparity, but only if organ preservation efforts are utilized. Concern about potential legal liability (...) for temporary preservation of organs pending a search for family members appears to be one of the impediments to wider use of donation in cases of uncontrolled cardiac death in states without statutes explicitly authorizing such action. However, we think that the risk of liability for organ preservation under these circumstances is de minimis, and that concerns about legal impediments to preservation should yield to the ethical imperative of undertaking it. (shrink)

In this paper, we assume that organ donation policy in the United States will continue to be based on an opt-in model, requiring express consent to donate, and that families will continue to have the prerogative to make donation decisions whenever the deceased person has not recorded his or her own preferences in advance. The limited question addressed here is what should be done when a potential donor dies unexpectedly, without any recorded expression of his or her wishes at hand, (...) while a family decision is being sought. (shrink)

We estimate that 208,000 deep brain stimulation (DBS) devices have been implanted to address neurological and neuropsychiatric disorders worldwide. DBS Think Tank presenters pooled data and determined that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. The DBS Think Tank was founded in 2012 providing a space where clinicians, engineers, researchers from industry and academia discuss current and emerging DBS technologies and logistical and ethical issues facing the field. (...) The emphasis is on cutting edge research and collaboration aimed to advance the DBS field. The Eighth Annual DBS Think Tank was held virtually on September 1 and 2, 2020 (Zoom Video Communications) due to restrictions related to the COVID-19 pandemic. The meeting focused on advances in: (1) optogenetics as a tool for comprehending neurobiology of diseases and on optogenetically-inspired DBS, (2) cutting edge of emerging DBS technologies, (3) ethical issues affecting DBS research and access to care, (4) neuromodulatory approaches for depression, (5) advancing novel hardware, software and imaging methodologies, (6) use of neurophysiological signals in adaptive neurostimulation, and (7) use of more advanced technologies to improve DBS clinical outcomes. There were 178 attendees who participated in a DBS Think Tank survey, which revealed the expansion of DBS into several indications such as obesity, post-traumatic stress disorder, addiction and Alzheimer’s disease. This proceedings summarizes the advances discussed at the Eighth Annual DBS Think Tank. (shrink)

ObjectiveTo further delineate risk and resilience factors contributing to trajectories of mental health symptoms experienced by college students through the pandemic.Participantsn = 183 college students.MethodsLinear mixed models examined time effects on depression and anxiety. Propensity-matched subgroups exhibiting “increased” versus “low and stable” depression symptoms from before to after the pandemic-onset were compared on pre-pandemic demographic and psychological factors and COVID-related experiences and coping strategies.ResultsStudents experienced worsening of mental health symptoms throughout the pandemic, particularly during Fall 2020 compared with Fall 2019. (...) The propensity-matched subgroup exhibiting relative resilience reported less alcohol use prior to the pandemic, greater use of active coping strategies, and less of an impact on their college progress.ConclusionsResults point to several potential targets of screening and intervention to decrease residual impacts of the pandemic. (shrink)