Clinical red blood cell transfusion guidelines have been widely adopted in clinical practice, resulting in standardized transfusion practices in hospitalized patients with anemia. Standardization of transfusion practice has been welcomed by clinicians and health systems as a mechanism for reducing unnecessary, harmful, and costly practice variation that results in healthcare disparities. However, overzealously applied guidelines can have deleterious consequences for individual patients, ultimately resulting in and/or exacerbating healthcare disparities, rather than resolving them. This article provides empirical examples of the adverse (...) consequences from the well-meaning attempt to standardize transfusion practice based on clinical practice guidelines and discusses the ethical implications of standardized transfusion practice. (shrink)

In recent research, the concept of “media diets” has received increased attention. However, the concept remains vague and not fully developed, and rarely, if at all, do researchers ask citizens about their perceptions of their own and others’ media diets. With the ongoing transformation of the media landscape, there has never been a more pertinent time to explore these perceptions, which this research intends to do. The main goal of this paper then is to identify recommendations addressing recently voiced concerns (...) about news consumption patterns in contemporary society to relevant stakeholders. Empirically, the study is based on a series of focus group interviews with younger (18–25 years old) and older (over 55) adults in five European countries (Germany, Poland, Romania, Spain, and the UK). Our results show important cohort differences as well as cross-country similarities, which are pertinent insights for the formulation of stakeholder recommendations. (shrink)

U.S. researchers and scholars often point to two legal factors as significant obstacles to the inclusion of pregnant women in clinical research: the Department of Health and Human Services’ regulatory limitations specific to pregnant women's research participation and the fear of liability for potential harm to children born following a pregnant woman's research participation. This article offers a more nuanced view of the potential legal complexities that can impede research with pregnant women than has previously been reflected in the literature. (...) It reveals new insights into the role of legal professionals throughout the research pathway, from product conception to market, and it highlights a variety of legal factors influencing decision-making that may slow or halt research involving pregnant women. Our conclusion is that closing the evidence gap created by the underrepresentation and exclusion of pregnant women in research will require targeted attention to the role of legal professionals and the legal factors that influence their decisions. (shrink)

Background Although medical ethicists and educators emphasise patient-centred decision-making, previous studies suggest that patients often prefer their doctors to make the clinical decisions. Objective To examine the associations between a preference for physician-directed decision-making and patient health status and sociodemographic characteristics. Methods Sociodemographic and clinical information from all consenting general internal medicine patients at the University of Chicago Medical Center were examined. The primary objectives were to (1) assess the extent to which patients prefer an active role in clinical decision-making, (...) and (2) determine whether religious service attendance, the importance of religion, self-rated spirituality, Charlson Comorbidity Index, self-reported health, Vulnerable Elder Score and several demographic characteristics were associated with these preferences. Results Data were collected from 8308 of 11 620 possible participants. Ninety-seven per cent of respondents wanted doctors to offer them choices and to consider their opinions. However, two out of three (67%) preferred to leave medical decisions to the doctor. In multiple regression analyses, preferring to leave decisions to the doctor was associated with older age (per year, OR=1.019, 95% CI 1.003 to 1.036) and frequently attending religious services (OR=1.5, 95% CI 1.1 to 2.1, compared with never), and it was inversely associated with female sex (OR=0.6, 95% CI 0.5 to 0.8), university education (OR=0.6, 95% CI 0.4 to 0.9, compared with no high school diploma) and poor health (OR=0.6, 95% CI 0.3 to 0.9). Conclusions Almost all patients want doctors to offer them choices and to consider their opinions, but most prefer to leave medical decisions to the doctor. Patients who are male, less educated, more religious and healthier are more likely to want to leave decisions to their doctors, but effects are small. (shrink)

Throughout the history of psychoanalysis, the study of creativity and fine art has been a special concern. _Psychoanalytic Studies of Creativity, Greed and Fine Art: Making Contact with the Self_ makes a distinct contribution to the psychoanalytic study of art by focusing attention on the relationship between creativity and greed. This book also focuses attention on factors in the personality that block creativity, and examines the matter of the self and its ability to be present and exist as the essential (...) element in creativity. Using examples primarily from visual art_ David Levine_ explores the subjects of creativity, empathy, interpretation and thinking through a series of case studies of artists, including Robert Irwin, Ad Reinhardt, Susan Burnstine, and Mark Rothko. _Psychoanalytic Studies of Creativity, Greed and Fine Art_ explores the highly ambivalent attitude of artists toward making their presence known, an ambivalence that is evident in their hostility toward interpretation as a way of knowing. This is discussed with special reference to Susan Sontag’s essay on the subject of interpretation. Psychoanalytic Studies of Creativity, Greed and Fine Art contributes to a long tradition of psychoanalytically influenced writing on creativity including the work of Deri, Kohut, Meltzer, Miller and Winnicott among others. It will be of interest to psychoanalysts, psychoanalytic psychotherapists, historians and theorists of art. (shrink)

Roger Garrison's commentary on Alan Meltzer's interpretation of Keynes and Meltzer's interpretation itself are closer to each other and further from Keynes's sense than one might imagine. Keynes's logic rests on an unsubstantiated guess, as Keynes admitted, about the tendency for consumption to stagnate in an advanced economy; and on the nonsensical proposition that the possessors of loanable funds are unilaterally able to determine the cost of those funds outside of the supply‐and‐demand financial market.

Recent studies indicate that the processing of an unexpected word is costly when the initial, disconfirmed prediction was strong. This penalty was suggested to stem from commitment to the strongly predicted word, requiring its inhibition when disconfirmed. Additional studies show that comprehenders rationally adapt their predictions in different situations. In the current study, we hypothesized that since the disconfirmation of strong predictions incurs costs, it would also trigger adaptation mechanisms influencing the processing of subsequent strong predictions. In two experiments, participants (...) made speeded congruency judgments on two-word phrases in which the first word was either highly constraining or not. We manipulated the proportion of disconfirmed predictions in highly constraining contexts between participants. The results provide additional evidence of the costs associated with the disconfirmation of strong predictions. Moreover, they show a reduction in these costs when participants experience a high proportion of disconfirmed strong predictions throughout the experiment, indicating that participants adjust the strength of their predictions when strong prediction is discouraged. We formulate a Bayesian adaptation model whereby prediction failure cost is weighted by the participant’s belief about the likelihood of encountering the expected word, and show that it accounts for the trial-by-trial data. (shrink)

Part of the appeal of the biological approach to personal identity is that it does not have to countenance spatially coincident entities. But if the termination thesis is correct and the organism ceases to exist at death, then it appears that the corpse is a dead body that earlier was a living body and distinct from but spatially coincident with the organism. If the organism is identified with the body, then the unwelcome spatial coincidence could perhaps be avoided. It is (...) argued that such an identification would be a mistake. A living organism has a different part/whole relationship and persistence conditions than the alleged body. A case will be made that the concept ‘human body’ is a conceptual mess, vague in an unprincipled manner, and that an eliminativist stance towards dead bodies is the appropriate response. CiteULike Connotea Del.icio.us What's this? (shrink)

Moderate physiological or emotional arousal induced after learning modulates memory consolidation, helping to distinguish important memories from trivial ones. Yet, the contribution of subjective awareness or interpretation of arousal to this effect is uncertain. Alexithymia, which is an inability to describe or identify one’s emotional and arousal states even though physiological responses to arousal are intact, provides a tool to evaluate the role of arousal interpretation. Participants scoring high and low on alexithymia learned a list of 30 words, followed by (...) immediate recall. Participants then saw either an arousing or neutral video . Memory was tested 24-h later. Physiological response to arousal was comparable between groups, but subjective response to arousal was impaired in high alexithymia. Yet, delayed word recognition was enhanced by arousal regardless of alexithymia status. Thus, subjective response to arousal, i.e., cognitive appraisal, was not necessary for memory modulation to occur. (shrink)

The terms complexity, complex adaptive systems, and sciences of complexity are found often in recent scientific literature, reflecting the remarkable growth in collaborative academic research focused on complexity from the origin and dynamics of organisms to the largest social and political organizations. One of the great challenges in this field of research is to discover which features are essential and shared by all of the seemingly disparate systems that are described as complex. Is there sufficient synthesis to suggest the possibility (...) of an overarching science of complexity? This report describes current views on this subject held by various eminent scholars associated with the Santa Fe Institute.The physical sciences have traditionally been concerned with “simple” systems whose dynamics can be described in mathematical terms with precision and certainty. In contrast, the biological and social sciences are inevitably concerned with self-organized or social “complex” systems whose detailed behaviors appear to be unpredictable. The two categories differ greatly in size and diversity, prompting the late mathematician Stanislaus Ulam to remark that research on complex systems might be compared to the study of non-elephants. Nevertheless, certain integrative themes have begun to emerge.Rising activity in this field of research runs completely counter to the trend toward increasing fragmentation and specialization in the sciences. It has stimulated a resurgence of interest in a broad synthesis involving mathematics, computational science, physics, chemistry, biology, neuroscience, and the social sciences. The growth of effort in this very extended field has been greatly stimulated by the development of new computational tools that are capable of dealing with vast, interrelated databases. Many of the participants in complexity research feel that it is now time to reintegrate the fragmented interests of much of the academic community. The reader is encouraged to consider whether such views are sparking a historic renaissance of scholarship or represent a passing scientific diversion. (shrink)

Du sommaire: I -- Clinique et philosophie: Le probleme -- La polemique. II -- Eloge du masochisme, critique de la notion de plaisir. III -- Philosophie de la repetition: Les trois repetitions -- Comment une philosophie du temps revient a Masoch et a Sade -- L'inconscient et les problemes. IV -- Le corps sans organes, critique ou abandon de la psychanalyse?: Artaud et Van Gogh -- La distance prise par rapport a l'organisme -- Les devenirs et leur fin immanente. V (...) -- Les devenirs et les syntheses disjonctives: Les syntheses disjonctives et l'invention de la vie et de la pensee -- Repeter et inventer selon Deleuze et selon Freud -- Ambiguite de la repetition en psychanalyse. VI -- Philosophie de l'infini, creer des concepts est-ce circuler a vitesse infinie sur le chaos?: L'affinite de la philosophie avec l'infini -- L'infini et la raison contingente -- Sur la lecture de Deleuze par Alain Badiou -- Une invention conceptuelle met-elle en jeu l'infini?". (shrink)

These essays define three significant “periods” in Derrida’s writing: his early, seemingly revolutionary phase; a middle stage, often autobiographical, that included spirited defense of his work; and his late period, when his persona ...

Our aim is to shed light on the relationships between research, knowledge, and policy in the case of goitre and the use of iodine as a preventive measure against it in Norway from the 1850s onward. Goitre was previously widespread in certain areas of Norway, but disappeared around 1950. After many decades of silence about goitre and iodine, an expert report in 2016 argued that action should be taken to prevent iodine deficiency. Already in 1927, an international conference on goitre (...) led to the agreement that the best preventive measure against goitre was to fortify table salt with iodine. The conference had Norwegian participants, but Norwegian health authorities did not follow the recommendations from the conference. To understand why new knowledge and recommendations did not result in new policy, we explore the history of Norwegian research on goitre and iodine, and Norwegian contributions to and the inspiration from international research in the field. Furthermore, we analyse the measures for the prevention and curing of goitre that have been implemented by authorities over time. The preventive measures introduced in Norway from the 1930s were very modest and differed from those in other countries. We argue for the importance of analysing the political context to understand the success or failure of advice given by researchers to policymakers. (shrink)

In this innovative study, Lea David critically investigates the relationship between human rights and memory, suggesting that, instead of understanding human rights in a normative fashion, human rights should be treated as an ideology. Conceptualizing human rights as an ideology gives us useful theoretical and methodological tools to recognize the real impact human rights has on the ground. David traces the rise of the global phenomenon that is the human rights memorialization agenda, termed 'Moral Remembrance', and explores what (...) happens once this agenda becomes implemented. Based on evidence from the Western Balkans and Israel/Palestine, she argues that the human rights memorialization agenda does not lead to a better appreciation of human rights but, contrary to what would be expected, it merely serves to strengthen national sentiments, divisions and animosities along ethnic lines, and leads to the new forms of societal inequalities that are closely connected to different forms of corruptions. (shrink)

Liberal thinkers of the eighteenth and nineteenth centuries were alert to the political costs and human cruelties involved in European colonialism, but they also thought that European expansion held out progressive possibilities. In Progress, Pluralism, and Politics David Williams examines the colonial and anti-colonial arguments of Adam Smith, Immanuel Kant, Jeremy Bentham, and L.T. Hobhouse. Williams locates their ambivalent attitude towards European conquest and colonial rule in a set of tensions between the impact of colonialism on European states, the (...) possibilities of progress in distant and diverse places, and the relationship between universalism and cultural pluralism. In so doing he reveals some of the central ambiguities that characterize the ways that liberal thought has dealt with the reality of an illiberal world. Of particular importance are appeals to various forms of universal history, attempts to mediate between the claims of identity and the reality of difference, and the different ways of thinking about the achievement of liberal goods in other places. Pointing to key elements in still ongoing debates within liberal states about how they should relate to illiberal places, Progress, Pluralism, and Politics enriches the discussion on political thought and the relationship between liberalism and colonialism. (shrink)

Thus, Meyers provides a valuable account, not only of current medical attitudes, but also of relevant case and statute law as it stands at present.

Under the sway of the postulate of determinism, sociologists (with some exceptions) have given little direct attention to sheerly fortuitous events. Such events are analytically distinguishable from those which are considered the results of chance only because we currently lack knowledge of their causation. Exemplifications of pure chance abound in the various arts and sciences, including sociology (especially in work by symbolic interactionists). Direct, explicit consideration of random, accidental, or chance phenomena requires approaches that emphasize both the processes of behavior (...) and interaction and the case-study method of investigation. (shrink)

The Patient Self Determination Act of 1991 brought much needed attention to the importance of advance care planning and surrogate decision-making. The purpose of this law is to ensure that a patient’s preferences for medical care are recognized and promoted, even if the patient loses decision-making capacity. In general, patients are presumed to have DMC. A patient’s DMC may come under question when distortions in thinking and understanding due to illness, delirium, depression or other psychiatric symptoms are identified or suspected. (...) Physicians and other healthcare professionals working in hospital settings where medical illness is frequently comorbid with depression, adjustment disorders, demoralization and suicidal ideation, can expect to encounter ethical tension when medically sick patients who are also depressed or suicidal request do not resuscitate orders. (shrink)

The book introduces to readers the scope and nature of Meltzer’s contribution, and suggests the wider social context in which he saw psychoanalysis.

It is doubtless appropriate to read The Interpretation of Dreams according to the image of the journey which Sigmund Freud describes in a letter to Wilhelm Fliess:The whole thing is planned on the model of an imaginary walk. First comes the dark wood of the authorities , where there is no clear view and it is easy to go astray. Then there is a cavernous defile through which I lead my readers—my specimen dream with its peculiarities, its details, its indiscretions (...) and its bad jokes—and then, all at once, the high ground and the open prospect and the question: “Which way do you want to go?”1This walk has nothing of the nonchalant about it. Rather, it is strewn with tests and trials, as is usually the case in the “myth of the hero” or of the “conquistador,” which we know played a major role in Freud’s thought and in that of his disciples. The progress, in epic poetry, moves toward a discovery, the founding of a city, by means of difficult stages and combats. Every “discourse” capable of attaining a goal distant from its prolegomena finds its appropriate metaphor in the hero’s progress, or in the voyage of initiation. Discursivity then becomes the intellectual equivalent of the epic’s trajectory. At the time of its publication, Freud found his book insufficiently probing, and imperfect in its discursivity. He criticized himself for having failed to link properly his arguments . Doubt was momentarily cast on the achievement of the main goal…. But such severity was not to persist.But one can also read the work by discerning its framing devices. Several authors mentioned in the first chapter reappear at the work’s conclusion. Such a return is far from fortuitous; it is the result of an extremely well-calculated strategy. Another framing system which has been noticed by many readers is the one, shortly before the end of the book, which returns to a line from Virgil that Freud had placed as an epigraph on the title page: Flectere si nequeo superos, Acheronta movebo. This line, because of its repetition at two crucial points in the book, traces its message in the form of an emblem. When it breaks in, it makes explicit that the dream mechanism is the return of the repressed:In waking life the suppressed material in the mind is prevented from finding expression and is cut off from internal perception owing to the fact that the contradictions present in it are eliminated—one side being disposed of in favor of the other; but during the night, under the sway of an impetus towards the construction of compromises, this suppressed material finds methods and means of forcing its way into consciousness.Flectere si nequeo superos, Acheronta movebo.2 1. Sigmund Freud to Wilhelm Fliess, 6 Aug. 1899, Freud, The Origins of Psychoanalysis: Letters to Wilhelm Fliess, Drafts and Notes, 1887-1902, ed. Marie Bonaparte, Anna Freud, and Ernst Kris, trans. James Strachey , p. 290.2. Freud, The Interpretation of Dreams, ed. and trans. Strachey , p. 647; my emphasis. The Latin is translated in n. 1 on that page of Freud’s text: “If I cannot bend the High Powers, I will move the Infernal Regions.” All further references to this work, abbreviated I, will be included in the text. Another framing device is created by the theme of the prophetic dream, discussed at the outset of the first chapters and taken up again, with the ambivalence of denial and concession, in the final paragraph of the book. Jean Starobinski, professor emeritus at the University of Geneva, has devoted studies to Montaigne, Diderot, Rousseau, Saussure, and modern French poets. As an M.D., he is familiar with psychoanalysis and participates in the editorial board of La Nouvelle Revue de Psychanalyse . Some of his recent research deals with the history of melancholia; his most recent books are Montaigne in Motion and Rousseau . He was awarded the Balzan Prize in 1984. (shrink)

Alexithymia is associated with emotion processing deficits, particularly for negative emotional information. However, also common are a high prevalence of somatic symptoms and the perception of somatic sensations as distressing. Although little research has yet been conducted on memory in alexithymia, we hypothesized a paradoxical effect of alexithymia on memory. Specifically, recall of negative emotional words was expected to be reduced in alexithymia, while memory for illness words was expected to be enhanced in alexithymia.Eighty-five high or low alexithymia participants viewed (...) and rated arousing illness-related , emotionally positive , negative , and neutral words . Recall was assessed 45 min later.High alexithymia participants recalled significantly fewer negative emotion words but also more illness-related words than low alexithymia participants. The results suggest that personal relevance can shape cognitive processing of stimuli, even to enhance retention of a subclass of stimuli whose retention is generally impaired in alexithymia. (shrink)

Here the philosopher and physicist David Z Albert argues, among other things, that the difference between past and future can be understood as a mechanical phenomenon of nature and that quantum mechanics makes it impossible to present the entirety of what can be said about the world as a narrative of “befores” and “afters.”.

The federal regulations that govern biomedical research, most notably those enshrined in the Common Rule, express a protectionist ethos aimed at safeguarding subjects of human experimentation from the potential harms of research participation. In at least one critical way, however, the regulations have always fallen short of this promise: if a subject suffers a research-related injury, then neither the investigator nor the sponsor has any legal obligation under the regulations to care for or compensate the subject. Because very few subjects (...) with research-related injuries can meet the financial or evidentiary requirements associated with a successful legal claim to recover the costs associated with their injuries, most injured subjects must shoulder the burden of those expenses alone. For 40 years, national advisory panels have concluded that this result is out of step with the Common Rule's otherwise protectionist promise. When the Department of Health and Human Services released an Advance Notice of Proposed Rulemaking (ANPRM) in 2011, suggesting potential changes to the Common Rule, the time seemed ripe to address research-related injuries. The ANPRM, however, makes no mention of compensation for research-related injuries, and the federal government once again seems poised to stop short of addressing what has arguably become the most longstanding, frequent, and consistent plea for regulatory reform of research: protections for injured subjects. This article asks why, despite decades of federal-level panels recommending no-fault compensation for research-related injuries, the United States has so strongly resisted change. I suggest that a central reason for our current impasse is that, despite consensus among federal advisory committees that there is an obligation to compensate injured subjects, the committees have not coalesced around a moral justification for that duty. Although multiple justifications can support and even strengthen a single ethical obligation, the reverse has occurred in this context. I demonstrate that the committees' articulation of multiple ethical principles – including humanitarianism, professional beneficence, and compensatory justice – results in incongruent obligations that favor different kinds of compensation systems. This outcome, which I call “moral gridlock,” makes it extremely difficult to determine what kind of compensation scheme to implement. Recognizing that each moral argument for compensation creates a slightly different trajectory is, however, an important first step in moving toward a more systematic approach to compensating injured research subjects. (shrink)