Retinoids play an important role in development and differentiation(1,2). Their effect is mediated through nuclear receptors, RAR (α, β and γ) and RXR (α, β and γ),Abbreviations. RAR: retinoic acid receptor; RXR: retinoid X receptor; T3:thyroid hormone receptor; VD3R: vitamin D3 receptor; PPAR: peroxisome proliferator activated receptor; EcR ecdycsone receptor; USP, ultraspiracle; NGFI‐B: also referred to as nur77a; ELP: embryonal long terminal repeat‐binding protein; FTZ‐F1: positive regulator of the fushi tarazu gene in blastodermstage embryos of Drosophila melanogaster; GR: (...) glucocorticoid receptor; ER: estrogen receptor; RARE, retinoic acid response element; PR: progesterone receptor; DR+x: direct repeat with a spacing of x nucleotides; DBD: DNA‐binding domain; CRABP I and II: cellular retinoic acid binding protein type I and II, respectively; MoMLV: Moloney Murine Leukemia Virus; TBP: TATA‐binding protein; TAF: TBP associated factor. which are members of a distinct subclass (hereafter referred to as type II) of the nuclear receptor superfamily that includes the thyroid hormone receptor (T3R), the vitamin D3 receptor (VD3R) and the peroxisome proliferator activated receptor (PPAR). Type II receptors transactivate through binding sites composed of closely related half‐sites (consensus sequence AGG/T TCA) arranged as direct repeats and, with the possible exception of RXR, do not bind to their cognate binding sites as homodimers but require RXR for high affinity binding. RXR thus provides a link between biologically distinct ligand induced pathways and is a potential target for cross‐regulation. In addition, RAR can utilize alternative routes to enhance transcription initiation mediated through transcriptional co‐activators which are expressed in a cell‐type specific manner. (shrink)

Horizontal transfer (HT) is the transmission of genetic material between non‐mating species, a phenomenon thought to occur rarely in multicellular eukaryotes. However, many transposable elements (TEs) are not only capable of HT, but have frequently jumped between widely divergent species. Here we review and integrate reported cases of HT in retrotransposons of the BovB family, and DNA transposons, over a broad range of animals spanning all continents. Our conclusions challenge the paradigm that HT in vertebrates is restricted to infective (...) class='Hi'>long terminal repeat (LTR) retrotransposons or retroviruses. This raises the possibility that other non‐LTR retrotransposons, such as L1 or CR1 elements, believed to be only vertically transmitted, can horizontally transfer between species. Growing evidence indicates that the process of HT is much more general across different TEs and species than previously believed, and that it likely shapes eukaryotic genomes and catalyses genome evolution. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“Can They Do This?” Dealing with Moral Distress after Third–Party Termination of the Doctor–Patient RelationshipSusan McCammonNot so long ago, a storm badly damaged the tertiary care hospital in which I practice surgical oncology. In the aftermath of the storm, the institution determined it was no longer able to provide unreimbursed cancer care, and many of my patients were terminated by a form letter from the hospital. The helplessness (...) and outrage that I experienced when I was first handed one of these letters, crumpled from the damp fist of one of my patients, was immense, and frightening in its unfamiliarity: “Can they do this?” I asked repeatedly, ascending a hierarchy of authority, which was increasingly reticent and then elusive. In short, the answer was “yes.”While this decision was made by the administration, its enactment was delegated to the physicians. Thus, not only were the physicians not involved in the decision to terminate their patients, they shouldered the burden of telling their patients that they would no longer be treated. The reason given—storm devastation—was contradicted by the orderly flow of insured patients in and out of unaffected clinics and hospitals.In those months, when the operating rooms were closed, I took to the road and learned about hospice and palliative care medicine on the ground. I drove from city to smaller city to the devastated countryside, locating my patients and providing all the care that I could with only my hands and mind and heart. I struggled with the limitations of the health care system and worked to rebuild a sustainable infrastructure at my own institution, all while trying to come to terms with bioethicist Haavi Morreim’s (1995) caution that “... it is not the physician who owes the resources at all. He cannot owe what others own and control, because moral obligations can only be assigned to those capable of fulfilling them” (p. 87).In considering my experience of moral distress over this period of time, I have reflected on the different connotations of the word, “practice.” I grappled with the philosophical terms “practice,” “praxis,” and “phronesis,” and I questioned their relevance to the word, as used in my professional life. However, in struggling to understand my moral obligations after the storm, when I was learning to do what I could, even when I couldn’t do what I felt like I should, I reconsidered. The elements of immersion, repetition, particularity, and utility that pervade this language of philosophers and artists turned out to be what preserved my ability [End Page 109] to practice medicine in a space holding only patient and practitioner.Many of the patients that I take care of are very poor. Many more are working but uninsured. This is a result of both their risk factors and the demographics and resources in my geographic catchment area. Their access to care was disrupted after a natural disaster and concerted efforts to reestablish it have not succeeded. Since then, I have learned how to tell people that they will die of cancer because they don’t have enough money. This is not a skill I was taught in medical school. I can talk about death, imminent or not, feared or anticipated. I can talk about unresectable tumors, treatments that have more risk than benefit (or no benefit at all), suffering beyond what has yet been experienced or imagined, helplessness, futility and grief. I could be neither surgeon nor oncologist without some facility with these. But I was unprepared for this move from medical to economic “can’t,” the nexus where an institutional “won’t” becomes a personal “can’t.”I should say here that I was not blind to the expense and technological hype of the American medico–industrial complex or our systematic marginalization of public health or the ever–present cries for health care reform. I understood that I was a steward and that I served both the individual and the society and had at my disposal what I was told were limited resources. These values, however, were only just being incorporated into the training of medical professionals; certainly they played no role in my own education. Morreim’s (1995) conclusion... (shrink)

The pituitary hormone prolactin (PRL) is best known for its role in the regulation of lactation. Recent evidence furthermore indicates PRL is required for normal reproduction in rodents. Here, we report on the insertion of two transposon-like DNA sequences in the human prolactin gene, which together function as an alternative promoter directing extrapituitary PRL expression. Indeed, the transposable elements contain transcription factor binding sites that have been shown to mediate PRL transcription in human uterine decidualised endometrial cells and lymphocytes. We (...) hypothesize that the transposon insertion event has resulted in divergent (pituitary versus extrapituitary) expression of prolactin in primates, and in differential actions of pituitary versus extrapituitary prolactin in lactation versus pregnancy respectively. Importantly, the TE insertion might provide a context for some of the conflicting results obtained in studies of PRL function in mice and man. (shrink)

The study aims to build a model that predicts the behavior of the use of blended learning by English teachers of basic education in China in the environment of repeated lockdowns during the COVID-19 pandemic. It examines the relationships between ICT self-efficacy, organizational support for blended learning, attitudes toward blended learning, and the use of blended learning. Data were collected from 562 teachers using a survey questionnaire. Employing partial least squares structural equation modeling, a hypothesized model was tested for path (...) coefficients and predictive power. This study found that ICT self-efficacy and organizational support for blended learning are sound predictors of teachers' use of blended learning and that the former appeared to be a stronger determinant. In addition, attitudes toward blended learning can directly influence teachers' use of blended learning and mediate the relationship between ICT efficacy and the use of blended learning and between organizational support for blended learning and the use of blended learning. These three variables account for 54.7% of the variance in teachers' use of blended learning. (shrink)

ABSTRACT Belgium legalised voluntary euthanasia in 2002, thus ending the long isolation of the Netherlands as the only country in which doctors could openly give lethal injections to patients who have requested help in dying. Meanwhile in Oregon, in the United States, doctors may prescribe drugs for terminally ill patients, who can use them to end their life – if they are able to swallow and digest them. But despite President Bush's oft‐repeated statements that his philosophy is to ‘trust (...) individuals to make the right decisions’ and his opposition to ‘distant bureaucracies’, his administration is doing its best to prevent Oregonians acting in accordance with a law that its voters have twice ratified. The situation regarding voluntary euthanasia around the world is therefore very much in flux. This essay reviews ethical arguments regarding voluntary euthanasia and physician‐assisted suicide from a utilitarian perspective. I shall begin by asking why it is normally wrong to kill an innocent person, and whether these reasons apply to aiding a person who, when rational and competent, asks to be killed or given the means to commit suicide. Then I shall consider more specific utilitarian arguments for and against permitting voluntary euthanasia. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:When Is Enough, Enough?Megan HomsyThis was a case that stuck with many members of our transplant team for a long time. The patient was a 44-year-old Caucasian male evaluated for a liver transplant with a diagnosis of hepatitis C virus (HCV), originally diagnosed 11 years before the transplant evaluation. The patient met the criteria for the following substance use diagnoses: alcohol use disorder moderate in sustained remission, in (...) a controlled environment, opioid use disorder, severe, in sustained remission, on maintenance therapy, in a controlled environment, stimulant use disorder, amphetamine-type, severe, in early remission, in a controlled environment and stimulant use disorder, cocaine-type, severe in early remission, in a controlled environment.The patient had been living in a sober living housing program for approximately ten months prior to his transplant evaluation with me, his social worker. He had also been diagnosed with depression and bipolar disorder. He had been intermittently linked with mental health services and had participated in numerous detox and substance abuse programs over the last ten years, with varying degrees of success. He was in dual diagnosis treatment (i.e., treatment for co-occurring substance use and mental health disorders) through his Suboxone clinic and was completing toxicology screenings on a biweekly basis.After concluding the minimum three months of drug and alcohol treatment set forth by the state's Organ Transplantation Consortium, the patient graduated from his sober living program, moved in with his sister, and was listed for a liver transplant.The patient was transplanted five months after his clinic evaluation. At the time of the surgery, the patient's Suboxone was abruptly discontinued and replaced with IV Dilaudid. Within days of his transplant, the patient frequently expressed concerns about his pain. Several medical services attempted to manage the pain medications, resulting in his pain management plan being changed repeatedly and much confusion over his current medication regimen. During his liver transplant hospitalization, the RN found the patient with a needle in his arm, and after a search of the patient's hospital room, the hospital police found drug paraphernalia and illicit substances. The patient was eventually discharged to an inpatient substance abuse program, which he left before completing the program and against medical advice.During his first year post-transplant, I attempted to arrange other various treatment programs for him (most of which he did not follow through with) and to find housing for him (as he had been forced to leave his sister's home after his relapse). Eventually, the patient was incarcerated on drug-related charges. Numerous times, the patient missed completing his labs and his post-transplant appointments. He did not refill his immunosuppressant medications, and for lengthy periods of time, he was unreachable by the transplant care team, which resulted in my team members and I calling the patient's family, other providers, and the police for safety checks.In the aftermath of these issues, my colleagues and I had to reckon with the realization that we had failed the patient. As a team, our transplant center created a task force to review this case and what to do in the future to prevent such breakdowns in patient care. We created protocols for managing patients who, at the time of their transplant, are on Medication Assisted Treatment (MAT) such as Suboxone and methadone. Staff across the multidisciplinary team attended trainings regarding addiction, pain management, and best practices for MAT services. Additionally, our transplant center collaborated with our hospital's addiction treatment program for a streamlined referral process for transplant patients to addiction services.This patient's case and its sensational nature resulted in many conversations, both professional and unprofessional. Members of the social worker department became aware that personnel within transplant, though not involved in patient care, were inappropriately discussing this patient's case and engaging in unprofessional behavior. Said actions led to the termination of a member of the transplant team. I was placed in the unenviable [End Page E3] position of having to report this behavior to hospital management and legal teams to protect a vulnerable patient.The ethical challenge behind this case really stems from the transplant team attempting to balance two... (shrink)

.A term rewrite system is called simply terminating if its termination can be shown by means of a simplification ordering. According to a result of Weiermann, the derivation length function of any simply terminating finite rewrite system is eventually dominated by a Hardy function of ordinal less than the small Veblen ordinal. This bound had appeared to be of rather theoretical nature, because all known examples had had multiple recursive complexities, until recently Touzet constructed simply terminating examples with complexities beyond (...) multiple recursion. This was established by simulating the Hydra battle for all ordinal segments below the proof-theoretic ordinal of Peano arithmetic. By extending this result to the small Veblen ordinal we prove the huge bound of Weiermann to be sharp. As a spin-off we can show that total termination allows for complexities as high as those of simple termination. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Beyond the Abortion Wars: A Way Forward for a New Generation by Charles C. CamosyRebecca Todd PetersBeyond the Abortion Wars: A Way Forward for a New Generation Charles C. Camosy Grand Rapids, MI: Eerdmans, 2015. 207Pp. $22.00As the title Beyond the Abortion Wars suggests, Camosy seeks a new way to address abortion in the United States that moves past the binary divisions of “pro-life” and “pro-choice.” Based on (...) his read of shifting public opinion, demographics, and interpretations of constitutional law, Camosy bypasses the question of whether our national abortion policy will change (he thinks it will) in order to focus on the question of what the new public policy ought to be (3).Camosy, a Catholic theologian, acknowledges early on that the argument he is putting forth is consistent with defined Catholic doctrine (6). Placing him solidly in the “pro-life” camp, many of the positions he seeks to defend and promote (life begins at conception, women are coerced into abortion, abortion is “tragic,” and most women seek abortion for “convenience”) are hardly new. In fact, his whole framing of the argument falls in line with the increasingly strident “pro-life” approach to abortion, which argues that abortion “hurts” women (112). This strategy developed in the 1990s after the Planned Parenthood vs. Casey decision opened up the possibility for state regulation of abortion and is the predominant rationale behind the recent spate of state regulations following the 2010 midterm elections that swept Republicans into state houses across the country (288 regulations between 2010–15 compared to 292 between 1995–2010). Camosy’s most controversial claim for the pro-life side is likely to be that the use of “indirect abortion” is morally acceptable for “proportionately serious reason(s),” which he identifies as rape and saving the life of the pregnant woman (83). The bill he proposes, the Mother and Prenatal Child Protection Act, allows for “indirect abortion” after a three-day waiting period and with submission of a signed affidavit claiming that the pregnancy is the result of nonconsensual sex. But it also establishes “equal protection of the law for prenatal children” and criminalizes abortion under most circumstances.It is unlikely that many on the pro-choice side will see these concessions as acceptable compromises. It’s a shame that Camosy seeks such an unlikely compromise rather than developing a common ground legislative proposal incorporating the many long-term feminist goals that are actually included in his bill: equal pay for equal work; addressing discrimination against parents (especially women), pregnant women, and new mothers; protection against domestic [End Page 210] violence; parental leave; universal prekindergarten and subsidized child care; and increased measures to collect child support, among others. These could serve as a basis for important legislation that would support pregnant women and their families and might indeed create circumstances in which some would decide to continue their pregnancies. Tellingly, his legislation completely ignores comprehensive sex education and free and unhindered access to all forms of contraception—the two strategies that have historically proven most effective in reducing abortion rates.As a Christian ethicist who is also working on the issue of abortion, I can appreciate that Camosy’s work is informed by his own beliefs and commitments on this issue. I share his desire to find a way forward on the issue of abortion and move beyond the abortion wars. However, I was unsatisfied with Camosy’s paternalistic approach to the issue of abortion and the women who terminate their pregnancies. His repeated assertions that women are coerced into abortion do not reflect the majority of social-scientific studies on the issue; his belief that criminalizing abortion would function to teach people (including these coerced women) that abortion is morally wrong is positively patriarchal; and his judgmental accusation that most women seek abortions for reasons of convenience betrays a deep disregard for women’s safety, economic well-being, and concern for their families, not to mention their health. We clearly have very different definitions of convenience.Rebecca Todd PetersElon UniversityCopyright © 2016 The Society of Christian Ethics... (shrink)

ObjectiveThe study aimed to enhance the learning motivation of college physical education students and improve their learning outcomes. Based on the perspective of the self-determination theory, this study explores the influence of “Small Private Online Course + flipped classroom” teaching on the learning motivation of students majoring in physical education and profoundly analyzes the influencing factors and promotion paths of learning motivation using this model.Materials and methodsA total of four classes of physical education majors in a university were selected and (...) randomly divided into an experimental group and a control group. The experimental group received “SPOC + flipped classroom” teaching, the control group received traditional teaching. Before and after the 16-week intervention, learning motivation, teacher support perception, basic psychological need satisfaction, and academic emotions of the 64 students were measured, and the data were analyzed by repeated-measures analysis of variance and partial least square regression.Results The instructional intervention reduced non-regulation, external regulation, and introjected regulation, while increased identified regulation, intrinsic regulation, and self-determination levels in the students. The levels of non-regulation, external regulation, identified regulation, and self-determination were also significantly different from those of the control group. After the intervention, the scores of support for autonomy, support for competence, support for relatedness, and need for relatedness in the experimental group were significantly higher than those in the control group. Support for autonomy, support for competence, support for relatedness, need for competence and need for relatedness positively predicted the self-determination level, and intrinsic regulation and identified regulation negatively predicted non-regulation, external regulation, and introjected regulation.Conclusion“SPOC + flipped classroom” teaching has a positive impact on students’ learning motivation of basketball skills and promotes students’ motivation autonomy. The improvement of support for autonomy, support for competence, support for relatedness, need for competence, and need for relatedness may be related to the improvement of learning motivation of college students majoring in Physical Education. “SPOC + flipped classroom” teaching enables students to obtain more demand satisfaction by giving them more demand support, while demand support and demand satisfaction can promote the internalization of learning motivation so that students can maintain high autonomy motivation. (shrink)

Personalized and continuing relationships play a central role in any society. Economists have built upon the theories of repeated games and reputations to make important advances in understanding such relationships. Repeated Games and Reputations begins with a careful development of the fundamental concepts in these theories, including the notions of a repeated game, strategy, and equilibrium. Mailath and Samuelson then present the classic folk theorem and reputation results for games of perfect and imperfect public monitoring, with the benefit of the (...) modern analytical tools of decomposability and self-generation. They also present more recent developments, including results beyond folk theorems and recent work in games of private monitoring and alternative approaches to reputations. Repeated Games and Reputations synthesizes and unifies the vast body of work in this area, bringing the reader to the research frontier. Detailed arguments and proofs are given throughout, interwoven with examples, discussions of how the theory is to be used in the study of relationships, and economic applications. The book will be useful to those doing basic research in the theory of repeated games and reputations as well as those using these tools in more applied research. (shrink)

Directive 36 of the Ethical and Religious Directives for Catholic Health Care Services gives guidance to health care professionals on the reactive administration of contraceptives to women in instances of isolated rape. This paper examines the moral permissibility of long-term proactive contraceptive use in instances of repeated marital rape by comparing it to the moral permissibility of reactive contraceptive use in cases of isolated rape found in directive 36.

In order to manage the electricity consumption information of microgrid users, the reliability of electricity information collection is studied in this paper. The normal communication between the acquisition terminal and the smart meter is a key factor affecting the accurate collection of power information; it is the basis for ensuring the operation of the microgrid as well. In order to improve the reliability of the low power line communication between the acquisition terminal and smart meters, this article first (...) uses the static networking method to layer the smart meters and select relays from them and then select the optimal communication path based on integrating communication quality and relay forwarding number dynamically, which could avoid the signal conflict problem caused by simultaneous communication. Finally, by analyzing the influence of the time-varying power line channel on the smart meter communication, a method based on the integrated communication quality and the relay number to consider the time variability of low power line communication is proposed. Choosing the optimal path of the smart meters when the communication path is abnormal can not only establish a new communication path for communication in time, but also avoid communication failures caused by the time-varying channel. Through MATLAB simulation, the time-varying dynamic network of the power line channel is introduced in this paper, which improves the reliability of the smart meter communication and has certain guiding significance for the actual smart meter network construction in microgrid. (shrink)

Recent narratives and debates surrounding long-term AI concerns—the prospect of artificial general intelligence in particular—are fraught with hidden assumptions, priorities, and values. This paper employs a humanistic, narrative-centered approach to analyze the works of two vocal, and opposing, thinkers in the field—Luciano Floridi and Nick Bostrom—to ask how the representational, descriptive differences in their works reveal the high stakes of narrative choices for how we form ideas about humanity, urgency, risk, harm, and possibility in relation to AI. This paper (...) closely reads Floridi and Bostrom using different representational models and historical narratives from works in the environmental humanities, literary theory, bioethics, and the history of technology to uncover the imaginative terrain of recent long-term AI discourse and reveal the complexity and limitations of the messaging underlying the works of different authors. (shrink)

The Termination Thesis (or “TT”) is the view that people go out of existence when they die. Lots of philosophers seem to believe it. Epicurus, for example, apparently makes use of TT in his efforts to show that it is irrational to fear death. He says, “as long as we exist, death is not with us; but when death comes, then we do not exist.”1 Lucretius says pretty much the same thing, but in many more words and more poetically: (...) “Death therefore to us is nothing, concerns us not a jot, since the nature of the mind is proved to be mortal; . . . when we shall be no more, when there shall have been a separation of body and soul, out of both of which we are each formed into a single being, to us, you may be sure, who then shall be no more, nothing whatever can happen to excite sensation.”. (shrink)

“Terminal sedation” refers to the use of sedation as palliation in dying patients with a terminal diagnosis. Although terminal sedation has received widespread legal and ethical justification, the practice remains ethically contentious, particularly as some hold that it foreseeably hastens death. It has been proposed that empirical studies show that terminal sedation does not hasten death, or that even if it may hasten death it does not do so in a foreseeable way. Nonetheless, it is clear (...) that providing terminal sedation in combination with the withholding or withdrawing of life-prolonging treatments such as fluid and nutrition can foreseeably hasten death significantly—what is here called early terminal sedation . There are ethical justifications for the use of sedation in palliative care and thus it would seem that ETS is an ethically and legally acceptable practice. However, what emerges from the literature is the repeated assertion that terminal sedation must be restricted to use in imminently dying patients—the “imminence condition”—and that therefore ETS is unacceptable. This restriction has taken on greater significance with the trend of palliative care to include the care of patients who are not imminently dying. This paper proposes to show that although there is widespread intuitive support for the imminence condition, it does not follow from the justifications for sedation as palliation, and that explicit arguments for the imminence condition are needed. (shrink)

Repeating history? Public and community health nursing in AustraliaDespite the long history in Australia of public and community health nursing, it has never been regarded as important as hospital‐based nursing. Notwithstanding the establishment of nursing organisations in the very early years of the 20th century and subsequent efforts to develop the nursing workforce, public and community health nursing has been neglected in terms of policy, research into public health nursing practice and workforce development. Even in the present day, public (...) and community health nurses are marginalised from mainstream nursing interests and there is a lack of conceptualisation about the value of nursing’s contribution to the primary health sector. This sector is experiencing a new wave of reforms driven by a combination of managerialism and systems change for improved responses to address health inequalities. Because there is not a strong institutionalised professional policy and support base for public and community health nurses, they are vulnerable in these reforms to increased domination and appropriation of their practice by stronger professional interests. There is an urgent need for professionally organised support from mainstream nursing to ensure that public and community health nurses are positioned as a unified force in efforts to advance the health of the community. (shrink)

The moral importance of the ‘intention–foresight’ distinction has long been a matter of philosophical controversy, particularly in the context of end-of-life care. Previous empirical research in Australia has suggested that general physicians and surgeons may use analgesic or sedative infusions with ambiguous intentions, their actions sometimes approximating ‘slow euthanasia’. In this paper, we report findings from a qualitative study of 18 Australian palliative care medical specialists, using in-depth interviews to address the use of sedation at the end of life. (...) The majority of subjects were agnostic or atheistic. In contrast to their colleagues in acute medical practice, these Australian palliative care specialists were almost unanimously committed to distinguishing their actions from euthanasia. This commitment appeared to arise principally from the need to maintain a clear professional role, and not obviously from an ideological opposition to euthanasia. While some respondents acknowledged that there are difficult cases that require considered reflection upon one's intention, and where there may be some ‘mental gymnastics,’ the nearly unanimous view was that it is important, even in these difficult cases, to cultivate an intention that focuses exclusively on the relief of symptoms. We present four narratives of ‘terminal’ sedation – cases where sedation was administered in significant doses just before death, and may well have hastened death. Considerable ambiguities of intention were evident in some instances, but the discussion around these clearly exceptional cases illustrates the importance of intention to palliative care specialists in maintaining their professional roles. (shrink)

This paper examines large development projects as a function of finance in the context of Hong Kong, taking Kowloon Station as an exceptionally revealing case. Hong Kong's property market is one of the most established in Asia, and it points to the ways in which large-scale development schemes proliferate along efficient and affordable mass transit railway systems with great speed and success. At Kowloon Station, finance redefines architecture; instead of focusing on aesthetics and community, it is now promoting standardization, market (...) visibility and semantic control. The financial viability of these developments depends entirely on these new goals; mega-developments such as Kowloon Station – and those in other parts of Asia – are successful in inventing major mass transit railway stations as terminals, in capturing commuters within spatial enclosures surrounded by barrier-like physical features, and in terminating architecture as it has long been established as a discipline. Mega-development is increasingly reinventing the contemporary Asian city. (shrink)

Maybe they should never have called the first movie The Terminator. After all, there’s more than one Terminator. That may seem like a picky point, but, believe it or not, philosophers have long been obsessed with trying to determine the meaning of the word “the.†Indeed, much controversy swirls around this seemingly innocuous definite article. Specifically, the controversy focuses on whether or not definite descriptions are ambiguous.

Caffeine, a known CNS stimulant is given as an adjunct component in most abused drugs which could be fatal with repeated administration in many circumstances. This paper presents a study to investigate the effect of repeated administration of caffeine at high dose on rat liver, and discusses ethical and policy issues of caffeine use. Long Evans rats were treated with pure caffeine solution in distilled water through intragastric route once daily for consecutive 56 days. Three groups of rats recognized (...) as low dose, high dose and control group received 6mg caffeine / kg BW, 12mg caffeine / kg BW and distilled water, respectively. Rat plasma was examined for liver transaminases and alkaline phosphatases concentrations which were significantly increased in plasma as compared to the control. Both rat plasma and liver homogenate were subjected to estimate malondialdehyde, advanced oxidation protein product, nitric oxide, antioxidant enzyme catalase, glutathione and superoxide dismutase activity. MDA, AOPP, NO levels increased and SOD activity decreased significantly in both plasma and liver as compared to those of control where as CAT and GSH activity remain unchanged. Rat liver tissues were studied histochemically with Hematoxylin and Eosin, and Picro Sirius Red staining. Significantly increased infiltration of inflammatory cells and progressive deposition of collagen fibre were visible in liver tissue of caffeine treated both dose groups as compared to the control. Long term administration of caffeine at higher dose, significantly contributes to liver inflammation and consequent fibrogenesis. This raises significant ethical and policy issues. (shrink)

Head injuries are an inherent risk of participating in the major collision sports played in Australia. Protocols introduced by the governing bodies of these sports are ostensibly designed to improve player safety but do not prevent players suffering from repeated concussions. There is evidence that repeated traumatic brain injuries increase the risk of developing a number of long term problems but scientific and popular debates have largely focused on whether there is a causal link between concussion and chronic traumatic (...) encephalopathy. We argue that the governing bodies of collision sports played in Australia have used uncertainty about CTE to justify a “wait and see” approach instead of attempting to prevent repeated head injuries. This stance is difficult to defend when these governing bodies claim to give a high priority to protecting player welfare. (shrink)

This staggering work of erudition and passion -Terminal Philosophy Syndrome: Ecology and the Imponderable - points the finger to the human as catalyst for countless ways of self-destruction and devastation of innumerable forms of non-humans. What can be done? How can we even recognize our complicity in so many tragedies, from the Holocaust and the many events before and since including the invasion of Ukraine and the ongoing slaughter of billions of animals each year to slake unquenched human hunger? (...) Tobias and Morrison call for a mind shift, a radical move from passivity to bold changes in thinking and lifestyle. By itemizing the scope and scale of our current global emergency in the context of a long and brutal history, this book serves as a powerful incentive to stand up and be counted, and to commit oneself personally to be part of the needed solutions. Tobias and Morrison's encounter with Putin underlines the fragility and limits and urgency of human agency. The question remains: will the examples of Jain austere living and Bhutan's good government be enough to provide a roadmap into an uncertain future? (shrink)

Repeat offenders receive longer sentences than first offenders in virtually every modern jurisdiction. Such prior-record enhancements are politically popular. Scholars are more divided, especially regarding severe enhancements. Retributivists have long disagreed about which enhancements, if any, are morally justifiable and on what basis. This article advances the debate, offering lessons for retributivists on all sides. I address an intuitive argument that justifies enhancements in terms of character. This argument has been caricatured and dismissed, with defenders of enhancements preferring character-independent (...) arguments. I reconstruct an argument for enhancements that assumes recidivism constitutes evidence of culpability-aggravating character traits. The argument seems at least coherent, inferentially valid, and intuitively plausible. I then raise what I see as the real threats to the argument, which are neither conceptual nor normative, but empirical. I identify some formal features that the character argument requires of culpability-aggravating traits. To support enhancements, such traits must also correlate properly with criminal records. One place to look for characterizations of such traits, and evidence of correlation, is criminology, in theories of criminogenesis and criminality. I conclude that character arguments for prior-record enhancements cannot be dismissed, although their thorough evaluation awaits answers to complex empirical questions. (shrink)

Subjects classified visible 2-digit numbers as larger or smaller than 55. Target numbers were preceded by masked 2-digit primes that were either congruent (same relation to 55) or incongruent. Experiments 1 and 2 showed prime congruency effects for stimuli never included in the set of classified visible targets, indicating subliminal priming based on long-term semantic memory. Experiments 2 and 3 went further to demonstrate paradoxical unconscious priming effects resulting from task context. For example, after repeated practice classifying 73 as (...) larger than 55, the novel masked prime 37 paradoxically facilitated the “larger” response. In these experiments task context could induce subjects to unconsciously process only the leftmost masked prime digit, only the rightmost digit, or both independently. Across 3 experiments, subliminal priming was governed by both task context and long-term semantic memory. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Care of the terminal patient:Are we on the same page?Lauren WancataIn surgical training a “service” or care team consists of sick patients admitted to the hospital and the medical team caring for the patient. Each service consists of an attending physician, a chief resident, a senior resident and junior residents structured as a hierarchy. The chief was gone for the week. As a senior trainee I would be (...) the acting chief—a role I had assumed many times before this month. To prepare for the week of his absence, I read through each patient’s chart, and the chief and I discussed each patient—diagnosis, procedures, and plans.One was a 41–year–old male with cancer—he was young, but a patient like him was not uncommon at my institution. He originally came in through the emergency department with abdominal pain and difficulty with urination. His admitting medical team started the work–up for his symptoms—blood tests, a CAT scan, and consults to other physician services with specialized knowledge. He eventually underwent endoscopy with biopsies of his stomach and placement of stents into his ureter and kidney for his urinary issues. With return of the biopsies, he had a diagnosis—cancer. He required additional procedures, including the placement of stents into his bile ducts, as they, like his ureter, had become affected by the cancer. The next step was staging the cancer to determine his treatment options. Our surgical service was consulted for a diagnostic laparoscopy with washing—we would take a look inside his abdomen with a camera and obtain a fluid sample to be sent to the pathologist for review, the standard of care for this type of cancer. When the camera was placed nodules were seen—a sample of the nodules and the fluid were sent to a pathologist and determined to be positive for cancer: metastatic disease, stage IV. A special feeding tube was placed into his small intestine to aid in nutritional support, as he had already lost a significant amount of weight, and improving his nutrition would be imperative for any further treatments. Following this operation, oversight of his day–to–day care was taken on by our surgical service, and he had been under our care for a period of time before I rotated onto the service for the month.What was the plan for his care in the hospital, and what was his–long–term plan? His cancer could not be surgically removed due to the extent of its spread within his body. He had recently undergone another CAT scan due to an elevation in his white blood cell count (this elevation was a sign of possible infection) and a thoracentesis, a procedure to remove some of the fluid that was collecting around his lungs. Nephrologists (kidney specialist) had been consulted due to his declining kidney function. Throughout the days, his tube feeds, his source of nutrition, would often be turned off due to bloating and feeling full.Each morning, I rounded with our team, and we would see how he was doing. We would discuss how his night went, and make a plan for the day. He was a man of few words, but his wife was always at his bedside, to support him, listen to updates and keep tract of his progress. She had worked at the hospital and had seen a wide range of patients. She would ask about his kidney function, his tube feeds, and his labs. But, she never asked about his prognosis. I would leave his room each day with the unnerving feeling that the patient, family members and care team were not on the same page. Yes, we all wanted him to get better and to leave the hospital. [End Page 28] But, was he really going to get better? What defined better? Did the patient and his family really know the extent of his disease and his prognosis?Towards the end of my week as chief, I started to ask if they had any other questions. It had been a few weeks since his operation. Was there anything that they wanted to discuss or ask me about? At the... (shrink)

Long DNA palindromes pose a threat to genome stability. This instability is primarily mediated by slippage on the lagging strand of the replication fork between short directly repeated sequences close to the ends of the palindrome. The role of the palindrome is likely to be the juxtaposition of the directly repeated sequences by intrastrand base‐pairing. This intra‐strand base‐pairing, if present on both strands, results in a cruciform structure. In bacteria, cruciform structures have proved difficult to detect in vivo, suggesting (...) that if they form, they are either not replicated or are destroyed. SbcCD, a recently discovered exonuclease of Escherichia coli, is responsible for preventing the replication of long palindromes. These observations lead to the proposal that cells may have evolved a post‐replicative mechanism for the elimination and/or repair of large DNA secondary structures. (shrink)

When deciding how ‘death’ should be defined, it is helpful to consider cases in which vital functions are restored to an organism long after those vital functions have ceased. Here I consider whether such restoration cases can be used to refute termination theses. Focusing largely on the termination thesis applied to human animals, I develop a line of argument from the possibility of human restoration to the conclusion that in many actual cases, human animals continue to exist after they (...) die. The line of reasoning developed here can be extended to show that other organisms survive death in many actual cases. This line of reasoning improves on other arguments that have been offered against termination theses. And if my argument regarding human animals surviving death is successful, then assuming that human persons are animals, we can also conclude that human persons in many actual cases continue to exist after death. (shrink)

The nursing profession in Germany is facing a public debate on legal and ethical questions concerning euthanasia on request and physician-assisted suicide. However, it seems questionable if the profession itself, individual nurses or the professional associations are prepared to be involved in such a public debate. To understand this hesitation, the present situation is considered in the light of the tradition and history of professional care in Germany. Obedience to medical as well as to religious authorities was long part (...) of nurses' professional identity, but is no longer relevant. The lack of reflection and discussion on how to take a balanced view of ethical and political questions concerning nursing, and the role and responsibility of nurses in end-of-life decisions and situations of caring for dying people are discussed using the situation of nurses in the Netherlands as a comparison. (shrink)

It is becoming increasingly clear that repetitive DNA is of biological significance as well as experimental importance. Here we review the information available about one type of repetitive DNA, the trinucleotide repeat (CAC)n, and briefly compare it with other trinucleotide repeats. Although much work has been done in analysing DNA fingerprinting patterns produced using the synthetic oligonucleotide (CAC)5 as a probe, there is relatively little information about individual (CAC)n‐containing sequences and their abundance, organisation and distribution in mammalian DNA. From (...) the data that is available, it is clear that there are at least two areas that should repay further study: (1) the organisation and generation of long sequences that contain (CAC)n motifs as part of a larger repeating unit (minisatellites) and (2) the distribution of small (CAC)n sequences (microsatellites), in particular their relationship to genes. (shrink)

Respecting and encouraging autonomy in the elderly is basic to the practice of geriatrics. In this paper, we examine the practice of cardiopulmonary resuscitation (CPR) and "artificial" feeding in a geriatric unit in a general hospital subscribing to jewish orthodox religious principles, in which the sanctity of life is a fundamental ethical guideline. The literature on the administration of food and water in terminal stages of illness, including dementia, still shows division of opinion on the morality of withdrawing nutrition. (...) We uphold the principle that as long as feeding by naso-gastric (N-G) or percutaneous endoscopic gastrostomy (PEG) does not constitute undue danger or arouse serious opposition it should be given, without causing suffering to the patient. This is part of basic care, and the doctor has no mandate to withdraw this. The question of CPR still shows much discrepancy regarding elderly patients' wishes, and doctors' opinions about its worthwhileness, although up to 10 percent survive. Our geriatric patients rarely discuss the subject, but it is openly ventilated with families who ask about it, who are then involved in the decision-making, and the decision about CPR or "do-not-resuscitate" (DNR) is based on clinical and prognostic considerations. (shrink)

Long‐range correlation is a general class of coordination pattern found to be common to the intrinsic dynamics of complex systems, including human behavior. Balasubramaniam, Hove, and Médé investigate intrinsic dynamics in repeated finger movements, and they find that different measures of movement dynamics yield different long‐range correlations. Results shed light on the way that coordination patterns are expressed as a function of measurement context.

Background On a daily basis, healthcare professionals deal with various ethical issues and it can be difficult to determine how to act best. Clinical ethics support (CES) has been developed to provide support for healthcare professionals dealing with complex ethical issues. A long-term perspective of participating in inter-professional dialogue and reflective-based CES sessions is seemingly sparse in the literature. Research aim The aim was to describe experiences of impact of Inter-professional Ethics Communication in groups (IEC) based on Habermas’ theory (...) of communicative actions, after 6 months from the perspective of an inter-professional team. Research design A qualitative inductive approach was chosen, and individual interviews ( n = 13) were conducted. Interview data were analysed using qualitative content analysis. Participants The participants, 10 females and two males, represented assistant nurses, registered nurses, physicians, occupational therapists, physiotherapists, welfare officers and psychologists. Each had attended at least four IEC sessions. Ethical considerations The study was approved by the Regional Ethical Review Board in Umeå, Sweden, and it has been undertaken in accordance with the Helsinki Declaration. Findings Overall, the descriptions expressed a perceived achievement of a deepened and integrated ethical awareness that increased the participants’ awareness of ethically difficult situations as well as their own ethical thinking, actions and approaches in daily work. Perspectives were shared and the team become more welded. They carried the memories of the reflections within them, which was perceived as supportive when encountered new ethically situations. Discussion Putting words to unarticulated thoughts may stimulate repeated reflections, leading to new insights and alternative thoughts. Conclusion The outcome of IEC sessions 6 months following the last session can be described as an incorporated knowledge that enables actions in ethically difficult situations based on an ethical awareness both at a ‘We-level’ and an ‘I-level’. (shrink)

Los cuidados paliativos deben manejar los diferentes problemas que los pacientes y las familias pueden tener al final de la vida. La sedación es una maniobra terapéutica utilizada con cierta frecuencia en cuidados paliativos y constituye una buena práctica médica cuando está bien indicada; sin embargo, presenta el riesgo de conculcar algunos principios éticos. Los principios de beneficencia y autonomía son posiblemente los principios éticos mayormente afectados cuando se considera la sedación. Se deben cumplir los siguientes requisitos: síntoma refractario, enfermedad (...) terminal y consentimiento, y en lo posible estar avalada por una segunda opinión médica. La sedación paliativa no es eutanasia y las diferencias están en el objetivo, el proceso y el resultado. En el presente trabajo se discuten algunos de los aspectos para prevenir la conculcación de los principios éticos, asimismo se proporcionan algunas sugerencias para ayudar en la toma de decisiones. Palliative care to the different problems encountered by patients and their families at the end of life. Sedation is a therapeutic manoeuvre frequently used in palliative medicine, that could eventually infringe some ethical principles. From our standpoint, beneficence and autonomy are probably the most affected principles when sedation is considered. The following conditions are required in order for it to be applied: refractory symptom, terminal illness and consent, and as long as possible, the decision must be supported by a second medical opinion Palliative sedation is different from euthanasia, and the differences lie in the objective, the pro- cess and the result. Some measures to prevent such violations to occur are discussed, and suggestions intended to guide in decision making are proposed. (shrink)

In this review, we discuss how two evolutionarily conserved pathways at the interface of DNA replication and repair, template switching and break-induced replication, lead to the deleterious large-scale expansion of trinucleotide DNA repeats that cause numerous hereditary diseases. We highlight that these pathways, which originated in prokaryotes, may be subsequently hijacked to maintain long DNA microsatellites in eukaryotes. We suggest that the negative mutagenic outcomes of these pathways, exemplified by repeat expansion diseases, are likely outweighed by their positive (...) role in maintaining functional repetitive regions of the genome such as telomeres and centromeres. Break-induced replication and template switching are conserved mechanisms of replication fork restart. They do not cause microsatellite instability in prokaryotes, but promote repeat expansion in eukaryotes. We suggest that TS and BIR persisted in eukaryotes despite their mutagenic potential because they help maintain long repetitive telomeres and centromeres. (shrink)

The development of cancer therapies is a long and arduous process. Because it can take several years for a cancer agent to pass clinical testing and be approved for use, terminal cancer patients rarely have the time to see these experimental therapies become widely available. For most terminal cancer patients the only opportunity they have to access an experimental drug that could potentially improve their prognosis is by joining a clinical trial. Unfortunately, several aspects of clinical trial (...) methodology that are set in place in order to optimise drug development for the benefit of future generations of cancer patients, pose significant limitations to current patient participation. Therefore, several terminal cancer patients believe that they should have the right to access experimental agents that have passed initial safety testing without having to participate in clinical trials. However, granting off-trial access to patients could be detrimental to the scientific process of drug development, and thus could pose significant risks to the health of future patients relying on sound research. Examining this matter through two divergent ethical lenses, rights-based ethics and communitarian ethics, may provide new insight into the issues surrounding the balance between the autonomous rights of current terminal cancer patients, and the needs of future patients and the values of society. (shrink)

Decreasing unintended teenage pregnancy, especially repeat teenage pregnancy, is an important public health goal. Unfortunately, legal barriers in the USA impede this goal as all minors are unable to consent for birth control in 24 states, and only 10 of those states allow consent after the minor has given birth according to state statutory law. Placement of long-acting reversible contraception is one of the most effective methods of preventing rapid repeat pregnancies. However, restrictions are placed on adolescents who may (...) not have the option of parental consent if the parents are unwilling, or not present, to give consent. A predicament arises when healthcare professionals are willing to place the contraceptive for the patient, but cannot due to the restrictions and guidelines outlined by each state. Even though these adolescents are legally viewed as minors, adolescent mothers should be able to consent to the placement of LARC. Notably, adolescents have the legal ability to give consent for the healthcare of their child starting in the prenatal period. I argue that this ability should be extended to include adolescent consent for their own healthcare. Additionally, the procedure to place LARC is relatively low risk and highly effective, which is an opportune situation to allow minors to consent. Allowing adolescents to consent to LARC after delivery is a simple and effective way to decrease rapid repeat pregnancy rates in the USA. All data relevant to the study are included in the article. (shrink)

As long-term childhood cancer survivors are at risk for late effects, ongoing medical care is crucial to detect and treat physical illnesses as early as possible. However, previous research from around the world has shown that many adult survivors did not participate in long-term medical follow-up. This study aimed to provide insight into German survivors’ care situation, with a particular focus on barriers to follow-up care. We investigated a sample of adult CCS drawn from the German Childhood Cancer (...) Registry’s oldest cohort. Our analyses included data from a standardized medical examination, a self-report questionnaire, and in-depth interviews with a subsample. Half of the participants reported participating in some kind of medical follow-up. In a logistic regression analysis, attendance of medical follow-up care was associated with higher age. Reasons for non-attendance were assigned to four categories: lack of information about medical follow-up and/or its purpose, termination by the health care provider, structural barriers, and emotional-motivational aspects. The interviews contributed to a better understanding of how these reported barriers played out in the care of individual survivors. Further, they revealed that some survivors currently in medical follow-up had had periods without follow-up care in the past—which were also in many cases related to a lack of information, both on the part of health care providers and CCS themselves. The results indicated that a large proportion of long-term CCS do not receive the recommended follow-up care. Further, there is a great need for more information regarding the aims of long-term medical follow-up and available offers. This is an important prerequisite for CCS to make informed decisions. (shrink)

In an effort to restrict seed piracy in the global agricultural market, Monsanto intends to implement some form of genetic use restriction technology. Regarding such intentions, many activist groups adamantly contend that Monsanto will be acting immorally if GURTs, specifically Terminator Technology, are implemented in the global agricultural market. They argue that the potential implementation of TT is immoral because it threatens to infringe upon the rights of resource-poor farmers by denying them the ability to save the seed derived from (...) their harvests. While there may be ways that the implementation of TT can be construed as wrong, I narrowly argue that Monsanto will not be wrongfully infringing upon the basic rights of resource-poor farmers if it actually implements TT. Moreover, as long as Monsanto takes the appropriate measures to minimize the possible negative effects that TT may have on resource-poor farmers, and allows these farmers to make an autonomous choice to use seed that contains this technology, Monsanto's possible implementation of TT cannot be accurately considered to instantiate an immoral violation of basic rights. (shrink)

Genomes of higher eukaryotes contain abundant non‐coding repeated sequences whose overall biological impact is unclear. They comprise two categories. The first consists of retrotransposon‐derived elements. These are three major families of retroelements (LINEs, SINEs and LTRs). SINEs are clustered in gene‐rich regions and are found in promoters of genes while LINEs are concentrated in gene‐poor regions and are depleted from promoters. The second class consists of non‐coding tandem repeats (satellite DNAs and TTAGGG arrays), which are associated with mammalian centromeres, (...) heterochromatin and telomeres. Terminal TTAGGG arrays are involved in telomere capping and satellite DNAs are located in heterochromatin, which is implicated in transcription silencing by gene repositioning (relocalization). It is unknown whether interstitial TTAGGG sequences, which are present in many vertebrates, have a function. Here, evidence will be presented that retroelements and TTAGGG arrays are involved in regulation of gene expression. Retroelements can provide binding sites for transcription factors and protect promoter CpG islands from repressive chromatin modifications, and may be also involved in nuclear compartmentalization of transcriptionally active and inactive domains. Interstitial telomere‐like sequences can form dynamically maintained three‐dimensional nuclear networks of transcriptionally inactive domains, which may be involved in transcription silencing like classic heterochromatin. BioEssays 30:338–348, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

It has long been believed that membrane proteins present in degradative compartments such as endolysosomes or vacuoles would be destined for destruction. Now however, it appears that mechanisms and machinery exist in simple eukaryotes such as yeast and more complex organisms such as mammals that can rescue potentially “doomed” membrane proteins by retrieving them from these “late” compartments and recycling them back to the Golgi complex. In yeast, a sorting nexin dimer containing Snx4p can recognize and retrieve the Atg27p (...) membrane protein while in mammals, the AP5 complex (with SPG11 and SPG15) directs the recycling of Golgi‐localized proteins along with the cation‐independent mannose 6‐phosphate receptor (CIMPR). Although the respective machinery is different, there is much commonality between yeast and mammals regarding the mechanisms of retrieval and the physiological importance of these late recycling pathways. (shrink)

What is this "same thing" which Socrates is always repeating "in the same words"? What impels him "to search into himself and other men", a pursuit, which according to the Apology, he considers his sole vocation?

According to the standard objection to backward induction in games, its application depends on highly questionable assumptions about the players' expectations as regards future counterfactual game developments. It seems that, in order to make predictions needed for backward reasoning, the players must expect each player to act rationally at each node that in principle could be reached in the game, and also to expect that this confidence in the future rationality of the players would be kept by each player come (...) what may: even at the game-nodes that could only be reached by irrational play. Both expectations seem to be rather unreasonable: a player's initial disposition to rational behaviour may be weakened by a long stretch of irrational play on his part and, even more importantly, his initial confidence in the other players' future rationality may be undermined by an irrational play on their part. For different formulations of this objection see Binmore, Reny and, Bicchieri, Pettit and Sugden. and Aumann and.). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:It Is Going to Be a Long Clinic DaySalvador Cruz-FloresIt was a routine neurology clinic day. I entered the room where one of the residents was seeing a patient that we will call Patty, a 32-year-old long-standing epilepsy patient. Patty was sitting in the chair with her husband by her side. She started screaming at me, complaining that she was tired of feeling sick and unable to (...) do anything. She had been in and out of emergency rooms with a variety of complaints, from passing out to dizziness with nausea and vomiting. She was visibly angry and started cursing me with direct expletives and blaming me for all her ailments.Her husband was quiet and, at times, would cover his face as if he was embarrassed. I felt an initial burst of anger. I felt my face getting red. I made a great effort to stay quiet, leaned on the exam table facing them, lowered my voice, and braced to take the barrage of insults that were coming my way. I had to make a strong conscious effort to control my emotions and let her vent. I felt that if I responded in kind, I would inflame the situation. Moreover, a resident and a student working with me that day were also present in the room, and I felt it was my duty to behave professionally, so I sat and tried to do active listening with the idea of offering solutions to her complaints. I am not sure how long the event lasted, but it seemed like an eternity. As she slowed down, I apologized for making her feel not cared for, repeated some of her complaints, and tried to offer solutions to them, but she would not have it and did not accept anything I said. She wanted to get her prescriptions and leave the clinic. I offered to have one of my colleagues do the follow-up as she really did not want to see me anymore.Patty is one of those patients that when you see the name in the schedule, you cringe and tell yourself, it is going to be a long clinic day. She could be in the group of patients who are considered very difficult. Before me, she had been seen by several other neurologists. They likely also preferred not to see her on the schedule because she is one of the 20–30% of patients that have a type of functional psychogenic disorder that becomes more complicated because of the coexistence of epileptic seizures along with non-epileptic psychogenic events. The latter is a more problematic event because it does not respond to pharmacological treatment and causes a lot of disability. The best way to establish whether an event is a true epileptic event or a non-epileptic psychogenic event is to do continuous electroencephalographic monitoring to capture as many events as possible on video. I tried different combinations of medications to no avail and with significant side effects. I tried to set her up for electroencephalogram home monitoring to tease the epileptic and psychogenic events apart. In truth, her social circumstances, insurance coverage, and economic situation made it impossible to do so. Every time she came to the clinic, she had a multitude of complaints, and she would ask for a medication to treat the problem. Any mention of the potential psychogenic nature of her problems would result in a defensive attitude "so you are saying I am crazy." We discussed multiple times the need to be careful with the medications and the potential bad side effects. I wanted to help her, but with every visit, there seemed to be a barrier, and the visit would end on bad terms. At least, that is how I felt. I was left every time, with a feeling of frustration. I believe that she left the clinic feeling the same. That day, I left the clinic upset and depressed. I tried to convince myself I had done all I could to help her. I just could not understand why this was the result.Several years have passed since I have seen Patty in the clinic. She certainly has not... (shrink)

Since USA constitutional precedent established in 1976, adolescents have increasingly been afforded the right to access contraception without first obtaining parental consent or authorisation. There is general agreement this ethically permissible. However, long-acting reversible contraception methods have only recently been prescribed to the adolescent population. They are currently the most effective forms of contraception available and have high compliance and satisfaction rates. Yet unlike other contraceptives, LARCs are associated with special procedural risks because they must be inserted and removed (...) by trained healthcare providers. It is unclear whether the unique invasive nature of LARC changes the traditional ethical calculus of permitting adolescent decision-making in the realm of contraception. To answer this question, we review the risk–benefit profile of adolescent LARC use. Traditional justifications for permitting adolescent contraception decision-making authority are then considered in the context of LARCs. Finally, analogous reasoning is used to evaluate potential differences between permitting adolescents to consent for LARC procedures versus for emergency and pregnancy termination procedures. Ultimately, we argue that the invasive nature of LARCs does not override adolescents’ unique and compelling need for safe and effective forms of contraception. In fact, LARCs may oftentimes be in the best interest of adolescent patients who wish to prevent unintended pregnancy. We advocate for the specific enumeration of adolescents’ ability to consent to both LARC insertion and removal procedures within state policies. Given the provider-dependent nature of LARCs and the stigma regarding adolescent sexuality, special political and procedural safeguards to protect adolescent autonomy are warranted. (shrink)

Allocating attention determines what we remember later. Attentional demands vary in a task-switching paradigm, with greater demands for switch than for repeat trials. This also results in lower subsequent memory performance for switch compared to repeat trials. The main goal of the present study was to investigate the consequences of task switching after a long study-test interval and to examine the contributions of the two memory components, recollection and familiarity. In the study phase, the participants performed a task-switching procedure (...) in which they had to switch between two classifications tasks with pictures. After a short vs. a long study-test interval of a week, the participants performed a surprise memory test for the pictures and gave remember/know judgements. The results showed that recognition memory declined after 1 week and this was mainly due to a decrease in “remember” responses. The results also showed that the task-switching effect on memory was enduring. Whereas the results of the immediate test were mixed, the results of the delayed tests showed that the task-switching effect was based on recollection, expressed in more “remember” responses for repeat than for switch trials. As recollection is more sensitive to attention manipulations than familiarity, the results align with the notion that attentional requirements at study determine what we remember, in particular after a long study-test interval. (shrink)