Despite evidence indicating that public health services are the most effective means of improving the population's health status, health care services receive the bulk of funding and political support. The recent passage of the Affordable Care Act, which focused on improving access to health care services through insurance reform, reflects the primacy of health care over public health. Although policymakers typically conceptualize health care and public health as two distinct systems, gains in health status are most effectively and cost-efficiently achieved (...) through their integration into a single health system. The Act does little to compel integration; however, there are numerous opportunities to encourage the coordination of public health and health care in the Act's implementation. (shrink)

Heath care and public health are typically conceptualized as separate, albeit overlapping, systems. Health care’s goal is the improvement of individual patient outcomes through the provision of medical services. In contrast, public health is devoted to improving health outcomes in the population as a whole through health promotion and disease prevention. Health care services receive the bulk of funding and political support, while public health is chronically starved of resources. In order to reduce morbidity and mortality, policymakers must shift their (...) attention to public health services and to the improved integration of health care and public health. In other words, health care and public health should be treated as two parts of a single integrated health system. Furthermore, in order to maximize improvements in health status, policymakers must consider the impact of all governmental policies on health. (shrink)

The ethical concept of justice, as it relates to the development and deployment of innovative health technologies, commands the fair and equitable distribution of burdens and benefits. In bioethics, specific guidance on practical strategies for achieving what this concept of justice demands are somewhat elusive. Drawing on issues of justice arising or likely to arise in the context of the search for a vaccine or cure for COVID‐19, this paper argues for a focus on the concept of “practical justice” in (...) post‐pandemic bioethics work. To illustrate the value and promise of this concept, the paper reflects on an approach to achieving practical justice in health biotechnology research that is grounded in a commitment to offer technical assistance to developing and under‐resourced nations. (shrink)

We present a population density and moment-based description of the stochastic dynamics of domain $${\text{Ca}}^{2+}$$ -mediated inactivation of L-type $${\text{Ca}}^{2+}$$ channels. Our approach accounts for the effect of heterogeneity of local $${\text{Ca}}^{2+}$$ signals on whole cell $${\text{Ca}}^{2+}$$ currents; however, in contrast with prior work, e.g., Sherman et al. :985–995, 1990), we do not assume that $${\text{Ca}}^{2+}$$ domain formation and collapse are fast compared to channel gating. We demonstrate the population density and moment-based modeling approaches using a 12-state Markov chain model (...) of an L-type $${\text{Ca}}^{2+}$$ channel introduced by Greenstein and Winslow :2918–2945, 2002). Simulated whole cell voltage clamp responses yield an inactivation function for the whole cell $${\text{Ca}}^{2+}$$ current that agrees with the traditional approach when domain dynamics are fast. We analyze the voltage-dependence of $${\text{Ca}}^{2+}$$ inactivation that may occur via slow heterogeneous domain [ $${\text{Ca}}^{2+}$$ ]. Next, we find that when channel permeability is held constant, $${\text{Ca}}^{2+}$$ -mediated inactivation of L-type channels increases as the domain time constant increases, because a slow domain collapse rate leads to increased mean domain [ $${\text{Ca}}^{2+}$$ ] near open channels; conversely, when the maximum domain [ $${\text{Ca}}^{2+}$$ ] is held constant, inactivation decreases as the domain time constant increases. Comparison of simulation results using population densities and moment equations confirms the computational efficiency of the moment-based approach, and enables the validation of two distinct methods of truncating and closing the open system of moment equations. In general, a slow domain time constant requires higher order moment truncation for agreement between moment-based and population density simulations. (shrink)

For years a debate has raged within the various literatures of philosophy, psychiatry, and psychology over whether, and to what degree, the concepts that characterize psychopathology are social constructions that reflect cultural values. While the majority position among philosophers has been normativist, i.e., that the conception of a mental disorder is value-laden, a vocal and cogent minority have argued that psychopathology results from malfunctions that can be described by terminology that is objective and scientific. Scientists and clinicians have tended to (...) endorse the objectivist position, with some notable exceptions. (shrink)

En este artículo se plantea una discusión con el enfoque doxástico de los delirios. A pesar de que esta línea de análisis ha hecho importantes aportes en cuanto a la comprensión del fenómeno, tiene dificultades importantes a la hora de aportar un marco explicativo completo de los delirios porque deja por fuera el aspecto total de la experiencia y sigue basándose implícitamente en la idea de que podemos estudiar de manera separada e independiente los aspectos físicos, cognitivos y experienciales de (...) un fenómeno tan complejo. Se propondrá que, más allá de la decisión acerca de si debemos considerar a los delirios como creencias irracionales o no, o de si puede concebírselos como creencias en absoluto, es necesario tener en cuenta la transformación drástica del mundo entero de experiencia que se da en el sujeto delirante, tal como lo plantea la fenomenología. (shrink)

Anthony Giddens’ theory of structuration is a theory of social action, which claims that society should be understood in terms of action and structure; a duality rather than two separate entities. This paper introduces some of the central characteristics of structuration theory, presenting a conceptual framework that helps to explore how people produce the systems and structures that shape their practice. By understanding how people produce and reproduce structures, then there is the potential for changing them. Criticisms that have been (...) raised about the theory are introduced, followed by examples of how the theory might be useful to nursing research. Structuration theory can be employed to explore how nurses produce, reproduce, and transform nursing practice through social interaction across time and space. (shrink)

In this essay, we present three case studies which suggest that sometimes we are better off supporting a so–called irrational suicide, and that emotional or psychological distress – even if medically controllable – might justify a suicide. We underscore how complicated these decisions are and how murky a physician's moral role can be. We advocate a more individualized route to end–of–life care, eschewing well–meaning, principled, generalizations in favor of a highly contextualized, patient–centered, approach. We conclude that our Western traditions of (...) promoting reasoned behavior and life themselves may at times be counter–productive. (shrink)

Evolutionary psychologists claim that the mind contains “hundreds or thousands” of “genetically specified” modules, which are evolutionary adaptations for their cognitive functions. We argue that, while the adult human mind/brain typically contains a degree of modularization, its “modules” are neither genetically specified nor evolutionary adaptations. Rather, they result from the brain’s developmental plasticity, which allows environmental task demands a large role in shaping the brain’s information-processing structures. The brain’s developmental plasticity is our fundamental psychological adaptation, and the “modules” that result (...) from it are adaptive responses to local conditions, not past evolutionary environments. If different individuals share common environ- ments, however, they may develop similar “modules,” and this process can mimic the development of genetically specified modules in the evolutionary psychologist’s sense. (shrink)

In Sisyphus's Boulder, Eric Dietrich and Valerie Hardcastle argue that we will never get such a theory because consciousness has an essential property that..

Volume 19, Issue 12, December 2019, Page 66-68.

We argue that the trend toward providing users with feasible and actionable explanations of AI decisions—known as recourse explanations—comes with ethical downsides. Specifically, we argue that recourse explanations face several conceptual pitfalls and can lead to problematic explanation hacking, which undermines their ethical status. As an alternative, we advocate that explanations of AI decisions should aim at understanding.

A large proportion of the total global burden of disease is caused by emergency medical conditions. Emergency care research is essential to improving emergency medicine but this research can raise some distinctive ethical challenges, especially with regard to (1) standard of care and risk–benefit assessment; (2) blurring of the roles of clinician and researcher; (3) enrolment of populations with intersecting vulnerabilities; (4) fair participant selection; (5) quality of consent; and (6) community engagement. Despite the importance of research to improve emergency (...) care in low-income and middle-income countries (LMICs) and the widely acknowledged ethical challenges, very little has been written on the ethics of emergency care research in LMICs. This paper examines the ethical and regulatory challenges to conducting emergency care research with human participants in LMICs. We outline key challenges, present potential solutions or frameworks for addressing these challenges, and identify gaps. Despite the ethical and regulatory challenges, conducting high-quality, ethical emergency care research in LMICs is possible and it is essential for global health. (shrink)

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Gils-Schmidt and Salloch recognise that human and climate health are inextricably linked, and that mitigating healthcare-associated climate harms is essential for protecting human health.1 They argue that physicians have a duty to consider how their own practices contribute to climate change, including during their interactions with patients. Acknowledging the potential for conflicts between this duty and the provision of individual patient care, they propose the application of Korsgaard’s neo-Kantian account of practical identities to help navigate such scenarios. In this commentary, (...) we argue that by focusing attention on this physician–patient level, the authors overlook the complexity of climate change, both within the healthcare sector and beyond. We recognise the importance of individual agency in tackling this issue, and we also recognise that the authors do briefly acknowledge the importance of considering these broader complexities; however, we emphasise the need for climate and health discussions/action to be situated in a wider framework of systemic change. Our concern is that overemphasis on patient-level interactions risks normalising the prioritisation of individual-level approaches to addressing climate change, detracting from such a broader approach. Physician training emphasises the need for trust, confidentiality and shared decision-making in the doctor–patient relationship. …. (shrink)

What is consciousness? Of course, each of us knows, privately, what consciousness is. And we each think, for basically irresistible reasons, that all other conscious humans by and large have experiences like ours. So we conclude that we all know what consciousness is. It's the felt experiences of our lives. But that is not the answer we, as cognitive scientists, seek in asking our question. We all want to know what physical process consciousness is and why it produces this very (...) strange, almost mysterious, phenomenon of felt experience. (shrink)

In her paper, Galasso contends that transitioning precision medicine from its current emphasis on healthcare benefits, to a focus on precision public health, may help address the equity concerns th...

What is consciousness? Of course, each of us knows, privately, what consciousness is. And we each think, for basically irresistible reasons, that all other conscious humans by and large have experiences like ours. So we conclude that we all know what consciousness is. It's the felt experiences of our lives. But that is not the answer we, as cognitive scientists, seek in asking our question. We all want to know what physical process consciousness is and why it produces this very (...) strange, almost mysterious, phenomenon of felt experience. (shrink)

There is an increasing suspicion that Multiple Personality Disorder is one extreme along a continuum of dissociative phenomena, ranging from children’s pretend play and dreams at one end, through borderline personality disorder, posttraumatic stress syndrome, dissociative disorders not originally specified to a severe and complete personality fragmentation at the other. In this essay, we address the questions of whether a continuum view is correct and how to characterize the differences among the various disorders through distinguishing multiplex from multiple selves. This (...) analysis has implications for how the symptoms of MPD should be characterized and treated as well as shedding some light on the relation between conscious experience and selfhood. (shrink)

BackgroundBiobanks and biomedical research data repositories collect their samples and associated data from volunteer participants. Their aims are to facilitate biomedical research and improve health, and they are framed in terms of contributing to the public good. Biobank resources may be accessible to researchers with commercial motivations, for example, researchers in pharmaceutical companies who may utilise the data to develop new clinical therapeutics and pharmaceutical drugs. Studies exploring citizen perceptions of public/private interactions associated with large health data repositories/biobanks indicate that (...) there are sensitivities around public/private and/or non-profit/profit relationships and international sample and data sharing. Less work has explored how biobanks communicate their public/private partnerships to the public or to their potential research participants. MethodsWe explored how a biobank’s aims, benefits and risks, and private/public relationships have been framed in public facing recruitment documents.ResultsBiobank documents often communicate their commercial access arrangements but not the detail about what these interactions would entail, and how risks and benefits would be distributed to the public.ConclusionWe argue that this leads to a polarised discourse between public and private entities and/or activities, and fails to attend to the blurred lines between them. This results in a lack of attention to more important issues such as how risks and benefits in general are distributed to the public. We call for a nuanced approach that can contribute to the much-needed dialogue in this space. (shrink)

This book is perhaps the first to open a dialogue between the two disciplines.

"An essential overview of an important intellectual movement, Logical Empiricism in North America offers the first significant, sustained, and multidisciplinary attempt to understand the intellectual, cultural, and political dimensions of ...

There is a bias in neuroscience toward localizing and modularizing brain functions. Single cell recording, imaging studies, and the study of neurological deficits all feed into the Gallian view that different brain areas do different things and the things being done are confined to particular processing streams. At the same time, there is a growing sentiment that brains probably don’t work like that after all; it is better to conceive of them as fundamentally distributed units, multi‐tasking at every level. This (...) sentiment, however, is much less congenial to the tried‐and‐true experimental protocols available today and to theorizing about the brain in general. This essay examines the tension between current experimental methods and large-scale views of the brain. We argue that this disconnection between experiment and what really are guiding theoretical metaphors seriously impedes progress in neuroscience. (shrink)

Introducing Dialogic Pedagogy presents some of the ideas of Russian philosopher Mikhail Bakhtin concerning dialogism in a way that will engage and inspire those studying early childhood education. By translating the growing body of dialogic scholarship into a practical application of teaching and learning with very young children, this book provides readers with alternative ways of examining, engaging and reflecting on practice in the early years to provoke new ways of understanding and enacting pedagogy. This text combines important theoretical ideas (...) with a practical application to support practitioners who are keen to promote creativity and agency through ethical self-other relations. It provides unique insights into the amazing world of the youngest child, and offers enriched understandings of the profound impact of adults in their journey of becoming (or bildung). Key points covered include: Investigating dialogic philosophy and its application to early childhood education, with an emphasis on notions of justice, democracy, ethics and answerability Considering the relationship between dialogism and pedagogical approaches Theorising a range of approaches to relevant early childhood practice, as pedagogy This accessible and readable guide offers sound theoretical principles with practical suggestions for early years' settings. The book is supplemented by an extensive online video resource website that will bring these revolutionary ideas to life.. (shrink)

Spelling out in detail what we do and do not know about phenomenological experience, this book denies the common view of consciousness as a central decision...