Therapeutic practice with stem cells even if not yet realistic has open a cautious optimism among scientists. The mechanism controlling cell differentiation into cell types are not known in details yet. Exists real danger to influence wrongly the public opinion.

Reviews the special issue of The Journal of Mind and Behavior, Challenging the therapeutic state: Critical perspectives on psychiatry and the mental health system, edited by D. Cohen . This special issue serves as an update on the critique of the medical model in psychiatry. In editing this volume, Cohen has assembled a collection of work from authors in many disciplines—including some laypersons—who are concerned with what they see as the frightening power of the "Therapeutic State." While the (...) work of Thomas Szasz is a guiding light for several of these authors, they certainly are not all associated with his work. In fact, some of them explicitly disavow what they see as Szasz's overly simple stance toward madness. Moreover, the ideas in this volume expand the critique of the medical model far beyond the range of Szasz's work. Disagreements among authors are for the most part confined to a few footnotes in this volume. The book's purpose is to expose the problem before exploring solutions to it. When the volume is at its best, the papers are united by their contention that the medical model in psychiatry is disastrous both for individuals who are victimized by its institutions and practices, and for the society that embraces its disempowering philosophy. There is little, if any, brand new material in this book. Virtually all of the articles contain research and ideas tat the authors have already published elsewhere. The virtue of the book is in bringing together a diversity of work across disciplines that would not ordinarily appear between the same two covers. The common element running through all of these articles is one that the authors almost never state in so many words, but it gives a cumulative force to their very different treatments of psychiatry's problems. Each of these papers, in its own way, reveals aspects of the irrationality implicit in psychiatric orthodoxy. Psychiatry stands at the fringe of medical science, and the fringe of any science is where the inadequacies of its paradigm are most obvious. The attempt to make the medical model fit the problem of madness has not succeeded, but orthodox psychiatry continues to pursue it. 2012 APA, all rights reserved). (shrink)

The ubiquitin–proteasome system (UPS) is the major proteolytic pathway that degrades intracellular proteins in a regulated manner. Deregulation of the UPS has been implicated in the pathogenesis of many neurodegenerative disorders like Alzheimer's disease, Parkinson's diseases, Huntington disease, Prion‐like lethal disorders, in the pathogenesis of several genetic diseases including cystic fibrosis, Angelman's syndrome and Liddle syndrome and in many cancers. Multiple lines of evidence have already proved that UPS has the potential to be an exciting novel therapeutic target for (...) the treatment of these diseases. Here I review how aberrant functions of various genes have implicated UPS in many human disorders including neurodegeneration and cancers. I also discuss the finding that some proteasome inhibitors possess a therapeutic potential as drugs against many such diseases. BioEssays 30:1172–1184, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

Conversational Artificial Intelligence (CAI) systems (also known as AI “chatbots”) are among the most promising examples of the use of technology in mental health care. With already millions of users worldwide, CAI is likely to change the landscape of psychological help. Most researchers agree that existing CAIs are not “digital therapists” and using them is not a substitute for psychotherapy delivered by a human. But if they are not therapists, what are they, and what role can they play in (...) mental health care? To answer these questions, we appeal to two well-established and widely discussed concepts: cognitive and affective artifacts. Cognitive artifacts are artificial devices contributing functionally to the performance of a cognitive task. Affective artifacts are objects which have the capacity to alter subjects’ affective state. We argue that therapeutic CAIs are a kind of cognitive-affective artifacts which contribute to positive therapeutic change by (i) simulating a (quasi-)therapeutic interaction, (ii) supporting the performance of cognitive tasks, and (iii) altering the affective condition of their users. This sheds new light on why virtually all existing mental health CAIs implement principles and techniques of Cognitive Behavioral Therapy — a therapeutic orientation according to which affective change and, ultimately, positive therapeutic change is mediated by cognitive change. Simultaneously, it allows us to conceptualize better the potential and limitations of applying these technologies in therapy. (shrink)

The doctrines of therapeutic nihilism and administrative nihilism are both based on the belief that the norms of activity are intrinsically linked to the structure of the body. Just as there is a vis medicatrix naturae in the individual organism, which renders any intervention of the therapist vain, there would be a vis medicatrix rei publicae in the social body, which makes the intervention of the legislator in economic life pointless and even dangerous. However, such a symmetry is not (...) quite as clear as it appears at first. It has also been upheld that the real parallel is not between therapeutic and administrative nihilism, but between therapeutic nihilism and statism. In this view, government is less comparable to a therapist than to the nervous system, and just as a well regulated organism is a one with an extensive nervous system, a well regulated society is one with a strong State.We intend to retrace the historical origin of these two schemas of correspondence, which has his roots in the celebrated controversy in the 1870’s between Herbert Spencer and Thomas Henry Huxley. We examine the causes of this apparent paradox, which sometimes views the doctrine of administrative nihilism, and sometimes the opposing doctrine of statism, as being the equivalent in politics of therapeutic nihilism in medicine. In our opinion, an important part of the explanation must be sought in the variations of the field of extension, which is implicitly given to the concept of vis medicatrix, or –as we now usually call this notion– that of Self-regulation. (shrink)

ArgumentThis essay places some therapeutic vaccines, including particularly the diphtheria antitoxin, into their larger historical context of the late nineteenth century. As industrially produced drugs, these vaccines ought to be seen in connection with the structural changes in medicine and pharmacology at the time. Given the spread of industrial culture and technology into the field of medicine and pharmacology, therapeutic vaccines can be understood as boundary objects that required and facilitated communication between industrialists, medical researchers, public health officials, (...) and clinicians. It was in particular in relation to evaluation and testing for efficacy in animal models that these medicines became a model for twentieth-century medicine. In addition, these medicines came into being as a parallel invention in two very distinct local cultures of research: the Institut Pasteur in Paris and the Institut für Infektionskrankheiten in Berlin. While their local cultural origins were plainly visible, the medicines played an important role in the alignment of the methods and objects that took place in bacteriology research in France and Germany in the 1890s. This article assesses the two locally specific regimes for control in France and in Imperial Germany. In France the Institut Pasteur, building on earlier successful vaccines, enjoyed freedom from scrutinizing control. The tight and elaborate system of control that evolved in Imperial Germany is portrayed as being reliant on experiences that were drawn from the dramatic events that surrounded the launching of a first example of so-called “bacteriological medicine,” tuberculin, in 1890. (shrink)

The mapping of therapeutic collaboration throughout counseling deepens our understanding of how the helping relationship fosters client change. To better understand the process of career construction counseling, we analyzed the therapeutic collaboration on six successful face-to-face cases. The participants were six Portuguese adults, five women and one man, real clients of a career counseling service, and four psychologists, three female and one male trained in the career intervention model. The participants completed demographic questions and measures of career certainty, (...) vocational identity, career indecision, and psychological functioning. The Therapeutic Collaboration Coding System was used to track collaboration throughout all interactive episodes. The clinical significance of the intervention was calculated by analyzing pre-post-test statistical differences for each case, with the Reliable Change Index and Z score. The findings evidenced a pattern of therapeutic collaboration evolution for good outcome cases. Based on this pattern, we propose a model of process-outcome evolution for the three phases of CCC. (shrink)

This article describes the pilot project Shadows & Light Within: Untold Stories—a two-phase, multi-partner community-based project that explores the hypothesis that Autobiographical Therapeutic Performance can help traumatized individuals to improve executive functioning. A group of 10 individuals ranging in age from 32 to 69, with lived experiences at the intersection of trauma, mental health, and the court system, were paired with theater mentor-coaches for a 10-month creative group process, in which they shaped their stories into autobiographical performance pieces, through (...) movement, improvisation, story-telling, and self-discovery. In the second phase of the project, their stories were merged into a theater production, weaving movement, song, and voice, and performed by an ensemble of experienced actors from the community. Pre- and post-interviews and self-report standardized measures of executive functioning were used to assist in establishing criteria and direction for future research. The results suggest that the individuals involved in this pilot may have improved executive functioning and acquired more ability to engage in human service programs designed to increase job readiness and enhance adaptive living skills. (shrink)

In analysing the position adopted by the United Kingdom over therapeutic cloning, this paper will endeavour to examine the question of regulation, its necessity and extent. This will be achieved through considering different models of relevant theoretical discourse before, in applying that discourse to identified systems of regulation, the advantages and pitfalls of each system will be assessed in the hope of reaching a solution appropriate to the sensitive, yet dynamic, needs of the issue.

It will be remembered that the introductory chapter to this paper differentiated between human therapeutic cloning and embryonic stem cell research, with the former concept encapsulating the latter one. In turning to examine the current system of regulation found within the United Kingdom this has particular relevance as it is only the practice of therapeutic cloning – the creation and use of an embryo – which engages with the regulative measures adopted.

Synthetic biology is an emerging engineering discipline that attempts to design and rewire biological components, so as to achieve new functions in a robust and predictable manner. The new tools and strategies provided by synthetic biology have the potential to improve therapeutics for neurodegenerative diseases. In particular, synthetic biology will help design small molecules, proteins, gene networks, and vectors to target disease‐related genes. Ultimately, new intelligent delivery systems will provide targeted and sustained therapeutic benefits. New treatments will arise (...) from combining ‘protect and repair’ strategies: the use of drug treatments, the promotion of neurotrophic factor synthesis, and gene targeting. Going beyond RNAi and artificial transcription factors, site‐specific genome modification is likely to play an increasing role, especially with newly available gene editing tools such as CRISPR/Cas9 systems. Taken together, these advances will help develop safe and long‐term therapies for many brain diseases in human patients. (shrink)

The aim of this article was to interpret Habermas's concept of language in terms of its therapeutic potential which can be effectively realized in nursing practice. Drawing on Habermas's definition, we analyse the components of rational communication which are necessary for the patient and the therapist to achieve understanding. In doing this, we examine not only lifeworld, system and validity claims, which are well‐known notions within Habermas's theory of communicative action, but also less frequently studied elements of this theory, (...) such as everyday world, to which the patient refers in the process of self‐understanding and identity construction. We also address culture and language as a pre‐rational factor which can disturb, or even preclude, communication and understanding. In such circumstances, we propose supplementing the Habermasian therapeutic project with a psychoanalytical interpretations of the utterances of the patients who have difficulty defining the situation within which therapy is possible. (shrink)

Se realiza un estudio de los principios básicos o tradicionales de la bioética y su influencia en la práctica de la limitación del esfuerzo terapéutico en las Unidades de Cuidados Intensivos, como condicionante que favorece su aplicación en los pacientes en estado terminal. Se aborda la necesidad de una bioética no importada de otros países, que se corresponda a las características de la realidad latinoamericana y a cada contexto sociocultural. El trabajo tiene como objetivo fundamental resaltar la importancia de estos (...) principios básicos en la discusión ético-clínica para la toma de decisiones, a partir de una bioética que se corresponda a la realidad de los sistemas imperantes. A study of basic or traditional principles of bioethics and its influence in the practice of the limits of the therapeutic effort in the intensive care units, as a requirement that favors its application in terminal ill patients was carried out. The need of having bioethics principles that match Latin-American reality and each sociocultural context, not imported ones from other countries, was stated. This paper main objective is to highlight the importance of these basic principles in ethic-clinic discussion for decision-making, taking as the starting point a bioethics that corresponds to the reality of the dominant system. (shrink)

Psychotherapists in mental health institutions as a professional group are part of the medical system, and from this perspective, as representing an occupation that serves the public health interests, as well as those of the individual seeking help. Despite the different existing therapeutic approaches and diverse forms of therapy deriving from these approaches critical theories, however, consider psychotherapy as a profession with a specific jurisdictional claim and own highly specific interests. In contrast to most of the recent discussion around (...) therapy culture, in this article, I argue that sociology and social theory could benefit from an understanding of psychotherapy as a profession with a separate logic and claim for jurisdiction for mental health. Moreover, I present some general trends showing that, regarding psychotherapy, we face a concurrence of a professionalisation, and simultaneously, an already ongoing deprofessionalisation. To develop my argument, I first discuss the perspectives of sociology of the psychotherapy professions. Second, I present the potential lack of professionalism in four dimensions. Third, I discuss possible tendencies of deprofessionalisation. Finally, I conclude by pointing out the importance of theorising the psychotherapy professions for medical sociology. (shrink)

Brazil is among the approximately 100 countries that recognize a constitutional right to health that includes access to medicines. All over Brazil, patients are turning to courts to access prescribed medicines. Although lawsuits secure access for thousands of people, at least temporarily, this judicialization of the right to health generates intensely complex sociomedical realities and significant administrative and fiscal challenges that, officials argue, have the potential to widen inequalities in health-care delivery. In this article, we explore how right-to-health litigation became (...) an alternative pathway for Brazilians to access health care, now understood as access to medicines that are either on government lists for pharmaceutical distribution or are only available through the market. Is the judicial system an effective venue to implement socioeconomic rights? Which practices of citizenship and governance are crystallized in these struggles over drug access and administrative accountability? (shrink)

WHO II low grade glioma evolves inevitably to anaplastic transformation. Magnetic resonance imaging is a good non-invasive way to watch it, by hemodynamic and metabolic modifications, thanks to multinuclear spectroscopy 1H/31P. In this work we study a multi-scale minimal model of hemodynamics and metabolism applied to the study of gliomas. This mathematical analysis leads us to a fast-slow system. The control of the position of the stationary point brings to the concept of domain of viability. Starting from this system, the (...) equations bring to light the parameters that push glioma cells out of their domain of viability. Four fundamental factors are highlighted. The first two are cerebral blood flow and the rate of lactate transport through monocarboxylate transporters, which must be reduced in order to push glioma out of its domain of viability. Another factor is the intra arterial lactate, which must be increased. The last factor is pH, indeed a decrease of intra cellular pH could interfere with glioma growth. These reflections suggest that these four parameters could lead to new therapeutic strategies for the management of low grade gliomas. (shrink)

Recommender systems assist users in receiving preferred or relevant services and information. Using such technology could be instrumental in addressing the lack of relevance digital mental health apps have to the user, a leading cause of low engagement. However, the use of recommender systems for digital mental health apps, particularly those driven by personal data and artificial intelligence, presents a range of ethical considerations. This paper focuses on considerations particular to the juncture of recommender systems and digital (...) mental health technologies. While separate bodies of work have focused on these two areas, to our knowledge, the intersection presented in this paper has not yet been examined. This paper identifies and discusses a set of advantages and ethical concerns related to incorporating recommender systems into the digital mental health ecosystem. Advantages of incorporating recommender systems into DMH apps are identified as a reduction in choice overload, improvement to the digital therapeutic alliance, and increased access to personal data & self-management. Ethical challenges identified are lack of explainability, complexities pertaining to the privacy/personalization trade-off and recommendation quality, and the control of app usage history data. These novel considerations will provide a greater understanding of how DMH apps can effectively and ethically implement recommender systems. (shrink)

Tschacher and Haken have recently applied a systems-based approach to modeling psychotherapy process in terms of potentially beneficial tendencies toward deterministic as well as chaotic forms of change in the client’s behavioral, cognitive and affective experience during the course of therapy. A chaotic change process refers to a greater exploration of the states that a client can be in, and it may have a potential positive role to play in their development. A distinction is made between on the one (...) hand, specific instances of instability which are due to techniques employed by the therapist, and on the other, a more general instability which is due to the therapeutic relationship, and a key, necessary result of a successful therapeutic alliance. Drawing on Friston’s systems-based model of free energy minimization and predictive coding, it is proposed here that the increase in the instability of a client’s functioning due to therapy can be conceptualized as a reduction in the precisions with which the client’s prior beliefs about themselves and their world, are held. It is shown how a good therapeutic alliance results in the emergence of a new hierarchical level in the client’s generative model of themselves and their relationship with the world. The emergence of this new level of functioning permits the reduction of the precisions of the client’s priors, which allows the client to ‘open up’: to experience thoughts, emotions and experiences they did not have before. It is proposed that this process is a necessary precursor to change due to psychotherapy. A good consilience can be found between this approach to understanding the role of the therapeutic alliance, and the role of epistemic trust in psychotherapy as described by Fonagy and Allison. It is suggested that beneficial forms of instability in clients are an underappreciated influence on psychotherapy process, and thoughts about the implications, as well as situations in which instability may not be beneficial for therapy, are considered. (shrink)

virgilee's smile brightens the gloaming, some sunlight penetrates the low-lying clouds, but a persistent mist hides merchants from one another. She sweeps her arm around this eerie scene and conjures up the attraction of the Market. So many people learned about business here, their kids are now in business all over the City. You're free here; everybody is doing their own thing at their own pace. Folks working here want to be successful. At work you go by the other guys' (...) rules, you're free here for a few hours, like being out in the woods, you can come in the middle of the week and it's private here and people don't notice you, it's therapeutic like being in an oasis. You meet so many people it really is the melting... (shrink)

This contribution discusses competencies needed for regulating systems with properties of multi-causality and non-linear dynamics (therapeutic, economical, organizational, socio-political, technical, ecological, etc.). Various research communities have contributed insights, but none has come forward with an inclusive framework. To advance the debate, I propose to draw from dynamic systems theory (DST) and “4E” (embodied, embedded, enactive, and extended), cognition approaches, which offer a set of perspectives to understand what expert regulators in real-life settings do. They define the regulator's (...) agency as skillfully imposing constraints on a target system and hereby creating context-sensitive openings for self-organizing dynamics, rather than “controlling” the system. Adept regulators apply multi-pronged and multi-timescale constraints to achieve nuanced effects. Among other things, their skill set includes scarcely noted enactive processual competencies for “emergence management”, which the intellectualistic and insufficiently ecologically situated accounts of the complex problem solving literature omit. To capture the nature of system regulation, I advocate treating regulation dynamics and target system dynamics “symmetrically” by grounding regulator competencies in concepts from complexity theory. (shrink)

Precision medicine and molecular systems medicine (MSM) are highly utilized and successful approaches to improve understanding, diagnosis, and treatment of many diseases from bench-to-bedside. Especially in the COVID-19 pandemic, molecular techniques and biotechnological innovation have proven to be of utmost importance for rapid developments in disease diagnostics and treatment, including DNA and RNA sequencing technology, treatment with drugs and natural products and vaccine development. The COVID-19 crisis, however, has also demonstrated the need for systemic thinking and transdisciplinarity and the (...) limits of MSM: the neglect of the bio-psycho-social systemic nature of humans and their context as the object of individual therapeutic and population-oriented interventions. COVID-19 illustrates how a medical problem requires a transdisciplinary approach in epidemiology, pathology, internal medicine, public health, environmental medicine, and socio-economic modeling. Regarding the need for conceptual integration of these different kinds of knowledge we suggest the application of general system theory (GST). This approach endorses an organism-centered view on health and disease, which according to Ludwig von Bertalanffy who was the founder of GST, we call Organismal Systems Medicine (OSM). We argue that systems science offers wider applications in the field of pathology and can contribute to an integrative systems medicine by (i) integration of evidence across functional and structural differentially scaled subsystems, (ii) conceptualization of complex multilevel systems, and (iii) suggesting mechanisms and non-linear relationships underlying the observed phenomena. We underline these points with a proposal on multi-level systems pathology including neurophysiology, endocrinology, immune system, genetics, and general metabolism. An integration of these areas is necessary to understand excess mortality rates and polypharmacological treatments. In the pandemic era this multi-level systems pathology is most important to assess potential vaccines, their effectiveness, short-, and long-time adverse effects. We further argue that these conceptual frameworks are not only valid in the COVID-19 era but also important to be integrated in a medicinal curriculum. (shrink)

In the process of individual psychotherapy, the client and the therapist work together towards clarifying the client's problems, unlocking vicious circles, opening new perspectives and creating a new narrative congruent with the client's experiencing. The real and undeniable situation in individual psychotherapy across different therapeutic systems is that therapists enter the therapeutic encounter equipped with their own vision of humanity and their own particular theory and methods of psychotherapy. Through the differences in power between therapists and clients (...) and the powerful role of language, clients in their dependent position are apt to assimilate the percepts and the ideas of their therapists. Consequently therapists tend to exert a dominant and influential force in their client's lives. This raises a main ethical concern: to what extent do therapists from different therapeutic systems really help clients to recover their freedom to live their lives congruent to their own authentic perceptions and experiences? (shrink)

Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino (...) and Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend to disadvantage individuals with barriers in access to care (3). There is mounting evidence of racial, ethnic, and socioeconomic disparities in access to medications for COVID-19 (4, 5). -/- One potential method to promote equitable allocation is to use a weighted lottery, which is an allocation strategy that gives all eligible patients a chance to receive the scarce treatment while also allowing the assignment of higher or lower chances according to other ethical considerations (6). We sought to assess the feasibility of implementing a weighted lottery to allocate scarce COVID-19 medications in a large U.S. health system and to determine whether the weighted lottery promotes equitable allocation. (shrink)

The author presents a varied menu of ideas and experiences in many areas - in research, in diagnosis, and in psychotherapy, each using art media with patients of all ages. She integrates art, phenomenology and gestalt psychology, describing specific techniques and findings. Part I of the book lays out the theoretical foundations and the techniques; Part II addresses the formal components used in art therapy - line, shape and colour in their interrelated dynamics and discusses other aspects and modes of (...) symbolic expression found in clients' work. Part III looks at symbolic expression through the scribble, offering a system of classification, diagnostic possibilities and case studies of work with eating disorders. Part IV focuses on art expression for art therapy diagnostics, including a method for qualitative diagnostics, and a first full diagnostic battery for adolescents. Part V is devoted to Holocaust children's art expressions, highlighting the power of art expression in children under ultimate stress, the intensity of their inner experience, and its visualization in the structure of the pictures. The book is for art therapists and advanced students. It can be used as a textbook on phenomenological art therapy; for therapeutically-oriented art teachers, educators and social workers; and for practicing psychotherapists, to see that art is a source of expression demonstrating how a person is. (shrink)

Rather than approaching the question of the constructive or therapeutic character of Hegel’s Logic through a global consideration of its argument and its relation to the rest of Hegel’s system, I want to come at the question by considering a specific thread that runs through the argument of the Logic, namely the question of the proper understanding of power or control. What I want to try to show is that there is a close connection between therapeutic and constructive (...) elements in Hegel’s treatment of power. To do so I will make use of two deep criticisms of Hegel’s treatment from Michael Theunissen. First comes Theunissen’s claim that in Hegel’s logical scheme, reality is necessarily dominated by the concept rather than truly reciprocally related to it. Then I will consider Theunissen’s structurally analogous claim that for Hegel, the power of the concept is the management of the suppression of the other. Both of these claims are essentially claims about the way in which elements of the logic of reflection are modified and yet continue to play a role in the logic of the concept. (shrink)

In the atavistic model of cancer progression, tumor cell dedifferentiation is interpreted as a reversion to phylogenetically earlier capabilities. The more recently evolved capabilities are compromised first during cancer progression. This suggests a therapeutic strategy for targeting cancer: design challenges to cancer that can only be met by the recently evolved capabilities no longer functional in cancer cells. We describe several examples of this target‐the‐weakness strategy. Our most detailed example involves the immune system. The absence of adaptive immunity in (...) immunosuppressed tumor environments is an irreversible weakness of cancer that can be exploited by creating a challenge that only the presence of adaptive immunity can meet. This leaves tumor cells more vulnerable than healthy tissue to pathogenic attack. Such a target‐the‐weakness therapeutic strategy has broad applications, and contrasts with current therapies that target the main strength of cancer: cell proliferation. (shrink)

The boundary work approach has been established as one of the main ways to study controversies in science. However, it has been proposed that it does not meet the power dynamics of the scientific field sufficiently. This article concentrates on the intertwining of boundary work and power. It combines the boundary work approach developed by Thomas Gieryn and the analysis of power in the work of Pierre Bourdieu. Based on a literature review and an analysis of a controversy over (...) class='Hi'>therapeutic touch, it finds four forms of boundary work: intradisciplinary, interdisciplinary, between science and society, and between science and other knowledge systems. The article shows how the different forms of boundary work reveal multiple power struggles, hierarchisations and tensions. The controversy appeared in Finnish nursing science when the Finnish Association of Sceptics gave its annual Humbug Award to a book on therapeutic touch. The book was based on a master’s thesis at the University of Tampere department of nursing science. The nursing scholars in the department reacted abruptly and banned certain books, which astonished the students, and a lively public debate followed. In the debate, nursing science was both defended and challenged. The framework of the study shows that the boundary work approach can be used to study different aspects of power. The article proposes that the framework could be used in other controversies as well to study the layers of power in boundary work. (shrink)

This paper presents a case study that explores the application of systemic family therapy in working with children who are victims of violence within their family. The case study focuses on the Johnson family, comprising a father, mother, and their two children, who sought therapy after a traumatic incident of domestic violence. The therapeutic approach utilized a systemic family therapy framework, aiming to address the complex dynamics resulting from the violence and its impact on family members. The goals include (...) providing a safe environment for children to process their experiences, enhancing communication, promoting non-violent parenting, and strengthening the family’s support network. The interventions involved individual sessions with the children, family sessions, psychoeducation, and collaborative goal setting. Throughout the therapy process, significant improvements were observed, including enhanced communication, improved emotional well-being for the children, non-violent parenting strategies, and the development of a support network. The findings of this case study highlight the effectiveness of systemic family therapy in promoting healing, fostering healthy relationships, and creating a nurturing environment for children affected by family violence. (shrink)

The coronavirus disease 2019 (COVID-19) pandemic has motivated medical ethicists and several task forces to revisit or issue new guidelines on allocating scarce medical resources. Such guidelines are relevant for the allocation of scarce therapeutics and vaccines and for allocation of ICU beds, ventilators, and other life-sustaining treatments or potentially scarce interventions. Principles underlying these guidelines, like saving the most lives, mitigating disparities, reciprocity to those who assume additional risk (eg, essential workers and clinical trial participants), and equal access may (...) compete with one another. We propose the use of a “categorized priority system” (also known as a “reserve system”) as an improvement over existing allocation methods, particularly because it may be able to achieve disparity mitigation better than other methods. (shrink)

In a previous article, I attempted to assess the likely impact of the most prominent versions of the therapeutic misconception (TM) on research subjects’ informed consent. I concluded that the TM is not nearly as significant a concern as is commonly thought, and that focusing on it is more likely to undermine than promote research subjects’ informed consent.A recent commentary rejects these conclusions, as least as they pertain to the “consensus” definition of the TM. The authors of the commentary (...) argue that work on the TM remains central to ensuring the appropriateness of research subjects’ consent and, by implication, the ethical acceptability of clinical research.The present work evaluates the arguments offered in support of these claims. This analysis reveals that the authors offer few substantive responses to my arguments, and the responses they do offer fail to undermine my prior conclusions. Furthermore, consideration of an additional issue—the emergence of learning healthcare systems—suggests that the TM is likely to be even less significant in the future, hence, focusing on it may be even more problematic than I argued previously. (shrink)

The Japanese Medical Act section 21 states that doctors must report unnatural deaths to the police, even though the term “unnatural death” is not defined by law. However, many doctors are reluctant to report potential therapeutic deaths . The Japanese Society of Legal Medicine has submitted guidelines for unnatural death, including PTD. These define a PTD as an unexpected death, the cause of which is unknown, but which is potentially related to medical practice. Such deaths are “reportable” to the (...) coroner in the UK. In this study, we addressed the question of whether physicians would report each of eight hypothetical PTDs. Although the clinical societies declare that doctors must report deaths due to gross negligence, 60% of the participants said that they would not report gross negligence involving an overdose in cases where they had obtained informed consent or had provided an explanation after the death occurred. This can be accounted for by the mistaken belief on the part of the participants that obtaining informed consent exempts Japanese physicians from the duty of reporting PTDs. The attitude of Japanese physicians is caused by the death investigation system, which is designed to discover whether a crime has been committed rather than focusing on the cause of death. Accordingly, the Japanese Government has decided to commission a pilot study from an independent organisation in which medical specialists will investigate PTDs in order to prevent deaths occurring as a result of gross negligence. (shrink)

Invertebrate genetic models with their tractable neuromuscular systems are effective vehicles for the study of human nerve and muscle disorders. This is exemplified by insights made into spinal muscular atrophy (SMA) using the fruit fly Drosophila melanogaster and the nematode worm Caenorhabditis elegans. For speed and economy, these invertebrates offer convenient, whole‐organism platforms for genetic screening as well as RNA interference (RNAi) and chemical library screens, permitting the rapid testing of hypotheses related to disease mechanisms and the exploration of (...) new therapeutic routes and drug candidates. Here, we discuss recent developments encompassing synaptic physiology, RNA processing, and screening of compound and genome‐scale RNAi libraries, showcasing the importance of invertebrate SMA models.Editor's suggested further reading in BioEssays: SMN and Gemins: ‘We are family’... or are we? Abstract. (shrink)

Among the objections to the implementation of what I will call "genome editing in human reproduction" is that it does not address any unmet medical need, and therefore fails to meet an important criterion for introducing an unproven procedure with potentially adverse consequences. To be clear: what I mean by GEHR is the use of any one of a number of related biological techniques, such as the CRISPR-Cas9 system, deliberately to modify a functional sequence of DNA in a cell of (...) a human embryo, so that the modified sequence is replicated in the cells of a resulting child and may, without further intervention, be passed on to that child's biological descendants. It is... (shrink)

The main aim of this study is to explore the breadth of the inference field and the type of etiopathogenetic contents of symptom explanations provided by the client and therapist in the first two psychotherapy sessions conducted using a systemic approach. Does the therapist use triadic explanations of psychopathology as suggested by her approach? And do clients resort almost exclusively to monadic and dyadic explanations as did the university students in our previous study? What kind of explanations do they propose? (...) The coding system “1 to 3: from the monad to the triad” was applied to the transcripts of 25 individual systemic therapies conducted by the same therapist. This manual allows to code the inference field of symptom explanations according to three categories: monadic, dyadic and triadic. These three broad categories are also used to analyse the etiopathogenetic content of each explanation: traumatic, intrapersonal, and interpersonal. Our findings showed that clients and their therapist actually used different inference fields: clients resorted almost exclusively to monadic and dyadic explanations, whereas their therapist included the triadic explanatory level. Moreover, the therapist provided more interpersonal explanations than her clients. Hence, the dissonance between client and therapist about the inference fields¬–a crucial premise of one of the most accepted ideas of therapeutic change according to systemic therapies–is proved, at least among our participants. Thanks to this dissonance, clients and therapists can create a new story, potentially able to change clients’ feelings, without disconfirming their emotions. (shrink)

The multiplicity of deubiquitinating enzymes (DUBs) encoded by vertebrate genomes is partly attributable to whole genome duplication events that occurred early in chordate evolution. By surveying the literature for the largest family of DUBs (the ubiquitin-specific proteases), extensive functional redundancy for duplicated genes has been confirmed as opposed to singletons. Dramatically conflicting results have been reported for loss of function studies conducted through RNA interference as opposed to inactivating mutations, but the contradictory findings can be reconciled by a recently proposed (...) compensatory mechanism involving nonsense-mediated RNA degradation. Duplicated genes are often inactivated to become pseudogenes, and it is proposed that such is the fate of the USP15 gene of zebrafish, a commonly used model system. As it is reviewed here, these observations have implications not only for the interpretation of model system phenotypes but also for therapeutic interventions designed to target DUBs. (shrink)

The controversy over the prescription drug, alosetron, is examined in order to investigate what is permitted to count as ‘therapeutic advance’ and ‘therapeutic breakthrough’ within pharmaceutical innovation and regulation. It is argued that those official accounting categories can mask very modest efficacy of some drugs by reference to the official techno-scientific evidence, thus leading to questionable acceptance of risks to public health. This is explained by: the drug availability options set by the commercial interests of manufacturers; the FDA (...) management's need to demonstrate rapid approval of therapeutic advances to their budgetary masters, especially in the context of patient demands for access to new drugs; and the increasing capacity of patient groups, sometimes in collaboration with pharmaceutical manufacturers, to challenge techno-scientific expertise and evidence with experiential testimony. It is concluded that regulatory policy-makers need much more sophisticated accounting systems for differentiating between drugs defined as significant therapeutic advances, and between drugs (‘therapeutic breakthroughs’ fast-tracked to treat serious or life-threatening conditions. Contrary to some STS analyses, the desirability of an ascendancy of patients’ anecdotal evidence in regulatory decisions for public health is questioned. (shrink)

Selective protein degradation maintains cellular homeostasis, but this process is disrupted in many diseases. Targeted protein degradation (TPD) approaches, built upon existing cellular mechanisms, are promising methods for therapeutically regulating protein levels. Here, we review the diverse palette of tools that are now available for doing so throughout the gene expression pathway and in specific cellular compartments. These include methods for directly removing targeted proteins via the ubiquitin proteasome system with proteolysis targeting chimeras (PROTACs) or dephosphorylation targeting chimeras (DEPTACs). Similar (...) effects can also be achieved through the lysosomal system with autophagy‐targeting chimeras (AUTACs), autophagosome tethering compounds (ATTECs), and lysosome targeting chimeras (LYTACs). Other methods act upstream to degrade RNAs (ribonuclease targeting chimeras; RIBOTACs) or transcription factors (transcription factor targeting chimeras; TRAFTACs), offering control throughout the gene expression process. We highlight the evolution and function of these methods and discuss their clinical implications in diverse disease contexts. (shrink)

Neuro-technical interfaces are technical devices that bridge the electronic world to neurons with the objective to establish a long term stable contact for bidirectional information exchange. What does that mean in detail and to what kind of machine and for what purpose should the central nervous system, i.e. the brain, be connected? Science fiction literature and movies offer a tremendous variety of usually uncomfortable scenarios including cyborg and robocop super-humans and mass control. Do these implants change the psyche in general (...) and what is feasible in nowadays therapeutic and rehabilitative approaches? In this overview, the author will not answer these questions but tries to deliver an overview of the technological background, the opportunities and the limitations of neuro-technical interfaces to the central nervous system. The fundamental specifications for neuro-technical interfaces will be introduced. Different degrees of implant invasiveness will be discussed and lead to a summary of clinical systems with their application-specific complexity. Actual technological opportunities and limitations will be addressed as well as general physical limitations. Current and future scenarios of neuro-technical interfaces to the central nervous system will be presented from an engineering point of view arising some questions that might be of interest with respect to ethical and societal implications when those interfaces are transferred into clinical practice and public applications. (shrink)

High degrees of uncertainty and a lack of effective therapeutic treatments have characterized the COVID-19 pandemic and the provision of drug products outside research settings has been controversial. International guidelines for providing patients with experimental interventions to treat infectious diseases outside of clinical trials exist but it is unclear if or how they should apply in settings where clinical trials and research are strongly regulated. We propose the Professional Oversight of Emergency-Use Interventions and Monitoring System as an alternative pathway (...) based on guidance developed for the ethical provision of experimental interventions to treat COVID-19 in Singapore. We support our proposal with justifications that establish moral duties for physicians to record outcomes data and for institutions to establish monitoring systems for reporting information on safety and effectiveness to the relevant authorities. Institutions also have a duty to support generation of evidence for what constitutes good clinical practice and so should ensure the unproven intervention is made the subject of research studies that can contribute to generalizable knowledge as soon as practical and that physicians remain committed to supporting learning health systems. We outline key differences between POEIMS and other pathways for the provision of experimental interventions in public health emergencies. (shrink)

Graphical AbstractOrganelles are reaction vessels containing metabolic pathways. As in a chemical factory, the size of the reaction vessels limits the rate of product formation. Organelle size is tuned to metabolic needs, hence reprogramming organelle size could be a novel therapeutic strategy as well as a new tool for metabolic engineering.

In contrast to recent trends that depict the later Wittgenstein’s work as wholly therapeutic in nature, this essay argues that the famous wood sellers scenario of Remarks on the Foundations of Mathematics is evidence of the later Wittgenstein’s linguistic naturalism and relativism. This scenario, like many others, is intended to show the naturalistic and arbitrary character of our own concepts, as well as the possibility of different forms of life with different concepts. David R. Cerbone’s more therapeutic take (...) on these passages, that the purpose of the wood sellers is to demonstrate the impossibility of logically alien practices, is then addressed. It is shown that such a read is incompatible with numerous passages in Wittgenstein’s writings, overlooks the nexus of remarks within which this scenario appears, and ignores much of what Wittgenstein actually states about the wood sellers. (shrink)

In contrast to recent trends that depict the later Wittgenstein’s work as wholly therapeutic in nature, this essay argues that the famous wood sellers scenario of Remarks on the Foundations of Mathematics is evidence of the later Wittgenstein’s linguistic naturalism and relativism. This scenario, like many others, is intended to show the naturalistic and arbitrary character of our own concepts, as well as the possibility of different forms of life with different concepts. David R. Cerbone’s more therapeutic take (...) on these passages, that the purpose of the wood sellers is to demonstrate the impossibility of logically alien practices, is then addressed. It is shown that such a read is incompatible with numerous passages in Wittgenstein’s writings, overlooks the nexus of remarks within which this scenario appears, and ignores much of what Wittgenstein actually states about the wood sellers. (shrink)

Department of Economics, University of Calgary, 2500 University Dr NW, Calgary AB, T2N 1N4, Canada. Tel.: +1403220 5861; Fax: +1403220 5861; Email: ahollis{at}ucalgary.ca ' + u + '@' + d + ' '//--> . Abstract The Health Impact Fund has been proposed as an optional, comprehensive advance market commitment system offering financial payments or ‘prizes’ to patentees of new drugs, which are sold globally at an administered low price. The Fund is designed to offer payments based on the therapeutic (...) impact of the drugs or vaccines, so that innovators will have efficient incentives to develop drugs that maximize health gains. Consumers would have improved access to such drugs because of low prices. CiteULike Connotea Del.icio.us What's this? (shrink)

The advance in Internet of Things technology has increased the opportunities for a healthcare system design, which is an urgent need owing to the growth in population among the older adults in many countries. This requires giving thought to the kind of innovative technological design methods that can find suitable solutions for home care. The application of Health Smart Homes by means of the technologies of the Internet of Things, can be used to support rehabilitation treatment and help the senior (...) citizens to understand the importance of taking measures to maintain a healthy standard of living that can meet their needs. The aim of this article is to develop and assess a design method for the following purposes: to determine and map out the physical and emotional state of the home care users, such as senior citizens; to implement a participatory design that includes the user within its social, psychological and therapeutic context; to explore the flexible method when applied to older users; to provide a way for the users to be “personalized” through a wide range of solutions that involve analyzing the behavioral patterns of different individuals in a standardized manner and to define a set of smart technologies for each problem and senior citizen. This article sets out a collaborative method called FlexPersonas, which is employed for the flexible mapping of users and to improve decision-making with the support of Internet of Things technologies. In this context, computing systems can identify the behavior of the user and issue warnings to the Carers about any abnormal event. Studies with an interdisciplinary team point out the potential and drawbacks of the method. (shrink)

The renin-angiotensin system (RAS) is critical in sodium and blood pressure (BP) regulation, and in cardiovascular-renal (CVR) diseases and therapeutics. As a contribution to SAPHIR project, we present a realistic computer model of renin production and circulating RAS, integrated into Guyton’s circulatory model ( GCM ). Juxtaglomerular apparatus, JGA , and Plasma modules were implemented in C ++/M2SL (Multi-formalism Multi-resolution Simulation Library) for fusion with GCM . Matlab © optimization toolboxes were used for parameter identification. In JGA , renin production (...) and granular cells recruitment (GCR) are controlled by perfusion pressure (PP), macula densa (MD), angiotensin II (Ang II), and renal sympathetic activity (RSNA). In Plasma , renin and ACE (angiotensin-converting enzyme) activities are integrated to yield Ang I and II. Model vs. data deviation is given as normalized root mean squared error (nRMSE; n points). Identification: JGA and Plasma parameters were identified against selected experimental data. After fusion with GCM : (1) GCR parameters were identified against Laragh’s PRA-natriuresis nomogram; (2) Renin production parameters were identified against two sets of data ([renin] transients vs. ACE or renin inhibition). Finally, GCR parameters were re-identified vs. Laragh’s nomogram (nRMSE 8%, n = 9). Validation: (1) model BP, PRA and [Ang II] are within reported ranges, and respond physiologically to sodium intake; (2) short-term Ang II infusion induces reported rise in BP and PRA. The modeled circulating RAS, in interaction with an integrated CVR, exhibits a realistic response to BP control maneuvers. This construction will allow for modelling hypertensive and CVR patients, including salt-sensitivity, polymorphisms, and pharmacotherapeutics. (shrink)

Medical expert systems (MES) are knowledge-based computer programs that are designed for advising physicians on diagnostical and therapeutical decision-making. They use heuristic methods developed by Artificial Intelligence researchers in order to retrieve from large knowledge-bases information needed in the situation. Constructing the knowledge-base of a MES embraces the problem of explicating and fixing the conceptual, causal and epistemic relations between a lot of medical objects. There is a number of preconditions which any adequate representation of such knowledge must fulfil, (...) among them the conditions of consistency, of completeness, of unequivocality, etc. Existing systems for classification and coding, like ICD and SNOMED, are not designed for the needs of constructing expert systems or, more generally, of knowledge processing and knowledge engineering. Their syntax is not sufficiently rich for expressing the more complex structures of (medical) knowledge. What is needed, is a language that can be used for expressing logical and descriptive relations between medical objects and facts, approximately at the level of the language of second order predicate logic. Simultaneously, it must be possible to process this language at the machine level. This can be achieved by using some dialects of the programming language LISP or, particularly, by using the programming language PROLOG. Thus, in order to achieve a suitable classification system, it is necessary to develop a system of medical data structures and predicates expressed in LISP or PROLOG. (shrink)

The inability of government, communities and churches to deal with complex HIV and AIDS challenges may foster pathological psychosocial and systemic dysfunctionalities. The reframing of pathological and disempowering pastoral therapeutic and health promotion praxes are sought. The objective was to construct a new pastoral and social therapeutic methodology. It should develop in line with health promotion praxes in strengthening both ecclesial and community health praxes. Reframing agents such as pastoral therapeutic and health praxes, as well as ecclesial (...) and community systems, could ultimately engender a transformative process in transforming pathological HIV and AIDS praxes. (shrink)