Defining experiment was particularly vexed in the realm of anatomical dissection and vivisection. Was dissection merely descriptive, or something more? Harvey's discovery of the circulation of the blood and Aselli's discovery of the so-called lacteal veins shaped much anatomical research between the late 1620s and the 1650s. While the techniques of dissection and vivisection gained wide use, there was much debate on the validity of the circulation in particular, and its relationship to the lacteal veins. Critics, particularly the French anatomist (...) Jean Riolan, but also the natural philosopher Pierre Gassendi, focused on the lack of causation in Harvey's method and the lack of medical use and not on his use of vivisection. Jean Pecquet's discovery of the thoracic duct in 1651 changed the terms of the debate by definitively connecting the circulation with the lacteals. Riolan's critiques of Pecquet in the 1650s show profoundly differing notions of the purpose of dissection. While Gassendi eventually accepted Harvey's concept of the circulation, Riolan never did. (shrink)

In recent years, there have been a number of well‐documented examples demonstrating that one cell type can be converted to another. Two such examples are the appearance of ectopic pancreas in the liver and formation of hepatic tissue in the pancreas. The conversion of liver to pancreas raises the intriguing possibility of generating insulin‐producing β cells for therapeutic transplantation into diabetics. There is now a striking addition to the growing list of pancreatic conversions: the formation of pancreatic tissue in the (...) developing biliary system.1 BioEssays 26:932–937, 2004. © 2004 Wiley Periodicals, Inc. (shrink)

In preparation for the development of a rapid tissue donation programme, we surveyed healthcare providers in our institution about knowledge and attitudes related to RTD with lung cancer patients. A 31-item web based survey was developed collecting data on demographics, knowledge and attitudes about RTD. The survey contained three items measuring participants’ knowledge about RTD, five items assessing attitudes towards RTD recruitment and six items assessing HCPs’ level of agreement with factors influencing decisions to discuss RTD. Response options were presented (...) on a 5-point Likert scale. Ninety-one HCPs participated in the study. 66% indicated they had never heard of RTD prior to the survey, 78% rated knowledge of RTD as none or limited and 95.6% reported not having ethical or religious concerns about discussing RTD with patients. The majority were either not comfortable or not sure if they felt comfortable discussing RTD with cancer patients . 56.1% indicated their knowledge of RTD would play an integral role in their decision to discuss RTD with patients. 71.4% reported concerns with RTD discussion and the emotional state of the patient. Physicians and nurses play an important role in initiating conversations about recruitment and donation to research that can ultimately influence uptake. Increasing HCP knowledge about RTD is a necessary step towards building an RTD programme. Our study provides important information about characteristics associated with low levels of knowledge and practice related to RTD where additional education and training may be warranted. (shrink)

Anydomainofscientificresearchhasitssustainingorthodoxy. Thatis, research on a problem, whether in astronomy, physics, or biology, is con- ducted against a backdrop of broadly shared assumptions. It is these as- sumptionsthatguideinquiryandprovidethecanonofwhatisreasonable-- of what "makes sense." And it is these shared assumptions that constitute a framework for the interpretation of research results. Research on the problem of how we see is likewise sustained by broadly shared assump- tions, where the current orthodoxy embraces the very general idea that the business of the visual system is to (...) create a detailed replica of the visual world, and that it accomplishes its business via hierarchical organization and by operatingessentiallyindependently of other sensorymodalitiesas well as independently of previous learning, goals, motor planning, and motor execution. (shrink)

It is unclear whether the regulatory distinction between non-identifiable and identifiable information—information used to determine informed consent practices for the use of clinically derived samples for genetic research—is meaningful to patients. The objective of this study was to examine patients' attitudes and preferences regarding use of anonymous and identifiable clinical samples for genetic research. Telephone interviews were conducted with 1,193 patients recruited from general medicine, thoracic surgery, or medical oncology clinics at five United States academic medical centers. Wanting to (...) know about research being done was important to 72% of patients when samples would be anonymous and to 81% of patients when samples would be identifiable. Only 17% wanted to know about the identifiable scenario but not the anonymous scenario. Curiosity-based reasons were the most common among patients who wanted to know about anonymous samples. Of patients wanting to know about either scenario, approximately 57% would require researchers to seek permission, whereas 43% would be satisfied with notification only. Patients were more likely to support permission in the anonymous scenario if they had more education, were Black, less religious, in better health, more private, and less trusting of researchers. The sample, although not representative of the general population, does represent patients at academic medical centers whose clinical samples may be used for genetic research. Few patients expressed preferences consistent with the regulatory distinction between non-identifiable and identifiable information. Data from this study should cause policy-makers to question whether this distinction is useful in relation to research with previously collected clinically derived samples. (shrink)

In 2002, I wrote an editorial in this Journal arguing that it was time to review the structure and function of ethics committees in the USA, Australia and the UK.1 This followed the deaths of Ellen Roche and Jesse Gelsinger, which were at least in significant part due to the poor functioning of research ethics committees in the USA.2 In the case of Ellen Roche, it was the failure to require a systematic review of the existing literature which led to (...) her death. Iain Chalmers and I had previously documented in 1996 the failure of ethics committees to require systematic review.3 In 1998, at the time of revising the previous guidelines and forming the first Australian National Statement on Research Ethics, I made a public submission to the Australian Health Ethics Committee arguing that the new guidelines for RECs should include a person with skills in conducting systematic reviews of the literature and that the requirement to have a religious representative on the committee be replaced with the requirement to have an ethicist. Neither of these changes was made. I argued, ‘It is time to ask whether institutional RECs should be abandoned in favour of expert committees that cover many institutions—suprainstitutional specialist committees. Supraregional specialist ethics committees could specialise—for example, in genetic research, cancer clinical trials, dermatology, respiratory physiology and each of the specialist areas of medical research. An example of such a committee is provided by the Thoracic Society of Australia and New Zealand research ethics committee, which reviews multicentre trials of respiratory drugs’.4 Around that time, I was involved ‘at the coal face’ as Chair of the Department of Human Services Ethics Committee in Victoria. In a public presentation, I arguedThere are two philosophical views of what ethics review is. On the …. (shrink)

Nurses, like many other professional and semiprofessional groups, have a code of con duct. This raises important philosophical questions about the point of including nursing ethics in nursing education and about the content and methods of such teaching. This paper identifies seven functions that might be fulfilled by professional codes; it discusses the philosophical issues these raise and the implications for teaching professional ethics. It is argued that, far from codes rendering the teaching of ethics unnecessary, they pro vide (...) additional reasons for its inclusion. An enhanced ability to make moral decisions helps to overcome the shortcomings of the codes, enables a profession to be autonomous in the development of its code, enables individuals to be authentic moral agents, and is essential in matters concerning the disciplinary function of the codes. The role of emo tions, feelings and attitudes in ethics also presents philosophical problems that moral edu cation can help to resolve. (shrink)

In this issue of Perspectives in Biology and Medicine, Schneiderman and colleagues critique a recent multi-society policy statement—developed by the American Thoracic Society and endorsed by four other organizations—entitled “Responding to Requests for Potentially Inappropriate Treatment in Intensive Care Units”. The focus of Schneiderman’s critique is the Multiorganization Policy Statement’s choice of the term “potentially inappropriate” to describe a class of interventions that clinicians should resist providing for patients near the end of life, even when patients or their families (...) request or demand them.1 Schneiderman and colleagues argue that the term... (shrink)

The aim of this study was to analyse experiences of moral concerns in intensive care nursing. The theoretical perspective of the study is based on relational ethics, also referred to as ethics of care. The participants were 36 intensive care nurses from 10 general, neonatal and thoracic intensive care units. The structural characteristics of the units were similar: a high working pace, advanced technology, budget restrictions, recent reorganization, and shortage of experienced nurses. The data consisted of the participants’ examples (...) of ethical situations they had experienced in their intensive care unit. A qualitative content analysis identified five themes: believing in a good death; knowing the course of events; feelings of distress; reasoning about physicians’ ‘doings’ and tensions in expressing moral awareness. A main theme was formulated as caring about - caring for: moral obligations and work responsibilities. Moral obligations and work responsibilities are assumed to be complementary dimensions in nursing, yet they were found not to be in balance for intensive care nurses. In conclusion there is a need to support nurses in difficult intensive care situations, for example, by mentoring, as a step towards developing moral action knowledge in the context of intensive care nursing. (shrink)

Formation of branching epithelial trees from unbranched precursors is a common process in animal organogenesis. In humans, for example, this process gives rise to the airways of the lungs, the urine‐collecting ducts of the kidneys and the excretory epithelia of the mammary, prostate and salivary glands. Branching in these different organs, and in different animal classes and phyla, is morphologically similar enough to suggest that they might use a conserved developmental programme, while being dissimilar enough not to make it obviously (...) certain that they do. In this article, I review recent discoveries about the molecular regulation of branching morphogenesis in the best‐studied systems, and present evidence for and against the idea of there being a highly conserved mechanism. Overall, I come to the tentative conclusion that key mechanisms are highly conserved, at least within vertebrates, but acknowledge that more work needs to be done before the case is proved beyond reasonable doubt. BioEssays 24:937–948, 2002. © 2002 Wiley Periodicals, Inc. (shrink)

Somites are transient structures which represent the most overt segmental feature of the vertebrate embryo. The strict temporal regulation of somitogenesis is of critical developmental importance since many segmental structures adopt a periodicity based on that of the somites. Until recently, the mechanisms underlying the periodicity of somitogenesis were largely unknown. Based on the oscillations of c-hairy1 and lunatic fringe RNA, we now have evidence for an intrinsic segmentation clock in presomitic cells. Translation of this temporal periodicity into a spatial (...) periodicity, through somite formation, requires Notch signaling. While the Hox genes are certainly involved, it remains unknown how the metameric vertebrate axis becomes regionalized along the antero–posterior (AP) dimension into the occipital, cervical, thoracic, lumbar, and sacral domains. We discuss the implications of cell division as a clock mechanism underlying the regionalization of somites and their derivatives along the AP axis. Possible links between the segmentation clock and axial regionalization are also discussed. BioEssays 22:72–83, 2000. ©2000 John Wiley & Sons, Inc. (shrink)

Somites are transient structures which represent the most overt segmental feature of the vertebrate embryo. The strict temporal regulation of somitogenesis is of critical developmental importance since many segmental structures adopt a periodicity based on that of the somites. Until recently, the mechanisms underlying the periodicity of somitogenesis were largely unknown. Based on the oscillations of c-hairy1 and lunatic fringe RNA, we now have evidence for an intrinsic segmentation clock in presomitic cells. Translation of this temporal periodicity into a spatial (...) periodicity, through somite formation, requires Notch signaling. While the Hox genes are certainly involved, it remains unknown how the metameric vertebrate axis becomes regionalized along the antero–posterior (AP) dimension into the occipital, cervical, thoracic, lumbar, and sacral domains. We discuss the implications of cell division as a clock mechanism underlying the regionalization of somites and their derivatives along the AP axis. Possible links between the segmentation clock and axial regionalization are also discussed. (shrink)

In many bilaterian phyla, appendages are morphological traits that characterise the identity of the various body parts. In pterygote insects, wings are dorsal appendages on the thorax. The famous “bithorax” fly created by Ed Lewis is the emblematic example of the role of Hox genes.1 Now, Tomoyasu et al.,2 using classical genetics, transgenesis and RNAi, have examined the function of thoracic Hox genes in the beetle Tribolium castaneum. Beetles have rigid elytra in place of the first pair of wings. (...) Instead of the expected transformation of the elytron into a wing, loss of Hox genes' function leads to the homeotic transformation of the second pair of dorsal appendages, the wings, into elytra. This has important consequences for the way that we see the role of Hox genes in development and evolution. BioEssays 27:673–675, 2005. © 2005 Wiley Periodicals, Inc. (shrink)

Information on the risks and benefits related to surgical procedures is essential for patients in order to obtain their informed consent. Some disciplines, such as sociolinguistics, offer insights that are helpful for patient—professional communication in both written and oral consent. Communication difficulties become more acute when patients make decisions through an informed consent document because they may sign this with a lack of understanding and information, and consequently feel deprived of their freedom to make their choice about different treatments or (...) surgery. This article discusses findings from documentary analysis using the sociolinguistic SPEAKING model, which was applied to the general and specific informed consent documents required for laparoscopic surgery of the bile duct at Torrecárdenas Hospital, Almería, Spain. The objective of this procedure was to identify flaws when information was provided, together with its readability, its voluntary basis, and patients’ consent. The results suggest potential linguistic communication difficulties, different languages being used, cultural clashes, asymmetry of communication between professionals and patients, assignment of rights on the part of patients, and overprotection of professionals and institutions. (shrink)

It is unclear whether the regulatory distinction between non-identifiable and identifiable information—information used to determine informed consent practices for the use of clinically derived samples for genetic research—is meaningful to patients. The objective of this study was to examine patients' attitudes and preferences regarding use of anonymous and identifiable clinical samples for genetic research. Telephone interviews were conducted with 1,193 patients recruited from general medicine, thoracic surgery, or medical oncology clinics at five United States academic medical centers. Wanting to (...) know about research being done was important to 72% of patients when samples would be anonymous and to 81% of patients when samples would be identifiable. Only 17% wanted to know about the identifiable scenario but not the anonymous scenario. Curiosity-based reasons were the most common among patients who wanted to know about anonymous samples. Of patients wanting to know about either scenario, approximately 57% would require researchers to seek permission, whereas 43% would be satisfied with notification only. Patients were more likely to support permission in the anonymous scenario if they had more education, were Black, less religious, in better health, more private, and less trusting of researchers. The sample, although not representative of the general population, does represent patients at academic medical centers whose clinical samples may be used for genetic research. Few patients expressed preferences consistent with the regulatory distinction between non-identifiable and identifiable information. Data from this study should cause policy-makers to question whether this distinction is useful in relation to research with previously collected clinically derived samples. (shrink)

The fast changing business environment and the ever-growing de- mand facing professional communicators in the 21st century pose new challenges to language learners and teachers alike. Competitive business organizations at- tempt to recruit employees who have excellent linguistic competence coupled with nonlinguistic competences and skills. It is not easy to acquire these addi- tional competences and skills. However, most of them are transferable and can be greatly improved if students are provided with adequate teaching materials and appropriate input from the (...) teacher. The aim of the paper is to address the complexity of ESP teaching today. Firstly, it presents an overview of the changes that have occurred in the practice of teaching ESP in the last few decades. It also sheds some light on the increasing importance of needs analysis. Then it presents new developments in teaching English for professional communication at the ter- tiary level of education. These developments include content-and-language integrated learning, use of didactic case studies, corpus studies con- ducted for teaching purposes and aimed at identifying high-frequency language elements: terms, specialized lexis items, collocations, formulae, acronyms, etc., that need to be prioritized in language courses, more effective course-books with higher terminology indexes, extended use of online materials, teach- ing writing for specialized purposes, and teaching cross-cultural and social skills. The new approach is more challenging for ESP teachers and requires much higher qualifications, such as content knowledge and transferable skills. In order to increase students’ employability and promotion opportunities, we need teaching materials and approaches that help streamline students’ efforts, economize on time, and increase the effectiveness of language courses. (shrink)

Objective The objective of this article is to provide an ethical analysis of a high-risk, advanced treatment case where the patient received transcatheter aortic valve insertion, for aortic valve stenosis. Particular emphasis will be placed upon the significance of evidence and the implications for priority setting. Method One paradigmatic case involving a TAVI patient from a large university hospital in Norway is described and analysed. The method used was ethical case analysis modified after Kymlicka by Miljeteig et al. Perioperative mortality (...) risk was estimated using the Euroscore risk-logarithm and the Society of Thoracic Surgeons’ risk model, STS. These predict the risk of operative mortality and morbidity associated with adult cardiac surgery. GRADE, the Grading of Recommendations Assessment, Development and Evaluation, was used to evaluate the evidence. Results In the case analysis, we found that it would be ethically justifiable not to recommend TAVI treatment for this patient. Although the patient had a severe condition in need of treatment, the expected improvement was marginal, the quality of evidence was low and the opportunity costs for other patients and society were higher than usually deemed appropriate. Conclusions Decision-making in the absence of high quality evidence from randomized trials is a complex process involving difficult ethical judgments. Novel high-risk devices often enter the European market with limited clinical evidence. Transparency and improved clinical evaluation are required so patient safety is not jeopardized. We argue that implementation of high risk, high cost interventions should be better regulated at a national level. Background All clinical decisions imply priority setting and therefore indirectly affect other patients and other patient groups. The use of expensive, innovative health technologies has an affect on individual patients as well as on other patient groups competing for the same resources. (shrink)

Ethical concerns regarding the conceptual framework for the determination of death by neurological criteria, including several clinical and diagnostic practices, are addressed. The significance of a diagnosis of brain death, diagnostic criteria, and certain technical aspects of the brain-death exam are presented. Standard and ancillary tests that typically help achieve prudential certitude that an individual has died are indicated. Ethical concerns surrounding interinstitutional variability of testing protocols are evaluated and considered, as are potential apnea-testing confounders such as hypotension, hypoxemia, hypercarbia, (...) and penumbra effects during ancillary testing. Potential adjustments to apnea-testing protocols involving capnography, thoracic impedance monitors, or spirometers to assess respiratory efforts are discussed. Situations in which individuals determined to be brain dead “wake up,” or fail to manifest the imminent cessation of somatic functioning typically seen when supported only by a ventilator, are also briefly reviewed. (shrink)

The debate about the definition of scientific miscon duct is being revisited by the scientific community in response to the Commission on Research Integrity's recommendation for a new definition. Scientists and lawyers are debating whether scientific misconduct should include acts that are not unique to the scientific community and do not affect the research. Falsification of credentials is one form of such misconduct.The Office of Research Integrity and the National Science Foundation, the two federal agencies primarily responsible for developing (...) policies on scientific misconduct, have struggled to define scientific rnisconduct and to decide which forms of professional misconduct do and do not fall within the definition. Although falsification of credentials is not unique to the scientific community, OR1 and NSF have determined that when researchers lie about their credentials, such conduct may constitute scientific misconduct. The question is why this form of professional misconduct has been labeled scientific misconduct when it occurs in a research setting, and whether any distinction exists between this white coat crime and white collar crime. (shrink)

This piece, included in the drift special issue of continent. , was created as one step in a thread of inquiry. While each of the contributions to drift stand on their own, the project was an attempt to follow a line of theoretical inquiry as it passed through time and the postal service(s) from October 2012 until May 2013. This issue hosts two threads: between space & place and between intention & attention . The editors recommend that to experience the (...) drifiting thought that attention be paid to the contributions as they entered into conversation one after another. This particular piece is from the BETWEEN SPACE & PLACE thread: April Vannini, Those Between the Common * Laura Dean & Jesse McClelland, Ballard: A Portrait of Placemaking * Amara Hark Weber, Crossroad * Isaac Linder & Berit Soli-Holt, The Call of the Wild: Terro(i)r Modulations * Ashley D. Hairston, Momma taught us to keep a clean house * Sean Smith, The Garage (Take One) * * * * Preface: Variations of Archiving the Anarchive Through Editorial Witnessing by April Vannini “a diagram is a map, or rather several superimposed maps.” 1 What do we do with essays, art, artefacts, and practices that go against, resist, challenge and reject archival capture or documentation since they do not fit within the screen or manage to move beyond conventional scales? What do we do with an essay or artefact that is the event of the event becoming-event itself, or how do we move from volumetric space to two-dimensional space? How do editors, curators, participants, etc. become witness to an anarchive? And most importantly, what are the potential and unanticipated ways in which a volumetric submission can be diagrammed within a two- dimensional space? In short, how do we archive the anarchive? These are questions that have emerged and have been consciously and purposely activated by Sean Smith’s thinkpiece for this issue, The Garage (Take One) . Sean, as part of his contribution to the special issue of drift within the thread in between space and place , created an artefact that emerged out of an event held during May 2013, titled Cottage University: Topology and Immanence . The visual documentation of The Garage (Take One) is not an archive but an anarchive due to its multimodal form, non-representational diagramming, and its reactivation of non-representational folding which animates its non-representational or more-than -representational condition. In short, The Garage (Take One) stymies attempts to be translated into digital text, representationally. As a reader of Sean’s submission you will only have access to a portion of the original submitted contribution (see “Take One”). At this time, I remain the only witness of The Garage (Take One) in its entirety: I was present at the original event, Cottage University: Topology and Immanence , and I was the sole receiver of the original package because of my role as editor for the thread, in between space and place . However, I would like to stress that I was unaware of what Sean would submit as his contribution to the special issue. What is presented here is an emergent rippling of the event that was not predetermined or arranged in advance ... a drifting of sorts! As for now, the artefact sits here on my desk next to a pile of books—folded, creased and somewhat lost in its translation into digital form. Questions of transcribing, translating and converting volumetric space to two-dimensional space have been considered throughout this process. And more importantly this artefact and its processes raise the issue of not what has been saved and included but what has been left out in each conversion of the original into the academic publication. What follows this preface are various “cuts” or “takes” from The Garage: Take One . Each take or cut is merely an interpretive and representational rendering of the original volumetric submission. Although with that said I would like to propose they are more than just representations or interpretations: each take or cut works as rippling variations of the event itself . It is important to acknowledge that much has been lost in the creases and much still lingers which will never be archived within an academic journal. Hence, a discussion of how to archive the anarchive is so crucial to para-academic “scholarship”. I will sum up the process that has emerged from The Garage (Take One) with a final word from Brian Massumi, written in his foreword to Deleuze and Guattari’s A Thousand Plateaus : Each 'plateau' is an orchestration of crashing bricks extracted from a variety of disciplinary edifices. They carry traces of their former emplacement, which give them a spin defining the arc of their vector. The vectors are meant to converge at a volatile juncture, but one that is sustained, as an open equilibrium of moving parts each with its own trajectory. The word 'plateau' comes from an essay by Gregory Bateson on Balinese culture, in which he found a libidinal economy quite different from the West's orgasmic orientation. In Deleuze and Guattari, a plateau is reached when circumstances combine to bring an activity to a pitch of intensity that is not automatically dissipated in a climax. The heightening of energies is sustained long enough to leave a kind of afterimage of its dynamism that can be reactivated or injected into other activities, creating a fabric of intensive states between which any number of connecting routes could exist. 2 The Garage (Take One) Double Take 2:31pm/5:31pm Sean Smith You there? I just wanted to emphasize a couple of things about the process of the submission: 2:31pm/5:31pm April Warn-Vannini Yes, listening. 2:36pm/5:36pm Sean Smith 1.When you describe feeding forward from the CU (Cottage University) event, it is a WALKING ACTIVITY that reinvests/reactivates the intensive energies of the event. that is what my photos are in Take One......it connects the intensive state of CU to my "one-take" writing on construction paper experience. i'm not sure if i adequately conveyed that or not, or if you did, or how important that is. 2. In doing so, it ruptures open the "space" and "place" of material practice ...and how these may enter into the mediated production of academic journal work...and its flattened two-dimensional experience. 3. the abstract machines of CU (i.e.coming out of silence) are invested with a new diagramming practice (the photo walk) to produce a new text that is neither-nor: "spaced" as a content of that walk (garages), but "placed" as a technical question (coming out of silence to language). 4. the new text is precisely diagrammatic, non-representational, anarchival. ....multimodal. ok, that's all that comes to mind right now. appreciating your efforts. 5. oh, finally, i think you might need a better definition of "anarchive" here..... it was hard to pin them down in montreal on what this is, so you wouldn't be wrong, per se, but more require a working definition for the reader. obviously, as you say, without getting too academic/citations, etc. know what i am saying? 2:46pm/5:46pm April Warn-Vannini 1. Totally got it but I think I did because of our many past conversations about how to archive the event 2. Yes this is what I love about this. And I think you speak to this very carefully in your writing on the Garage. Now whether others pick up on this I don't know. This is why I wanted to see what it would look like if I flattened it (take 3). 5. I agree that a better definition is needed. This is where I've been stumbling because I have not found anything that clearly defines what is meant by anarchive. 2:47pm/5:47pm Sean Smith "with take one being the only remainder of the original submission left to reveal...." precisely because of its digitality!!! yeah, i would probably just append an edited version of what we are saying here, as if the editing process was still a ripple of the event. me "adding" new text later i think defeats the purpose, but if you were to take snippets of this dialogue as part of the anarachive/ 2:48pm/5:48pm April Warn-Vannini Totally! 2:49pm/5:49pm Sean Smith and just *use them*, i think that's fair game. that way i won't be crafting my words with intent. you can even use this profile pic. 2:50pm/5:50pm April Warn-Vannini Okay perfect. With that said, do you think I should just discuss your process further in the preface or include an introduction that would be in take one? 2:51pm/5:51pm Sean Smith could it be Take Two in its own right, like an atemporal ripple that coexists with the others and bumps them to Three, Four and Five? Or could it be called "Double Take" and leave the others as Two, Three, Four? 2:53pm/5:53pm April Warn-Vannini Perfect. I like double take 2:53pm/5:53pm Sean Smith and it's us hashing through this discussion 2:53pm/5:53pm April Warn-Vannini Double take will follow take one. i like this. The Garage (Take Two) Folded, taped (scotch and duct), folded recycled chart paper previous emergent thoughts: performed, inscribed and made anew Red jiffy, black jiffy, blue ink pen cursive writing/block writing diagramming amplification dilated » » » » directional arrows « « « « Moistened, torn, crinkled Ruptures Anarchive of thought events Deciphering language/writing Exchanged as a volumetrics of new spaces Performing tactics of “writing off the page” on the page Enclosed [OPEN THE DOORS, MOVE FROM SURFACE TO VOLUME…AND THE CONVERSATION JUST MIGHT BEGIN ANEW. *stamped* SEAN SMITH] Drifting Drifting Drifting The Garage (Take Three) 6 Sean Smith video from April Vannini on Vimeo . The Garage (Take Four) The Garage (Take Five). (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)

BackgroundThe prognosis of patients undergoing lung cancer treatment might be influenced by mental health status. Resilience is one of the important predictors to reflect the mental health status. It has been shown that patients with higher levels of social support, self-care self-efficacy, and positive coping have greater resilience. This study aimed to determine the mediating role of self-efficacy and positive coping in the relationship between social support and psychological resilience in patients with lung cancer.MethodThis is a cross-sectional study that was (...) conducted in in the oncology departments and thoracic surgical wards of four tertiary hospitals in Hunan Province, China, between November 2016 and November 2017. Three hundred and three patients who were undergoing treatment for lung cancer volunteered their participation in the study. Participants completed questionnaires, including the Chinese version of the Perceived Social Support Seale Scale, the Chinese version of Strategies Used by People to Promote Health Scale, and the Chinese version of the Connor-Davidson Resilience Scale.ResultsMediation analysis indicated that self-care self-efficacy and social support partially mediate the effect of social support on resilience. Direct paths from social support to self-efficacy, self-efficacy to positive coping, positive coping to psychological resilience, self-efficacy to psychological resilience, and social support to psychological resilience were significant. The indirect paths from social support to self-efficacy and self-efficacy to psychological resilience were also significant. The chain mediation from social support to self-efficacy, self-efficacy to positive coping, and positive coping to resilience were significant.ConclusionSelf-efficacy and positive coping play an important role in the relationship between social support and resilience in patients receiving cancer treatment. Social support not only directly influenced psychological resilience but also indirectly influenced psychological resilience through self-efficacy and positive coping. (shrink)

This paper addresses two specific and related questions the Buddhist neuroethics program raises for our traditional understanding of Buddhist ethics: Does affective neuroscience supply enough evidence that contempla- tive practices such as compassion meditation can enhance normal cognitive functioning? Can such an account advance the philosophical debate concerning freedom and determinism in a profitable direction? In response to the first question, I argue that dispositions such as empathy and altruism can in effect be understood in terms of the mechanisms that (...) regulate affective cognition. In response to the second question, I claim that moral agency is a type of achievement that comes with learning the norms of ethical con- duct, which are not tractable by specifically neurobiological mechanisms and processes (though, once learned, such norms would have their neural cor- relates when enacted). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Comme Elle Respire:Memory of Breath, Breath of MemoryFrédérique Berthet (bio)Translated by David F. Bell (bio)La poésie est un système de respiration, c'est fait pour mieux respirer.[Poetry is a respiration system, it's made for breathing better.]—Erri De Luca- Stop!- What?- I can hear you breathing!...- Stop!- Breathing?- Yes!—Paul Thomas AndersonLittle paper-fish cutouts have been placed on the ground, on the carpet.We're in the reassuring '70s stylishness of a doctor's office. (...) The carpet is soft and glistens like in interior decoration magazines, it's with it, in. We couldn't care less about what Dyson vacuum cleaners and "purifiers" boast they can eliminate several decades later: acarids, those microscopic domestic arthropods, human parasites (notably), and airborne vectors of infectious disease (colds, coughs, respiratory distress). No, in the spring of 1975, innocently and self-satisfyingly, the urbane doctor flaunts the opulent carpet with curly pile in his luxury apartment with its state-of-the-art waiting room.In this grand interior of a medical office, a man in a white coat plies his important trade. For example, that day a little girl is re-learning how to breathe. One might think that exhaling and inhaling is learned for life—je t'aime comme je respire, elle parle comme elle respire, il ment comme il respire1—from the very first cry at birth. But in fact, sometimes in life breathing gets stuck between the nasal cavity and the bronchial tubes, between the respiratory tract and the lungs. Progressively, imperceptibly, the organism is short of air, a malicious infection spreads and impairs [End Page 92] alveolar diffusion to the point of respiratory exhaustion: Is it serious, doctor? We must act quickly, very quickly. How to liquify what stopped up the system one day to the point of blocking it—the doctors know what to do.This doctor undertook long, arduous and learned studies. He knows functionally how a living being breathes, how a child lives organically. He can also re-teach the little girl what she no longer knows how to do: inhale, exhale using the full volume of the thoracic cage, regulating the ventilatory flow, solidifying the invisible membranes. In the child's family, everyone knows (and knows how to do) important things, but no one undertook extensive studies, much less studies of the aerial exchanges in the human body. This special knowledge possessed by the doctor (unless special means something else unspoken that would explain why this specific doctor was chosen rather than any other) surrounds him with a padding of respect that creates (and the little girl feels this) a sort of protective continuum between him and the walls within which he sees her, where he practices his kind of calm and slow urbane medicine. It's far from the formidable hospital she has just left, with its spherical apparatus next to the bed aspirating the red and yellow pleural liquid, the "treatment room" where the surgeon, the "butcher" as the nurses call him among themselves, manipulated the drain without anesthesia, with no regard for the child's suffering. The doctor, and his place in the elevated tower, even though they are not to be confused, make for a cozy reception space in which one is comfortable, even in passing.This doctor—who is, in truth, a massage-physiotherapist—is located in a designer high-rise building with a façade decorated by white, pointed features that manifest a will toward an architectural act. On the ground floor, the entrance hall is finished in dark-veined, clear brown marble, and the entry threshold between the exterior and interior is marked by large transparent glass panes that must be manipulated with care. The entrance hall has an intimidating sonority and a useless cold nudity from which one escapes in an elevator where one is surrounded by mirrors and gold buttons and in which one speeds upward silently toward floors, clouds.The designer high-rise is located at the outskirts, the outskirts of a city of recent Olympic stature, where several years earlier Olympic athletes were welcomed and trained to increase their respiratory capacity and... (shrink)

This essay analyzes Senator Bill Frist's 2001 address to the American Society of Thoracic Surgeons. The author argues that the address represents an attempt to reframe physicians' political identity to authorize more active participation by them. Frist authorizes and demands such participation through the construction of a medical jeremiad. He argues that American physicians must have greater involvement to preserve the health of the body politic and to reassert physician control over the biomedical system. Although Frist's arguments are built (...) on an apparently democratic form of address, his jeremiad illustrates aristocratic possibilities in medico-political rhetoric. (shrink)

The first reported case of postmortem sperm retrieval occurred in 1978, involving a man who became brain dead after a motor vehicle accident and whose wife requested removal of his sperm so that she could be artificially inseminated. Physicians performed the retrieval by surgically excising the ducts that transport sperm from the testes and removing sperm from them. Since that time, several other methods for retrieving sperm from such patients have been reported, and at least 141 cases have been documented (...) in which requests were made for removal of sperm from men who were dead or irreversibly unconscious. Moreover, there have been several reports of pregnancies and births resulting from assisted reproduction using sperm retrieved in such cases. (shrink)

We explored differences in the course of physiological functions and in the subjective evaluations in response to listening to a 7-min recording of the sound of a chainsaw and to the sounds of a forest. A Biofeedback 2000x-pert apparatus was used for continual recording of the following physiological functions in 50 examined persons: abdominal and thoracic respiration and their amplitude and frequency, electrodermal activity, finger skin temperature, heart rate and heart rate variability. The group of 25 subjects listening to (...) the sound of a chainsaw exhibited significantly lower values of blood volume pulse amplitude, lower values in peak alpha frequency HRV and higher values in peak high-frequency HRV. In the time interval from 80 s to 209 s, in which the two groups showed the greatest differences, lower values of blood volume pulse were also recorded while listening to the sound of a chainsaw. Listening to the sound of a chainsaw is associated with a greater feeling of fatigue and higher tension, while listening to the sounds of a forest is even considered to elicit feelings of improved learning abilities. The assumption that listening to the sound of a chainsaw results in higher defense arousal was confirmed. The greater variability which is exhibited by a majority of physiological functions while listening to the forest sounds may also be an innovative finding. It seems that there are two types of arousal following from correlations between physiological functions and subjective assessment. Low values of blood volume pulse amplitude are especially important from the health perspective. They correspond to the amount of vasoconstriction which occurs in the endothelial dysfunction related to increased mortality, incidence of myocardial infarction, leg atherosclerosis and topically to COVID-19. (shrink)

The field of modern logic is too extensive to be worked through by open cast mining. To open it up, we need to sink shafts and construct adits. This is the method of most text books: a systematic exposition of a number of main topics, supplemented by exercises to teach skill in the appurtenant techniques, lays a secure foundation for subsequent dis cussion of selected questions. Compared with this, the present treatment is more like a network of exploratory drillings to (...) show that it would be worthwhile to start mining operations, or to work the existing shafts and adits, as the case may be. Within this metaphor we may also describe the inherent weakness of this conception: once a cavity is pierced, the duct's capacity will in general not be sufficient to carry away the discovered riches. But whether we are concerned with a new or an already worked mine - at any rate, the experience should stimulate us into either reviving an existing system of shafts or even, in particularly fortunate cases, designing a new ap proach. (shrink)

The precariat is a notion and a phenomenon that has drawn special attention of economists since the turn of 20th and 21st centuries. The article is based on the assumption that the precariat involves unwanted and long-term insecurity and uncertainty, a highly changeable situation on the labour market and many other negative consequences. The paper advances the thesis according to which the phenomenon in ques-tion will escalate and be experienced by a growing number of people who have reached pre-retirement age (...) and are no longer mobile in occupational terms. The article is aimed at presenting reasons of possible growth of the problem under discussion, as well as the consequences faced by people who deal with it. Last but not least, potential ways of fighting precarity will be discussed. The analysis will be based on the literature on the subject, data derived from Central Statistical Office of Poland (GUS) and Eurostat, as well as research con-ducted by the author. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Transformative Journey of TransplantationValen KeeferThe moisture from the ocean floated effortlessly through the air as it glided over the rocky cliff. The steady stream of mist covered my face and frizzy hair with beaded water droplets. I had been sitting on a bench alone for hours admiring the Northern California coast at a magnificent overlook featuring a bird’s-eye view of the endless sea and campground I called home (...) for the past month. The stunning mountain landscape behind me, the soothing colors of the coastal shrubbery, and the smell of eucalyptus made for a trifecta of surreal beauty. The ocean disappeared from my view and I became engulfed in the precipitation and felt like I was suspended in a cloud. I was soaking in every moment as it was the last day of my solo RV trip.The fog slowly separated and exposed bits and pieces of the ocean again and then a breathtaking rainbow came into sight. Each end appeared to be touching either side of the campground like it was giving it a hug. I was eye-level with the center and highest point of the rainbow, arching above our home on wheels. I stood on the bench with my arms wide open, embracing nature and the gift of life in all its glory. This moment would not have possessed such deep meaning if it wasn’t for the journey that came before it—the transformative journey of transplantation.Some may think of transplantation as a singular event when in reality, it’s a lifelong journey that can start with a diagnosis many years prior. My transplant journey began when I was diagnosed with polycystic kidney disease (PKD) at 10-years-old. Being diagnosed with a hereditary disease that has deeply impacted multiple generations of our family and with no known treatment or cure was a lot to carry as a child.My youth was full of love from my parents and filled with illness and the limitations and long-term impacts of growing up with multiple chronic illnesses. My education on PKD was the brutal real-life experiences of enduring it firsthand—with no support groups, resources, or internet to seek answers. I always felt different during a time when you’d do anything to fit in. I couldn’t play sports and had to sit on the sidelines in gym class. I was often in the nurse’s office, hospital, or recovering from a surgery. I hid my scars and unattractive body while changing in gym class. Friendships were really hard. Relationships were even harder.Growing up with chronic illnesses takes away from the fun of dreaming. It’s like that bright future full of endless possibilities is blocked by a huge mountain you know you have to summit first with no supplies, no friends, and no paved path to follow.Complications from PKD followed me from high school right into college, when I spent almost a year in the hospital. Both of my kidneys were removed, I was on dialysis, had pancreatitis, received over 70 blood transfusions, survived an internal bleed, and was in dire need of a lifesaving kidney transplant.At 19-years-old, I was too sick to be placed on the transplant waiting list, but needed a kidney to survive. My parents were living at the Ronald McDonald House, wondering if they would be the next ones to lose their teenage daughter. A close family friend forever changed our lives when she restored my health by selflessly donating her kidney to me. While it was an arduous path to transplantation, in some ways, the journey was just beginning.Fifteen years following my kidney transplant and summiting what I thought was going to be the most challenging mountain of my health journey, I found myself back on death’s doorstep with another battle ahead. I was in need of a second miracle, this time a lifesaving liver transplant. It was PKD again. The bile ducts in my liver were so gnarly that they looked like limbs of an oak tree rather than the desired smooth straw-like appearance. Their malformations led to chronic liver infections and multiple sepsis... (shrink)

People in isolation or quarantine, and people confined in nursing homes, insane asylums, prisons, and refugee camps are cut off from the outside world, where the coronavirus invisibly drifts. It besieges our homes. And the virus invades, through heating ducts and on packages delivered. Our home is no longer a refuge of rest, tranquility, substance, and sustenance, no longer the place of hospitality. And the coronavirus pursues the homeless, sleeping in municipal shelters or under bridges and overpasses.

One of the central but yet unresolved problems in evolutionary biology concerns the origin of novel complex traits. One hypothesis is that complex traits derive from pre‐existing gene regulatory networks (GRNs) reused and modified to specify a novel trait somewhere else in the body. This simple explanation encounters problems when the novel trait that emerges in a body is in a region that is known to harbor a latent or repressed trait that has been silent for millions of years. Is (...) the novel trait merely a re‐emerged de‐repressed trait or a truly novel trait that emerged via a novel deployment of an old GRN? A couple of new studies sided on opposite sides of this question when investigating the origin of horns in dung beetles and helmets in treehoppers that develop in the first thoracic segment (T1) of their bodies, a segment known to harbor a pair of repressed/modified wings in close relatives. Here, I point to some key limitations of the experimental approaches used and highlight additional experiments that could be done in future to resolve the developmental origin of these and other traits. (shrink)

The origin of insulin‐expressing β‐cells in the adult mammalian pancreas is controversial. During normal tissue turnover and following injury, β‐cells may be replaced by duplication of existing β‐cells.1 However, an alternative source of β‐cells has recently been proposed based on neogenesis from a Ngn3‐positive population present in regenerating pancreatic ducts.2 The appearance of β‐cells from Ngn3‐positive progenitors is reminiscent of normal pancreas development, and Ngn3‐expressing cells isolated from regenerating pancreas can generate the full repertoire of endocrine phenotypes. The isolation and (...) characterisation of the equivalent human progenitors may represent a significant step forward in the hunt for a cure for diabetes. BioEssays 30:617–620, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

The debate about the definition of scientific miscon duct is being revisited by the scientific community in response to the Commission on Research Integrity's recommendation for a new definition. Scientists and lawyers are debating whether scientific misconduct should include acts that are not unique to the scientific community and do not affect the research. Falsification of credentials is one form of such misconduct.The Office of Research Integrity and the National Science Foundation, the two federal agencies primarily responsible for developing (...) policies on scientific misconduct, have struggled to define scientific rnisconduct and to decide which forms of professional misconduct do and do not fall within the definition. Although falsification of credentials is not unique to the scientific community, OR1 and NSF have determined that when researchers lie about their credentials, such conduct may constitute scientific misconduct. The question is why this form of professional misconduct has been labeled scientific misconduct when it occurs in a research setting, and whether any distinction exists between this white coat crime and white collar crime. (shrink)

Welcome to the 23rd volume 2nd issue of Cumhuriyet Theology Journal which left behind 22 years of academic publication journey. It is important to carry out valuable scientific studies in academic life as well as to reach a wide audience. Our journal has achieved great progress in both national and interna-tional academic publication. Today, almost all scientific knowledge can be reached through online access. The researchs in the field of religious studies in Turkey deserves to reach all the world beyond (...) the boundaries of the libraries. Cumhuriyet Theology Journal has gained a very rapid acceleration in the last five years by meeting the international publication criteria with its format and publication principles and has managed to attract the attention of the scientific world. The Isnad Citation Style developed within our journal and workshops con-ducted under the leadership of our journal are examples of the Theology Field Journals. We are pleased to announce two important news in this issue. The first is that the 2nd Edition of the Isnad Citation System is available to you, and the second is the addition of the Arabic language option to our journal. In 23rd volume 2nd issue two Arabic articles were published for the first time. Our journal now has been indexed by various international indexes: TURKISH NATIONAL DATABASE Social Sciences and Humanities Database (Accept-ed: 13/11/2015) The European Reference Index for the Humanities and the Social Sciences (Accepted: 25/03/2016) ATLA RDB©: ATLA Religion Database© (Indexing and Abstracting Start: 20/05/2016) BROWZINE Academic Journal Collections (Accepted: 07/07/2016) J-GATE: E-Journal Gateway (Accepted: 07/07/2016) ROAD: Directory Of Open Access Scholarly Resources (Accepted: 24/08/2016) DOAJ: Directory of Open Access Journals (Accepted: 02/09/2016) MLA International Bibliography (Indexing and Abstracting Start: 14/06/2016) CEEOL: Central and Eastern European Online Library (Accepted: 06/10/2016) EBSCO Humanities International Index (Indexing and Abstracting Start: 07/01/2016) EBSCO Humanities Source Ultimate Database (Indexing and Abstracting Start: 07/01/2016) PHILPAPERS: Bibliography of Philosophy (Accepted: 01/01/2016) ROOT INDEXING: Journal Abstracting and Indexing (Accepted: 12/02/2017) ESCI: Emerging Sources Citation Index (Indexing and Abstracting Start: 01/01/2016) ProQuest Central (Accepted: 15/01/2017, 21/1) ProQuest Turkey Database (Accepted: 15/01/2017, 21/1) Index Islamicus (Indexing and Abstracting Start: 13/12/2017) Scopus (S.Date: 01/01/2016; Accepted: 23/01/2018) Moreover, we have also announced the preliminary review form and the review form for the blind review process. We examine Turkish and English titles, summaries, and keywords to make sure that they correspond to the field’s terminology. Furthermore, we require proper nouns and concepts/terms to be written in the reference style of TDV Ency-clopaedia of Islam. We also particularly require for the articles to use the Isnad Citation Style. To improve the academic quality of the journal, we have also checked the article up for plagiarism. The articles that are marked with a result above %15 are returned to the authors with a plagiarism report. It might be right to note here that we have been getting more attention from scholar-ly world day by day with our mission and standards. The journal has received 73 articles between July 1- Sptember 15, 2019 from the academic world. All articles went through the pre-review process to check the referencing and transliteration style before testing them using a plagiarism checker. We then have forwarded the articles that successfully passed the plagiarism check to our reviewers. Following this process, we have been able to offer to you 40 articles, a bookreview and a symposium review at two our issues. We are delighted to offer you the various ranges of themes and topics with this new issue. We sincerely thank the contributors for their submission, the editorial and review board, and particularly to the assistant editors, Dr. Adem Çiftci, Dr. Fatma Kurttekin, Res. Asst. Maruf Cakır, Res. Asst. Alper Ay, Res. Asst. Esma Güneş, Res. Asst. Bayram Ün-ce, Res. Asst. Sena Kaplan, Res. Asst. Gülistan Aktaş, Res. Asst. Hamit Demir Res. Asst. Merve Yetim, Res. Asst. Rukiye Göğen, Res. Asst. Ömer Faruk Özbek, Res. Asst. Salime Bera Kemikli, Res. Asst. Naim Yaman, Res. Asst. Sema Tombul, Res. Asst. Nurgül Akdoğan, Res. Asst. Ayşe Mine Akar, Res. Asst. İlknur Bahadır and the editors of the language review-process Prof. Dr. Ömer Faruk Yavuz, Dr. Miyase Yavuz Altıntaş, Zeynep Yucedoğru, Dr. Zuhal Ağılkaya Şahin, Dr. Metin Güven and Dr. Kenan Tekin. For the next issue, which will be published on June 15, 2020 we announce the ac-ceptance of the articles from Jenuary 1 to March 15 by our editorial board. We wish you convenience in your studies. (shrink)

The evolution of a female penis is an extremely rare event and is only known to have occurred in a tribe of small cave insects, Sensitibillini (Psocodea: Trogiomorpha: Prionoglarididae). The female penis, which is protrudable and inserted into the male vagina‐like cavity during copulation to receive semen, is thought to have evolved independently twice in this tribe, in the Brazilian Neotrogla and the African Afrotrogla. These findings strongly suggest that there are some factors unique to Sensitibillini that have facilitated female (...) penis evolution. Here, several hypothetical factors are presented that may have enabled the evolution of the female penis in Sensitibillini. The female–female competition for nutritious semen, the oligotrophic environment, and the twin insemination slots with switching valve are considered to be the driving factors for female penis evolution. Additionally, the following factors are considered responsible for relaxing the constraint against female penis evolution: preexistence of the female‐above mating position, the elongated duct connecting the female pre‐penis with the sperm storage organ, and the small male genital cavity accepting the female genital tubercle bearing the opening of this duct. Understanding the factors enabling female penis evolution may also shed light on the evolution of the male penis. (shrink)

The aim of this paper is to verify whether step aerobics training has an impact on the temperature of deep muscles of the spine of young, healthy subjects and if there exists a relationship between the maximal oxygen uptake and thermal results. The study was conducted in a group of 21 subjects of both sexes, aged 20.2 ± 0.38. The step aerobics training sessions lasted 30 weeks, one training session per week, 60 minutes per session. Thermograms of the spine were (...) taken with the use of an infrared thermographic camera. Instrumental measurements included BMI, vital capacity of the lungs, and maximal oxygen uptake. After a 30-weeklong SAT, a statistically significant increase in the average temperature of the muscles of the thoracic and lumbar spine was observed in subjects of both sexes. The relationship between VO2max and temperature of the muscles of the thoracic and lumbar spine after the 30th SAT was not statistically significant. The study showed that a 30-weeklong step aerobics training had a positive impact on thermoregulation of apparently healthy male and female subjects aged 20. Furthermore, it can be safely assumed that thermography may be used as a non-invasive method of examination of the thermoregulation mechanism of SAT participants. (shrink)

Background: Serious games have shown positive results in increasing motivation, adherence to treatment and strengthening the therapeutic alliance in multiple psychiatric disorders. In particular, patients with impulse control disorders and other disorders in which the patient suffers from inhibitory control deficits have been shown to benefit from serious games.Aim: The aim of this study was to describe the characteristics and to evaluate the usability of a new serious videogame, e-Estesia. This serious videogame was designed to improve emotion regulation in patients (...) with gambling disorder. Preliminary results from a pilot sample are also reported.Method: A pilot sample of 26 patients undergoing treatment for GD was recruited. Participants used e-Estesia on a tablet, which was connected to a thoracic band that sent heart rate and heart rate variability data to the videogame platform in order to provide biofeedback. The System Usability Scale was completed by patients to determine the usability of e-Estesia.Results and Discussion: e-Estesia performed comparatively well for all the explored groups. Around 84.6% of the patients endorsed that it was easy to use. Female patients with GD presented higher HRV during the use of the serious videogame compared to men. (shrink)

Because the kidney (metanephros) starts to function before completing development, its patterning and morphogenesis need to be closely integrated with its growth. This is achieved by blast cells at the kidney periphery generating new nephrons that link up to the extending collecting‐duct arborisation, while earlier‐formed and more internal nephrons are maturing and beginning to filter serum. This pattern of development requires that cell division and apoptosis be co‐ordinated in the various kidney compartments (collecting‐ducts, blast cells, metanephric mesenchyme, nephrons and (...) vascular system). The underlying regulatory networks for cell proliferation are beginning to be unravelled, mainly through expression studies, mutation analysis and experimentation in vitro. This article summarises current knowledge of kidney growth and apoptosis, and analyses some of the 80 or so ligand–receptor pairings that seem to sustain development and growth. It also points to some unanswered questions, the most intriguing being what role does apoptosis play during normal kidney development? BioEssays 24:72–82, 2002. © 2002 John Wiley & Sons, Inc. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Limits of Our ObligationsRyan C. MavesDisclaimers. No funding was utilized for this manuscript. Dr. Maves is a retired U.S. Navy officer, and the opinions contained herein are his own. The opinions in this manuscript do not reflect the official opinion of the Department of the Navy, Department of Defense, nor of the U.S. Government.In 2012, I was a commander in the United States Navy, deployed to the NATO (...) Role 3 Multinational Medical Unit in Kandahar Airfield (KAF), Afghanistan. The KAF Role 3 began as a tent hospital under Canadian command, built along the flight line at Ahmad Shah Baba International Airport as [End Page 176] part of an expanding NATO base. By the time of my arrival, it was a small but capable brick-and-mortar building under U.S. Navy command, with four operating rooms, two CT scanners, and a busy intensive care unit (ICU).Not long before my deployment, the KAF Role 3 was described as one of the busiest trauma hospitals in the world. Casualties arrived every day, usually by helicopter. Blast injuries from improvised explosive devices (IEDs) were common, ranging in severity from concussions in passengers in armored vehicles, to multiple amputations from blast injuries with concomitant thoracic, abdominal, and pelvic trauma. KAF had a daytime population of over 30,000 in 2012, and our hospital was effectively the referral center for the region, so patients with non-surgical diagnoses were similarly common: myocardial infarctions, seizures, pulmonary emboli, and endemic infections, to name a few.As an infectious disease (I.D.) specialist, I functioned mainly as a hospitalist, managing patients postoperatively, but I also provided any consultative support when needed. During mass casualty events, the intensivists and I would act as backups in the trauma bay, freeing up the surgeons for the most acutely injured patients. It turned out that an I.D. doctor’s skillset lent itself well to acute trauma evaluations; we are well known for having an eye for fine details, combined with low-grade paranoia. These traits served me well during what I came to describe as “my involuntary trauma fellowship.”Our patients could be divided into five key groups: Afghan National Security Forces (ANSF, including the army and national police), non-Afghan coalition military (mostly U.S. and other NATO members), Afghan civilians, NATO civilian contract staff, and the Taliban. Our approach to each of these groups was different. For all patient groups, we would provide the same emergency care, including acute resuscitation and immediate life-saving surgery. It was after this emergency care period that our management plans diverged.For coalition forces, our next priority after acute resuscitation and stabilization was to assess whether a patient could remain in theater. Stable patients with relatively minor injuries could often undergo rehabilitation at KAF; many personnel could subsequently return to combat duty with their units. More seriously-injured patients would be transported out of Afghanistan within 24-48 hours (if not faster). Usually, this would involve stops at Bagram Airfield near Kabul and then Landstuhl Regional Medical Center in Germany before reaching a military hospital in their home countries. There were few limits on whom could be transported. Dedicated critical care air transport teams (CCATT) included intensivists, respiratory therapists, and critical care nurses, who could manage the most unstable patients on board what was effectively a flying ICU. The “lung team” in Landstuhl could fly to KAF to start patients with severe respiratory failure on extracorporeal membrane oxygenation (ECMO) and then fly them out on maximal support.NATO civilian contractors would receive comparable care, although the exact details of how they would be transported out of theater would depend on their home countries and the nature of their contract. We cared for one civilian contractor with newly-diagnosed HIV infection whom we were able to stabilize on the ventilator, get him extubated, start on initial antiretroviral therapy, and transport him home with a referral to his local HIV care program.Afghan soldiers were part of the coalition, but there was no distant home country where we could transport them. They were home. After their resuscitations and surgeries, we would arrange transfer to the Kandahar Regional... (shrink)

New observations by Hatini et al.(1) on the ‘winged helix’ transcription factor BF‐2 will make us change our views about kiney development. This gene is only expressed in stromal cells associated with the kidney medulla and cortex, but the BF‐2 knockout has unexpected abnormalities. Although the stromal cells appear normal, the kidney is small, the ducts have limited branching and, instead of the many normal nephrogenic aggregates, there are relatively few large mesenchymal aggregates that fail to differentiate. The stromal cells (...) thus seem to produce factors regulating other aspects of kidney development, while the abnormalities highlight a series of unsolved problems in kidney morphogenesis. (shrink)

In this commentary on the previous paper it is explained that screen-detected Duct Carcinoma In Situ is effectively a new disease of unknown natural history. It is therefore impossible that 'the doctor knows best' and it is therefore both in the patient and the public's best interests that such cases are submitted to the rigours of the randomised controlled trial. Inevitably this brings the ethical dilemma of how to explain to patients the uncertainty and how to involve them in (...) a rational decision to take part in the randomised controlled trial. It is argued that as well as there being a collective benefit for future generations of women, that we should resolve this problem now, the individual woman is likely to benefit from being treated according to a strict protocol. Nevertheless the time of diagnosis is paradoxically not the best time for a patient to become aware of these matters and it is about time that the lay public and the opinion formers recognized their responsibility to become acquainted with the benefits and the needs of the randomised controlled trial in anticipation of the day when they themselves will be patients. (shrink)

RationaleSurrogates of critically ill patients often have inaccurate expectations about prognosis. Yet there is little research on how intensive care unit clinicians should discuss prognosis, and existing expert opinion-based recommendations give only general guidance that has not been validated with surrogate decision makers.ObjectiveTo determine the perspectives of key stakeholders regarding how prognostic information should be conveyed in critical illness.MethodsThis was a multicenter study at three academic medical centers in California, Pennsylvania, and Washington. One hundred eighteen key stakeholders completed in-depth semistructured (...) interviews. Participants included 47 surrogates of adult patients with acute respiratory distress syndrome; 45 clinicians working in study ICUs, including physicians, nurses, social workers, and spiritual care providers; and 26 experts in health communication, decision science, ethics, family-centered care, geriatrics, healthcare disparities, palliative care, psychology, psychiatry, and critical care.Measurements and main resultsThere was broad support among surrogates for existing expert recommendations, including truthful prognostic disclosure, emotional support, tailoring the disclosure strategy to each family's needs, and checking for understanding. In addition, stakeholders offered suggestions that add specificity to existing recommendations, including: In addition to conveying prognostic estimates, clinicians should help families "see the prognosis for themselves" by showing families radiographic images and explaining the clinical significance of physical manifestations of severe disease at the bedside. Many physicians did not support using numeric estimates to convey prognosis to families, whereas many surrogates, clinicians from other disciplines, and experts believed numbers could be helpful. Clinicians should conceptualize prognostic communication as an iterative process that begins with a preliminary mention of the possibility of death early in the ICU stay and becomes more detailed as the clinical situation develops. Although prognostic information should be initially disclosed by physicians, other members of the multidisciplinary team-nurses, social workers, and spiritual care providers-should be given explicit role responsibilities to reinforce physicians' prognostications and help families process a poor prognosis emotionally.ConclusionsFamily members, clinicians, and experts identified specific communication behaviors that clinicians should use to discuss prognosis in the critical care setting. These findings extend existing opinion-based recommendations and should guide interventions to improve communication about prognosis in ICUs. (shrink)