For the past two decades, agricultural workers in regions of Central America have reported an epidemic of chronic kidney disease of undetermined etiology (CKDu) that is not associated with established risk factors of chronic kidney disease. Several hypotheses have emerged, but the etiology of CKDu remains elusive and controversial. The aim of this literature review was to describe the potential risk factors of CKDu in Mesoamerica and implications for the U.S. agricultural worker population. PubMed and CINAHL databases were (...) searched for articles published between 2000 and 2018 that examined CKDu in Mesoamerica; 29 original studies were included in this review. CKDu is a multifactorial disease that is often asymptomatic with hallmark characteristics of elevated serum creatinine and blood urea nitrogen (BUN), low glomerular filtration rate, electrolyte abnormalities, and non-nephrotic proteinuria. Reducing the global prevalence of CKDu will require more robust studies on causal mechanisms and on interventions that can reduce morbidity and mortality in vulnerable populations. (shrink)

The concept of quality of life is the basis for a new paradigm of clinical medicine. Its assessment is considered to be an important instrument in determining disease severity and effectiveness of different treatment modalities. Our studies are devoted to the problem of diabetes complications especially anemia in patients with diabetic kidney disease. Anemia in subjects with diabetic nephropathy may result from various pathogenic factors including erythropoietin deficiency, iron deficiency, vitamin B12 and/or folate deficiencies, the effects of proinflammatory cytokines (...) etc. Diabetic patients with anemia are at increased risk of cardiovascular accidents and death. The aim of this study was to assess the influence of anemia on the quality of life of patients with early stages of diabetic nephropathy. We investigated 127 patients with type 2 diabetes mellitus and early diabetic nephropathy. Anemia was defined according to the World Health Organization criteria. Anemic patients were divided into three groups according to the stage of chronic kidney disease. Patients’ quality of life was assessed with SF-36 health survey. Anemic patients had lower scores of physical role functioning and emotional role functioning as compared to the patients with normal hemoglobin level, irrespective of the stage of chronic kidney disease. Patients with anemia and chronic kidney disease stage 3 had lower scores of general health perceptions, physical functioning, bodily pain, vitality and mental health than patients in the non-anemic group. Social role functioning was similar in anemic and non-anemic patients. The possible mechanisms and implications of the above mentioned findings are discussed with a medical and humanitarian perspective. The directions of further studies are proposed. (shrink)

Speciesism, difference of treatment based on an appeal to species membership, is often likened to racism and sexism, and condemned on those grounds. Some philosophers, however, reject this argument by analogy and instead forward an argument for speciesism based on a postulated right of species to compete for survival. This paper attacks this strong form of speciesism by showing that the underlying concept of ‘species’ is incoherent in the context of morality, and that strong speciesism has unacceptable corollaries.

Speciesism, difference of treatment based on an appeal to species membership, is often likened to racism and sexism, and condemned on those grounds. Some philosophers, however, reject this argument by analogy and instead forward an argument for speciesism based on a postulated right of species to compete for survival. This paper attacks this strong form of speciesism by showing that the underlying concept of ‘species’ is incoherent in the context of morality, and that strong speciesism has unacceptable corollaries.

Cognitive deficits were produced in rats by different methods of damaging the brain: chronic ingestion of alcohol, causing widespread damage to diffuse cholinergic and aminergic projection systems; lesions (by local injection of the excitotoxins, ibotenate, quisqualate, and AMPA) of the nuclei of origin of the forebrain cholinergic projection system (FCPS), which innervates the neocortex and hippocampal formation; transient cerebral ischaemia, producing focal damage especially in the CA1 pyramidal cells of the dorsal hippocampus; and lesions (by local injection of the (...) neurotoxin, colchicine) of the granule cells of the dentate gyrus. Following chronic alcohol or lesions of the FCPS, transplants of cholinergically rich fetal brain tissue into the terminal areas (neocortex and/or hippocampus) restored performance almost to control levels, with a time course consistent with growth of the transplants and integration with host tissue; transplants of cholinergically poor fetal tissue (hippocampus) were without effect, as were transplants of cholinergically rich tissue into the region containing the nuclei of origin of the FCPS. Grafts of primary cells enriched in glia and cultured neuroblastoma cells into the terminal areas of the FCPS were equally effective, suggesting that there are multiple mechanisms by which neural transplants can restore cognitive function following diffuse cholinergic damage. In contrast, after ischaemia- or neurotoxin-induced damage to CA1 or dentate granule cells respectively, cholinergically rich fetal transplants into the damaged hippocampal formation were ineffective in restoring performance. After ischaemic damage, however, performance was restored by suspension grafts of CA1 cells but not by transplants containing CA3 pyramidal cells or granule cells; and after colchicine damage it was restored by solid grafts containing granule but not CA1 pyramidal cells. Furthermore, electrophysiological evidence has demonstrated functional, graft type-specific host-graft functional neuronal connectivity. Thus, restoration of cognitive function by neural transplants is possible after damage to either diffuse (cholinergic) or point-to-point (intrahippocampal) forebrain systems, but the transplant must be appropriate to the damage to be repaired. Because the different types of brain damage studied provide analogues of human alcoholic dementia, Alzheimer's disease, and heart attack, these results are encouraging with regard to the eventual application of neural transplant surgery to the treatment of cognitive deficits in humans. (shrink)

The world’s first living donor liver transplant from an HIV-positive mother to her HIV-negative child, performed by our team in Johannesburg, South Africa in 2017, was necessitated by disease profile and health system challenges. In our country, we have a major shortage of donor organs, which compels us to consider innovative solutions to save lives. Simultaneously, the transition of the HIV pandemic, from a death sentence to a chronic illness with excellent survival on treatment required us to rethink our (...) policies regarding HIV infection and living donor liver transplantation. Although HIV infection in the donor is internationally considered an absolute contraindication for transplant to an HIV-negative recipient, there have been a very small number of unintentional transplants from HIV-positive deceased donors to HIV-negative recipients. These transplant recipients do well on antiretroviral medication and their graft survival is not compromised. We have had a number of HIV-positive parents in our setting express a desire to be living liver donors for their critically ill children. Declining these parents as living donors has become increasingly unjustifiable given the very small deceased donor pool in SA; and because many of these parents are virally suppressed and would otherwise fulfil our eligibility criteria as living donors. This paper discusses the evolution of HIV and transplantation in SA, highlights some of the primary ethical considerations for us when embarking on this case and considers the new ethical issues that have arisen since we undertook this transplant. (shrink)

Chad A Witt, Ramsey R Hachem Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, MO, USA: The role of donor-specific antibodies to human leukocyte antigens and the burden of antibody-mediated rejection in lung transplantation remain enigmatic. Over the past several years, evidence has been emerging that humoral immunity plays an important role in the development of both acute and chronic lung allograft dysfunction. Multiple case reports and case series have (...) identified lung allograft recipients with clinical findings consistent with acute AMR. However, there is currently no widely accepted definition for AMR in lung transplantation, and this has been a significant barrier to furthering our understanding of this form of rejection. Nonetheless, the development of DSA after transplantation has consistently been identified as an independent risk factor for persistent and high-grade acute cellular rejection and CLAD. This has raised the possibility that chronic AMR may be a distinct phenotype of CLAD although evidence supporting this paradigm is still lacking. Additionally, antibodies to lung-restricted self-antigens have been associated with primary graft dysfunction early and the development of CLAD late after transplantation, and emerging evidence underscores significant interactions between autoimmunity and alloimmunity after transplantation. There is currently an active International Society for Heart and Lung Transplantation working group that is developing an operational definition for AMR in lung transplantation. This will be critical to improve our understanding of this form of rejection and conduct clinical trials to identify optimal treatment strategies. This review will summarize the literature on DSA and AMR in lung transplantation and discuss the impact of antibodies to self-antigens on lung allograft dysfunction. Keywords: antibody-mediated rejection, donor-specific antibodies, lung transplantation. (shrink)

This case report illustrates the ethical issues involved in paediatric liver transplantation, especially in terms of assessing recipient suitability and the role of parents as donors. Ms. X was a child with advanced chronic liver disease who undergone an elective living donor liver transplant with her father as the donor. Post-operatively, she was in a critically ill state as a result of acute liver graft failure with resultant multi-organ dysfunction. A re-transplant was done at 36 hours after the (...) first one, this time with her mother as the donor. She responded well to the transplant, however by post-operative day 8, it was evident that she had features of severe brain stem dysfunction and brain death was subsequently certified. The ethical issues that arise from this case, including the need for careful assessment of recipient suitability for a transplant and the specific considerations of using parents as organ donors, are discussed. (shrink)

This case describes an adolescent in a crisis of a chronic medical condition whose situation is complicated by substance abuse and mental illness. D. Micah Hester provides an analytic approach, teasing apart the multiple layers of medical, developmental, and moral issues at hand and describing possible responses and outcomes. Amy T. Campbell examines existing legal guidelines for adolescent decision making, arguing that greater space exists for clinical discretion in these matters than commonly thought. Cheryl D. Lew discusses the development (...) of agency in adolescent patients, the ideal of autonomous decision making in the context of impairment and chronic illness, and the obligation of healthcare teams to examine an adolescent patient’s decisions in relation to her identity. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Bonaventure, the Body, and the Aesthetics of Salvation by Rachel DaviesRobin LandrithRachel Davies, Bonaventure, the Body, and the Aesthetics of Salvation. Cambridge, UK: Cambridge University Press, 2020. Pp. Xii + 187. $105.00. ISBN: 9781108485371. Rachel Davies's Bonaventure, the Body, and the Aesthetics of Salvation finds in Bonaventure a resource for contemporary theological efforts to read embodied experience as a primary text. She argues that Bonaventure supports these efforts (...) by affirming the body as an aid to the soul in the whole self's sanctification. In her effort to read Bonaventure's account of the body in aesthetic terms, Davies argues that Bonaventure sees the suffering body as the site of the revelation of God's beauty. Distinguishing her reading from that of Hans Urs von Balthasar, however, Davies avoids suggesting that bodily suffering is beautiful per se (19–21), emphasizing instead the need to seek the beauty unique to bodily suffering "through" that suffering, looking toward its redemption (25). The beauty of suffering is beauty in potency—beautiful only insofar as it is grafted onto Christ's suffering, and, like Christ's suffering, only revealed as beautiful when it appears in the resurrected body. For Davies, the "deep logic" (32) by which Christ's suffering and resurrection transform human suffering permits hope that suffering can be made meaningful, but that same logic also refuses premature attempts to say how it will be made meaningful. Davies's argument is most persuasive when read as a mystical meditation on the beauty unique to human suffering—that is, as a theo-logical text in the formal sense. There is a pastoral sensitivity motivating her scholarly contribution. The book attempts to address "a common human struggle: the experience of bodily diminishment, which threatens to turn corporeality into a noetic obstacle rather than the communicative medium it was intended to be" (170). In some ways, Davies shows Bonaventure to be a useful resource in pursuit of this aim. At the same time, Bonaventure's works and milieu create conditions within which Davies's scholarly and pastoral theses occasionally work against each other. Davies first intends to highlight Bonaventure's (occasionally) favorable view [End Page 245] of the body—a view which stands apart from less-favorable assessments frequent in medieval theology (32). In doing so, Davies recovers an important, surprisingly tender, instance of medieval sensitivity to the soul's abandonment of the body in sin alongside medieval references to the body's rebellion against the soul. As a scholarly contribution, Davies's work draws attention to these existing, if at times undeveloped, intuitions within Bonaventure's account of the role of the body in the process of sanctification. Still, it is difficult to see an obvious pastoral application for the claim that the soul abandons the body when we consider cases of involuntary chronic or terminal suffering. Davies does not try to offer one, but neither does she address the fact that shifting the accent to the guilt of the soul in abandoning the body risks shifting the blame for suffering—even chronic suffering—to the sufferer herself. Davies by no means thinks the blame lies here. She is attentive to the challenges that such suffering presents to the sufferer. Indeed, it is to alleviate some of these challenges that Davies emphasizes the mystical, rather than imitative, aspect of Bonaventure's account of the effect of Christ's suffering on other instances of human suffering (109). She observes that Christ's "victory is a victory for the entire Church," which means that "those who cannot begin to imagine the transfiguration of their own sufferings, or direct their feelings toward any sort of fruitfulness, can at least consent to be carried along passively in Christ's return to the Father" (108). This "requires nothing but blind trust, and does not ask people to find meaning in their own suffering, or even to be at peace with it" (108). I am convinced by the pastoral merit of this point, and of the capacity of Bonaventure's mystical soteriology to sustain it. But the notion of an unconscious or unintentional transfiguration of suffering raises two further questions regarding attempts to apply Davies's... (shrink)

A grafted frame is a new kind of frame which combines a modal frame and some relevance frames. A grafted model consists of a grafted frame and a truth-value assignment. In this paper, the grafted frame and the grafted model are constructed and used to show the completeness of S1. The implications of S1-completeness are discussed. A grafted frame does not combine two kinds of frames simply by putting relations defined in the components together. That is, the resulting grafted frame (...) is not in the form of $\langle W, R, R'\rangle$ , or more generally, in the form of $\langle W, R, R', R'',...\rangle$ , which consists of a non-empty set with several relations defined on it. Rather, it resembles the construction of fibering proposed by D. M. Gabbay and M. Finger (see [4] and [3]). On a grafted frame, some modal worlds, which belong to the initial modal frame, are attached by some relevance frames. However, these two semantics have important differences. Consider the combined semantics involving semantics of relevance logic and modal logic. A fibred model and a grafted model proposed in this paper differ in the following respects. First, a fibred model is constructed from a class of modal models and a class of relevance models. A grafted model consists of a grafted frame and a truth-value assignment, where the grafted frame is constructed from a modal frame and some relevance frames, and the assignment is a union of a modal truth-value assignment V M and some relevance truth-value assignments V R . V M (V R ) defined in this paper is not the same as the assignment contained in a modal (relevance) model. Second, in a fibred model each relevance world is associated (or fibred) with a modal model and each modal world with a relevance model. To be the grafted frame on which a grafted model is based, it is enough to have some modal worlds attached by some relevance frames. Moreover, no relevance world is associated with a modal frame in the grafted frame. Third, fibred models are intended to provide an appropriate semantics to combined logics. Grafted frames and grafted models are inspired to characterize S1, which, containing only one modality □, is not a combined logic. It is shown in this paper that S1 is sort of a meta-logic of the intersection of S0.4 and F, where S0.4, a new system proposed in this paper, is in turn a meta-logic of the relevance logic. (shrink)

A grafted frame is a new kind of frame which combines a modal frame and some relevance frames. A grafted model consists of a grafted frame and a truth-value assignment. In this paper, the grafted frame and the grafted model are constructed and used to show the completeness of S1. The implications of S1-completeness are discussed. A grafted frame does not combine two kinds of frames simply by putting relations defined in the components together. That is, the resulting grafted frame (...) is not in the form of $\langle W, R, R'\rangle$, or more generally, in the form of $\langle W, R, R', R'',...\rangle$, which consists of a non-empty set with several relations defined on it. Rather, it resembles the construction of fibering proposed by D. M. Gabbay and M. Finger. On a grafted frame, some modal worlds, which belong to the initial modal frame, are attached by some relevance frames. However, these two semantics have important differences. Consider the combined semantics involving semantics of relevance logic and modal logic. A fibred model and a grafted model proposed in this paper differ in the following respects. First, a fibred model is constructed from a class of modal models and a class of relevance models. A grafted model consists of a grafted frame and a truth-value assignment, where the grafted frame is constructed from a modal frame and some relevance frames, and the assignment is a union of a modal truth-value assignment V$_M$ and some relevance truth-value assignments V$_R$. V$_M$ defined in this paper is not the same as the assignment contained in a modal model. Second, in a fibred model each relevance world is associated with a modal model and each modal world with a relevance model. To be the grafted frame on which a grafted model is based, it is enough to have some modal worlds attached by some relevance frames. Moreover, no relevance world is associated with a modal frame in the grafted frame. Third, fibred models are intended to provide an appropriate semantics to combined logics. Grafted frames and grafted models are inspired to characterize S1, which, containing only one modality $\square$, is not a combined logic. It is shown in this paper that S1 is sort of a meta-logic of the intersection of S0.4 and F, where S0.4, a new system proposed in this paper, is in turn a meta-logic of the relevance logic. (shrink)

BackgroundMany procedures currently require the use of bone grafts to replace or recover bone volume that has been resorbed. However, the patient’s opinion and preferences must be taken into account before implementing any treatment. Researchers have focused primarily on assessing the effectiveness of bone grafts rather than on patients' perceptions. Thus, the aim of this study was to explore patients' opinions regarding the different types of bone grafts used in dental treatments.MethodsOne hundred patients were randomly chosen participated in the study. (...) A standardized survey of 10 questions was used to investigate their opinions regarding the different types of bone grafts used in dental treatments. Descriptive statistics were calculated for the different variables, and absolute frequencies and percentages were used as summary measures. A value of p <0.05 was selected as the threshold for statistical significance.ResultsThe highest rate of refusal was observed for allografts and xenografts. The grafts with the lowest rates of refusal were autologous grafts and alloplastics. No significant differences were found between the various types of bone grafts in the sociodemographic variables or the refusal/acceptance variable. Similarly, no significant relations were observed between a specific religious affiliation and the acceptance/refusal rates of the various types of graft.ConclusionsAllografts and xenografts elicited the highest refusal rates among the surveyed patients, and autologous bone and alloplastics were the most accepted bone grafts. Moreover, no differences were found in the sociodemographic variables or religious affiliations in terms of the acceptance/refusal rates of the different bone grafts. (shrink)

: Chronic illness is a major cause of disability, especially in women. Therefore, any adequate feminist understanding of disability must encompass chronic illnesses. I argue that there are important differences between healthy disabled and unhealthy disabled people that are likely to affect such issues as treatment of impairment in disability and feminist politics, accommodation of disability in activism and employment, identification of persons as disabled, disability pride, and prevention and "cure" of disabilities.

Grafting: do we ever do anything other than that? And are we ever free from vegetal influences when we engage in its operations? For the philosopher Michael Marder, our reflections on vegetal life have a fundamental importance in how we can reflect on our own conceptions of ethics, politics, and philosophy in general. Taking as his starting point the simple vegetal conception of grafting, Marder guides the reader through his concise and numerous reflections on what could be described as a (...) vegetal philosophy. Grafts are transplants either of a shoot inserted into the trunk of another tree or, surgically, of skin (among other living tissues). They are delicate operations intended to preserve, improve, and modify both the grafted materials and the body that receives them. To graft is to create unlikely encounters, hybrid mixes, and novel surfaces. Moving across disciplinary lines, Grafts combines the lessons of plant science with the history of philosophy, semiotics, literary compositions, and political theory. Co-authoring some of the texts with other philosophers, plant scientists and artists, Marder allows their insights to be grafted onto his own, and vice versa. Weighing in on contemporary debates such as the ethics of biotechnology, dietary practices or political organization, Marder inserts an unmistakable vegetal perspective into topics of discussion where it normally wouldnt be found. Transferring the living tissue of his own texts into another context, he helps them live better, more fully, than otherwise. (shrink)

This article studies the phenomenology of chronic illness in light of phenomenology’s insights into ecstatic temporality and freedom. It shows how a chronic illness can, in lived experience, manifest itself as a disturbance of our usual relation to ecstatic temporality and thence as a disturbance of freedom. This suggests that ecstatic temporality is related to another sort of time—“provisional time”—that is in turn rooted in the body. The article draws on Merleau-Ponty’s Phenomenology of Perception and Heidegger’s Being and (...) Time , shedding light on the latter’s concept of ecstatic temporality. It also discusses implications for self-management of chronic illness, especially in children. (shrink)

While some philosophers believe disabilities constitute a “bad-difference,” others think they constitute a “mere-difference” (Barnes 2016). On this latter view, while disabilities may create certain hardships, having a disability is not bad in itself. I argue that chronic pain problematizes this disability-neutral view. In doing so, I first survey the literature on chronic pain (§1). Then, I argue that Barnes’s mere-difference view cannot adequately accommodate the lived experiences of many people who suffer from chronic pain (§2). Next, (...) I consider two ways Barnes might respond and I explain why these responses are not workable (§3). Finally, I conclude with a brief discussion of disability variantism, the view that just as some disabilities can be neutral or even positive for some individuals, other disabilities like chronic pain can understandably make some people’s lives miserable not because society has failed them but simply because some conditions can openly conflict with well-being (§4). (shrink)

While some philosophers believe disabilities constitute a “bad-difference,” others think they constitute a “mere-difference” (Barnes 2016). On this latter view, while disabilities may create certain hardships, having a disability is not bad in itself. I argue that chronic pain problematizes this disability-neutral view. In doing so, I first survey the literature on chronic pain (§1). Then, I argue that Barnes’s mere-difference view cannot adequately accommodate the lived experiences of many people who suffer from chronic pain (§2). Next, (...) I consider two ways Barnes might respond and I explain why these responses are not workable (§3). Finally, I conclude with a brief discussion of disability variantism, the view that just as some disabilities can be neutral or even positive for some individuals, other disabilities like chronic pain can understandably make some people’s lives miserable not because society has failed them but simply because some conditions can openly conflict with well-being (§4). (shrink)

In 1866, six Inuits were taken to the United States for the purpose of serving as specimens to American scientists at the Natural History Museum. Shortly after their arrival in New York, four of them had died. One of the survivors returned to the Arctic, while the sixth, Minik, now alone, fought to make possible the return of the remains of his dead companions to their village. Since the latter were being exhibited, as was then often the case (and happens (...) even today in many museums), in order to offer visitors examples of the Inuk people, Minik protested in vain. In 1909 he returned to Greenland when the scientists denied that the remains of his friends still existed. Several years later, still pursuing the issue, he went back to the United States to take up the fight against the bureaucracy for the repatriation of the bodies. He died in the United States in 1918. It was only in 1993 that he won out and that the remains of the four were returned to the Arctic homeland. (shrink)

Leading paradigms of clinical ethics consultation closely follow a biomedical model of care. In this paper, we present a theoretical reflection on the underlying biomedical model of disease, how it shaped clinical practices and patterns of ethical deliberation within these practices, and the repercussions it has on clinical ethics consultations for patients with chronic illness. We contend that this model, despite its important contribution to capturing the ethical issues of day-to-day clinical ethics deliberation, might not be sufficient for patients (...) presenting with chronic illnesses and navigating as “lay experts” of their medical condition(s) through the health care system. Not fully considering the sources of personal knowledge and expertise may lead to epistemic injustice within an ethical deliberation logic narrowly relying on a biomedical model of disease. In caring “for” and collaboratively “with” this patient population, we answer the threat of epistemic injustice with epistemic modesty and humility. We will propose ideas about how clinical ethics could contribute to an expansion of the biomedical model of care, so that important aspects of chronic illness experience would flow into clinical-ethical decision-making. (shrink)

Stress is prevalent in our daily life, and people often make moral decision-making in a stressful state. Several studies have indicated the influence of acute stress on moral decision-making and behavior. The present study extended the investigation to chronic stress, and employed a new approach, the CNI model, to add new insights regarding the mechanism underlying the association between chronic stress and moral decision-making. A total of 197 undergraduates completed the Perceived Stress Scale and made moral decision-making on (...) a series of deliberately designed moral dilemmas. The results indicated that the high-stress group (one standard deviation above the mean) preferred more deontological options than the low-stress group (one standard deviation below the mean). Process-dissociation analysis revealed that the two groups had differences on deontological inclinations but not on utilitarian inclinations. And CNI model analyses suggested that the high-stress group showed a stronger general preference for inaction than the low-stress group did, but there were no significant differences in sensitivity to consequences or sensitivity to moral norms between the two groups. Finally, the implications of our findings were discussed. (shrink)

The transplantation of cholinergic neurons into the hippocampal formation has been well characterized. We describe our studies on the effects of cholinergic transplants in the retrosplenial cortex. These transplants were capable of ameliorating spatial navigation deficits in rats with septohippocampal lesions. In addition, we provide evidence for the modulation of transplanted neurons by the host brain.

The use of neural transplantation to alleviate cognitive deficits is still in its infancy. We have an inadequate understanding of the deficits induced by different types of brain damage and their homologies in animal models against which to assess graft-induced recovery, and of the ways in which graft growth and function are influenced by factors within the host brain and the environment in which the host is operating. Further, use of fetal tissue may only be a transitory phase (...) in the search for appropriate donor sources. Nevertheless, findings from our laboratory and elsewhere have made a prima facie case for successful cognitive reconstruction by graft methods. (shrink)

Over the past two decades, research on neural transplantation in animal models of neurodegeneration has provided provocative in sights into the therapeutic use of grafted tissue for various neurological diseases. Although great strides have been made and functional benefits gained in these animal models, much information is still needed with regard to transplantation in human patients. Several factors are unique to human disease, for example, age of the recipient, duration of disease, and drug interaction with grafted cells; these need to (...) be explored before grafting can be considered a safe and effective therapeutic tool. (shrink)

The Latin translation of Sextus Empiricus’ ‘Outlines of Pyrrhonism’, published by Henri Estienne in 1562, are amongst the most influential texts in the history of scepticism. And yet, we still lack a complete and detailed study of their reception in modern times. Through investigation of the emblem on the frontispiece of the book, this paper argues that Estienne’s motivations for the publication should be interpreted as essentially anti-dogmatic and humanistic in nature. -/- .

We investigate the semantics of the logical systems obtained by introducing the modalities and into the family of substructural implication logics (including relevant, linear and intuitionistic implication). Then, in the spirit of the LDS (Labelled Deductive Systems) methodology, we "import" this semantics into the classical proof system KE. This leads to the formulation of a uniform labelled refutation system for the new logics which is a natural extension of a system for substructural implication developed by the first two authors in (...) a previous paper. (shrink)

The article maintains that chronic fatigue syndrome can be properly understood only by taking an integrated perspective in which evolutionary, developmental and ecological aspects are considered. The integrative approach, supplemented by a complexity theory and psychoneuroimmunological research, is capable of explaining why there are so few structural aberrations to be found in chronic fatigue syndrome and why specific treatment is so difficult to establish. A major outcome of the investigation, that all individuals with chronic fatigue syndrome are (...) diseased in their own way, emphasises the need to study the development of personalised life histories. It also highlights an ethical dimension; personalised disease defies essentialist thinking on patient management. Another major outcome, which follows from the developmental systems perspective, is the dissolution of ontological mind-body dualism. This in turn allows for a methodological complementation of the biological and phenomenological approaches to knowledge. New research strategies that may help to resolve chronic fatigue syndrome, grounded in the revised perspective on individual development, are suggested. (shrink)

Living with a chronic condition represents a strenuous experience that often could be lived as a sequence of waiting and crisis times. Therapeutic path incidents could represent however a catalysts and revelatory time, useful to patients to discover their own resources. A qualitative study according to the phenomenological hermeneutic perspective was conducted to understand the kind of skills expressed by the patients during a difficult episode, and the characteristics that identify patients who can overcome them better. From September 2019 (...) to August 2020 twenty-three patients followed-up in four Hospital Units of Northeastern of Italy were enrolled. All the patients described an episode linked whit their pathological condition; they mentioned mainly supportive, reactive, or behavioral strategies and an acceptance attitude. The sample characteristics may explain the recurring acceptance attitude; however, the younger individuals, those with a higher level of education and those who faced precedent negative life experiences seem to better overcome challenging events. It can’t be taken for granted that patients possess all the skills necessary to overcome the frequent challenging episodes they have to face; for this reason, healthcare professionals should assess their learning and reactive attitude in order to tailor for them therapeutic education paths. (shrink)

Chronic pain affects a large part of the population causing functional disability, being often associated with coexisting psychological disorders, such as depression and anxiety, besides cognitive deficits, and sleep disturbance. The world elderly population has been growing over the last decades and the negative consequences of chronic pain for these individuals represent a current clinical challenge. The main painful complaints in the elderly are related to neurodegenerative and musculoskeletal conditions, peripheral vascular diseases, arthritis, and osteoarthritis, contributing toward poorly (...) life quality, social isolation, impaired physical activity, and dependence to carry out daily activities. Organ dysfunction and other existing diseases can significantly affect the perception and responses to chronic pain in this group. It has been proposed that elderly people have an altered pain experience, with changes in pain processing mechanisms, which might be associated with the degeneration of circuits that modulate the descending inhibitory pathways of pain. Aging has also been linked to an increase in the pain threshold, a decline of painful sensations, and a decrease in pain tolerance. Still, elderly patients with chronic pain show an increased risk for dementia and cognitive impairment. The present review article is aimed to provide the state-of-art of pre-clinical and clinical research about chronic pain in elderly, emphasizing the altered mechanisms, comorbidities, challenges, and potential therapeutic alternatives. (shrink)

Pains that persist long after damaged tissue hasrecovered remain a perplexing phenomenon. Theseso-called chronic pains serve no useful function foran organism and, given its disabling effects, mighteven be considered maladaptive. However, a remarkablesimilarity exists between the neural bases thatunderlie the hallmark symptoms of chronic pain andthose that subserve learning and memory. Bothphenomena, wind-up in the pain literature andlong-term potentiation (LTP) in the learning andmemory literature, are forms of neuroplasticity inwhich increased neural activity leads to a longlasting increase in (...) the excitability of neuronsthrough structural modifications at pre- andpost-synaptic sites. Moreover, the synapticmodifications of wind-up and LTP share a commonmechanism: a glutamate N -methyl-D-aspartate(NMDA) receptor interaction that initiates a calciummediated biochemical cascade that ultimately enhancessignal processing at the -amino-3-hydroxy-5-methyl-4-isoxazoleproprionic acid (AMPA) receptor. This paper arguesthat chronic pain, which has no adaptive value, canbe accounted for in terms of the highly adaptivephenomenon of activity-dependent neural plasticity;hence, some cases of chronic pain can beconceptualized as a memory trace in spinal neurons. (shrink)

Globally, chronic disease and conditions such as diabetes, cardiovascular disease, depression and cancer are the leading causes of morbidity and mortality. Why, then, are public health efforts and programs aimed at preventing chronic disease so difficult to implement and maintain? Also, why is primary care—the key medical specialty for helping persons with chronic disease manage their illnesses—in decline? Public health suffers from its often being socially controversial, personally intrusive, irritating to many powerful corporate interests, and structurally designed (...) to be largely invisible and, as a result, taken for granted. Primary care struggles from low reimbursements, relative to specialists, excessive paperwork and time demands that are unattractive to medical students. Our paper concludes with a discussion of why the need for more aggressive public health and redesigned primary care is great, will grow substantially in the near future, and yet will continue to struggle with funding and public popularity. (shrink)

We propose that hyper‐inflammation (HYPi) is a ‘‘runaway’’ consequence of acute inflammation (ACUi) that arises more easily (and also abates less easily) in those who host a pre‐existing chronic inflammation (CHRi), because (i) most factors involved in generating an ACUi to limit viral proliferation are already present when there is an underlying CHRi, and also because (ii) anti‐inflammatory (AI) mechanisms for the abatement of ACUi (following containment of viral proliferation) are suppressed and desensitized where there is an underlying CHRi, (...) with this causing the ACUi to spiral into a HYPi. Stress, pollution, diet, and gut microbiomes (alterable in weeks through dietary changes) have an intimate and bidirectional cause‐effect relationship with CHRi. We propose that avoidance of CHRi‐promoting foods and adoption of CHRi‐suppressing foods could reduce susceptibility to HYPi, in Covid‐19 and in other viral diseases, such as influenza, which are characterized by episodic and unpredictable HYPi. (shrink)

Chronic pain patients often miss receiving acknowledgement for the multidimensional struggles they face with their specific conditions. People suffering from chronic pain experience a type ofinvisibilitythat is also borne by other chronically ill people and their respective medical conditions. However, chronic pain patients face both passive and active exclusion from social participation in activities like family interactions or workplace inclusion. Although such aspects are discussed in the debates lead by the bio-psycho-social model of pain, there seems to (...) be a lack of a distinct interest in assessing more specifically the social aspects regarding chronic pain. As a result, the social aspects have yet to be taken into a more thorough theoretical consideration of chronic pain and to be practically implemented to help affected patients. By addressing chronic pain patients’ struggle for recognition, this paper attempts to shed light on some of these social aspects. We base this attempt on a theoretical framework that combines patients’ statements with an adaptation of Axel Honneth’s social-philosophical work onrecognition. Thus, this paper tries to make a suggestion on how the bio-psycho-social model of pain can live up to its name by helping to address more adequately some of the more neglected aspects in chronic pain patients’ suffering than has been possible to date. (shrink)

This paper starts by establishing a prima facie case that disadvantaged groups or individuals are more likely to get a chronic disease and are in a disadvantaged position to adhere to chronic treatment despite access through Universal Health Coverage. However, the main aim of this paper is to explore the normative implications of this claim by examining two different but intertwined argumentative lines that might contribute to a better understanding of the ethical challenges faced by chronic disease (...) health policy. The paper develops the argument that certain disadvantages which may predispose to illness might overlap with disadvantages that may hinder self-management, potentially becoming disadvantageous in handling chronic disease. If so, chronic diseases may be seen as disadvantages in themselves, describing a reproduction of disadvantage among the chronically ill and a vicious circle of disadvantage that could both predict and shed light on the catastrophic health outcomes among disadvantaged groups—or individuals—dealing with chronic disease. (shrink)

While the biomedical model is still theleading paradigm within modern medicine and healthcare, and people with generalised chronicmusculoskeletal pain are frequent users of health careservices, their diagnoses are rated as having thelowest prestige among health care personnel. Anepistemological framework for understanding relationsbetween body, emotions, mind and meaning is presented.An approach based on a phenomenological epistemologyis discussed as a supplement to actions based on thebiomedical model.Within the phenomenological frame of understanding,the body is viewed as a subject and carrier ofmeaning, and therefore (...) chronic pain can be interpretedas a rational reaction to the totality of a person'slife situation. Search for possible hidden individualmeanings in painful muscles presupposes meeting healthpersonnel who view the person within a holistic frameof reference. (shrink)

Transpersonal agroecology (TPAE) is a theory, derived from the collective leanings of various important thinkers and practitioners in the field of alternative agriculture over the last century, which sees the mindset of the farmer to be just as important as his or her agricultural practices. However, these accumulated intuitions do not provide a coherent metaphysics within which to practice TPAE. Process metaphysics provides such a coherent framework for TPAE and for sustainable agriculture.

The following article is a response to the position paper of the Hastings Center, “Ethical Challenges of Chronic Illness”, a product of their three year project on Ethics and Chronic Care. The authors of this paper, three prominent bioethicists, Daniel Callahan, Arthur Caplan, and Bruce Jennings, argue that there should be a different ethic for acute and chronic care. In pressing this distinction they provide philosophical grounds for limiting medical care for the elderly and chronically ill. We (...) give a critical survey of their position and reject it as well as any attempt to characterize the physician-patient relationship as a commercial contract. We emphasize, as central features of good medical practice, a commitment to be the patient's agent and a determination to acquire and be guided by knowledge. These commitments may sometimes conflict with efforts to have the physician serve as an instrument of social and economic policies limiting medical care. (shrink)

Bear Suppression Inventory (WBSI), was I'ound to correlate with n>casurcs of obsessional thinking and depressive and anxious al'lect, t pridic( signs «I' clinical «hscssion ainong individuals prone (oward «h»c»»i«n >I (hi>>king, (« predict depression tive (h (», and to predict I''iilurc «I' electr«dermal responses to habituate am«ng pci>pic having emotional thoughts. The WBSI was inversely correlated with repression as assessed by the Repression-Sensitization Scale, and so tap» a trait that i» itc unlike rcprc»si«n:is traditi«n;illy c«nccivcd.

Marc Lewis argues that addiction is not a disease, it is instead a dysfunctional outcome of what plastic brains ordinarily do, given the adaptive processes of learning and development within environments where people are seeking happiness, or relief, or escape. They come to obsessively desire substances or activities that they believe will deliver happiness and so on, but this comes to corrupt the normal process of development when it escalates beyond a point of functionality. Such ‘deep learning’ emerges from consumptive (...) habits, or ‘motivated repetition’, and although addiction is bad, it ferments out of the ordinary stuff underpinning any neural habit. Lewis gives us a convincing story about the process that leads from ordinary controlled consumption through to quite heavy addictive consumption, but I claim that in some extreme cases the eventual state of deep learning tips over into clinically significant impairment and disorder. Addiction is an elastic concept, and although it develops through mild and moderate forms, the impairment we see in severe cases needs to be acknowledged. This impairment, I argue, consists in the chronic automatic consumption present in late stage addiction. In this condition, the desiring self largely drops out the picture, as the addicted individual begins to mindlessly consume. This impairment is clinically significant because the machinery of motivated rationality has become corrupted. To bolster this claim I compare what is going on in these extreme cases with what goes on in people who dissociate in cases of depersonalization disorder. (shrink)