IntroductionMother–child interactions during the first years of life have a significant impact on the emotional and cognitive development of the child. In this work, we study how a prenatal diagnosis of malformation may affect maternal representations and the quality of these early interactions. To this end, we conducted a longitudinal observational study of mother–child interactions from the gestational stage until the baby completed 12 months of age.Participants and MethodsWe recruited 250 pregnant women from a local university hospital. Among them, (...) 50 mother–infant dyads participated in all stages of the study. The study group consisted of 25 pregnant women with fetuses with some structural alteration and the control group consisted of 25 pregnant women with fetuses without structural anomalies. We collected obstetric and socio demographic data and pregnancy outcomes. Anxiety and depressive state data were collected using the COVI and Raskin Scales. We video-recorded the mother–infant interactions during several stages, including when the child was a newborn and when the child was 2, 4, 6, 9, and 12 months of age. The quality of the mother infant interactions were measured using the Coding Interactive Behavior. The interactive moments recorded on video was composed of three different activities, each one lasting appoximately 3 min, which included Free Interaction, where the mother was instructed to interact “as usual” without any toy, Toy Interaction, where the mother and baby played with a puppv, and Song Interaction, where the mother and baby interacted while the mother sang the “Happy Birthday” song.ResultsIn the gestational phase, there was a significant difference between the groups with respect to anxiety and depression scores, which were significantly higher for the study group. In the postnatal phase, we found significant differences between the groups with respect to CIB scales after the child completed 6 months of age: the study group presented significantly higher values of Maternal Sensitivity at 6 months of age, of Baby Involvement at 9 and 12 months of age, and of Dyadic Reciprocity at 6, 9, and 12 months of age, while the control group presented significantly higher values of Withdrawal of the Baby at 6 months of age, and of Dyadic Negative States at 6 and 9 months of age.ConclusionThe support offered by the study favored the mother–infant bond and had a positive effect on the quality of interaction during the first year of life, despite the presence of prenatal diagnosis. (shrink)

PurposeThe aim of this study was to investigate the effect of possible late effects of cancer treatment and of two job resources on future burnout complaints, among employees living 2–10 years beyond breast cancer diagnosis.MethodsData at T1 and at T2 were collected in 2018 and 2019. These data were part of a longitudinal study among Dutch speaking workers with a cancer diagnosis 2–10 years ago. All complaints and job resources were self-reported. Longitudinal multivariate regression analyses were executed, controlling (...) for years since diagnosis, living with cancer, and other chronic or severe diseases. Mediation by baseline burnout complaints was considered.ResultsA higher level of fatigue and cognitive complaints at baseline resulted in higher future burnout complaints, with partial mediation by baseline burnout complaints. No effect of physical complaints at T1 was observed. Higher levels of autonomy or a supportive leadership style resulted in lower burnout complaints, with full mediation by baseline burnout complaints. Buffering was observed by autonomy in the relationship of cognitive complaints with future burnout complaints. No moderation was observed by supportive leadership.ConclusionThe level of burnout complaints among employees 2–10 years beyond breast cancer diagnosis may be an effect of fatigue or cognitive complaints, and awareness of this effect is necessary. Interventions to stimulate supportive leadership and autonomy are advisable, the latter especially in the case of cognitive complaints. (shrink)

Multiple sclerosis significantly affects how patients maintain the resources they consider important. The aim of this paper is to describe the moderation effect of time since diagnosis on the evaluation of resources by patients with multiple sclerosis, on the basis of S.E. Hobfoll’s Conservation of Resources theory. The study was conducted using paper and pencil methods and involved 77 patients, of whom 32 received their diagnosis less than four years ago, and 45 more than four years ago. The (...) patients’ resource evaluation was investigated using the Polish adaptation of the COR questionnaire. Patients who received their diagnosis more than four years ago were more likely to consider vital and spiritual resources to be more important. In patients diagnosed less than four years ago, the loss of economic, political, and vital resources was significant. It is shown moderation effect of time since diagnosis. The results may for the basis for further research. (shrink)

Illness narrative has often been found to play a positive role in both patients’ and providers’ efforts to find meaning in the illness experience. However, illness narrative can sometimes become counterproductive, even pathological, particularly in cases of medical mystery—cases wherein biopsychosocial factors blur the distinction between bodily dysfunction and somatizing behavior. In this article, the author draws attention to two examples of medical mystery, the clinical presentation of medically unexplained symptoms, and the popular reality television program Mystery Diagnosis, to (...) demonstrate the potentially harmful effects of illness narrative. The medical mystery’s complex narrative structure reflects and tends to reinforce providers’ and patients’ mistaken assumptions, anxieties, and conflicts in ways which obstruct, rather than facilitate, healing. (shrink)

Now in its fourth edition, Rational Diagnosis and Treatment: Evidence-Based Clinical Decision - Making is a unique book to look at evidence-based medicine and the difficulty of applying evidence from group studies to individual patients._ The book analyses the successive stages of the decision process and deals with topics such as the examination of the patient,_the reliability of clinical data, the logic of diagnosis, the fallacies of uncontrolled therapeutic experience and the need for randomised clinical trials and meta-analyses. (...) It is the main theme of the book that, whenever possible, clinical decisions must be based on the evidence from clinical research, but the authors also explain the pitfalls of such research and the problems involved in applying evidence from groups of patients to the individual patient._ For this new edition, the sections on placebo and meta-analysis and on alternative medicine have been thoroughly updated, and there is more focus on insufficient reporting of harms of interventions. The sections on different research designs describe advantages and limitations, and the increased medicalisation and the effects of cancer screening on health people are noted. A section on academic freedom when clinicians collaborate with industry and ghost authors is added._ This essential reference work integrates the science and statistical approach of evidence-based medicine with the art and humanism of medical practice; distinguishing between data, sets of data, knowledge and wisdom, and their application. Such an intellectually challenging book is ideal for both medical students and doctors who require theoretical and practical clinical skills to help ensure that they apply theory in practice. (shrink)

Internationally, there are reports of adverse health effects (AHE) in the environs of industrial wind turbines (IWT). There was multidisciplinary confirmation of the key characteristics of the AHE at the first international symposium on AHE/iwt. The symptoms being reported are consistent internationally and are characterized by crossover findings or a predictable appearance of signs and symptoms present with exposure to IWT sound energy and amelioration when the exposure ceases. There is also a revealed preference of victims to seek restoration away (...) from their homes. This article identifies the need to create a case definition to establish a clinical diagnosis. A case definition is proposed that identifies the sine qua non diagnostic criteria for a diagnosis of adverse health effects in the environs of industrial wind turbines. Possible, probable, and confirmed diagnoses are detailed. The goal is to foster the adoption of a common case definition that will facilitate future research efforts. (shrink)

Two versions of the argument that prenatal diagnosis discriminates against the disabled are distinguished and analysed. Both are shown to be inadequate, but some valid concerns about the social effects of prenatal diagnosis are highlighted.

Fast and effective detection of the causative agent of malaria in humans, protozoan Plasmodium parasites, is of crucial importance for increasing the effectiveness of treatment and to control a devastating disease that affects millions of people living in endemic areas. The microscopic examination of Giemsa‐stained blood films still remains the gold‐standard in Plasmodium detection today. However, there is a high demand for alternative diagnostic methods that are simple, fast, highly sensitive, ideally do not rely on blood‐drawing and can potentially (...) be conducted by the patients themselves. Here, the history of Plasmodium detection is discussed, and advantages and disadvantages of diagnostic methods that are currently being applied are assessed. (shrink)

Playing an important role in electromechanical systems, hydraulic servo system is crucial to mechanical systems like engineering machinery, metallurgical machinery, ships, and other equipment. Fault diagnosis based on monitoring and sensory signals plays an important role in avoiding catastrophic accidents and enormous economic losses. This study presents a fault diagnosis scheme for hydraulic servo system using compressed random subspace based ReliefF method. From the point of view of feature selection, the scheme utilizes CRSR method to determine the most (...) stable feature combination that contains the most adequate information simultaneously. Based on the feature selection structure of ReliefF, CRSR employs feature integration rules in the compressed domain. Meanwhile, CRSR substitutes information entropy and fuzzy membership for traditional distance measurement index. The proposed CRSR method is able to enhance the robustness of the feature information against interference while selecting the feature combination with balanced information expressing ability. To demonstrate the effectiveness of the proposed CRSR method, a hydraulic servo system joint simulation model is constructed by HyPneu and Simulink, and three fault modes are injected to generate the validation data. (shrink)

Electromechanical actuators are more and more widely used as actuation devices in flight control system of aircrafts and helicopters. The reliability of EMAs is vital because it will cause serious accidents if the malfunction of EMAs occurs, so it is significant to detect and diagnose the fault of EMAs timely. However, EMAs often run under variable conditions in realistic environment, and the vibration signals of EMAs are nonlinear and nonstationary, which make it difficult to effectively achieve fault diagnosis. This (...) paper proposed a fault diagnosis method of electromechanical actuators based on variational mode decomposition multifractal detrended fluctuation analysis and probabilistic neural network. First, the vibration signals were decomposed by VMD into a number of intrinsic mode functions. Second, the multifractal features hidden in IMFs were extracted by using MFDFA, and the generalized Hurst exponents were selected as the feature vectors. Then, the principal component analysis was introduced to realize dimension reduction of the extracted feature vectors. Finally, the probabilistic neural network was utilized to classify the fault modes. The experimental results show that this method can effectively achieve the fault diagnosis of EMAs even under diffident working conditions. Simultaneously, the diagnosis performance of the proposed method in this paper has an advantage over that of EMD-MFDFA method for feature extraction. (shrink)

Inflammatory bowel disease is chronic and incurable. Imperious diarrhea, rectal bleeding, fatigue, and weight loss, the main manifestations, cause a decrease in the quality of the patient’s personal and professional life. The objectives of this study were to identify a possible relationship between early maladaptive schemas and disease activity status using logistic regression, to identify the prevalence of early maladaptive schemes in patients and to propose a psychotherapeutic intervention plan. The following were found in a sample of 46 patients aged (...) 16–76 years. An increase in the domain overvigilance and inhibition score had a significant effect, with an increase of 1.137 CI95% [1.031, 1.254] of the risk of the disease being diagnosed as active. High and very high scores were observed for the emotional deprivation scheme and dependence/incompetence, vulnerability to harm and illness and subjugation schemas. The results show that the proposed model could predict and reconfirm the diagnosis; patients have specific psychotherapeutic needs. The therapeutic goal would be to offer care, empathy and protection, to strengthen self-confidence, to make patients realize that they have the ability to cope, to provide permission, encourage the patient to experiment, and guide the patient to express their anger healthily. The therapy scheme’s intervention could lead to increased long-term disease management capacity and, consequently, reduce costs directly and indirectly caused by this condition. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hypatia 16.3 (2001) 172-176 [Access article in PDF] Book Review Diagnosis: Difference: The Moral Authority of Medicine Diagnosis: Difference: The Moral Authority of Medicine. By Abby L. Wilkerson. Ithaca: Cornell University Press, 1998. In this compact volume, Abby Wilkerson makes several important contributions to the burgeoning literature of feminist (bio)ethics by providing substantive arguments in support of some of the key intuitive beliefs that are central to (...) much feminist bioethics thinking. Most centrally, she carefully fleshes out a feminist case for re-framing traditional bioethics approaches to the relation between health and justice. Particularly valuable is her richly detailed argument establishing the importance of bringing to the realm of health and health care Iris Marion Young's (1990) important insight that justice involves far more than questions of distribution.At the same time, Wilkerson demonstrates another major feminist tenet: that ethics and epistemology are intimately related. This connection is developed [End Page 172] through a second major theme in which she systematically tracks medicine's tendency to extend its accepted epistemic authority over physical ailments into a general authority over many other aspects of life. She documents examples of medicine's success in leveraging its scientific knowledge about certain aspects of the body into a broader ideological vision through which it claims epistemic authority in the personal and moral realm. By making explicit the gaps between medical knowledge and moral knowledge, she is able to challenge the moral authority and social power that are now granted to medical experts.While these arguments are important, they are not the whole story of the book, for its message is as much about process in bioethics as it is about conclusions. Wilkerson insists that the specific perspective of the theorist affects her/his reasoning. She demonstrates the importance of this fact by using her own distinct position as a bisexual woman to make visible the implicit acceptance and perpetuation of several ideological norms by those in dominant positions in both medicine and bioethics. The central method of the book is what she calls "material-semiotic." It involves the assumption that all human experience is mediated by culture, and the body (specifically the medicalized body) must be recognized as a political site subject to a variety of social values. We must, therefore, attend to the cultural meanings of health and illness and explore the ways that society labels and responds to these conditions. This requires investigation of the specific bodily (material) effects of these meanings in both individual and social experience.The book begins with the epistemological frame of the argument in which Wilkerson claims that medicine is deeply infected by the values and biases of the dominant culture, including its tendencies towards sexist, racist, classist, homophobic, and ablist attitudes. She explores ways in which medical theory and practice stigmatize bodily experiences common to women (in gynecology, obstetrics, and the treatment of victims of sexual or domestic violence). Medicalizing so many aspects of women's experience has the effect of obscuring women's subjective experiences and replacing them with medicine's normative perspectives of appropriate psychological norms. Moreover, the norm of femaleness promoted is a heterosexual, middle class, white variety such that other forms of social difference (e.g., non-white, non-heterosexual) must then also be medicalized and stigmatized; that is, the medical model requires explanations of difference that render pathological most variations on the privileged norm. Hence, alternative sexualities, like differences in class, abilities, race, and gender are interpreted through a medical lens that is thoroughly value-laden. In such ways, the epistemological authority granted to medicine is conflated into an unjustified form of moral authority. Although similar biases are common to every powerful social institution in the United States, they are especially pernicious within medicine because of the enormous influence it exerts in shaping knowledge about the nature of difference between social [End Page 173] groups. This immense social power may be directed towards reducing inequalities and promoting social justice, but, all too often, it is used to convey beliefs and norms that serve the interests of the privileged.Wilkerson's criticism is not reserved... (shrink)

The aim of my article is to analyze the concepts and phenomena of diagnosis and recognition, often considered to be semantically identical. While in psychiatric practice such an identity does not necessarily have adverse effects, in the anthropological and cultural domains identification of diagnosis and recognition may cause stigmatization, or other undesirable consequences. The article attempts to justify this thesis.

There has always been an intimate and complex relationship between the diagnosis of a disease and its treatment. The approach dubbed theranostics aims to combine diagnostic techniques with therapeutic ones by deploying the same molecule in two roles, exploiting the specificity of its function to render disease treatment more effective. Does this technical development have the potential to change our conception of disease diagnosis? With the treatment approach so intimately linked to the diagnostic tool, might it be (...) possible to treat a disease without having first made an independent clinical or laboratory diagnosis? Here we discuss medical diagnosis, arguing for three categories of diagnosis, before presenting an example of a theranostic approach using radioactive prostate-specific membrane antigen ligands. This example allows us to envision a form of theranostic agent that would be able to diagnose a cancer, for example, and engage directly in its treatment, opening up the possibility of treating patients at risk of developing this cancer without any other clinical diagnostic steps. Would it be a problem if these approaches eventually became independent of any specialist clinical diagnostic supervision? If a theranostic technique is shown to work, following its own logic, do we still need an independent ‘traditional’ diagnosis prior to its use? We argue that such a diagnosis would no longer be necessary provided certain conditions are fulfilled. (shrink)

With the development of artificial intelligence technologies, it is possible to use computer to read digital medical images. Because Alzheimer’s disease has the characteristics of high incidence and high disability, it has attracted the attention of many scholars, and its diagnosis and treatment have gradually become a hot topic. In this paper, a multimodal diagnosis method for AD based on three-dimensional shufflenet and principal component analysis network is proposed. First, the data on structural magnetic resonance imaging and functional (...) magnetic resonance imaging are preprocessed to remove the influence resulting from the differences in image size and shape of different individuals, head movement, noise, and so on. Then, the original two-dimensional ShuffleNet is developed three-dimensional, which is more suitable for 3D sMRI data to extract the features. In addition, the PCANet network is applied to the brain function connection analysis, and the features on fMRI data are obtained. Next, kernel canonical correlation analysis is used to fuse the features coming from sMRI and fMRI, respectively. Finally, a good classification effect is obtained through the support vector machines method classifier, which proves the feasibility and effectiveness of the proposed method. (shrink)

Computer-based diagnostic systems are widely regarded as having only a supportive role in assisting physicians make diagnostic decisions. Continuing progress in the design of diagnostic software, however, may not only produce systems which have heuristic and consultative value, but which may render the traditional role of the physician as a ‘polyfunctional practitioner’ obsolete should it become feasible to replace practitioner-dependent diagnostic skill with more accurate, reliable and cost-effective computer-based programs. Should the implementation of such programs prove to be both (...) a more practical and beneficial alternative than continuing to rely upon the exercise of practitioner-specific diagnostic skill, it would be unethical if the traditional role of the physician qua diagnostician were not phased out and supplanted by a more modular approach to medical decision making. Keywords: art of clinical diagnosis, computer-based diagnostic system, polyfunctional practitioner, Standard View CiteULike Connotea Del.icio.us What's this? (shrink)

The goal of this article is to present the possibility of using Diagnosis- Related Groups (DRG) in the hospital management process and to analyse the need for business performance management on the part of hospital management staff. The following research methods were used: literature analysis, case studies, and poll analysis. It is not possible to increase the effectiveness of operation of healthcare entities without increasing the importance of IT systems and using DRG more effectively in the management process. Training (...) users in IT and the use of DRGs is important to achieving hospital effectiveness. The increased importance of analyses and planning in a hospital should be reflected in the organisational structure of service providers. Hospital controllers should have a similar role to those present in most companies in other industries. (shrink)

Categorization-based diagnosis, which endeavors to be consistent with the third-person, objective measures of science, is not always adequate with respect to problems concerning diagnostic accuracy, demarcation problems when there are comorbidities, well-documented problems of symptom amplification, and complications of stigmatization and looping effects. While psychiatric categories have proved useful and convenient for clinicians in identifying a recognizable constellation of symptoms typical for a particular disorder for the purposes of communication and eligibility for treatment regimes, the reification of these categories (...) has without doubt had negative consequences for the patient and also for the general understanding of psychiatric disorders. We argue that a complementary, integrated framework that focuses on descriptive symptom-based classifications (drawing on phenomenological interview methods and narrative) combined with a more comprehensive conception of the human subject (found in the pattern theory of self), can not only offer a solution to some of the vexed issues of psychiatric diagnosis but also support more efficacious therapeutic interventions. (shrink)

Preimplantation genetic diagnosis (PID) is often seen as an improvement upon prenatal testing. I argue that PID may exacerbate the eugenic features of prenatal testing and make possible an expanded form of free-market eugenics. The current practice of prenatal testing is eugenic in that its aim is to reduce the numbers of people with genetic disorders. Due to social pressures and eugenic attitudes held by clinical geneticists in most countries, it results in eugenic outcomes even though no state coercion (...) is involved. I argue that technological advances may soon make PID widely accessible. Because abortion is not involved, and multiple embryos are available, PID is radically more effective as a tool of genetic selection. It will also make possible selection on the basis of non-pathological characteristics, leading, potentially, to a full-blown free-market eugenics. For these reasons, I argue that PID should be strictly regulated. (shrink)

Each year in the UK there are approximately 250,000 miscarriages, 3,000 stillbirths and 3,000 terminations following a diagnosis of fetal-abnormality. This paper draws from original empirical research into the experience of pregnancy loss and the accompanying decisionmaking processes. A key finding is that there is considerable variation across England in the range of options that are offered for disposal of pregnancy remains and the ways in which information around disposal are communicated. This analysis seeks to outline the key features (...) of what constitutes effective communication in this context, where effective communication is taken to mean that patients are provided with the key information necessary, in an appropriate manner, so that they are fully able to make a decision. A primary source of evidence includes interviews with the bereaved and pregnancy-loss support workers, in order to understand how the options available, and associated necessary procedures, are communicated. In addition, patient information leaflets are also analyzed as they offer an important tool for information delivery at a difficult and emotionally charged time. Following this, an overview is provided of the information that these leaflets should contain, along with guidance on effective presentation of this information. (shrink)

The paper investigates the epistemological and communicative competences the experts need to use and communicate evidence in the reasoning process leading to diagnosis. The diagnosis and diagnosis communication are presented as intertwined processes that should be jointly addressed in medical consultations, to empower patients’ compliance in illness management. The paper presents defeasible reasoning as specific to the diagnostic praxis, showing how this type of reasoning threatens effective diagnosis communication and entails that we should understand diagnostic (...) evidence as defeasible as well. It argues that metaphors might be effective communicative devices to let the patients understand the relevant defeasors in the diagnostic reasoning process, helping to improve effective diagnosis communication, and also encouraging a change in patients’ beliefs and attitudes on their own experience of illness and illness’ management. (shrink)

Metal roof enclosure system is an important part of steel structure construction. In recent years, it has been widely used in large-scale public or industrial buildings such as stadiums, airport terminals, and convention centers. Affected by bad weather, various types of accidents on metal roofs frequently occurred, causing huge property losses and adverse effects. Because of wide span, long service life and hidden fault of metal roof, the manual inspection of metal roof has low efficiency, poor real-time performance, and it (...) is difficult to find hidden faults. On the basis of summarizing the working principle of metal roof and cause of accidents, this paper classifies the fault types of metal roofs in detail and establishes a metal roof monitoring and fault diagnosis system using distributed multisource heterogeneous sensors and Zigbee wireless sensor networks. Monitoring data from strain gauge, laser ranging sensor, and ultrasonic ranging sensor is utilized comprehensively. By extracting time domain feature, the data trend characteristics and correlation characteristics are analyzed and fused to eliminate erroneous data and find superficial faults such as sensor drift and network interruption. Aiming to the hidden faults including plastic deformation and bolt looseness, an SVM fault diagnosis algorithm based on RBF kernel function is designed and applied to diagnose metal roof faults. The experimental results show that the RBF-SVM algorithm can achieve high classification accuracy. (shrink)

The aim of my article is to analyze the concepts and phenomena of diagnosis and recognition, often considered to be semantically identical. While in psychiatric practice such an identity does not necessarily have adverse effects, in the anthropological and cultural domains identification of diagnosis and recognition may cause stigmatization, or other undesirable consequences. The article attempts to justify this thesis.

This article argues that traditional models of diagnosis are incomplete in their reliance on a models of certainty that are no longer tenable in a postmodern world. Further, it argues that the current form of diagnosis, as applied to psychiatric and affective disorders, reduces patient agency and reinscribes the effects of biopower.

The diagnosis of Functional Neurological Disorder (FND) requires differentiation from other neurologic diseases/syndromes, and from the comparatively rare diagnosis of feigning (Malingering and Factitious Disorder). Analyzing the process of diagnosing FND reveals a necessary element of presumption, which I propose underlies some of the uncertainty, discomfort, and stigma associated with this diagnosis. A conflict between the neurologist’s natural social cognition and professional judgement (cognitive dissonance) can be understood by applying a framework originally designed for the determination of (...) moral responsibility. Understanding the source of this cognitive dissonance may effect its alleviation, and in turn, allow more compassionate treatment of patients with FND. (shrink)

The familiar Cartesian sceptical arguments all involve an explanation of our experiences. An account of the persuasive power of the sceptical arguments should explain why this is so. This supports a diagnosis of the error in Cartesian sceptical arguments according to which they mislead us into regarding our perceptual beliefs as if they were justified as inferences to the best explanation. I argue that they have instead a perceptual justification that does not involve inference to the best explanation and (...) that should not be put in doubt by the sceptical hypotheses. (shrink)

Background: Previous studies on the effectiveness of psychological interventions in oncology mainly used quantitative measures and no study was conducted with regard to both caregivers and patients. Aim: This study evaluates the effectiveness of psychoeducational support groups, both for women with breast cancer, and for their informal caregivers through the use of quantitative and qualitative measures. Methods: A longitudinal design was used comparing two psychoeducational support groups with other two groups in a standard care control condition. Participants were 28 women (...) with a diagnosis of breast cancer in the care of a hospital in Northern Italy, and 21 family caregivers. The quantitative data were collected by Cognitive Behavioral Assessment for Outcome Evaluation (CBA-OE) and the qualitative data through the use of semi-structured interviews. Results: The statistical analysis showed a significant change attributable to the psychological intervention that proves the effectiveness of such an intervention in the patients’ and caregivers’ group. The qualitative analysis allowed us to interpret the behavioral and psychological profile emerging from CBA-OE, by considering the subjective experience of the treatment groups. The group experience offered affective, relational and informative support, and allowed participants to create a network and to feel understood and reassured. Conclusions: The results suggest the usefulness of psychoeducational support groups for women with breast cancer and for their caregivers. The value of this kind of intervention is not only at an individual level but also at a systems level, and family involvement ensures the best positive outcomes. (shrink)

The Human Fertilisation and Embryology Authority have recently granted a licence to perform preimplanation genetic diagnosis (PGD) for the homozygous form of familial hypercholesterolaemia (FH), explicitly excluding its use for the heterozygous form. The grounds for such decisions centre on how serious a condition is thought to be as well as on the availability of effective treatment, and decisions are made on a case-by-case basis. The case for licensing homozygous FH is discussed and compared with other cases, and (...) the case for making a distinction between PGD for homozygous and heterozygous FH is also examined. Testing for homozygous FH raises difficult issues of non-disclosure of results for heterozygous FH. Fears that this decision may represent a ‘slippery slope’ to more widespread testing are argued to be overstated. (shrink)

Pre-Implantation Genetic Diagnosis represents the first fusion of genomics and assisted reproduction and the first reproductive technology that allows prospective parents to screen and select the genetic characteristics of their potential offspring. However, for some, the idea that we can intervene in the mechanisms of human existence at such a fundamental level can be, at a minimum, worrying and, at most, repugnant. Religious doctrines particularly are likely to collide with the rapidly advancing capability for science to make such interventions. (...) This paper focuses on opinions and arguments of selected religious scholars regarding ethical issues pertaining to PGD. In-depth interviews were conducted with religious scholars from three different religious organizations in the Klang Valley, Malaysia. Findings showed that Christian scholars are very sceptical of the long-term use of PGD because of its possible effect on the value of humanity and the parent-children relationship. This differs from Islamic scholars, who view PGD as God-given knowledge in medical science to further help humans understand medical genetics. For Buddhist scholars, PGD is considered to be new medical technology that can be used to save lives, avoid suffering, and bring happiness to those who need it. Our results suggest that it is important to include the opinions and views of religious scholars when it comes to new medical technologies such as PGD, as their opinions will have a significant impact on people from various faiths, particularly in a multi-religious country like Malaysia where society places high value on marital relationships and on the traditional concepts of family. (shrink)

Classification shapes medicine and guides its practice. As clinicians classify symptoms and illnesses, they trigger a range of actions and consequences. The assignment of particular disease labels is linked to both therapeutic and social responses. However, the classifications of medicine, natural though they may seem, contain significant social content, and are arrived at via a number of cultural framing devices (Aronowitz 2008). This article will explore the social intent and construction of classification and their embodiment in medical diagnosis.Effective (...) classification recognizes difference as well as similarity. By classifying, we are putting items together that have more in common with one another than they .. (shrink)

The classification frameworks for fault diagnosis of rolling element bearings in rotating machinery are mostly based on analysis in a single time-frequency domain, where sensitive features are not completely extracted. To solve this problem, a new fault diagnosis technique is proposed in the mixed domain, based on the crossover-mutation chaotic particle swarm optimization support vector machine. Firstly, fault features are generated using techniques in the time domain, the frequency domain, and the time-frequency domain. Secondly, the weighted maximum relevance (...) minimum redundancy algorithm is adopted to reduce the dimension of the feature set and to establish the representative feature set. Thirdly, a new crossover-mutation strategy is suggested to reduce the local minima in optimization, and an optimization disturbance is added. Finally, the support vector machine is optimized using the improved chaotic particle swarm to improve fault classification diagnosis. The effectiveness of the proposed new bearing fault diagnostic technique is verified by experimental tests under different bearing conditions. Test results showed that the bearing fault classification accuracy of CMCPSO-SVM in the mixed domain was much higher than those in a single feature domain. (shrink)

e understanding of the etiology and pathogenesis of these psyc hiatric disorders such as schizophrenia and depression is still n ot completely clear. At present, there is a lack of objective ne urobiological markers that can be used in clinical routine work such as clinical diagnosis, curative effect evaluation and progn osis evaluation of psychiatric disorders. Therefore, it is of great clinical significance to find biomarkers to improve the diagnos is level and evaluate the curative effect. Electroencephalogram (EEG) is (...) a non-invasive technique to record the potential activi ty of biological brain, through which researchers can analyze th e mechanisms underlying psychiatric disorders. In addition, mac hine learning can be used to further verify the role of these el ectrophysiological indicators in clinical diagnosis and curative e ffect evaluation of psychiatric disorders. The goal of this resear ch topic is to advance research on neurobiomarkers and EEG/ MEG-based diagnostic methods for mental disorders. We hope to conduct in-depth research on the pathogenesis and diagnostic measures of mental diseases such as schizophrenia and depressi ve disorder through EEG/MEG, in order to improve the perfor mance of artificial intelligence for mental diseases diagnosing.Under this research theme, the following is a brief overview of nine published articles, which respectively studied the diagnosis, The work in this special issue may fall into three categories of research: 1) method... (shrink)

In this paper I describe and analyze the need for an alternative, non-clinical approach to counseling, i.e., philosophical counseling. Throughout the first part of this paper. I aim to prove pragmatically the truth or validity of this new non-clinical approach to counseling by describing its effectiveness in a case-study. In the second part, I suggest that many philosophers have made use of philosophical self-diagnosis and self-help to improve their own well-being, although for their private practice of philosophy they did (...) not use the words I have chosen here. I exemplify this by analyzing the representative life narrative of Jean-Jacques Rousseau as a case study. (shrink)

In this paper I describe and analyze the need for an alternative, non-clinical approach to counseling, i.e., philosophical counseling. Throughout the first part of this paper. I aim to prove pragmatically the truth or validity of this new non-clinical approach to counseling by describing its effectiveness in a case-study. In the second part, I suggest that many philosophers have made use of philosophical self-diagnosis and self-help to improve their own well-being, although for their private practice of philosophy they did (...) not use the words I have chosen here. I exemplify this by analyzing the representative life narrative of Jean-Jacques Rousseau as a case study. (shrink)

In this article I draw on two scenarios from my personal life—the diagnosis of my newborn grandnephew with CHARGE syndrome and the diagnosis of my father with depression—to reflect on whether and when diagnosis may be harmful to patients. Despite the great differences between the two scenarios, I argue that in both cases the tendency of diagnosis to generalize, categorize, and stigmatize can lead to insidious and counterproductive effects. The perspective of disability studies can help physicians (...) to anticipate, minimize or avoid these negative ramifications. I also reflect on the matter of who "owns" a particular diagnosis, whose purposes it serves, and how. (shrink)

Writing is central both to the medical diagnostic codification of disability and to disabled people’s efforts to interrupt, complicate, or disrupt dominant medical narratives. This Symposium, like the George Washington University conference from which it takes its name, creates space for diverse modes and genres of claiming authority regarding diagnosis and its cultural and material effects. “Queer” and “crip” interrogations of diagnosis illuminate its status as a cultural phenomenon, embracing culturally disavowed embodiments and embodied experiences as tools for (...) diagnosing inegalitarian social relations and opportunities for cultural interventions. This Symposium traces the workings of diagnostic normativity manifested in experiences such as “disruptive deafness,” unstable bodily materialities, pathologized grief and other forms of affective distress, and “surgical assemblages.” It presents a diverse array of compositions, articulated on each writer’s own terms, addressing a range of embodied experiences through multiple genres and voices, ranging from conversation transcript to scholarly essay, poetry, graphic memoir, and personal essay. Here, laypersons interrupt monologic medical diagnosis, claiming space to compose themselves. Together, the authors trace instances of corporeal “correction” back to the noxious agents, both environmental and political, that consistently breach the boundaries of corporeality. (shrink)

In a spirit of critical appreciation, this essay challenges several core aspects of the critique of secular morality and the defense of Orthodox Christianity offered by H. Tristram Engelhardt in After God. First, I argue that his procedurally driven approach to a binding morality based solely on a principle of permission leaves morality without any substantive definition in general terms, in ways that are both conceptually problematic and also at odds with Engelhardt’s long-standing distinction between non-malevolence and beneficence. Second, I (...) question the accuracy or adequacy of Engelhardt’s critique of the Enlightenment project for his unwarranted privileging of a particular version of Enlightenment thinking at the expense of other Enlightenment perspectives less amenable to Engelhardt’s working generalizations. Third, I challenge the theoretical cogency of Engelhardt’s insistence on the ubiquity and intractability of moral controversies and his depiction of moral strangers and moral friends as, in effect, mutually exclusive terms. Finally, I question Engelhardt’s embrace of a divine command model of ethics as the appropriate resolution of Euthyphro’s dilemma and suggest that there may be intermediate approaches to the usual starkly drawn contrasts between divine command and naturalist accounts. (shrink)

Background: Healthcare workers in the front line of diagnosis, treatment, and care of patients with coronavirus disease 2019 are at great risk of both infection and developing mental health symptoms. This study aimed to investigate the following: whether healthcare workers in general hospitals experience higher mental distress than those in psychiatric hospitals; the role played by religion and alexithymic trait in influencing the mental health condition and perceived level of happiness of healthcare workers amidst the stress of the COVID-19 (...) pandemic; and factors that influence the resilience of healthcare workers at 6 weeks' follow-up.Methods: Four-hundred and fifty-eight healthcare workers were recruited from general and psychiatric hospitals, and 419 were followed-up after 6 weeks. All participants filled out the 20-item Toronto Alexithymia Scale, five-item Brief-Symptom Rating Scale, and the Chinese Oxford Happiness Questionnaire.Results: Under the stress of the COVID-19 pandemic, 12.3% of frontline healthcare workers in general hospitals reported having mental distress and perceived lower social adaptation status compared with those working in psychiatric hospitals. Christians/Catholics perceived better psychological well-being, and Buddhists/Taoists were less likely to experience mental distress. The results at 6 weeks of follow-up showed that the perceived lower social adaptation status of general hospital healthcare workers was temporary and improved with time. Christian/Catholic religion and time had independent positive effects on psychological well-being; however, the interaction of Christian/Catholic religion and time had a negative effect.Conclusions: Collectivism and individualism in the cultural context are discussed with regard to alexithymic trait and Buddhist/Taoist and Christian/Catholic religious faiths. Early identification of mental distress and interventions should be implemented to ensure a healthy and robust clinical workforce for the treatment and control of the COVID-19 pandemic. (shrink)

In this paper, we consider three arguments for the irrelevance of the doctrine of double effect in end-of-life decision making. The third argument is our own and, to that extent, we seek to defend it. The first argument is that end-of-life decisions do not in fact shorten lives and that therefore there is no need for the doctrine in justification of these decisions. We reject this argument; some end-of-life decisions clearly shorten lives. The second is that the doctrine of double (...) effect is not recognized in UK law ; therefore, clinicians cannot use it as the basis for justification of their decisions. Against this we suggest that while the doctrine might have dubious legal grounds, it could be of relevance in some ways, e.g. in marking the boundary between acceptable and unacceptable practice in relation to the clinician's duty to relieve pain and suffering. The third is that the doctrine is irrelevant because it requires there to be a bad effect that needs justification. This is not the case in end-of-life care for patients diagnosed as dying. Here, bringing about a satisfactory dying process for a patient is a good effect, not a bad one. What matters is that patients die without pain and suffering. This marks a crucial departure from the double-effect doctrine; if the patient's death is not a bad effect then the doctrine is clearly irrelevant. A diagnosis of dying allows clinicians to focus on good dying and not to worry about whether their intervention affects the time of death. For a patient diagnosed as dying, time of death is rarely important. In our conclusion we suggest that acceptance of our argument might be problematic for opponents of physician-assisted death. We suggest one way in which these opponents might argue for a distinction between such practice and palliative care; this relies on the double-effect doctrine's distinction between foresight and intention. (shrink)

Background: In this study, we aimed to investigate the effects of a mindfulness program including Mindfulness-Based Stress Reduction on the mental health of student teachers when offered at their educational institution in a real-life context.Methods: A parallel randomized controlled trial was conducted among self-selected student teachers at a Danish undergraduate program for teacher education in the autumns of 2019 and 2020. Participation was not recommended in case of clinical depression or a diagnosis of psychosis or schizophrenia, abuse of alcohol, (...) drugs, and/or medicine. Randomization was performed by a Statistician who was blinded to the identity of the students. Data was collected using self-reported questionnaires. The primary outcome was a change in perceived stress 3 months from baseline. Secondary outcome measures were symptoms of anxiety and depression, well-being, resilience, mindfulness, and thoughts and feelings during rest. The effects were analyzed according to the intention-to-treat principle using mixed-effect linear regression models. Mediating effects of mindfulness skills on the mental health outcomes were explored using structural equation modeling.Results: The study group included 67 student teachers with 34 allocated to the intervention group ; and 33 students allocated to a waiting list control group. At baseline, mean Perceived Stress Scale scores were 18.88 in the intervention group and 17.91 in the waiting list control group. A total of 56 students completed the questionnaire at a 3-month follow-up. Statistically significant effects of the intervention were found on perceived stress, symptoms of anxiety and depression, well-being, and on three of seven resting-state dimensions. No effects were found on resilience or mindfulness. Statistically significant mediated effects via resting-state dimensions were found.Conclusion The findings suggested that offering a mindfulness program at an undergraduate program for teacher education could significantly improve the mental health among self-selected students within 3 months. Results of mediation analysis supported the hypothesis that some of the effects might be explained by reduced distracting thoughts.Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [NCT04558099]. (shrink)

From computerized medical records to databases of pharmacological interactions and automated provisional EKG readings, the emergence of information technology has significantly altered the practice of medicine. Information technology has been widely used to enhance diagnosis and treatment and to improve communication between providers. The advent of the Internet also brings far-reaching implications for patient–physician communication, challenging physicians, patients, and policymakers to consider its impact on the delivery of medical care and the therapeutic relationship. A new set of practices by (...) patients and physicians is unfolding in cyberspace, ranging from the use of e-mail to communicate between physicians and patients in an existing relationship to one-to-one consultations with an anonymous physician and ongoing online treatment, such as psychotherapy. These practices are emerging in both the for-profit and not-for-profit spheres. (shrink)

CRISPR‐Cas technology accelerates development of fast, accurate, and portable diagnostic tools, typified by recent applications in COVID‐19 diagnosis. Parasitic helminths cause devastating diseases afflicting 1.5 billion people globally, representing a significant public health and economic burden, especially in developing countries. Currently available diagnostic tests for worm infection are neither sufficiently sensitive nor field‐friendly for use in low‐endemic or resource‐poor settings, leading to underestimation of true prevalence rates. Mass drug administration programs are unsustainable long‐term, and diagnostic tools – required to (...) be rapid, specific, sensitive, cost‐effective, and user‐friendly without specialized equipment and expertise – are urgently needed for rapid mapping of helminthic diseases and monitoring control programs. We describe the key features of the CRISPR‐Cas12/13 system and emphasise its potential for the development of effective tools for the diagnosis of parasitic and other neglected tropical diseases (NTDs), a key recommendation of the NTDs 2021–2030 roadmap released by the World Health Organization. (shrink)

Pre-natal-diagnosis technologies allow parents to discover whether their child is likely to suffer from serious disability. One argument for state funding of access to such technologies is that doing so would be “cost-effective”, in the sense that the expected financial costs of such a programme would be outweighed by expected “benefits”, stemming from the births of fewer children with serious disabilities. This argument is extremely controversial. This paper argues that the argument may not be as unacceptable as is (...) often assumed. In doing so, it sets out a more general framework for assessing the relevance of efficiency calculations to policy-making. The final section also investigates the relationship between the paper’s arguments and claims about parental responsibility for child-bearing and rearing, with reference to Scanlon’s work on “substantive responsibility”. (shrink)

Pre-natal-diagnosis technologies allow parents to discover whether their child is likely to suffer from serious disability. One argument for state funding of access to such technologies is that doing so would be “cost-effective”, in the sense that the expected financial costs of such a programme would be outweighed by expected “benefits”, stemming from the births of fewer children with serious disabilities. This argument is extremely controversial. This paper argues that the argument may not be as unacceptable as is (...) often assumed. In doing so, it sets out a more general framework for assessing the relevance of efficiency calculations to policy-making. The final section also investigates the relationship between the paper’s arguments and claims about parental responsibility for child-bearing and rearing, with reference to Scanlon’s work on “substantive responsibility”. (shrink)