This review was conducted to examine the causes, diagnoses, clinical manifestations, and available treatments for Graves' disease. Keywords like "Graves' disease," "radioactive iodine," "etiology," and "treatment" were used to search for data pertaining to Textbooks on endocrinology and other papers from these sources were also located. The introduction, etiology, risk factors, symptoms, diagnosis, course of treatment, and the contribution of many factors to the beginning of Graves' disease are all covered in this review article.

There have been innumerable attempts to characterize personal identity either in terms of psychological continuity or in terms of the linear and self-referential process of reproduction of one's self. I will defend the thesis according to which personal identity emerges mainly as a process of transcendence of one's own "minimal self". It is precisely by means of this critical distancing from his self, I contend, that the individual learns to see himself under a new perspective as far as to experience (...) his self as a surprise. Amazed at his own self, he lives a reawakening which leads him to a transformation of his way of living. This transcendence of the self cannot take place self-referentially but only through the force of an example provided by another person. Such act neither aims at the annihilation of the individual, nor does it contrast with self-love. It is in conlict merely with what Harry Frankfurt calls "selfindulgence". The idea of a transcendence of the self is already to be found in Plato, who fostered the overcoming of and puriication from amathia (in the sense of a "not knowing but pretending to know") and from an excessive love of oneself. Indeed, these latter would be the two grave diseases which render formless the soul of a human being, for they stand in the way of the cura sui. The same theme will reappear in Max Scheler's phenomenological reduction, which endeavours to bracket egocentrism (construed as excessive love of oneself) in order to give a form to the personal identity. (shrink)

Over 60% of all epidemics have a zoonotic origin, that is, they result from the transmission of infectious diseases from animals to humans. The spill-over of diseases often happens because humans exploit and use animals. In this article, I outline the four most common interfaces that favour the emergence and spread of zoonotic infectious diseases: wildlife hunting, small-scale farming, industrialised farming practices and live animal markets. I analyse which practices serve human food security – and thus have a non-trivial purpose (...) – and which predominantly have an economic purpose or serve as a symbol of wealth. I conclude that many practices that increase the risk for zoonotic infectious disease outbreaks actually do not contribute to the survival and food security of humans. I make two arguments in turn. First, I argue that in cases where the consumption and use of animal products does not contribute to the food security of a population, then this population has a duty to abstain from them, since they impose a grave and avoidable risk to themselves as well as to innocent third-parties. However, some communities must sometimes rely on practices that increase the risk of emergence and transmission of zoonotic infectious diseases, because they have no healthy alternatives. That is, the food security of the local population depends on the consumption and use of risky animal products. The second argument I advance is that, in such scenarios, the international community has a duty to provide the communities concerned with alternative food options, as well as economic and educational opportunities and technologies, in order to reduce the spill-over risk of infectious diseases. Given that abstention from such practices contributes signifcantly to the public good and benefits the international community, the latter has a corresponding duty to provide local communities which abandon such practices with alternatives. (shrink)

All the biotic and abiotic factors that act on an organism, population, or ecological community and influence its survival and development constitute its environment. Biotic factors include the organisms themselves, their food, and their interactions. Abiotic factors include such items as sunlight, soil, air, water, climate, and pollution. Organisms respond to changes in their environment by evolutionary adaptations in form and behaviour. At present humanity is facing great challenges for its survival as both these factors have come under great stress (...) due to its unbridled demands of national economic growth and individual needs and desires. Grave Crisis: On the abiotic front, a grave ecological crisis is caused by man’s exploitation of Nature, which is leading to a large scale depletion of natural resources, destruction of forests, and overuse of land for agriculture and habitation. Pollution is contaminating air, land, and water. Smoke from industries, homes and vehicles, is in the air. A smoky haze envelopes the major cities of the world. Industrial waste and consumer trash are choking streams and rivers, ponds and lakes, killing the marine life. Much of the waste is a product of modern technology. It is neither biodegradable nor reusable, and its longterm consequences are unknown. The viability of many animal and plant species, and possibly that of the humankind itself, is at stake. At the biotic level, humanity is facing a social justice crisis, which is caused by humanity’s confrontation with itself. The social justice crisis is that poverty, hunger, disease, exploitation and injustice are widespread. There are economic wars over resources and markets. The rights of the poor and the marginal are violated. Women, constituting half the world’s population, have their rights abused. Obviously, the contemporary human society is in the midst of a grave environmental crisis. There is a serious concern that the earth may no longer be a sustainable biosystem. Although human beings are seen as the most intelligent life form on earth, yet they are responsible for almost all the ecological damage done to the planet. The Sikh scripture, Sri Guru Granth Sahib (SGGS), declares that the purpose of human beings is to achieve a blissful state and to be in harmony with the earth and all of God’s creation. It seems, however, that humans have drifted away from that ideal. According to the Sikh scriptures, humans create their surroundings as a reflection of their inner state. Thus, the increasing barrenness of the earth reflects a spiritual emptiness within humans. (shrink)

PUERPÉRIO EM BOVINOS -/- INTRODUÇÃO -/- O puerpério é definido como o período entre o parto e a apresentação do primeiro estro fértil. Dois processos ocorrem durante o puerpério: a involução uterina e o início da atividade ovariana pós-parto. Em vacas leiteiras, os cuidados médicos pós-parto são essenciais nos programas de manejo, uma vez que as patologias uterinas são diagnosticadas e tratadas nesse período para que a vaca esteja em ótimas condições para ser inseminada, uma vez terminado o período de (...) espera voluntário. -/- 4.1 Involução uterina -/- O útero após o parto sofre modificações macroscópicas e microscópicas, até atingir as características de um útero não gestante, o que leva de 30 a 45 dias. O peso e o tamanho pós-parto diminuem rapidamente como consequência da atrofia das fibras musculares; por necrose das carúnculas e por eliminação de líquidos. Ao mesmo tempo em que o útero diminui de tamanho, o endométrio passa por um processo regenerativo para poder hospedar uma nova gestação. -/- A involução é promovida pelas contrações uterinas, que facilitam a eliminação de fluidos e dejetos e reduzem o tamanho do útero. As contrações são causadas pela secreção contínua de PGF2α, de origem uterina, e pela ocitocina secretada durante a amamentação. A PGF2α é secretada durante as primeiras 3 semanas pós-parto e seu envolvimento é considerado necessário para que a involução uterina ocorra normalmente. -/- Durante a involução uterina, as secreções conhecidas como lóquios, que são formadas por restos de membranas, carúnculas, fluidos fetais e sangue, são derramadas pela vagina. Essas secreções variam da cor vermelha ao marrom, têm consistência viscosa e são inodoras. A maioria dos lóquios é descartada durante os primeiros 15 dias após o parto e, em seguida, praticamente desaparece, exceto em casos de involução uterina anormal, quando o útero continua a derramar fluidos de consistência, cor e odor diferentes (figura 1). -/- Figura 1: O útero após o parto sofre alterações macroscópicas e microscópicas, até atingir as características de um útero não grávido, o que leva de 30 a 45 dias. -/- Antes do parto, o útero é estéril, pois é protegido da contaminação bacteriana pelo colo do útero ou cérvix. Durante e após o parto, essa barreira física desaparece e o útero é invadido por bactérias que se encontram no meio ambiente, pele e fezes, ou que são introduzidas durante a assistência ao parto. Além disso, a capacidade funcional dos fagócitos uterinos é baixa após o parto, o que contribui para o estabelecimento de infecções. Cerca de 95% das vacas desenvolvem infecções uterinas durante a involução, e uma alta porcentagem de vacas as eliminam por meio de mecanismos naturais. -/- Os mecanismos de defesa uterinos são constituídos pelas barreiras anatômicas (vagina, vulva e cérvix); fatores fisiológicos (produção de muco na vagina e cérvix); fagocitose promovida por neutrófilos, que migram da circulação geral para o útero; pela produção de substâncias inespecíficas, que inibem o crescimento bacteriano e favorecem a eliminação de microrganismos. A capacidade de eliminar bactérias do útero é determinada pelos hormônios ovarianos (progesterona e estrogênios); durante o diestro, a progesterona reduz a migração de neutrófilos, suprime o sistema imunocompetente, fecha o colo do útero e causa atonia uterina, resultando em aumento da suscetibilidade à infecção. Ao contrário, durante a fase folicular do ciclo estral (proestro e estro), o estradiol promove a migração de neutrófilos, abre a cérvix e aumenta o tônus uterino, o que facilita a eliminação de agentes infecciosos. Além disso, a atividade dos neutrófilos é afetada pelas deficiências antioxidantes e pela profundidade do balanço energético negativo. -/- 4.2 Anormalidades do puerpério -/- Após o parto, ocorrem algumas patologias que retardam a involução uterina e, consequentemente, afetam o intervalo entre o parto e o primeiro serviço. -/- 4.2.1 Retenção da placenta -/- A placenta é eliminada dentro de 12 horas após o parto; a retenção da placenta por mais de 24 horas é considerada uma patologia. A retenção placentária (RP) é uma alteração frequente do puerpério, que deve ser considerada como um sinal clínico de várias condições que podem ter origem infecciosa (aborto), metabólica (hipocalcemia, cetose, síndrome do vaca gorda), deficiências nutricionais (selênio e vitamina E) e erros de manejo (demasiada intervenção no parto). -/- A incidência de RP varia de 5 a 15% e depende, em grande parte, do estado de saúde e do manejo do rebanho. A RP é o principal fator de risco para infecções uterinas (metrite puerperal, metrite, endometrite e endometrite subclínica); também causa atraso no período entre o parto e a concepção e está associada à redução do percentual de concepção no primeiro serviço. -/- Em termos econômicos, determinou-se que a RP causa perdas significativas principalmente devido aos custos de serviços médicos, aumento da taxa de eliminação e diminuição da fecundidade. Além disso, vacas com retenção placentária produzem 355 kg a menos de leite durante os primeiros 60 dias do que vacas que não apresentam esta patologia (figuras 2 e 3). -/- 4.2.2 Patogenia -/- A placenta está ligada ao endométrio pelas vilosidades coriônicas, que estão ligadas às carúnculas (junção carúncula-cotilédone). A união entre essas estruturas é favorecida por um fluido adesivo formado por colágeno e outras proteínas. Antes e durante o trabalho de parto, observa-se um aumento da atividade das enzimas proteolíticas (colagenase, talvez a mais importante), que são responsáveis por separar o cotilédone da carúncula. Posteriormente, a placenta é removida mecanicamente por contrações uterinas após o parto do feto. -/- A etiologia e patogênese da retenção placentária não são conhecidas. Uma explicação proposta é que isso se deve a uma falha dos mecanismos proteolíticos responsáveis pela separação do cotilédone da carúncula. Foi observado que a atividade da colagenase no cotilédone é maior em vacas que não retêm placenta do que naquelas que a retêm. Propõe-se que alguns fatores de risco para retenção placentária possam estar atuando na redução da atividade da colagenase. Por outro lado, as condições inflamatórias na junção carúncula-cotilédone de origem infecciosa também impedem a separação da placenta. -/- Figura 3: Vaca com retenção placentária. -/- Figura 2: Vaca com retenção placentária. Em rebanhos comerciais, 5 a 15% das vacas retêm a placenta. -/- 4.2.3 Tratamento -/- Existem vários tratamentos, como a remoção manual da placenta em combinação com a aplicação local de antibióticos (infusões intrauterinas) e a administração de produtos hormonais (ocitócicos e PGF2α). A eficácia desses tratamentos é discutível. -/- A remoção manual da placenta é o tratamento mais popular; entretanto, não é a melhor, pois causa danos ao endométrio, que variam de leve sangramento a hematomas, mesmo quando não há evidências externas. Além disso, a remoção manual diminui a capacidade fagocítica dos leucócitos uterinos, resultando em metrite mais grave, maior atraso na involução uterina e baixo desempenho reprodutivo. -/- Outro tratamento consiste em cortar a placenta ao nível da vulva. Posteriormente, quando a placenta se separa das carúnculas, devido ao processo de decomposição do tecido, uma leve tração da vulva é suficiente para retirá-la, sem consequências. Essas vacas devem ser observadas quanto à febre e imediatamente integradas ao programa de check-up pós-parto, pois certamente desenvolverão metrite ou endometrite. A administração de antibióticos, tanto nos casos de retirada manual como naqueles em que a placenta é cortada, depende do estado geral da vaca. Deve-se sempre ter em mente que a RP é o principal fator de risco para metrite, portanto as vacas devem ser observadas para detectar prontamente aquelas que apresentam febre. Os antibióticos devem ser considerados para inibir a putrefação das membranas fetais, o que pode atrasar sua expulsão. No caso de opção pela administração de antibióticos, deve-se optar pela via parenteral em vez da intrauterina, pois esta causa irritação do endométrio, que está associada à baixa fertilidade (figura 4). -/- Outros tratamentos são baseados na administração de hormônios que estimulam a mobilidade uterina (ocitocina, estrogênios e PGF2α); entretanto, não há evidências clínicas que demonstrem sua eficácia; além disso, a causa menos frequente de RP é a incapacidade mecânica do útero de expelir a placenta. -/- 4.2.4 Prevenção -/- As estratégias de prevenção dessa patologia devem ter como objetivo reduzir a influência dos fatores de risco para RP. Assim, a incidência de abortos deve ser reduzida por meio de programas eficazes de vacinação e biossegurança; deve-se evitar períodos de seca muito longos para que as vacas não cheguem obesas ao parto; intervir o mínimo possível nos partos, e se atendido, deve ser feito com medidas de higiene rígidas; oferecer sais minerais de boa qualidade e administrar antioxidantes antes do parto (vitamina E, selênio e betacarotenos; tabela 1). -/- Figura 4: A placenta não deve ser removida inserindo a mão na vagina. É aconselhável aguardar a autólise (48 horas) e removê-la por leve tração. -/- Tabela 1: Incidência de retenção na membrana fetal (RMF), metrite hemorrágica (HM), metrite purulenta (PM) e puerpério anormal (PA) em vacas leiteiras tratadas com selênio e vitamina E nos dias 60, 21 antes do parto e 30, 90 pós-parto (grupo pré-pós-parto) e 21 dias pré-parto (grupo pré-parto) e testemunhas. -/- Laterais diferentes na mesma coluna indicam diferença estatística (P < 0,05). Adaptado de RUIZ et al., 2008. -/- 4.3 Infecções uterinas -/- Cerca de 95% das vacas desenvolvem infecção uterina durante os primeiros dias pós-parto; no entanto, a maioria elimina infecções por meio de seus mecanismos de defesa e apenas 30 a 50% delas desenvolvem metrite ou endometrite nas primeiras três semanas. As bactérias mais frequentes encontradas em processos inflamatórios no útero são: Arcanobacterium pyogenes (antes Actinomyces pyogenes), Fusobacterium necrophorum e Escherichia coli. Essas três bactérias agem sinergicamente. -/- 4.3.1 Metrite puerperal -/- A metrite puerperal é comum em vacas com retenção placentária. Essa patologia é observada nas três primeiras semanas pós-parto e é caracterizada pela presença de secreções abundantes na luz uterina que são vermelhas ou marrons, aquosas, fétidas e com involução retardada. As vacas afetadas mostram sinais de doença sistêmica (toxemia e febre > 39,5 °C) e diminuição da produção de leite (figura 5). -/- Figura 5: Vaca com metrite puerperal; vacas afetadas apresentam sinais de doença sistêmica. -/- 4.3.2 Metrite clínica -/- Metrite é o processo inflamatório que envolve as diferentes camadas do útero (mucosa, muscular e serosa). Esta condição se apresenta nos primeiros 21 dias pós-parto e é caracterizada por atraso na involução uterina e secreção purulenta, e não há sinais de doença sistêmica (figura 6). -/- 4.3.3 Endometrite clínica -/- Endometrite se refere à inflamação do revestimento uterino; clinicamente, caracteriza-se por retardo na involução uterina e eliminação de exsudato purulento ou mucopurulento. Pode surgir nos primeiros 21 dias pós-parto ou mais, sem apresentar qualquer afetação no estado geral. -/- Figura 6: Vaca com exsudato mucopurulento. Na prática, é difícil estabelecer um diagnóstico diferencial entre endometrite e metrite. Uma vaca com essa secreção pode ser tratada com cefalosporinas intrauterinas ou, se ela já estiver em ciclo, a administração de PGF2a é eficaz. -/- 4.3.4 Endometrite subclínica -/- Apresenta-se entre 21 e 40 dias pós-parto, não apresenta sinais externos e só é diagnosticada pela citologia uterina. Essa condição afeta entre 20 e 30% das vacas. Os fatores de risco identificados são retenção placentária e metrite. -/- 4.4 Diagnóstico -/- O diagnóstico é baseado na avaliação uterina por palpação retal, na qual são verificados o grau de involução e as características das secreções. Além disso, é necessária uma avaliação clínica geral, uma vez que vacas com metrite nos primeiros 10 dias pós-parto desenvolvem febre. Outra forma de estabelecer o diagnóstico é avaliando as secreções uterinas sem palpação retal. Pode ser feito introduzindo a mão por via vaginal, após a limpeza da região; embora este método possa parecer arriscado, a experiência em campo indica que é um método seguro e rápido. Outra possibilidade é por meio da vaginoscopia, esse método permite a avaliação da cérvix e das secreções uterinas. Existe um instrumento (Metricheck) que é inserido pela vagina e possui uma campânula atraumática na extremidade que permite a coleta das secreções uterinas (figuras 7 e 8). -/- 4.5 Impacto das infecções uterinas na reprodução e produção -/- As infecções uterinas (metrite e endometrite) prolongam o período do parto até a concepção; diminuem a porcentagem de concepção no primeiro serviço; a porcentagem de resíduos aumenta; a taxa de vacas inseminadas diminui e a produção diminui (300 kg a menos que vacas não afetadas). Além disso, eles afetam o período do parto à primeira ovulação; em vacas com puerpério anormal, os folículos dominantes são menores em diâmetro e produzem menos estradiol do que vacas saudáveis. Também uma proporção menor dos folículos da primeira onda ovula em comparação com as vacas com puerpério anormal. -/- A endometrite subclínica diminui a taxa de concepção no primeiro serviço e aumenta os dias abertos. Além disso, a metrite ou endometrite pode afetar os ovidutos e causar inchaço, obstrução e aderências (esse processo é mais frequente em vacas que recebem injeções de estrogênio). -/- Figura 8: Outra forma de diagnosticar infecções uterinas é por meio da introdução de um instrumento que possui em sua extremidade uma campânula atraumática que permite a coleta de secreções uterinas (Metricheck). -/- Figura 7: O diagnóstico de infecções uterinas pode ser estabelecido com a introdução da mão por via vaginal, após limpeza da região. -/- 4.6 Tratamentos -/- Para evitar o efeito negativo das infecções uterinas na eficiência reprodutiva, é necessário um diagnóstico e tratamento oportunos. Existem diversos tratamentos para a metrite ou endometrite, como o uso de antibióticos sistêmicos ou intrauterinos, infusões intrauterinas de antissépticos e a administração de hormônios. -/- 4.6.1 Antibióticos -/- Os tratamentos com antibióticos intrauterinos são usados há muitos anos e são uma opção, desde que alguns aspectos sejam considerados: que o útero é um ambiente anaeróbio; que há a presença de exsudatos e tecidos em decomposição e a existência de uma grande diversidade de bactérias, algumas das quais até produzem enzimas que inativam alguns antibióticos. -/- Como o útero é um ambiente anaeróbio, os antibióticos do grupo dos aminoglicosídeos não são ativos, pois precisam de oxigênio. Por outro lado, o acúmulo de exsudato purulento e restos de tecido no útero inibe a atividade das sulfonamidas. Os nitrofuranos são eficazes contra A pyogenes, somente quando doses extremamente altas são usadas; as doses usuais nunca atingem a concentração inibitória mínima no endométrio; além disso, não são ativos na presença de sangue ou exsudato purulento, são irritantes e estão associados a problemas de fertilidade. -/- A penicilina intrauterina ou parenteral é eficaz na cura de infecções entre os dias 25 e 30 após o parto; ou seja, quando for observada uma diminuição na diversidade de espécies bacterianas (menor probabilidade de que algumas bactérias produzam penicilinase) e predomina A pyogenes, que é sensível a este antibiótico. As formulações intrauterinas de cefalosporinas (cefapirina benzatina) são eficazes em vacas com endometrite entre os dias 15-20 pós-parto e não é necessário retirar o leite do mercado. -/- A tetraciclina é o antibiótico mais utilizado devido ao seu amplo espectro e por manter sua atividade nas condições do útero pós-parto; porém, a probabilidade de resistência bacteriana é alta devido ao seu uso contínuo por muitos anos, também causa danos ao endométrio e reduz a fertilidade (figura 9). -/- Em testes de campo, a administração de uma única infusão intrauterina de cefapirina benzatina, em vacas com endometrite entre os dias 15 a 20 pós-parto, produz uma maior taxa de recuperação e não afeta a fertilidade, em comparação com aquelas que foram tratadas com infusões de oxitetraciclina. -/- O problema mais importante na terapia com antibióticos é estabelecer um critério de quais animais realmente precisam. Nos casos de metrite puerperal não há dúvida, essas vacas precisam de tratamento com antibióticos por via sistêmica e intrauterina. Porém, em casos de metrite e endometrite a decisão é difícil, pois muitas vacas se curam sem nenhum tratamento. Na prática, antes que os antibióticos sejam administrados às vacas, deve-se considerar alguns dos fatores: características das secreções uterinas, dias após o parto, início da atividade ovariana, presença de febre e condição corporal. -/- Figura 9: As infusões de oxitetraciclina causam irritação do endométrio e diminuem a fertilidade. -/- 4.6.2 Tratamento com infusões de substâncias antissépticas -/- Tratamentos baseados na administração intrauterina de substâncias antissépticas também são usados. O tratamento mais frequente consiste na infusão de soluções de iodo; no entanto, os resultados com esta terapia não são positivos e estão associados a uma diminuição subsequente da fertilidade. Deve-se ter cautela no uso de antissépticos intrauterinos, pois todos causam irritação, afetam os mecanismos de defesa do útero e, em alguns casos, chegam a causar necrose do endométrio. -/- 4.6.3 Tratamentos hormonais -/- Na prática, a administração de estrogênio é comum em casos de metrite, principalmente quando o útero retém muito líquido. Sabe-se que os estrógenos em condições fisiológicas favorecem a contratilidade uterina e auxiliam na eliminação de infecções, porém, em doses farmacológicas o efeito é negativo. A administração de estrogênios pode contribuir para infecções que ascendem aos ovidutos e causam salpingite, aderências ovarianas e infertilidade. -/- A PGF2α desempenha um papel importante no parto e durante a involução uterina. Em vacas com puerpério normal, a duração dos níveis elevados de PGF2α está negativamente correlacionada com o tempo de involução uterina; portanto, quanto mais tempo duram os níveis elevados de PGF2α, menor é o tempo de involução uterina. Além disso, a administração de PGF2α a cada 12 horas, dos dias 3 a 10 pós-parto, encurta o período de involução uterina. Ao contrário, em vacas com puerpério anormal, foi observada uma correlação positiva entre as concentrações de PGF2α e o tempo de involução uterina; portanto, vacas com retenção placentária ou endometrite apresentam níveis mais elevados de PGF2α. -/- Algumas evidências envolvem a PGF2α como parte do mecanismo de eliminação da placenta; ou seja, foi observado que as vacas que normalmente eliminam a placenta apresentaram maiores concentrações de PGF2α na placenta, em comparação com as vacas com retenção placentária. Foi proposto que a falha do processo que leva à separação do cotilédone da carúncula está associada a uma alteração no metabolismo da prostaglandina, resultando em uma diminuição na PGF2α e um aumento na PGE2. Por outro lado, a inibição da síntese de PGF2α após o parto, por meio da injeção de ácido acetilsalicílico (aspirina), causa retenção da placenta. Esse conhecimento motivou estudos nos quais o tratamento com PGF2α após o parto foi avaliado para prevenir a retenção placentária ou reduzir o tempo de involução em vacas com retenção placentária ou metrite. Em alguns estudos, uma única injeção de PGF2α foi administrada nas primeiras horas após o parto com resultados conflitantes. Em outros estudos, a injeção de PGF2α entre os dias 20 a 30 pós-parto foi avaliada e não foi observado um efeito favorável na involução uterina. Porém, a injeção sistemática de PGF2α, a cada 14 dias a partir do 25º dia pós-parto, aumenta a proporção de vacas inseminadas, o que aumenta a taxa de prenhez. A PGF2α causa contrações uterinas e favorece a eliminação de secreções; entretanto, um efeito favorável da PGF2α na involução uterina, sem envolver um corpo lúteo, é questionável. -/- Na prática, um programa é usado com base na administração sistemática de PGF2α a todas as vacas a cada 14 dias, do 25º ao 30º dia pós-parto. Esse tratamento é baseado no encurtamento das fases lúteas, o que favorece a eliminação das infecções. Deve-se observar que cerca de 30% das vacas desenvolvem corpos lúteos longevos (21 a 50 dias) nos primeiros ciclos pós-parto, nessas condições a injeção de PGF2α, a cada 14 dias, encurta o ciclo estral e diminui o risco de persistência de infecções uterinas. -/- 4.7 Piometra -/- Esta patologia se desenvolve em vacas que ovulam nos primeiros 20 dias pós-parto e, concomitantemente, sofrem de infecção uterina. Nessas condições, a progesterona promove a proliferação bacteriana e fecha o colo do útero, causando acúmulo de exsudato purulento no útero. As alterações causadas no endométrio alteram a secreção de PGF2α, resultando na persistência do corpo lúteo e anestro. Vacas com piometra respondem muito bem ao tratamento com PGF2α; uma segunda injeção desse hormônio, 14 dias depois, encurta o período de recuperação (figura 10). -/- Figura 10: A piometra é caracterizada pelo acúmulo de exsudato purulento no útero, colo uterino fechado e presença de corpo lúteo. O diagnóstico é feito por palpação retal e tratado com PGF2α. -/- 4.8 Vaginite em fêmeas gestantes -/- A vaginite em fêmeas grávidas ocorre com baixa frequência; porém, quando há um caso, causa alarme porque é confundido com um aborto. Nesses casos, o veterinário deve fazer um exame retal para determinar se o produto está vivo e se a cérvix está aberta. O diagnóstico é concluído com o exame vaginal com vaginoscópio ou diretamente à mão com luva limpa. -/- No caso de um aborto, o produto geralmente está morto e a cérvix está aberta; nestes casos, o produto deve ser extraído. Ao contrário, se a cérvix estiver fechada e o feto estiver vivo, o prognóstico é favorável e o problema diminui com o tratamento com antibióticos sistêmicos. -/- RESUMO -/- < >O útero após o parto pesa 13 kg e no dia 21 pós-parto, 1 kg. A regeneração do epitélio uterino leva 25 dias. A regeneração das camadas profundas do endométrio leva 42 a 56 dias. 95% das vacas desenvolvem alguma infecção uterina. 30 a 50% das vacas desenvolvem metrite nas primeiras duas semanas após o parto. 15 a 20% persistem como endometrite clínica > 3 semanas após o parto. 18 a 20% têm metrite com efeitos sistêmicos. 20 a 30% das vacas têm endometrite subclínica. 5 a 15% das vacas retêm a placenta. 355 kg de leite são perdidos em vacas com retenção placentária. Em vacas que sofrem de puerpério anormal, a proporção de vacas prenhes é reduzida em 10 por cento no 90º dia pós-parto. No Reino Unido, 192 euros são gastos por cada vaca que tem um puerpério anormal. REFERÊNCIAS BIBLIOGRÁFICAS -/- ANDREWS, Anthony H. et al. (Ed.). Bovine medicine: diseases and husbandry of cattle. John Wiley & Sons, 2008. -/- AZAWI, O. I. Postpartum uterine infection in cattle. Animal reproduction science, v. 105, n. 3-4, p. 187-208, 2008. -/- BEARDEN, Henry Joe et al. Applied animal reproduction. Reston Publishing Company, Inc., 1984. -/- HOLY, Lubos; MARTÍNEZ JÚSTIZ, G. Colab. Biología de la reproducción bovina. Havana: Revolucionária, 1975. -/- HOPPER, Richard M. (Ed.). Bovine reproduction. John Wiley & Sons, 2014. -/- HORTA, António Eduardo Monteiro. Fisiologia do puerpério na vaca. Jornada Internales de Reproductión Animal, v. 8, p. 73-84, 1995. -/- KOZICKI, Luiz Ernandes. Aspectos fisiológicos e patológicos do puerpério em bovinos. Archives of Veterinary Science, v. 3, n. 1, 1998. -/- LEBLANC, S. J. et al. Defining and diagnosing postpartum clinical endometritis and its impact on reproductive performance in dairy cows. Journal of dairy science, v. 85, n. 9, p. 2223-2236, 2002. -/- LEBLANC, S. J. et al. The effect of treatment of clinical endometritis on reproductive performance in dairy cows. Journal of dairy science, v. 85, n. 9, p. 2237-2249, 2002. -/- MARTINS, T. M.; BORGES, A. M. Avaliação uterina em vacas durante o puerpério. Rev. Bras. Reprod. Anim, Belo Horizonte, v. 35, n. 4, p. 433-443, 2011. -/- RADOSTITS, Otto M. et al. Clínica Veterinária: um tratado de doenças dos bovinos, ovinos, suínos, caprinos e eqüinos. Rio de Janeiro: Guanabara Koogan, 2002. -/- RISCO, CARLOS A.; YOUNGQUIST, ROBERT S.; SHORE, M. DAWN. Postpartum uterine infections. In: Current therapy in large animal theriogenology. WB Saunders, 2007. p. 339-344. -/- SHELDON, I. M. et al. Influence of uterine bacterial contamination after parturition on ovarian dominant follicle selection and follicle growth and function in cattle. REPRODUCTION-CAMBRIDGE-, v. 123, n. 6, p. 837-845, 2002. -/- SHELDON, I. M. et al. Mechanisms of infertility associated with clinical and subclinical endometritis in high producing dairy cattle. Reproduction in domestic animals, v. 44, p. 1-9, 2009. -/- SHELDON, I. Martin et al. Uterine diseases in cattle after parturition. The Veterinary Journal, v. 176, n. 1, p. 115-121, 2008. -/- TIXI, C. et al. Factores que afectan el porcentaje de vacas gestantes en el día 90 posparto. In: Memorias del XXXIII Congreso Nacional de Buiatría. Tuxtla Gutiérrez Chiapas. México. pp. 2009. (shrink)

It has been argued that ethical frameworks for data science often fail to foster ethical behavior, and they can be difficult to implement due to their vague and ambiguous nature. In order to overcome these limitations of current ethical frameworks, we propose to integrate the analysis of the connections between technical choices and sociocultural factors into the data science process, and show how these connections have consequences for what data subjects can do, accomplish, and be. Using healthcare as an example, (...) attention to sociocultural conversion factors relevant to health can help in navigating technical choices that require broader considerations of the sociotechnical system, such as metric tradeoffs in model validation, resulting in better ethical and technical choices. This approach promotes awareness of the ethical dimension of technical choices by data scientists and others, and that can foster the cultivation of 'ethical skills' as integral to data science. (shrink)

The expanding social role and continued development of artificial intelligence (AI) needs theological investigation of its anthropological and moral potential. A pragmatic theological anthropology adapted for AI can characterize moral AI as experiencing its natural, social, and moral world through interpretations of its external reality as well as its self-reckoning. Systems theory can further structure insights into an AI social self that conceptualizes itself within Ignacio Ellacuria’s historical reality and its moral norms through Thomistic ideogenesis. This enables a conceptualization process (...) capable of carrying moral weight and grounded in reality; structures the experience of an AI emergent self into multiple levels of interpretation; and drives a multi-level systems architecture for moral AI. Modeling AI’s interpretive experience and self-reckoning as a causal, sociotechnical, and moral actor can help moral AI identify conflicts between its normative values and develop the practical wisdom (phronesis) needed to apply its general moral models. (shrink)

Examining AI spirituality can illuminate problematic assumptions about human spirituality and AI cognition, suggest possible directions for AI development, reduce uncertainty about future AI, and yield a methodological lens sufficient to investigate human-AI sociotechnical interaction and morality. Incompatible philosophical assumptions about human spirituality and AI limit investigations of both and suggest a vast gulf between them. An emergentist approach can replace dualist assumptions about human spirituality and identify emergent behavior in AI computation to overcome overly reductionist assumptions about computation. Using (...) general systems theory to organize models of human experience yields insight into human morality and spirituality, upon which AI modeling can also draw. In this context, the pragmatist Josiah Royce’s semiotic philosophy of spirituality identifies unanticipated overlap between symbolic AI and spirituality and suggests criteria for a human-AI community focused on modeling morality that would result in an emergent Interpreter-Spirit sufficient to influence the ongoing development of human and AI morality and spirituality. (shrink)

The purpose of this book is to piece together in some detail the philosophy of Common Sense from its fragmentary state in the writings of Thomas Reid and the other members of his school, to consider it in relation to David Hume, and to try and show the significance of its account of the nature and authority of common sense for present-day discussion.

Amongst the anonymous critics of Locke's "Essay concerning Human Understanding" was a writer of very considerable contemporary eminence, Thomas Burnet. Burnet's criticism is contained in "Remarks upon an Essay Concerning Humane Understanding" and in two subsequent sets of Remarks. This monograph surveys the clash between Locke and Burnet on morality, certainty in revealed religion, and the immortality of the soul.

The purpose of this book is to further an understanding of religion -- not of the kind that might come from psychological or sociological enquiry -- but an understanding from the inside, so to speak, of the subject-matter of such explanatory enquiries. An understanding of the kind possessed by someone who, firmly believing in a religion, has thought about the nature of religion. The book aims to increase this kind of understanding where it already exists, and in its absence, at (...) bringing about some degree of it without presupposing in a reader any religious belief at all. (shrink)

In a series of pre-registered studies, we explored (a) the difference between people’s intuitions about indeterministic scenarios and their intuitions about deterministic scenarios, (b) the difference between people’s intuitions about indeterministic scenarios and their intuitions about neurodeterministic scenarios (that is, scenarios where the determinism is described at the neurological level), (c) the difference between people’s intuitions about neutral scenarios (e.g., walking a dog in the park) and their intuitions about negatively valenced scenarios (e.g., murdering a stranger), and (d) the difference (...) between people’s intuitions about free will and responsibility in response to first-person scenarios and third-person scenarios. We predicted that once we focused participants’ attention on the two different abilities to do otherwise available to agents in indeterministic and deterministic scenarios, their intuitions would support natural incompatibilism—the view that laypersons judge that free will and moral responsibility are incompatible with determinism. This prediction was borne out by our findings. (shrink)

This paper defends “Animal Universalism,” the thesis that all sentient non-human animals will be brought into Heaven and remain there for eternity. It assumes that God exists and is all-powerful, perfectly loving, and perfectly just. From these background theses, the authors argue that Animal Universalism follows. If God is perfectly loving, then God is concerned about the well-being of non-human animals, and God chooses to maximize the well-being of each individual animal when doing so does not harm other individual creatures (...) or violate creaturely freedom. If God is perfectly just, then God does not arbitrarily discriminate against non-human animals by offering humans an opportunity to enter Heaven but not offering the same to each animal. Each of these conclusions implies Animal Universalism. (shrink)

Much of the literature from political psychology has focused on the negative traits that are positively associated with affective polarization—e.g., animus, arrogance, distrust, hostility, and outrage. Not as much attention has been focused on the positive traits that might be negatively associated with polarization. For instance, given that people who are intellectually humble display greater openness and less hostility towards conflicting viewpoints (Krumrei-Mancuso & Rouse, 2016; Hopkin et al., 2014; Porter & Schumann, 2018), one might reasonably expect them to be (...) less polarized. -/- We ran two studies designed to explore the relationship between various forms of humility and polarization. Our chief finding is that people who value humility are prone to what we are calling epistemic polarization—that is, judging the epistemic traits of contrapartisans negatively—which in turn plays a role in polarization more generally. Not only are contrapartisans deemed to have the wrong moral and political beliefs, they are also viewed as less humble and more arrogant, close-minded, and irrational. This makes matters even worse when it comes to the growing partisan divide. In light of our findings, we believe that the novel concept of epistemic polarization that we introduce is a promising target for further investigation. (shrink)

Letters commenting on Hardwig, J "Is There a Duty to Die?" with a reply to those letters by the author.

Rare diseases pose a particular priority setting problem. The UK gives rare diseases special priority in healthcare priority setting. Effectively, the National Health Service is willing to pay much more to gain a quality-adjusted life-year related to a very rare disease than one related to a more common condition. But should rare diseases receive priority in the allocation of scarce healthcare resources? This article develops and evaluates four arguments in favour of such a priority. These pertain to public values, (...) luck egalitarian distributive justice the epistemic difficulties of obtaining knowledge about rare diseases and the incentives created by a higher willingness to pay. The first is at odds with our knowledge regarding popular opinion. The three other arguments may provide a reason to fund rare diseases generously. However, they are either overinclusive because they would also justify funding for many non-rare diseases or underinclusive in the sense of justifying priority for only some rare diseases. The arguments thus fail to provide a justification that tracks rareness as such. There are no data in this work. (shrink)

Technological developments have resulted in tremendous increases in the volume and diversity of the data and information that must be processed in the course of biomedical and clinical research and practice. Researchers are at the same time under ever greater pressure to share data and to take steps to ensure that data resources are interoperable. The use of ontologies to annotate data has proven successful in supporting these goals and in providing new possibilities for the automated processing of data and (...) information. In this chapter, we describe different types of vocabulary resources and emphasize those features of formal ontologies that make them most useful for computational applications. We describe current uses of ontologies and discuss future goals for ontology-based computing, focusing on its use in the field of infectious diseases. We review the largest and most widely used vocabulary resources relevant to the study of infectious diseases and conclude with a description of the Infectious Disease Ontology (IDO) suite of interoperable ontology modules that together cover the entire infectious disease domain. (shrink)

There are many eye diseases but the most two common retinal diseases are Age-Related Macular Degeneration (AMD), which the sharp, central vision and a leading cause of vision loss among people age 50 and older, there are two types of AMD are wet AMD and DRUSEN. Diabetic Macular Edema (DME), which is a complication of diabetes caused by fluid accumulation in the macula that can affect the fovea. If it is left untreated it may cause vision loss. Therefore, early detection (...) of diseases is a critical importance. Our main goal is to help doctors detect these diseases quickly before reaching a late stage of the disease. In ophthalmology, optical coherence tomography (OCT) is critical for evaluating retinal conditions. OCT is an imaging technique used to capture high-resolution cross-sections of the retinas of patient. In this thesis, we review ways and techniques to use deep learning classification of the optical coherence tomography images of diseases from which a Retinal is suffering. The models used to improve patient care are (VGG-16, MobileNet, ResNet-50, Inception V3, and Xception) to reduce costs and allow fast and reliable analysis in large studies. The obtained results are encouraging, since the best model ResNet-50 reaching 96.21% of testing accuracy, which is very useful for doctors, to diagnose retinal diseases. (shrink)

We introduce what we call the Emergent Model of forgiving, which is a process-based relational model conceptualizing forgiving as moral and normative repair in the wake of grave wrongs. In cases of grave wrongs, which shatter the victim’s life, the Classical Model of transactional forgiveness falls short of illuminating how genuine forgiveness can be achieved. In a climate of persistent threat and distrust, expressions of remorse, rituals and gestures of apology, and acts of reparation are unable to secure (...) the moral confidence and trust required for moral repair, much less for forgiveness. Without the rudiments of a shared moral world — a world in which, at the very least, the survivor’s violation can be collectively recognized as a violation, and her moral status and authority collectively acknowledged and respected — expressions of remorse, gestures and rituals of apology, or promises of compensation have no authority as meaningful communicative acts with reparative significance. Accordingly, we argue that repair in the wake of traumatic violence involves ‘world-building,’ which supports the ability of survivors to move from despair to hope, from radical and disabling distrust to trust and engagement, and thus from impotence to effective agency. Our Emergent Model treats forgiveness as a slowly developing outcome of a series of changes in a person’s relationship to the trauma and its aftermath, in which moral agency is regained. We argue that forgiveness after grave wrongs and world-shattering harm, when it occurs, emerges from other phenomena, such as cohabitation within a community, gestures of reconciliation, working on shared projects, the developing of trust. On this view, forgiveness is an emergent phenomenon; it entails taking and exercising normative power—coming to claim one’s own moral authority in relation to oneself, one’s assailant, and one’s community. The processes that ultimately constitute forgiving are part and parcel of normative repair more broadly construed. (shrink)

Debates about the genuine disease status of controversial diseases rely on intuitions about a range of factors. Adopting tools from experimental philosophy, this paper explores some of the factors that influence judgments about whether low sexual desire should be considered a disease and whether it should be medically treated. Drawing in part on some assumptions underpinning a divide in the literature between viewing low sexual desire as a genuine disease and seeing it as improperly medicalized, we investigate (...) whether health and disease judgments are affected by factors such as an individual’s gender, the cause of the low desire, whether the desire is high or low, and both personal and societal valuations of the condition. Our main findings indicate that (a) the cause of a condition influences whether it is judged a disorder, (b) how the individual values the condition influences whether the condition is seen as a proper target of medical intervention, and (c) perceived dysfunction influences judgments regarding health, disorder classification, medicalization, and medical intervention. Our findings help further illuminate the intricate interplay of factors that influence judgments about health and disease in controversial conditions. (shrink)

The Neurological Disease Ontology (ND) is being developed to provide a comprehensive framework for the representation of neurological diseases (Diehl et al., 2013). ND utilizes the model established by the Ontology for General Medical Science (OGMS) for the representation of entities in medicine and disease (Scheuermann et al., 2009). The goal of ND is to include information for each disease concerning its molecular, genetic, and environmental origins, the processes involved in its etiology and realization, as well as (...) its clinical presentation including signs and symptoms. (shrink)

Our goal in this paper is to articulate a precise concept of at least a certain kind of disease-mongering, showing how pharmaceutical marketing can commercially exploit certain diseases when their best definition is given through the success of a treatment in a clinical trial. We distinguish two types of disease-mongering according to the way they exploit the definition of the trial population for marketing purposes. We argue that behind these two forms of disease-mongering there are two well-known (...) problems in the statistical methodology of clinical trials (the reference class problem and the distinction between statistical and clinical significance). Overcoming them is far from simple. (shrink)

Abstract: Heart diseases are increasing daily at a rapid rate and it is alarming and vital to predict heart diseases early. The diagnosis of heart diseases is a challenging task i.e. it must be done accurately and proficiently. The aim of this study is to determine which patient is more likely to have heart disease based on a number of medical features. We organized a heart disease prediction model to identify whether the person is likely to be diagnosed (...) with a heart disease or not using the medical features of the person. We used many different algorithms of machine learning such as Gaussian Mixture, Nearest Centroid, MultinomialNB, Logistic RegressionCV, Linear SVC, Linear Discriminant Analysis, SGD Classifier, Extra Tree Classifier, Calibrated ClassifierCV, Quadratic Discriminant Analysis, GaussianNB, Random Forest Classifier, ComplementNB, MLP Classifier, BernoulliNB, Bagging Classifier, LGBM Classifier, Ada Boost Classifier, K Neighbors Classifier, Logistic Regression, Gradient Boosting Classifier, Decision Tree Classifier, and Deep Learning to predict and classify the patient with heart disease. A quite helpful approach was used to regulate how the model can be used to improve the accuracy of prediction of heart diseases in any person. The strength of the proposed model was very satisfying and was able to predict evidence of having a heart disease in a particular person by using Deep Learning and Random Forest Classifier which showed a good accuracy in comparison to the other used classifiers. The proposed heart disease prediction model will enhances medical care and reduces the cost. This study gives us significant knowledge that can help us predict the person with heart disease. The dataset was collected from Kaggle depository and the model is implemented using python. (shrink)

In the contemporary biomedical literature, every disease is considered genetic. This extension of the concept of genetic disease is usually interpreted either in a trivial or genocentrist sense, but it is never taken seriously as the expression of a genetic theory of disease. However, a group of French researchers defend the idea of a genetic theory of infectious diseases. By identifying four common genetic mechanisms (Mendelian predisposition to multiple infections, Mendelian predisposition to one infection, and major gene (...) and polygenic predispositions), they attempt to unify infectious diseases from a genetic point of view. In this article, I analyze this explicit example of a genetic theory, which relies on mechanisms and is applied only to a specific category of diseases, what we call “a regional genetic theory.” I have three aims: to prove that a genetic theory of disease can be devoid of genocentrism, to consider the possibility of a genetic theory applied to every disease, and to introduce two hypotheses about the form that such a genetic theory could take by distinguishing between a genetic theory of diseases and a genetic theory of Disease. Finally, I suggest that network medicine could be an interesting framework for a genetic theory of Disease. (shrink)

Response to commentary. We are grateful to Crockett and Craigie for their interesting remarks on our paper. We accept Crockett’s claim that there is a need for caution in drawing inferences about patient groups from work on healthy volunteers in the laboratory. However, we believe that the evidence we cited established a strong presumption that many of the patients who are routinely taking a medication, including many people properly prescribed the medication for a medical condition, have morally significant aspects of (...) their cognition and behavior modified in a way that is unintended and may sometimes be unwelcome. Crockett notes that in some cases the effects of long-term drug use may differ, sometimes markedly, from the effects of short-term use. However, if acute use of a drug affects a neural system involved in mediating moral cognition or behavior, this nevertheless provides some evidence that chronic use of the drug may affect that same system and thus have morally significant effects. It is also plausible, in some cases, that an acute moral effect would give rise to a chronic moral effect via cognitive mechanisms. ... (shrink)

Brain-related diseases are among the most difficult diseases due to their sensitivity, the difficulty of performing operations, and their high costs. In contrast, the operation is not necessary to succeed, as the results of the operation may be unsuccessful. One of the most common diseases that affect the brain is Alzheimer’s disease, which affects adults, a disease that leads to memory loss and forgetting information in varying degrees. According to the condition of each patient. For these reasons, it (...) is important to classify memory loss and to know the patient at what level and his assessment of Alzheimer's disease through CT scans of the brain. In this thesis, we review ways and techniques to use deep learning classification to classifying the Alzheimer's Disease The proposed method used to improve patient care, reduce costs, and allow fast and reliable analysis in large studies. The model will be designed using Python language for implementing the system, which is very useful for doctors, classifying the Alzheimer's Disease, was used. The model used 70% from image for training and 30% from image for validation, our trained model achieved an accuracy of 100% on a held-out test set. (shrink)

Some ‘naturalist’ accounts of disease employ a biostatistical account of dysfunction, whilst others use a ‘selected effect’ account. Several recent authors have argued that the biostatistical account offers the best hope for a naturalist account of disease. We show that the selected effect account survives the criticisms levelled by these authors relatively unscathed, and has significant advantages over the BST. Moreover, unlike the BST, it has a strong theoretical rationale and can provide substantive reasons to decide difficult cases. (...) This is illustrated by showing how life-history theory clarifies the status of so-called diseases of old age. The selected effect account of function deserves a more prominent place in the philosophy of medicine than it currently occupies. _1_ Introduction _2_ Biostatistical and Selected Effect Accounts of Function _3_ Objections to the Selected Effect Account _3.1_ Boorse _3.2_ Kingma _3.3_ Hausman _3.4_ Murphy and Woolfolk _4_ Problems for the Biostatistical Account _4.1_ Schwartz _5_ Analysis versus Explication _6_ Explicating Dysfunction: Life History Theory and Senescence _7_ Conclusion. (shrink)

On 11 March 2020, the World Health Organization declared a pandemic of the COVID-19 coronavirus disease that was first recognized in China in late 2019. Among the primary effects caused by the pandemic, there was the dissemination of health preventive measures such as physical distancing, travel restrictions, self-isolation, quarantines, and facility closures. This includes the global disruption of socio-economic systems including the postponement or cancellation of various public events (e.g., sporting, cultural, or religious), supply shortages and fears of the (...) same, schools and universities closure, evacuation of foreign citizens, a rise of unemployment, changes in the international aid schemes, misinformation, and incidents of discrimination toward people affected by or suspected of having the COVID-19 disease. The pandemic has brought to the fore unpreparedness in critical areas that require attention, amid prospects and challenges. Moreover, considerable reorganization efforts are required with implications for assets, resources, norms, and value systems. COVID-19 is challenging the concept of globalization and stimulating responses at the levels of local and regional socio-economic systems that lead to the mobilization of assets that have been unrecognized earlier on, such as various forms of economic capital, social capital, cultural capital, human capital, and creative capital. For example, through digital channels, local groups are forming to create schemes of support for physical and mental wellbeing. These emerging exchanges lead to various social and technological innovations by building on skills and assets that are less important in the free-market economy, such as empathy, skills for crafts, making and fixing; locally grown microgreens; and micromanufacturing. Isolation and local living are also making it much harder to ignore the civic responsibilities towards communities, meant as individuals, vulnerable groups, and local businesses. Whilst the pandemic is limiting physical participation, this challenging time is uncovering alternative ways of mutual support, which may create long-term benefits for socio-economic systems, including environmental and biodiversity protection, reduction of the air pollution, and climate action. The pandemic’s threat to public health will hopefully be overcome with implications for disruption for an extended period that we are unable to forecast at this stage. It is key to focus on studies recognizing the activities and interventions leading to the recovery of socio-economic systems after the pandemic. Reflecting and planning on how societies and economies will go back to “business as usual” requires new forms of communication and cooperation, imaginative design thinking, new styles of management, as well as new tools and forms of participation in various public policies. Many questions related to the care of the vulnerable, economic restart, and the risk of future pandemics, to mention but a few, are already occupying the academic, scientific, experts, and activist communities, who have started to imagine the “new normal.”. (shrink)

Cardiovascular diseases, including heart disease, pose a significant global health challenge, contributing to a substantial burden on healthcare systems and individuals. Early detection and accurate prediction of heart disease are crucial for timely intervention and improved patient outcomes. This research explores the potential of neural networks in predicting heart disease using a dataset collected from Kaggle, consisting of 1025 samples with 14 distinct features. The study's primary objective is to develop an effective neural network model for binary (...) classification, identifying the presence or absence of heart disease. The neural network architecture includes an input layer, a hidden layer, and an output layer, designed to capture intricate relationships within the dataset. Rigorous training and validation processes, accompanied by data preprocessing steps, ensure the model's robustness and generalization capabilities. The results demonstrate promising performance, with an accuracy of 92% and an average error of 0.062. Moreover, an analysis of feature importance highlights key predictors, including "oldpeak," "thalach," "trestbps," "ca," "thal," "cp," "chol," "sex," "restecg," "age," "slope," "fbs," and "exang." This research contributes to the field of predictive healthcare by leveraging neural networks to enhance heart disease prediction. The developed model offers the potential for early identification of individuals at risk, facilitating timely medical interventions and ultimately improving public health. Further exploration of machine learning techniques in healthcare promises to reshape disease prediction and prevention strategies. (shrink)

In this paper, we identify some key features of what makes something a disease, and consider whether these apply to pregnancy. We argue that there are some compelling grounds for regarding pregnancy as a disease. Like a disease, pregnancy affects the health of the pregnant person, causing a range of symptoms from discomfort to death. Like a disease, pregnancy can be treated medically. Like a disease, pregnancy is caused by a pathogen, an external organism invading (...) the host’s body. Like a disease, the risk of getting pregnant can be reduced by using prophylactic measures. We address the question of whether the ‘normality’ of pregnancy, its current necessity for human survival, or the value often attached to it are reasons to reject the view that pregnancy is a disease. We point out that applying theories of disease to the case of pregnancy, can in many cases illuminate inconsistencies and problems within these theories. Finally, we show that it is difficult to find one theory of disease that captures all paradigm cases of diseases, while convincingly excluding pregnancy. We conclude that there are both normative and pragmatic reasons to consider pregnancy a disease. (shrink)

Artificial Intelligence (AI) technologies are now widely used in a variety of fields to aid with knowledge acquisition and decision-making. Health information systems, in particular, can gain the most from AI advantages. Recently, symptoms-based illness prediction research and manufacturing have grown in popularity in the healthcare business. Several scholars and organisations have expressed an interest in applying contemporary computational tools to analyse and create novel approaches for rapidly and accurately predicting illnesses. In this study, we present a paradigm for assessing (...) the efficacy of combining Machine Learning (ML) and Natural Language Processing (NLP) technologies in a disease prediction system. We scraped a disease-symptom dataset with NLP characteristics from one of the UK's most trusted National Health Service (NHS) websites as an example. In addition, we will thoroughly examine our data using symptom frequency, similarity, and clustering analysis. As a consequence, we can observe that the forecast has a high efficiency rate, but there are still some challenges to work out. (shrink)

There is no doubt that custard apple diseases are among the important reasons that destroy the Custard Apple plant and its agricultural crops. This leads to obvious damage to these plants and they become inedible. Discovering these diseases is a good step to provide the appropriate and correct treatment. Determining the treatment with high accuracy depends on the method used to correctly diagnose the disease, expert systems can greatly help in avoiding damage to these plants. The expert system correctly (...) diagnoses Custard Apple disease to make it easier for farmers to find the right treatment based on the appropriate diagnosis. Objectives: A specialized syllable language system was established for the diagnosis of Custard Apple plant disease. (shrink)

Parkinson's Disease (PD) is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms generally come on slowly over time. Early in the disease, the most obvious are shaking, rigidity, slowness of movement, and difficulty with walking. Doctors do not know what causes it and finds difficulty in early diagnosing the presence of Parkinson’s disease. An artificial neural network system with back propagation algorithm is presented in this paper for helping (...) doctors in identifying PD. Previous research with regards to predict the presence of the PD has shown accuracy rates up to 93% [1]; however, accuracy of prediction for small classes is reduced. The proposed design of the neural network system causes a significant increase of robustness. It is also has shown that networks recognition rates reached 100%. (shrink)

Similarly to other accounts of disease, Christopher Boorse’s Biostatistical Theory (BST) is generally presented and considered as conceptual analysis, that is, as making claims about the meaning of currently used concepts. But conceptual analysis has been convincingly critiqued as relying on problematic assumptions about the existence, meaning, and use of concepts. Because of these problems, accounts of disease and health should be evaluated not as claims about current meaning, I argue, but instead as proposals about how to define (...) and use these terms in the future, a methodology suggested by Quine and Carnap. I begin this article by describing problems with conceptual analysis and advantages of “philosophical explication,” my favored approach. I then describe two attacks on the BST that also question the entire project of defining “disease.” Finally, I defend the BST as a philosophical explication by showing how it could define useful terms for medical science and ethics. (shrink)

This is a two page handout summarizing a number of objections made against Robert Graves's book of Greek myths.

The declaration of the COVID-19 pandemic by the World Health Organization on March 11, 2020, led to unprecedented events. All regions of the world participated in implementing preventive health measures such as physical distancing, travel restrictions, self-isolation, quarantines, and facility closures. The pandemic started global disruption of socio-economic systems, covering the postponement or cancellation of public events, supply shortages, schools and universities’ closure, evacuation of foreign citizens, a rise in unemployment and inflation, misinformation, the anti-vaccine movement, and incidents of discrimination (...) toward people affected by or suspected of having coronavirus disease. Attempts have been made to protect the oldest age group at risk, but in many cases, this has led to over-restriction and age discrimination. The rationale for working on the Research Topic "Socio-economic systems in the post-pandemic world: Design thinking, strategic planning, management, and public policy" was the need to start reflecting on resilience and lessons learned from this public health event that revealed the global unpreparedness in critical areas. Also, the pandemic triggered both top-down and bottom-up responses that needed more in-depth analyzes. This Research Topic covers interdisciplinary contributions addressing new thinking, challenges, and transformations required for post-pandemic global, national, regional, and local realities. The presented Research Topic combines studies focused on recognizing the actions and interventions leading to the recovery of socio-economic systems during the tail end and after the pandemic. The studies delivered recommendations regarding, among others, the care of vulnerable, planning socio-economic restart, and imagining the "new normal.". (shrink)

Claims about whether or not infertility is a disease are sometimes invoked to defend or criticize the provision of state-funded treatment for infertility. In this paper, I suggest that this strategy is problematic. By exploring infertility through key approaches to disease in the philosophy of medicine, I show that there are deep theoretical disagreements regarding what subtypes of infertility qualify as diseases. Given that infertility's disease status remains unclear, one cannot uncontroversially justify or undermine its claim to (...) medical treatment by claiming that it is or is not a disease. Instead of focusing on disease status, a preferable strategy to approach the debate about state-funded treatment is to explicitly address the specific ethical considerations raised by infertility. I show how this alternative strategy can be supported by a recent theoretical framework in the philosophy of medicine, which avoids the problems associated with the concepts of health and disease. (shrink)

We recently suggested that there are both pragmatic and normative reasons to classify pregnancy as a disease. Several scholars argued against our claims. In this response, we defend the disease view of pregnancy against their criticism. We claim that the dysfunctional account of disease that some of our critics rely on has some counterintuitive results. Furthermore, we claim that our critics assume what needs to be argued that the primary function of our sexual organs is to reproduce. (...) Since only a small percentage of sexual intercourse leads to pregnancy, it is far from obvious that reproduction is the primary biological function of our sexual organs. We also claim that while taking pregnancy itself as a reference class could avoid the conclusion that pregnancy is a disease, the strategy is problematic since it renders the Boorsean approach to disease and health circular and effectively deprives it of any utility in determining whether a particular phenomenon is a disease or not. (shrink)

Abstract: Alzheimer's disease (AD) is one of the most common types of dementia. Symptoms appear gradually and end with severe brain damage. People with Alzheimer's disease lose the abilities of knowledge, memory, language and learning. Recently, the classification and diagnosis of diseases using deep learning has emerged as an active topic covering a wide range of applications. This paper proposes examining abnormalities in brain structures and detecting cases of Alzheimer's disease especially in the early stages, using features (...) derived from medical images. The entire brain image was passed on through the transmission of Xception learning architectures. The Convolutional Neural Network (CNN) was constructed with the help of separable convolution layers that It can automatically learn general features from imaging data for classification. (shrink)

The Infectious Disease Ontology (IDO) is a suite of interoperable ontology modules that aims to provide coverage of all aspects of the infectious disease domain, including biomedical research, clinical care, and public health. IDO Core is designed to be a disease and pathogen neutral ontology, covering just those types of entities and relations that are relevant to infectious diseases generally. IDO Core is then extended by a collection of ontology modules focusing on specific diseases and pathogens. In (...) this paper we present applications of IDO Core within various areas of infectious disease research, together with an overview of all IDO extension ontologies and the methodology on the basis of which they are built. We also survey recent developments involving IDO, including the creation of IDO Virus; the Coronaviruses Infectious Disease Ontology (CIDO); and an extension of CIDO focused on COVID-19 (IDO-CovID-19).We also discuss how these ontologies might assist in information-driven efforts to deal with the ongoing COVID-19 pandemic, to accelerate data discovery in the early stages of future pandemics, and to promote reproducibility of infectious disease research. (shrink)

This paper addresses the use of dispositions in the Infectious Disease Ontology (IDO). IDO is an ontology constructed according to the principles of the Open Biomedical Ontology (OBO) Foundry and uses the Basic Formal Ontology (BFO) as an upper ontology. After providing a brief introduction to disposition types in BFO and IDO, we discuss three general techniques for representing combinations of dispositions under the headings blocking dispositions, complementary dispositions, and collective dispositions. Motivating examples for each combination of dispositions is (...) given along with a specific use case in IDO. Description logic restrictions are used to formalize statements relating to these combinations. (shrink)

In this article, I will reconstruct the monocausal model and argue that modern 'multifactorial diseases' are not monocausal by definition. 'Multifactorial diseases' are instead defined according to a constitutive disease model. On closer analysis, infectious diseases are also defined using the constitutive model rather than the monocausal model. As a result, our classification models alone cannot explain why infectious diseases have a universal etiology while chronic and noncommunicable diseases lack one. The explanation is instead provided by the nineteenth-century germ (...) theorists. (shrink)

Whipple disease is a rare, infectious, disease first described from a single case by Whipple in 1907. As well as characterising the clinical and pathological features of the condition, Whipple made two suggestions regarding its aetiology. These were either than the disease was caused by an infectious agent, or that it was of metabolic origin. As the disease is now thought to be caused by infection with the bacterium Tropheryma whipplei, historical reviews of the history of (...) the disease typically mention only the first of these suggestions. In this paper, we therefore revisit Whipple’s other theory. We argue that a diverse and often successful research programme was developed around this mechanism of disease causation which gave rise to many useful findings on the condition. In the later parts of this article, we then turn to discuss the surprising neglect of this period of Whipple disease research in the current literature, and conclude by offering a brief reconstruction of this early history suitable for use in a technical context. (shrink)

Deutsche Krankheit: eine Diagnosestellung mit Rückblick und Ausblick auf Krankheitsverlauf.

Background: The castor bean is a large grassy or semi-wooden shrub or small tree. Any part of the castor plant parts can suffering from a disease that weakens the ability to grow and eliminates its production. Therefore, in this paper will identify the pests and diseases present in castor culture and detect the symptoms in each disease. Also images is showing the symptom form in this disease. Objectives: The main objective of this expert system is to obtain (...) appropriate diagnosis of the disease. Methods: In this paper, the expert system is designed for the ability of agricultural engineers to detect and diagnose disease of castor like as: seeding blight, alternaria blight, cercospora leaf spot, powdery mildew and wilt. This system presents the disease symptoms, survival and spread, favorable conditions and image for each disease. Clips and Delphi expert system languages are used for designing and implementing the proposed expert system. Results: The expert system in the diagnosis of castor diseases was assessed by farmers and agricultural engineers and they were satisfied and accepted with its quality of performance. Conclusions: The expert system is easy for farmers and people have experience in the plant of castor to detect and diagnosis the symptoms that may face this plant from several disease. (shrink)

Last year saw the 20th anniversary edition of JECP, and in the introduction to the philosophy section of that landmark edition, we posed the question: apart from ethics, what is the role of philosophy ‘at the bedside’? The purpose of this question was not to downplay the significance of ethics to clinical practice. Rather, we raised it as part of a broader argument to the effect that ethical questions – about what we should do in any given situation – are (...) embedded within whole understandings of the situation, inseparable from our beliefs about what is the case, what it is that we feel we can claim to know, as well as the meaning we ascribe to different aspects of the situation or to our perception of it. Philosophy concerns fundamental questions: it is a discipline requiring us to examine the underlying assumptions we bring with us to our thinking about practical problems. Traditional academic philosophers divide their discipline into distinct areas that typically include logic: questions about meaning, truth and validity; ontology: questions about the nature of reality, what exists; epistemology: concerning knowledge; and ethics: how we should live and practice, the nature of value. Any credible attempt to analyse clinical reasoning will require us to think carefully about these types of question and the relationships between them, as they influence our thinking about specific situations and problems. So, the answers to the question we posed, about the role of philosophy at the bedside, are numerous and diverse, and that diversity is illustrated in the contributions to this thematic edition. (shrink)

Cardiovascular diseases (CVD) represent a significant cause of morbidity and mortality worldwide, necessitating early detection for effective intervention. This research explores the application of machine learning (ML) algorithms in predicting cardiovascular diseases with enhanced accuracy by integrating optimization techniques. By leveraging data-driven approaches, ML models can analyze vast datasets, identifying patterns and risk factors that traditional methods might overlook. This study focuses on implementing various ML algorithms, such as Decision Trees, Random Forest, Support Vector Machines, and Neural Networks, optimized through (...) techniques like hyperparameter tuning, cross-validation, and feature selection to improve prediction accuracy. (shrink)

Background: There is no doubt that strawberry diseases are one of the most important reasons that led to the destruction of strawberry plants and their crops. This leads to obvious damage to these plants and they become inedible. Discovering these diseases after a good step for proper and correct treatment. Determining the treatment with high accuracy depends on the method used in the diagnosis. Correctly, expert systems can greatly help in avoiding damage to these plants. The expert system correctly diagnoses (...) strawberry disease to make it easier for farmers to find the right treatment based on the appropriate diagnosis. Objectives: The main goal of this expert system is to get the appropriate diagnosis of disease and the correct treatment. Methods: In this paper the design of the proposed Expert System which was produced to help Farmers and students interested in agriculture strawberry in diagnosing many of the strawberry diseases such as: Leaf Spots, Grey Mold, Red Stele/Red Core, Wilt, Powdery Mildew, Alternaria Spot, Black Root Rot, Anthracnose (black spot), and Angular Leaf Spot. The proposed expert system presents an overview about strawberry diseases are given, the cause of diseases are outlined and the treatment of disease whenever possible is given out. CLIPS language was used for designing and implementing the proposed expert system. Results: The proposed strawberry diseases diagnosis expert system was evaluated by Farmers and they were satisfied with its performance. Conclusions: The Proposed expert system is very useful for Farmers with strawberry problem and students interested in agriculture strawberry. (shrink)

The highly contagious 2019 novel coronavirus disease (COVID-19) outbreak has not only impacted health systems, economies, and governments, it has also rapidly grown into a global health crisis, which is now threatening the lives of millions of people globally. While, on one hand, medical institutions are critically attempting to find a cure, on the other hand, governments have introduced striking measures and policies to curtail the rapid spread of the disease. Although COVID-19 has achieved pandemic status and is (...) predominantly viewed as a biomedical issue, it is argued that it should also be treated as a psychological crisis. This paper also reviews the literature to examine and comment on the detrimental effects of isolation, which has been enforced as one of the primary preventative measures to manage the spread of COVID-19. This paper further outlines key recommendations that should be addressed across different levels to buffer against the known adverse effects of isolation, which is especially relevant for the current COVID-19 situation, where a large proportion of the global population is isolated, confined, and/or quarantined. (shrink)