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

Does DBS change a patient’s personality? This is one of the central questions in the debate on the ethics of treatment with Deep Brain Stimulation (DBS). At the moment, however, this important debate is hampered by the fact that there is relatively little data available concerning what patients actually experience following DBS treatment. There are a few qualitative studies with patients with Parkinson’s disease and Primary Dystonia and some case reports, but there has been no qualitative study (...) yet with patients suffering from psychiatric disorders. In this paper, we present the experiences of 18 patients with Obsessive-Compulsive Disorder (OCD) who are undergoing treatment with DBS. We will also discuss the inherent difficulties of how to define and assess changes in personality, in particular for patients with psychiatric disorders. We end with a discussion of the data and how these shed new light on the conceptual debate about how to define personality. (shrink)

People suffering from Obsessive-Compulsive Disorder (OCD) do things they do not want to do, and/or they think things they do not want to think. In about 10 percent of OCD patients, none of the available treatment options is effective. A small group of these patients is currently being treated with deep brain stimulation (DBS). Deep brain stimulation involves the implantation of electrodes in the brain. These electrodes give a continuous electrical pulse to the brain area in which they (...) are implanted. It turns out that patients may experience profound changes as a result of DBS treatment. It is not just the symptoms that change; patients rather seem to experience a different way of being in the world. These global effects are insufficiently captured by traditional psychiatric scales, which mainly consist of behavioural measures of the severity of the symptoms. In this article we aim to capture the changes in the patients’ phenomenology and make sense of the broad range of changes they report. For that we introduce an enactive, affordance-based model that fleshes out the dynamic interactions between person and world in four aspects. The first aspect is the patients’ experience of the world. We propose to specify the patients’ world in terms of a field of affordances, with the three dimensions of broadness of scope (‘width’ of the field), temporal horizon (‘depth’), and relevance of the perceived affordances (‘height’). The second aspect is the person-side of the interaction, that is, the patients’ self-experience, notably their moods and feelings. Thirdly, we point to the different characteristics of the way in which patients relate to the world. And lastly, the existential stance refers to the stance that patients take towards the changes they experience: the second-order evaluative relation to their interactions and themselves. With our model we intend to specify the notion of being in the world in order to do justice to the phenomenological effects of DBS treatment. (shrink)

This commentary defends 3 arguments for changing the label of levonorgestrel-based emergency contraception (LNG EC) so that it no longer supports the possibility of a mechanism of action after fertilization. First, there is no direct scientific evidence confirming any postfertilization mechanisms. Second, despite the weight of evidence, there is still widespread public misunderstanding over the mechanism of LNG EC. Third, this FDA label is not a value-free claim, but instead it has functioned like a political tool for reducing contraceptive (...) access. The label is laden with antiabortion values (even though EC is contraception, not abortion), and it imposes these values on potential users, resulting in barriers to access such as with Burwell v. Hobby Lobby. These 3 arguments together provide scientific, social, and ethical grounds for the FDA to take the initiate in changing Plan B's drug label. (shrink)

Different sort of people are interested in personal identity. Philosophers frequently ask what it takes to remain oneself. Caregivers imagine their patients’ experience. But both philosophers and caregivers think from the armchair: they can only make assumptions about what it would be like to wake up with massive bodily changes. Patients with a locked-in syndrome (LIS) suffer a full body paralysis without cognitive impairment. They can tell us what it is like. Forty-four chronic LIS patients and 20 (...) age-matched healthy medical professionals answered a 15-items questionnaire targeting: (A) global evaluation of identity, (B) body representation and (C) experienced meaning in life. In patients, selfreported identity was correlated with B and C. Patients differed with controls in C. These results suggest that the paralyzed body remains a strong component of patients’ experienced identity, that patients can adjust to objectives changes perceived as meaningful and that caregivers fail in predicting patients’ experience. (shrink)

“I am still in despair over losing my identity,” said a blog comment in a discussion about post-menopause weight gain. Instead of recovering an identity, for some of us, as women age, our attitudes toward fitness may require forging new identities. But the challenge in coming to desire fitness, post-menopause, is a project of actually changing my desires. Habituating a good practice can lead to a change in our appetites, so that instead of losing our identities, we may (...) become the characters that we set goals to be. (shrink)

Lippert-Rasmussen and Petersen discuss my ‘Moral case for legal age change’ in their article ‘Age change, official age and fairness in health’. They argue that in important healthcare settings (such as distributing vital organs for dying patients), the state should treat people on the basis of their chronological age because chronological age is a better proxy for what matters from the point of view of justice than adjusted official age. While adjusted legal age should not be used (...) in deciding who gets scarce vital organs, I remind the readers that using chronological age as a proxy is problematic as well. Using age as a proxy could give wrong results and it is better, if possible, for states to use the vital information directly than use age as a proxy. (shrink)

This paper critically examines Japan's approach toward the adoption of Generative AI such as ChatGPT in education via studying media discourse and guidelines at both the national as well as local levels. It highlights the lack of consideration for socio-cultural characteristics inherent in the Japanese educational systems, such as the notion of self, teachers’ work ethics, community-centric activities for the successful adoption of the technology. We reveal ChatGPT’s infusion is likely to further accelerate the shift away from traditional notion (...) of self, which has been ongoing during past educational reforms, towards active and self-directed learning. The current discourse on Generative AI’s infusion in education is driven by neoliberal agendas aimed at increasing employability and individualism. Moreover, the introduction of ChatGPT in the context of Japan's educator culture offers potential solutions to address issues of overwork but also necessitates considerations regarding increased responsibilities for teachers and the preservation of their central role in student education. Finally, the irreplicable social growth fostered by community-centric activities in the Japanese educational system highlights the limitations of ChatGPT in replicating dynamic social interactions, emphasizing the importance of holistic approaches to education beyond technological integration. (shrink)

Objective: This study aimed to investigate and compare the effects of tubular gastroesophageal anastomosis and traditional gastroesophageal supra-arch anastomosis on the postoperative lung function of patients with esophageal carcinoma. -/- Methods: A total of 90 patients with middle-lower segmental esophageal cancer admitted in our hospital from August 2014 to August 2016 were recruited to our study. They were randomly divided into two groups. The observation group underwent tubular gastroesophageal anastomosis, whereas the control group underwent traditional gastroesophageal supra-arch anastomosis. (...) Changes in the postoperative pulmonary function were compared between the two groups. -/- Results: The numbers of CD4 cells (27.45 ± 5.48), CD8 cells (35.97 ± 7.16), and natural killer cells (20.79 ± 2.49), as well as the CH4/CD8 ratio (0.69 ± 0.18), of the patients in the observation group were significantly higher than the (38.45 ± 5.98), (20.45 ± 6.41), (39.44 ± 3.49), and (1.31 ± 0.48), respectively, of the patients in the control group. The differences between the two groups were statistically significant (P<0.05). By contrast, the preoperative forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and maximum voluntary ventilation (MVV) did not significantly differ between the two groups (P>0.05). The FEV1 (1.76 ± 0.41 L), FVC (2.33 ± 0.32 L), and MVV (33.7 ± 5.2 L/min) of the observation group were significantly higher than those of the control group (P<0.05). Meanwhile, the complication rate of the observation group was 42.2%, which was significantly lower than that of the control group (75.6%) (P<0.05). -/- Conclusion: Tubular gastroesophageal anastomosis can benefit patients with esophageal cancer by significantly reducing the adverse effects on their postoperative pulmonary function and control the occurrence of postoperative complications. (shrink)

About death, grief, mourning, life after death and immortality. Why should we die like humans to survive as a species. -/- "No one wants to die. Even people who want to go to heaven don't want to die to get there. And yet death is the destination we all share. No one has ever escaped it. And that is as it should be, because Death is very likely the single best invention of Life. It is Life's change agent. It (...) clears out the old to make way for the new." (Steve Jobs) -/- CONTENTS: -/- Death - Philosophy of death - Religions - - Animism - - Atheism - - Buddhism - - Christianity - - Hinduism - - Islam - - Jainism - - Jehovah's Witnesses - - Judaism - - Latter-day Saints - - Spiritism - Symbolism - Personification of Death - - Notable personifications - - In mythologies - - - Hindu mythology - - - In Japan - - - Slavic paganism - - - Lithuanian paganism - - In the three monotheistic religions - - - Judaism - - - Christianity - - - In Mexico - - - Islam - Axiochos - - The characters of dialogue - - Dialogue - - Prologue - - Arguments - - Citations - Paradise - - Greco-Roman mythology - - Mesopotamian mythology and influences - - According to Judaism - - According to Christianity - - - According to Catholicism - - - According to Protestantism - - - According to the Church of Jesus Christ of Latter-day Saints - - According to Islam - - According to Hinduism - - According to modern spiritualities - - - According to the esoteric - Hell - - Mesopotamian origins - - According to Christianity - - - Names appearing in the biblical texts - - - Medieval artistic representations - - - Concepts according to Christian movements - - According to Judaism - - According to Islam - - According to Buddhism - - According to Hinduism - - According to modern esotericism - - - According to Aïvanhov - - - According to Allan Kardec - - Philosophy - - - Jewish Kabbalah - - - Sartre - - - Popular wisdom Funerals - The funeral ritual: a rite of passage - Prehistory - Ancient death customs - - The family bereavement - - Mummification - - Sarcophagi - - Funerals - - Ancient Greece - - Ancient Rome - - Celts, Germans and Scandinavians - Religious funeral rites - - Buddhism - - Judaism - Christianity - - Protestantism - - Islam - Funeral rites by continent - - In Africa - - In Europe - The contemporary era - Mourning (Grief) - - Steps - - - Death of a close - - Loss events without mourning value (white factors) - - Duration and manifestations - - Risks - - Colors - Graveyards (Cemeteries) - - First cemeteries - - Cemeteries today - Funerary art - Dolmens - - Types of dolmens - - Function - - Location - Passage graves - Cenotaphs - - Famous cenotaphs - Lanterns of the Dead Afterlife - History - Questions about death and immortality - Testimonials - - Spiritualistic experiences - - Popular literature on the afterlife - - "Memories" and reminiscences - - Early studies of the science of the 19th century and early 20th century - Types of scenarios - Some religious and philosophical concepts - - Afterlife in Buddhism - - Afterlife in Christianity - - According to Hinduism - - According to Islam - - According to Judaism - - According to Mormonism - - According to the ancient philosophies - - According to Spiritism - - According to Native American traditions - - According to Vedism - - According to Esotericism - In science - Near-death experiences - - Clinical death - - NDE frequency - - Effects of depth of NDE on survival - - Near-death experiences and shared-death experience - - - The first contemporary testimonials - - - Experience according to Moody - - - The concept of "shared death" - - - The NDE scales - - The study of Pim van Lommel - - Spiritual and patient point of view - - - Survivalists studies - - - The religious understanding of the phenomenon - - Scientific views - - - Physiological explanation - - - Psychological explanation - Reincarnation - - Religions - - - In Hinduism - - - In Jainism - - - In Buddhism - - - In Judaism - - - In Christianity - - - In Islam - - In contemporary times - - - Esotericism - - - Works of the psychiatrist Ian Stevenson - - - Radical increase in life expectancy and artificial reincarnation - - Criticism - - - Arthur Schopenhauer - - - Ramana Maharshi - - - Rene Guenon - - - Ananda Kentish Coomaraswamy - Metempsychosis - - Theories - - Ideas - Maschalismos Immortality - Immortality of the soul and religious traditions - - Buddhism - - Christianity - - Islam - - Mormonism - Contemporary perception of the immortality of the body - - Observation in the animal kingdom - - Perspectives for mankind - Immortality in science - - Alexis Carrel - - Jean Rostand - - Hayflick limit - - Étienne-Émile Baulieu and DHEA - - Aubrey de Grey - - Professor Skulachev - - Regenerative medicine - - Professor Christopher Jaeger - Eternal Return - - According to the Mesopotamians - - According to Heraclitus and the Stoics - Fountain of Youth - - History of myth and relatives myths - - - In Roman mythology, Germanic, Celtic and Irish - - - In the Middle-East - - - In Spain - - - In the Bible - - The fountain in art and literature - - Painting - - - Literature and cinema - - Persistent of the myth until today - Senescence - - Why do we age? - - Gene regulation - - Cellular senescence Undead - Ghoul - Lich - Mummy - Skeleton - Vampire - Zombie - Other legendary creatures - Creatures specific to a particular universe - Spiritism - - Point out - - Origins of spiritism - - - The traditions through the ages - - - Advent of Christianity in Europe - - - The survival of necromancy - - - The precursors - - - Relations of spiritualism to science - Mediumship - - History - - Skeptical point of view - - Favorable doctor's viewpoint - Ghosts - - Appearance - - Belief in ghosts - - Origin - - - Duality and return dead - - - Ancient roots - - Typology - - - Poltergeists - - - Revenants - - - Ghosts - - - Banshees - - - Apparitions of crisis - - - Phantasms of the living - - - Vision of his own double - - - Ghost armies - - - Ghosts of animals - - - Means of transport - - Science perspective - - - Hallucinations - - - Sleep paralysis - - - Induced ghosts - - - Aches and infrasounds - - - Magnetic fields - Vampires - - Characteristics - - - Vampire transformation - - - Identification - - - Faculties - - Protection against the vampires - - - Precautions at death and burial - - - Apotropaic objects and places - - Destruction of vampires - Zombie - - The concept - - Africa and voodoo - - - West Africa - - - South Africa - - - In Haiti (and the Caribbean) - - - Scientific research - - The "revenants" in the Western imaginary Death in art - Memento mori - - History - - - Antiquity - - - Christianity - - - Mexican syncretism - - Performing arts - - - In painting - - - In literature - - - In movies - - - In video games - - - In Japanese animation - - - In music - The iconography of Weighing of souls (Particular judgment) - - Origin - - Written sources - - Weighing in Romanesque art - - Weighing in Gothic art - - Weighing in the late Middle Ages: to a new iconography - - Weighing of souls or actions? - Poems - - Charlotte Brontë, “On the Death of Anne Brontë” - - Edgar Allan Poe, “Annabel Lee” - - Edna St. Vincent Millay, “And you as well must die” - - Emily Dickinson, “Because I could not stop for Death” - - Emily Dickinson, “If I Should Die” - - Lord Byron, “Epitaph to a Dog” - - Pablo Neruda, “Only Death” - - Stephen Crane, “God Lay Dead in Heaven” - - W. B. Yeats, “He Wishes His Beloved Were Dead” - - Rainer Maria Rilke, “Death” - Paintings - - The Three Dead Kings - - The Death of Nelson - - Beata Beatrix - Sculptures - - The Kiss of Death - - Background - - Imagery - - Angel of Grief - - Fallen Astronaut - Quotes References About the author - Nicolae Sfetcu - - By the same author - - Contact Publishing House - MultiMedia Publishing -/- DOI: 10.58679/TW44411. (shrink)

Both patients and clinicians frequently report problems around communicating and assessing pain. Patients express dissatisfaction with their doctors and doctors often find exchanges with chronic pain patients difficult and frustrating. This chapter thus asks how we could improve pain communication and thereby enhance outcomes for chronic pain patients. We argue that improving matters will require a better appreciation of the complex meaning of pain terms and of the variability and flexibility in how individuals think about pain. (...) We start by examining the various accounts of the meaning of pain terms that have been suggested within philosophy and suggest that, while each of the accounts captures something important about our use of pain terms, none is completely satisfactory. We propose that pain terms should be viewed as communicating complex meanings, which may change across different communicative contexts, and this in turn suggests that we should view our ordinary thought about pain as similarly complex. We then sketch what a view taking seriously this variability in meaning and thought might look like, which we call the “polyeidic” view. According to this view, individuals tacitly occupy divergent stances across a range of different dimensions of pain, with one agent, for instance, thinking of pain in a much more “bodycentric” kind of way, while another thinks of pain in a much more "mindcentric” way. The polyeidic view attempts to expand the multidimensionality recognised in, e.g., biopsychosocial models in two directions: first, it holds that the standard triumvirate— dividing sensory/cognitive/affective factors— needs to be enriched in order to capture important distinctions within the social and psychological dimensions. Second, the polyeidic view attempts to explain (at least in part) why modulation of experience by these social and psychological factors is possible in the first place. It does so by arguing that because the folk concept of pain is complex, different weightings of the different parts of the concept can modulate pain experience in a variety of ways. Finally, we argue that adopting a polyeidic approach to the meaning of pain would have a range of measurable clinical outcomes. (shrink)

Conflicts between morality and prudence are often thought to pose a special problem because the normativity of moral considerations derives from a distinctively moral point of view, while the normativity of prudential considerations derives from a distinctively prudential point of view, and there is no way to ‘put together’ the two points of view. I argue that talk of points of view is a red herring, and that for any ‘prumoral’ conflict there is some or other more comprehensive value – (...) often nameless – that accounts for the relative normative weight of conflicting moral and prudential considerations. The rational resolution of conflict is possible only in virtue of a more comprehensive value that includes the conflicting moral and prudential considerations as parts. (shrink)

On a ‘comparative’ conception of practical reasons, reasons are like ‘weights’ that can make an action more or less rational. Bernard Gert adopts instead a ‘toggle’ conception of practical reasons: something counts as a reason just in case it alone can make some or other otherwise irrational action rational. I suggest that Gert’s conception suffers from various defects, and that his motivation for adopting this conception – his central claim that actions can be rational without there being reasons for them (...) – does not require adoption of the toggle conception. The more intuitive comparative conception of reasons for action can accommodate the insight. (shrink)

The quantization error in a fixed-size Self-Organizing Map (SOM) with unsupervised winner-take-all learning has previously been used successfully to detect, in minimal computation time, highly meaningful changes across images in medical time series and in time series of satellite images. Here, the functional properties of the quantization error in SOM are explored further to show that the metric is capable of reliably discriminating between the finest differences in local contrast intensities and contrast signs. While this capability of the QE is (...) akin to functional characteristics of a specific class of retinal ganglion cells (the so-called Y-cells) in the visual systems of the primate and the cat, the sensitivity of the QE surpasses the capacity limits of human visual detection. Here, the quantization error in the SOM is found to reliably signal changes in contrast or colour when contrast information is removed from or added to the image, but not when the amount and relative weight of contrast information is constant and only the local spatial position of contrast elements in the pattern changes. While the RGB Mean reflects coarser changes in colour or contrast well enough, the SOM-QE is shown to outperform the RGB Mean in the detection of single-pixel changes in images with up to five million pixels. This could have important implications in the context of unsupervised image learning and computational building block approaches to large sets of image data (big data). (shrink)

Psychotherapy is effective. Since the 1970’s, meta-analyses, and meta-analyses of meta-analyses, have consistently shown a significant effect size for psychotherapeutic interventions when compared to no treatment or placebo treatments. This effectiveness is normally taken as a sign of the scientific legitimization of clinical psychotherapy. A significant problem, however, is that most psychotherapies appear to be equally effective. This poses a problem for specific psychotherapies: they may work, but likely not for the reasons that ground their theoretical explanations for their effectiveness. (...) A prominent explanation for the findings of common efficacy in psychotherapy is to postulate that all successful therapies work by altering maladaptive meanings and providing patients with new, more adaptive meanings. This paper argues that the ‘meaning view’ of psychological change is likely mistaken; psychological problems are not normally problems of meaning nor are they directly ameliorated by changes in meaning. This paper then outlines a skill-based explanation for the findings of the common efficacy of psychotherapy. (shrink)

In this paper, I defend the agent/patient distinction against critics who argue that causal interactions are symmetrical. Specifically, I argue that there is a widespread type of causal interaction between distinct entities, resulting in a type of ontological asymmetry that provides principled grounds for distinguishing agents from patients. The type of interaction where the asymmetry is found is when one of the entities undergoes a change in kind, structure, powers, or intrinsic properties as a result of the interaction (...) while the other does not. Interactions of this type are widespread in molecular biology and chemistry. I focus specifically on (i) the actions of enzymes on substrates and (ii) water molecules breaking the bonds of polarized molecules. Finally, I respond to objections by laying out and to a limited extent defending three commitments of my account: emergent entities and powers, realism about chemical kinds or structures, and the assumption of the agent/patient distinction in functional attributions in biology. (shrink)

Background: Multi Drug Therapy approved by WHO is the best treatment option for Leprosy. There is a significant decline of mortality and morbidity after the introduction of multi drug therapy. But the adverse effects causing changes in clinical and laboratory parameters to multi drug therapy are the main limiting obstacle for the treatment course completion. Objective: The aim of this study is to find out the effects on routine laboratory parameters including hematological and biochemical changes before, during and after the (...) treatment of multi drug therapy in leprosy. Methodology: A descriptive cohort hospital based study on 85 multi drug therapy treated leprosy patients using standard laboratory tools for routine investigations for 18 months. Results: During the one year multidrug treatment period, most of the routine laboratory parameters showed mild to moderate change from normal level during the first 3 months with gradual recovery in the following months. Complete blood count assessment revealed mild decline in Hb, PCV, MCH, MCHC, and moderate decline in WBC and Platelet count. A mild increase in liver function tests (Bilirubin, AST, ALT, Alkaline phosphatase) and renal function tests (S.Creatinine, b. Urea) was observed. A moderate decline in S. Sodium with mild increase in S. Potassium was found on investigating S. Electrolytes. Patients were fully recovered from all hemato-biochemical adverse effects after 6 months of completion of the multi drug therapy. Conclusion: Despite of mild to moderate hematological and biochemical adverse reactions with multi drug therapy, recovery was excellent after 6 months of completion of therapy. (shrink)

The present study collected a larger set of three-dimensional data on human crania from the Kofun period (as well as from previous periods, i.e., the Jomon and Yayoi periods) in the Japanese archipelago (AD 250 to around 700) than previous studies. Three-dimensional geometric morphometrics were employed to investigate human migration patterns in finer-grained phases. These results are consistent with those of previous studies, although some new patterns were discovered. These patterns were interpreted in terms of demic diffusion, archaeological findings, (...) and historical evidence. In particular, the present results suggest the presence of a gradual geological cline throughout the Kofun period, although the middle period did not display such a cline. This discrepancy might reflect social changes in the middle Kofun period, such as the construction of keyhole-shaped mounds in the peripheral regions. The present study implies that a broader investigation with a larger sample of human crania is essential to elucidating macro-level cultural evolutionary processes. (shrink)

Aim: The researcher studied how the teachers at Guangdong Business and Technology University manage change based on the present situation in the country. -/- Methodology: This study utilized the descriptive – comparative research design with 275 teachers as respondents. Statistical test of data includes frequency count and percentage, weighted mean, t- test and/or ANOVA. -/- Results: Teacher respondents are very much ready to manage the change for the teaching and learning based on teaching-related factors which ranked first, as (...) well as on teaching-related factors which ranked second, and on technology-related factors which ranked third. It is noticeable that technology-related factor was the least assessed factors as regards their readiness to manage the change. Generally, an over-all mean value of 3.52 reveals that teachers are very much ready to manage the change for the teaching and learning. Based on the result, teacher respondents strongly agree on their level of motivation on their teaching and learning performance. The result reveals that teachers are highly motivated in performing their job as teachers based on their own assessment. -/- Conclusion: Majority of the respondents are female teachers in middle age aiming to earn their doctoral degree and have been in the university for not more than five years. Teachers believed that they are very much ready to manage the change for the teaching and learning. They also seem to be less ready in terms of accessing professional development opportunities that focus on continuous improvement of digital-age teaching skills. The use of variety of assessment strategies applying the technology and the implementation of alternative strategies in the classroom seems to be less managed by the teachers. They also have relatively the same assessment on how ready they are to manage the change in the teaching and learning regardless of their sex, age, educational level they have attained, and the length of stay in the institution. (shrink)

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: -/- The main aim of this review will be to assess the effects of changing practitioner empathy or patient expectations for all conditions. The main objective is to conduct a systematic review of randomised trials where the intervention involves manipulating either (a) practitioner empathy or (b) patient expectations, or (c) both.

Background: The complexity of diagnostic presentations of an inpatient psychiatry population requires an integrative approach to health and well-being. In this sense, the primary need of this research aims at developing clinical strategies and healthier coping skills for anger, anxiety, and depression; promoting self-esteem, healthier sleep, and anxiety reduction; as well as enhancing mood and emotional–behavioral regulation via exercise and nutrition education. Objectives: The primary objective is to promote exercise, fitness, and physical health in inpatient psychiatry patients. The secondary (...) objective includes therapeutic management of depressive symptoms and patient-centered approach to mania, angry outbursts, and generalized disruptive behavior. The tertiary objective is promoting research in the psychophysiological effectors of exercise and nutrition education in combination with psychotherapy. Method: Monitoring self-reported changes in mood and general well-being via administration of surveys and questionnaires pre- and postexercise sessions. Results: The research yielded positive outcomes in all areas investigated, suggesting the positive effects of exercise and mind–body strategies in the context of psychotherapy in inpatient psychiatry. Conclusion: Physical exercise may be a helpful way to reduce mental health disorders in the context of inpatient psychiatry by targeting anxiety, depression, anger, psychomotor agitation, and muscle tension and addressing stressors and triggers and to develop a more balanced and integrated sense of self. (shrink)

Background: Arthritis is very common but is not well understood. Actually, “arthritis” is not a single disease; it is an informal way of referring to joint pain or joint disease. There are more than 100 different types of arthritis and related conditions. People of all ages, sexes and races can and do have arthritis, and it is the leading cause of disability in America. More than 50 million adults and 300,000 children have some type of arthritis. It is most common (...) among women and occurs more frequently as people get older. Common arthritis joint symptoms include swelling, pain, stiffness and decreased range of motion. Symptoms may come and go. They can be mild, moderate or severe. They may stay about the same for years, but may progress or get worse over time. Severe arthritis can result in chronic pain, inability to do daily activities and make it difficult to walk or climb stairs. Arthritis can cause permanent joint changes. These changes may be visible, such as knobby finger joints, but often the damage can only be seen on X-ray. Some types of arthritis also affect the heart, eyes, lungs, kidneys and skin as well as the joints. Objectives: The main goal of this expert system is to get the appropriate diagnosis of disease and the correct treatment and give the appropriate method of treatment through several tips that concern the disease and how to treat it and we will see it through the application on the expert system. Methods: in this paper the design of the proposed Expert System which was produced to help Orthopedist in diagnosing Arthritis disease through its symptoms such as: pain on pressure in a joint , Inflammation indicated by joint swelling, Stiffness especially in the morning , Loss of flexibility of joint, Limited, joint movement, Deformity of the joints , Weight loss and fatigue , Non-specific fever and Crepitus. The proposed expert system presents an overview about Arthritis disease is given, the cause of diseases is outlined and the treatment of disease whenever possible is given out. SL5 Object Expert System language was used for designing and implementing the proposed expert system. Results: The proposed Arthritis disease diagnosis expert system was evaluated by Orthopedics students and they were satisfied with its performance. Conclusions: The Proposed expert system is very useful for Orthopedist, patients with arthritis and newly graduated Orthopedics students. (shrink)

Nancy Jecker and Andrew Ko (2017) wish to present an account of personal identity which captures what matters to the patient and places the patient at the center of medical decisions. They focus particularly on medical interventions in the brain that can cause drastic changes in personality; under what circumstances should we say the patient has 'survived' these changes? More specifically, how can we best understand the notion of survival in a way that captures what is of concern to the (...) patient? This goal is laudable, however, their chosen account of narrative identity is ill-suited to this task for one reason in particular; it does not give sufficient guidance in predicting which medical decisions are likely to be experienced as disruptive to identity. (shrink)

Epileptogenesis involves an increase in excitatory synaptic strength in the brain in a manner similar to synaptic potentiation. In the present study we investigated the mechanisms of short-term synaptic potentiation in patients with focal epilepsy by using 5 Hz repetitive transcranial magnetic stimulation (rTMS), a non invasive neurophysiological technique able to investigate the mechanisms of synaptic plasticity in humans. Ten patients with focal idiopathic cortical epilepsy were studied. 5 Hz-rTMS (10 stimuli-trains, 120% of motor threshold, RMT) was delivered (...) over the first dorsal interosseus (FDI) motor area of both (affected and unaffected) hemispheres. Changes in the motor evoked potential (MEP) size in the FDI muscle during the trains and the RMT were measured and compared between the hemispheres. 5 Hz-rTMS was also delivered in a group of healthy subjects over both hemispheres. 5 Hz-rTMS in patients elicited a reduced MEP facilitation compared to normal subjects. The reduced MEP amplitude was more evident in the affected hemisphere than in the unaffected hemisphere. RMT in the affected hemisphere was higher than in the unaffected hemisphere and in healthy subjects. Our findings showing a decreased response to 5 Hz-rTMS over the affected hemisphere, differently from the expected results suggest a reduced cortical excitability in epileptic patients. We hypothesize an altered balance between excitatory and inhibitory circuits in epileptic patients under chronic therapy. (shrink)

Patient preference predictors aim to solve the moral problem of making treatment decisions on behalf of incapacitated patients. This commentary on a case of an unrepresented patient at the end of life considers 3 related problems of such predictors: the problem of restricting the scope of inputs to the models (the “scope” problem), the problem of weighing inputs against one another (the “weight” problem), and the problem of multiple reasonable solutions to the scope and weight problems (the (...) “multiple reasonable models” problem). Each of these problems poses challenges to reliably implementing patient preference predictors in important, high-stakes health care decision making. This commentary also suggests a way forward. (shrink)

The present study examines the 3-dimensional data of human crania from the Yayoi period (800 BC to AD 250) of the Japanese archipelago by geometric morphometrics to investigate demic diffusion patterns. This is the first study on the Yayoi crania using their 3D data and geometric morphometrics with a much larger number of skeletal remains outside of the Kyushu regions than previous studies. The comparative results between the Jōmon and Yayoi samples show that the Yayoi people not only in (...) the eastern parts but also in the western parts of the archipelago are significantly different from the final Jōmon people and the Yayoi people were not strongly affected by the Jōmon people. A relatively gradual geological cline is also found among the Yayoi population, suggesting that the immigrants from the continental East Asia moved from the western parts to the eastern parts of the archipelago though the causes of the morphological changes are unclear. (shrink)

Deep Brain Stimulation (DBS) is a relatively new, experimental treatment for patients suffering from treatment-refractory Obsessive Compulsive Disorder (OCD). The effects of treatment are typically assessed with psychopathological scales that measure the amount of symptoms. However, clinical experience indicates that the effects of DBS are not limited to symptoms only: patients for instance report changes in perception, feeling stronger and more confident, and doing things unreflectively. Our aim is to get a better overview of the whole variety of (...) changes that OCD patients experience during DBS treatment. For that purpose we conducted in-depth, semi-structured interviews with 18 OCD patients. In this paper, we present the results from this qualitative study.We list the changes grouped in four domains: with regard to (a) person, (b) (social) world, (c)characteristics of person-world interactions, and (d) existential stance. We subsequently provide an interpretation of these results. In particular, we suggest that many of these changes can be seen as different expressions of the same process; namely that the experience of anxiety and tension gives way to an increased basic trust and increased reliance on one’s abilities. We then discuss the clinical implications of our findings, especially with regard to properly informing patients of what they can expect from treatment, the usefulness of including CBT in treatment, and the limitations of current measures of treatment success. We end by making several concrete suggestions for further research. (shrink)

The aim of this paper is to provide a detailed characterisation of some ways in which our preferences reflect our reasons. I will argue that practical reasons can be characterised along two dimensions that influence our preferences: their balance and their weight. This is analogous to a similar characterisation of the way in which probabilities reflect the balance and weight of evidence in epistemology. In this paper, I will illustrate the distinction between the balance and weight of (...) reasons, and show how this is crucial for an adequate account of preference and choice. The upshot is a more complete picture of a particular kind of decision, labelled by Isaac Levi and, more recently, Ruth Chang as ‘hard choices’. These are choices in which one option is better than another in some ways, the other is better than the first in some ways, but neither seems better overall. The distinction between the balance and weight of reasons presents a new way of understanding how hard choices vary by degree and what it is that makes them so hard. (shrink)

The (moral) permissibility of an act is determined by the relative weights of reasons, or so I assume. But how many weights does a reason have? Weight Monism is the idea that reasons have a single weight value. There is just the weight of reasons. The simplest versions hold that the weight of each reason is either weightier than, less weighty than, or equal to every other reason. We’ll see that this simple view leads to paradox (...) in at least two ways. We must complicate the picture somehow. I consider two candidate complications. The first, Parity Monism, is inspired by Ruth Chang’s suggestion that parity is a fourth comparative beyond the traditional three (>, <, =). This view complicates the single weight relation by allowing that the weights of reasons can be on a par. Unfortunately, Parity Monism resolves only one of the two paradoxes that afflict simple versions of Weight Monism. To resolve both paradoxes, we need our second candidate complication, Weight Pluralism. This view holds that reasons have at least two weight values (e.g., justifying weight and requiring weight) and these two values aren’t always equivalent. Parity is no substitute for Pluralism. (shrink)

The study aimed to identify the relationship between correcting the deviations in the measurement of performance and achieving the objectives of control and the performance of the job at the Islamic University in the Gaza Strip. To achieve the objectives of the research, the researchers used the descriptive analytical approach to collect information. The questionnaire consisted of (20) statements distributed to three categories of employees of the Islamic University (senior management, faculty members, their assistants and members of the administrative board). (...) A random sample of 314 employees was selected and 276 responses were retrieved with a recovery rate of 88.1%. The Statistical Analysis Program (SPSS) was used to enter, process, and analyze the data. The results of the study showed a positive relationship between correcting deviations in performance measurement and achieving the control objectives represented by the functional performance in the Islamic University from the point of view of the members (senior management, faculty and their assistants, and the administrative board), where the relative weight of all the paragraphs was (74.25%). The study recommended the need to ensure that the actual performance of the planned performance is matched and decisions are taken to correct the serious deviations and take the necessary measures in terms of retraining and change in regulations, wages and bonuses and punishment of the culprit, neglect and negligence by mistake. (shrink)

In this commentary, I critique three aspects of Emily Walsh's proposal to reduce the moral and legal weight of advance directives: (1) the ambiguity of its initial thesis, (2) its views about the ethics and legality of clinical practice, and (3) its interpretation and application of Ronald Dworkin’s account of advance directives and L.A. Paul's view on transformative experience. I also consider what Walsh’s proposal would mean for people facing the prospect of dementia. I conclude that our reasons to (...) honor many advance directives survive the move to a transformative experience framework. (shrink)

This paper explores how a set of observations on the weight of lead were interpreted and assessed between the 1540s and the 1630s across three different interconnecting disciplines: medicine, mineralogy and chemistry. The epistemic import of these discussions will be demonstrated by showing: 1) the changing role and articulation of experience and quantification in the investigation of metals; and 2) the notions associated with weight in different disciplinary frameworks. In medicine and mineralogy, weight was not considered as (...) a specific subject of inquiry in itself, but as a “sign” indicating other relevant properties of metals. In contrast, the chemistry tradition was increasingly concerned with the specific investigation of weight as a property of matter, as seen in the debates that took place in the “chemical revolution.” In addition, this study will reveal the versatility, polysemy, and parallel purposes of the recourse to experiential knowledge in different contexts, where the same “facts” operate within different disciplines. (shrink)

Patients are generally assumed to have the right to choices about treatment, including the right to refuse treatment, which is constrained by considerations of cost‐effectiveness. Independently, many people support the idea that patients who are responsible for their ill health should incur penalties that non‐responsible patients do not face. Surprisingly, these two areas have not received much joint attention. This paper considers whether restricting the scope of responsibility to pre‐treatment decisions can be justified, or whether a demand (...) to hold people responsible for 'usual suspect' choices such as smoking or failure to exercise commits us to also holding people responsible for their treatment choices. I argue that there is no good reason to support this restriction: those who advocate responsibility for (some) pre‐treatment choices should also advocate responsibility for (some) treatment choices. However, I also note that, as with pre‐treatment choices, patients may sometimes have reason to choose in ways that do not optimize their health. As such, I also consider a process, based on the idea of public reasons, for deciding which treatment choices patients cannot legitimately be held responsible for, along with a method for considering proposed changes to this category. (shrink)

Political philosophers commonly tackle the issue of climate change by focusing on fundamental interests as a basis for human rights. This approach struggles, however, in cases where one set of fundamental interests requires one course of action, and another set of fundamental interests requires another course of action. This article advances an alternative response to climate change based on an account of global justice that gives weight to utilitarian, prioritarian, and luck egalitarian considerations. A practical application of (...) this pluralistic account is provided, which shows that it handles trade-offs between individuals’ interests in an appealing way, and that it supports an aggressive policy of climate change mitigation. This account provides a more plausible justification for rights against the harms of climate change. (shrink)

The main goal of the article is a further development of the usage of income and comparable approaches to company valuation aimed at defining market capitalization sensitivity to value changing in the conditions of dynamization of internal and external business parameters. The relevance of the researched topic is determined by the importance of establishing the factors influencing the change in company market capitalization based on the synthesis of approaches to company valuation. To obtain the results of the study, the (...) following methods were used: structural and logical analysis – to improve the process approach to company valuation in the context of determining the impact of its change on market capitalization; discounted cash flow method (DCF-model) – to determine the value of the enterprise based on the income approach; comparable companies method – to determine the value of the company on the basis of a market approach; factor analysis method – to assess the impact of changes in value on company market capitalization; generalization and logical analysis – in conclusions building. The results of critical analysis of publications of domestic and foreign scientists on the application of company valuation methods identified the need of improvement the process approach to company valuation in the context of determining the impact of its change on the company market capitalization. To adequately assess company value, the use of a synthesis of income and market approaches is proposed. The implementation of the DCF-model and comparable companies valuation method while valuation of Private Joint-Stock Company “SKF Ukraine” allowed to establish that the greatest impact on the target metric (company market capitalization) has an average industry multiplier EV/EBITDA, terminal growth rate and weighted average cost of capital – 5.9 %, 3.2% and 2.7% respectively. The practical value of the results of the study is determined by the importance of forming a full analytical basis for establishing the attractiveness of the performance of joint-stock companies in the market and consolidating management decisionsin order to increase market capitalization. (shrink)

In this paper, I discuss empirical evidence regarding anorexic patients’ distorted body representations. I fit this evidence into a broader framework for understanding how the spatial content of the body is tracked and represented. This framework is motivated by O’Shaughnessy’s (1980) long-term body image hypothesis. This hypothesis posits a representation that tracks changes in the spatial content of the body and supplies this content to other body representations. I argue that a similar kind of body representation might exist and, (...) in the case of anorexia, be distorted. Finally, I suggest that this body representation might become distorted through influence by affect. -/- . (shrink)

Every day nurses are required to make ethical decisions in the course of caring for their patients. Ethics in Nursing Practice provides the background necessary to understand ethical decision making and its implications for patient care. The authors focus on the individual nurse’s responsibilities, as well as considering the wider issues affecting patients, colleagues and society as a whole. This third edition is fully updated, and takes into account recent changes in ICN position statements, WHO documents, as well (...) as addressing current issues in healthcare, such as providing for the health and care needs of refugees and asylum seekers, bioethics and the enforcement of nursing codes. (shrink)

It has been commonly claimed that prehistoric warfare in Japan began in the Yayoi period. Population increases due to the introduction of agriculture from the Korean Peninsula to Japan resulted in the lack of land for cultivation and resources for the population, eventually triggering competition over land. This hypothesis has been supported by the demographic data inferred from historical changes in Kamekan, a burial system used especially in the Kyushu area in the Yayoi period. The present study aims to examine (...) the previous claim by using an expanded dataset of human skeletal remains and Kamekan. First, in order to quantify the intensity of warfare, we developed a database of injured individuals found in the middle phase of the Yayoi period in two large populations in the northern Kyushu area, the Fukuoka plain and the upperand middle-stream of the Homan River. Second, we collected Kamekan data from site reports published after 1990 and constructed a comprehensive database to infer the demography in these areas. Finally, we compared the frequency of injured individuals and the inferred demography. The results suggest that the frequency of injured individuals and the population increase tended to be higher at the upper- and middle-stream of the Homan River than on the Fukuoka plain. Different assumptions of the lifetime of each type of Kamekan can produce mixed results on the relationship between demography and the frequency of injured individuals. They were positively correlated under the traditional assumption of constant time intervals, while there was no correlation using time intervals based on carbon dating by the National Museum of Japanese History. Thus, our results are partially consistent with the previous claim that the population increase and the lack of land and resources due to the introduction of agriculture were causes of warfare in the northern Kyushu area in the middle phase of the Yayoi period. (shrink)

When visual attention is directed away from a stimulus, neural processing is weak and strength and precision of sensory data decreases. From a computational perspective, in such situations observers should give more weight to prior expectations in order to behave optimally during a discrimination task. Here we test a signal detection theoretic model that counter-intuitively predicts subjects will do just the opposite in a discrimination task with two stimuli, one attended and one unattended: when subjects are probed to discriminate (...) the unattended stimulus, they rely less on prior information about the probed stimulus’ identity. The model is in part inspired by recent findings that attention reduces trial-by-trial variability of the neuronal population response and that they use a common criterion for attended and unattended trials. In five different visual discrimination experiments, when attention was directed away from the target stimulus, subjects did not adjust their response bias in reaction to a change in stimulus presentation frequency despite being fully informed and despite the presence of performance feedback and monetary and social incentives. This indicates that subjects did not rely more on the priors under conditions of inattention as would be predicted by a Bayes-optimal observer model. These results inform and constrain future models of Bayesian inference in the human brain. (shrink)

In this paper, the design of a low cost portable ventilator with performance analysis have been done to solve the scarcity of respiratory ventilators for COVID-19 patients. The materials used to build the system are: DC motor, rotating disc and pneumatic piston. The system input is the patient heart beat and the output is volume of air to the patient lung with adjusted breathing rate. This ventilator adjusts the breathing rate to the patient depending on his heart beat rate. (...) The performance analysis of this system have been done using Proportional Integral Derivative (PID) and Full State Feedback H2 controllers. Comparison of the system with the proposed controllers have been done using a step change and a random change of the patient heart beat and a promising result have been analyzed successfully. (shrink)

In this paper, the design of a low cost portable ventilator with performance analysis have been done to solve the scarcity of respiratory ventilators for COVID-19 patients. The materials used to build the system are: DC motor, rotating disc and pneumatic piston. The system input is the patient heart beat and the output is volume of air to the patient lung with adjusted breathing rate. This ventilator adjusts the breathing rate to the patient depending on his heart beat rate. (...) The performance analysis of this system have been done using Proportional Integral Derivative (PID) and Full State Feedback H2 controllers. Comparison of the system with the proposed controllers have been done using a step change and a random change of the patient heart beat and a promising result have been analyzed successfully. (shrink)

Ethical analyses of the effects of neural interventions commonly focus on changes to personality and behavior, interpreting these changes in terms of authenticity and identity. These phenomena have led to debate among ethicists about the meaning of these terms for ethical analysis of such interventions. While these theoretical approaches have different criteria for ethical significance, they agree that patients’ reports are concerning because a sense of self is valuable. In this paper, I question this assumption. I propose that the (...) Buddhist theory of no‐self offers a novel approach to making ethical sense of patients’ claims following deep brain stimulation. This alternative approach is based on the value of insight into patterns of cause and effect among mental states and actions. (shrink)

In the domain of medical science, factual evidence is usually considered as the criterion on which to base decisions and construct hypotheses. Evidence-based medicine is the translation of this approach into the field of patient care, and it means providing only the type of care that is based on evidence that proves its effectiveness and appropriateness. However, while the literature has focused on the types and force of evidence used to establish the recommendation and treatment guidelines, the problem of how (...) evidence is used in doctor–patient interactions to motivate, or refuse, treatment or habit change has been almost completely neglected. In this specific context, characterized by the epistemic unbalance between the interlocutors and a specific conversational goal, the scientific categories of evidence are often irrelevant. The goal of this paper is to address this challenge by analyzing the role evidence plays in doctor–patient interactions in diabetes care. After introducing an analytical distinction between the epistemic and the pragmatic aspect of evidence, we will propose a classification of the types and functions of evidence in chronic care communication, and illustrate its possible uses through its application to our corpus of diabetes-care consultations. From our qualitative analyses, it is possible to observe how in this communicative context a crucial role is played by the conflicts of evidence, in which providers correct patients’ uses of evidence leading them to using less defeasible levels of evidence. (shrink)

The brain’s intrinsic activity plays a fundamental role in its function. In normal conditions this activity is responsive to behavioural context, changing as an individual switches between directed tasks and task‐free conditions. A key feature of such changes is the movement of the brain between corresponding critical and sub‐critical states, with these dynamics supporting efficient cognitive processing. Breakdowns in processing efficiency can occur, however, in brain disorders such as depression. It was therefore hypothesised that depressive symptoms would be related to (...) reduced intrinsic activity responsiveness to changes in behavioural state. This was tested in a mixed group of major depressive disorder patients (n = 26) and healthy participants (n = 37) by measuring intrinsic EEG activity temporal structure, quantified with detrended fluctuation analysis (DFA), in eyes‐closed and eyes‐open task‐free states and contrasting between the conditions. The degree to which DFA values changed between the states was found to be negatively correlated with depressive symptoms. DFA values did not differ between states at all in those with higher symptom levels, meaning that the brain remained in a less flexible sub‐critical condition. This sub‐critical condition in the eyes‐closed state was further found to correlate with levels of maladaptive rumination. This may reflect a general cognitive inflexibility resulting from a lack in neural activity reactivity that may predispose people to overly engage in self‐directed attention. These results provide an initial link between intrinsic activity reactivity and psychological features found in psychiatric disorders. (shrink)

At the height of the Covid-19 pandemic, frontline medical professionals at intensive care units around the world faced gruesome decisions about how to ration life-saving medical resources. These events provided a unique lens through which to understand how the public reasons about real-world dilemmas involving trade-offs between human lives. In three studies (total N = 2298), we examined people’s moral attitudes toward the triage of acute coronavirus patients, and found elevated support for utilitarian triage policies. These utilitarian tendencies did (...) not stem from period change in moral attitudes relative to pre-pandemic levels–but rather, from the heightened realism of triage dilemmas. Participants favoured utilitarian resolutions of critical care dilemmas when compared to structurally analogous, non-medical dilemmas–and such support was rooted in prosocial dispositions, including empathy and impartial beneficence. Finally, despite abundant evidence of political polarisation surrounding Covid-19, moral views about critical care triage differed modestly, if at all, between liberals and conservatives. Taken together, our findings highlight people’s robust support for utilitarian measures in the face of a global public health threat, and illustrate how the dominant methods in moral psychology (e.g. trolley cases) may deliver insights that do not generalise to real-world moral dilemmas. (shrink)

How should one decide whether to undergo an experience that changes who one is? In her discussion of ‘transformative experiences’, L.A. Paul argues that to choose rationally when deliberating first-personally, one should base one’s decision on ‘revelation’, i.e. to discover out what the experience will be like. If this solution is taken as the sole means by which a transformative choice is made, then I argue it is problematic. This is because (i) it overlooks the role that one’s practical identity (...) ought to play when making a major life decision; and (ii) it ignores morally relevant reasons for action. Even if we retain the revelation approach as only part of the means through which a transformative choice is made, I argue that revelation should frequently carry little weight in our decision-making. Rather than focusing on the subjective quality of future experiences, it is often preferable to reflect on who one is and what one’s endorsed practical identity commits one to. (shrink)

In our article (Zawadzki and Adamczyk 2021), we analyzed threats that novel memory modifying interventions may pose in the future. More specifically, we discussed how optogenetics’ potential for reversible erasure/deactivation of memory “may impact authenticity by producing changes at different levels of personality.” Our article has received many thoughtful open peer commentaries for which we would like to express our great appreciation. We have identified two main threads of objections. They are related to the potential applicability of optogenetics as a (...) therapeutic memory modification technology (MMT) in humans—applicability thread, and the normative value of authenticity, that is, the assumption that preserving authenticity is valuable (either in general or in the particular approach we adopted)—normative thread. Both of these threads concern fundamental issues: The former deals with the scientific credibility of the case vignette on which our discussion is based, and the latter deals with the normative weight of our considerations. We think that addressing both of them can be instructive in a broader context as they reflect a more general disagreement among neuroethicists about the very purpose and method of our discipline. (shrink)

The paper focuses on the kind of expertise required by doctors in health communication and argues that such an expertise is twofold: both epistemological and communicative competences are necessary to achieve compliance with the patient. Firstly, we introduce the specific epistemic competences that deal with diagnosis and its problems. Secondly, we focus on the communicative competences and argue that an inappropriate strategy in communicating the reasons of diagnosis and therapy can make patient compliance unworkable. Finally, we focus on the case (...) of diabetes metaphor and propose the deliberate use of metaphors in health communication as an educational tool. On the one hand, metaphors might help doctors in explaining the disease in simpler terms and framing the experience of illness according to patient’s specific needs. On the other hand, metaphors might encourage a change in patient’s beliefs on their own experience of illness, and enable them to reach a shared decision making with doctors. (shrink)

Temporality and Spatiality have been extensively addressed in philosophy, and their disturbances have been extensively studied in psychopathology (e.g. Wyllie 2005). Mental health patients: (1) describe pathological experiences of Time and Space (Gallagher and Varela 2003); (2) show disturbed timing (Tysk 1984); (3) experience psychopathological phenomena that could be the cause of changes in temporality and spatiality. These topics will be discussed in the case of mood disorders, in particular euphoric and dysphoric mania episodes. Any phenomenological study in mood (...) disorders is delicate as affective disorders are in themselves phenomenologically diverse, because they have obscure meaning, multitude of criteria and inconsistent reference norms. Also, psychoanalytical, colloquial and cognitive psychologies keep instilling comprehensive and epistemological structures onto both mood and time/space notions. Nevertheless, bridging philosophical phenomenology and epistemology on time and temporality with mood psychopathology and taxonomy constitutes an on-going project. Theories by Heidegger, Husserl and Merleau-Ponty as well as by Minkowsky, Binswanger, Fuchs, Parnas, and Sass could help to describe this relation deepened into many other Twentieth-Century philosophical papers. A similar account of space and spatiality will be brought about. We will reason about the concept that they provide evidence to address current conceptualization of “bipolar” disorder and the hierarchical grouping of dysphoric and euphoria mania. (shrink)

Introduction. The medical sphere is constantly evolving, requiring improved approaches to its organisation and functioning. Advances in medical technology, observable changes in patient needs and growing competition challenge medical institutions to improve their strategies and approaches. Marketing technologies are becoming one of the key tools for achieving strategic goals. Purpose. This article is aimed at studying the peculiarities of the use of marketing technologies in the medical field. The main purpose of the study is to analyse the impact of marketing (...) tools on the development and success of medical institutions. Method (methodology). The methodological approach involves the use of an analytical approach to studying current trends in marketing and their impact on the healthcare sector. The study uses methods of data analysis and comparative analysis of marketing practices in medical institutions. Results. The study found that the use of targeted marketing strategies allows healthcare facilities to attract more patients, increase customer satisfaction and ensure an excellent reputation. The results of the study show a positive impact of the use of marketing tools on changing the perception of medical services by patients. Conclusions. The scope of application of the results is the practical activities of medical institutions seeking to improve their strategy of promotion and interaction with customers. The findings of the study can be used by marketers and managers of healthcare organisations to develop and implement effective marketing strategies. In summary, this article reveals the importance of using marketing technologies in the healthcare sector and provides practical recommendations for their successful implementation. The study emphasises that marketing in the healthcare industry is necessary to increase competitiveness and ensure quality medical care. (shrink)