Coronary artery vasospasm (CAVS) is a clinical entity that can cause angina, but also unstable angina pectoris, acute myocardial infarction, fatal arrhythmias, and sudden death. Although it is a condition that is usually controlled with medical treatment, more aggressive treatments may rarely be required. In this case, the patient with a known diagnosis of CAVS had multiple arrests despite optimal medical treatment. We observed that fatal arrhythmias persisted in the Implantable Cardioverter Defibrillator (ICD) records, even though we implanted a stent (...) and gave the patient maximal medical treatment. We performed sympathectomy as a last resort and we did not detect any recurrence in the 6-month follow-up of the patient. ICD implantation and sympathectomy should always be considered in resistant CAVS cases. (shrink)

It is widely believed to be permissible for a physician to discontinue any treatment upon the request of a competent patient. Many also believe it is never permissible for a physician to intentionally kill a patient. I argue that the prospect of deactivating a patient’s artificial heart presents us with a dilemma: either the first belief just mentioned is false or the second one is. Whichever horn of the dilemma we choose has significant implications for contemporary medical ethics.

This paper uses the fictional case of the ‘Babel fish’ to explore and illustrate the issues involved in the controversy about the use of cochlear implants in prelinguistically deaf children. Analysis of this controversy suggests that the development of genetic tests for deafness poses a serious threat to the continued flourishing of Deaf culture. I argue that the relationships between Deaf and hearing cultures that are revealed and constructed in debates about genetic testing are themselves deserving of ethical evaluation. Making (...) good policy about genetic testing for deafness will require addressing questions in political philosophy and anthropology about the value of culture and also thinking hard about what sorts of experiences and achievements make a human life worthwhile. (shrink)

For many employees, ‘work’ is no longer something performed while sitting at a computer in an office. Employees in a growing number of industries are expected to carry mobile devices and be available for work-related interactions even when beyond the workplace and outside of normal business hours. In this article it is argued that a future step will increasingly be to move work-related information and communication technology (ICT) inside the human body through the use of neuroprosthetics, to create employees who (...) are always ‘online’ and connected to their workplace’s digital ecosystems. At present, neural implants are used primarily to restore abilities lost through injury or illness, however their use for augmentative purposes is expected to grow, resulting in populations of human beings who possess technologically altered capacities for perception, memory, imagination, and the manipulation of physical environments and virtual cyberspace. Such workers may exchange thoughts and share knowledge within posthuman cybernetic networks that are inaccessible to unaugmented human beings. Scholars note that despite their potential benefits, such neuroprosthetic devices may create numerous problems for their users, including a sense of alienation, the threat of computer viruses and hacking, financial burdens, and legal questions surrounding ownership of intellectual property produced while using such implants. Moreover, different populations of human beings may eventually come to occupy irreconcilable digital ecosystems as some persons embrace neuroprosthetic technology, others feel coerced into augmenting their brains to compete within the economy, others might reject such technology, and still others will simply be unable to afford it. In this text we propose a model for analyzing how particular neuroprosthetic devices will either facilitate human beings’ participation in new forms of socioeconomic interaction and digital workplace ecosystems – or undermine their mental and physical health, privacy, autonomy, and authenticity. We then show how such a model can be used to create device ontologies and typologies that help us classify and understand different kinds of advanced neuroprosthetic devices according to the impact that they will have on individual human beings. (shrink)

Atualmente, biotecnologias são empregadas na forma de protocolos a fim de sincronizar o crescimento folicular e a ovulação, bem como permitir que vacas atuem como receptoras de embriões visando melhorar o potencial genético do rebanho. O objetivo desse estudo foi avaliar o efeito da utilização de implantes intravaginais de progesterona de 1º, 2º e 3º uso no protocolo de transferência de embriões em tempo fixo (TETF) sobre a taxa de prenhez em receptoras girolandas. O experimento ocorreu em uma fazenda localizada (...) no município de São Sebastião do Maranhão (MG). Foram utilizadas 74 vacas submetidas aos seguintes protocolos: No dia 0 (D0) administrou-se 2 ml de 17β-Estradiol e progesterona e foi colocado o implante intravaginal de progesterona. Estes implantes foram colocados de forma aleatória, sendo de 1° uso (grupo 1; n=15), 2° (grupo 2; n=24) ou 3° (grupo 3; n=35).No D8, os implantes foram retirados e administrou-se 2 ml PGF2α; 1,5 ml de eCG e 1 ml de 17β-Estradiol e progesterona. A inovulação dos embriões in vitroo correu no D (16) para todas as vacas que apresentaram um corpo lúteo. As variáveis qualitativas (prenhe ou não prenhe) foram comparadas em tabelas de contingência e analisadas pelo teste de qui-quadrado a 5% de probabilidade. Neste estudo não houve diferença estatística entre os grupos protocolados em relação ao aproveitamento como receptoras: 1º uso (53,3%), 2º (79,2%) e 3º (68,65). Ademais, observou-se uma taxa de prenhez entre os grupos de 37,5% para o 1º uso, 42,1% para o 2º e 33,3% para o 3º (P>0,05). Dentre as vantagens ao reaproveitamento dos implantes multiusos destaca-se a redução dos custos dos protocolos hormonais, já que a progesterona é o hormônio mais oneroso, desta forma, a maximização do uso reduz o valor final do protocolo sem prejuízos a taxa de prenhez. (shrink)

I introduce the implantation argument, a new argument for the existence of God. Spatiotemporal extensions believed to exist outside of the mind, composing an external physical reality, cannot be composed of either atomlessness, or of Democritean atoms, and therefore the inner experience of an external reality containing spatiotemporal extensions believed to exist outside of the mind does not represent the external reality, the mind is a mere cinematic-like mindscreen, implanted into the mind by a creator-God. It will be shown that (...) only a creator-God can be the implanting creator of the mindscreen simulation, and other simulation theories, such as Bostrom’s famous account, that do not involve a creator-God as the mindscreen simulation creator, involve a reification fallacy. (shrink)

When information on a coma patient’s expected outcome is uncertain, a moral dilemma arises in clinical practice: if life-sustaining treatment is continued, the patient may survive with unacceptably poor neurological prospects, but if withdrawn a patient who could have recovered may die. Continuous electroencephalogram-monitoring is expected to substantially improve neuroprognostication for patients in coma after cardiac arrest. This raises expectations that decisions whether or not to withdraw will become easier. This paper investigates that expectation, exploring cEEG’s impacts when it (...) becomes part of a socio-technical network in an Intensive Care Unit. Based on observations in two ICUs in the Netherlands and one in the USA that had cEEG implemented for research, we interviewed 25 family members, healthcare professionals, and surviving patients. The analysis focuses on the way patient outcomes are constructed, the kind of decision support these outcomes provide, and how cEEG affects communication between professionals and relatives. We argue that cEEG can take away or decrease the intensity of the dilemma in some cases, while increasing uncertainty for others. It also raises new concerns. Since its actual impacts furthermore hinge on how cEEG is designed and implemented, we end with recommendations for ensuring responsible development and implementation. (shrink)

The development of predictive brain implant (PBI) technology that is able to forecast specific neuronal events and advise and/or automatically administer appropriate therapy for diseases of the brain raises a number of ethical issues. Provided that this technology satisfies basic safety and functionality conditions, one of the most pressing questions to address is its relation to the autonomy of patients. As Frederic Gilbert in his article asks, if autonomy implies a certain idea of freedom, or self-government, how can an (...) individual be considered to decide freely if the implanted device stands at the inception of the causal chain producing his decisions? He claims that PBIs threaten persons’ autonomy by diminishing their post-operative experience of self-control. In this commentary, I wish to discuss this claim. Contrary to Gilbert, I will suggest that PBIs do not pose a significant threat to patient’s autonomy, as self-control, but rather to his/her sense of authenticity. My claim is that the language of authenticity, already introduced in the recent bioethical literature, may offer a better way to voice some of the concerns with PBIs that Gilbert recognized. (shrink)

In liberal moral theory, interfering with someone’s deliberate engagement in a self-harming practice in order to promote their own good is often considered wrongfully paternalistic. But what if self-harming decisions are the product of an oppressive social context that imposes harmful norms on certain individuals, such as, arguably, in the case of cosmetic breast surgery? Clare Chambers suggests that such scenarios can mandate state interference in the form of prohibition. I argue that, unlike conventional measures, Chambers’ proposal recognises that harmful, (...) discriminatory norms entail a twofold collective moral obligation: to eliminate the harmful norm in the long run, but also to address unjust harm that is inflicted in the meantime. I show that these two obligations tend to pull in opposite directions, thus generating a serious tension in Chambers’ proposal which eventually leads to an undue compromising of the second obligation in favour of the first. Based on this discussion, I develop an alternative proposal which, instead of prohibiting breast implant surgery, offers compensation for the disadvantages suffered by individuals who decide not to have surgery. (shrink)

Exercise-based rehabilitation forms a key part of the UK National Health Service patient-care pathway for cardiac rehabilitation (CR). Only around half of all eligible patients attend core CR, however, with social inequalities affecting participation. Few qualitative studies have explored in-depth the key factors influencing engagement with CR, specifically from a sociological theoretical, and ethnographic perspective. Utilising an ethnographic approach allowed us to get a sense of the embodied experiences of 10 participants attending or declining core CR, together with a (...) further seven family members/significant others. This provided in-depth appreciation of participants’ lifeworld contexts as key influences on CR participation. The article draws on these qualitative data and focuses on 1) participants’ initial thoughts about CR; and 2) navigating the field of CR, analysed via thematic analysis. We utilise a Bourdieusian theoretical perspective to theorise the findings, including salient socio-cultural factors influencing attendance/non-attendance and (non)adherence. The article findings highlight how perceptions of CR and the ability to navigate the field are strongly influenced by habitus and capital, and how personal biographies and socio-material conditions affect adherence to CR programmes. The study provides original insights into embodied experiences of exercise-based CR, and novel understandings of the reasons for drop-out/poor adherence, theorised from a Bourdieusian perspective. (shrink)

Aim: To elicit preferences for prognostic information, attitudes towards withdrawal of life-sustaining treatment (WLST) and perspectives on acceptable quality of life after post-anoxic coma within the adult general population of Germany, Italy, the Netherlands and the United States of America. Methods: A web-based survey, consisting of questions on respondent characteristics, perspectives on quality of life, communication of prognostic information, and withdrawal of life-sustaining treatment, was taken by adult respondents recruited from four countries. Statistical analysis included descriptive analysis and chi2-tests for (...) dierences between countries. Results: In total, 2012 respondents completed the survey. In each country, at least 84% indicated they would prefer to receive early prognostic information. If a poor outcome was predicted with some uncertainty, 37-54% of the respondents indicated that WLST was not to be allowed. A conscious state with severe physical and cognitive impairments was perceived as acceptable quality of life by 17–44% of the respondents. Clear differences between countries exist, including respondents from the U.S. being more likely to allow WLST than respondents from Germany (OR = 1.99, p < 0.001) or the Netherlands (OR = 1.74, p < 0.001) and preferring to stay alive in a conscious state with severe physical and cognitive impairments more than respondents from Italy (OR = 3.76, p < 0.001), Germany (OR = 2.21, p < 0.001), or the Netherlands (OR = 2.39, p < 0.001). Conclusions: Over one-third of the respondents considered WLST unacceptable when there is any remaining prognostic uncertainty. Respondents had a more positive perspective on acceptable quality of life after coma than what is currently considered acceptable in medical literature. This indicates a need for a closer look at the practice of WLST based on prognostic information, to ensure responsible use of novel prognostic tests. (shrink)

Systems biologists often distance themselves from reductionist approaches and formulate their aim as understanding living systems “as a whole.” Yet, it is often unclear what kind of reductionism they have in mind, and in what sense their methodologies would offer a superior approach. To address these questions, we distinguish between two types of reductionism which we call “modular reductionism” and “bottom-up reductionism.” Much knowledge in molecular biology has been gained by decomposing living systems into functional modules or through detailed studies (...) of molecular processes. We ask whether systems biology provides novel ways to recompose these findings in the context of the system as a whole via computational simulations. As an example of computational integration of modules, we analyze the first whole-cell model of the bacterium M. genitalium. Secondly, we examine the attempt to recompose processes across different spatial scales via multi-scale cardiac models. Although these models rely on a number of idealizations and simplifying assumptions as well, we argue that they provide insight into the limitations of reductionist approaches. Whole-cell models can be used to discover properties arising at the interfaces of dynamically coupled processes within a biological system, thereby making more apparent what is lost through decomposition. Similarly, multi-scale modeling highlights the relevance of macroscale parameters and models and challenges the view that living systems can be understood “bottom-up.” Specifically, we point out that system-level properties constrain lower-scale processes. Thus, large-scale modeling reveals how living systems at the same time are more and less than the sum of the parts. (shrink)

The mythical bronze creature Talos (Greek: Τάλως) was worshiped initially as the god of light or the sun in the Hellenic Island of Crete. He is supposed to have lived in the peak Kouloukona of the Tallaia Mountains in the Gerontospelio cave. His relation towards bronze and fire and his continuous voyage circling the island of Crete most probably introduces the concept of the change of the four seasons. The sun was considered in the area of the South-East Mediterranean nations (...) as just judge, a guardian who monitors and judges from above all the actions of the commoners, a controller for the faithful application of laws in Crete [1]. Hesychios in his Lexicon notes that talos means sun and that the name Tallaios was initially attributed to Zeus [2]. The birth of the Olympian gods forged a new Pantheon and nomenclature forcing some of the old gods to fell into lower deities. This happened to Talos who soon became a mythical hero [1]. According to Apollodorus, the bronze creature was forged by the magnificent constructor Hephaestus as a gift to the mythical King Minoa to help him guard the island [3]. Although the verb “peritrohazo” (Greek: περιτροχαζω) was used, meaning a movement in a steady orbit (track), some depictions image him as a winged being. To protect the island, he was throwing rocks into unknown ships or in the case of a foreign landing he was burning with fire or with his flamed bronze body the intruders. He was holding copper plates with the laws of the island and his circle allowed him to pass all island sores three times daily [1,4-6]. Plato, speaks of him as a real person, suggesting he was the brother of King Rhadamanthys, thus a son of Zeus [5]. Talos may be considered as the token of the Cretan power, a symbol of technological development in the field of metalworking in prehistoric and Minoan times. An animated, programmed gigantic android to enforce its will. A primitive robot for basic actions having a power source, fire and ichor (Greek: ιχώρ) the sacred fluid in the vessels of the gods. The first manufactured being with his individual intelligence, a primary concept of artificial intelligence (AI) [7]. -/- Homer was the first to introduce the term automata (Greek: αυτόματα), to describe ingenious machines built by the supreme blacksmith god of invention and technology, God of metal and fire, Hephaestus, manufactured devices “acting of one’s own will” as the Hellenic word indicates [8]. Eons later, the humanoid automaton the “Automa cavaliere” (English: Automaton knight) appeared in the court of the nobleman and Duke of Milan Ludovico Maria Sforza. It was the year 1495, when Leonardo da Vinci presented his robotic knight, an innovative construction operated by a series of pulleys and cables, presenting though no individual mind. Although it was manufactured by a highly intelligent polymath, it could only be operated through an outer intelligence [9]. Advancements made during the Fourth Industrial Revolution allowed modern technology to manufacture intelligent machines to aid the field of invasive surgery. One of those most sophisticated devises is the da Vince Surgical Tower. -/- Launched in the setting of the 21st century, the DaVinci System is one of the most commonly employed tools/systems, which has prevailed in the field of robotic-assisted surgery [10]. One could claim that it practically reshaped the concept of surgery, providing doctors with immense capabilities, aiming towards the optimal post-operative outcome. Through visual augmentation, high resolution 3D video, enhanced precision and reduced complication rates [11] the DaVinci Si and the latest DaVinci Xi system have been implemented in a variety of surgeries, including but not limited to general, urologic, gynecologic, thoracic and even cardiac procedures; valve and coronary artery bypass graft operations [12,13]. Da Vinci is cleared globally for cardiosurgery and came in vogue to fulfill the dream of cardiac surgeons to operate in closet chest. It offers in patients the same benefits as those that open chest incision surgery procedures do [14]. -/- The more recent DaVinci Xi model was introduced to counteract commonly known drawbacks of the Si system, such as the inability to simultaneously manipulate the different abdominal quadrants [10]. It consists of four boom mounted robotic arms along with a mobile platform and a master console. The latter with the adaptable intraocular distance, the cushioned headrest, the modifiable arm bars and the flexible finger loops, is meticulously designed to meet the surgeon´s “demands” [12]. Every robotic arm has three degrees of freedom, which combined with the EndoWrist technology to imitate the delicate motion of the surgeon´s hand, acquires an extra seven degrees of freedom. Evidently, the combination of the user-friendly interface, the high-quality 3D intraoperative images, the multiple joints and sensors, as well as the surgeon himself, who can learn to handle the DaVinci Xi Surgical System in a relatively short period of time, has established the model in the surgical armamentarium, paving the way towards a continuously progressive future of minimally invasive and robotic surgery (Figure 1) [12]. -/- History testifies that the nomination of the AI surgical tower as da Vinci was wrongfully given to commemorate a majestic historical figure. It is clear that the mythical creature Talos which was fabricated by the ingenious god Hephaestus was the first true automaton in the line of AI origins. (shrink)

In this talk, I’d like to focus not on external technologies like computers, smart boards, virtual experience, nor the Orgasmatron in Woody Allen’s movie Sleeper (1973), but rather on some of the possible social implications of bodily implanted devices on the future of human nature and society. In other words, I’ll leave the science underlying cyborgs to the boffins in engineering, computer science and artificial intelligence, and just focus on some conceptualizations of the word ‘cyborg’, along with possible social implications (...) and concerns surrounding cyborgization. (shrink)

This article’s conclusion is that the theories of Einstein are generally correct and will still be relevant in the next century (there will be modifications necessary for development of quantum gravity). Those Einsteinian theories are Special Relativity, General Relativity, and the title of a paper he published in 1919 which asked if gravitation plays a role in the composition of elementary particles of matter. This paper was the bridge between General Relativity and the Unified Field Theory he sought during the (...) last 25 years of his life. In an article published in the "Annals of Physics" in 1957, Charles Misner and John Wheeler claimed that Einstein's latest equations demonstrated the unified field theory. But Einstein himself felt he had not fully succeeded. The present article begins with Olbers’ paradox (why is the sky dark at night?) Then it briefly proceeds to the subjects of Newtonian gravity, quantum entanglement, gravitational waves, E=mc^2, dark energy, dark matter, cosmic expansion, redshift, blueshift, the cosmic microwave background, the 1st Law of Thermodynamics, and explanation of advanced waves travelling back in time. The section “vector-tensor-scalar geometry” touches on mass, quantum spin, the Higgs boson and Higgs field, stellar jets, the pervasiveness of photons and gravitons, and supersymmetry. Then come half a dozen paragraphs referring to formation of planets, black holes, and bosons of the weak and strong nuclear forces. They end with Descartes’ space-matter relation. Also added are paragraphs about simply-connected mathematics, non-orientability, consciousness, the Law of Falling Bodies, the multiverse, space-time travel developed from maths’ Brouwer Fixed Point Theorem and from an experiment in electrical engineering performed at Yale University, development from future space-time travel of human flight in the manner of fiction’s Superman and Supergirl, as well as downloaded band-gap implants in the brain that could deal with forms of matter. They could add or delete anything and everything we choose by emulating computers’ copy/paste function to add things; as well as their delete function, to remove things. To complete my seemingly unusual ideas, 6 sections are added – 1) “Advanced and Retarded Waves” is extended to include dinosaurs, ageing, and photography, 2) there’s a bit about space-time warping and “imaginary” computers, 3) several paragraphs about restoring health (even gaining immortality) by using gravity, 4) a section about superconductivity and the electric or magnetic fields of planets (this section mentions Mercury, Planet 9 and precession), 5) a section titled EXPLAINING OCEAN TIDES WHEN GENERAL RELATIVITY SAYS GRAVITY IS A PUSH CAUSED BY THE CURVATURE OF SPACE-TIME (this has subsections about M-Sigma, Geysers on Saturn’s Moon Enceladus, and A Brief History of Gravity), plus 5) the potential of COVID-19 to create the Golden Rule, world peace, eternal life, and a non-economic world that doesn’t use any form of money (no cash, credit cards, digital currency, etc.) The final section is called DISTANT-FUTURE SCIENCE INTERPRETED BY RELIGIONS AS SUPERNATURAL and introduces an idea for becoming immortal in these physical bodies. If the Theory of Everything sought by physicists applies to all space-time, then every person’s brain must be entangled with the 22nd century (and far beyond that time too). (shrink)

Abstract: Heart attacks, or myocardial infarctions, are a leading cause of mortality worldwide. Early prediction and accurate analysis of potential risk factors play a crucial role in preventing heart attacks and improving patient outcomes. In this study, we conduct a comprehensive review of datasets related to heart attack analysis and prediction. We begin by examining the various types of datasets available for heart attack research, encompassing clinical, demographic, and physiological data. These datasets originate from diverse sources, including hospitals, research institutions, (...) and public health agencies. Our analysis aims to identify common features, data quality, and potential biases in these datasets. Next, we explore the predictive modeling techniques employed in heart attack prediction. Machine learning algorithms, such as decision trees, support vector machines, and deep neural networks, have gained prominence in predicting heart attacks. We discuss the strengths and limitations of these methods and highlight recent advancements in predictive modeling. Furthermore, we delve into the critical risk factors associated with heart attacks. Factors such as age, gender, hypertension, diabetes, and cholesterol levels are examined for their significance in predicting cardiac events. We also investigate the role of lifestyle factors, including smoking, diet, and physical activity, in heart attack risk assessment. Additionally, this review addresses the importance of data preprocessing and feature engineering in improving prediction accuracy. Feature selection methods, missing data handling, and data scaling techniques are discussed to enhance the robustness of heart attack prediction models. In conclusion, this comprehensive dataset review provides valuable insights into the state of heart attack analysis and prediction. It serves as a resource for researchers and healthcare professionals seeking to better understand the datasets available for heart attack research and the methods employed for accurate prediction. Ultimately, our efforts in dataset analysis and predictive modeling contribute to the advancement of preventive cardiology and the reduction of heart attack-related morbidity and mortality. (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)

Abstract. Intelligent Tutoring System Builder (ITSB) is an authoring tool designed and developed to aid teachers in constructing intelligent tutoring systems in a multidisciplinary fields. The teacher is needed to create a set of pedagogical fundamentals, which, in line, are inured to automatically build up a broad tutor framework and construct an intelligent tutoring system. In this paper an explanation of the theory and the architecture of the tool is outlined. A presentation of several system components, the requirements of the (...) different components, integration of these components in ITSB tool are shown. Furthermore, implanting of requirements, cognitive principle, and common design fundamentals in the tool to ease the use of teachers. A variety of design matters, an example of building an intelligent tutoring system for teaching Java language using ITSB tool and an evaluation are presented. (shrink)

RD, a 32-year-old male, was admitted to the hospital with hypoxic COVID pneumonia–a potentially life-threatening condition characterized by dangerously low levels of oxygen in the body- during one of the pandemic’s surges. While RD’s age gave the clinical team hope for his prognosis, his ability to recover was complicated by his being unvaccinated and having multiple comorbidities, including diabetes and obesity. His condition worsened to the point that he required extracorporeal membrane oxygenation (ECMO), a machine that maintains the functioning of (...) a person’s heart and lungs. -/- Given its scarcity–only 264 of the over 6,000 hospitals in the United States offer ECMO, according to the Extracorporeal Life Support Organization–as well as its high cost and the inadequate supply of staff required to maintain it, ECMO primarily serves as a bridge to support critically ill patients until they can receive an organ transplant or implanted medical device. For RD, ECMO was started to support him until he could be evaluated for, and possibly receive, a bilateral lung transplant. Despite its intended use as a treatment of last resort, some patients can remain on ECMO for weeks or months. And some are awake, alert, and capable of medical decision-making. -/- RD was one such patient. However, the transplant evaluation committee ruled out RD’s candidacy for bilateral lung transplantation, based on his poor potential for recovery and a lack of family and friends to provide post-transplant support. This determination raised the prospect of continued ECMO treatment being a bridge to nowhere. But RD was comfortable on ECMO and wanted to remain in the ICU. The ICU intensivist contacted the ethics consult service with questions about whether continued ECMO support was medically and ethically inappropriate. (shrink)

Elselijn Kingma argues that, in cases of mammalian placental pregnancy, the foster (roughly, the post-implantation embryo/foetus) is part of the gravida (the pregnant organism). But she does not consider the possibility of proper overlap. I show that this generates a number of serious problems for her argument and trace the oversight to a quite general issue within the literature on biological individuality. Doing so provides an opportunity to pull apart and clarify the relations between some importantly distinct questions concerning organismality (...) and organismic parthood, and to identify the implications that this has for those who want to draw on this literature when making metaphysical or mereological arguments. (shrink)

In this paper I present an argument in favour of a parental duty to use preimplantation genetic diagnosis (PGD). I argue that if embryos created in vitro were able to decide for themselves in a rational manner, they would sometimes choose PGD as a method of selection. Couples, therefore, should respect their hypothetical choices on a principle similar to that of patient autonomy. My thesis shows that no matter which moral doctrine couples subscribe to, they ought to conduct the PGD (...) procedure in the situations when it is impossible to implant all of the created embryos and if there is a significant risk for giving birth to a child with a serious condition. (shrink)

Recently, I argued that human subjects in artificial wombs ‘share the same moral status as newborns’ and so, deserve the same treatment and protections as newborns. This thesis rests on two claims: subjects of partial ectogenesis—those that develop in utero for at time before being transferred to AWs—are newborns and subjects of complete ectogenesis—those who develop in AWs entirely—share the same moral status as newborns. In response, Elizabeth Chloe Romanis argued that the subject in an AW is ‘a unique human (...) entity…rather than a fetus or a newborn’. She provides four lines of response to my essay. First, she argues that I have ‘misconstrued’ what birth is. Once we correct that error, it becomes clear that subjects of partial ectogenesis have not been born. Second, she argues that my claims imply that non-implanted embryos ‘would also be “born”’. But that is absurd. Third, she claims I fail to ‘meaningfully respond’ to distinctions she draws between subjects of ectogenesis and neonates. Finally, she criticises my essay for focusing on subjects of AWs rather than focusing on pregnant persons. I respond to each of these charges. In doing so, I reaffirm that some subjects of ectogenesis are newborns and all subjects of ectogenesis—even those that have not been born—share the same moral status as newborns. (shrink)

Recently, I argued that human subjects in artificial wombs (AWs) “share the same moral status as newborns” and so, deserve the same treatment and protections as newborns. This thesis rests on two claims: (A) “Subjects of partial ectogenesis—those that develop in utero for at time before being transferred to AWs—are newborns,” and (B) “Subjects of complete ectogenesis—those who develop in AWs entirely—share the same moral status as newborns.” In response, Elizabeth Chloe Romanis argued that the subject in an AW is (...) “a unique human entity…rather than a fetus or a newborn.” She provides four lines of response to my essay. First, she argues that I have “misconstrued” what birth is. Once we correct that error, it becomes clear that subjects of partial ectogenesis have not been born. Second, she argues that my claims imply that non-implanted embryos (existing in vivo) “would also be ‘born.’” But that is absurd. Third, she claims I fail to “meaningfully respond” to distinctions she draws between subjects of ectogenesis and neonates. Finally, she criticizes my essay for focusing on subjects of AWs rather than focusing on pregnant persons (who should be at the “centre” of debates over AWs). I respond to each of these charges. In doing so, I reaffirm that (contra Romanis) some subjects of ectogenesis are newborns and all subjects of ectogenesis—even those that have not been born—share the same moral status as newborns. (shrink)

Should parents try to give their children the best lives possible? Yes. Do parents have an obligation to give their children the widest possible set of opportunities in the future? No. Understanding how both of these things can be true will allow us to go a long way towards understanding why a Deaf couple might wish their child to be born Deaf and why we might have reason to respect this desire.

Formal clinical trials of pig-to-human organ transplant—known as xenotransplantation—may begin this decade, with the first trials likely to consist of either adult renal transplants or pediatric cardiac transplant patients. Xenotransplantation as a systematic scientific study only reaches back to the latter half of the 20th century, with episodic xenotransplantation events occurring prior to that. As the science of xenotransplantation has progressed in the 20th and 21st centuries, the public's knowledge of the potential therapy has also increased. With this, there (...) have been shifting ethical stances toward xenotransplantation in key areas, such as religious and public viewpoints towards xenotransplantation, animal rights, and public health concerns. This review provides a historical–ethical account of xenotransplantation and details if or how viewpoints have shifted over time. (shrink)

The recent publications reported in 2022 reveal the possibility of obtaining mouse embryos without the need for egg or sperm. These ‘artificial embryos’ can recapitulate some stages of development ex utero – from neurulation to organogenesis – without implantation. Synthetic mouse embryos might serve as a valuable model to gain further insights into early developmental stages. Indeed, it is expected for these models to be replicated by employing human cells. This promising research raises ethical issues and expands the horizon of (...) ethics in regard to the development of the human embryo. From this point of view, we state some of the new open venues for bioethical research. (shrink)

Animal-derived constituents are frequently used in anaesthesia and surgery, and patients are seldom informed of this. This is problematic for a growing minority of patients who may have religious or secular concerns about their use in their care. It is not currently common practice to inform patients about the use of animal-derived constituents, yet what little empirical data does exist indicates that many patients want the opportunity to give their informed consent. First, we review the nature and scale of the (...) problem by looking at the groups who may have concerns about the use of animal-derived constituents in their care. We then summarise some of the products used in anaesthesia and surgery that can contain such constituents, such as anaesthetic drugs, surgical implants and dressings. Finally, we explore the problem of animal-derived constituents and consent using Beauchamp and Childress’ four principles approach, examining issues of autonomy, beneficence, nonmaleficence and justice. Disclosing the use of animal-derived constituents in anaesthesia and surgery is warranted under Beauchamp and Childress’ four principles approach to the problem. Although there exist systemic and practical challenges to implementing this in practice, the ethical case for doing so is strong. The Montgomery ruling presents additional legal reason for disclosure because it entails that patients must be made aware of risks associated with their treatment that they attach significance to. (shrink)

In conceptual modeling (CM) as a subdiscipline of software engineering, current proposed ontologies (categorical analysis of entities) are typically established through whole adoption of philosophical theories (e.g. Bunge’s). In this paper, we pursue an interdisciplinary research approach to develop a diagrammatic-based ontological foundation for CM using philosophical ontology as a secondary source. It is an endeavor to escape an offshore procurement of ontology from philosophy and implant it in CM. In such an effort, the CM diagrammatic language plays an (...) important role in contrast to dogmatic philosophical languages’ obsession with abstract entities. Specifically, this paper is about developing a descriptive (in contrast to formal) ontology that a modeler accepts as a supplementary account of reality when using thinging machines (TMs; i.e. a reality that uncovers the ontology of things that TM modeling discusses or “talks about,” akin to the ontology of natural language). Although existence is a well-established notion, we defend subsistence (Stoic term) as a supplementary mode of reality (e.g. reflection of event). The aim here is aligned toward developing CM notions and processes that are firm enough. Classical analysis of being per se (e.g. identity, substance, classes, objects) is de-emphasized in this work; nevertheless, philosophical concepts form an acknowledged authority to compare to. As a case study, such a methodology is applied to the notion of information that provides a common-sense understanding of the world. This application would enhance understanding of the TM methodology and clarify some of the issues that shed light on the question of the nature of information as an important concept in software engineering. Information is defined as about events; that is, it is about existing things. It is viewed as having a subsisting nature that exists only through being “carried on” by other things. The results seem to indicate a promising approach to define information and understand its nature. (shrink)

'Sliders' are a speculative introspection-enhancing future technology allowing humans with cybernetic brain implants to precisely and voluntarily modulate moods and other mental states that vary along a one-dimensional scale. Such future humans may, for example, use the Sliders interface to temporarily present a COWARDLY–COURAGEOUS 'slider' in their visual field, and with a mere act of will change their level of courage from a 60 to a 65 on the 100-point scale. The present article discusses the implications of such a technology (...) in the form of an epistolary fiction in which the author's future persona warns the reader of the dire consequences and hardearned insights arising from widespread Slider use and abuse. (shrink)

There is an interesting historical detour in the dissemination of one of the seventeenth century’s most praised discoveries: the reception of Harvey’s account of the circulation of the blood is closely intertwined, especially in the Low Countries, with Descartes’ account of the origin of the heartbeat. Descartes was one of the first figures to support the circulation of the blood and to give credit to Harvey for it, although he presumably arrived at the same conclusion independently through his own anatomical (...) experiments. He did so while vocally rejecting Harvey’s views on the muscular nature of the heart and his explanation of cardiac motion, to promote his own mechanistic solutions instead. Although Descartes’ .. (shrink)

In their paper, “Autonomy and the ethics of biological behaviour modification”, Savulescu, Douglas, and Persson discuss the ethics of a technology for improving moral motivation and behaviour that does not yet exist and will most likely never exist. At the heart of their argument sits the imagined case of a “moral technology” that magically prevents people from developing intentions to commit seriously immoral actions. It is not too much of a stretch, then, to characterise their paper as a thought experiment (...) in service of a thought experiment. In order for an argument involving a thought experiment to progress debate in applied ethics three things must be true. First, the thought experiment must accurately represent and illuminate a pressing ethical dilemma. Second – and most obviously – the central claims of the argument regarding the thought experiment must be plausible. Third, it must be possible to apply or develop the arguments established with reference to the thought experiment to the real world cases the experiment is intended to illuminate. In this commentary, I argue that there are serious reasons to question the extent to which their argument meets each of these challenges involved in the use of thought experiments in applied ethics. While Savulescu et al. succeed in showing how behavioural modification might be compatible with freedom and autonomy – and perhaps justifiable even if it were not — in the fantastic case they consider, there is little we can conclude from this about any technology of “moral bioenhancement” in the foreseeable future. Indeed, there is a real danger that their argument will license attempts to manipulate behaviour through drugs and brain implants, which raise profound moral issues that they barely mention. (shrink)

In The Future of Human Nature, Jürgen Habermas raises the question of whether the embryonic genetic diagnosis and genetic modification threatens the foundations of the species ethics that underlies current understandings of morality. While morality, in the normative sense, is based on moral interactions enabling communicative action, justification, and reciprocal respect, the reification involved in the new technologies may preclude individuals to uphold a sense of the undisposability of human life and the inviolability of human beings that is necessary for (...) their own identity as well as for reciprocal relations. Engaging with liberal bioethics and Catholic approaches to bioethics, the article clarifies how Habermas’ position offers a radical critique of liberal autonomy while maintaining its postmetaphysical stance. The essay argues that Habermas’ approach may guide the question of rights of future generations regarding germline gene editing. But it calls for a different turn in the conversation between philosophy and theology, namely one that emphasizes the necessary attention to rights violations and injustices as a common, postmetaphysical starting point for critical theory and critical theology alike. In 2001, Jürgen Habermas published a short book on questions of biomedicine that took many by surprise.[1] To some of his students, the turn to a substantive position invoking the need to comment on a species ethics rather than outlining a public moral framework was seen as the departure from the “path of deontological virtue,”[2] and at the same time a departure from postmetaphysical reason. Habermas’ motivation to address the developments in biomedicine had certainly been sparked by the intense debate in Germany, the European Union, and internationally on human cloning, pre-implantation genetic diagnosis, embryonic stem cell research, and human enhancement. He turned to a strand of critical theory that had been pushed to the background by the younger Frankfurt School in favor of cultural theory and social critique, even though it had been an important element of its initial working programs. The relationship of instrumental reason and critical theory, examined, among others, by Max Horkheimer, Theodor W. Adorno, and Herbert Marcuse and taken up in Habermas’ own Knowledge and Interest and Theory of Communicative Action became ever-more actual with the development of the life sciences, human genome analysis, and genetic engineering of human offspring. Today, some of the fictional scenarios discussed at the end of the last century as “science fiction” have become reality: in 2018, the first “germline gene-edited” children were born in China.[3] Furthermore, the UK’s permission to create so-called “three-parent” children may create a legal and political pathway to hereditary germline interventions summarized under the name of “gene editing.”In this article, I want to explore Habermas’ “substantial” argument in the hope that philosophy and theology become allies in their struggle against an ever-more reifying lifeworld, which may create a “moral void” that would, at least from today’s perspective, be “unbearable”, and for upholding the conditions of human dignity, freedom, and justice. I will contextualize Habermas’ concerns in the broader discourse of bioethics, because only by doing this, his concerns are rescued from some misinterpretations.[1] Jürgen Habermas, The Future of Human Nature.[2] Ibid., 125, fn. 58. 8[3] Up to the present, no scientific publication of the exact procedure exists, but it is known that the scientist, Jiankui He, circumvented the existing national regulatory framework and may have misled the prospective parents about existing alternatives and the unprecedented nature of his conduct. Yuanwu Ma, Lianfeng Zhang, and Chuan Qin, "The First Genetically Gene‐Edited Babies: It's “Irresponsible and Too Early”," Animal Models and Experimental Medicine ; Matthias Braun, Meacham, Darian, "The Trust Game: Crispr for Human Germline Editing Unsettles Scientists and Society," EMBO reports 20, no. 2. (shrink)

Since at least 2016, many have worried that social media enables authoritarians to meddle in democratic politics. The concern is that trolls and bots amplify deceptive content. In this chapter I argue that these tactics have a more insidious anti-democratic purpose. Lies implanted in democratic discourse by authoritarians are often intended to be caught. Their primary goal is not to successfully deceive, but rather to undermine the democratic value of testimony. In well-functioning democracies, our mutual reliance on testimony also generates (...) a distinctively democratic value: decentralized testimonial networks evade control by the state or powerful actors. The deliberate exposure of deception in democratic testimonial networks undermines this value by implicating citizens in their own epistemic corruption, weakening the resilience of democratic society against authoritarian pressure. In this chapter I illustrate that danger through a close reading of recent Russian social media interference operations, showing both their epistemic underpinnings and their ongoing political threat. (shrink)

.... The strategy I have defended involves drawing a distinction between those who can and cannot legitimately hold an agent responsible in circumstances when the agent is being covertly controlled (e.g. through implantation processes). What is intuitively unacceptable, I maintain, is that an agent should be held responsible or subject to reactive attitudes that come from another agent who is covertly controlling or manipulating him. This places some limits on who is entitled to take up the participant stance in relation (...) to agents who are rational self-controllers but nevertheless subject to covert control.26 In this way, what is compromised by conditions of covert control is not the responsibility of the agent as such. It is, rather, the participant stance of those other agents who covertly control him. Clearly it is possible to establish these specific limits on who can hold these agents responsible without denying that the agents themselves remain free and responsible. When we take this approach we will find that we are no longer faced with an unattractive choice between simply “biting the bullet” or having to “spit it out”. All we need to do is chew carefully, until there is nothing left that we find too hard to swallow. (shrink)

Deep Brain Stimulation is currently being investigated as an experimental treatment for patients suffering from treatment-refractory AN, with an increasing number of case reports and small-scale trials published. Although still at an exploratory and experimental stage, initial results have been promising. Despite the risks associated with an invasive neurosurgical procedure and the long-term implantation of a foreign body, DBS has a number of advantageous features for patients with SE-AN. Stimulation can be fine-tuned to the specific needs of the particular patient, (...) is relatively reversible, and the technique also allows for the crucial issue of investigating and comparing the effects of different neural targets. However, at a time when DBS is emerging as a promising investigational treatment modality for AN, lesioning procedures in psychiatry are having a renaissance. Of concern it has been argued that the two kinds of interventions should instead be understood as rivaling, yet “mutually enriching paradigms” despite the fact that lesioning the brain is irreversible and there is no evidence base for an effective target in AN. We argue that lesioning procedures in AN are unethical at this stage of knowledge and seriously problematic for this patient group, for whom self-control is particularly central to wellbeing. They pose a greater risk of major harms that cannot justify ethical equipoise, despite the apparent superiority in reduced short term surgical harms and lower cost. (shrink)

Over the course of the past several decades, Kant scholars have made significant headway in showing that emotions play a more significant role in Kant's ethics than has traditionally been assumed. Closer attention has been paid to the Metaphysics of Morals (MS) where Kant provides important insights about the value of moral sentiments and the role they should play in our lives. One particularly important discussion occurs in sections 34 and 35 of the Doctrine of Virtue where Kant claims we (...) have a duty to use sympathetic feelings "as a means of promoting active and rational benevolence" (MS 6:457). Kant labels this the "duty of humanity," and he suggests that nature has implanted sympathetic feelings in us "to do what the representation of duty alone might not accomplish" (ibid.). Commentators have rightly highlighted these remarks as prime evidence that feelings do play a positive role in Kant's ethics after all. (shrink)

nanological gates, in order to design nano-scale computers with dual-scale capabilities. All living biological systems function due to the molecular interactions of different subsystems. Molecular components (proteins and nucleic acids, lipids and carbohydrates, DNA and RNA) can be used as an inspirational strategy on how to design high-performance NEMS and MEMS that have the required features and characteristics. Considered. In addition, analytical and numerical methods are available for dynamic analysis and three-dimensional geometry, bonding and other properties of atoms and molecules. (...) Thus, electromagnetic and mechanical, and other physical and chemical properties can be studied. Nanostructures and nanosystems can be widely used in medicine and health. Possible applications of nanotechnology include: drug synthesis and drug delivery (therapeutic potential is greatly increased due to the effective direct delivery of new types of drugs to specific sites in the body), nanosurgery and nanotherapy Synthesis and detection of genomes, nano-scale stimuli and sensors (diagnosis and prevention of disease), design and implantation of non-rejection artificial organs and design of high performance nanomaterials. It is important that these technologies change the manufacture of materials, devices and systems. (shrink)

Memory is everywhere in Blade Runner 2049. From the dead tree that serves as a memorial and a site of remembrance (“Who keeps a dead tree?”), to the ‘flashbulb’ memories individuals hold about the moment of the ‘blackout’, when all the electronic stores of data were irretrievably erased (“everyone remembers where they were at the blackout”). Indeed, the data wiped out in the blackout itself involves a loss of memory (“all our memory bearings from the time, they were all damaged (...) in the blackout”). Memory, and lack of it, permeates place, where from the post-blackout Las Vegas Deckard remembers it as somewhere you could “forget your troubles.” Memory is a commodity, called upon and consumed by the Wallace Corporation, purchased from the memory-maker, Dr Ana Stelline, who constructs and implants “the best memories” in replicants so as to instil in them real human responses. Memory is ubiquitous in Blade Runner 2049, involving humans, replicants, objects, and machines. Even “God,” we are told, “remembered Rachael.” Nowhere, though, is the depiction of memory more important than in the attempt to solve a question of identity. Officer K has a memory of his past. Even though he knows it is an implant, it is a memory he is emotionally attached to, frequently narrating it to Joi, his digital girlfriend. But it is a memory that starts to puzzle and trouble him. When K discovers the remains of a dead replicant, a female NEXUS-7, he uncovers a secret—this replicant was pregnant and died during childbirth, a discovery that could “break the world.” K is charged with hunting down the child and making the problem disappear. Yet as K starts seeking answers to the question of the child’s identity he gets inextricably caught up in the mystery. Is he merely Officer K, or is he Joe, the miracle child of Rachael and Deckard? The answer to this question hinges on K’s memory. But is the memory genuine? Is the memory his? Blade Runner 2049 encourages us to think deeply about the nature of memory, identity, and the relation between them. Indeed, the film does not just serve as a starting point for thinking about philosophical issues related to memory and identity. Rather, as we show in this chapter, the film seems to offer a view on these philosophical issues. Blade Runner 2049 offers us a view of memory as spread out over people, objects, and the environment, and it shows us that memory’s role in questions of identity goes beyond merely accurately recalling one’s past. Identity depends not on memory per se, but partly on what we use memory for. (shrink)

Objective: Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults. Anticoagulation significantly reduces stroke and related mortality in AF patients. This study conducted a bibliometric analysis of the top 50 most-cited articles in the literature on dabigatran, the first new-generation oral anticoagulant. -/- Methods: We searched the Web of Science for articles with dabigatran in the title. The top 50 most cited articles (T50) were selected. Characteristics of the articles (such as author, source, institution, country, scientific category, (...) number of citations, citation density, and citations per article) were analyzed. -/- Results: T50 had a total of 33,301 citations. The average number of citations per article was 666. The United States of America (USA) was the most prolific country in T50, with 36 papers and 26,043 citations. Wallentin Lars from Uppsala University was the most prolific author, with 14 articles and 13,532 citations. Circulation was the most prolific journal, with 11 articles. -/- Conclusions: We analyzed the classic publications on dabigatran, the first new-generation oral anticoagulant. The most prolific country was the USA, author was Wallentin, and journal was Circulation. Researchers and clinicians can easily access influential publications by reviewing our study. (shrink)

Physicalism is the thesis that everything is physical, including the mind. One argument against physicalism appeals to neardeath experiences, conscious experiences during episodes, such as cardiac arrest, when one's normal brain functions are severely impaired. The core contention is that NDEs cannot be physically explained, and so we have reason to appeal to the non-physical in explaining them. In this paper, we consider in detail a recent article by Pim van Lommel in which he appeals to NDEs in arguing (...) against physicalism and in favour of an alternative conception of the mind as non-localized and immaterial. Our main contentions are, first, that it is not clear that physicalism cannot accommodate the phenomena of NDEs and, second, that it is not obvious how the conception of the mind as non-localized and immaterial is supposed to help. (shrink)

Deep brain stimulation (DBS), a surgical procedure involving the implantation of electrodes in the brain, has rekindled the medical community’s interest in psychosurgery. Whereas many researchers argue DBS is substantially different from psychosurgery, we argue psychiatric DBS—though a much more precise and refined treatment than its predecessors—is nevertheless a form of psychosurgery, which raises both old and new ethical and legal concerns that have not been given proper attention. Learning from the ethical and regulatory failures of older forms of psychosurgery (...) can help shed light on how to address the regulatory gaps that exist currently in DBS research. To show why it is important to address the current regulatory gaps within psychiatric DBS, we draw on the motivations underlying the regulation of earlier forms of psychosurgery in the US. We begin by providing a brief history of psychosurgery and electrical brain stimulation in the US. Against this backdrop, we introduce psychiatric DBS, exploring current research and ongoing clinical trials. We then draw out the ethical and regulatory similarities between earlier forms of psychosurgery and psychiatric DBS. As we will show, the factors that motivated strict regulation of earlier psychosurgical procedures mirror concerns with psychiatric DBS today. We offer three recommendations for psychiatric DBS regulation, which echo earlier motivations for regulating psychosurgery, along with new considerations that reflect the novel technologies used in DBS. (shrink)

Bioethical discourse on organ donation covers a wide range of topics, from informed consent procedures and scarcity issues up to ‘transplant tourism’ and ‘organ trade’. This paper presents a ‘depth ethics’ approach, notably focussing on the tensions, conflicts and ambiguities concerning the status of the human body. These will be addressed from a psychoanalytical angle. First, I will outline Lacan’s view on embodiment as such. Subsequently, I will argue that, for organ recipients, the donor organ becomes what Lacan refers to (...) as an object a, the ‘partial object’ of desire, the elusive thing we are deprived of, apparently beyond our grasp. Within the recipient’s body an empty space emerges, a kind of ‘vacuole’, once occupied by a faltering organ. This space can only be filled by a ‘gift’ from the other, by an object a. Once implanted, however, this implant becomes an ‘extimate’ object: something both ‘external’ and ‘intimate’, both ‘embedded’ and ‘foreign’, and which is bound to remain an object of concern for quite some time, if not for life. A Lacanian analysis allows us, first of all, to address the question what organ transplantation has in common with other bodily practices involving bodily parts procured from others, such as cannibalism. But it also reveals the basic difference between the two, as well as the distance between the ‘fragmented body’ of Frankenstein’s ‘monster’—as an aggregate of replaceable parts—and the multiple organ recipients of today. (shrink)

Objective: In this study, we aimed to identify patients at risk of chemotherapy-induced cardiotoxicity with a simple method like platelet-to-lymphocyte ratio (PLR) before starting therapy. Method: A total of 65 breast cancer patients who completed anthracycline or adjuvant trastuzumab treatment were evaluated retrospectively. Serial PLR calculations, echocardiographic examinations, and cardiac markers before treatment and after follow-up period were analyzed. Cardiotoxicity was determined according to Cardiac Review and Evaluation Committee Criteria. Results: Patients were divided into two groups according to (...) their baseline PLR levels as Group C—PLR < 119 and Group D—PLR 120. The median follow-up of the study was 22.23 (12-42) months. Concomitant disease and baseline characteristics were similar in both groups. Symptomatic cardiotoxicity was not observed in both groups. Cardiotoxicity was occurred in one patient (2.3%) in Group C and in four patients (9.5%) in Group D (P ¼ .005). Average mean left ventricular ejection fraction loss from baseline was 10.7 6 7.0% in Group D vs 2.3 6 6.4% in Group C (P ¼ .008). Interpretation of cardiac markers that were present in nearly half of the patients revealed that serum hs-c-reactive protein and pro-brain natriu¨ retic peptide levels were significantly higher in patients who developed cardiotoxicity compared to who did not develop cardiotoxicity. PLR 120 had 99% sensitivity and 85% specificity in predicting cardiotoxicity. Conclusion: This study’s results showed that high PLR levels were associated with chemotherapy-induced cardiotoxicity. To our best knowledge, this is the first study, examining the impact of whole blood test on chemotherapy-induced cardiotoxicity before starting the therapy and allowing doctors plot a route for these risky patients. (shrink)

This paper addresses concerns raised recently by Datteri (Biol Philos 24:301–324, 2009) and Craver (Philos Sci 77(5):840–851, 2010) about the use of brain-extending prosthetics in experimental neuroscience. Since the operation of the implant induces plastic changes in neural circuits, it is reasonable to worry that operational knowledge of the hybrid system will not be an accurate basis for generalisation when modelling the unextended brain. I argue, however, that Datteri’s no-plasticity constraint unwittingly rules out numerous experimental paradigms in behavioural and (...) systems neuroscience which also elicit neural plasticity. Furthermore, I propose that Datteri and Craver’s arguments concerning the limitations of prosthetic modelling in basic neuroscience, as opposed to neuroengineering, rests on too narrow a view of the ways models in neuroscience should be evaluated, and that a more pluralist approach is needed. I distinguish organisational validity of models from mechanistic validity. I argue that while prosthetic models may be deficient in the latter of these explanatory virtues because of neuroplasticity, they excel in the former since organisational validity tracks the extent to which a model captures coding principles that are invariant with plasticity. Changing the brain, I conclude, is one viable route towards explaining the brain. (shrink)

Stress profoundly impacts quality of life and may lead to various diseases and conditions. Understanding the underlying physiological and neurological processes that take place during stress and meditation techniques may be critical for effectively treating stress-related diseases. The article examines a hypothetical physiological homeostatic response that compares and contrasts changes in central and peripheral oscillations during stress and meditation, and relates these to changes in the autonomic system and neurological activity. The authors discuss how cardiorespiratory synchronization, which occurs during the (...) parasympathetic response and meditation, influences and modulates activity and oscillations of the brain and autonomic nervous system. Evidence is presented on how synchronization of cardiac and respiratory rates during meditation may lead to a homeostatic increase in cellular membrane potentials in neurons and other cells throughout the body. These potential membrane changes may underlie the reduced activity in the amygdala, and other cortical areas during meditation, and research examining these changes may foster better understanding of the restorative properties and health benefits of meditation. (shrink)

Objective: microRNAs (miRNAs) have important potential as biomarkers in the diagnosis and prognosis of ischemia/reperfusion (I/R) injury in coronary artery bypass grafting surgery (CABG). This study investigated the relationship between preoperative (preop) and postoperative (post-op) cardiac parameters and miRNA expressions in CABG. -/- Methods: We analyzed a total of 94 individuals (CABG, n= 46 and healthy control, n=48). Quantitative real-time polymerase chain reaction (qRT) was performed to determine plasma miRNA expressions (miR-21, miR-181a, miR-199a, miR-199b, and miR-320a-5p) in triplicates: before (...) surgery, 1 hour after surgery, and 24 hours after surgery. The target genes and pathways of miRNA were determined using bioinformatic analysis. The biomarker potentials of miRNAs were evaluated with receiver operating characteristic (ROC) curve analysis. -/- Results: All miRNAs were significantly downregulated (p < 0.05). Troponin I, LVEF, CPK, and CK-MB were found to be statistically significant for operation groups (p < 0.05). miRNA expressions and cardiac markers were associated with troponin I and/or CK-MB. In ROC analyses, miR-199a was a good diagnostic marker. CREBRF and ZNF704 genes may be a target for these miRNAs. -/- Conclusions: Downregulation of miR-199a has a regulatory role in ischemia/reperfusion. They may contribute to CABG pathology through these two genes involved in signaling cascades to turn on protein response and ion binding. (shrink)

High blood pressure is an important component of pre-eclampsia. The underlying mechanism of development of hypertension in pre-eclampsia is complicated and still remains obscure. Several theories have been advanced including endothelial dysfunction, uteroplacental insufficiency leading to generalized vasoconstriction, increased cardiac output, and sympathetic hyperactivity. Increased blood flow and pressure are thought to lead to capillary dilatation, which damages end-organ sites, leading to hypertension, proteinuria and edema. Additional theories have been put forward based on epidemiological research, implicating immunological and genetic (...) factors. None of these theories have been substantiated. Based on a review of literature this paper postulates that the initiating event for the development of preeclampsia is intermittent hypoxia associated with irregular breathing during sleep, hypoapnea, apnea,inadequate respiratory excursions during the waking hours and inadequate cardiopulmonary synchronization (abnormal sympatho-vagal balance). (shrink)

Deep Brain Stimulation (DBS) is an invasive therapeutic method involving the implantation of electrodes and the electrical stimulation of specific areas of the brain to modulate their activity. DBS brings therapeutic benefits, but can also have adverse side effects. Recently, neuroethicists have recognized that DBS poses a threat to the very fabric of human existence, namely, to the selves of patients. This article provides a review of the neuroethical literature examining this issue, and identifies the crucial dimensions related to the (...) self which DBS may endanger—personal identity, authenticity, and autonomy. The most influential theories accounting for these dimensions are analyzed herein, and it is argued that most of these theories require further refinement. This paper also demonstrates the interrelation between personal identity, authenticity, and autonomy, and concludes that one can only fully understand the impact of DBS on the self when all of these factors are taken into account. (shrink)

Recent fndings illustrate how changes in consciousness accommodated by neural correlates and plasticity of the brain advance a model of perceptual change as a function of meditative practice. During the mindbody response neural correlates of changing awareness illustrate how the autonomic nervous system shifts from a sympathetic dominant to a parasympathetic dominant state. Expansion of awareness during the practice of meditation techniques can be linked to the Default Mode Network (DMN), a network of brain regions that is active when the (...) one is not focused on the outside world and the brain is restful yet awake (Chen et al., 2008). A model is presented illustrating the dynamic mindbody response before and after mindfulness meditation, and connections are made with prefrontal cortex activity, the cardiac and respiratory center, the thalamus and amygdala, the DMN and cortical function connectivity. The default status of the DMN changes corresponding to autonomic modulation resulting from meditation practice. (shrink)

While the Value-Free Ideal of science has suffered compelling criticism, some advocates like Gregor Betz continue to argue that science policy advisors should avoid value judgments by hedging their hypotheses. This approach depends on a mistaken understanding of the relations between facts and values in regulatory science. My case study involves the morning-after pill Plan B and the “Drug Fact” that it “may” prevent implantation. I analyze the operative values, which I call zygote-centrism, responsible for this hedged drug label. Then, (...) I explain my twofold account of value-ladenness, involving the constitutive role of value judgments in science and the social function of facts as political tools. Because this drug fact is ineliminably value-laden in both senses, I conclude that hedged hypotheses are not necessarily value-free. (shrink)