Purpose: The method of diagnosing diabetic retinopathy (DR) through artificial intelligence (AI)-based systems has been commercially available since 2018. This introduces new ethical challenges with regard to obtaining informed consent from patients. The purpose of this work is to develop a checklist of items to be disclosed when diagnosing DR with AI systems in a primary care setting. -/- Methods: Two systematic literature searches were conducted in PubMed and Web of Science databases: a narrow search focusing on DR (...) and a broad search on general issues of AI-based diagnosis. An ethics content analysis was conducted inductively to extract two features of included publications: (1) novel information content for AI-aided diagnosis and (2) the ethical justification for its disclosure. -/- Results: The narrow search yielded n = 537 records of which n = 4 met the inclusion criteria. The information process was scarcely addressed for primary care setting. The broad search yielded n = 60 records of which n = 11 were included. In total, eight novel elements were identified to be included in the information process for ethical reasons, all of which stem from the technical specifics of medical AI. -/- Conclusions: Implications for the general practitioner are two-fold: First, doctors need to be better informed about the ethical implications of novel technologies and must understand them to properly inform patients. Second, patient's overconfidence or fears can be countered by communicating the risks, limitations, and potential benefits of diagnostic AI systems. If patients accept and are aware of the limitations of AI-aided diagnosis, they increase their chances of being diagnosed and treated in time. (shrink)

Artificial intelligence (AI) is expected to revolutionise the practice of medicine. Recent advancements in the field of deep learning have demonstrated success in variety of clinical tasks: detecting diabetic retinopathy from images, predicting hospital readmissions, aiding in the discovery of new drugs, etc. AI’s progress in medicine, however, has led to concerns regarding the potential effects of this technology on relationships of trust in clinical practice. In this paper, I will argue that there is merit to these concerns, (...) since AI systems can be relied on, and are capable of reliability, but cannot be trusted, and are not capable of trustworthiness. Insofar as patients are required to rely on AI systems for their medical decision-making, there is potential for this to produce a deficit of trust in relationships in clinical practice. (shrink)

Over the past year, technology companies have made headlines claiming that their artificially intelligent (AI) products can outperform clinicians at diagnosing breast cancer, brain tumours, and diabetic retinopathy. Claims such as these have influenced policy makers, and AI now forms a key component of the national health strategies in England, the United States, and China. While it is positive to see healthcare systems embracing data analytics and machine learning, concerns remain about the efficacy, ethics, and safety of some (...) commercial, AI health solutions. This paper argues that improved regulation and guidance is urgently required to mitigate risks, ensure transparency and best practice, Without this, patients, clinicians, and other stakeholders cannot be assured of an app’s efficacy, and safety. (shrink)

Diabetes is one of the most common diseases worldwide where a cure is not found for it yet. Annually it cost a lot of money to care for people with diabetes. Thus the most important issue is the prediction to be very accurate and to use a reliable method for that. One of these methods is using artificial intelligence systems and in particular is the use of Artificial Neural Networks (ANN). So in this paper, we used artificial neural networks to (...) predict whether a person is diabetic or not. The criterion was to minimize the error function in neural network training using a neural network model. After training the ANN model, the average error function of the neural network was equal to 0.01 and the accuracy of the prediction of whether a person is diabetics or not was 87.3%. (shrink)

Diabetes is a major public health issue that affects the nations of our time to a large extent and is described as a non-communicable epidemic. Diabetes mellitus is a common disease where there is too much sugar (glucose) floating around in your blood. This occurs because either the pancreas can’t produce enough insulin or the cells in body have become resistant to insulin. The concentration in this paper is on diagnosis diabetes by designing a proposed expert system. The main goal (...) of this expert system is to get the appropriate diagnosing of the illness, dealing with it quickly, and tips for permanent treatment whenever possible is given out. SL5 object expert system language was used for designing and implementing the proposed expert system. (shrink)

Prolife theorists typically hold to the claim that all human beings possess equal moral status from conception and consequently possess a right to life. This, they believe, entails that abortion is impermissible in all circumstances. Critics characterize this as an extreme anti-abortion position, as it prima facie allows no exceptions, even in cases of rape. Here, I examine whether the prolife claim regarding equal moral status is compatible with a more attractive moderate stance that permits an exception in the case (...) of rape. I show that Judith Jarvis Thomson's analysis of rights can be used to modify the prolife position in this way, but that doing so involves concessions that prolife theorists are unlikely to find acceptable. (shrink)

Opponents of abortion are often described as ‘inconsistent’ (hypocrites) in terms of their beliefs, actions and/or priorities. They are alleged to do too little to combat spontaneous abortion, they should be adopting cryopreserved embryos with greater frequency and so on. These types of arguments—which we call ‘inconsistency arguments’—conform to a common pattern. Each specifies what consistent opponents of abortion would do (or believe), asserts that they fail to act (or believe) accordingly and concludes that they are inconsistent. Here, we show (...) that inconsistency arguments fail en masse. In short, inconsistency arguments typically face four problems. First, they usually fail to account for diversity among opponents of abortion. Second, they rely on inferences about consistency based on isolated beliefs shared by some opponents of abortion (and these inferences often do not survive once we consider other beliefs opponents of abortion tend to hold). Third, inconsistency arguments usually ignore the diverse ways in which opponents of abortion might act on their beliefs. Fourth, inconsistency arguments criticise groups of people without threatening their beliefs (eg, that abortion is immoral). Setting these problems aside, even supposing inconsistency arguments are successful, they hardly matter. In fact, in the two best-case scenarios—where inconsistency arguments succeed—they either encourage millions of people to make the world a (much) worse place (from the critic’s perspective) or promote epistemically and morally irresponsible practices. We conclude that a more valuable discussion would be had by focusing on the arguments made by opponents of abortion rather than opponents themselves. (shrink)

This study employs machine learning to predict diabetes using a Kaggle dataset with 13 features. Our three-layer model achieves an accuracy of 98.73% and an average error of 0.01%. Feature analysis identifies Age, Gender, Polyuria, Polydipsia, Visual blurring, sudden weight loss, partial paresis, delayed healing, irritability, Muscle stiffness, Alopecia, Genital thrush, Weakness, and Obesity as influential predictors. These findings have clinical significance for early diabetes risk assessment. While our research addresses gaps in the field, further work is needed to enhance (...) model generalizability. (shrink)

The diabetic foot is a global threat to public health because it can result in infection and amputation, as well as cause the patient to experience considerable pain and incur financial costs. The condition of patients with diabetic foot in North China is distinguished by more severe local ulcers, a worse prognosis, and a longer duration of disease than that of patients with diabetic foot in the south. Through appropriate preventive measures, the diabetic foot can be (...) effectively avoided. This study assesses the existing knowledge, attitudes and practices associated with diabetic foot prevention among adults with diabetes living in rural areas of North China. (shrink)

Diabetic ketoacidosis is a serious, medical emergency that can be fatal but treatable, we aimed to evaluate the clinical profile of patients admitted with diabetic ketoacidosis. This case series study enrolled 213 non-pregnant adult and adolescent patients admitted with diabetic ketoacidosis at Tripoli Diabetes Hospital from January to September 2023. Demographic data, clinical characteristics, laboratory findings, precipitating factors, and patient outcomes were extracted from medical records and analyzed. Type 1 diabetes mellitus was present in 187 (87.8%) of (...) patients, the age range 11-84 years, (30.26±13.28), with 130 patients ≤30 years old (61.0%), females accounting for 110 of the patients (51.6%), 109 had a diabetes duration of less than 10 years (51.2%). The most common precipitating factor was insulin omission 92 (43.2%) in patients with known diabetes mellitus, whereas, diabetic ketoacidosis as the first presentation of diabetes mellitus in 24 patients (11.7%), systolic blood pressure ranged 50-160 mmHg (112.82±16.19), diastolic blood pressure varied 30-100 mmHg (70.24±11.32). Plasma glucose at presentation ranged 183-1494 mg/dl (462.92±169.85), with Eu-glycemic diabetic ketoacidosis 100-249 mg/dl were in nine patients (4.2%), whereas most of cases (135 patients, 63.4%) present with plasma glucose 250-500 mg/dl, while hyperosmolar status (≥701 mg/dl) were present in 13 patients (6.1%). Venous pH varied from 6.7-7.42 (7.13±0.14), 132 (62.0%) patients presented with pH <7.24, while severe acidosis was pH < 7 in 32 of patients (14.6%), serum bicarbonate with 10.93±4.95, severe (<5 mmol) in 91 patients (42.7%) and moderate (5-10 mmol) were in 79 patients (37.08%). The mean length of hospital stay was 3.33 days, with an average of 2.11 days spent in the high-dependent unit. Serum potassium varied from 2.4-6.7 meq/L with 3.66± 0.63, most common complications of diabetic ketoacidosis treatment were hypokalemia observed in 82 (35.7%) of cases, and hypoglycemia was detected in 41 patients (19.2%). 170 patients were discharged in good condition (79.8%), and 17.8% of patients were transferred to another hospital to receive further management for co-morbid diseases with diabetes after controlling their hyperglycemic crises. The majority of patients presented with the critical status of diabetic ketoacidosis. The findings emphasize the importance of patient education about prevention measures prompt presentation to the hospital, and clinicians' awareness for early and aggressive treatment of hyperglycemic crises. (shrink)

Vitamin D deficiency and its effect have attracted considerable research interest due to its relation to glucose homeostasis, insulin secretion, sensitivity and synthesis. This study aimed to evaluate vitamin D levels in patients with type II diabetes mellitus aged between 35-65 years and investigate their relations with glycemic control and obesity. The study included 74 Libyan patients with a known history of type II diabetes mellitus (33 males and 41 females). Serum glucose, glycosylated hemoglobin (HbA1c) and vitamin D levels were (...) biochemically estimated in these patients. Further, body mass index (BMI) was calculated for all diabetic patients (weight in kilogram per height in meter square). The mean level of plasma glucose level was 150.58±63.82 mg/dl (mean±SD). The mean of HbA1c level was 7.90±8.48% (mean±SD). The mean level of vitamin D was 22.75±14.97 ng/ml. The mean of BMI was 26.55±4.10 Kg per m2. The findings showed that 58.10% of the cases had vitamin D deficiency (Out of which 24.24% were males and 85.36% were females). This study showed significant differences in glucose, HbA1c, vitamin D and BMI between male and female patients. Moreover, elderly ages for both sexes had adverse effects on vitamin D status. Vitamin D levels have negatively been correlated with levels of glucose, HbA1c and BMI. It is concluded that vitamin D deficiency has an adverse effect on glucose homeostasis in patients with type II diabetes mellitus and this can be a contributing risk factor in complications of type II diabetes mellitus development in Libyan patients. (shrink)

Type 2 diabetes mellites (T2DM) is a common complex disease with multiple factors contributing to its development and progression. Dyslipidemia refers to the abnormality of lipid metabolism, characterized by elevated levels of low-density lipoprotein (LDL), total cholesterol (TC), triglycerides (TG), and decreased levels of high-density lipoprotein (HDL). It is a major risk factor for cardiovascular disease in type 2 diabetic patients. This study aimed to evaluate the diagnostic value of glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG) in predicting (...) the risk of developing diabetic dyslipidemia. 86 clinically diagnosed Libyan patients with type 2 diabetes mellitus (44 males: 42 females), 30 years and 70 years of age were engaged in this study. Levels of HbA1C, blood glucose, TC, TG, LDL, and HDL were performed using a Lntegra Cobas 400+ analyzer. The findings showed that HbA1c exhibits a significant positive correlation with TC and TG with no significant correlation with LDL and HDL levels. Thus, this study suggests that HbA1c can be used as a potential dual marker of glycemic control and dyslipidemia in type 2 diabetes mellitus. (shrink)

Uric acid has increasingly been associated with insulin resistance, hyperinsulinemia, and type 2 diabetes mellitus. Diabetic patients who are hyperuricemic have a risk of developing diabetic complications. Pathogenesis of uric acid may decrease nitric oxide bioavailability in vascular smooth muscle, endothelial cells and direct scavenging of nitric oxide by uric acid. A decrease in endothelial nitric oxide production by uric acid has also been associated with endothelial dysfunction and insulin resistance. This study aims to determine the relationship between (...) uric acid and glucose levels in patients with type 2 diabetes mellitus. The study included 161 Libyan patients (67 males and 94 females) diagnosed with type 2 diabetes mellitus. Both levels of serum uric acid and hemoglobin A1c (HbA1c) were determined. The patients were divided into two groups. The controllable diabetic group with HbA1c of less than 06.0% and the uncontrollable diabetic group with HbA1c of more than 06.0%. Patients who are suffering from type 2 diabetes mellitus without complications were included whereas patients with smoking, alcoholism, nephrotic disease, malignancy, hepatitis, and renal failure or kidney disease were excluded. The mean and standard deviation of uric acid, HbA1c and Pearson correlation coefficient test were considered. In the controllable diabetic group, serum uric acid mean was found to be 4.807±1.39 and HbA1c was found to be 5.032±1.39. In the uncontrollable diabetic group, serum uric acid was 4.897±1.66 and HbA1c was 8.396±1.65. Uric acid level has significantly been correlated with HBA1C in controlled and uncontrolled diabetic patients (p<0.05). In addition, the uric acid level was found to be higher in the uncontrolled diabetic group than that in the controlled group (p<0.05). A possible relationship between serum uric acid and the incidence of type 2 diabetes mellitus was noted. Thus, uric acid can be used as a potential biomarker to indicate impaired glucose metabolism. (shrink)

Objectives: This study aimed to fill the gap between Vietnamese diabetic patients' needs and care through a qualitative study asking about their experiences with diabetes and quality of care. -/- Methods: Interviews with five diabetic patients were conducted at a tertiary general hospital located in southern Vietnam. The transcribed data were first subjected to quantitative text analysis using KH Coder to identify major categories of frequently used words, followed by a qualitative analysis of selected cases using the Steps (...) for Coding and Theorization (SCAT) method. -/- Results: The major categories of frequently used words were chronic health conditions, services, facilities, insurance, patient-doctor communication, and medication. SCAT analysis of three selected cases identified six themes: “Disregarding the disease at the early stage,” “Fear of complications,” “Satisfaction with hospital services and medical staff,” “Insurance-related problems,” “Long waiting times,” and “Communication barriers between patients and doctors.” Patients were satisfied with improved hospital facilities and services; however, the overloading of one hospital led to long waiting times and communication difficulties with doctors. Difficulties with health insurance were also observed, and patients were rather passive in disease management and needed to be empowered through improved communication with doctors and other care providers. -/- Conclusion: These findings from our trial of introducing a qualitative study into service evaluation suggest that listening to patients can help health providers learn their perspectives and be more responsive to their needs. (shrink)

Elisabeth Meru, born in Hamburg, is a poetess by heart, a storyteller by nature, a forwarding merchant / financial accountant by training, and a Sikh by choice. She is currently settled in Munich, Germany. During the past three decades, she has authored numerous short stories, articles, and poetic compositions for various newspapers, journals, and radio broadcasts. With over a dozen books, both in English and German languages, to her credit to date, she is a prolific author who specializes in writing (...) on Sikh history, tradition, and culture. Her 24-year-long spiritual quest brought her to the Gurdwara in Munich, wherein she heard Gurbani Kirtan for the first time. Therein she felt as if she had reached home. After continuous devotion and dedication to Sikhi for about seven years, she converted to Sikhism. Due to her love for Sikhi, Punjabi and Punjabiat, she learned Gurmukhi. Her first book in German, “Aus dem Herzen des Sikhismus - Guru Nanak Dev Ji - In deinem stillen Rosengarten” was published in 2009. The English version of the book "From the Heart of Sikhism - Guru Nanak Dev Ji - In your quiet rose garden" was published in 2010. These books describe the legends about the ten Gurus, their wisdom and teachings, and her poems, fables and a fairytale in German style. Elisabeth’s second set of books “Sikhism - Wellspring of Love” (in English) and “Sikhismus - Quell der Liebe” (in German), were published in 2010. This book contains her poems and stories about Sikhism. The stories are rooted in the spirit of fairy tales. Her next book, in German, “Sikhs und Sikhismus: Religion, Riten und der Goldene Tempel ” was published in 2011. In Feb. 2012,she with her team published the German edition of “Guru Granth Sahib Ji Essenz und Sikh Terminologie von A - Z.” It is a must-book for German-speaking Sikhs and all those who want a quick overview of basic terms in Sikhism. Another of her book, in German, “Sikhs ... der Bart ist ab,” was published in 2017. (shrink)

Background: This study was conducted to measure depression literacy (D-Lit) and mental health literacy (MHL) and to investigate their relationship with psychological status and quality of life among Iranian patients with type 2 diabetes mellitus (T2DM). -/- Methods: This cross-sectional study was conducted in 2021 among 400 patients with T2DM in Iran. Samples were selected using proportional stratified sampling. Data collection tools comprised a demographic questionnaire, measures of MHL and D-Lit, the diabetes quality of life (DQOL) scale, and the DASS-21. (...) After confirming the normality of the data using the Kolmogorov-Smirnov test, parametric statistical tests (such as one-way ANOVA, independent samples t-test, and Chi-Square) were used to investigate the relationship between the variables using SPSS v22 software. The results of continuous quantitative data are reported in the form of means and standard deviations, and qualitative data are reported in the form of absolute and relative frequencies. -/- Results: In this study, 10.25% of the participants (n = 41) had severe depression, while 36.75% (n = 147) experienced severe anxiety. The mean (standard deviation) of MHL was 80.92 (9.16) from 130 points. Of the participants, only 1.7% (n = 7) did not answer any questions correctly on the D-lit scale, and only 5.8% (n = 23) were able to answer 15 questions or more correctly on the D-lit. MHL had a significant negative correlation with depression (r = −0.236), anxiety (r = −0.243), and stress (r = −0.155) (P < 0.001). There was a positive and significant correlation between MHL and D-Lit (r = 0.186) (P < 0.001). D-Lit had a significant negative correlation with depression (r = −0.192), anxiety (r = −0.238), and stress (r = −0.156) (P < 0.001). There was a positive and significant correlation between the ability to recognize disorders (r = 0.163), knowledge of self-treatment (r = 0.154), and DQOL (P < 0.001). Depression (r = −0.251), anxiety (r = −0.257), and stress (r = −0.203) had a significant negative correlation with DQOL (P < 0.001). -/- Conclusion: MHL and D-Lit levels were found to be inadequate in patients with T2DM. These low levels of MHL and D-Lit among patients with T2DM were associated with higher levels of anxiety, depression, and stress, as well as a lower quality of life. Therefore, designing and implementing preventive programs to improve the mental health of patients with T2DM can help prevent mental disorders and ultimately improve their quality of life. (shrink)

Metformin is considered the first-line treatment as a monotherapy for patients with type 2 diabetes mellitus. Emerging evidence suggests that metformin may have a renoprotective role; therefore, understanding the impact of metformin dose and therapy duration on renal function may significantly improve renal outcomes in type 2 diabetes patients. This study aims to investigate the renoprotective effects of metformin by analyzing its dose-dependent impacts on the estimated glomerular filtration rate in patients with type 2 diabetes mellitus. A retrospective cross-sectional study (...) design was used from September 2022 to October 2023. Data from 302 type 2 diabetes patients were collected from patient files at the Benghazi Diabetic Center and the Aljabal Al-Alkdar Diabetic Center, including all with type 2 diabetes mellitus patients on varying doses of metformin. The collected data included age, gender, metformin dose, duration of metformin therapy, urea, and creatinine. Exclusion criteria included patients with significant comorbidities such as chronic kidney disease (other than diabetic nephropathy), liver disease, heart failure, or malignancy; those taking nephrotoxic medications; individuals with recent acute illnesses or surgical procedures; pregnant or lactating women; participants with inadequate medical records; and patients who were non-adherent to metformin therapy. Survival analysis was conducted to evaluate the effect of different metformin doses on the estimated glomerular filtration rate. The study analyzed 302 diabetic patients, of whom 46.0% were male and 54.0% were female. The age was 58.3±11.9 years. The HbA1c was 7.7%±1.3%. The duration of diabetes was 11.4±8.1 years. The creatinine was 1.0±0.9 mg/dL, and the urea was 36.7±23.8 mg/dL. Data analysis revealed a statistically significant difference in survival distribution across the dose groups. Different metformin doses significantly impact the estimated glomerular filtration rate, suggesting that dosage plays a crucial role in maintaining renal function. (shrink)

Type 1 diabetes (T1D) is a chronic illness that requires intensive lifelong management of blood glucose concentrations by means of external insulin administration. There have been substantial developments in the ways of measuring glucose levels, which is crucial to T1D self-management. Recently, continuous glucose monitoring (CGM) has allowed people with T1D to keep track of their blood glucose levels in near real-time. These devices have alarms that warn users about potentially dangerous blood glucose trends, which can often be shared with (...) ther people. CGM is consistently associated with improved glycemic control and reduced hypoglycemia and is currently recommended by doctors. However, due to the costs of CGM, only those who qualify for hospital provision or those who can personally afford it are able to use it, which excludes many people. In this paper, I argue that unequal access to CGM results in: (1) unjust health inequalities, (2) relational injustice, (3) injustice with regard to agency and autonomy, and (4) epistemic injustice. These considerations provide prima facie moral reasons why all people with T1D should have access to CGM technology. I discuss the specific case of CGM policy in the Netherlands, which currently only provides coverage for a small group of people with T1D, and argue that, especially with additional considerations of cost-effectiveness, the Dutch government ought to include CGM in basic health care insurance for all people with T1D. (shrink)

A community based cross-sectional study was carried out by a self-structured questionnaire on 168 participants aged between 18 and 60 years at two arsenic prone area of Bangladesh to determine the association between extent of depression and socio-demographic as well as illness characteristics in arsenicosis population. The mean age ± SD was 42 ± 10.15 years. Female respondents were almost twice (63.1%) than the males (36.9%) in this study. Most of the respondents (94.0%) were shallow tube well water user. Among (...) them most (80.0%) of the respondents were detected as arsenic contaminated water consumer over more than six months. Study estimated that almost half (44.3%) of the participants had suffered from mild to moderate depression in the moderate arsenicosis group. Less than quarter (20.8%) participants suffered severe depression in severe arsenicosis group. Quarter (26.7%) had mild arsenicosis with no depression. This difference was not significant. Gender had significant influence on proportion of level of depression. Females significantly suffered more from depressive symptoms than males. More than two third of the female respondents suffered from some kind of depressive symptoms; where less than one third of the males were suffered from depressive symptoms. Age has no significant relation with depression. Respondents who were 48 years and above age group had highest percentages of severe depressive symptoms (35.8%). This age group also suffered from highest percentage of mild to moderate depression (37.1%). Though most of the respondent (85.1) had no diabetes and hypertension. Respondents with physical illness suffered more from some sorts of depression than those without illness, but the result is not statistically significant. We understood that depression has health challenges in adult arsenicosis patients. Therefore, physicians should take account depression in their treatment management when deal with arsenicosis patients. (shrink)

While there is a prolific debate surrounding the issue of conscientious objection of individuals towards performing certain clinical acts, this debate ignores the fact that there are other reasons why clinicians might wish to object providing specific services. This paper briefly discusses the idea that healthcare workers might object to providing specific services because they are against their professional judgement, they want to maintain a specific reputation, or they have pragmatic reasons. Reputation here is not simply understood as being in (...) good standing with a professional body. Rather, reputation is treated in the sense that a craftsman might wish to be known for providing a specific type, quality, and style of service. Professionalism is understood as acting according to the philosophical and scientific principles that are the basis of healthcare (such as acting for the benefit of the patient’s health and following well- evidenced treatment pathways). (shrink)

Metaphors allow us to come to terms with abstract and complex information, by comparing it to something which is structured, familiar and concrete. Although modern science is “iconoclastic”, as Gaston Bachelard phrases it, scientists are at the same time prolific producers of metaphoric images themselves. Synthetic biology is an outstanding example of a technoscientific discourse replete with metaphors, including textual metaphors such as the “Morse code” of life, the “barcode” of life and the “book” of life. This paper focuses on (...) a different type of metaphor, however, namely on the archetypal metaphor of the mandala as a symbol of restored unity and wholeness. Notably, mandala images emerge in textual materials related to one of the new “frontiers” of contemporary technoscience, namely the building of a synthetic cell: a laboratory artefact that functions like a cell and is even able to replicate itself. The mandala symbol suggests that, after living systems have been successfully reduced to the elementary building blocks and barcodes of life, the time has now come to put these fragments together again. We can only claim to understand life, synthetic cell experts argue, if we are able to technically reproduce a fully functioning cell. This holistic turn towards the cell as a meaningful whole also requires convergence at the “subject pole”: the building of a synthetic cell as a practice of the self, representing a turn towards integration, of multiple perspectives and various forms of expertise. (shrink)

This article evaluates seven strategies for managing the high costs of GLP-1 receptor agonists (GLP-1RAs) like semaglutide and tirzepatide for weight management: complete exclusion of coverage, annual cost increase caps, lifetime cost caps, tiered access, formulary reevaluation, subscription payment models, and patent reform. The authors assess each strategy against three ethical objectives: benefiting people and preventing harm, showing equal moral concern, and mitigating disadvantage. Complete coverage exclusions, arbitrary reimbursement caps, and lifetime limits are deemed unethical as they fail to meet (...) these objectives. Tiering access based on relative benefit is considered justifiable, though current implementation often unfairly favors diabetes over obesity treatment. The authors recommend formulary reevaluation as the most ethical approach for smaller health plans, allowing them to prioritize more cost-effective treatments. For larger payers with market power and for governments, subscription payment models and patent reforms are potentially ethical solutions if implemented sustainably. The authors conclude that health plans should avoid ad hoc restrictions on GLP-1RAs in favor of comprehensive policy reforms that ensure sustainable access to these and future breakthrough treatments. (shrink)

Glucagon-like peptide-1 (GLP-1) receptor agonists, such as semaglutide, and dual GLP-1 and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists, such as tirzepatide, have been found to be effective for treating obesity and diabetes, significantly reducing weight and the risk or predicted risk of adverse cardiovascular events. There is a global shortage of these medications that could last several years and raises questions about how limited supplies should be allocated. We propose a fair-allocation framework that enables evaluation of the ethics of current (...) practices and could guide governments, professional societies, and physicians in allocation decisions. (shrink)

¿Qué ocurre con la continuidad del tratamiento de los sujetos de investigación después de que realizan la última visita del ensayo en el que participan? En algunos casos, la falta de continuidad de atención de la salud apropiada podría poner en peligro la salud de estas personas. Por lo tanto, es probable que los sujetos de investigación que al terminar su participación en un ensayo todavía se encuentran enfermos, necesiten continuar con el tratamiento en estudio u otra atención de la (...) salud adecuada por el resto de sus vidas, sean unos pocos meses o muchos años. No obstante, no todas las sociedades cuentan con los recursos e instituciones para resolver el problema de la continuidad de tratamiento beneficioso. La opinión de un sujeto de investigación norteamericano, al que llamaremos Pedro, sin seguro de salud que participó en un ensayo de largo plazo sobre diabetes ejemplifica el problema de la continuidad de tratamiento beneficioso: “de repente [ellos] simplemente cortan la cuerda, y uno está solo por su cuenta, ya sabes. O consigues trescientos o cuatrocientos dólares al mes para seguir con esto o simplemente sigues adelante y mueres”. En este trabajo intentaré dar un panorama de la reciente discusión en torno al problema de la continuidad de tratamiento beneficioso en la ética de la investigación. Por tratamiento beneficioso hago referencia a dos cosas. En primer lugar, el tratamiento beneficioso puede ser (1) el tratamiento en estudio, p. e. el tratamiento o intervención en investigación que estaba recibiendo Pedro para su diabetes en el ejemplo anterior. Una droga o un producto biológico es un tratamiento en estudio para un uso propuesto (indicación) desde el primer ensayo con seres humanos hasta el momento en que es aprobado para su comercialización por las autoridades reguladoras de fármacos. El segundo lugar, el tratamiento beneficioso también puede ser (2) otra atención de la salud apropiada para el sujeto de investigación distinta del tratamiento en estudio, p. e. si existiera un tratamiento alternativo disponible para la enfermedad o condición de Pedro, distinto del tratamiento en estudio, y se justificara hacer la transición a ese otro tratamiento por razones de un mejor perfil de efectividad, seguridad y/o toxicidad. En la sección 1 de este trabajo introduciré una taxonomía de las obligaciones éticas de acceso posinvestigación (1.1.), realizaré un relevamiento histórico del concepto basado en las guías éticas internacionales (1.2) y analizaré el surgimiento del término “continuidad de tratamiento beneficioso hacia los sujetos de investigación” y otros términos análogos como “atención después de la investigación” (1.3). En la sección 2 presentaré los casos ejemplares en la bibliografía: continuidad de tratamiento en investigación en VIH/SIDA (2.1), continuidad de tratamiento en investigación en cáncer (2.2.) y otros casos de continuidad de tratamiento (2.3). (shrink)

The data analyzed in this paper are part of the results described in Bueno et al. (2000). Three cytogenetics endpoints were analyzed in three populations of a species of wild rodent – Akodon montensis – living in an industrial, an agricultural, and a preservation area at the Itajaí Valley, State of Santa Catarina, Brazil. The polychromatic/normochromatic ratio, the mitotic index, and the frequency of micronucleated polychromatic erythrocites were used in an attempt to establish a genotoxic profile of each area. It (...) was assumed that the three populations were in the same conditions with respect to the influence of confounding factors such as animal age, health, nutrition status, presence of pathogens, and intra- and inter-populational genetic variability. Therefore, any differences found in the endpoints analyzed could be attributed to the external agents present in each area. The statistical models used in this paper are mixtures of negative-binomials and Poisson variables. The Poisson variables are used as approximations of binomials for rare events. The mixing distributions are beta densities. The statistical analyzes are under the bayesian perspective, as opposed to the frequentist ones often considered in the literature, as for instance in Bueno et al. (2000). (shrink)

A few decades from now, it might become possible to gestate fetuses in artificial wombs. Ectogestation as this is called, raises major legal and ethical issues, especially for abortion rights. In countries allowing abortion, regulation often revolves around the viability threshold—the point in fetal development after which the fetus can survive outside the womb. How should viability be understood—and abortion thus regulated—after ectogestation? Should we ban, allow or require the use of artificial wombs as an alternative to standard abortions? Drawing (...) on Cohen, I evaluate three possible positions for the post-ectogestative abortion laws: restrictive, conservative and liberal. While the restrictive position appears untenable, I argue that the liberal and conservative positions can be combined to form a legally and morally coherent basis for post-ectogestative abortion legislation, offering an improvement from the point of both prolife and prochoice positions. (shrink)

John McGowan is a prolific humanities scholar whose writings engage topical issues in political philosophy, literary criticism and rhetorical studies. In Pragmatist Politics, American liberal democracy and its contentious philosophical commitments are his chosen subject-matter for a second time. What distinguishes this recent treatment from the one previous—aptly titled American Liberalism (University of North Carolina Press 2007)—is its more thorough grounding in the homegrown American philosophy known as pragmatism. In the introduction, McGowan announces the primary aim of his project: ‘Pragmatism, (...) a philosophy of possibility tied to a commitment to liberal democracy, provides me with the opportunity to articulate in these pages a more expansive vision of what our polity might be’ (xii). Besides ‘a more expansive vision,’ the author catalogues those challenges that the American polity faces today, from culture wars to environmental crises, from wars on drugs and terrorism to the failings in the policy agendas of both the political right and left. So, the question arises: What makes American liberalism capable of ameliorating, if not settling, seemingly intractable policy problems without sacrificing citizens’ effective freedom? The author provides an answer to this question in five chapters, the majority of which can be found in the initial three: the first, ‘The Philosophy of Possibility,’ explores American pragmatism’s potential as a resource in the fight against ideological extremism; the second, ‘Is Progress Possible?’ addresses how hope and progress shape a political environment in continual flux; the third, ‘The Democratic Ethos,’ speaks to the way of life that democracy engenders; and the final two chapters, titled ‘Human Rights’ and ‘Liberal Democracy as Secular Comedy,’ treat the topics of how to alleviate human suffering and bring a healthy dose of humor to the tragedy of liberal politics, respectively. (shrink)

Étant donné la définition de l'eugénisme, il est très difficile d'établir une distinction claire entre la science (médecine, ingénierie génétique) et l'eugénisme en tant que domaine inclus. Et pour définir une ligne sur laquelle l'ingénierie génétique ne devrait pas aller plus loin, conformément aux normes morales, juridiques et religieuses. Si nous acceptons l'aide de la génétique pour trouver des moyens de lutter contre le cancer, le diabète ou le VIH, nous acceptons également l'eugénisme positif tel qu'il est défini à présent. (...) Et si nous acceptons le dépistage génétique et les interventions sur le fœtus, ou l’avortement, nous acceptons implicitement l’eugénisme négatif. En outre, au niveau gouvernemental, bien que l'eugénisme soit officiellement refusé, il a été légalisé dans de nombreux pays jusqu'à récemment et est toujours accepté et légalisé, même sous des formes subtiles, même de nos jours. -/- TABLE: -/- Abstract Introduction 1. Histoire de l'eugénisme - 1.1 Antiquité - 1.2 Le darwinisme social - 1.3 Francis Galton - 1.4 Charles Davenport - 1.5 L'eugenisme en tant que politique d'État - - 1.5.1 L'eugenisme en États-Unis - - 1.5.2 L'eugenisme en Allemagne - 1.6 La période d'après-guerre 2. L'eugénisme actuel - 2.1 L'eugénisme libéral - 2.2 L'eugénisme en tant que politique d'État 3. L'éthique de l'eugénisme 4. L'avenir de l'eugénisme Conclusions Bibliographie -/- DOI: 10.13140/RG.2.2.12520.83203 . (shrink)

Pragmatic presupposition is analyzed in this paper as grounded on an implicit reasoning process based on a set of presumptions, which can define cultural differences. The basic condition for making a presupposition can be represented as a reasoning criterion, namely reasonableness. Presuppositions, on this view, need to be reasonable, namely as the conclusion of an underlying presumptive reasoning that does not or may not contain contradictions with other presumptions, including the ordering of the hierarchy of presumptions. Presumptions are in turn (...) analyzed considering their nature and their hierarchy, namely their object and their possible contextual backing, which eliminates some of their possible defaults. This analysis of presupposition brings to light the relationship between communicative infelicities or misunderstandings deriving from presuppositional failures and the underlying system of presumptions and presumptive reasoning. This approach can be applied to the investigation of communicative problems within the medical context, and more precisely the communication in diabetes cases. (shrink)

Metformin hydrochloride is the first-line anti-diabetic drug used to treat type 2 diabetes mellites and helps to control blood sugar levels. Various brands of metformin are available in the Libyan market which makes it challenging to select, an effective and economical one. This study aimed to compare different brands of metformin available in the Misurata and evaluate the quality parameter according to the British Pharmacopoeia. Six brands of metformin tablets (850 mg) were taken from the market and assessed. To (...) achieve this purpose five tests were done on each brand, the uniformity of weight test shows the average weight and 5.0% deviation, the friability test gives how much the tablet can stand attrition, the disintegration time test shows the time taken by the tablet to disintegrate, dissolution test to confirm the rate of drug release, weight variation and friability test of all brands was within the specified limit. Disintegration time for all the brands was within 30 minutes. All six brands of metformin hydrochloride tablets fulfilled the in-vitro dissolution rate test specification not less than 80% of the drug is released within 45 minutes. Using Ultraviolet-visible (UV) spectroscopy, UV analysis of different samples shows that the percentage content of active ingredients of five brands of metformin hydrochloride tablets was within the monograph specification (95%-105%) of drug content but one brand failed this test. The study indicated that strict quality control of imported drugs should enforced to ensure effective and safe medicines in the Libyan market. (shrink)

Abstract: Tomatoes are part of the major crops in food security. Tomatoes are plants grown in temperate and hot regions of South American origin from Peru, and then spread to most countries of the world. Tomatoes contain a lot of vitamin C and mineral salts, and are recommended for people with constipation, diabetes and patients with heart and body diseases. Studies and scientific studies have proven the importance of eating tomato juice in reducing the activity of platelets in diabetics, which (...) helps in protecting them from developing deadly blood clots. A tomato classification approach is presented with a data set containing approximately 5,266 images with 7 species belonging to tomatoes. The Neural Network Algorithms (CNN), a deep learning technique applied widely in image recognition, is used for this task. (shrink)

Metaphors can be used as crucial tools for reaching shared understanding, especially where an epistemic imbalance of knowledge is at stake. However, metaphors can also represent a risk in intercultural or cross-cultural interactions, namely in situations characterised by little or deficient common ground between interlocutors. In such cases, the use of metaphors can lead to misunderstandings and cause communicative breakdowns. The conditions defining when metaphors promote, and hinder understanding have not been analyzed in detail, especially in intracultural contexts. This study (...) proposes an analysis of metaphors identified within an Italian corpus of diabetes care interviews. Through a coding scheme capturing the types and the probative weights of the linguistic evidence that can be used to detect misunderstandings, the communicative effectiveness of metaphors is indirectly assessed. The quantitative and qualitative analyses show a positive correlation between metaphor use and problematic understanding. A more detailed scrutiny of the interlocutors’ roles and topics of the metaphors points out that most of the problematic metaphors are used by patients, while most of the problematic ones used by providers concern non-clinical matters. These results can be explained as resulting from incorrect presumptions of common ground between the interlocutors. (shrink)

As eugenics is defined, it is very difficult to make a clear distinction between science (medicine, genetic engineering) and eugenics as a included field. And to set a line over which genetic engineering should not go further, according to moral, legal and religious norms. If we accept the help of genetics in finding ways to fight cancer, diabetes, or HIV, we also accept positive eugenics as they are defined now. And if we accept genetic screening, and interventions on the unborn (...) baby, or abortion, we also implicitly accept negative eugenics. In addition, at government level, although eugenics are officially denied, it has been legalized in many countries until recently, and is still accepted and legalized, albeit in subtle forms, even these days. The section Introduction defines the term and classification modes. The section History of Eugenics follows eugenics from the ancient period, the introduction of eugenics by Francis Galton, the practice of eugenics as a state policy in various countries, and the present eugenics (liberal eugenics). I then analyze various issues raised by the Ethics of Liberal Eugenics, and I have developed a special section for the Future of Eugenics, focusing on the human genome project. Finally, in the Conclusions, I express my personal views on the current practice of eugenics. -/- CONTENTS: -/- Abstract Introduction New Eugenics The Future of Eugenics Conclusions Bibliography -/- DOI: 10.13140/RG.2.2.28662.45120. (shrink)

The detection and analysis of misunderstandings are crucial aspects of discourse analysis, and presuppose a twofold investigation of their structure. First, misunderstandings need to be identified and, more importantly, justified. For this reason, a classification of the types and force of evidence of a misunderstanding is needed. Second, misunderstandings reveal differences in the interlocutors’ interpretations of an utterance, which can be examined by considering the presumptions that they use in their interpretation. This paper proposes a functional approach to misunderstandings grounded (...) on presumptive reasoning and types of presumptions, in which incompatible interpretations or interpretative failures are examined as defaults of the underlying interpretative reasoning, caused by overlooked evidence or conflicting presumptions. Moreover, it advances a classification of the types and the probative weights of the evidence that can be used to detect misunderstandings. The proposed methodology and its implications are illustrated through the analysis of doctor–patient communication in diabetes care. (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)

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

Today the whole world is facing a very difficult time due to corona virus which initially originated in Wuhan city of China. In China an unusual pneumonia was noticed earlier which later recognized as a pandemic. There have been two events in the past wherein crossover of animal corona viruses to humans has resulted in severe disease, one was SARS-CoV and the other was MERS-CoV. The genetic sequence of the COVID19 showed more than 80% similarities to SARS-CoV and 50% to (...) the MERSCoV. Corona viruses are enveloped positive sense single-stranded RNA virus belongs to a large family in which all strains of the family do not have virulent capacity. World Health Organisation has classified COVID-19 as a β CoV of group 2B. Structurally, SARS-CoV-2 has four main structural proteins and several accessory proteins through which it enters into the cell. This virus enters the through ACE2 receptors, which are found on various organs in human body. After entering into one body, it enters to another body via transmission through sneezing, coughing etc. People who have had diabetes, chronic respiratory disease, cardiovascular disease, or even high blood pressure and cancer are at higher risk of coronavirus. (shrink)

Avicenna and Al-Ghazali are two Islamic philosophers, who wrote on Islamic philosophy, and were among the most prolific philosophers in philosophy. It can be said that the philosopher is a human being like others, and he is the son of his time in which he is born, and intellectual, political and social events effect of his personality. Therefore, he is known by simply studying the prevailing social pattern of his time. -/- Avicenna was a lover of science and scholars and (...) had knowledge of the methods of literature and philosophy, held the ministry and has many books. -/- For Al-Ghazali, philosophy in his time became public, due to the spread of doctrines and their opposition, and the ideas of Al-Ghazali represented the response to and discussion of philosophers, correcting what required correction, and evaluating what deserved evaluation. -/- Avicenna and Al-Ghazali have authored many books, but what concerns us in this research is a comparison between the natural terms contained in Ibn Sina's Risalat al-Hudud and the Risala al-Hudud by al-Ghazali. -/- . (shrink)

Shadmehr and Ahmed’s book is a welcome extension of optimal foraging theory and neuroeconomics, achieved by integrating both with parameters relating to effort and rate of movement. Their most persuasive and prolific data comes from saccades, where times before and after decision are reasonably determinate. Skeletal movements are less likely to exhibit such tidy temporal organisation.

continent. 1.1 : 3-13. / 0/ – Introduction I want to propose, as a trajectory into the philosophically weird, an absurd theoretical claim and pursue it, or perhaps more accurately, construct it as I point to it, collecting the ground work behind me like the Perpetual Train from China Mieville's Iron Council which puts down track as it moves reclaiming it along the way. The strange trajectory is the following: Kant's critical philosophy and much of continental philosophy which has followed, (...) has been a defense against horror and madness. Kant's prohibition on speculative metaphysics such as dogmatic metaphysics and transcendental realism, on thinking beyond the imposition of transcendental and moral constraints, has been challenged by numerous figures proceeding him. One of the more interesting critiques of Kant comes from the mad black Deleuzianism of Nick Land stating, “Kant’s critical philosophy is the most elaborate fit of panic in the history of the Earth.” And while Alain Badiou would certainly be opposed to the libidinal investments of Land's Deleuzo-Guattarian thought, he is likewise critical of Kant's normative thought-bureaucracies: Kant is the one author for whom I cannot feel any kinship. Everything in him exasperates me, above all his legalism—always asking Quid Juris? Or ‘Haven’t you crossed the limit?’—combined, as in today’s United States, with a religiosity that is all the more dismal in that it is both omnipresent and vague. The critical machinery he set up has enduringly poisoned philosophy, while giving great succour to the academy, which loves nothing more than to rap the knuckles of the overambitious [….] That is how I understand the truth of Monique David-Menard’s reflections on the properly psychotic origins of Kantianism. I am persuaded that the whole of the critical enterprise is set up to to shield against the tempting symptom represented by the seer Swedenborg, or against ‘diseases of the head’, as Kant puts it. An entire nexus of the limits of reason and philosophy are set up here, namely that the critical philosophy not only defends thought from madness, philosophy from madness, and philosophy from itself, but that philosophy following the advent of the critical enterprise philosophy becomes auto-vampiric; feeding on itself to support the academy. Following Francois Laruelle's non-philosophical indictment of philosophy, we could go one step further and say that philosophy operates on the material of what is philosophizable and not the material of the external world. [1] Beyond this, the Kantian scheme of nestling human thinking between our limited empirical powers and transcendental guarantees of categorical coherence, forms of thinking which stretch beyond either appear illegitimate, thereby liquefying both pre-critical metaphysics and the ravings of the mad in the same critical acid. In rejecting the Kantian apparatus we are left with two entities – an unsure relation of thought to reality where thought is susceptible to internal and external breakdown and a reality with an uncertain sense of stability. These two strands will be pursued, against the sane-seal of post-Kantian philosophy by engaging the work of weird fiction authors H.P. Lovecraft and Thomas Ligotti. The absolute inhumanism of the formers universe will be used to describe a Shoggothic Materialism while the dream worlds of the latter will articulate the mad speculation of a Ventriloquil Idealism. But first we must address the relation of philosophy to madness as well as philosophy to weird fiction. /1/ – Philosophy and Madness There is nothing that the madness of men invents which is not either nature made manifest or nature restored. Michel Foucault. Madness and Civilization. The moment I doubt whether an event that I recall actually took place, I bring the suspicion of madness upon myself: unless I am uncertain as to whether it was not a mere dream. Arthur Schopenhauer. The World as Will and Idea, Vol. 3. Madness is commonly thought of as moving through several well known cultural-historical shifts from madness as a demonic or otherwise theological force, to rationalization, to medicalization psychiatric and otherwise. Foucault's Madness and Civilization is well known for orientating madness as a form of exclusionary social control which operated by demarcating madness from reason. Yet Foucault points to the possibility of madness as the necessity of nature at least prior to the crushing weight of the church. Kant’s philosophy as a response to madness is grounded by his humanizing of madness itself. As Adrian Johnston points out in the early pages of Time Driven pre-Kantian madness meant humans were seized by demonic or angelic forces whereas Kantian madness became one of being too human. Madness becomes internalized, the external demonic forces become flaws of the individual mind. Foucault argues that, while madness is de-demonized it is also dehumanized during the Renaissance, as madmen become creatures neither diabolic nor totally human reduced to the zero degree of humanity. It is immediately clear why for Kant, speculative metaphysics must be curbed – with the problem of internal madness and without the external safeguards of transcendental conditions, there is nothing to formally separate the speculative capacities for metaphysical diagnosis from the mad ramblings of the insane mind – both equally fall outside the realm of practicality and quotidian experience. David-Menard's work is particularly useful in diagnosing the relation of thought and madness in Kant's texts. David-Menard argues that in Kant's relatively unknown “An Essay on the Maladies of the Mind” as well as his later discussion of the Seer of Swedenborg, that Kant formulates madness primarily in terms of sensory upheaval or other hallucinatory theaters. She writes: “madness is an organization of thought. It is made possible by the ambiguity of the normal relation between the imaginary and the perceived, whether this pertains to the order of sensation or to the relations between our ideas” Kant's fascination with the Seer forces Kant between the pincers of “aesthetic reconciliation” – namely melancholic withdrawal – and “a philosophical invention” – namely the critical project. Deleuze and Guattari's schizoanalysis is a combination and reversal of Kant's split, where an aesthetic over engagement with the world entails prolific conceptual invention. Their embrace of madness, however, is of course itself conceptual despite all their rhizomatic maneuvers. Though they move with the energy of madness, Deleuze and Guattari save the capacity of thought from the fangs of insanity by imbuing materiality itself with the capacity for thought. Or, as Ray Brassier puts it, “Deleuze insists, it is necessary to absolutize the immanence of this world in such a way as to dissolve the transcendent disjunction between things as we know them and as they are in themselves”. That is, whereas Kant relied on the faculty of judgment to divide representation from objectivity Deleuze attempts to flatten the whole economy beneath the juggernaut of ontological univocity. Speculation, as a particularly useful form of madness, might fall close to Deleuze and Guattari’s shaping of philosophy into a concept producing machine but is different in that it is potentially self destructive – less reliant on the stability of its own concepts and more adherent to exposing a particular horrifying swath of reality. Speculative madness is always a potential disaster in that it acknowledges little more than its own speculative power with the hope that the gibbering of at least a handful of hysterical brains will be useful. Pre-critical metaphysics amounts to madness, though this may be because the world itself is mad while new attempts at speculative metaphysics, at post-Kantian pre-critical metaphysics, are well aware of our own madness. Without the sobriety of the principle of sufficient reason we have a world of neon madness: “we would have to conceive what our life would be if all the movements of the earth, all the noises of the earth, all the smells, the tastes, all the light – of the earth and elsewhere, came to us in a moment, in an instant – like an atrocious screaming tumult of things”. Speculative thought may be participatory in the screaming tumult of the world or, worse yet, may produce its spectral double. Against theology or reason or simply commonsense, the speculative becomes heretical. Speculation, as the cognitive extension of the horrorific sublime should be met with melancholic detachment. Whereas Kant's theoretical invention, or productivity of thought, is self -sabotaging, since the advent of the critical project is a productivity of thought which then delimits the engine of thought at large either in dogmatic gestures or non-systematizable empirical wondrousness. The former is celebrated by the fiction of Thomas Ligotti whereas the latter is espoused by the tales of H.P. Lovecraft. /2/ – Weird Fiction and Philosophy. Supernatural horror, in all its eerie constructions, enables a reader to taste treats inconsistent with his personal welfare. Thomas Ligotti Songs of a Dead Dreamer. I choose weird stories because they suit my inclination best—one of my strongest and most persistent wishes being to achieve,momentarily, the illusion of some strange suspension or violation of the galling limitations of time, space, and natural law which forever imprison us and frustrate our curiosity about the infinite cosmic spaces beyond the radius of our sight and analysis H.P. Lovecraft. “Notes on Writing Weird Fiction” Lovecraft states that his creation of a story is to suspend natural law yet, at the same time, he indexes the tenuousness of such laws, suggesting the vast possibilities of the cosmic. The tension that Lovecraft sets up between his own fictions and the universe or nature is reproduced within his fictions in the common theme of the unreliable narrator; unreliable precisely because they are either mad or what they have witnessed questions the bounds of material reality. In “The Call of Cthulhu” Lovecraft writes: The most merciful thing in the world, I think, is the inability of the human mind to correlate all its contents. We live on a placid island of ignorance in the midst of black seas of infinity, and it was not meant that we should voyage far. The sciences, each straining in its own direction, have hitherto harmed us little; but some day the piecing together of dissociated knowledge will open up such terrifying vistas of reality, and of our frightful position therein, that we shall either go mad from the revelation or flee from the deadly light into the peace and safety of a new dark age. Despite Lovecraft's invocations of illusion, he is not claiming that his fantastic creations such as the Old Ones are supernatural but, following Joshi, are only ever supernormal. One can immediately see that instead of nullifying realism Lovecraft in fact opens up the real to an unbearable degree. In various letters and non-fictional statements Lovecraft espoused strictly materialist tenets, ones which he borrowed from Hugh Elliot namely the uniformity of law, the denial of teleology and the denial of non-material existence. Lovecraft seeks to explore the possibilities of such a universe by piling horror upon horror until the fragile brain which attempts to grasp it fractures. This may be why philosophy has largely ignored weird fiction – while Deleuze and Guattari mark the turn towards weird fiction and Lovecraft in particular, with the precursors to speculative realism as well as contemporary related thinkers have begun to view Lovecraft as making philosophical contributions. Lovecraft's own relation to philosophy is largely critical while celebrating Nietzsche and Schopenhauer. This relationship of Lovecraft to philosophy and philosophy to Lovecraft is coupled with Lovecraft's habit of mercilessly destroying the philosopher and the figure of the academic more generally in his work, a destruction which is both an epistemological destruction and an ontological destruction. Thomas Ligotti's weird fiction which he has designated as a kind of “confrontational escapism” might be best described in the following quote from one of his shortstories, “The human phenomenon is but the sum of densely coiled layers of illusion each of which winds itself on the supreme insanity. That there are persons of any kind when all there can be is mindless mirrors laughing and screaming as they parade about in an endless dream”. Whereas Lovecraft's weirdness draws predominantly from the abyssal depths of the uncharted universe, Ligotti's existential horror focuses on the awful proliferation of meaningless surfaces that is, the banal and every day function of representation. In an interview, Ligotti states: We don't even know what the world is like except through our sense organs, which are provably inadequate. It's no less the case with our brains. Our whole lives are motored along by forces we cannot know and perceptions that are faulty. We sometimes hear people say that they're not feeling themselves. Well, who or what do they feel like then? This is not to say that Ligotti sees nothing beneath the surface but that there is only darkness or blackness behind it, whether that surface is on the cosmological level or the personal. By addressing the implicit and explicit philosophical issues in Ligotti's work we will see that his nightmarish take on reality is a form of malevolent idealism, an idealism which is grounded in a real, albeit dark and obscure materiality. If Ligotti's horrors ultimately circle around mad perceptions which degrade the subject, it takes aim at the vast majority of the focus of continental philosophy. While Lovecraft's acidic materialism clearly assaults any romantic concept of being from the outside, Ligotti attacks consciousness from the inside: Just a little doubt slipped into the mind, a little trickle of suspicion in the bloodstream, and all those eyes of ours, one by one, open up to the world and see its horror [...] Not even the solar brilliance of a summer day will harbor you from horror. For horror eats the light and digests it into darkness. Clearly, the weird fiction of Lovecraft and Ligotti amount to a anti-anthrocentric onslaught against the ramparts of correlationist continental philosophy. /3/ – Shoggothic Materialism or the Formless Formless protoplasm able to mock and reflect all forms and organs and processes—viscous agglutinations of bubbling cells—rubbery fifteen-foot spheroids infinitely plastic and ductile—slaves of suggestion, builders of cities—more and more sullen, more and more intelligent, more and more amphibious, more and more imitative—Great God! What madness made even those blasphemous Old Ones willing to use and to carve such things? H.P. Lovecraft. “At the Mountains of Madness” On the other hand, affirming that the universe resembles nothing and is only formless amounts to saying that the universe is something like a spider or spit. Georges Bataille. “Formless”. The Shoggoths feature most prominently in H.P. Lovecraft's shortstory “At the Mountains of Madness” where they are described in the following manner: It was a terrible, indescribable thing vaster than any subway train – a shapeless congeries of protoplasmic bubbles, faintly self -luminous, and with myriads of temporary eyes forming and un-forming as pustules of greenish light all over the tunnel-filling front that bore down upon us, crushing the frantic penguins and slithering over the glistening floor that it and its kind had swept so evilly free of all litter. The term is a litmus test for materialism itself as the Shoggoth is an amorphous creature. The Shoggoths were living digging machines bio engineered by the Elder Things, and their protoplasmic bodies being formed into various tools by their hypnotic powers. The Shoggoths eventually became self aware and rose up against their masters in an ultimately failed rebellion. After the Elder Ones retreated into the oceans leaving the Shoggoths to roam the frozen wastes of the Antarctic. The onto-genesis of the Shoggoths and their gross materiality, index the horrifyingly deep time of the earth a concept near and dear to Lovecraft's formulation of horror as well as the fear of intelligences far beyond, and far before, the ascent of humankind on earth and elsewhere. The sickly amorphous nature of the Shoggoths invade materialism at large, where while materiality is unmistakably real ie not discursive, psychological, or otherwise overly subjectivist, it questions the relation of materialism to life. As Eugene Thacker writes: The Shoggoths or Elder Things do not even share the same reality with the human beings who encounter them—and yet this encounter takes place, though in a strange no-place that is neither quite that of the phenomenal world of the human subject or the noumenal world of an external reality. Amorphous yet definitively material beings are a constant in Lovecraft's tales. In his tale “The Dream-Quest of Unknown Kadatth” Lovecraft describes Azathoth as, “that shocking final peril which gibbers unmentionably outside the ordered universe,” that, “last amorphous blight of nethermost confusion which blashphemes and bubbles at the centre of all infinity,” who, “gnaws hungrily in inconceivable, unlighted chambers beyond time”. Azathoth's name may have multiple origins but the most striking is the alchemy term azoth which is both a cohesive agent and a acidic creation pointing back to the generative and the decayed. The indistinction of generation and degradation materially mirrors the blur between the natural and the unnatural as well as life and non-life. Lovecraft speaks of the tension between the natural and the unnatural is his short story “The Unnameable.” He writes, “if the psychic emanations of human creatures be grotesque distortions, what coherent representation could express or portray so gibbous and infamous a nebulousity as the spectre of a malign, chaotic perversion, itself a morbid blasphemy against Nature?”. Lovecraft explores exactly the tension outlined at the beginning of this chapter, between life and thought. At the end of his short tale Lovecraft compounds the problem as the unnameable is described as “a gelatin—a slime—yet it had shapes, a thousand shapes of horror beyond all memory”. Deleuze suggests that becoming-animal is operative throughout Lovecraft's work, where narrators feel themselves reeling at their becoming non-human or of being the anomalous or of becoming atomized. Following Eugene Thacker however, it may be far more accurate to say that Lovecraft's tales exhibit not a becoming-animal but a becoming-creature. Where the monstrous breaks the purportedly fixed laws of nature, the creature is far more ontologically ambiguous. The nameless thing is an altogether different horizon for thought. The creature is either less than animal or more than animal – its becoming is too strange for animal categories and indexes the slow march of thought towards the bizarre. This strangeness is, as aways, some indefinite swirling in the category of immanence and becoming. Bataille begins “The Labyrinth” with the assertion that being, to continue to be, is becoming. More becoming means more being hence the assertion that Bataille's barking dog is more than the sponge. This would mean that the Shoggotth is altogether too much being, too much material in the materialism. Bataille suggests that there is an immanence between the eater and the eaten, across the species and never within them. That is, despite the chaotic storm of immanence there must remain some capacity to distinguish the gradients of becoming without reliance upon, or at least total dependence upon, the powers of intellection to parse the universe into recognizable bits, properly digestible factoids. That is, if we undo Deleuze's aforementioned valorization of sense which, for his variation of materialism, performed the work of the transcendental, but refuse to reinstate Kant's transcendental disjunction between thing and appearance, then it must be a quality of becoming-as-being itself which can account for the discernible nature of things by sense. In an interview with Peter Gratton, Jane Bennett formulates the problem thusly: What is this strange systematicity proper to a world of Becoming? What, for example, initiates this congealing that will undo itself? Is it possible to identify phases within this formativity, plateaus of differentiation? If so, do the phases/plateaus follow a temporal sequence? Or, does the process of formation inside Becoming require us to theorize a non-chronological kind of time? I think that your student’s question: “How can we account for something like iterable structures in an assemblage theory?” is exactly the right question. Philosophy has erred too far on the side of the subject in the subject-object relation and has furthermore, lost the very weirdness of the non-human. Beyond this, the madness of thought need not override. /4/ - Ventriloquial Idealism or the Externality of Thought My aim is the opposite of Lovecraft's. He had an appreciation for natural scenery on earth and wanted to reach beyond the visible in the universe. I have no appreciation for natural scenery and want the objective universe to be a reflection of a character. Thomas Ligotti. “Devotees of Decay and Desolation.” Unless life is a dream, nothing makes sense. For as a reality, it is a rank failure [….] Horror is more real than we are. Thomas Ligotti. “Professor Nobody's Little Lectures on Supernatural Horror”. Thomas Ligotti's tales are rife with mannequins, puppets, and other brainless entities which of replace the valorized subject of philosophy – that of the free thinking human being. His tales such as “The Dream of the Manikin” aim to destroy the rootedness of consciousness. James Trafford has connected the anti-egoism of Ligotti to Thomas Metzinger – where the self is at best an illusion and we plead desperately for someone else to acknowledge that we are real. Trafford has stated it thus, “Life is played out as an inescapable puppet show, an endless dream in which the puppets are generally unaware that they are trapped within a mesmeric dance of whose mechanisms they know nothing and over which they have no control”. An absolute materialism, for Ligotti, implies an alienation of the idea which leads to a ventriloquil idealism. As Ligotti notes in an interview, “the fiasco and nightmare of existence, the particular fiasco and nightmare of human existence, the sense that people are puppets of powers they cannot comprehend, etc.” And then further elaborates that,“[a]ssuming that anything has to exist, my perfect world would be one in which everyone has experienced the annulment of his or her ego. That is, our consciousness of ourselves as unique individuals would entirely disappear”. The externality of the idea leads to the unfortunate consequence of consciousness eating at itself through horror which, for Ligotti, is more real than reality and goes beyond horror-as-affect. Beyond this, taking together with the unreality of life and the ventriloquizing of subjectivity, Ligotti's thought becomes an idealism in which thought itself is alien and ultimately horrifying. The role of human thought and the relation of non-relation of horror to thought is not completely clear in Ligotti's The Conspiracy Against the Human Race. Ligotti argues in his The Conspiracy Against the Human Race,that the advent of thought is a mistake of nature and that horror is being in the sense that horror results from knowing too much. Yet, at the same time, Ligotti seems to suggest that thought separates us from nature whereas, for Lovecraft, thought is far less privileged – mind is just another manifestation of the vital principal, it is just another materialization of energy. In his brilliant “Prospects for Post-Copernican Dogmatism” Iain Grant rallies against the negative definition of dogmatism and the transcendental, and suggests that negatively defining both over-focuses on conditions of access and subjectivism at the expense of the real or nature. With Schelling, who is Grant's champion against the subjectivist bastions of both Fichte and Kant, Ligotti's idealism could be taken as a transcendental realism following from an ontological realism. Yet the transcendental status of Ligotti's thought move towards a treatment of the transcendental which may threaten to leave beyond its realist ground. Ligotti states: Belief in the supernatural is only superstition. That said, a sense of the supernatural, as Conrad evidenced in Heart of Darkness, must be admitted if one's inclination is to go to the limits of horror. It is the sense of what should not be- the sense of being ravaged by the impossible. Phenomenally speaking, the super-natural may be regarded as the metaphysical counterpart of insanity, a transcendental correlative of a mind that has been driven mad. Again, Ligotti equates madness with thought, qualifying both as supernatural while remaining less emphatic about the metaphysical dimensions of horror. The question becomes one of how exactly the hallucinatory realm of the ideal relates to the black churning matter of Lovecraft's chaos of elementary particles. In his tale “I Have a Special Plan for This World” Ligotti formulates thus: A: There is no grand scheme of things. B: If there were a grand scheme of things, the fact – the fact – that we are not equipped to perceive it, either by natural or supernatural means, is a nightmarish obscenity. C: The very notion of a grand scheme of things is a nightmarish obscenity. Here Ligotti is not discounting metaphysics but implying that if it does exist the fact that we are phenomenologically ill-equipped to perceive that it is nightmarish. For Ligotti, nightmare and horror occur within the circuit of consciousness whereas for Lovecraft the relation between reality and mind is less productive on the side of mind. It is easier to ascertain how the Kantian philosophy is a defense against the diseases of the head as Kant armors his critical enterprise from too much of the world and too much of the mind. The weird fiction of both Lovecraft and Ligotti demonstrates that there is too much of both feeding into one another in a way that corrodes the Kantian schema throughly, breaking it down into a dead but still ontologically potentiated nigredo. The haunting, terrifying fact of Ligotti's idealism is that the transcendental motion which brought thought to matter, while throughly material and naturalized, brings with it the horror that thought cannot be undone without ending the material that bears it either locally or completely. Thought comes from an elsewhere and an elsewhen being-in-thought. The unthinkable outside thought is as maddening as the unthought engine of thought itself within thought which doesn't exist except for the mind, the rotting décor of the brain. /5/ - Hyperstitional Transcendental Paranoia or Self -Expelled Thought Weird fiction has been given some direct treatment in philosophy in the mad black Deleuzianism of Nick Land. Nick Land along with others in the 1990s created the Cyber Culture Research Unit as well as the research group Hyperstition. The now defunct hyperstitional website, an outgrowth of the Cyber Culture Research Unit, defined hyperstition in the following fourfold: 1-Element of effective culture that makes itself real. 2-Fictional quantity functional as a time-traveling device. 3-Coincidence intensifier. 4-Call to the Old Ones. The distinctively Lovecraftian character of hyperstition is hard to miss as is its Deleuzo-Guattarian roots. In the opening pages of A Thousand Plateaus Deleuze and Guattari write, “We have been criticized for over-quoting literary authors. But when one writes, the only question is which other machine the literary machine can be plugged into”. The indisinction of literature and philosophy mirrors the mess of being and knowing as post-correlationist philosophy, where philosophy tries to make itself real where literature, especially the weird, aims itself at the brain-circuit of horror. The texts of both Lovecraft and Ligotti work through horror as epistemological plasticity meeting with proximity as well as the deep time of Lovecraft and the glacially slow time of paranoia in Ligotti. Against Deleuze, and following Brassier, we cannot allow the time of consciousness, the Bergsonian time of the duree, to override natural time, but instead acknowledge that it is an unfortunate fact of existence as a thinking being. Horror-time, the time of consciousness, with all its punctuated moments and drawn out terrors, cannot compare to the deep time of non-existence both in the unreachable past and the unknown future. The crystalline cogs of Kant's account of experience as the leading light for the possibility of metaphysics must be throughly obliterated. His gloss of experience in Prolegomena to any Future Metaphysics could not be more sterile: Experience consists of intuitions, which belong to the sensibility, and of judgments, which are entirely a work of the understanding. But the judgments which the understanding makes entirely out of sensuous intuitions are far from being judgments of experience. For in the one case the judgment connects only the perceptions as they are given in sensuous intuition [....] Experience consists in the synthetic connection of appearances in consciousness, so far as this connection is necessary. Here it is difficult to dismiss the queasiness that Kant's legalism induces upon sight for both Badiou and David-Menard. Kant's thought becomes, as Foucault says when reflecting on Sade's text in relation to nature, “the savage abolition of itself”. For Badiou, Kant's philosophy simply closes off too much of the outside, freezing the world of thought in an all too limited formalism. Critical philosophy is simply the systematized quarantine on future thinking, on thinking which would threaten the formalism which artificially grants thought its own coherency in the face of madness. Even the becoming-mad of Deleuze, while escaping the rumbling ground, makes grounds for itself, mad grounds but grounds which are thinkable in their affect. The field of effects allows for Deleuze's aesthetic and radical empiricism, in which effects and/or occasions make up the material of the world to be thought as a chaosmosis of simulacra. Given a critique of an empiricism of aesthetics, of the image, it may be difficult to justify an attack on Kantian formalism with the madness of literature, which does not aim to make itself real but which we may attempt to make real. That is, how do Lovecraft's and Ligotti's materials, as materials for philosophy to work on, differ from either the operative formalisms of Kant or the implicitly formalized images of Deleuzian empiricism? It is simply that such texts do not aim to make themselves real, and make claims to the real which are more alien to us than familiar, which is why their horror is immediately more trustworthy. This is the madness which Blanchot discusses in The Infinite Conversation through Cervantes and his knight – the madness of book-life, of the perverse unity of literature and life a discussion which culminates in the discussion of one of the weird's masters, that of Kafka. The text is the knowing of madness, since madness, in its moment of becoming-more-mad, cannot be frozen in place but by the solidifications of externalizing production. This is why Foucault ends his famous study with works of art. Furthermore extilligence, the ability to export the products of our maligned brains, is the companion of the attempts to export, or discover the possibility of intelligences outside of our heads, in order for philosophy to survive the solar catastrophe. To borrow again from Deleuze, writing is inseparable from becoming. The mistake is to believe that madness is reabsorbed by extilligence, by great works, or that it could be exorcised by the expelling of thought into the inorganic or differently organic. Going out of our heads does not guarantee we will no longer mean we cannot still go out of our minds. This is simply because of the outside, of matter, or force, or energy, or thing-in-itself, or Schopenhauerian Will. In Lovecraft’s “The Music of Erich Zahn” an “impoverished student of metaphysics” becomes intrigued by strange viol music coming from above his room. After meeting the musician the student discovers that each night he plays frantic music at a window in order to keep some horridness at bay, some “impenetrable darkness with chaos and pandemonium”. The aesthetic defenses provided by the well trained brain can bear the hex of matter for so long, the specter of unalterability within it which too many minds obliterate, collapsing everything before the thought of thought as thinkable or at least noetically mutable on our own terms. Transcendental paranoia is the concurrent nightmare and promise of Paul Humphrey's work, of being literally out of our minds. It is the gothic counterpart of thinking non-conceptually but also of thinking never belonging to any instance of purportedly solid being. As Bataille stated, “At the boundary of that which escapes cohesion, he who reflects within cohesion realizes there is no longer any room for him” Thought is immaterial only to the degree that it is inhuman, it is a power that tries, always with failure, to ascertain its own genesis. Philosophy, if it can truly return to the great outdoors, if it can leave behind the dead loop of the human skull, must recognize not only the non-priority of human thought, but that thought never belongs to the brain that thinks it, thought comes from somewhere else. To return to the train image from the beginning “a locomotive rolling on the surface of the earth is the image of continuous metamorphosis” this is the problem of thought, and of thinking thought, of being no longer able to isolate thought, with only a thought-formed structure. [1] One of the central tenets of Francois Laruelle's non-philosophy is that philosophy has traditionally operated on material already presupposed as thinkable instead of trying to think the real in itself. Philosophy, according to Laruelle, remains fixated on transcendental synthesis which shatters immanence into an empirical datum and an a prori factum which are then fused by a third thing such as the ego. For a critical account of Laruelle's non-philosophy see Ray Brassier's Nihil Unbound. (shrink)

Contemporary theoretical physics is divided into diversified theories of different phenomena. These are characteristically frameworks for giving mathematical descriptions of perceptions, in the absence of understandable explanations or a unified worldview. This is not an optimal state of affairs, for people by nature desire to understand; this sets a major obstacle for an optimal progress rate of physics, for understandable explanations are more prolific of new predictions and applications than non-understandable explanations. Disunification in physics can be remedied only by discovering (...) an understandable ontology and applying it as the basis of unifying explanations of phenomena that were earlier explained by different theories. Due to disunified physics and the nature of traditional analysis in philosophy, there is no consensus about central concepts such as time, possibility and truth. It is suggested that philosophical analysis would be more prolific of understandable and applicable concepts, were it complemented by a method of unification. (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)

This chapter explores insights concerning the relations among imagination, imagined selves, and knowledge of one’s own self that are to be found in Fernando Pessoa’s The Book of Disquiet. The insights are explored via close reading of the text and comparison with contemporaries of Pessoa. First, a tempting account of the importance of imagination in The Book of Disquiet is set out. On this reading, Pessoa is immersed in miasmatic boredom, but able to temporarily rise above it through the restorative (...) powers of escapist imagination. But, it is suggested, Pessoa neither enjoys his prolific imaginings, nor returns from them restored. It is argued that Pessoa’s disquiet owes to failures of imagination; the book presents a sharp contrast between Pessoa’s keen awareness of the importance of a successful, active imaginative life, and his failure to maintain such a thing. It is further argued that these failures point us towards a better account of imagination’s importance to Pessoa, an account that both prefigures and goes beyond Sartre’s ideas about the relations between nothingness, imagination, and self-consciousness. (shrink)

Research ethics committees and institutional review boards spend considerable time developing, scrutinising, and revising specific consent processes and materials for survey-based studies conducted on crowdsourcing and online recruitment platforms such as MTurk and Prolific. However, there is evidence to suggest that many users of ICT services do not read the information provided as part of the consent process and they habitually provide or refuse their consent without adequate reflection. In principle, these practices call into question the validity of their consent. (...) In this paper we argue that although the ‘no read problem’ and the routinisation of consent may apply to research participants’ consent practices for studies on crowdsourcing platforms, this is not a serious problem. Furthermore, given that the informational requirements for informed consent in these contexts are minimal, we argue that these participants are, nevertheless, sufficiently informed to give valid consent. We conclude that research ethics committees and institutional review boards should only agonise over the precise details of the informed consent process and materials in those rare cases where appreciable risks to research participants need to be managed. (shrink)

The proposition that digital innovations can put people in charge of their health has been accompanied by prolific talk of empowerment. In this paper we consider ethical challenges and opportunities of trying to achieve justice and empowerment using digital health initiatives. The language of empowerment can misleadingly suggest that by using technology, people can control their health and take responsibility for health outcomes to a greater degree than is realistic or fair. Also, digital health empowerment often primarily reaches people who (...) already have high technological and health literacy, leaving others behind. We critically investigate whether the concept of health empowerment could be re-engineered to mean something different, namely the process of improving the health literacy and access of those who least possess it, in line with recent proposals for conceptual engineering in the service of justice. We settle on the weaker conclusion that underlying ethical values including justice should be used to interpret the existing concept of empowerment. To conclude, we take a high-level view of various strategies for achieving the ethical value associated with digital health empowerment. (shrink)

Postpartum depression is a major maternal health problem after childbirth. It can start at any time within the first year after delivery and continue for several years. It is characterized by an inability to experience pleasure, anxiety symptoms, panic attacks, spontaneous crying and depressed mood. Some women with postpartum depression even have thoughts of harming their child and self-harm. This study aims to find out the status of postpartum depression and the associated factors among postnatal mothers at the first, fourth (...) and sixth month. This study is a prospective descriptive study, carried out in three major health facilities in Misurata. This study consists of a three-part questionnaire. Part 1 covers the demographic characteristics of the participants, while Part 2 explores the associated risk factors according to the variables used. Part 3 consists of the psychological evaluation of the participants. A hundred mothers (ages between 15 and 43 years) were enrolled in this study. The findings revealed that the prevalence of depression is 60.0% and 22.0% are suffering from borderline depression. Development of depression was strongly correlated with sleeping disturbances, the state of the neonate after birth, excess consumption of stimulants, less weight acceptance by mothers during pregnancy and infant illness. There was a weak relation between depression and delivery state, maternal admission to the hospital during the current pregnancy, and infant gender dissatisfaction. No correlation was found with the development of depression regarding miscarriage, maternal medical problems after delivery, previous child sex, maternal age, education, parity or neonate weight. Thus, this study shows that the chance of having a miscarriage and an unhealthy neonate increases with advanced maternal age. It also shows that caesarean section is associated with bad neonatal outcomes, more weight gain and having gestational diabetes or preeclampsia during pregnancy. Maternal sleeping problems are more pronounced in the first month, attributed to the baby's care, compared with the fourth and sixth months. The study indicates that depression is a common state of psychiatric disorders among Libyan women and should have appropriate attention by physicians and gynecologists. (shrink)

Dharmakīrti’s (c. seventh century) Examination of Relations (Sambandhaparīkṣā) is unique in the Indian Buddhist canon for its being the only extant root text devoted entirely to the topic of the ontological status of relations. But the core thesis of this treatise—that relations are only nominally real—is in prima facie tension with another claim that is central to Dharmakīrti’s epistemology: that there exists some kind of “natural relation” (svabhāvapratibandha) that reliably underwrites inferences. Understanding how Dharmakīrti can consistently rely on natural relations (...) to prop up his presentation of inferential reasoning while at the same time advancing an anti-realist account of relations is critical for making sense of his system of logic and epistemology, which came to be nearly universally adopted in Tibetan Buddhism cutting across traditions. Chomden Rikpé Reldri (1227–1305), who was perhaps the most prolific commentator on logic and epistemology in the history of Tibetan philosophy, composed two texts commenting on the Examination of Relations, neither of which have received any scholarly attention to date. In this paper, I provide an introduction to Chomden Reldri’s two commentaries and consider how they may illuminate Dharmakīrti’s text and also what they reveal about the understanding of Dharmakīrti’s account of relations in early Tibetan scholasticism. I then present a translation of Dharmakīrti’s Examination of Relations together with Chomden Reldri’s commentary, Annotations and Topical Outline of the Examination of Relations (’Brel pa brtag pa’i mchan dang sa bcad gnyis). (shrink)

Zygmunt Bauman wrote tirelessly on the ever-changing world that we live in, lucidly analysing our contemporary times in an intelligent and insightful manner in both oral and written discourses where the topics ranged from Holocaust reflections, modernity and postmodernity, urban and social liquidity and mobility, and utopia and dystopia, to mention but a few. In his astute observations Bauman paints an often sombre and depressing picture of society and the role we play in it. Writing at length on modernity and (...) postmodernity (the latter dependent on the former for its existence), the Polish sociologist, who was impressively prolific during his lengthy career at the University of Leeds, presents us with a world in flux, one in which citizens likened to hunters lead an increasingly solitary and rootless existence in the name of staunch individualism while, all along, they seemingly push faster and increasingly desperately into an uncertain future. In Bauman’s many accounts, these members, or denizens, of the postmodern habitat lead an ambivalent existence in an apparent utopia that is far from as utopic as one would have hoped for. This article will discuss Bauman’s views on modernity and postmodernity, social fluidity and identity change, ultimately highlighting the importance of his works and the great legacy Zygmunt Bauman has left behind. -/- Key words: Zygmunt Bauman, Fluid, Liquid, Modernity, Postmodernity . (shrink)

Postpartum depression is a major maternal health problem after childbirth. It can start at any time within the first year after delivery and continue for several years. It is characterized by an inability to experience pleasure, anxiety symptoms, panic attacks, spontaneous crying and depressed mood. Some women with postpartum depression even have thoughts of harming their child and self-harm. This study aims to find out the status of postpartum depression and the associated factors among postnatal mothers at the first, fourth (...) and sixth month. This study is a prospective descriptive study, carried out in three major health facilities in Misurata. This study consists of a three-part questionnaire. Part 1 covers the demographic characteristics of the participants, while Part 2 explores the associated risk factors according to the variables used. Part 3 consists of the psychological evaluation of the participants. A hundred mothers (ages between 15 and 43 years) were enrolled in this study. The findings revealed that the prevalence of depression is 60.0% and 22.0% are suffering from borderline depression. Development of depression was strongly correlated with sleeping disturbances, the state of the neonate after birth, excess consumption of stimulants, less weight acceptance by mothers during pregnancy and infant illness. There was a weak relation between depression and delivery state, maternal admission to the hospital during the current pregnancy, and infant gender dissatisfaction. No correlation was found with the development of depression regarding miscarriage, maternal medical problems after delivery, previous child sex, maternal age, education, parity or neonate weight. Thus, this study shows that the chance of having a miscarriage and an unhealthy neonate increases with advanced maternal age. It also shows that caesarean section is associated with bad neonatal outcomes, more weight gain and having gestational diabetes or preeclampsia during pregnancy. Maternal sleeping problems are more pronounced in the first month, attributed to the baby's care, compared with the fourth and sixth months. The study indicates that depression is a common state of psychiatric disorders among Libyan women and should have appropriate attention by physicians and gynecologists. (shrink)