Weight-gain in psychiatric populations is a common clinical challenge. Many patients suffering from mental disorders, when exposed to psychotropic medications, gain significant weight with or without other side-effects. In addition to reducing the patients' willingness to comply with treatment, this weight-gain may create added psychological or physiological problems that need to be addressed. Thus, it is critical that clinicians take precautions to monitor and control weight-gain and take into account and treat all problems facing an individual. In this review, we (...) examine some of the key issues surrounding weight-gain in individuals suffering from mental disorders for contemporary practitioners in community clinics. We describe some factors known to make certain patients more susceptible to treatment-induced weight-gain and mechanisms implicated in this process. We also highlight a few psychological and pharmacological interventions that have proven effective in weight management. Importantly, we provide critical steps for management and prevention of weight-gain and related issues in the clinical practice of psychopharmacology. (shrink)

Medical tourism is a practice, whereby individuals travel across national borders with the intention of receiving medical care. Medical tourists are motivated to travel abroad by a number of factors, including the affordability of care abroad, access to treatments not available at home, and wait times for care at home. In this article, we share the findings of interviews conducted with 32 Canadian medical tourists with the aim of developing a better understanding of medical tourism, the ethical issues it raises (...) for public health within Canada and other source countries for medical tourists, and to identify research gaps and policy responses to this practice. While patient and academic perspectives overlap in several regards, we suggest areas in which academic consideration of the ethical issues raised by medical tourism can be informed by patient perspectives. (shrink)

This important volume explores alternative ways in which those involved in the field of speech communication have attempted to find a philosophical grounding for rhetoric. Recognizing that rhetoric can be supported in a wide variety of ways, this text examines eight different philosophies of rhetoric: realism, relativism, rationalism, idealism, materialism, existentialism, deconstructionism, and pragmatism. The value of this book lies in its pluralistic and comparative approach to rhetorical theory. Although rhetoric may be the more difficult road to philosophy, the fact (...) that it is being traversed by a group of authors largely from speech communication demonstrates important growth in this field. Ultimately, there is recognition that if different thinkers can have solid reasons to adhere to disparate philosophies, serious communication problems can be eliminated. _Rhetoric and Philosophy_ will assist scholars in choosing from among the many philosphical starting places for rhetoric. (shrink)

The randomised controlled trial (RCT) constitutes a quantitative, comparative, controlled study of a particular treatment, and provides invaluable evidence regarding its pharmacotherapeutic efficacy. These studies are generally predicated upon the ethical principle of clinical equipoise. However, this may be insufficient to justify withholding treatment from a control group while assessing drug therapy in a potentially fatal disease. Thus, the criteria for randomisation, informed consent methodology and timing, and consideration of treatment options in such a scenario remain the province of medical (...) ethics. This paper addresses the need for an RCT of ribavirin in the treatment of Crimean Congo haemorrhagic fever, and highlights underlying ethical concerns in light of the current medical, virological and ethical literature. (shrink)

Medical tourism—the practice where patients travel internationally to privately access medical care—may limit patients’ regular physicians’ abilities to contribute to the informed decision-making process. We address this issue by examining ways in which Canadian family doctors’ typical involvement in patients’ informed decision-making is challenged when their patients engage in medical tourism.

Medical tourists, persons that travel across international borders with the intention to access non-emergency medical care, may not be adequately informed of safety and ethical concerns related to the practice of medical tourism. Researchers indicate that the sources of information frequently used by medical tourists during their decision-making process may be biased and/or lack comprehensive information regarding individual safety and treatment outcomes, as well as potential impacts of the medical tourism industry on third parties. This paper explores the feedback from (...) former Canadian medical tourists regarding the use of an information sheet to address this knowledge gap and raise awareness of the safety and ethical concerns related to medical tourism. (shrink)

BackgroundMedical tourism, the practice of persons intentionally travelling across international boundaries to access medical care, has drawn increasing attention from researchers, particularly in relation to potential ethical concerns of this practice. Researchers have expressed concern for potential negative impacts to individual safety, public health within both countries of origin for medical tourists and destination countries, and global health equity. However, these ethical concerns are not discussed within the sources of information commonly provided to medical tourists, and as such, medical tourists (...) may not be aware of these concerns when engaging in medical tourism. This paper describes the methodology utilized to develop an information sheet intended to be disseminated to Canadian medical tourists to encourage contemplation and further public discussion of the ethical concerns in medical tourism.MethodsThe methodology for developing the information sheet drew on an iterative process to consider stakeholder feedback on the content and use of the information sheet as it might inform prospective medical tourists’ decision making. This methodology includes a literature review as well as formative research with Canadian public health professionals and former medical tourists.ResultsThe final information sheet underwent numerous revisions throughout the formative research process according to feedback from medical tourism stakeholders. These revisions focused primarily on making the information sheet concise with points that encourage individuals considering travelling for medical tourism to do further research regarding their safety both within the destination country, while travelling, and once returning to Canada, and the potential impacts of their trip on third parties. This methodology may be replicated for the development of information sheets intending to communicate ethical concerns of other practices to providers or consumers of a certain service. (shrink)

Medical tourism, the practice of persons intentionally travelling across international boundaries to access medical care, has drawn increasing attention from researchers, particularly in relation to potential ethical concerns of this practice. Researchers have expressed concern for potential negative impacts to individual safety, public health within both countries of origin for medical tourists and destination countries, and global health equity. However, these ethical concerns are not discussed within the sources of information commonly provided to medical tourists, and as such, medical tourists (...) may not be aware of these concerns when engaging in medical tourism. This paper describes the methodology utilized to develop an information sheet intended to be disseminated to Canadian medical tourists to encourage contemplation and further public discussion of the ethical concerns in medical tourism. The methodology for developing the information sheet drew on an iterative process to consider stakeholder feedback on the content and use of the information sheet as it might inform prospective medical tourists’ decision making. This methodology includes a literature review as well as formative research with Canadian public health professionals and former medical tourists. The final information sheet underwent numerous revisions throughout the formative research process according to feedback from medical tourism stakeholders. These revisions focused primarily on making the information sheet concise with points that encourage individuals considering travelling for medical tourism to do further research regarding their safety both within the destination country, while travelling, and once returning to Canada, and the potential impacts of their trip on third parties. This methodology may be replicated for the development of information sheets intending to communicate ethical concerns of other practices to providers or consumers of a certain service. (shrink)

In De Anima II.6, Aristotle divides the objects of perception into three kinds: “special perceptibles" (idia aisthêta) such as colours, sounds and flavours, which can be perceived in their own right by only one sense; “common perceptibles" (koina aisthêta) such as shapes, sizes and movements, which can be perceived in their own right by multiple senses; and “incidental perceptibles,” such as the son of Diares, which can be perceived only “incidentally” (kata sumbebêkos). In this paper, I examine this division of (...) perceptibles and consider what it amounts to. First, I argue that Aristotle’s distinction between perceiving something in its own right (kath' hauto) and perceiving it incidentally marks a causal distinction: what is perceived in its own right causes perception as such, whereas what is perceived incidentally coincides with what is perceived in its own right. Second, I argue that for Aristotle special perceptibles, unlike common perceptibles, belong to homogeneous bodies on account of their chemical composition. Finally, I explain the primacy Aristotle assigns to special perceptibles and his claim that perception of them alone is free from error. I conclude with some brief remarks on Aristotle and the primary/secondary quality distinction. (shrink)

Background: Medical tourism, thought of as patients seeking non-emergency medical care outside of their home countries, is a growing industry worldwide. Canadians are amongst those engaging in medical tourism, and many are helped in the process of accessing care abroad by medical tourism brokers - agents who specialize in making international medical care arrangements for patients. As a key source of information for these patients, brokers are likely to play an important role in communicating the risks and benefits of undergoing (...) surgery or other procedures abroad to their clientele. This raises important ethical concerns regarding processes such as informed consent and the liability of brokers in the event that complications arise from procedures. The purpose of this article is to examine the language, information, and online marketing of Canadian medical tourism brokers' websites in light of such ethical concerns. Methods: An exhaustive online search using multiple search engines and keywords was performed to compile a comprehensive directory of English-language Canadian medical tourism brokerage websites. These websites were examined using thematic content analysis, which included identifying informational themes, generating frequency counts of these themes, and comparing trends in these counts to the established literature. Results: Seventeen websites were identified for inclusion in this study. It was found that Canadian medical tourism broker websites varied widely in scope, content, professionalism and depth of information. Three themes emerged from the thematic content analysis: training and accreditation, risk communication, and business dimensions. Third party accreditation bodies of debatable regulatory value were regularly mentioned on the reviewed websites, and discussion of surgical risk was absent on 47% of the websites reviewed, with limited discussion of risk on the remaining ones. Terminology describing brokers' roles was somewhat inconsistent across the websites. Finally, brokers' roles in follow up care, their prices, and the speed of surgery were the most commonly included business dimensions on the reviewed websites. Conclusion: Canadian medical tourism brokers currently lack a common standard of care and accreditation, and are widely lacking in providing adequate risk communication for potential medical tourists. This has implications for the informed consent and consequent safety of Canadian medical tourists. (shrink)

The sense of smell occupies a peculiar intermediate position within Aristotle's theory of sense perception: odours, like colours and sounds, are perceived at a distance through an external medium of air or water; yet in their nature they are intimately related to flavours, the proper objects of taste, which for Aristotle is a form of touch. In this paper, I examine Aristotle's claims about odour and smell, especially in De Anima II.9 and De Sensu 5, to see what light they (...) shed on his theory of sense perception more generally. In the first half, I argue that neither of the two most influential recent ways of understanding Aristotle's theory of perception can adequately account for what he says about the sense of smell. In the second half, I offer my own positive account, considering and resolving various puzzles raised by Aristotle's claims about the nature of odour and its relation to flavour. Finally, I conclude that Aristotle's discussions of odour and smell suggest a plausible and interesting way of understanding the relationship, on his view, between ordinary, material changes in the sense organs and the activation of the capacity to perceive, considered merely as such. (shrink)

This book presents a posthumous collection of previously uncollected works of political theory written by Whittle Johnston. Johnston believed that both the liberal tradition of political thought and the realist tradition of international thought had contributed much to humanity's store of political wisdom, but that each had limitations that could most easily be recognized by its encounter with the other. His method of accomplishing this task was to examine the liberal conception of political life in general and international political life (...) in particular and then to explore the realist critique of the liberal view, particularly as it was expressed by three great twentieth-century realist thinkers, all of whom were, in their various ways, skeptical of liberal assumptions: Reinhold Niebuhr, Hans Morgenthau, and E. H. Carr. In doing so, Johnston reveals the power of the realist outlook, but also the areas in which it remains insufficient, and insufficient particularly where it underestimates the complexity and prudence that liberalism is capable of displaying. There have been studies of both liberalism and realism, but no other work has put them into conversation with each other in the way that this book does. (shrink)

People are motivated to acquire self-evaluative information that favours themselves or information that confirms their present self-views. We proposed that par...

The general process view of learning, which guided research into learning for the first half of this century, has come under attack in recent years from several quarters. One form of criticism has come from proponents of the so-called biological boundaries approach to learning. These theorists have presented a variety of data showing that supposedly general laws of learning may in fact be limited in their applicability to different species and learning tasks, and they argue that the limitations are drawn (...) by the nature of each species' adaptation to the particular requirements of its natural environment. The biological boundaries approach has served an important critical function in the move away from general process learning theory, but it is limited in its ability to provide an alternative to the general process approach. In particular, the biological boundaries approach lacks generality, it is in some respects subservient to the general process tradition, and its ecological content is in too many cases limited toex post factoadaptive explanations of learning skills. A contrasting, ecological approach to learning, which can provide a true alternative to general process theory, is presented. The ecological approach begins by providing an ecological task description for naturally occurring instances of learning; this step answers the question:Whatdoes this animal learn to do? The next step is an analysis of the means by which learning occurs in the course of development, answering the question:Howdoes the animal learn to do this? On the basis of such analyses, local principles of adaptation are formulated to account for the learning abilities of individual species. More global principles are sought by generalization among these local principles and may form the basis for a general ecological theory of learning. (shrink)

We introduce the resurrection axioms, a new class of forcing axioms, and the uplifting cardinals, a new large cardinal notion, and prove that various instances of the resurrection axioms are equiconsistent over ZFC with the existence of an uplifting cardinal.

Canada's enduring success has been based on trust--trust in each other; in our businesses, organizations, and markets; and in our public institutions and the officials who run them. David Johnston--reflecting on seven decades of personal experiences including seven years as Governor General--identifies the 20 ways we can make ourselves, our organizations, and our institutions even more worthy of trust, and in doing so build a better Canada for coming generations and the world. This new book is in part a follow-up (...) to The Idea of Canada, in that the author draws upon his own remarkable experience to illustrate where his strong convictions have come from. In this book, however, Johnston strikes notes that are more universally applicable than those in any of this earlier works. First, he speaks directly to the reader, offering practical advice about the attitudes, approaches, and habits that make a person trustworthy. Second, he offers compelling evidence that enduring community trust can be built with similarly simple techniques. Third, by drawing examples from Canadian and international experience, he shows how a whole nation can become trustworthy and, ultimately, trusted by its citizens, allies, trading partners and other societies. In short, Trust is a much needed manual for the repair of the one social quality on which all others are based. (shrink)

Using the lottery preparation, we prove that any strongly unfoldable cardinal $\kappa$ can be made indestructible by all.

The prospect of using cell-based interventions to treat neurological conditions raises several important ethical and policy questions. In this target article, we focus on issues related to the unique constellation of traits that characterize CBIs targeted at the central nervous system. In particular, there is at least a theoretical prospect that these cells will alter the recipients' cognition, mood, and behavior—brain functions that are central to our concept of the self. The potential for such changes, although perhaps remote, is cause (...) for concern and careful ethical analysis. Both to enable better informed consent in the future and as an end in itself, we argue that early human trials of CBIs for neurological conditions must monitor subjects for changes in cognition, mood, and behavior; further, we recommend concrete steps for that monitoring. Such steps will help better characterize the potential risks and benefits of CBIs as they are tested and potentially used for treatment. (shrink)

Objective Ethical standards state research participation must be voluntary and free of coercion and undue influence, but what if a third party appears to engage in research-relevant coercion, without the researchers’ knowledge? This case study describes this type of situation and its resolution. Methods We are engaged in a randomized clinical trial evaluating pedestrian safety with 7- and 8- years old. Depending on children's rate of learning, families receive up to $1275 for their time. We recently learned a third-party “talent (...) agency,” a firm placing children in modeling and acting jobs, was referring families to our research with the expectation that families would share 20% of study reimbursements. Results We sensed clear impropriety, but identified no ethical violations on our part as researchers. Once paid a study reimbursement, participants can spend funds how they wish. We were concerned, however, that the third-party was exploitatively coercing families to participate. Conclusions We pursued four avenues to resolve the issue. First, we documented the situation to our university Institutional Review Board. Second, we contacted the talent agency and requested they stop referring families to our research. They agreed. Third, we retained children engaged in our study who were referred from the talent agency; removing them partway through the clinical trial could impact study results. In doing so, we explained that we were unaware of the talent agency referral and that they were not obligated by us to offer a portion of the study reimbursement to the talent agency. Last, we asked newly enrolled families about their referral source. (shrink)

Experiential evidence shows that pain is associated with common meanings. These include a meaning of threat or danger, which is experienced as immediately distressing or unpleasant; cognitive meanings, which are focused on the long-term consequences of having chronic pain; and existential meanings such as hopelessness, which are more about the person with chronic pain than the pain itself. This interdisciplinary book - the second in the three-volume Meanings of Pain series edited by Dr Simon van Rysewyk - aims to better (...) understand pain by describing experiences of pain and the meanings these experiences hold for the people living through them. The lived experiences of pain described here involve various types of chronic pain, including spinal pain, labour pain, rheumatic pain, diabetic peripheral neuropathic pain, fibromyalgia, complex regional pain syndrome, endometriosis-associated pain, and cancer-related pain. Two chapters provide narrative descriptions of pain, recounted and interpreted by people with pain. Language is important to understanding the meaning of pain since it is the primary tool human beings use to manipulate meaning. As discussed in the book, linguistic meaning may hold clues to understanding some pain-related experiences, including the stigmatisation of people with pain, the dynamics of patient-clinician communication, and other issues, such as relationships between pain, public policy and the law, and attempts to develop a taxonomy of pain that is meaningful for patients. Clinical implications are described in each chapter. This book is intended for people with pain, their family members or caregivers, clinicians, researchers, advocates, and policy makers. (shrink)

We introduce the strongly uplifting cardinals, which are equivalently characterized, we prove, as the superstrongly unfoldable cardinals and also as the almost-hugely unfoldable cardinals, and we show that their existence is equiconsistent over ZFC with natural instances of the boldface resurrection axiom, such as the boldface resurrection axiom for proper forcing.

A collection of new essays on the influential medieval philosopher John Buridan, written by leading Buridan scholars. The volume places Buridan in his philosophical context and examines his writings on topics including logic, modal logic, paradoxes, metaphysics, epistemology, theory of knowledge, moral philosophy, and natural philosophy.

Finitary sketches, i.e., sketches with finite-limit and finite-colimit specifications, are proved to be as strong as geometric sketches, i.e., sketches with finite-limit and arbitrary colimit specifications. Categories sketchable by such sketches are fully characterized in the infinitary first-order logic: they are axiomatizable by σ-coherent theories, i.e., basic theories using finite conjunctions, countable disjunctions, and finite quantifications. The latter result is absolute; the equivalence of geometric and finitary sketches requires (in fact, is equivalent to) the non-existence of measurable cardinals.

Since the early seventeenth century of Bacon, Gallileo and Descartes, the relations between science and religion as well as mind and body have remained volatile fault lines of conflict. The controversies surrounding these relations are as alive and pressing now as at any point over the course of the past four centuries. Adrian Johnston's transcendental materialism offers a new theoretical approach to these issues. Arming himself with resources provided by German idealism, Marxism, psychoanalysis, the life sciences and contemporary philosophical developments, (...) Johnston formulates an account of subjectivity that, although being both materialist and naturalist, does full justice to human beings as irreducible to natural matter alone. At the same time he argues against relapses into idealisms, dualisms and spiritualisms. Adventures in Transcendental Materialism elaborates Johnston's position through critical engagements with some of today's most important thinkers including Slavoj Žižek, Alain Badiou, Catherine Malabou, Jean-Claude Milner, Martin Hägglund, William Connolly, and Jane Bennett"--Back cover. (shrink)

Revisiting the history of relativity Content Type Journal Article DOI 10.1007/s11016-010-9466-4 Authors Lewis Pyenson, Department of History, Western Michigan University, Kalamazoo, MI 49008-5242, USA Sean F. Johnston, School of Interdisciplinary Studies, University of Glasgow, Rutherford-McCowan Building, Dumfries, Glasgow, Scotland G2 0RB, UK Alberto A. Martínez, Department of History, University of Texas at Austin, 1 University Station B7000, Austin, TX 78712-0220, USA Richard Staley, Department of the History of Science, University of Wisconsin-Madison, 226 Bradley Memorial Building, 1225 Linden Drive, Madison, WI (...) 53706-1528, USA Journal Metascience Online ISSN 1467-9981 Print ISSN 0815-0796 Journal Volume Volume 20 Journal Issue Volume 20, Number 1. (shrink)

Many scientists and doctors hope that affordable genome sequencing will lead to more personalized medical care and improve public health in ways that will benefit children, families, and society more broadly. One hope in particular is that all newborns could be sequenced at birth, thereby setting the stage for a lifetime of medical care and self‐directed preventive actions tailored to each child's genome. Indeed, commentators often suggest that universal genome sequencing is inevitable. Such optimism can come with the presumption that (...) discussing the potential limits, cost, and downsides of widespread application of genomic technologies is pointless, excessively pessimistic, or overly cautious. We disagree. Given the pragmatic challenges associated with determining what sequencing data mean for the health of individuals, the economic costs associated with interpreting and acting on such data, and the psychosocial costs of predicting one's own or one's child's future life plans based on uncertain testing results, we think this hope and optimism deserve to be tempered.In the analysis that follows, we distinguish between two reasons for using sequencing: to diagnose individual infants who have been identified as sick and to screen populations of infants who appear to be healthy. We also distinguish among three contexts in which sequencing for either diagnosis or screening could be deployed: in clinical medicine, in public health programs, and as a direct‐to‐consumer service. Each of these contexts comes with different professional norms, policy considerations, and public expectations. Finally, we distinguish between two main types of genome sequencing: targeted sequencing, where only specific genes are sequenced or analyzed, and whole‐exome or whole‐genome sequencing, where all the DNA or all the coding segments of all genes are sequenced and analyzed.In a symptomatic newborn, targeted or genome‐wide sequencing can help guide other tests for diagnosis or for specific treatment that is urgently needed. Clinicians use the infant's symptoms (or phenotype) to interrogate the sequencing data. These same complexities and uncertainties, however, limit the usefulness of genome‐wide sequencing as a population screening tool. While we recognize considerable benefit in using targeted sequencing to screen for or detect specific conditions that meet the criteria for inclusion in newborn screening panels, use of genome‐wide sequencing as a sole screening tool for newborns is at best premature. We conclude that sequencing technology can be beneficially used in newborns when that use is nuanced and attentive to context. (shrink)