Pediatric critical careCritical care refers to the health care of children with life-threatening illness or following major surgery or severe injury. This care is offered in different contexts across the globe. In well-resourced environments, critical careCritical care may be provided in pediatric intensive care units, which provide highly complex medical care with advanced, potentially expensive technological devices aimed primarily at sustaining life; whereas in poorly resourced regions, only primary care may be available for critically ill or injured childrenInjured children. Even (...) where PICU facilities are available, they are a scarce and expensive resource. The knowledge and ability to sustain a critically ill or injured child’sInjured children life, potentially with effects on the child and family’s quality of lifeQuality of life and at the expense of other children’s health care, leads to frequent ethical challenges. Ethical issues related to how best to ensure optimal quality of lifeQuality of life and the fair distribution of scarce resources are common. In-depth knowledge and understanding of the individual patient’s medical, scientific and psychosocial context, through interdisciplinary discussion and collaboration; as well as familiarity with the overriding, relevant ethico-legal policiesPolicy and principles is essential for appropriate decision-makingDecision-making. Truthful communicationCommunication with the family is essential, using a shared decision-makingDecision-making process, and the child’s best interestBest interest must be central to every decision. This chapter presents an overview of the recommended approach to, and important considerations for, ethical decision-makingDecision-making in the PICU, using a hypothetical case example. (shrink)

Executive functions (EFs) and impulsivity are dimensions of self-regulation that are both related to psychopathology. However, self-report measures of impulsivity and laboratory EF tasks typically display small correlations, and existing research indicates that impulsivity and EFs may tap separate aspects of self-regulation that independently statistically predict psychopathology in adulthood. However, relationships between EFs, impulsivity, and psychopathology may be different in childhood compared to adulthood. Here, we examine whether these patterns hold in the baseline assessment of the Adolescent Brain and Cognitive (...) Development (ABCD) sample, a national sample of over 11,000 children (including 749 twin pairs) ages 9–10 years. We examine the phenotypic and genetic relationships among latent variables for different components of EFs and multiple facets of impulsivity. Additionally, we assess how EFs and impulsivity relate to composite measures and latent variables of psychopathology derived from parent report. EFs were weakly correlated with impulsivity, and the strength varied by impulsivity facet, emphasizing their separability. We did not identify significant genetic and environmental correlations between EFs and impulsivity. Moreover, controlling for their small relationships with each other, both EFs and some facets of impulsivity statistically predicted an Externalizing factor, attention problems, and social problems, and twin analyses suggested these relationships were genetic in origin. These findings indicate that EFs and impulsivity represent phenotypically and genetically separable aspects of self-regulation that are both transdiagnostic correlates of psychopathology in childhood. (shrink)

BackgroundThe widespread sharing of biological and biomedical data is recognised as a key element in facilitating translation of scientific discoveries into novel clinical applications and services. At the same time, twenty-first century states are increasingly concerned that this data could also be used for purposes of bioterrorism. There is thus a tension between the desire to promote the sharing of data, as encapsulated by the Open Data movement, and the desire to prevent this data from ‘falling into the wrong hands’ (...) as represented by ‘dual use’ policies. Both frameworks posit a moral duty for life sciences researchers with respect to how they should make their data available. However, Open data and dual use concerns are rarely discussed in concert and their implementation can present scientists with potentially conflicting ethical requirements.DiscussionBoth dual use and Open data policies frame scientific data and data dissemination in particular, though different, ways. As such they contain implicit models for how data is translated. Both approaches are limited by a focus on abstract conceptions of data and data sharing. This works to impede consensus-building between the two ethical frameworks. As an alternative, this paper proposes that an ethics of responsible management of scientific data should be based on a more nuanced understanding of the everyday data practices of life scientists. Responsibility for these ‘micromovements’ of data must consider the needs and duties of scientists as individuals and as collectively-organised groups.SummaryResearchers in the life sciences are faced with conflicting ethical responsibilities to share data as widely as possible, but prevent it being used for bioterrorist purposes. In order to reconcile the responsibilities posed by the Open Data and dual use frameworks, approaches should focus more on the everyday practices of laboratory scientists and less on abstract conceptions of data. (shrink)

The rapid rise of international collaborative science has enabled access to genomic data. In this article, it is argued that to move beyond mapping genomic variation to understanding its role in complex disease aetiology and treatment will require extending data sharing for the purposes of clinical research translation and implementation.

The Genetic Information Nondiscrimination Act of 2008 prohibits most forms of discrimination on the basis of genetic information in health insurance and employment. The findings cited as justification for the act, the almost universal political support for it, and much of the scholarly literature about genetic discrimination, all betray a confusion about what is really at issue. They imply that genetic discrimination is wrong mainly because of genetic exceptionalism: because some special feature of genetic information makes discrimination on the basis (...) thereof wrong. I suggest, to the contrary, that the best arguments against genetic discrimination assume that health care is an entitlement . I do this by examining two different exceptionalist arguments for genetic nondiscrimination, showing that they do not furnish good reasons for prohibiting genetic discrimination unless one supposes that health care is an entitlement. (shrink)

I defend the following version of the ought-implies-can principle: (OIC) by virtue of conceptual necessity, an agent at a given time has an (objective, pro tanto) obligation to do only what the agent at that time has the ability and opportunity to do. In short, obligations correspond to ability plus opportunity. My argument has three premises: (1) obligations correspond to reasons for action; (2) reasons for action correspond to potential actions; (3) potential actions correspond to ability plus opportunity. In the (...) bulk of the paper I address six objections to OIC: three objections based on putative counterexamples, and three objections based on arguments to the effect that OIC conflicts with the is/ought thesis, the possibility of hard determinism, and the denial of the Principle of Alternate Possibilities. (shrink)

Professor Kemp Smith in providing a new edition of Hume’s Dialogues Concerning Natural Religion , embodying all the author’s additions and corrections, has given expression to the perennial interest and fascination which this work has possessed for many minds during the odd one hundred and fifty years since it was first published by Hume’s nephew. The editor himself has performed a great service by contributing an Introduction and a clear and concise summary of the Dialogues , in both of which (...) he expounds his own view as to how Hume’s discussion is to be interpreted. Hume employs three characters—Demea, Philo, and Cleanthes; and. (shrink)

The Acarnanian chrēsmologos Amphilytos spoke the verses to Peisistratos just before the battle of Pallene in 546 b.c. They contain a prediction of imminent victory for Peisistratos and total defeat for the Athenians. The Athenians will be routed and deprived of political self-determination, while the victory will restore to Peisistratos the tyranny from which he was twice forced, ‘rooting’ it once for all. Of course, all of this appears quite evident from the narrative. But as the verses form part of (...) Herodotos' account of Peisistratos' ascent to power they amount to much more, for they constitute penultimate proof of Peisistratos' irresistibility , a recurrent theme in Herodotos' logos, but one which was undoubtedly encouraged by his Athenian sources as a means of explaining how the Athenians were forced to yield the tyranny. Indeed, the theme of irresistibility helps to excuse the Athenians for being overcome; as much of the logos, which is historically quite vague, it is a reaction to fact, not factual itself. (shrink)

We analyse the effect of the regulatory T cells (Tregs) in the local control of the immune responses by T cells. We obtain an explicit formula for the level of antigenic stimulation of T cells as a function of the concentration of T cells and the parameters of the model. The relation between the concentration of the T cells and the antigenic stimulation of T cells is an hysteresis, that is unfold for some parameter values. We study the appearance of (...) autoimmunity from cross-reactivity between a pathogen and a self antigen or from bystander proliferation. We also study an asymmetry in the death rates. With this asymmetry we show that the antigenic stimulation of the Tregs is able to control locally the population size of Tregs. Other effects of this asymmetry are a faster immune response and an improvement in the simulations of the bystander proliferation. The rate of variation of the levels of antigenic stimulation determines if the outcome is an immune response or if Tregs are able to maintain control due to the presence of a transcritical bifurcation for some tuning between the antigenic stimuli of T cells and Tregs. This behavior is explained by the presence of a transcritical bifurcation. (shrink)

Unrecognized presuppositions about patient appearance have become increasingly important in medicine, medical ethics and medical law. Symptoms of these historically conditioned assumptions include common ageism, aesthetic surgery, and litigation about ‘wrongful life’. These phenomena suggest a societal intolerance for what is considered an ‘abnormal’ appearance. Among others, eighteenth-century artists and anatomists helped to set these twentieth-century precedents, actually measuring deviations of external traits to analogous deformations of the soul, and drawing moral conclusions from physiognomic measurements. Other eighteenth-century artists countered with (...) pathognomy, recognizing that uneven physical features may indicate humanity, instead of character flaws. We suggest that there is an important and as yet unrecognized role played by visual and perceptual preferences in our judgments concerning normalcy and anomaly. We further suggest a shift away from our current fashion-magazine, youth-oriented aesthetic, and towards an aesthetic of imperfection. Physicians and medical students can be made aware of their historically conditioned reactions to ‘abnormal’ appearing patients by studying the understandings and methods with which artists have portrayed those who are considered deformed in appearance. (shrink)

PREFACE. THE Author of this very practical treatise on Scotch Loch - Fishing desires clearly that it may be of use to all who had it. He does not pretend to have written anything new, but to have attempted to put what he has to say in as readable a form as possible. Everything in the way of the history and habits of fish has been studiously avoided, and technicalities have been used as sparingly as possible. The writing of this (...) book has afforded him pleasure in his leisure moments, and that pleasure would be much increased if he knew that the perusal of it would create any bond of sympathy between himself and the angling community in general. This section is interleaved with blank shects for the readers notes. The Author need hardly say that any suggestions addressed to the case of the publishers, will meet with consideration in a future edition. We do not pretend to write or enlarge upon a new subject. Much has been said and written-and well said and written too on the art of fishing but loch-fishing has been rather looked upon as a second-rate performance, and to dispel this idea is one of the objects for which this present treatise has been written. Far be it from us to say anything against fishing, lawfully practised in any form but many pent up in our large towns will bear us out when me say that, on the whole, a days loch-fishing is the most convenient. One great matter is, that the loch-fisher is depend- ent on nothing but enough wind to curl the water, -and on a large loch it is very seldom that a dead calm prevails all day, -and can make his arrangements for a day, weeks beforehand whereas the stream- fisher is dependent for a good take on the state of the water and however pleasant and easy it may be for one living near the banks of a good trout stream or river, it is quite another matter to arrange for a days river-fishing, if one is looking forward to a holiday at a date some weeks ahead. Providence may favour the expectant angler with a good day, and the water in order but experience has taught most of us that the good days are in the minority, and that, as is the case with our rapid running streams, -such as many of our northern streams are, -the water is either too large or too small, unless, as previously remarked, you live near at hand, and can catch it at its best. A common belief in regard to loch-fishing is, that the tyro and the experienced angler have nearly the same chance in fishing, -the one from the stern and the other from the bow of the same boat. Of all the absurd beliefs as to loch-fishing, this is one of the most absurd. Try it. Give the tyro either end of the boat he likes give him a cast of ally flies he may fancy, or even a cast similar to those which a crack may be using and if he catches one for every three the other has, he may consider himself very lucky. Of course there are lochs where the fish are not abundant, and a beginner may come across as many as an older fisher but we speak of lochs where there are fish to be caught, and where each has a fair chance. Again, it is said that the boatman has as much to do with catching trout in a loch as the angler. Well, we dont deny that. In an untried loch it is necessary to have the guidance of a good boatman but the same argument holds good as to stream-fishing... (shrink)

DavidHume, a member of the well-known Border family of Home, was born on April 26, 1711. After a period of preparatory training he matriculated at Edinburgh College in 1723, although he may have entered earlier. His course during this period is obscure; according to his own statement the curriculum was mainly literary; on leaving College he records that his interests lay predominantly in this direction, and, being left to his own choice, he was able to indulge his inclinations. An attempt (...) to train him for a legal career ended in failure; and he continued to live at his ancestral home of Ninewells, to the west of Berwick, for some years, devoting himself. (shrink)