Specialists and primary care physicians play an integral role in treating the twin epidemics of pain and addiction. But inadequate access to specialists causes much of the treatment burden to fall on primary physicians. This article chronicles the differences between treatment contexts for both pain and addiction — in the specialty and primary care contexts — and derives a series of reforms that would empower primary care physicians and better leverage specialists.
A commentary on “Models of Consent to Return of Incidental Findings in Genomic Research” by Paul S. Appelbaum, Erik Parens, Cameron R. Waldman, Robert Klitzman, Abby Fyer, Josue Martinez, W. Nicholson Price II, and Wendy K. Chung, in the July-August 2014 issue, http://www.thehastingscenter.org/Publications/HCR/Detail.aspx?id=6964.
An obligation may take either of two forms, each form being reported in a different way. For example, when we report the obligation of parents to care for their children, if it is the moral obligation we mean, we will say ‘Parents ought to look after their children’ but if we mean the legal obligation, we will say ‘Parents have to look after their children’. The law specifies that people shall do thus and so, not that they ought to do (...) thus and so. (shrink)
We conducted a survey of residents of Kingston, Ontario, Canada, to understand their attitudes to and experiences of waste management and governance. Currently, the municipality is emphasising waste diversion and exploring new waste processing systems to reduce costs. Using Foucault's governmentality theory, our data suggest Kingston's reliance on an attitude-behaviour-context model of behaviour change successfully fosters an environmental citizenship identity based on waste diversion. However, we argue that the neoliberal governmentality upon which the attitude-behaviour-context model is predicated elides the need (...) for, and inhibits consideration of, broader societal change concerning urgent environmental issues involving consumption and waste. (shrink)
In this 1970 introduction to philosophy Mr Taylor concentrates on two central topics - explanation and meaning. He takes the argument far enough to acquaint the reader first-hand with the methods and approach of analytical philosophy, and yet because of the scope of these two topics he is able to introduce many of the traditional philosophical problems in epistemology, metaphysics, ethics, aesthetics, and logic. By this approach he avoids the dangers both of superficiality and of undue technicality. Philosophers are concerned (...) to analyse and describe certain concepts and modes of argument, not to establish facts or conclusions of any sort that can be tested by formal demonstration or controlled observation; their findings cannot be conveniently categorized or graded into a comprehensive and progressive course of studies. Mr Taylor meets this difficulty with his extended discussions of specific topics and questions which have implications over the whole subject. (shrink)
We have studied a number of long-term meditators in previous studies. The purpose of this study was to determine if there are differences in baseline brain function of experienced meditators compared to non-meditators. All subjects were recruited as part of an ongoing study of different meditation practices. We evaluated 12 advanced meditators and 14 non-meditators with cerebral blood flow SPECT imaging at rest. Images were analyzed with both region of interest and statistical parametric mapping. The CBF of long-term meditators was (...) significantly higher compared to non-meditators in the prefrontal cortex, parietal cortex, thalamus, putamen, caudate, and midbrain. There was also a significant difference in the thalamic laterality with long-term meditators having greater asymmetry. The observed changes associated with long-term meditation appear in structures that underlie the attention network and also those that relate to emotion and autonomic function. (shrink)
Objective: To determine whether the marks in the third year Objective Structured Clinical Examination were affected by the collusion reported by the students themselves on an electronic discussion board.Design: A review of the student discussion, examiners’ feedback and a comparison of the marks obtained on the 2 days of the OSCE.Participants: 255 third year medical students.Setting: An OSCE consisting of 15 stations, administered on three sites over 2 days at a UK medical school.Results: 40 students contributed to the discussion on (...) the electronic discussion board. The main points raised were perceived inequity between students who did, or did not, have prior knowledge of the station content, and the lack of honesty and professionalism of their peers. Most contributors claimed to have received, or knew of others receiving, prior knowledge, but none confessed to passing on information. No significant difference was observed in the overall mark for the OSCE on day 1 ) and day 2 ). On day 2, marks were considerably greater for four stations and markedly lower for three stations. It was not obvious why collusion should affect these station marks. A clear indication of the effects of collusion could only be obtained from a single subsection of an individual station where 82 students on day 2 incorrectly gave the diagnosis from day 1.Conclusion: Marks do not provide a sound inference of student collusion in an OSCE and may mask the aspects of professional development of students. (shrink)
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