Background: Arthritis is very common but is not well understood. Actually, “arthritis” is not a single disease; it is an informal way of referring to joint pain or joint disease. There are more than 100 different types of arthritis and related conditions. People of all ages, sexes and races can and do have arthritis, and it is the leading cause of disability in America. More than 50 million adults and 300,000 children have some type of (...) class='Hi'>arthritis. It is most common among women and occurs more frequently as people get older. Common arthritis joint symptoms include swelling, pain, stiffness and decreased range of motion. Symptoms may come and go. They can be mild, moderate or severe. They may stay about the same for years, but may progress or get worse over time. Severe arthritis can result in chronic pain, inability to do daily activities and make it difficult to walk or climb stairs. Arthritis can cause permanent joint changes. These changes may be visible, such as knobby finger joints, but often the damage can only be seen on X-ray. Some types of arthritis also affect the heart, eyes, lungs, kidneys and skin as well as the joints. Objectives: The main goal of this expert system is to get the appropriate diagnosis of disease and the correct treatment and give the appropriate method of treatment through several tips that concern the disease and how to treat it and we will see it through the application on the expert system. Methods: in this paper the design of the proposed Expert System which was produced to help Orthopedist in diagnosing Arthritis disease through its symptoms such as: pain on pressure in a joint , Inflammation indicated by joint swelling, Stiffness especially in the morning , Loss of flexibility of joint, Limited, joint movement, Deformity of the joints , Weight loss and fatigue , Non-specific fever and Crepitus. The proposed expert system presents an overview about Arthritis disease is given, the cause of diseases is outlined and the treatment of disease whenever possible is given out. SL5 Object Expert System language was used for designing and implementing the proposed expert system. Results: The proposed Arthritis disease diagnosis expert system was evaluated by Orthopedics students and they were satisfied with its performance. Conclusions: The Proposed expert system is very useful for Orthopedist, patients with arthritis and newly graduated Orthopedics students. (shrink)

Rheumatoid arthritis (RA) may not be a multifactorial disease; it can be hypothesized that RA is developed through a series of events following a triggering event, which is the emergence of a chemokine for neutrophils in the synovium. IL‐17A, secreted by infiltrated neutrophils, stimulates synoviocytes to produce CCL20, which attracts various CCR6‐expressing cells, including Th17 cells. Monocytes (macrophages) appear after neutrophil infiltration according to the natural course of inflammation and secrete IL‐1β and TNFα. Then, IL‐17A, IL‐1β, and TNFα stimulate (...) synoviocytes to produce CCL20, amplifying the inflammation. Varieties of chemokines secreted by infiltrating cells accumulate in the synovium and induce synoviocyte proliferation by binding to the corresponding G protein‐coupled receptors, thus expanding the synovial tissue. CCL20 in this tissue attracts circulating monocytes that express both CCR6 and receptor activator of NF‐κB (RANK), which differentiate into osteoclasts in the presence of RANKL. In this way, pannus is formed, and bone destruction begins. (shrink)

This chapter focuses on the view that diseases comprise natural kinds and how this view is in conflict with the essentialist picture of natural kinds as championed by Kripke and Putnam. This essentialist depiction of natural kinds contends that in order for a class of entities to be a natural kind, it is required that all and only members of the class instantiate very specific properties that explain the presence of any other properties typically associated with being a member of (...) the kind; these privileged properties constitute the “essence” of the kind. The problem is that the essentialist picture provides only two options, none of which is desirable: satisfy the essentialist desiderata by locating some etiological feature both necessary and sufficient for kind membership, or reject the thought that similarity between disease instances can be understood in terms of natural kinds. (shrink)

Tyler Burge's (1979) famous thought experiment concerning 'arthritis' is commonly assumed to show that all ascriptions of content to beliefs and other attitudes are dependent for their truth upon facts about the agent's social and linguistic environment. It is also commonly claimed that Burge's argument shows that Putnam's (1975) result regarding natural kind terms applies to all general terms whatever, and hence shows that all such terms have wide meanings.1 But I wish to show here, first, that neither Burge's (...) initial thought experiment nor a second type of example that Burge describes supports either of these conclusions. Second, I will identify the proper conclusion to draw from Burge's discussion and show that this conclusion does not really pose a serious problem for individualism about the mental. And finally, I will argue that Burge's discussion does not in fact provide a conclusive reason for believing its proper conclusion. (shrink)

Rheumatoid arthritis is a progressive systemic autoimmune disease characterized by inflammation of the joints and surrounding tissues, which seriously affects the life of patients. The Sharp/van der Heijde method has been widely used in clinical evaluation for the RA disease. However, this manual method is time-consuming and laborious. Even if two radiologists evaluate a specific location, their subjective evaluation may lead to low inter-rater reliability. Here, we developed an efficient model powered by deep convolutional neural networks to solve these (...) problems and automated the overall scoring on hand X-rays. The depthwise separable convolution technique is used based on ResNet-50 due to the high resolution of hand X-rays. An inverted residual block is introduced to devise a ResNet-Dwise50 model to enhance the efficiency of the model. The model was trained and tested using bilateral posteroanterior images of 3818 patients. The experiment results show the ResNet-Dwise50 model achieved an MAE of 14.90 and RMSE of 22.01 while ensuring high efficiency. There was no statistical difference between the average scores given by two experienced radiologists and predicted scores from our model. (shrink)

BackgroundAwareness of aging brings to light one’s own perceived behavioral, physical, and cognitive changes associated with getting older. Personality and physical illness are each related to two components of awareness of aging: attitudes toward own aging, and awareness of age-related changes. Here, we move beyond main effects to examine how personality and arthritis interact with respect to awareness of aging.Materials and Methods296 participants completed online self-report questionnaires of personality, arthritis, ATOA, and AARC gains and losses.ResultsWe ran three hierarchical (...) multiple regression models to test how personality traits and arthritis interacted to predict ATOA, AARC gains, and AARC losses, respectively. Higher extraversion was related to positive ATOA, and higher openness was related to positive ATOA and more AARC gains. Higher neuroticism was related to negative ATOA, more AARC losses, and less AARC gains. We found a main effect for arthritis, where those with arthritis reported more AARC losses. Lastly, we found a significant interaction between arthritis and agreeableness when predicting AARC gains. Among those with low agreeableness, people with arthritis reported significantly more AARC gains compared to those without arthritis.ConclusionPersonality and arthritis are each important for awareness of aging. Overall, our study suggests that for those with arthritis, it is especially important to consider behavioral and cognitive factors related to agreeableness, as they may be important means of promoting positive views on aging. (shrink)

Objectives: To elicit the perceptions and preferences of patients with rheumatoid arthritis regarding information and participation in treatment decision-making. To analyse the patients’ narratives on the background of the ethical discourse on various approaches to treatment decision-making. Design: In-depth interviews with themes identified using principles of grounded theory. Participants: 22 patients with long-standing rheumatoid arthritis. Main outcome measures: Qualitative data on patients’ perceptions and preferences regarding information and participation in decision-making about treatment. Results: Decision-making about treatment has been (...) described by the patients as a process consisting of different stages with shifting loci of control and responsibility. Patients initially received one treatment recommendation and were not aware of alternative treatment options. Those participants in this study who wanted information about negative effects of a treatment cited “interest in one’s own health” and the potential “use of information” as reasons for their preference. The physicians’ expert knowledge and clinical experience regarding the effects of medication were cited as arguments by patients for a treatment recommendation. Conclusions: The patients’ accounts of decision-making about treatment differ from models of physician–patient relationship that have been put forward in ethical discourse. These differences may be relevant with respect to the starting point of an ethical analysis of treatment decision-making. Patients’ accounts with respect to a lack of information on treatment alternatives point to ethically relevant challenges regarding treatment decision-making in clinical practice. (shrink)

Background Genuine uncertainty on superiority of one intervention over the other is called equipoise. Physician-investigators in randomized controlled trials need equipoise at least in studies with more than minimal risks. Ideally, this equipoise is also present in patient-participants. In pediatrics, data on equipoise are lacking. We hypothesize that 1) lack of equipoise at enrolment among parents may reduce recruitment; 2) lack of equipoise during participation may reduce retention in patients assigned to a less favoured treatment-strategy. Methods We compared preferences of (...) parents/patients at enrolment, documented by a questionnaire, with preferences developed during follow-up by an interview-study to investigate equipoise of child-participants and parents in the BeSt-for-Kids-study. This trial in new-onset Juvenile Idiopathic Arthritis-patients consists of three strategies. One strategy comprises initial treatment with a biological disease-modifying-antirheumatic-drug, currently not standard-of-care. Semi-structured interviews were conducted with 23 parents and 7 patients, median 11 months after enrolment. Results Initially most parents and children were not in equipoise. Parents/patients who refused participation, regularly declined due to specific preferences. Many participating families preferred the biological-first-strategy. They participated to have a chance for this initial treatment, and would even consider stopping trial-participation when not randomized for it. Their conviction of superiority of the biological-first strategy was based on knowledge from internet and close relations. According to four parents, the physician-investigator preferred the biological-first-strategy, but the majority stated that she had no preferred strategy. In phase 2, preferences tended to change to the treatment actually received. Conclusions Lack of equipoise during enrolment did not reduce study recruitment, mainly due to the fact that preferred treatment was only available within the study. Still, when developing a trial it is important to evaluate whether the physicians’ research question is in line with preferences of the patient-group. By exploring so-called ‘informed patient-group’-equipoise, successful recruitment may be enhanced and bias avoided. In our study, lack of equipoise during trial-participation did not reduce retention in those assigned to a less favoured option. We observed a change for preference towards treatment actually received, possibly explained by comparable outcomes in all three arms. (shrink)

Cortisone, initially known as ‘compound E’ was the medical sensation of the late 1940s and early 1950s. As early as April 1949, only a week after Philip Hench and colleagues first described the potential of ‘compound E’ at a Mayo Clinic seminar, the New York Times reported the drug’s promise as a ‘modern miracle’ in the treatment of rheumatoid arthritis. Given its high profile, it is unsurprising that historians of medicine have been attracted to study the innovation of cortisone. (...) It arrived at the end of a decade of ‘therapeutic revolutions’, kicked off by penicillin transforming the treatment of bacterial infections and ending with hopes of a revolution in the treatment of non-infectious, chronic inflammatory diseases. Despite these studies of cortisone’s introduction, few historians have taken the story forward and considered how cortisone was adopted and adapted into clinical practice. This article tells the longer of how the drug and its derivatives were taken from research laboratories and integrated into clinical practice; what has in recent decades become known as translational medicine. In exploring cortisone’s first decade in Britain, we focus specifically on its role in the treatment of RA. Our approach is always to consider cortisone’s use in the context of other treatments available to clinicians, and at local and national institutional settings. We do not discuss the many other therapeutic uses of cortisone, which ranged for topical applications for skin diseases to the management of cancers, especially childhood leukaemia, nor do we discuss its close analogue ACTH—AdenoCorticoTropic Hormone. We think there are lessons in our study for TM policies today. (shrink)

Cortisone, initially known as ‘compound E’ was the medical sensation of the late 1940s and early 1950s. As early as April 1949, only a week after Philip Hench and colleagues first described the potential of ‘compound E’ at a Mayo Clinic seminar, the New York Times reported the drug’s promise as a ‘modern miracle’ in the treatment of rheumatoid arthritis. Given its high profile, it is unsurprising that historians of medicine have been attracted to study the innovation of cortisone. (...) It arrived at the end of a decade of ‘therapeutic revolutions’, kicked off by penicillin transforming the treatment of bacterial infections and ending with hopes of a revolution in the treatment of non-infectious, chronic inflammatory diseases. Despite these studies of cortisone’s introduction, few historians have taken the story forward and considered how cortisone was adopted and adapted into clinical practice. This article tells the longer of how the drug and its derivatives were taken from research laboratories and integrated into clinical practice; what has in recent decades become known as translational medicine. In exploring cortisone’s first decade in Britain, we focus specifically on its role in the treatment of RA. Our approach is always to consider cortisone’s use in the context of other treatments available to clinicians, and at local and national institutional settings. We do not discuss the many other therapeutic uses of cortisone, which ranged for topical applications for skin diseases to the management of cancers, especially childhood leukaemia, nor do we discuss its close analogue ACTH—AdenoCorticoTropic Hormone. We think there are lessons in our study for TM policies today. (shrink)

Cortisone, initially known as ‘compound E’ was the medical sensation of the late 1940s and early 1950s. As early as April 1949, only a week after Philip Hench and colleagues first described the potential of ‘compound E’ at a Mayo Clinic seminar, the New York Times reported the drug’s promise as a ‘modern miracle’ in the treatment of rheumatoid arthritis. Given its high profile, it is unsurprising that historians of medicine have been attracted to study the innovation of cortisone. (...) It arrived at the end of a decade of ‘therapeutic revolutions’, kicked off by penicillin transforming the treatment of bacterial infections and ending with hopes of a revolution in the treatment of non-infectious, chronic inflammatory diseases. Despite these studies of cortisone’s introduction, few historians have taken the story forward and considered how cortisone was adopted and adapted into clinical practice. This article tells the longer of how the drug and its derivatives were taken from research laboratories and integrated into clinical practice; what has in recent decades become known as translational medicine. In exploring cortisone’s first decade in Britain, we focus specifically on its role in the treatment of RA. Our approach is always to consider cortisone’s use in the context of other treatments available to clinicians, and at local and national institutional settings. We do not discuss the many other therapeutic uses of cortisone, which ranged for topical applications for skin diseases to the management of cancers, especially childhood leukaemia, nor do we discuss its close analogue ACTH—AdenoCorticoTropic Hormone. We think there are lessons in our study for TM policies today. (shrink)

ObjectiveLeveraging an integrative multimodal MRI paradigm to elaborate on the hippocampus-derived structural and functional changes in children and adolescents with juvenile idiopathic arthritis and to explore potential correlations within the “joint-inflammation-brain” axis during the period of central neural system development.MethodsTwenty-one patients with JIA all completed the multimodal MRI scanning, laboratory tests, and neuropsychological assessments; meanwhile, 23 matched controls were recruited. We then harnessed the spherical harmonics with a point distribution model and the ROI-to-voxel functional connectivity to measure the hippocampal (...) shape and hippocampo-cortical FC patterns. Correlation analysis was performed to explore the potential links in neuroimaging features with disease-related indices.ResultsCompared to controls, JIA patients only presented an atrophic tendency in the posterior part of the bilateral hippocampus. The hippocampo-cortical FC revealed the between-group divergences mainly located at the pain matrix, striatum, and temporal lobe. Remarkably, the enhanced FC between the right hippocampus and postcentral cortex is positively correlated with the disability index, while the weakened FC of right anterior hippocampus with right insula and that of left posterior hippocampus with left superior temporal gyrus was inversely related to the erythrocyte sedimentation rate and anxiety status, separately.ConclusionAs with macroscopic damages, the altered functional-connectome patterns of the hippocampus in JIA patients might be more sensitive to detect the early neuropathological changes. Moreover, the functional disturbances were demonstrated associated with the physical disability, inflammation, and emotional status. These findings may enlighten us on the underlying neuropathological mechanism of CNS comorbidities in JIA. (shrink)

The above-mentioned article has been published online on 7 November 2019 as part of topical collection ‘_Before Translational Medicine: Laboratory Clinic Relations_’.

The above-mentioned article has been published online on 7 November 2019 as part of topical collection ‘Before Translational Medicine: Laboratory Clinic Relations’.

In the past decade, the availability of genetically modified animals has enabled the discovery of interesting roles for phosphatidylinositol 3‐kinase‐γ (PI3Kγ) and ‐δ (PI3Kδ) in different cell types orchestrating innate and adaptive immune responses. Therefore, these PI3K isoforms appear to be attractive drug targets for the treatment of diseases caused by unrestrained immune reactions. Currently, pharmacological targeting of PI3Kγ and/or PI3Kδ represents one of the most promising challenges for companies interested in the development of novel safe treatments for inflammatory diseases. (...) In this review we provide a general outline of PI3Kγ‐ and PI3Kδ‐specific functions in distinct subsets of inflammatory cells. We also discuss the therapeutic impact of novel compounds targeting PI3Kγ, PI3Kδ or both, in mouse models of autoimmune disorders (systemic lupus erythematosus (SLE) and rheumatoid arthritis), respiratory diseases (allergic asthma and chronic obstructive pulmonary disease) and cardiovascular dysfunctions (atherosclerosis and myocardial infarction). (shrink)

The problem of disease definition is related to theproblem of proving that a certain agent is thenecessary cause of a certain disease. Natural kindterms like ‘rheumatoid arthritis’ and ‘AIDS’ refer toessences which are discoverable rather thanpredeterminate. No statement about such diseases isa priori necessarily true. Because theories onnecessary causes involve natural kind semantics,Koch's postulates cannot be used to falsify or verifysuch theories. Instead of proving that agent A is thenecessary cause of disease D, we include A in atheoretical definition (...) of D, take this to representthe real meaning of ‘D’, and discard thepretheoretical definition. This is illustrated byKoch's own attempt to prove he had discovered thenecessary cause of tuberculosis. Methodologicalarguments about disease causation require a clear viewof our use of diagnostic terms. Medical lexicographersshould do more to provide such a view. (shrink)

This paper charts the concepts of grip and the bodily auxiliary in Maurice Merleau-Ponty to consider how they find expression in disability narratives. Arguing against the notion of “maximal grip” that some commentators have used to explicate intentionality in Merleau-Ponty, I argue that grip in his texts functions instead as a compensatory effort to stave off uncertainty, lack of mastery, and ambiguity. Nearly without exception in Phenomenology of Perception, the mobilization of “grip” is a signal of impending loss, and is (...) offered as a strategy for managing failure rather than as an example of sure-footed mastery. I read Merleau-Ponty alongside Mary Felstiner's Out of Joint: A Public and Private Story of Arthritis to explore these other, attenuated dimensions of grip. Finally, the paper turns to Harriet McBryde Johnson's memoir Too Late to Die Young as an example of a way of thinking disabled embodiment otherwise. (shrink)

Philosophers of language have tended to focus on examples that are not politically significant in any way. We spend a lot of time analyzing natural kind terms: We think hard about “water” and “pain” and “arthritis.” But we don’t think much about the far more politically significant kind terms (natural or social—it's a matter for dispute) like “race,” “sex,” “gender,” “woman,” “man,” “gay,” and “straight.” In this essay, I will try to show, using the example of “woman,” that it's (...) worth thinking about terms like these, for at least three reasons: (1) There are some interesting puzzles. (2) Politically significant terms matter to people's lives— and it's worth spending at least some of our energy thinking about things that matter in this way. (3) Most importantly, interesting methodological issues emerge at the intersection of philosophy of language and politics. (shrink)

I suggest a solution to a conflict between semantic internalism – according to which the concepts one expresses are determined by one's use of representations – and publicity – according to which, if two subjects successfully communicate or are in genuine agreement, then they entertain thoughts constituted by the same concepts. My solution rests on the thesis that there can be successful communication and genuine agreement between thinkers employing distinct concepts as long as there is a certain relation (of conceptually (...) guaranteed sameness of extension) between them. In section 2, I motivate semantic internalism and show how it conflicts with publicity. In section 3, I carve the logical space of possible solutions to the conflict into liberal and conservative solutions. Section 4 assesses Wikforss's conservative solution to Burge's arthritis thought‐experiment and concludes that it fails for more than one reason. Section 5 introduces a new case study involving a deferential concept. This case serves as the backdrop for my positive account offered in section 6. The conclusion of the article is preceded by a comparison of my view with another recently proposed by Recanati (section 7) and some replies to possible objections (section 8). (shrink)

Following the announcement in 1949 in the USA that cortisone offered rheumatoid arthritis sufferers effective treatment for their crippling disease, the Ministry of Health came under considerable pressure from the medical profession and the public to make cortisone available in Britain. The Ministry, therefore, urged British companies to start manufacturing cortisone. Among the several pharmaceutical firms responding to the Ministry’s request, Glaxo’s expertise in the field of vitamins gave them a head start. This paper describes the varied and flexible (...) strategy that enabled Glaxo to maintain this head start, and the scientific and technical capabilities which the company subsequently built up, enabling them to dominate the market for corticosteroids in Britain.Among the drugs to emerge out of the Glaxo project to manufacture cortisone, which began in 1950 and later became a wider R&D programme on steroids, was the topical steroid Betnovate, launched in 1963, which remains a best-seller today. However, although it led to successful new products, Glaxo’s programme had limitations. The paper identifies a missed opportunity, in the shape of the biosynthetic route to steroid drugs, often considered as a milestone in the development of the new biotechnology. Whether or not this missed opportunity proved costly to the company is uncertain. However, it illustrates the role of technological path-dependence, and the importance of the integration between different scientific disciplines, in this case chemistry and biology, in pharmaceutical innovation. (shrink)

Semantic externalism is the view that the meanings of referring terms, and the contents of beliefs that are expressed by those terms, are not fully determined by factors internal to the speaker but are instead bound up with the environment. The debate about semantic externalism is one of the most important but difficult topics in philosophy of mind and language, and has consequences for our understanding of the role of social institutions and the physical environment in constituting language and the (...) mind. In this long-needed book, Jesper Kallestrup provides an invaluable map of the problem. Beginning with a thorough introduction to the theories of descriptivism and referentialism and the work of Frege and Kripke, Kallestrup moves on to analyse Putnam’s Twin Earth argument, Burge’s arthritis argument and Davidson’s Swampman argument. He also discusses how semantic externalism is at the heart of important topics such as indexical thoughts, epistemological skepticism, self-knowledge, and mental causation. Including chapter summaries, a glossary of terms, and an annotated guide to further reading, _Semantic Externalism_ an ideal guide for students studying philosophy of language and philosophy of mind. (shrink)

Philosophy and science employ abstract hypothetical scenarios- thought experiments - to illustrate, defend, and dispute theoretical claims. Since thought experiments furnish no new empirical observations, the method prompts two epistemological questions: whether anything may be learnt from the merely hypothetical, and, if so, how. Various sceptical arguments against the use of thought experiments in philosophy are discussed and criticized. The thesis that thought experiments in science provide a priori knowledge through non-sensory grasping of abstract entities is discussed and rejected. The (...) thesis that thought experimentation consists in manipulations of mental models is examined and found to be of limited epistemological relevance. It is argued that thought experiments are associated with characteristic arguments in a manner similar to ordinary experiments. It is further argued that thought experiments function in the same way as experiments in general: by providing premises for their associated arguments. Like other experiments, a thought experiment is successful when the premises it provides are true. This holds both for philosophical and scientific thought experiments. An argument schema is proposed and shown to be a formal analogue to that associated with ordinary experiments; similar in being subject to epistemological holism; but differing in being modal: in employing statements about possibility and necessity. The evaluation of thought experiments thus depends on how modal statements may be justified. Intuition and conceivability are discussed as sources of modal justification and found problematic. Instead it is suggested that evaluation proceed by accommodation of the statements describing the experiment's hypothetical scenario. The method of accommodation is developed and applied to five influential thought experiments in philosophy: the brain in a vat; Putnam's Twin Earth; Burge's arthritis example; Searle's Chinese Room; and Newcomb's problem. Its application shows some of these to be failed, others to be successful only relative to controversial philosophical doctrines. (shrink)

Over 1.3 billion people in the world are challenged to access good and cheap healthcare when become ill. Health insurance policies are a fantastic strategy to assist people who can't afford medical care. For middle- and low-income nations, there hasn't been much research on the ability to pay for health insurance for public employees like school teachers. Therefore, this cross-sectional questionnaire based research has been undertaken to explore the reflection of health insurance among 383 Bangladeshi school teachers of 5 divisional (...) city center primary school and were being surveyed online between 1st August to 30th August 2022. According to survey, monthly average (mean) health expenditure of respondents were 7668.93 BDT (Bangladeshi Taka equivalent to $80.72) with 95% confidence interval. Of 35% responders suffered from high blood pressure, approximately 8% people were suffering from arthritis and asthma, 7.8% people have heart disease and 8.1 % people suffer from cholesterol problem. Maximum respondents (80%) agreed that health insurance is burden for them. About 51% teachers had no idea about health insurance. However, there was no significant relation in between educational status and health insurance perception for male and female teacher respondents. Moreover, the comparative data highlighted that more awareness and more exploration might be needed in health insurance perception for primary school teachers. This result can contribute to form people’s choice-oriented health insurance policy. (shrink)

This article presents an archaeological inquiry into the early histories of Quality of Life measures, and takes this as an occasion to rethink the concept of the ‘medical model of disability’. Focusing on three instruments that set the ground for the emergence of QoL measures, namely, the Karnofsky Performance Scale, and the classification of functional capacity as a diagnostic criterion for heart diseases and as a supplementary aid to therapeutic criteria in rheumatoid arthritis – I discuss how medicine, throughout (...) the emergence of QoL, began to expand its gaze beyond the confines of the body to what that body does in daily life. Building upon Armstrong et al.’s notion of ‘distal symptoms’ and Wahlberg’s idea of ‘knowledge of living’, I propose the notion of disabilitization to encapsulate this expansion of the clinical gaze, through which medicine has come to articulate diseases and their treatments in new ways, and in so doing, has inadvertently created disability as a new kind of knowledge category in itself – a category that is defined not through its reduction to mere pathology, but through its dispersal into everyday life. I present this concept not as a periodization, but as a provocative discontinuity with the totalizing history assumed within the medical model of disability, and in so doing, ask what, in fact, holds ‘the medical model’ together, and whether there might be other ways of understanding medicine’s complex relationship to disability than what the concept of the medical model allows us to envisage. (shrink)

Brandom (Citation1994) made inferentialism an intensely debated idea in the philosophy of language in the last three decades. Inferentialism is a view that associates the meaning of linguistic expression with the role said expression plays in inferences. It seems rather uncontroversial that the correct theory of meaning should distinguish between linguistic correctness and factual correctness. For instance, speaker S can be wrong in saying ‘I have arthritis’ in two distinct ways: (i) S fails to apply a word correctly to (...) make a true statement due to having made a factual error, and (ii) S uses an expression incorrectly because they are wrong about its meaning. In this paper, I show that properly understood normative inferentialism can make room for such a distinction. I propose that linguistic correctness is a structural issue: linguistic mistakes stem from the improper or insufficient acquisition of an inferential role. Factual correctness, on the other hand, is a one-off issue of the correct application of inferential rules to a particular situation. I argue that, by tying the issue of correctness to the game of giving and asking for reasons, inferentialism can establish a reliable method for distinguishing between two types of correctness (and mistakes). (shrink)

The provider–patient relationship is typically regarded as an expert-to-novice relationship, and with good reason. Providers have extensive education and experience that have developed in them the competence to treat conditions better and with fewer harms than anyone else. However, some researchers argue that many patients with long-term conditions (LTCs), such as arthritis and chronic pain, have become “experts” at managing their LTC. Unfortunately, there is no generally agreed-upon conception of “patient expertise” or what it implies for the provider–patient relationship. (...) I review three prominent accounts of patient expertise and argue that all face serious objections. I contend, however, that a plausible account of patient expertise is available and that it provides a framework both for further empirical studies and for enhancing the provider–patient relationship. (shrink)

Surgical clinical trials have seldom used a “sham” or placebo surgical procedure as a control, owing to ethical concerns. Recently, several ethical commentators have argued that sham surgery is either inherently or presumptively unethical. In this article I contend that these arguments are mistaken, and that there are no sound ethical reasons for an absolute prohibition of sham surgery in clinical trials. Reflecting on three cases of sham surgery, especially on the recently reported results of a sham-controlled trial of arthroscopic (...) surgery for arthritis of the knee, I present an ethical analysis that focuses on the methodological rationale for use of sham surgery, risk-benefit assessment, and informed consent. (shrink)

This book covers lymphoproliferative disorders in patients with congenital or acquired immunodeficiencies. Acquired immunodeficiencies are caused by infections with the human immunodeficiency virus or arise following immunosuppressive therapy administered after organ transplantation or to treat connective tissue diseases such as rheumatoid arthritis. It was recently discovered that various diseases or therapeutic modalities that induce a state of immunosuppression may cause virally driven lymphoproliferations. This book summarizes for the first time this group of immunodeficiency-associated lymphoproliferations.

Surgical clinical trials have seldom used a "sham" or placebo surgical procedure as a control, owing to ethical concerns. Recently, several ethical commentators have argued that sham surgery is either inherently or presumptively unethical. In this article I contend that these arguments are mistaken and that there are no sound ethical reasons for an absolute prohibition of sham surgery in clinical trials. Reflecting on three cases of sham surgery, especially on the recently reported results of a sham-controlled trial of arthroscopic (...) surgery for arthritis of the knee, I present an ethical analysis that focuses on the methodological rationale for use of sham surgery, risk-benefit assessment, and informed consent. (shrink)

Ageing causes progressive decline in metabolic, behavioural, and physiological functions, leading to a reduced health span. The extracellular matrix (ECM) is the three‐dimensional network of macromolecules that provides our tissues with structure and biomechanical resilience. Imbalance between damage and repair/regeneration causes the ECM to undergo structural deterioration with age, contributing to age‐associated pathology. The ECM ‘Ageing Across the Life Course’ interdisciplinary research network (ECMage) was established to bring together researchers in the United Kingdom, and internationally, working on the emerging field (...) of ECM ageing. Here we report on a consultation at a joint meeting of ECMage and the Medical Research Council / Versus Arthritis Centre for Integrated Research into Musculoskeletal Ageing, held in January 2023, in which delegates analysed the key questions and research opportunities in the field of ECM ageing. We examine fundamental biological questions, enabling technologies, systems of study and emerging in vitro and in silico models, alongside consideration of the broader challenges facing the field. (shrink)

RATIONALE AND AIMS: Total hip and knee replacements, usually, have long waiting lists. There are several prioritization tools for these kind of patients. A new tool should undergo a standardized validation process. The aim of the present study was to validate a new prioritization tool for primary hip and knee replacements. METHODS: We carried out a prospective study. Consecutive patients placed on the waiting list were eligible for the study. Patients included were mailed a questionnaire which included, among other questions, (...) the seven items of the priority tool and the Western Ontario and McMasters Universities Arthritis Index (WOMAC) specific questionnaire. The priority tool gives a score from 0 to 100 points, and three categories (urgent, preferent and ordinary). We studied the content and construct validity. We used Student's t-test or one-way analysis of variance. Correlational analysis was used to evaluate convergent and discriminate validity. RESULTS: The sample consisted of 838 patients (62.3% were female), with mean age of 70.2 years (SD 8.4). A total of 55.5% patients underwent knee replacement. Given that the tool was elaborated by patients and orthopaedic surgeons, it shows a good content validity. The priority score was statistically different (P < 0.001) among the three urgency categories created. The scores of the three WOMAC dimensions showed differences (P < 0.001) by the three urgency categories created. The correlations between the priority score and WOMAC dimensions were 0.79 (function), 0.69 (pain) and 0.51 (stiffness). The correlations between WOMAC items and items from priority tool were greater (0.47-0.69) between items measuring similar constructs than those measuring different constructs (0.27-0.49). These data are similar in both joints. CONCLUSIONS: Results support the validity of the prioritization tool to be used with patients waiting for hip or knee replacement. (shrink)

Tyler Burge has argued that an incorrect understanding of a word can be sufficient for possessing the concept the word literally expresses. His well-known 'arthritis' case involves a patient who understands 'arthritis' incorrectly, but who nevertheless, according to Burge, possesses the concept arthritis. Critics of Burge have objected that there is an alternative concept that best matches the patient's understanding and that this, therefore, is the patient's concept. The paper first argues that Burge's response to this objection (...) is unconvincing. A better response is then developed. It is argued that there is no alternative concept that matches the incorrect understanding, since the patient thinks he has a partial understanding. This, together with points about ordinary psychological explanation and modes of presentations of concepts, establish that it is impossible to undermine Burge's social externalism by appealing to the idea that an alternative concept matches the incorrect understanding. (shrink)

Inflammatory responses are essential for the clearance of pathogens and the repair of injured tissues; however, if these responses are not properly controlled chronic inflammation can occur. Chronic inflammation is now recognized as a contributing factor to many age‐associated diseases including metabolic disorders, arthritis, neurodegeneration, and cardiovascular disease. Due to the connection between chronic inflammation and these diseases, it is essential to understand underlying mechanisms behind this process. In this review, factors that contribute to chronic inflammation are discussed. Further, (...) we emphasize the emerging roles of microRNAs (miRNAs) and other noncoding RNAs (ncRNA) in regulating chronic inflammatory states, making them important future diagnostic markers and therapeutic targets. Copyright Line: © 2015 The Authors BioEssays Published by Wiley‐VCH Verlag GmbH & Co. KGaA. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:I Am Not Sure?Paul E. LevinIt was a beautiful Friday morning, a few weeks into the summer. My schedule appeared lighter than usual and I even envisioned leaving work a bit early. Maybe a challenging bike ride before dinner. I was sitting in the chairman’s office having our weekly meeting. One of our junior faculty members called... he needed help. He was on call and a 32–year–old pregnant woman (...) with a displaced femoral neck fracture had just been transferred to our emergency department (ED). Ms. B tripped in her kitchen last evening. She was unable to stand and was brought to the local ED by ambulance.My colleague was concerned that he wouldn’t be able to successfully reduce the fracture. The long–term prognosis of the hip joint depended on a successful reduction of the femoral neck fracture. In addition, there was an ongoing debate in the orthopaedic literature related to the urgency of operative care to prevent osteonecrosis of the femoral head. I reviewed the x–rays, didn’t anticipate a problem and let him know that I would come to the operating room (OR) to assist. “No”, he responded, “I am not comfortable caring for this patient”. I immediately left the office, went to the hospital and assumed care of the patient. Clearly, my plans for a bike ride were gone, but I had the opportunity to help a woman in need of expert orthopaedic care.Ms. B had been admitted to the obstetrical service. She was a 32–year–old woman of Haitian descent who had recently immigrated to the United States. She had very limited English comprehension and her primary spoken languages were French and Creole. She was alone, in a hospital in a foreign country. She was 24 weeks pregnant with her first child and had no other co–morbidities. Her pregnancy had ben progressing uneventfully.When I first met Ms. B she was lying on a stretcher in an observation unit on the obstetrical floor. She appeared frightened. Two orthopaedic residents were present and obtaining consent for surgical repair of the hip. In their minds there was nothing to discuss, the patient had a displaced femoral neck fracture and needed to have surgery immediately. In their minds, no other options were available and obtaining consent would be straightforward. I introduced myself, sat down on a lab stool by the bed and began a conversation. I needed to meet the patient, understand who she was and discuss treatment. I am not sure that obtaining an informed consent is ever “straightforward” when [End Page 14] a doctor is explaining to a patient that they require emergency surgery. This discussion surely would not be easy or straightforward.We utilized a telephone interpretation service. Every question and response required the transfer of the handset between the patient and physician. Ms. B was in pain and frightened. She immediately expressed concern about her pregnancy and her baby. I arranged for her to meet all of the physicians who would possibly be involved in her care and the care of her baby. Each consultant could explain their area of expertise and potential involvement in the care of Ms. B and her child. She met and had an opportunity to talk with the obstetrician on call, a maternal fetal medicine (MFM) fellow and a neonatologist. I supplied the orthopaedic information. I explained the severity of the injury, the risks of osteonecrosis either with or without surgery as well as concerns over non–union and traumatic arthritis of the hip. Undoubtedly, in a healthy 32–year–old woman who wasn’t pregnant, early surgical intervention would be the most appropriate management in hopes of preserving a normal hip joint. We also discussed the possibility of treating her without surgery. She would be administered pain medication, which were known to be safe during pregnancy, and allowed to begin to ambulate with a walker or crutches. I explained potential problems without surgery and what options would be available to treat any problems that developed with her hip after the child was born. Of course, hip fractures in pregnant woman are very rare, and as a result treating a... (shrink)

This study appeared in full in the last issue of Research Ethics Review : 53). John Harris is investigating the effectiveness of a new regime for the treatment rheumatoid arthritis. His role involves asking patients to fill out a questionnaire that normally takes about 35 minutes to complete. The case study outlines three events: a patient whose eyesight is poor, another who cannot read and a receptionist who is discovered reading some of the completed questionnaires.

A certain direction in cognitive science has been to try to “ground” public language statements in some species of mental representation. A central tenet of this trend is that communication – that is, public language – succeeds (when it does) because the elements of this public language are in some way correlated with mental items of both the speaker and the audience so that the mental state evoked in the audience by the use of that piece of public language is (...) the one that the speaker wanted to evoke. The “meaning”, therefore, of an utterance – and of the parts of an utterance, such as individual sentences and their parts, the individual words, etc. – is, in this view, some mental item. Successful communication requires that there be widespread agreement amongst speakers of the same public language as to the mental entities that are correlated with any particular public words. Such a view of meaning is variously called “internalist” or “cognitive” or “subjectivist” or “solipsistic” or (sometimes) “representationalist” (these terms having, however, further connotations which set them apart from one another in other ways), and can be found in a wide variety of writers who do not agree on many other things. It is opposed to views that take the meaning of an utterance to be an item of “reality,” however defined. In different writers this latter view is called “externalist” or “objectivist” or “realist” or (sometimes) “represent-ationalist,” always with the idea that there is something other (or at least, more) than the mental state of speakers and hearers that determines meaning. The literature is rife with arguments between internalists vs. externalists, subjectivists vs. objectivists, cognitivists vs. realists, on such topics as “truth” and “synonymy” and “twin earth” and “arthritis” (to mention only a few).. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 44, no. 1. © 2018 by Olga Zilberbourg 95 Olga Zilberbourg Helen More’s Suicide My retired colleague Marguerite called to tell me of Helen More’s suicide. “Of all the sad, ludicrous things people do to themselves!” She invited me over. “Thursday night, as usual. I could use the company of younger people.” It had been about a year since I’d first been invited to these Thursdays —monthly (...) literary and musical soirees Marguerite hosted in her living room. Helen had been a regular at Marguerite’s for several decades; the two women were close contemporaries and each a celebrity in her own field. Helen was scholar of the English Romantics at the same university where Marguerite had taught Flaubert, Zola, and Balzac, and where I was now a junior faculty member in the English department. I’d heard of Professor More long before I met her: she lectured at the university from the 1960s until being forced into retirement in 2006 ostensibly due to age. She had a reputation as a militant feminist who eagerly engaged in battles about appointments and promotions, and her politics could have had something to do with it. “Are they sure it was a suicide?” In person Helen was a quiet, reticent woman with a sly, sarcastic sense of humor, and the idea that she might’ve committed suicide seemed outlandish. Vague murder scenarios floated in my mind. A disgruntled student? A male professor, passed over for promotion years ago and blaming her for his career failure? 96 Olga Zilberbourg “Yes, quite. The details are unpleasant, but do you know what she wrote in her suicide note?” “Of course she left a note.” “She said, ‘Thanks for the trip. Love to all.’” I couldn’t help laughing. “Yet when you think that having written that, she took all those pills and put a plastic bag over her head,” Marguerite’s voice broke. “Anyway, it’s not a conversation to have over the telephone. Do come over.” On Thursday afternoon, having collected the student papers after the last exam of the semester, I took the subway down to Greenwich Village. Marguerite lived on a third floor walkup, in a wonderfully spacious and tall-ceilinged apartment that back in the 1970s she and her husband had converted from a pillow factory. Since her husband’s death ten years earlier, the apartment had slowly turned into a trap for Marguerite. She suffered from arthritis in her hands, shoulders, and knees, and walking up and down the stairs became a nearly impossible exercise. She ventured out once or twice a week with the assistance of a visiting nurse. The place could easily fetch three or four million dollars, and Marguerite could use the money. Yet she was reluctant to sell. “I’d rather go without bread than without my piano and my books,” she insisted. A feeling of reverence and trepidation caught my breath as I climbed the stairs to Marguerite’s apartment. One never knew what kind of celebrity of the arts or music world could show up on any given Thursday. In her lifetime, Marguerite had known everyone, from Sartre and de Beauvoir to Picasso and Chagall. In the last few years the circle of her acquaintances seemed to dwindle, and yet still world-renowned musicians, poets, playwrights sometimes appeared among the circle of her former colleagues and students. I rang the doorbell and waited for several minutes as Marguerite crept to the door. “I’m afraid you’re my only guest tonight,” she said through the door, struggling with the lock and the knob. Finally, she pushed the door open. “Several people cancelled because of the end of the semester, and then of course, there’s the funeral. But come in, come in—we’ll talk of that later.” Marguerite led me into the living room, heavily shaded from the street and dimly lit with two floor lamps. Decorated with musical instruments, piles of books on the floor and on the low tables, and bright Olga Zilberbourg 97 modernist watercolors on the walls, the room seemed to belong to a royal palace, a vast, untouchable space. Usually Helen or one of Marguerite ’s... (shrink)

Tyler Burge’s influential arguments have convinced most philosophers that a thinker can have a thought involving a particular concept without fully grasping or having mastery of that concept. In Burge’s (1979) famous example, a thinker who lacks mastery of the concept of arthritis nonetheless has thoughts involving that concept. It is generally supposed, however, that this phenomenon – incomplete understanding, for short – does not require us to reconsider in a fundamental way what it is for a thought to (...) involve a particular concept. In this paper, I argue that the real significance of incomplete understanding has not been appreciated. To the extent that theorists of content address the phenomenon of thoughts involving incompletely grasped contents at all, they tend to assume that some hand-waving about deference to other thinkers who fully grasp the relevant concepts will take care of the inconvenient cases of incomplete understanding. The main lesson of Burge’s arguments is often taken to be that the content of language and thought is socially determined. On this picture, we do not need to change our basic view about what it is to have a concept; we just need to recognize that some thinkers can manage to have a concept by piggybacking on others. In contrast, on the view I defend, taking incomplete understanding seriously forces us to rethink some of our most basic assumptions about the nature of mental content. Deference is a red herring. The role of society in determining the content of thought is not the main lesson, but at most a useful clue as to the nature of mental and linguistic content. (shrink)