The comorbidity of chronic pain and opioid addiction is a serious problem that has been growing with the practice of prescribing opioids for chronic pain. Neuroimaging research has shown that chronic pain and opioid dependence both affect brain structure and function, but this is the first study to evaluate the neurophysiological alterations in patients with comorbid chronic pain and addiction. Eighteen participants with chronic low back pain and opioid addiction were compared with eighteen age- and sex-matched healthy individuals in a (...) pain-induction fMRI task. Unified structural equation modeling (SEM) with Lagrange multiplier (LM) testing yielded a network model of pain processing for patient and control groups based on 19 a priori defined regions. Tests of differences between groups on specific regression parameters were determined on a path-by-path basis using z-tests corrected for the number of comparisons. Patients with the chronic pain and addiction comorbidity had increased connection strengths; many of these connections were interhemispheric and spanned regions involved in sensory, affective, and cognitive processes. The affected regions included those that are commonly altered in chronic pain or addiction alone, indicating that this comorbidity manifests with neurological symptoms of both disorders. Understanding the neural mechanisms involved in the comorbidity is crucial to finding a comprehensive treatment, rather than treating the symptoms individually. (shrink)

Over 100 million Americans suffer from chronic pain, which causes more disability than any other medical condition in the United States at a cost of $560–$635 billion per year. Opioid analgesics are frequently used to treat CP. However, long term use of opioids can cause brain changes such as opioid-induced hyperalgesia that, over time, increase pain sensation. Also, opioids fail to treat complex psychological factors that worsen pain-related disability, including beliefs about and emotional responses to pain. Cognitive behavioral therapy can (...) be efficacious for CP. However, CBT generally does not focus on important factors needed for long-term functional improvement, including attainment of personal goals and the psychological flexibility to choose responses to pain. Acceptance and Commitment Therapy has been recognized as an effective, non-pharmacologic treatment for a variety of CP conditions. However, little is known about the neurologic mechanisms underlying ACT. We conducted an ACT intervention in women with chronic musculoskeletal pain. Functional magnetic resonance imaging data were collected pre- and post-ACT, and changes in functional connectivity were measured using Network-Based Statistics. Behavioral outcomes were measured using validated assessments such as the Acceptance and Action Questionnaire, the Chronic Pain Acceptance Questionnaire, the Center for Epidemiologic Studies Depression Scale, and the NIH Toolbox Neuro-QoLTM scales. Results suggest that, following the 4-week ACT intervention, participants exhibited reductions in brain activation within and between key networks including self-reflection, emotion, and cognitive control. These changes in connectivity strength were correlated with changes in behavioral outcomes including decreased depression and pain interference, and increased participation in social roles. This study is one of the first to demonstrate that improved function across the DMN, SN, and FPN may drive the positive outcomes associated with ACT. This study contributes to the emerging evidence supporting the use of neurophysiological indices to characterize treatment effects of alternative and complementary mind-body therapies. (shrink)

ABSTRACTEmotional distractors can impair perception of subsequently presented targets, a phenomenon called emotion-induced blindness. Do emotional distractors lose their power to disrupt perception when appearing with increased frequency, perhaps due to desensitisation or enhanced recruitment of proactive control? Non-emotional tasks, such as the Stroop, have revealed that high frequency distractors or conflict lead to reduced interference, and distractor frequency appears to modulate attentional capture by emotional distractors in spatial attention tasks. But emotion-induced blindness is thought to reflect perceptual competition between (...) targets and emotional distractors, and it is unclear whether high frequency emotional stimuli cause less disruption at this relatively early stage of processing. In four experiments, participants searched streams of images for a rotated target image. A negative or neutral distractor appeared before the target, and their relative frequency was manipulated. Across all exper... (shrink)

Music training is associated with enhanced executive function but little is known about the extent to which harmonic aspects of musical training are associated with components of executive function. In the current study, an array of cognitive tests associated with one or more components of executive function, was administered to young adult musicians and non-musicians. To investigate how harmonic aspects of musical training relate to executive function, a test of the ability to compose a four-part harmony was developed and administered (...) to musicians. We tested the working hypothesis that musicians would outperform non-musicians on measures of executive function, and that among musicians, the ability to harmonize would correlate positively with measures of executive function. Results indicate that musicians outperformed non-musicians on the Tower of London task, a measure of planning and problem-solving. Group differences were not detected on tasks more selective for inhibitory control, conflict resolution, or working memory. Among musicians, scores on the harmony assessment were positively correlated with performance of the Tower of London task. Taken together, the current results support a strong relationship between musicianship and planning and problem solving abilities, and indicate that the ability to harmonize is associated with components of executive function contributing to planning and problem solving. (shrink)

Current treatments for chronic pain have limited benefit. We describe a resilience intervention for individuals with chronic pain which is based on a model of viewing chronic pain as dysregulated homeostasis and which seeks to restore homeostatic self-regulation using strategies exemplified by survivors of extreme environments. The intervention is expected to have broad effects on well-being and positive emotional health, to improve cognitive functions, and to reduce pain symptoms thus helping to transform the suffering of pain into self-growth. A total (...) of 88 Veterans completed the pre-assessment and were randomly assigned to either the treatment intervention or control. Fifty-eight Veterans completed pre- and post-testing. The intervention covered resilience strengths organized into four modules: engagement, social relatedness, transformation of pain and building a good life. A broad set of standardized, well validated measures were used to assess three domains of functioning: health and well-being, symptoms, and cognitive functions. Two-way Analysis of Variance was used to detect group and time differences. Broadly, results indicated significant intervention and time effects across multiple domains: Pain decreased in present severity [F = 5.02, p < 0.05, η2p = 0.08], total pain over six domains [F = 14.52, p < 0.01, η2p = 0.21], and pain interference [F = 6.82, p < 0.05, η2p = 0.11]; Affect improved in pain-related negative affect [F = 7.44, p < 0.01, η2p = 0.12], fear [F = 7.70, p < 0.01, η2p = 0.12], and distress [F = 10.87, p < 0.01, η2p = 0.16]; Well-being increased in pain mobility [F = 5.45, p < 0.05, η2p = 0.09], vitality [F = 4.54, p < 0.05, η2p = 0.07], and emotional well-being [F = 5.53, p < 0.05, η2p = 0.09] Mental health symptoms and the cognitive functioning domain did not reveal significant effects. This resilience intervention based on homeostatic self-regulation and survival strategies of survivors of extreme external environments may provide additional sociopsychobiological tools for treating individuals with chronic pain that may extend beyond treating pain symptoms to improving emotional well-being and self-growth.Clinical Trial Registration: Registered with ClinicalTrials.gov. (shrink)

This Article discusses BLAs as tools of global labor migration governance, with a specific focus on gender. Drawing on our global database of 582 bilateral labor migration agreements, we investigate the extent to which these governing instruments connect and align with relevant international normative frameworks, in particular the extent to which they represent gains, gaps or gaffs in terms of gender equality and the human and labor rights protection of women migrants. In the context of the Global Compact for Safe, (...) Orderly and Regular Migration, which stresses a gender-responsive approach to migration governance as one of its guiding principles, we ask: Do the BLAs which are increasingly being used as instruments to govern labor migration contribute toward sustainable gender equality, decent work and reduced inequalities for women and gender-diverse migrants? (shrink)

SummaryThe Gainj of highland Papua New Guinea do not use contraception but have a total fertility rate of only 4·3 live births per woman, one of the lowest ever recorded in a natural fertility setting. From an analysis of cross-sectional demographic and endocrinological data, the causes of low reproductive output have been identified in women of this population as: late menarche and marriage, a long interval between marriage and first birth, a high probability of widowhood at later reproductive ages, low (...) effective fecundability and prolonged lactational amenorrhoea. These are combined with near-universal marriage, a low prevalence of primary sterility and a pattern of onset of secondary sterility similar to that found in other populations. Of all the factors limiting fertility, by far the most important are those involved in birth spacing, especially lactational amenorrhoea. (shrink)

SummaryThe effects of infant suckling patterns on the post-partum resumption of ovulation and on birth-spacing are investigated among the Gainj of highland New Guinea. Based on hormonal evidence, the median duration of lactational anovulation is 20·4 months, accounting for about 75% of the median interval between live birth and next successful conception. Throughout lactation, suckling episodes are short and frequent, the interval changing slowly over time, from 24 minutes in newborns to 80 minutes in 3-year olds. Maternal serum prolactin concentrations (...) decline in parallel with the changes in suckling patterns, approaching the level observed in non-nursing women by about 24 months post-partum. A path analysis indicates that the interval between suckling episodes is the principal determinant of maternal prolactin concentration, with time since parturition affecting prolactin secretion only in so far as it affects suckling frequency. The extremely prolonged contraceptive effect of breast-feeding in this population thus appears to be due to a slow decline in suckling frequency with time since parturition and absence of a decline over time in hypothalamic–pituitary responsiveness to the suckling stimulus. (shrink)

Background Informed consent is an integral component of good medical practice. Many researchers have investigated measures to improve the quality of informed consent, but it is not clear which techniques work best and why. To address this problem, we propose developing a core outcome set to evaluate interventions designed to improve the consent process for surgery in adult patients with capacity. Part of this process involves reviewing existing research that has reported what is important to patients and doctors in the (...) informed consent process. Methods This qualitative synthesis comprises four phases: identification of published papers and determining their relevance; appraisal of the quality of the papers; identification and summary of the key findings from each paper while determining the definitiveness of each finding against the primary data; comparison of key themes between papers such that findings are linked across studies. Results Searches of bibliographic databases returned 11,073 titles. Of these, 16 studies met the inclusion criteria. Studies were published between 1996 and 2016 and included a total of 367 patients and 74 health care providers. Thirteen studies collected data using in-depth interviews and constant comparison was the most common means of qualitative analysis. A total of 94 findings were extracted from the primary papers and divided into 17 categories and ultimately 6 synthesised findings related to: patient characteristics, knowledge, communication, the model patient, trust and decision making. Conclusions This qualitative meta-aggregation is the first to examine the issue of informed consent for surgery. It has revealed several outcomes deemed important to capture by patients and clinicians when evaluating the quality of a consent process. Some of these outcomes have not been examined previously in research comparing methods for informed consent. This review is an important step in the development of a COS to evaluate interventions designed to improve the consent process for surgery. Registration The study protocol was registered on the international prospective register for systematic reviews. (shrink)

Humanitarian health care practitioners working outside familiar settings, and without familiar supports, encounter ethical challenges both familiar and distinct. The ethical guidance they rely upon ought to reflect this. Using data from empirical studies, we explore the strengths and weaknesses of two ethical models that could serve as resources for understanding ethical challenges in humanitarian health care: clinical ethics and public health ethics. The qualitative interviews demonstrate the degree to which traditional teaching and values of clinical health ethics seem insufficient (...) for addressing all the realities of health care practice during humanitarian missions. They equally suggest that greater good orientations of public health ethics can thwart the best intentions of health care professionals wanting to attend to the interests of individual patients. Even though neither is complete on its own for helping guide health professionals on field missions, taken together these models have much to offer. At the same time, the narratives of the humanitarian health care workers illustrate how some of the crucial differences between public health ethics and clinical ethics generate tensions in humanitarian health practice. We offer an analysis of some of the complexities this creates for humanitarian health care ethics, and consider ways of adjudicating between the two models. (shrink)

Taking Rom Harré's social constructionism as a focus we point to and discuss the issue of the a priori psychological subject in social constructionist theory. While Harré indicates that interacting, intending beings are necessary for conversation to occur, he assumes that the primary human reality is conversation and that psychological life emerges from this social domain. Nevertheless, we argue that a fundamental and agentive psychological subject is implicit to his constructionist works. Our critical analyses focus upon Harré's understandings of persons, (...) human development and human agency. Our intention is neither to suggest that this latent entity must be understood in a Cartesian sense nor is it to ask for an explicit accounting of an autonomous agent. Rather, our claim is simply that psychological subjectivity is reflexively entailed in Harré's human psychology. We suggest that this pertains more generally to social constructionist theory. (shrink)

Two complementary biographies of Ayn Rand were published in 2009: Goddess of the Market, by Jennifer Burns, and Ayn Rand and the World She Made, by Anne Heller. Burns focuses on Rand's influence on American political thought, while Heller's concern is Rand the screenwriter, novelist, and author of her personal mythos. Both books are meticulously researched and well written; neither author espouses Rand's philosophy or agrees with her politics. Such books establish that Rand's ideas have become part of American culture (...) and are no longer set over and against it. (shrink)

Think as If Your Life Depends on It puts Barbara Branden’s lectures on the Principles of Efficient Thinking in print at last, along with three later lectures. In Roger Bissell’s excellent transcription, the ten lectures introduce readers to psycho-epistemology, the difference between directed and undirected thinking, the role of the subconscious in problem-solving, common faults in thinking, and motivational issues that interfere with thinking. Her contributions were effectively erased from Objectivism after the Nathaniel Branden Institute closed; the original lectures were (...) the most significant part of the Objectivist corpus that remained to be recovered. (shrink)

It is often argued that the indispensability of continuum models comes from their empirical adequacy despite their decoupling from the microscopic details of the modelled physical system. There is thus a commonly held misconception that temperature varying across a region of space or time can always be accurately represented as a continuous function. We discuss three inter-related cases of temperature modelling — in phase transitions, thermal boundary resistance and slip flows — and show that the continuum view is fallacious on (...) the ground that the microscopic details of a physical system are not necessarily decoupled from continuum models. We show how temperature discontinuities are present in both data (experiments and simulations) and phenomena (theory and models) and how discontinuum models of temperature variation may have greater empirical adequacy and explanatory power. The conclusions of our paper are: a) continuum idealisations are not indispensable to modelling physical phenomena and both continuous and discontinuous representations of phenomena work depending on the context; b) temperature is not necessarily a continuously defined function in our best scientific representations of the world; and c) that its continuity, where applicable, is a contingent matter. We also raise a question as to whether discontinuous representations should be considered truly de-idealised descriptions of physical phenomena. (shrink)

Book reviewed in this article: Practical Medical Ethics. By Alastair Campbell, Grant Gillett, and Gareth Jones. If I Were a Rich Man Could I Buy a Pancreas? and Other Essays on the Ethics of Health Care. By Arthur L. Caplan. Bloomington Ethics on Call: A Medical Ethicist Shows How to Take Charge of Life and Death Choices in Today's Health Care System. By Nancy Dubler and David Nimmons.

Recently, shifting societal attitudes towards animals have resulted in an increasing challenge to the ‘social license’ to use animals in competitive sport. Against that background, this paper explores whether the use of animals in competitive sport is ever justifiable from the perspective of three commonly used ethical theories: deontology, utilitarianism and virtue ethics. In so doing, it recognises the importance of human understanding of animals as sentient beings. The author argues that when deontology, utilitarianism and virtue ethics are each used (...) to consider the question ‘Is the use of animals in sport ethically justifiable?’, only absolutist rights theory leads to a negative conclusion. Specified rights theory, utilitarianism and virtue ethics all allow for the human use of animals in sport. However, the author then goes onto argue that even if one does not accept an absolutist rights point of view and does believe that the use of animals in sport is generally ethically justifiable, that use should be limited by fulfilment of certain ‘qualifying constraints’: (a) minimisation of negative welfare effects and maximisation of positive welfare effects, to enable ‘good lives’ for animals (b) identification of and mitigation against avoidable, unnecessary risk and (c) compliance with governing body regulations and the law. (shrink)

How We Know is intended as a summary of Objectivist epistemology. Binswanger's treatment of a wide range of epistemological issues is examined. Because his theory of propositions is inadequate and his philosophy of mind is an extreme form of dualism, Binswanger has added little to previous efforts by “official” Objectivists. As a work of epistemology in the broad sense, Binswanger's effort is fatally impaired. It is undone by his bifurcation between consciousness and the physics of the brain, which, if accepted, (...) would largely deprive psychology and even computer science of their subject matter. (shrink)

The prohibition against psychologizing has been a source of confusion to many Randians. Psychologizing is the practice of incorrectly or improperly inferring motives in other people instead of rendering moral judgment. Rand thought that it could manifest in two ways: inquisitorial and excuse-making. However, Rand's concrete examples are preponderantly of the excuse-making type; her bright line between psychology and philosophy is unsuccessfully drawn; and in offering extended, strongly condemnatory analyses of the supposed motives behind psychologizing, she yields to the very (...) temptation she claims to warn against. “Psychologizing” turns out to be an anticoncept. (shrink)

There is a major debate as to whether there are non-causal mathematical explanations of physical facts that show how the facts under question arise from a degree of mathematical necessity considered stronger than that of contingent causal laws. We focus on Marc Lange’s account of distinctively mathematical explanations to argue that purported mathematical explanations are essentially causal explanations in disguise and are no different from ordinary applications of mathematics. This is because these explanations work not by appealing to what the (...) world must be like as a matter of mathematical necessity but by appealing to various contingent causal facts. (shrink)

Marine ecosystems are under increasing pressure from human activity, yet successful management relies on knowledge. The evidence-based policy (EBP) approach has been promoted on the grounds that it provides greater transparency and consistency by relying on ‘high quality’ information. However, EBP also creates epistemic responsibilities. Decision-making where limited or no empirical evidence exists, such as is often the case in marine systems, creates epistemic obligations for new information acquisition. We argue that philosophical approaches can inform the science-policy interface. Using marine (...) biosecurity examples, we specifically examine the epistemic challenges in the acquisition and acceptance of evidence to inform policy, discussing epistemic due care and biases in consideration of evidence. (shrink)

Procurement of organs from non-heart-beating cadaver donors raises concerns. Standards for optimal patient care during withdrawal of life-sustaining therapy are evolving and continue to be debated and studied. Consensus on specific procedures and methods has not been attained, however, and protocols for the procurement of organs from patients following the withdrawal of life-sustaining therapies may compromise the evolving standards and harm the patient and the attendant family. In addition, there is little evidence to suggest that such protocols will significantly increase (...) the number of organs procured. "Non-heart-beating cadaver" protocols that do not give comprehensive attention to optimal patient/family care at the time of withdrawal of life-sustaining therapy ought not to be endorsed. (shrink)

Academic incivility can create divisiveness and affect learners’ sustainability towards degree attainment. Therefore, there is a need to empirically assess learner views on what constitutes academic incivility in higher education. To fill this gap, we developed the Incivility Indicators Instrument (i3), a multifaceted scale that measures the extent to which students view cumulative behaviors and dynamics as instances of academic incivility. To examine the reliability and factor structure of the i3, we conducted a two-part study with two samples of adults (...) in the United States who were enrolled in higher education programs. In study 1 (N = 342), we conducted an exploratory factor analysis (EFA) and found the initial three-factor structure. In study 2, we administered the instrument to a validating sample (N = 510) and examined the stability of the three-factor model and scores through confirmatory factor analysis (CFA). In this study, we describe the results of the study, provide implications, and discuss future directions. (shrink)

So-called ‘distinctively mathematical explanations’ (DMEs) are said to explain physical phenomena, not in terms of contingent causal laws, but rather in terms of mathematical necessities that constrain the physical system in question. Lange argues that the existence of four or more equilibrium positions of any double pendulum has a DME. Here we refute both Lange’s claim itself and a strengthened and extended version of the claim that would pertain to any n-tuple pendulum system on the ground that such explanations are (...) actually causal explanations in disguise and their associated modal conditionals are not general enough to explain the said features of such dynamical systems. We argue and show that if circumscribing the antecedent for a necessarily true conditional in such explanations involves making a causal analysis of the problem, then the resulting explanation is not distinctively mathematical or non-causal. Our argument generalises to other dynamical systems that may have purported DMEs analogous to the one proposed by Lange, and even to some other counterfactual accounts of non-causal explanation given by Reutlinger and Rice. (shrink)