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The association of aging with an increased susceptibility to and mortality from infection has been observed since ancient times . There are a large number of organ-specific physiological changes associated with aging that increase infection risk, including urogenital changes, weakened cough reflex, endocrinological changes, thinning skin, impaired circulatory function, and sarcopenia, as well as general issues such as malnutrition and increased malignancies
Introduction: One of the most common adverse effects of habitual cannabis use is hyperemesis—recurrent bouts of protracted vomiting, retching and abdominal pain superimposed on a baseline of daily nausea and anorexia. Largely anecdotal evidence supports the use of haloperidol, benzodiazepines or topical capsaicin over traditional antiemetics, yet little is known about the cause or optimal treatment of this newly recognized disorder. We report the results of one of the first clinical trials on so-called cannabis hyperemesis syndrome (NCT03056482). Methods: We approached adults with a working diagnosis of hyperemesis due to cannabis, provided they had ongoing emesis for >2 hours, a cyclic pattern of 3+ episodes in the last 2 years, and near daily use of cannabis by inhalation. We excluded those who were pregnant, deemed unreliable, or using opioids. Subjects provided written consent to be randomized during the index or any subsequent visit to either haloperidol (with a nested randomization to either 0.05 mg/kg or 0.1 mg/kg) or ondansetron 8 mg intravenously in a quadruple-blind fashion, and to be followed for 7 days. The primary outcome was the average reduction from baseline in abdominal pain and nausea (each measured on a 10-cm VAS) at 2 hours. While the original trial design allowed for crossover, the primary analysis used only the first treatment period since fewer than the prespecified threshold of 20% of subjects crossed over. Results: We enrolled 33 subjects, of whom 30 (16 men, 29+/-11 years old, using 1.5+/-0.9 g/day since age 19+/-2 years) were treated at least once (haloperidol 13, ondansetron 17). Haloperidol at either dose was superior to ondansetron (difference 2.3 cm [95%CI 0.6, 4.0]; p = 0.01), with similar improvements in both pain and nausea, as well as less rescue antiemetics (27% vs 61%; p = 0.04), and shorter time to ED departure (3.1+/-1.7 vs 5.6+/-4.5 hours; p = 0.03 Wilcoxon rank sum). There were two (haloperidol) vs six (ondansetron) return visits for ongoing nausea/vomiting, as well as two return visits for acute dystonia, both in the higher dose haloperidol group. Conclusion: Haloperidol is superior to ondansetron for the acute symptomatic treatment of patients with ongoing hyperemesis attributed to habitual cannabis use. The efficacy of this agent over ondansetron provides insight into the mechanism of this new disorder, now almost a daily diagnosis in many Canadian emergency departments.
The aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model.
Twenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed.
The results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage.
The current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct “cores” of schizophrenia, the “Positive” and the “Negative,” while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition.
To examine demographic and behavioural correlates of frequent consumption of fast food among Australian secondary school students and explore the associations between fast food consumption and social/environmental factors.
Cross-sectional survey using a web-based self-report questionnaire.
Secondary schools across all Australian states and territories.
Students aged 12–17 years participating in the 2012–2013 National Secondary Students’ Diet and Activity survey (n 8392).
Overall, 38 % of students surveyed reported consuming fast food at least weekly. Being male, residing in lower socio-economic areas and metropolitan locations, having more weekly spending money and working at a fast food outlet were all independently associated with consuming fast food once a week or more, as were several unhealthy eating (low vegetable intake and high sugary drink and snack food intake) and leisure (low physical activity and higher commercial television viewing) behaviours and short sleep duration. Frequent fast food consumption and measured weight status were unrelated. Students who agreed they go to fast food outlets with their family and friends were more likely to report consuming fast food at least weekly, as were those who usually ‘upsize’ their fast food meals and believe fast food is good value for money.
These results suggest that frequent fast food consumption clusters with other unhealthy behaviours. Policy and educational interventions that reach identified at-risk groups are needed to reduce adolescent fast food consumption at the population level. Policies placing restrictions on the portion sizes of fast food may also help adolescents limit their intake.
Health anxiety is an under-recognised but a frequent cause of distress. It is particularly common in general hospitals.
We carried out an 8-year follow-up of medical out-patients with health anxiety (hypochondriasis) enrolled in a randomised-controlled trial in five general hospitals in London, Middlesex and Nottinghamshire. Randomisation was to a mean of six sessions of cognitive behaviour therapy adapted for health anxiety (CBT-HA) or to standard care in the clinics. The primary outcome was a change in score on the Short Health Anxiety Inventory, with generalised anxiety and depression as secondary outcomes. Of 444 patients aged 16–75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics, 306 (68.9%) were followed-up 8 years after randomisation, including 36 who had died. The study is registered with controlled-trials.com, ISRCTN14565822.
There was a significant difference in the HAI score in favour of CBT-HA over standard care after 8 years [1.83, 95% confidence interval (CI) 0.25–3.40, p = 0.023], between group differences in generalised anxiety were less (0.54, 95% CI −0.29 to 1.36), p = 0.20, ns), but those for depression were greater at 8 years (1.22, 95% CI 0.42–2.01, p < 0.003) in CBT-HA than in standard care, most in standard care satisfying the criteria for clinical depression. Those seen by nurse therapists and in cardiology and gastrointestinal clinics achieved the greatest gains with CBT-HA, with greater improvement in both symptoms and social function.
CBT-HA is a highly long-term effective treatment for pathological health anxiety with long-term benefits. Standard care for health anxiety in medical clinics promotes depression. Nurse therapists are effective practitioners.
Early-life stress (ELS) has previously been identified as a risk factor for cognitive decline, but this work has predominantly focused on clinical groups and indexed traditional cognitive domains. It, therefore, remains unclear whether ELS is related to cognitive function in healthy community-dwelling older adults, as well as whether any effects of ELS also extend to social cognition. To test each of these questions, the Childhood Trauma Questionnaire (CTQ) was administered to 484 older adults along with a comprehensive neuropsychological test battery and a well-validated test of social cognitive function. The results revealed no differences in global cognition according to overall experiences of ELS. However, a closer examination into the different ELS subscales showed that global cognition was poorer in those who had experienced physical neglect (relative to those who had not). Social cognitive function did not differ according to experiences to ELS. These results indicate that the relationship between ELS and cognition in older age may be dependent on the nature of the trauma experienced.
The present study aimed to identify whether discretionary food consumption declined in an intervention focused primarily on promoting fruit and vegetable consumption. We also aimed to identify potential mediators explaining intervention effects on discretionary food consumption.
Secondary analysis of data from the ShopSmart study, a randomised controlled trial involving a 6-month intervention promoting fruit and vegetable consumption. Linear regression models examined intervention effects on discretionary food consumption at intervention completion (T2). A half-longitudinal mediator analyses was performed to examine the potential mediating effect of personal and environmental factors on the association between the intervention effects and discretionary food consumption. Indirect (mediated) effects were tested by the product of coefficients method with bootstrapped se using Andrew Hayes’ PROCESS macro for SPSS.
Women were recruited via the Coles FlyBuys loyalty card database in socio-economically disadvantaged suburbs of Melbourne, Australia.
Analyses included 225 women (116 intervention and 109 control).
Compared with controls, intervention participants consumed fewer discretionary foods at T2, after adjusting for key confounders (B = −0·194, 95 % CI −0·378, −0·010 servings/d; P = 0·039). While some mediators were associated with the outcome (taste, outcome expectancies, self-efficacy, time constraints), there was no evidence that they mediated intervention effects.
The study demonstrated that a behavioural intervention promoting fruit and vegetable consumption among socio-economically disadvantaged participants was effective in reducing discretionary food intake. Although specific mediators were not identified, researchers should continue searching for mechanisms by which interventions have an effect to guide future programme design.
Hermínio Martins was one of the key pioneers of the sociology of science and technology. He published extensively in Portuguese and was recognized for his academic contributions with an honorary doctorate at Lisbon (2006) and two Portuguese Medals of Honour. Following his retirement from the University of Oxford, he wrote prolifically in English on a wide range of topics that examined the ethical and societal consequences of the commoditization of the human body and mind. These essays are deep philosophical reflections on our contemporary world, and draw extensively and eclectically upon a wide range of theoretical influences including continental philosophy, history and psychology, to name but a few disciplines. ‘The Technocene’ is a selection of some of these insightful essays, made available to a global audience for the first time.
The recent trend, by both Labour and Conservative governments, to substantially increase university tuition fees in the UK does not spring solely from the need to address the financial crisis in higher education. It is driven also by the sense that British universities, or at least some of them, must move towards a US exemplar/ myth/ utopia of the ‘world-class research university’, or some version of it, though no clear specification of the goal-state or even of a spectrum of scenarios, appears to have been published as yet. I am not sure whether many, or indeed any, of the distinguished academic backers and co-instigators of this drive share the brutal judgment expressed recently by a former Labour minister of education, resident in recent years in Cambridge, Massachusetts, that Britain does not currently possess a single ‘world-class’ university or multiversity, Britain having presumably slipped down into this outer darkness at some oddly undisclosed point in the recent, or perhaps not-so-recent, past. In fact, a ranking of 500 world universities and 100 European universities, prepared by a team at the Shiao Jong University of Shanghai, shows that Britain, as of 2003, was doing very well indeed in the number of universities in fairly high places on the list, in having two universities in the top ten (so part of the la crème de la crème), and four in the top twenty.
My concern here is not with the question of the comprehensiveness and equity of access to universities supposedly ensured by the new financial arrangements, important as it is, or with the ‘output’ so unengagingly described by the Financial Times in commending these proposals editorially, as nothing more than improved ‘intellectual skills of the workforce’ (2004). For which purpose, surely, you do not really need universities at all, let alone ‘elite universities’, as the FT calls them, and it is worth noting that this proverbial ‘mouthpiece of capitalism’ eschews any additional reference to such desiderata, if not sheer requisites, of a healthy democracy as a well-educated citizenry.
Herminio Martins was born in Lourenco Marques (now Maputo) in Mozambique in 1934. He was a second-generation Mozambican, in that both his parents were born there as well. Herminio attended the Liceu Nacional in Maputo, which was then a small city of about 20,000, with blacks, Chinese, Indians, Italians and Germans in a multiracial pot. For a small city, it had a lively intellectual life, with several visiting scientists and artists from around the world giving lectures and concerts. Martins grew up in a household with books. His aunt and uncle, with whom he lived after the passing of his mother, were voracious readers and imported books in Portuguese from Portugal and Brazil, in French from the Continent and in English from a bookshop in Johannesburg, South Africa.
When Herminio completed secondary school, his family hoped he would attend college somewhere nearby. Geography dictated South Africa, but the young 17-year-old disapproved of the aparthied system there and decided to travel to England, where he knew nobody. He subsequently studied at the London School of Economics (LSE) where, in 1957, he earned a BSc (Econ.), an interdisciplinary degree akin to Oxford's PPE, before doing graduate research under the supervision of Ernest Gellner during 1957 to 1959. Amongst the many highlights of his career at LSE were classes in the philosophy of science with Karl Popper and a deep friendship with Imre Lakatos who apparently claimed that Martins was ‘the only sane sociologist he knew!’ Martins's time at LSE were the golden years of the discipline of philosophy of science, and these influences were to prompt him to write a classic essay on Thomas Kuhn (Martins 1972).
Martins's first job was at the University of Leeds, where he worked from 1959 to 1964. He taught in the social studies department, with colleagues from the disciplines of sociology, anthropology and political science and, worked, amongst others, with John Rex and Bryan Wilson. Martins recalls several seminars that influenced him while at Leeds. These included what became Piyo Rattansi and James E. McGuire's classic paper on Newton (Rattansi and McGuire 2007) and lectures given by the effervescent genius, Jerome Ravetz. Martins then moved to the University of Essex (1964– 71), where he cofounded the Department of Sociology and the School of Comparative Studies.
Should the question of human reproductive cloning be relegated to the realm of techno-futurology if not techno-fantasy, beyond the purview of ethics, or is it amenable to some kind of serious philosophical reflection? The question has been addressed at some length by philosophers of morality, of law, of biology, of technology, as well as theologians, for some time. Already in the 1970s, thinkers of the stature of Hans Jonas had addressed the great width and depth of implications of the matter, and of course in the last few years, after the Dolly landmark in 1996, the pace of pertinent publications has accelerated, and numerous publications and collections of papers have appeared by serious scholars in a variety of disciplines in a number of countries. Human reproductive cloning (HRC) has not yet come to pass, as far as is known to the world, but there is already a corpus of thoughtful writing on the matter, as well as, to be sure, much facile – even ribald – comment from people who ought to have known better. By contrast, animal cloning, reproductive or therapeutic, has received little formal philosophical attention, and the ethical or other value issues raised by human therapeutic cloning, although addressed and referred to in the press, have been, perhaps rightly, overshadowed by those of HRC.
HRC is most obviously assigned to the genus ‘reproductive technologies’, or ‘new reproductive technologies’, which has expanded considerably in range, sophistication and deployment in the last three or four decades, though it surely constitutes a distinct species within this genus, at the very least. It is at least problematical that the social, ethical, axiological, metaphysical implications of this potential new species of human reproductive technologies can simply be regarded as perfectly continuous with the previous or current technologies of medically assisted reproduction (IVF) or ART, that have been implemented and accepted so far in the West. However, it should be noted that conventional bioethics restricts itself to ethical issues without much if any consideration of total axiological and, more broadly, ‘evaluative-metaphysical’ implications regarding especially the metaphysical status of the human person and the ontology of persons-insociety.
Our geological epoch since the 1750s, with the large-scale increase in the use of fossil fuels and thus CO2 emissions into the atmosphere, has been called the Anthropocene by some scientists, including the Nobel Prize winner for chemistry, Paul Crutzen. It could also be called the Technocene, inasmuch as the reasons for that denomination, which are because of the impact on the atmosphere of carbon dioxide emissions since the mideighteenth century, have more to do proximately with technological agency than with the psychophysiological make-up of Homo sapiens sapiens. Besides, while it is not clear whether Homo sapiens will survive, there is far more confidence in some circles that technology, in post-human vehicles, will outlive us. Thus, the Anthropocene (in the sense defined) may well represent simply a subset of the Technocene, overlapping for perhaps three centuries or so.
What does it mean to talk about technological agency? Our starting point is the idea that during the past three to four decades, the life trajectories of our species have been transformed by the concurrent, and often interdependent, mutually supportive technification and marketization of crucial phases of our life trajectories, and of most of the key dimensions of what it is to be human. The purpose of this chapter is to examine these interactions between technologies and markets and, in doing so, characterize the Technocene. The chapter has two substantial parts. The first describes the great transconfigurations underway as regards the physical body. The second is an examination of the changes in the social institutions that educate, employ, control, regulate and order our lives.
We will be born, with ever-increasing frequency, in a hospital or clinic run as a firm (if not in an ambulance of a private enterprise). The medicalization and hospitalization of childbirth has been pretty-well achieved completely, despite fluctuations according to movements of opinion over the last decades, and even longer. Even before birth, we will owe a lot to firms that may deal with our conception in the cases of in vitro fertilization (IVF) – in general under medical control – of uterine insemination and of gestation.
It were no slight attainment could we merely fulfil what the nature of man implies.
Eris sicut dii.
We shall be like gods.
Ex machina libertas.
Many current projects and visions about the future of humanity and the human being, allegedly well-grounded on the current moving frontiers of scientific and technological advance, envisage not only the substantial amelioration but also the transformation or surpassing of the present condition of the human species. This process would be accomplished through the ‘enhancement’ (a key term of this discourse) of its genome, in conjunction with developments in computation, Artificial Intelligence and the technologies of information and communication (ICTs), regarded as paramount, and often as the vehicles for the next and final stage in the post-biological self-transcendence of the human being, indeed, as they say with respect to the singularity in question, beyond which, as the name suggests, nothing can be known, even in principle. On the way, in the next few decades, we would acquire:
• a ‘new body’, version 2.0, to be followed, presumably, by versions 2.0 plus, 3.0 and so on (Kurzweil 2003);
• a ‘new brain’ (‘the merger of biology and technology’); a ‘new mind’ (‘the merger of psychology and technology’);
• a wealth of ‘smart genes’ or super-alleles;
• ‘super-senses’ aka bionic senses (Geary 2002);
• superlative cognitive competences;
and secure ‘radical life extension’ but with unimpaired quality of life (Wade 2009). In other words, we would acquire the next best thing to biological immortality before attaining genuine, post-biological immortality as virtual beings, a kind of eternal life without life, in the organic sense of the term ‘life’, or indeed of the ‘spiritual’ (Broderick 1999; Kurzweil 1999; Tipler 1994).
The sense of ‘body’ or rather of ‘the body’ that prevails today over all others, almost as if it were the ‘unmarked’ or default sense, is that of human body. When books, articles, exhibitions, art catalogues, thematic magazine issues or specialist learned journals (like the British-based Body and Society) appear with ‘the body’ as keywords in the titles, the sense that is taken for granted unless corrected is that the reference is to the human body. There has been quite a massive shift in learned discourse over the last decades, certainly over the last century or so, both in English and in other Western languages, over the incidence of ‘body’ as (human) body and ‘body’ requiring one or another of a considerable number of qualifiers not automatically entailing the presumption of human location, although metaphorically the term body is still potent in other co-occurrences (e.g., in the book titles ‘Gaia's body’, ‘Love's body’). In the now increasingly distant past, ‘body’ was very generally accompanied by other terms, to make up such composite expressions in current use such as ‘material bodies’, ‘natural bodies’, ‘heavenly bodies’, ‘celestial bodies’, ‘the body politic’, ‘the King's two bodies’, ‘the body ecclesiastical’, ‘the world's body’, ‘body of knowledge’, ‘body of work’, ‘bodies of opinion’, ‘the mystical body of Christ’ (not to mention more colloquial expressions such as ‘bodies of water’, ‘bodies of land’, and so forth and English expressions, very much alive, originally jurisprudential, drawing on the Latin for body, such as ‘corporate’, ‘incorporated’, and so forth). Legal English also retains the Latin ‘corpus’ in such expressions as – most famously – habeas corpus, and corpus/corpora appear also in semiology and literary theory.