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At the heart of Sophia Moreau's theory of wrongful discrimination is the moral duty to treat others as equals. This article raises some challenges regarding the contours of this duty and suggests some ways to make the theory stronger. In particular, it suggests that we incorporate a cosmopolitan view of the duty's scope, that we illuminate the features at the basis of individuals’ equal moral status to determine its grounds, and that we identify some considerations about important interests to articulate its contents. The relation between Moreau's theory and human rights discourse is also briefly examined, and more engagement with the latter is recommended.
Needs analysis has been proposed as a professional inquiry into second language learner needs that should inform task and syllabus design. These two areas, however, have been studied separately. We focus on the interface between learners’ needs and our macro and micro decisions during task and syllabus design. Needs analysis and its dimensions are defined by addressing important theoretical and methodological issues. We relate then relate needs analysis to the issue of how it may aid the highly complex decision regarding how tasks may be selected. We also inspect how needs analysis may directly and indirectly inform task design. Finally, we address the issue of how task sequencing may also be aided by needs analysis.
To evaluate social and occupational functioning in patients in partial remission (PR) compared with patients in complete remission (CR) of a major depressive disorder (MDD) episode.
Subjects and methods
This is a six-month prospective study. PR was defined as a score more than 7 and less or equal to 15 in the Hamilton Depression Rating Scale, and CR as less or equal to 7. All patients had been on acute antidepressant treatment during the previous three months and no longer met criteria for MDD. Functioning was assessed by the Social and Occupational Functioning Assessment Scale (SOFAS).
Results
Mean (S.D.) patient age was 50.5 (14.5) years (N = 292) and 77% were female. At baseline, partial remitters showed greater impairment in social and occupational functioning than complete remitters (62.8 [12.6] versus 80.4 [10.5], respectively; P < .0001). After six months, only 47% PR versus 77% CR reached normal functioning, and SOFAS ratings for PR were below normal range (76.2 [12.3] PR versus 84.6 [9.4] CR; P < .0001). PR reported three times more days absent from work due to sickness than CR (63 days versus 20 days; P < .001).
Conclusion
We conclude that PR of an MDD episode is associated with significant functional impairment that persists even after nine months of antidepressant treatment. Our results underline the importance of treating the patient until achieving full remission.
To describe the clinical profiles, modifications of the therapeutic strategies and relapse rate of patients with schizophrenia who are at risk of non-adherence to oral antipsychotic (AP) medication.
Methods
A cohort of 597 outpatients whose therapy was modified because of risk of non-adherence to oral AP was followed during 12 months. Authors used Cox regression to analyse the time to relapse.
Results
Patients’ mean (SD) age was 40.1 (11.1) and time since diagnosis was 15.2 (10.0) years; 64% were males. The clinical condition was at least moderate in most patients (CGI-S score ≥4 in 87%). Baseline AP medication was modified in 506 (85%) patients and non-pharmacological therapies in 190 (32%). In both cases, the main reason for modifications was insufficient efficacy. Concomitant medications were modified in 15%. The proportion of patients in AP monotherapy decreased in favour of polytherapy, and 15% started depot formulations.
During 12 months, 90 patients (15%) relapsed. Among relapsing patients, the proportion on monotherapy decreased to 42%, and the depot prescriptions rose to 28%. The risk of relapse was greater among patients with substance use disorder or familial psychiatric antecedents and lower in patients with poor attitude to AP medication or undergoing modifications of their non-pharmacological therapy at baseline.
Conclusions
Non-adherence management was focused on improving efficacy and consisted mainly of modifications of oral AP medication. The recognition and treatment, not necessarily pharmacological, of patients with a poor attitude to medication at baseline might explain their lower risk of relapse.
This article presents the long-term results in terms of antipsychotic medication maintenance and factors influencing it in a representative sample of patients with schizophrenia recruited in the SOHO study within Spain.
Methods
The SOHO was a prospective, 3-year observational study of the outcomes of schizophrenia treatment in outpatients who initiated therapy or changed to a new antipsychotic performed in 10 European countries with a focus on olanzapine. The Kaplan–Meier method was used to analyse the time to treatment discontinuation and the Cox proportional hazards model to investigate correlates of discontinuation.
Results and conclusions
In total, 1688 patients were included in the analyses. Medication maintenance at 3 years varied with the antipsychotic prescribed, being highest with clozapine (57.6%, 95% CI 39.2–74.5), followed by olanzapine (48.3%, 95% CI 45.1–51.5); and lowest with quetiapine (19.0%, 95% CI 13.0–26.3). Treatment discontinuation was significantly less frequent with olanzapine than with risperidone (p = 0.015), depot typical (p = 0.001), oral typical antipsychotics (p < 0.001) or quetiapine (p < 0.001); but not than with clozapine (p = 0.309). Longer maintenance was also associated with higher social abilities and better cognitive status at baseline; in contrast, a shorter time to discontinuation was associated with the need for mood stabilisers during follow-up. This study emphasises the different value of antipsychotics in day-to-day clinical practice, as some of them were associated with longer medication maintenance periods than others. This study has some limitations because of possible selection and information biases derived from the non-systematic, non-randomised allocation to treatments and the existence of unobserved covariates that may influence the outcome.
Progress in therapeutic options for schizophrenia has revived long-term expectations of researchers, practitioners and patients. At present, definitions of therapeutic outcome include both maintained symptomatic remission and appropriate functioning in a conceptual framework that targets patient's recovery as the ultimate goal. We aimed to know the prevalence and clinical features of patients with schizophrenia achieving these outcomes.
Methods
A multi-centre, cross-sectional study was performed in more than 100 mental health facilities within Spain. Recently published consensus-based operational criteria for symptomatic remission and the Global Assessment of Functioning scale were used to evaluate outcomes. Other clinical aspects like depressive symptoms, social cognition, premorbid adjustment and patients' attitudes to medication were also evaluated.
Results
Data from 1010 patients were analysed. Of these, 452 (44.8%) were at clinical remission, but only 103 (10.2%) showed an adequate social and/or vocational functioning. Factors predicting both outcomes were better pre-morbid adjustment (odds ratio, OR = 1.56) and better social cognitive function (OR = 1.14). Other factors, like treatment adherence, current or past psychotherapy and patient's age were not associated to functionality but only to clinical remission. Current substance use and previous rehabilitation were associated to a lower likelihood of symptomatic remission.
Conclusion
Although symptomatic remission in patients with schizophrenia is a realistic and reachable goal, future efforts should be directed to a sustained appropriate functioning in these patients.
Like planes that after thousands of hours of careful engineering design can successfully take us to our destination, task design for second or foreign language (L2) use and learning should be able to take learners who do not know or have not mastered a language to successfully and appropriately communicating in it. In this chapter, we reflect on how task design may be carried out when second languages are morphologically complex.
The goals of task design are manifold, and most L2 task designers and researchers would agree on the following facts: firstly, task design should guarantee that the pedagogic tasks used in a classroom slowly but steadily approximate L2 learners to real-life performance (see for example the concept of “target tasks” in Long, 2005; 2015). Secondly, while maintaining a focus on meaning, task goals, and task completion, task design should facilitate the conditions for language processing and language learning to take place through focus on form (Doughty & Williams, 1998; Doughty, 2001), and hence guarantee exposure to rich and meaningful input, the provision of opportunities for interaction, production, and feedback (Gass & Mackey, 2007).
We report a detailed study of the different categories and types of abnormal morphologies in planktic foraminifera recognizable in the lowermost Danian, mainly from the El Kef and Aïn Settara sections, Tunisia. Various types of abnormalities in the test morphology were identified, including protuberances near the proloculus, abnormal chambers, double or twinned ultimate chambers, multiple ultimate chambers, abnormal apertures, distortion in test coiling, morphologically abnormal tests, attached twins or double tests, and general monstrosities. Detailed biostratigraphic and quantitative studies of the Tunisian sections documented a major proliferation of aberrant planktic foraminifera (between approximately 5% and 18% in relative abundance) during the first 200 Kyr of the Danian, starting immediately after the Cretaceous/Paleogene (K/Pg) boundary mass extinction (spanning from the Guembelitria cretacea Zone to the lower part of the P. pseudobulloides Zone). This contrasts with the proportionately low frequency of aberrant tests (generally <2%) identified within the uppermost Maastrichtian, suggesting more stable environmental conditions during the last ~50–100 Kyr of the Cretaceous. Two main pulses with abundant aberrant tests were recognized in the earliest Danian, the one recorded in the well-known K/Pg boundary clay being the more intense of those (maxima of >18%). These main pulses of aberrants coincide approximately with relevant quantitative and evolutionary turnovers in the planktic foraminiferal assemblages. In this paper, we explore the relation of these high values of the foraminiferal abnormality index with the environmental changes induced by the meteorite impact of Chicxulub in Yucatan, Mexico, and the massive eruptions of the Deccan Traps, India.
This article offers an account of human dignity based on a discussion of Kant’s moral and political philosophy and then shows its relevance for articulating and developing in a fresh way some normative dimensions of Marx’s critique of capitalism as involving exploitation, domination and alienation, and the view of socialism as involving a combination of freedom and solidarity. What is advanced here is not Kant’s own conception of dignity, but an account that partly builds on that conception and partly criticizes it. The same is the case with the account of socialism in relation to Marx’s work. As articulated, Kantian dignity and Marxian socialism turn out to be quite appealing and mutually supportive.
Objectives: The aim of this study was to adapt and assess the value of a Multi-Criteria Decision Analysis (MCDA) framework (EVIDEM) for the evaluation of Orphan drugs in Catalonia (Catalan Health Service).
Methods: The standard evaluation and decision-making procedures of CatSalut were compared with the EVIDEM methodology and contents. The EVIDEM framework was adapted to the Catalan context, focusing on the evaluation of Orphan drugs (PASFTAC program), during a Workshop with sixteen PASFTAC members. The criteria weighting was done using two different techniques (nonhierarchical and hierarchical). Reliability was assessed by re-test.
Results: The EVIDEM framework and methodology was found useful and feasible for Orphan drugs evaluation and decision making in Catalonia. All the criteria considered for the development of the CatSalut Technical Reports and decision making were considered in the framework. Nevertheless, the framework could improve the reporting of some of these criteria (i.e., “unmet needs” or “nonmedical costs”). Some Contextual criteria were removed (i.e., “Mandate and scope of healthcare system”, “Environmental impact”) or adapted (“population priorities and access”) for CatSalut purposes. Independently of the weighting technique considered, the most important evaluation criteria identified for orphan drugs were: “disease severity”, “unmet needs” and “comparative effectiveness”, while the “size of the population” had the lowest relevance for decision making. Test–retest analysis showed weight consistency among techniques, supporting reliability overtime.
Conclusions: MCDA (EVIDEM framework) could be a useful tool to complement the current evaluation methods of CatSalut, contributing to standardization and pragmatism, providing a method to tackle ethical dilemmas and facilitating discussions related to decision making.
In this article we explore how oral and written modes may differentially influence processes involved in second language acquisition (SLA) in the context of task-based language teaching (TBLT). We first start by reflecting on the differences between spoken and written language. In what follows, we provide a general description of tasks in relation to the SLA processes. We then establish the links between the learning processes and task phases/features in the two modes. Concluding that the role of mode has been underresearched, we call for a more integrative and mode-sensitive TBLT research agenda, in which hybridness of discourse (i.e., mingling of the two modes within one communicative event/task) is taken into account.
This study explored the usefulness of dual-task methodology, self-ratings, and expert judgments in assessing task-generated cognitive demands as a way to provide validity evidence for manipulations of task complexity. The participants were 96 students and 61 English as a second language (ESL) teachers. The students, 48 English native speakers and 48 ESL speakers, carried out simple and complex versions of three oral tasks—a picture narrative, a map task, and a decision-making task. Half of the students completed the tasks under a dual-task condition. The remaining half performed the tasks under a single-task condition without a secondary task. Participants in the single condition were asked to rate their perceived mental effort and task difficulty. The ESL teachers provided expert judgments of anticipated mental effort and task difficulty along with explanations for their ratings via an online questionnaire. As predicted, the more complex task versions were found and judged to pose greater cognitive effort on most measures.
Parthenogenesis is the main mode of reproduction of aphids. Their populations are therefore composed of clones whose frequency distribution varies in space and time. Previous population genetic studies on aphids have highlighted the existence of highly abundant clones (‘super-clones’), distributed over large geographic areas and persisting over time. Whether the abundance of ‘super-clones’ results from their ecological success or from stochastic forces, such as drift and migration, is an open question. Here, we looked for the existence of clines in clonal frequency along a climatic gradient in the cereal aphid Rhopalosiphum padi (Linnaeus, 1758) and examined the possible influence of geographical distance and environmental variables in the buildup and maintenance of such clonal clines. We investigated the spatial distribution of the commonest genotypes of R. padi by sampling populations along an east–west transect in maize fields in the northern half of France in both spring and late summer. Individual aphids were genotyped at several polymorphic loci, allowing the assessment of frequency distributions of multilocus genotypes (MLGs) across the cropping season. We found several MLGs showing longitudinal clines in their frequency distribution in both spring and summer. In particular, two dominant asexual genotypes of R. padi showed inverted geographical clines, which could suggest divergent adaptations to environmental conditions. We concluded that while the distribution of some ‘super-clones’ of R. padi seems most likely driven by the action of migration and genetic drift, selection could be also involved in the establishment of longitudinal clines of others.
Rawls’s substantive conception of social justice, justice as fairness, includes two principles. They are an answer to this question: “viewing society as a fair system of cooperation between citizens regarded as free and equal, what principles of justice are most appropriate to specify basic rights and liberties, and to regulate social and economic inequalities in citizens’ prospects over a complete life?” (JF 41). The following are three key formulations of the two principles:
FIRST PRINCIPLE
Each person is to have an equal right to the most extensive total system of equal basic liberties compatible with a similar system of liberty for all.
SECOND PRINCIPLE
Social and economic inequalities are to be arranged so that they are both: (a) to the greatest benefit of the least advantaged, consistent with the just savings principle, and (b) attached to offices and positions open to all under conditions of fair equality of opportunity. (TJ 266)
Amartya Sen (b. 1933) is an economist and philosopher whose work in social choice theory, development economics, and moral and political theory has been very influential. This entry focuses on Sen’s discussion of Rawls’s views. These are summarized in Sen’s recent book The Idea of Justice (2009). Sen endorses several key features of Rawls’s theory of justice, including its focus on fairness, its account of objectivity, its characterization of persons as rational and reasonable, its view of liberty as a separate value, its insistence on the importance of procedural fairness in addition to the achievement of certain social and economic outcomes, its particular attention to the plight of the worst off, and its effort to connect freedom with real opportunities (Sen 2009, 63–64).
However, Sen makes several criticisms. The three most important concern the metric of justice (2009, 234–235, 253–254, 261–263), the site of justice (2009, x–xi, 10, 18–27, 67–69, 85), and the aims and structure of theorizing about justice (2009, 9–18, 56–57, 97–102). First, Sen argues that Rawls’s focus on social primary goods is insufficient for measuring and comparing peoples’ quality of life. Specifically, the difference principle’s focus on income and wealth faces a deficit common in “resourcist” views of justice. This is their blindness to the “conversion problem”: given personal heterogeneities, diversities in physical environment, variations in social climate, and differences in relational (cultural) perspectives, different individuals can have quite different abilities to convert income and other primary goods into valuable forms of life.