Somerville Hospital

Abstract This paper reviews the evidence for the existence of a complex form of post‐traumatic disorder in survivors of prolonged, repeated trauma. This syndrome is currently under consideration for inclusion in DSM‐IV under the name of DESNOS (Disorders of Extreme Stress Not Otherwise Specified). The current diagnostic formulation of PTSD derives primarily from observations of survivors of relatively circumscribed traumatic events. This formulation fails to capture the protean sequelae of prolonged, repeated trauma. In contrast to a single traumatic event, prolonged, repeated trauma can occur only where the victim is in a state of captivity, under the control of the perpetrator. The psychological impact of subordination to coercive control has many common features, whether it occurs within the public sphere of politics or within the private sphere of sexual and domestic relations.

I will begin by stating three theses which I present in this paper. The first is that it is not profitable for us at present to do moral philosophy; that should be laid aside at any rate until we have an adequate philosophy of psychology, in which we are conspicuously lacking. The second is that the concepts of obligation, and duty— moral obligation and moral duty, that is to say—and of what is morally right and wrong, and of the moral sense of “ought,” ought to be jettisoned if this is psychologically possible; because they are survivals, or derivatives from survivals, from an earlier conception of ethics which no longer generally survives, and are only harmful without it. My third thesis is that the differences between the wellknown English writers on moral philosophy from Sidgwick to the present day are of little importance.

Solid organs transport fluids through distinct vascular networks that are biophysically and biochemically entangled, creating complex three-dimensional (3D) transport regimes that have remained difficult to produce and study. We establish intravascular and multivascular design freedoms with photopolymerizable hydrogels by using food dye additives as biocompatible yet potent photoabsorbers for projection stereolithography. We demonstrate monolithic transparent hydrogels, produced in minutes, comprising efficient intravascular 3D fluid mixers and functional bicuspid valves. We further elaborate entangled vascular networks from space-filling mathematical topologies and explore the oxygenation and flow of human red blood cells during tidal ventilation and distension of a proximate airway. In addition, we deploy structured biodegradable hydrogel carriers in a rodent model of chronic liver injury to highlight the potential translational utility of this materials innovation.

Abstract Philippa Foot sets out a naturalistic theory of ethics, which she calls ‘natural normativity’ and which is radically opposed to the subjectivist, non‐naturalism tradition deriving from David Hume and to be found in G. E. Moore and modern theories of ethics influenced by Moore, such as emotivism and prescriptivism. Natural normativity involves a special form of evaluation that predicates goodness and defect to living things qua living things, and Foot argues that this is the form of evaluation in moral judgements. Moral evaluations thus share a conceptual structure with evaluations of the characteristics and operations of living things, and can only be understood in these terms. The thesis of the book, then, is that vice is a natural defect, and virtue goodness of will; therefore propositions to do with goodness or badness in human character and action are not to be understood in psychological terms. In Ch. 1, Foot discusses and criticizes the subjectivism and non‐cognitivism that has dominated the past 60 years of analytical moral philosophy. Ch. 2 provides a sketch of an account of natural normativity in plants and animals, while Ch. 3 applies this to human beings, including a discussion of Elizabeth Anscombe's discussion of promising. Ch. 4 exhibits the constraint that this account of natural normativity imparts to any adequate view of practical rationality. Ch. 5 attempts to dissolve any meaningful distinction between the domain of practical rationality and the domain of morality. Ch. 6 deals with the connection between goodness and happiness, while Ch. 7 discusses Nietzsche's immoralism.

In the past two decades, as the result of feminist consciousness-raising, sexual abuse of children has been recognized in North America and Western Europe as a serious social problem. The testimony of victims, first in consciousness-raising groups, then in public speakouts, and finally in formal survey research, has documented the high prevalence of sexual exploitation of children. The best available data, drawn from large-scale surveys of nonclinical populations, indicate that the risk of victimization may be as high as 1 in 10 for boys (), and greater than 1 in 3 for girls (). Whether the child victim is male or female, the perpetrator is usually male. Most perpetrators are not strangers but are well known to their child victims; often they are in a position of trust or authority that affords them access and power.

BACKGROUND AND PURPOSE: Little research has been done regarding the attitudes and behaviors of physical therapists relative to the use of evidence in practice. The purposes of this study were to describe the beliefs, attitudes, knowledge, and behaviors of physical therapist members of the American Physical Therapy Association (APTA) as they relate to evidence-based practice (EBP) and to generate hypotheses about the relationship between these attributes and personal and practice characteristics of the respondents. METHODS: A survey of a random sample of physical therapist members of APTA resulted in a 48.8% return rate and a sample of 488 that was fairly representative of the national membership. Participants completed a questionnaire designed to determine beliefs, attitudes, knowledge, and behaviors regarding EBP, as well as demographic information about themselves and their practice settings. Responses were summarized for each item, and logistic regression analyses were used to examine relationships among variables. RESULTS: Respondents agreed that the use of evidence in practice was necessary, that the literature was helpful in their practices, and that quality of patient care was better when evidence was used. Training, familiarity with and confidence in search strategies, use of databases, and critical appraisal tended to be associated with younger therapists with fewer years since they were licensed. Seventeen percent of the respondents stated they read fewer than 2 articles in a typical month, and one quarter of the respondents stated they used literature in their clinical decision making less than twice per month. The majority of the respondents had access to online information, although more had access at home than at work. According to the respondents, the primary barrier to implementing EBP was lack of time. DISCUSSION AND CONCLUSION: Physical therapists stated they had a positive attitude about EBP and were interested in learning or improving the skills necessary to implement EBP. They noted that they needed to increase the use of evidence in their daily practice.

According to what we call the Principle of Procreative Beneficence (PB),couples who decide to have a child have a significant moral reason to select the child who, given his or her genetic endowment, can be expected to enjoy the most well-being. In the first part of this paper, we introduce PB,explain its content, grounds, and implications, and defend it against various objections. In the second part, we argue that PB is superior to competing principles of procreative selection such as that of procreative autonomy.In the third part of the paper, we consider the relation between PB and disability. We develop a revisionary account of disability, in which disability is a species of instrumental badness that is context- and person-relative.Although PB instructs us to aim to reduce disability in future children whenever possible, it does not privilege the normal. What matters is not whether future children meet certain biological or statistical norms, but what level of well-being they can be expected to have.

We evaluated a program of payments for ecosystem services in Uganda that offered forest-owning households annual payments of 70,000 Ugandan shillings per hectare if they conserved their forest. The program was implemented as a randomized controlled trial in 121 villages, 60 of which received the program for 2 years. The primary outcome was the change in land area covered by trees, measured by classifying high-resolution satellite imagery. We found that tree cover declined by 4.2% during the study period in treatment villages, compared to 9.1% in control villages. We found no evidence that enrollees shifted their deforestation to nearby land. We valued the delayed carbon dioxide emissions and found that this program benefit is 2.4 times as large as the program costs.

A simple method has been designed for evaluating both non-narcotic and narcotic analgesics. The method is based upon the specific antagonism of analgesics to the typical “syndrome” produced by intra-peritoneal injection of 2-phenyl-1,4-benzo-quinone in mice. The antagonism occurs at doses far below those producing depression or other toxic effects. There is also a good correlation between clinical efficacy of a number of analgesics and their relative potency as established by this method. The endpoint is sharp, and the method is simple and quantitative.

Journal Article Book Reviews Get access Microcognition: Philosophy, Cognitive Science, and Parallel Distributed Processing. By Andy Clark. (Cambridge, Mass.: MIT Press, 1989. A Bradford Book. Pp. x + 226. Price not given.) James Higginbotham James Higginbotham Somerville College, Oxford Search for other works by this author on: Oxford Academic Google Scholar The Philosophical Quarterly, Volume 44, Issue 174, January 1994, Pages 112–115, https://doi.org/10.2307/2220153 Published: 01 January 1994

Each year companies and researchers expend significant resources developing basic beat detection and classification software. In an effort to reduce this duplication of effort we are developing and making available open source ECG analysis software. Our open source QRS detectors have sensitivities and positive predictivities that are close to 99.8% on the MIT/BIH and AHA arrhythmia databases. Our beat classifier has a sensitivity of 93.91% and a positive predictivity of 96.48% on the MIT/BIH arrhythmia database and a sensitivity of 93.2% and a positive predictivity of 97.83% on the AHA arrhythmia database. Since we have posted our source code, over 350 users have downloaded our ECG analysis software. Downloads have been nearly equally divided between students, researchers, and commercial developers.

Fueled by advances in technology, increased access to smartphones, and capital investment, the number of available health "apps" has exploded in recent years. Patients use their smartphones for many things, but not as much as they might for health, especially for managing their chronic conditions. Moreover, while significant work is ongoing to develop, validate, and evaluate these apps, it is less clear how to effectively disseminate apps into routine clinical practice. We propose a framework for prescribing apps and outline the key issues that need to be addressed to enable app dissemination in clinical care. This includes: education and awareness, creating digital formularies, workflow and EHR integration, payment models, and patient/provider support. As work in digital health continues to expand, integrating health apps into clinical care delivery will be critical if digital health is to achieve its potential.

We study whether transfer programs in which funds are targeted to women decrease the incidence of spousal abuse. We examine the impact of the Mexican Oportunidades program on spousal abuse rates and threats of violence using data from a specialized survey. Beneficiary women are 40 percent less likely to be victims of physical abuse, but are more likely to receive violent threats with no associated abuse. This evidence is consistent with a model of decision-makers' interactions with asymmetric information in the male partner's gains to marriage, who can then use threats of violence to extract rents from their female partners. (JEL D82, J12, J16, K42, O15, O17)

Abstract Mutations in fumarate hydratase (FH) cause hereditary leiomyomatosis and renal cell carcinoma 1 . Loss of FH in the kidney elicits several oncogenic signalling cascades through the accumulation of the oncometabolite fumarate 2 . However, although the long-term consequences of FH loss have been described, the acute response has not so far been investigated. Here we generated an inducible mouse model to study the chronology of FH loss in the kidney. We show that loss of FH leads to early alterations of mitochondrial morphology and the release of mitochondrial DNA (mtDNA) into the cytosol, where it triggers the activation of the cyclic GMP–AMP synthase (cGAS)–stimulator of interferon genes (STING)–TANK-binding kinase 1 (TBK1) pathway and stimulates an inflammatory response that is also partially dependent on retinoic-acid-inducible gene I (RIG-I). Mechanistically, we show that this phenotype is mediated by fumarate and occurs selectively through mitochondrial-derived vesicles in a manner that depends on sorting nexin 9 (SNX9). These results reveal that increased levels of intracellular fumarate induce a remodelling of the mitochondrial network and the generation of mitochondrial-derived vesicles, which allows the release of mtDNAin the cytosol and subsequent activation of the innate immune response.

Cells are essential to understanding health and disease, yet traditional models fall short of modeling and simulating their function and behavior. Advances in AI and omics offer groundbreaking opportunities to create an AI virtual cell (AIVC), a multi-scale, multi-modal large-neural-network-based model that can represent and simulate the behavior of molecules, cells, and tissues across diverse states. This Perspective provides a vision on their design and how collaborative efforts to build AIVCs will transform biological research by allowing high-fidelity simulations, accelerating discoveries, and guiding experimental studies, offering new opportunities for understanding cellular functions and fostering interdisciplinary collaborations in open science.

This paper reviews the evidence for the existence of a complex form of post-traumatic disorder in survivors of prolonged, repeated trauma. This syndrome is currently under consideration for inclusion in DSM-IV under the name of DESNOS (Disorders of Extreme Stress Not Otherwise Specified). The current diagnostic formulation of PTSD derives primarily from observations of survivors of relatively circumscribed traumatic events. This formulation fails to capture the protean sequelae of prolonged, repeated trauma. In contrast to a single traumatic event, prolonged, repeated trauma can occur only where the victim is in a state of captivity, under the control of the perpetrator. The psychological impact of subordination to coercive control has many common features, whether it occurs within the public sphere of politics or within the private sphere of sexual and domestic relations.

Subwavelength Patterning Microscopists have recently achieved fluorescence imaging at subwavelength resolution by focusing one beam of light in a halo around another beam, thereby quenching the glow of fluorescent dyes in all but the very center of the illuminated spot. Three studies have now adapted this approach to photolithography (see the Perspective by Perry ). Andrew et al. (p. 917 , published online 9 April) coated a photo-resist with molecules that, upon absorbing the ultraviolet etching beam, isomerized to a transparent layer but returned to the initially opaque form upon absorption of visible light. Applying an interference pattern with ultraviolet peaks superimposed on visible nodes restricted etching to narrow regions in the center of these nodes, yielding lines of subwavelength width. Scott et al. (p. 913 , published online 9 April) used a central beam to activate polymerization initiators, while using a halo-shaped surrounding beam to trigger inhibitors that would halt polymerization. Li et al. (p. 910 , published online 9 April) found that use of a different initiator molecule allowed both beams to share the same wavelength (800 nanometers), with a relatively weak quenching beam lagging a highly intense initiating beam slightly in time. Both the latter techniques produced three-dimensional features honed to subwavelength dimensions.

There is already a copious literature comparing Claudius' oration on the admission of the primores Galliae into the Roman Senate with Tacitus’ account of the speech and of the opposition's case in Annals 11. 23–4. Yet the Emperor's own purpose in speaking as he did still needs some illumination. Scholarly concentration on technical points about the citizenship, on Claudius’ antiquarianism and on his debt to Livy has been fruitful, but it has often distracted attention from Claudius’ immediate aim. Meanwhile, Tacitus’ interpretation has been insidious in colouring our view of what course of action the imperial orator was trying to defend before the Senate.

Difficulties associated with in vitro manipulation and culture of the early chicken embryo have restricted generation of transgenic chickens to approaches that use replication-competent retroviruses. The need to produce transgenic chickens in the absence of replicating virus prompted development of a new method of gene transfer into the chicken. Microinjection of the replication-defective reticuloendotheliosis virus (REV) vector ME111 beneath unincubated chicken embryo blastoderms results in infection of germline stem cells. This vector contains genetic information exogenous to the chicken genome, including both the herpes simplex virus type 1 thymidine kinase gene and the Tn5 neomycin phosphotransferase gene. About 8 percent of male birds hatched from injected embryos contained vector DNA in their semen. All four positive males tested passed vector sequences onto their progeny. Analysis of G1 offspring showed that gonads of G0 male birds were mosaic with respect to insertion of vector provirus. Thus, primordial germ cells present in the unincubated chicken embryo blastoderm are susceptible to infection by defective REV vectors.

BACKGROUND: In this study, coated polyglactin 910 suture with triclosan was evaluated for its ability to inhibit the growth of wild-type and methicillin-resistant Staphylococcus aureus and S. epidermidis using several in vitro models. METHODS: In the standard experimental procedure, sterile sutures were inoculated with bacteria, plated in semisolid culture media, incubated for 24 h, and examined for zones of inhibition surrounding the sutures. Sutures were pretreated by several methods prior to inoculation, these included: 24-h aqueous immersion, serial 7-day aqueous immersion, knotting, and passage through subcutaneous and fascial tissue. Sutures were also compared to determine if suture diameter had an effect on the zone of inhibition. RESULTS: Coated polyglactin 910 suture with triclosan inhibited growth of test organisms consistently over a range of suture diameters and treatment conditions. The antibacterial effect was robust and did not diminish when sutures were placed in an aqueous environment for up to 7 days. Knotted suture with triclosan inhibited bacterial colonization after replicate inoculation. The bacteria-free zone surrounding each knotted suture had a volume of 14.5 cm(3) for S. epidermidis and 17.8 cm(3) for S. aureus. Coated polyglactin 910 suture with triclosan continued to produce zones of inhibition after five and 10 passes through fascia and subcutaneous tissue. CONCLUSION: These data support the conclusion that coated polyglactin 910 suture with triclosan provides antimicrobial effect sufficient to prevent in vitro colonization by S. aureus and S. epidermidis.