We can identify two different models for the development of artificial intelligence. In the first... more We can identify two different models for the development of artificial intelligence. In the first, AIs are complex data-processing or patternrecognizing tools, lacking what we would describe as "human-like" intelligence. In this model, the ostensible reason for the lack of a specifically human-like intelligence is that the AIs are either not embodied or are "housed" in but not integrated with a body or body-like structure. In this model, the machine is the seat of the rational and intellectual, and emotion, insight, and intuition remain the product of the body. In the second model, intelligence is the result of integration of a "thinking" technology into a body of some sort, resulting in a recognizably human-like mind or intelligence. Ann Leckie's portrayal of artificial intelligence is more in line with this second model. Using characters in which AIs are integrated into biological bodies and then into technological ones, she provides us with a more complex and forward looking picture of how AIs might come to have emotional experience, intuition, and flexibility of thought and action, a model that bears similarities to both the cyborgs of science fiction and the second of the two AI models above. Her nuanced portrait of such a being can be taken as a possible end-goal for the creation of a more organismal, less constrained artificial mind.
An 83-year-old patient, accompanied by her daughter, seeks evaluation of progressive hearing loss... more An 83-year-old patient, accompanied by her daughter, seeks evaluation of progressive hearing loss and disequilibrium. She is a smoker with chronic obstructive pulmonary disease, osteoporosis, and a history of falls. The patient describes difficulty hearing in noisy environments and increasing difficulty maintaining balance. Wearing a mask makes her feel short of breath and increases her sense of instability. The mask's ear loops rub against her hearing aids, which feels uncomfortable and creates distracting noises. When removing her mask, her hearing aids fling across the room, and she is afraid she will lose them or that they will break. She has not received a COVID-19 vaccination. Her physical examination is consistent with presbycusis and multifactorial age-related balance deterioration. The patient is referred for balance rehabilitation therapy and possible adjustment or replacement of her hearing aids. The daughter requests a doctor's note that will excuse her mother from wearing a mask while riding a New York City bus, justified by shortness of breath, fall risk, and hearing challenges. She adds that her mother recently sustained a hip fracture in a fall and is recovering with the aid of a walker. She is concerned about another fall. The vignette presented is hypothetical.
Enzyme immunoassay and Western blotting (electrophoretic) techniques were used to determine hapto... more Enzyme immunoassay and Western blotting (electrophoretic) techniques were used to determine haptoglobin (HP) phenotypes from older bloodstains. Serum was collected from liquid blood and the HP phenotypes were determined. Bloodstains were prepared from these specimens and stored at various temperatures for several months. The stains were extracted and applied to gradient polyacrylamide gels. The Western blotting technique was used to achieve the transfer of HP bands from the gels to the nitrocellulose membranes. Enzyme immunoassay with goat anti-HP antiserum and rabbit anti-goat immunoglobulin peroxidase were used to identify the HP bands from the extracted samples. Enzyme immunoassay was found to be clearly more sensitive than o-dianisidine or o-tolidine in detecting HP bands from diluted serum samples. The haptoglobin frequency in a Caucasian population in Nebraska was calculated. The frequencies of Phenotypes 1, 2-1, and 2 were found to be 15.8, 48.4, and 35.8%, respectively.
Thinking Animals is an exploration of the space between a theoretical rock and a hard place. Kari... more Thinking Animals is an exploration of the space between a theoretical rock and a hard place. Kari Weil's project engages the impasse between the modernist understanding of relations between animals and humans (with its attendant humanism) and the postmodern breakdown of categories like "animal" and "human" (and the resulting lack of guidance as to how to conduct relationships between these groups). Because the scope of these essays is so broad and encompasses so many issues, this review attempts to bring to light one of the many narratives encompassed by this book. The basic problem with which Thinking Animals grapples is this: On the one hand, humanism has provided us codes of behavior and ethics but only at the expense of elevating human importance above that of nonhuman animals. Modernism delineated the problem of our relationship to nonhuman animals by reinforcing a category of "we" who must behave ethically, and a category of "the other" to whom we do or do not behave in such a way. Modernism must treat the categories of human and animal as "real" so as to give force to moral requirements. Modernism, in other words, reinforces the idea of human exceptionalism.
Overactive bladder (OAB) is experienced by more than half of patients with untreated Parkinson's ... more Overactive bladder (OAB) is experienced by more than half of patients with untreated Parkinson's disease. Treatment of overactive bladder in these patients has included antimuscarinic anticholinergics, raising concerns about the possibility of exacerbating cognitive impairment or constipation. Mirabegron (Myrbetriq), a β3-receptor agonist, provides relief of OAB without increasing cognitive impairment. While prior studies have examined the effect of mirabegron on OAB in a variety of patient populations, this study is the first controlled, prospective study investigating the effect of mirabegron on overactive bladder in patients with Parkinson's disease. By studying effective treatments for overactive bladder, this trial emphasizes the importance of antimicrobial stewardship so that lower urinary tract symptoms are not treated as lower urinary tract infections with antimicrobials and instead overactive bladder can be treated appropriately with medication. The MAESTRO study compared the effect of adding mirabegron to behavioral modification (including pelvic floor exercises) to behavior modification alone. Results from this novel study show that both the mean absolute change in the volume of micturition (objective measure) and the mean percent change increased significantly between visits two and three in the experimental group using mirabegron. Moreover, improvements in micturition in this study indicate that a larger-scale study of mirabegron with pelvic floor exercises and behavior modification is warranted.
We can identify two different models for the development of artificial intelligence. In the first... more We can identify two different models for the development of artificial intelligence. In the first, AIs are complex data-processing or patternrecognizing tools, lacking what we would describe as "human-like" intelligence. In this model, the ostensible reason for the lack of a specifically human-like intelligence is that the AIs are either not embodied or are "housed" in but not integrated with a body or body-like structure. In this model, the machine is the seat of the rational and intellectual, and emotion, insight, and intuition remain the product of the body. In the second model, intelligence is the result of integration of a "thinking" technology into a body of some sort, resulting in a recognizably human-like mind or intelligence. Ann Leckie's portrayal of artificial intelligence is more in line with this second model. Using characters in which AIs are integrated into biological bodies and then into technological ones, she provides us with a more complex and forward looking picture of how AIs might come to have emotional experience, intuition, and flexibility of thought and action, a model that bears similarities to both the cyborgs of science fiction and the second of the two AI models above. Her nuanced portrait of such a being can be taken as a possible end-goal for the creation of a more organismal, less constrained artificial mind.
In science fiction, the term "uplift" refers to the process of changing of nonhuman animals (from... more In science fiction, the term "uplift" refers to the process of changing of nonhuman animals (from here, NHAs) into sentient, or more sentient, beings. These changes are implemented by already sentient (or more sentient) organisms. Uplift is imagined as the result of one or more methods including surgical intervention, genetic modification (including breeding programs or intervention of genetic technology), and/or techno-mechanical enhancements. Exploring the idea of NHA uplift allows for the recognition and analysis of the similarity and relationship(s) between humans and NHAs. It should be the case, given the portrayal of NHAs as able to reach towards human-like existence, that these sorts of science fiction (SF) works emphasize NHA-human similarities, while minor differences are overcome by technologies of various sorts. David Brin, author of the Uplift Wars series, for example, sees the differences between NHAs and humans as a nonporous but surmountable biological barrier, requiring only a few perhaps painful modifications for "higher" NHAs to expand their abilities to include the kind of thinking and activity that humans currently engage in. "'In all my research I have concluded that cetaceans, primates, corvids (crows), parrots, pinnipeds (sea lions), and many other species on Earth appear to be stuck under a firm glass ceiling,' he told us, 'roughly the same level of thinking, problem-solving, linguistic ability, and evolution seems stingy about letting any of them crash through.'" Subsequently, Brin argues that it may actually be selfish for us to deny high-functioning animals our enhancement technologies. He pictures a potential future Earth civilization enlightened by diverse voices. "'Imagine dolphin philosophers, bonobo therapists, raven playwrights and poets,' he says, 'How lonely, if we bs_bs_banner MIDWEST STUDIES IN PHILOSOPHY
Proposed somatic cell gene-therapies (especially those involving in utero therapies) may involve ... more Proposed somatic cell gene-therapies (especially those involving in utero therapies) may involve a small risk of germ-line modifications; this risk has engendered serious concern, and arguments have been made that such therapies ought not be pursued if such risks exists. We argue here that while pursuing deliberate germ-line modifications in humans would be inappropriate given the current state of the art, the risk of accidental germ-line modifications from most currently proposed in utero gene therapy is no different in kind or degree from other risks regularly taken in medical procedures. Given the possible benefits of such therapies, we argue that the risk of accidental germ-line modifications is well worth taking in these cases.
Overactive bladder (OAB) is experienced by more than half of patients with untreated Parkinson's ... more Overactive bladder (OAB) is experienced by more than half of patients with untreated Parkinson's disease. Treatment of overactive bladder in these patients has included antimuscarinic anticholinergics, raising concerns about the possibility of exacerbating cognitive impairment or constipation. Mirabegron (Myrbetriq), a β3-receptor agonist, provides relief of OAB without increasing cognitive impairment. While prior studies have examined the effect of mirabegron on OAB in a variety of patient populations, this study is the first controlled, prospective study investigating the effect of mirabegron on overactive bladder in patients with Parkinson's disease. By studying effective treatments for overactive bladder, this trial emphasizes the importance of antimicrobial stewardship so that lower urinary tract symptoms are not treated as lower urinary tract infections with antimicrobials and instead overactive bladder can be treated appropriately with medication. The MAESTRO study compared the effect of adding mirabegron to behavioral modification (including pelvic floor exercises) to behavior modification alone. Results from this novel study show that both the mean absolute change in the volume of micturition (objective measure) and the mean percent change increased significantly between visits two and three in the experimental group using mirabegron. Moreover, improvements in micturition in this study indicate that a larger-scale study of mirabegron with pelvic floor exercises and behavior modification is warranted.
Overactive bladder (OAB) is experienced by more than half of patients with untreated Parkinson's ... more Overactive bladder (OAB) is experienced by more than half of patients with untreated Parkinson's disease. Treatment of overactive bladder in these patients has included antimuscarinic anticholinergics, raising concerns about the possibility of exacerbating cognitive impairment or constipation. Mirabegron (Myrbetriq), a β3-receptor agonist, provides relief of OAB without increasing cognitive impairment. While prior studies have examined the effect of mirabegron on OAB in a variety of patient populations, this study is the first controlled, prospective study investigating the effect of mirabegron on overactive bladder in patients with Parkinson's disease. By studying effective treatments for overactive bladder, this trial emphasizes the importance of antimicrobial stewardship so that lower urinary tract symptoms are not treated as lower urinary tract infections with antimicrobials and instead overactive bladder can be treated appropriately with medication. The MAESTRO study compared the effect of adding mirabegron to behavioral modification (including pelvic floor exercises) to behavior modification alone. Results from this novel study show that both the mean absolute change in the volume of micturition (objective measure) and the mean percent change increased significantly between visits two and three in the experimental group using mirabegron. Moreover, improvements in micturition in this study indicate that a larger-scale study of mirabegron with pelvic floor exercises and behavior modification is warranted.
Before considering a particular concern about Doukas and Berg’s “The Family Covenant and Genetic ... more Before considering a particular concern about Doukas and Berg’s “The Family Covenant and Genetic Testing” (2001), I want to acknowledge the many merits of the piece. The motivations for this piece are ones that it would be wise for those of us concerned with medical practice to consider adopting. In particular, the authors should be applauded for their explicit acknowledgment that a good (both in ethical and practical terms) practice of medicine acknowledges the context of an individual—that an individual is never an island unto himself or herself. In addition, they should be commended for providing a realistic portrayal of the way in which medicine is actually practiced: in a social context rather than in a vacuum that contains only the physician, the patient, and an adequately stocked examination room. Lastly, the underlying message regarding preventive care of relationships is a powerful and positive one: the complicated situations that might arise as a result of genetic testing can often be prevented by explaining what information might become available during testing—for example, nonpaternity or a predisposition to a condition that may be carried by other family members. My concern begins with Doukas and Berg’s claim that “when an individual receives genetic testing, the results may be relevant to many, if not all, family members.” As their article implies, this familial relationship need not be a “direct” genetic relationship; for example, if two nongenetically related persons are biological parents of the same child, their interests in the test results for one of them is the result in part of the joint genetic relationship they have through the child. An underlying assumption of the article is—reasonably—that at least some family members will have a genetic relationship to one another; thus, in creating family covenants, many of the persons who will be affected directly by the genetic information will be included. But is it the case that in fact a family consists of persons who are genetically related? Or, to present the problem in another way, can we assume that the ties of affection and reliance that characterize families necessarily characterize the relationships of those with close genetic relations? I would argue that families are not necessarily persons with genetic relationships, though genetic relations are clearly an important basis of most familial structures. According to the U.S. Census Bureau Economics and Statistics Administration, as of 1998, only 69% of children live in a two-parent family; the rest are nontraditional groupings. The same type of trend can be seen if we look to percentage of families not found in the traditional grouping: the single-mother family makes up 26% of U.S. households, and single-father families make up 5% (Casper and Bryson 1998). The number of persons living in nontraditional households has shown a nearly consistent increase since 1970, and the trend is likely to continue. Moreover, the 1995 U.S. Census notes that even the twoparent families do not necessarily involve biological relation, as they include stepparents and adoptive parents (Casper and Bryson 1998). A signiacant portion of children (approximately 9%) lives with a biological or adoptive parent and a stepparent. In certain populations this is particularly important; for example in African American populations, where 70% of births are to women who are not married (though not all of these households will therefore be single-parent households). If adult males are present in the household, they are often not those with a genetic relationship to the children present. Lastly, it is wise to consider abuse statistics—the National Committee for the Prevention of Child Abuse (1995) reports that over 3 million children were reported to CPS because of child abuse; spousal abuse is also an issue. The result is that even in family structures that are apparently traditional, we cannot guarantee that trust is an appropriate assumption in any and all cases. What I do not mean to argue by these statistics is that Doukas and Berg’s model is therefore inapplicable to a large number of families. This would clearly be fallacious. Moreover, it is not required that families be genetically related in order for the family covenant to work as described. However, the concern that I would like to raise involves the presumed beneat of creating family covenants. Doukas and Berg give two reasons for putting such a model into effect:
Enzyme immunoassay and Western blotting (electrophoretic) techniques were used to determine hapto... more Enzyme immunoassay and Western blotting (electrophoretic) techniques were used to determine haptoglobin (HP) phenotypes from older bloodstains. Serum was collected from liquid blood and the HP phenotypes were determined. Bloodstains were prepared from these specimens and stored at various temperatures for several months. The stains were extracted and applied to gradient polyacrylamide gels. The Western blotting technique was used to achieve the transfer of HP bands from the gels to the nitrocellulose membranes. Enzyme immunoassay with goat anti-HP antiserum and rabbit anti-goat immunoglobulin peroxidase were used to identify the HP bands from the extracted samples. Enzyme immunoassay was found to be clearly more sensitive than o-dianisidine or o-tolidine in detecting HP bands from diluted serum samples. The haptoglobin frequency in a Caucasian population in Nebraska was calculated. The frequencies of Phenotypes 1, 2-1, and 2 were found to be 15.8, 48.4, and 35.8%, respectively.
T his chapter will outline the various concerns which have been raised in scientific, bioethics, ... more T his chapter will outline the various concerns which have been raised in scientific, bioethics, and lay communities about the use of lentiviral vectors for purposes of gene therapy. Many of these concerns are ranged around gene therapy itself; others are concerns particular to using this sort of vector for genetic modification of human cells. These concerns are outlined within the chapter, and arguments are given in favor and against various approaches to these concerns. Lastly, it is noted throughout that at this stage of research into gene therapy, the most practical approach to these dilemmas is to maintain awareness of the ethical problems and provide information to those concerned with all aspects of the development of this set of technologies. 1. Genetic transfer may be targeted to specific cell types within an adult organism. For example, experimentation has been done for transfer of genes exclusively to liver cells, leukocytes,
Objective: To evaluate the potential of onabotulinum toxin A (Botox R , Allergan, Inc., Irvine, C... more Objective: To evaluate the potential of onabotulinum toxin A (Botox R , Allergan, Inc., Irvine, California) in the treatment of restless legs syndrome (RLS). Methods: A single-arm, open-label pilot trial of onabotulinum toxin A was conducted to determine its usefulness as an injectable treatment for RLS. Results: The primary outcome measure, change in score on the International Restless Legs Syndrome Scale, showed a statistically significant improvement in RLS during the first 4 weeks after treatment. Two of the secondary outcome measures, pain (measured using a visual analog scale) and patients' global impression of severity of illness also showed improvement. Conclusions: Onabotulinum toxin A warrants further study in RLS. Increasing the drug dosage, changing the dosing schedule, and increasing the number of injection sites may result in greater activity and longer duration of action.
Le clonage humain, quasi unanimement condamne, represente-t-il reellement une menace pour la soci... more Le clonage humain, quasi unanimement condamne, represente-t-il reellement une menace pour la societe ? Ce rejet ne traduit-il pas, finalement, une peur de l'inconnu ? Doit-on ignorer l'attirance qu'il peut exercer pour des personnes en mal de procreation ? Ina Roy nous propose un eclairage de ces questions.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2021
An 83-year-old patient, accompanied by her daughter, seeks evaluation of progressive hearing loss... more An 83-year-old patient, accompanied by her daughter, seeks evaluation of progressive hearing loss and disequilibrium. She is a smoker with chronic obstructive pulmonary disease, osteoporosis, and a history of falls. The patient describes difficulty hearing in noisy environments and increasing difficulty maintaining balance. Wearing a mask makes her feel short of breath and increases her sense of instability. The mask's ear loops rub against her hearing aids, which feels uncomfortable and creates distracting noises. When removing her mask, her hearing aids fling across the room, and she is afraid she will lose them or that they will break. She has not received a COVID-19 vaccination. Her physical examination is consistent with presbycusis and multifactorial age-related balance deterioration. The patient is referred for balance rehabilitation therapy and possible adjustment or replacement of her hearing aids. The daughter requests a doctor's note that will excuse her mother from wearing a mask while riding a New York City bus, justified by shortness of breath, fall risk, and hearing challenges. She adds that her mother recently sustained a hip fracture in a fall and is recovering with the aid of a walker. She is concerned about another fall. The vignette presented is hypothetical.
We can identify two different models for the development of artificial intelligence. In the first... more We can identify two different models for the development of artificial intelligence. In the first, AIs are complex data-processing or patternrecognizing tools, lacking what we would describe as "human-like" intelligence. In this model, the ostensible reason for the lack of a specifically human-like intelligence is that the AIs are either not embodied or are "housed" in but not integrated with a body or body-like structure. In this model, the machine is the seat of the rational and intellectual, and emotion, insight, and intuition remain the product of the body. In the second model, intelligence is the result of integration of a "thinking" technology into a body of some sort, resulting in a recognizably human-like mind or intelligence. Ann Leckie's portrayal of artificial intelligence is more in line with this second model. Using characters in which AIs are integrated into biological bodies and then into technological ones, she provides us with a more complex and forward looking picture of how AIs might come to have emotional experience, intuition, and flexibility of thought and action, a model that bears similarities to both the cyborgs of science fiction and the second of the two AI models above. Her nuanced portrait of such a being can be taken as a possible end-goal for the creation of a more organismal, less constrained artificial mind.
Thinking Animals is an exploration of the space between a theoretical rock and a hard place. Kari... more Thinking Animals is an exploration of the space between a theoretical rock and a hard place. Kari Weil's project engages the impasse between the modernist understanding of relations between animals and humans (with its attendant humanism) and the postmodern breakdown of categories like "animal" and "human" (and the resulting lack of guidance as to how to conduct relationships between these groups). Because the scope of these essays is so broad and encompasses so many issues, this review attempts to bring to light one of the many narratives encompassed by this book. The basic problem with which Thinking Animals grapples is this: On the one hand, humanism has provided us codes of behavior and ethics but only at the expense of elevating human importance above that of nonhuman animals. Modernism delineated the problem of our relationship to nonhuman animals by reinforcing a category of "we" who must behave ethically, and a category of "the other" to whom we do or do not behave in such a way. Modernism must treat the categories of human and animal as "real" so as to give force to moral requirements. Modernism, in other words, reinforces the idea of human exceptionalism.
We can identify two different models for the development of artificial intelligence. In the first... more We can identify two different models for the development of artificial intelligence. In the first, AIs are complex data-processing or patternrecognizing tools, lacking what we would describe as "human-like" intelligence. In this model, the ostensible reason for the lack of a specifically human-like intelligence is that the AIs are either not embodied or are "housed" in but not integrated with a body or body-like structure. In this model, the machine is the seat of the rational and intellectual, and emotion, insight, and intuition remain the product of the body. In the second model, intelligence is the result of integration of a "thinking" technology into a body of some sort, resulting in a recognizably human-like mind or intelligence. Ann Leckie's portrayal of artificial intelligence is more in line with this second model. Using characters in which AIs are integrated into biological bodies and then into technological ones, she provides us with a more complex and forward looking picture of how AIs might come to have emotional experience, intuition, and flexibility of thought and action, a model that bears similarities to both the cyborgs of science fiction and the second of the two AI models above. Her nuanced portrait of such a being can be taken as a possible end-goal for the creation of a more organismal, less constrained artificial mind.
An 83-year-old patient, accompanied by her daughter, seeks evaluation of progressive hearing loss... more An 83-year-old patient, accompanied by her daughter, seeks evaluation of progressive hearing loss and disequilibrium. She is a smoker with chronic obstructive pulmonary disease, osteoporosis, and a history of falls. The patient describes difficulty hearing in noisy environments and increasing difficulty maintaining balance. Wearing a mask makes her feel short of breath and increases her sense of instability. The mask's ear loops rub against her hearing aids, which feels uncomfortable and creates distracting noises. When removing her mask, her hearing aids fling across the room, and she is afraid she will lose them or that they will break. She has not received a COVID-19 vaccination. Her physical examination is consistent with presbycusis and multifactorial age-related balance deterioration. The patient is referred for balance rehabilitation therapy and possible adjustment or replacement of her hearing aids. The daughter requests a doctor's note that will excuse her mother from wearing a mask while riding a New York City bus, justified by shortness of breath, fall risk, and hearing challenges. She adds that her mother recently sustained a hip fracture in a fall and is recovering with the aid of a walker. She is concerned about another fall. The vignette presented is hypothetical.
Enzyme immunoassay and Western blotting (electrophoretic) techniques were used to determine hapto... more Enzyme immunoassay and Western blotting (electrophoretic) techniques were used to determine haptoglobin (HP) phenotypes from older bloodstains. Serum was collected from liquid blood and the HP phenotypes were determined. Bloodstains were prepared from these specimens and stored at various temperatures for several months. The stains were extracted and applied to gradient polyacrylamide gels. The Western blotting technique was used to achieve the transfer of HP bands from the gels to the nitrocellulose membranes. Enzyme immunoassay with goat anti-HP antiserum and rabbit anti-goat immunoglobulin peroxidase were used to identify the HP bands from the extracted samples. Enzyme immunoassay was found to be clearly more sensitive than o-dianisidine or o-tolidine in detecting HP bands from diluted serum samples. The haptoglobin frequency in a Caucasian population in Nebraska was calculated. The frequencies of Phenotypes 1, 2-1, and 2 were found to be 15.8, 48.4, and 35.8%, respectively.
Thinking Animals is an exploration of the space between a theoretical rock and a hard place. Kari... more Thinking Animals is an exploration of the space between a theoretical rock and a hard place. Kari Weil's project engages the impasse between the modernist understanding of relations between animals and humans (with its attendant humanism) and the postmodern breakdown of categories like "animal" and "human" (and the resulting lack of guidance as to how to conduct relationships between these groups). Because the scope of these essays is so broad and encompasses so many issues, this review attempts to bring to light one of the many narratives encompassed by this book. The basic problem with which Thinking Animals grapples is this: On the one hand, humanism has provided us codes of behavior and ethics but only at the expense of elevating human importance above that of nonhuman animals. Modernism delineated the problem of our relationship to nonhuman animals by reinforcing a category of "we" who must behave ethically, and a category of "the other" to whom we do or do not behave in such a way. Modernism must treat the categories of human and animal as "real" so as to give force to moral requirements. Modernism, in other words, reinforces the idea of human exceptionalism.
Overactive bladder (OAB) is experienced by more than half of patients with untreated Parkinson's ... more Overactive bladder (OAB) is experienced by more than half of patients with untreated Parkinson's disease. Treatment of overactive bladder in these patients has included antimuscarinic anticholinergics, raising concerns about the possibility of exacerbating cognitive impairment or constipation. Mirabegron (Myrbetriq), a β3-receptor agonist, provides relief of OAB without increasing cognitive impairment. While prior studies have examined the effect of mirabegron on OAB in a variety of patient populations, this study is the first controlled, prospective study investigating the effect of mirabegron on overactive bladder in patients with Parkinson's disease. By studying effective treatments for overactive bladder, this trial emphasizes the importance of antimicrobial stewardship so that lower urinary tract symptoms are not treated as lower urinary tract infections with antimicrobials and instead overactive bladder can be treated appropriately with medication. The MAESTRO study compared the effect of adding mirabegron to behavioral modification (including pelvic floor exercises) to behavior modification alone. Results from this novel study show that both the mean absolute change in the volume of micturition (objective measure) and the mean percent change increased significantly between visits two and three in the experimental group using mirabegron. Moreover, improvements in micturition in this study indicate that a larger-scale study of mirabegron with pelvic floor exercises and behavior modification is warranted.
We can identify two different models for the development of artificial intelligence. In the first... more We can identify two different models for the development of artificial intelligence. In the first, AIs are complex data-processing or patternrecognizing tools, lacking what we would describe as "human-like" intelligence. In this model, the ostensible reason for the lack of a specifically human-like intelligence is that the AIs are either not embodied or are "housed" in but not integrated with a body or body-like structure. In this model, the machine is the seat of the rational and intellectual, and emotion, insight, and intuition remain the product of the body. In the second model, intelligence is the result of integration of a "thinking" technology into a body of some sort, resulting in a recognizably human-like mind or intelligence. Ann Leckie's portrayal of artificial intelligence is more in line with this second model. Using characters in which AIs are integrated into biological bodies and then into technological ones, she provides us with a more complex and forward looking picture of how AIs might come to have emotional experience, intuition, and flexibility of thought and action, a model that bears similarities to both the cyborgs of science fiction and the second of the two AI models above. Her nuanced portrait of such a being can be taken as a possible end-goal for the creation of a more organismal, less constrained artificial mind.
In science fiction, the term "uplift" refers to the process of changing of nonhuman animals (from... more In science fiction, the term "uplift" refers to the process of changing of nonhuman animals (from here, NHAs) into sentient, or more sentient, beings. These changes are implemented by already sentient (or more sentient) organisms. Uplift is imagined as the result of one or more methods including surgical intervention, genetic modification (including breeding programs or intervention of genetic technology), and/or techno-mechanical enhancements. Exploring the idea of NHA uplift allows for the recognition and analysis of the similarity and relationship(s) between humans and NHAs. It should be the case, given the portrayal of NHAs as able to reach towards human-like existence, that these sorts of science fiction (SF) works emphasize NHA-human similarities, while minor differences are overcome by technologies of various sorts. David Brin, author of the Uplift Wars series, for example, sees the differences between NHAs and humans as a nonporous but surmountable biological barrier, requiring only a few perhaps painful modifications for "higher" NHAs to expand their abilities to include the kind of thinking and activity that humans currently engage in. "'In all my research I have concluded that cetaceans, primates, corvids (crows), parrots, pinnipeds (sea lions), and many other species on Earth appear to be stuck under a firm glass ceiling,' he told us, 'roughly the same level of thinking, problem-solving, linguistic ability, and evolution seems stingy about letting any of them crash through.'" Subsequently, Brin argues that it may actually be selfish for us to deny high-functioning animals our enhancement technologies. He pictures a potential future Earth civilization enlightened by diverse voices. "'Imagine dolphin philosophers, bonobo therapists, raven playwrights and poets,' he says, 'How lonely, if we bs_bs_banner MIDWEST STUDIES IN PHILOSOPHY
Proposed somatic cell gene-therapies (especially those involving in utero therapies) may involve ... more Proposed somatic cell gene-therapies (especially those involving in utero therapies) may involve a small risk of germ-line modifications; this risk has engendered serious concern, and arguments have been made that such therapies ought not be pursued if such risks exists. We argue here that while pursuing deliberate germ-line modifications in humans would be inappropriate given the current state of the art, the risk of accidental germ-line modifications from most currently proposed in utero gene therapy is no different in kind or degree from other risks regularly taken in medical procedures. Given the possible benefits of such therapies, we argue that the risk of accidental germ-line modifications is well worth taking in these cases.
Overactive bladder (OAB) is experienced by more than half of patients with untreated Parkinson's ... more Overactive bladder (OAB) is experienced by more than half of patients with untreated Parkinson's disease. Treatment of overactive bladder in these patients has included antimuscarinic anticholinergics, raising concerns about the possibility of exacerbating cognitive impairment or constipation. Mirabegron (Myrbetriq), a β3-receptor agonist, provides relief of OAB without increasing cognitive impairment. While prior studies have examined the effect of mirabegron on OAB in a variety of patient populations, this study is the first controlled, prospective study investigating the effect of mirabegron on overactive bladder in patients with Parkinson's disease. By studying effective treatments for overactive bladder, this trial emphasizes the importance of antimicrobial stewardship so that lower urinary tract symptoms are not treated as lower urinary tract infections with antimicrobials and instead overactive bladder can be treated appropriately with medication. The MAESTRO study compared the effect of adding mirabegron to behavioral modification (including pelvic floor exercises) to behavior modification alone. Results from this novel study show that both the mean absolute change in the volume of micturition (objective measure) and the mean percent change increased significantly between visits two and three in the experimental group using mirabegron. Moreover, improvements in micturition in this study indicate that a larger-scale study of mirabegron with pelvic floor exercises and behavior modification is warranted.
Overactive bladder (OAB) is experienced by more than half of patients with untreated Parkinson's ... more Overactive bladder (OAB) is experienced by more than half of patients with untreated Parkinson's disease. Treatment of overactive bladder in these patients has included antimuscarinic anticholinergics, raising concerns about the possibility of exacerbating cognitive impairment or constipation. Mirabegron (Myrbetriq), a β3-receptor agonist, provides relief of OAB without increasing cognitive impairment. While prior studies have examined the effect of mirabegron on OAB in a variety of patient populations, this study is the first controlled, prospective study investigating the effect of mirabegron on overactive bladder in patients with Parkinson's disease. By studying effective treatments for overactive bladder, this trial emphasizes the importance of antimicrobial stewardship so that lower urinary tract symptoms are not treated as lower urinary tract infections with antimicrobials and instead overactive bladder can be treated appropriately with medication. The MAESTRO study compared the effect of adding mirabegron to behavioral modification (including pelvic floor exercises) to behavior modification alone. Results from this novel study show that both the mean absolute change in the volume of micturition (objective measure) and the mean percent change increased significantly between visits two and three in the experimental group using mirabegron. Moreover, improvements in micturition in this study indicate that a larger-scale study of mirabegron with pelvic floor exercises and behavior modification is warranted.
Before considering a particular concern about Doukas and Berg’s “The Family Covenant and Genetic ... more Before considering a particular concern about Doukas and Berg’s “The Family Covenant and Genetic Testing” (2001), I want to acknowledge the many merits of the piece. The motivations for this piece are ones that it would be wise for those of us concerned with medical practice to consider adopting. In particular, the authors should be applauded for their explicit acknowledgment that a good (both in ethical and practical terms) practice of medicine acknowledges the context of an individual—that an individual is never an island unto himself or herself. In addition, they should be commended for providing a realistic portrayal of the way in which medicine is actually practiced: in a social context rather than in a vacuum that contains only the physician, the patient, and an adequately stocked examination room. Lastly, the underlying message regarding preventive care of relationships is a powerful and positive one: the complicated situations that might arise as a result of genetic testing can often be prevented by explaining what information might become available during testing—for example, nonpaternity or a predisposition to a condition that may be carried by other family members. My concern begins with Doukas and Berg’s claim that “when an individual receives genetic testing, the results may be relevant to many, if not all, family members.” As their article implies, this familial relationship need not be a “direct” genetic relationship; for example, if two nongenetically related persons are biological parents of the same child, their interests in the test results for one of them is the result in part of the joint genetic relationship they have through the child. An underlying assumption of the article is—reasonably—that at least some family members will have a genetic relationship to one another; thus, in creating family covenants, many of the persons who will be affected directly by the genetic information will be included. But is it the case that in fact a family consists of persons who are genetically related? Or, to present the problem in another way, can we assume that the ties of affection and reliance that characterize families necessarily characterize the relationships of those with close genetic relations? I would argue that families are not necessarily persons with genetic relationships, though genetic relations are clearly an important basis of most familial structures. According to the U.S. Census Bureau Economics and Statistics Administration, as of 1998, only 69% of children live in a two-parent family; the rest are nontraditional groupings. The same type of trend can be seen if we look to percentage of families not found in the traditional grouping: the single-mother family makes up 26% of U.S. households, and single-father families make up 5% (Casper and Bryson 1998). The number of persons living in nontraditional households has shown a nearly consistent increase since 1970, and the trend is likely to continue. Moreover, the 1995 U.S. Census notes that even the twoparent families do not necessarily involve biological relation, as they include stepparents and adoptive parents (Casper and Bryson 1998). A signiacant portion of children (approximately 9%) lives with a biological or adoptive parent and a stepparent. In certain populations this is particularly important; for example in African American populations, where 70% of births are to women who are not married (though not all of these households will therefore be single-parent households). If adult males are present in the household, they are often not those with a genetic relationship to the children present. Lastly, it is wise to consider abuse statistics—the National Committee for the Prevention of Child Abuse (1995) reports that over 3 million children were reported to CPS because of child abuse; spousal abuse is also an issue. The result is that even in family structures that are apparently traditional, we cannot guarantee that trust is an appropriate assumption in any and all cases. What I do not mean to argue by these statistics is that Doukas and Berg’s model is therefore inapplicable to a large number of families. This would clearly be fallacious. Moreover, it is not required that families be genetically related in order for the family covenant to work as described. However, the concern that I would like to raise involves the presumed beneat of creating family covenants. Doukas and Berg give two reasons for putting such a model into effect:
Enzyme immunoassay and Western blotting (electrophoretic) techniques were used to determine hapto... more Enzyme immunoassay and Western blotting (electrophoretic) techniques were used to determine haptoglobin (HP) phenotypes from older bloodstains. Serum was collected from liquid blood and the HP phenotypes were determined. Bloodstains were prepared from these specimens and stored at various temperatures for several months. The stains were extracted and applied to gradient polyacrylamide gels. The Western blotting technique was used to achieve the transfer of HP bands from the gels to the nitrocellulose membranes. Enzyme immunoassay with goat anti-HP antiserum and rabbit anti-goat immunoglobulin peroxidase were used to identify the HP bands from the extracted samples. Enzyme immunoassay was found to be clearly more sensitive than o-dianisidine or o-tolidine in detecting HP bands from diluted serum samples. The haptoglobin frequency in a Caucasian population in Nebraska was calculated. The frequencies of Phenotypes 1, 2-1, and 2 were found to be 15.8, 48.4, and 35.8%, respectively.
T his chapter will outline the various concerns which have been raised in scientific, bioethics, ... more T his chapter will outline the various concerns which have been raised in scientific, bioethics, and lay communities about the use of lentiviral vectors for purposes of gene therapy. Many of these concerns are ranged around gene therapy itself; others are concerns particular to using this sort of vector for genetic modification of human cells. These concerns are outlined within the chapter, and arguments are given in favor and against various approaches to these concerns. Lastly, it is noted throughout that at this stage of research into gene therapy, the most practical approach to these dilemmas is to maintain awareness of the ethical problems and provide information to those concerned with all aspects of the development of this set of technologies. 1. Genetic transfer may be targeted to specific cell types within an adult organism. For example, experimentation has been done for transfer of genes exclusively to liver cells, leukocytes,
Objective: To evaluate the potential of onabotulinum toxin A (Botox R , Allergan, Inc., Irvine, C... more Objective: To evaluate the potential of onabotulinum toxin A (Botox R , Allergan, Inc., Irvine, California) in the treatment of restless legs syndrome (RLS). Methods: A single-arm, open-label pilot trial of onabotulinum toxin A was conducted to determine its usefulness as an injectable treatment for RLS. Results: The primary outcome measure, change in score on the International Restless Legs Syndrome Scale, showed a statistically significant improvement in RLS during the first 4 weeks after treatment. Two of the secondary outcome measures, pain (measured using a visual analog scale) and patients' global impression of severity of illness also showed improvement. Conclusions: Onabotulinum toxin A warrants further study in RLS. Increasing the drug dosage, changing the dosing schedule, and increasing the number of injection sites may result in greater activity and longer duration of action.
Le clonage humain, quasi unanimement condamne, represente-t-il reellement une menace pour la soci... more Le clonage humain, quasi unanimement condamne, represente-t-il reellement une menace pour la societe ? Ce rejet ne traduit-il pas, finalement, une peur de l'inconnu ? Doit-on ignorer l'attirance qu'il peut exercer pour des personnes en mal de procreation ? Ina Roy nous propose un eclairage de ces questions.
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2021
An 83-year-old patient, accompanied by her daughter, seeks evaluation of progressive hearing loss... more An 83-year-old patient, accompanied by her daughter, seeks evaluation of progressive hearing loss and disequilibrium. She is a smoker with chronic obstructive pulmonary disease, osteoporosis, and a history of falls. The patient describes difficulty hearing in noisy environments and increasing difficulty maintaining balance. Wearing a mask makes her feel short of breath and increases her sense of instability. The mask's ear loops rub against her hearing aids, which feels uncomfortable and creates distracting noises. When removing her mask, her hearing aids fling across the room, and she is afraid she will lose them or that they will break. She has not received a COVID-19 vaccination. Her physical examination is consistent with presbycusis and multifactorial age-related balance deterioration. The patient is referred for balance rehabilitation therapy and possible adjustment or replacement of her hearing aids. The daughter requests a doctor's note that will excuse her mother from wearing a mask while riding a New York City bus, justified by shortness of breath, fall risk, and hearing challenges. She adds that her mother recently sustained a hip fracture in a fall and is recovering with the aid of a walker. She is concerned about another fall. The vignette presented is hypothetical.
We can identify two different models for the development of artificial intelligence. In the first... more We can identify two different models for the development of artificial intelligence. In the first, AIs are complex data-processing or patternrecognizing tools, lacking what we would describe as "human-like" intelligence. In this model, the ostensible reason for the lack of a specifically human-like intelligence is that the AIs are either not embodied or are "housed" in but not integrated with a body or body-like structure. In this model, the machine is the seat of the rational and intellectual, and emotion, insight, and intuition remain the product of the body. In the second model, intelligence is the result of integration of a "thinking" technology into a body of some sort, resulting in a recognizably human-like mind or intelligence. Ann Leckie's portrayal of artificial intelligence is more in line with this second model. Using characters in which AIs are integrated into biological bodies and then into technological ones, she provides us with a more complex and forward looking picture of how AIs might come to have emotional experience, intuition, and flexibility of thought and action, a model that bears similarities to both the cyborgs of science fiction and the second of the two AI models above. Her nuanced portrait of such a being can be taken as a possible end-goal for the creation of a more organismal, less constrained artificial mind.
Thinking Animals is an exploration of the space between a theoretical rock and a hard place. Kari... more Thinking Animals is an exploration of the space between a theoretical rock and a hard place. Kari Weil's project engages the impasse between the modernist understanding of relations between animals and humans (with its attendant humanism) and the postmodern breakdown of categories like "animal" and "human" (and the resulting lack of guidance as to how to conduct relationships between these groups). Because the scope of these essays is so broad and encompasses so many issues, this review attempts to bring to light one of the many narratives encompassed by this book. The basic problem with which Thinking Animals grapples is this: On the one hand, humanism has provided us codes of behavior and ethics but only at the expense of elevating human importance above that of nonhuman animals. Modernism delineated the problem of our relationship to nonhuman animals by reinforcing a category of "we" who must behave ethically, and a category of "the other" to whom we do or do not behave in such a way. Modernism must treat the categories of human and animal as "real" so as to give force to moral requirements. Modernism, in other words, reinforces the idea of human exceptionalism.
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