Critical care medicine at a new crossroads: the intersection of economics and ethics in the intensive care unit.
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Power corrupts in terms of both grandiose inflations and threatened narcissistic injuries. This paper deals with the rage states that may ensue in leaders. After explaining the individual psychodynamics of self-righteous rages in executives, this paper describes inferences about the group processes set in motion by such leaders and the reactions of subordinates. Independent thinkers in subordinate groups are both especially vulnerable to harm and especially important to preventing disasters within the group. The variable action of such persons leads to a sequence of possible phases. In bad scenarios the last phase is one containing institutional ruin, bloodbaths, or mutinies. Understanding the inference of individual and group dynamics on a theme of narcissistic injury may help prevent such disasters.
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The past two decades have yielded a recognition that intimate partner violence is ubiquitous. Although violence within relationships is bidirectional, there is acknowledgment that violence directed against women is more persistent and dangerous. Strategies for treatment of men have been largely unsuccessful, and studies of women centered approaches to prevention are in their infancy. An emerging concept in the brain-behavior field is the recognition of genetics as a powerful influence on aggressive and violent behaviors. Mouse models of human health and disease have facilitated our understanding of the role of genetics in the manifestation of these traits. There is a need to push the boundaries of research on intimate partner violence by adopting biosocial approaches to understand its causes.
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Autonomy and confidentiality are central topics in adolescent health care, both pertaining to findings that nonparent adults often benefit adolescent girls' psychological resilience. Traditionally, autonomy captures a patient's right to self-determine a course of treatment, whereas confidentiality is understood as privacy between doctor and patient. The author proposes a revision of these constructs to accommodate the psychology of adolescent girls in health care contexts through a case study of a 17-year-old girl's hospitalization. In particular, the importance of voice and trust in girls' psychology calls for understanding autonomy as self in relationship and confidentiality as mutual confidence. Suggestions for practice are guided by the premise that girls' health care can foster psychological risk or resilience, depending on the doctor-patient relationship.
Joining the discussion regarding the future of alternative and traditional medical practices and beliefs, the author explores how operating within the dominant sociopolitical system challenges alternative health care providers' definitions of themselves, their practices, and their systems of beliefs. Specifically, this case study articulates the experiences of one group of birth care providers (both certified nurse and nonlicensed, apprentice-trained midwives) as a web of paradox that simultaneously marginalizes parts of their occupational identity while allowing them to operate within the dominant sociopolitical system.
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This practice paper describes the preintervention training component of a feasibility study exploring the use of ho'oponopono, an indigenous Hawaiian healing practice, for enhancing psychosocial adaptation to breast cancer among Native Hawaiian women. Practitioners' adherence to research protocols and competence in intervention delivery are both regarded as essential to obtaining valid results in tests of intervention feasibility and efficacy; thus, training in this study dually focused on fortification of adherence and enhancing competence among those recruited to deliver the ho'oponopono intervention. A manual-based training, using adult pedagogical strategies infused with Native Hawaiian cultural practices, was delivered to community practitioners. Effects of the training on practitioners' knowledge and skills were evaluated through multiple methods. Knowledge significantly increased between pre- and post-intervention assessment. However, knowledge application for some practitioners was hindered by skill deficits, stylistic differences, and cultural conflict. Ongoing attention to competence and adherence is indicated. In-service training may bolster competence; however, practitioners may have difficulty in adhering to protocols for different reasons, and individualized clinical supervision and cultural consultation may be helpful in some situations.
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This article uses a case example to highlight some of the complexities of working with minority ethnic families. It addresses the dilemmas that exist for therapists and other professionals when carrying out cross-cultural assessments of parenting. In this article, we will examine how professionals' constructions impacted on the assessment process with regard to family life, culture and mental health. We will draw out implications for clinical practice in this area.
Sepsis is associated with immune dysregulated and organ dysfunction due to severe infection. Clinicians aim to restore organ function, rather than prevent diseases that are prone to sepsis, resulting in high mortality and a heavy public health burden. Some chronic diseases can induce sepsis through inflammation cascade reaction and Cytokine Storm (CS). Interleukin (IL)-6, the core of CS, and its related signaling pathways have been considered as contributors to sepsis. Therefore, it is important to study the relationship between IL-6 and its related pathways in sepsis-related chronic diseases. This review generalized the mechanism of sepsis-related chronic diseases via IL-6 related pathways with the purpose to take rational management for these diseases. IL-6 related signaling pathways were sought in Kyoto Encyclopedia of Genes and Genomes (KEGG), and retrieved protein-protein interaction in the Search for Interaction Genes tool (STRING). In PubMed and Google Scholar, the studies were searched out, which correlating to IL-6 related pathways and associating with the pathological process of sepsis. Focused on the interactions of sepsis and IL-6 related pathways, some chronic diseases have been studied for association with sepsis, containing insulin resistance, Alcoholic liver disease (ALD), Alzheimer disease (AD), and atherosclerosis. This article summarized the inflammatory mechanisms of IL-6 cross-talked with other mediators of some chronic diseases in vitro, animal models, and human experiments, leading to the activation of pathways and accelerating the progression of sepsis. The clinicians should be highlight to this kind of diseases and more clinical trials are needed to provide more reliable theoretical basis for health policy formulation.
BACKGROUND: Cardiometabolic diseases are among the leading causes of increasing morbidity and mortality worldwide. However, current population-based dietary recommendations do not sufficiently account for biological differences between individuals and therefore do not have the same effect on everyone. The multiomic approach, which incorporates genomic, epigenomic, transcriptomic, proteomic, metabolomic, and microbiome data, facilitates more accurate classification of disease risk and selection of appropriate nutritional interventions by mapping food-disease relationships across different biological layers. METHODS: Through a narrative synthesis of the current literature, we focused on evidence from multiomic studies to assess their ability to guide personalized nutrition strategies based on individual genetic, metabolic, and microbiome characteristics in cardiometabolic diseases. RESULTS: Recent evidence indicates that metabolomic markers have been reported to provide predictive value in addition to classic risk indicators and to increase the predictive power of models when combined with genetic data. Microbiome research shows that glycemic and lipemic responses can be predicted using algorithms based on gut microbiota. Recent clinical studies show that personalized nutrition plans, which evaluate the microbiome and clinical characteristics together, improve continuous glucose monitoring-based glycemic control, glycated hemoglobin levels, and triglycerides more than the classic Mediterranean diet. CONCLUSION: This review summarizes the current multiomic evidence, discusses the methodological and practical challenges in this field, and highlights future priorities. The integration of digital biomarkers obtained from wearable technologies with multiomic systems and artificial intelligence-supported models, when developed in accordance with ethical and equitable access principles, has the potential to support the transition from the discovery phase to patient-centered clinical applications.
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The article describes the process of planning the Memorial of Disappeared Detained Citizens in the City of Montevideo, Uruguay, the construction of which was completed in January 2003. It explores the role that memory, planning, and reconciliation carried out in the public realm can play in the context of an urban environment. It describes the procedures and involvement of different social agents in the achievement of a significant landmark where social healing is promoted in parallel to the materialization of the construction of the Memorial, the necessary interaction between the natural and the human dimensions, and how these relate to the city as a biosphere.