Shame and Attributability

Responsibility as accountability is normally taken to have stricter control conditions than responsibility as attributability. A common way to argue for this claim is to point to differences in the harmfulness of blame involved in these different kinds of responsibility. This paper argues that this explanation does not work once we shift our focus from other-directed blame to self-blame. To blame oneself in the accountability sense is to feel guilt and feeling guilty is to suffer. To blame oneself in the attributability sense, it will be argued, is to feel shame and feeling shame is also to suffer. The different control conditions cannot be explained by a difference in the harm of blame. Instead, this paper argues that accountability and attributability are governed by different kinds of appropriateness: an agent S is accountability blameworthy for X only if S deserves to feel guilty; an agent S is attributability blameworthy for X only if it is fitting that S feels shame for X

Responsibility and the emotions

According to the Strawsonian tradition, a person is responsible for an action just in case it is appropriate to hold them responsible for that action. One important way of holding people responsible for wrongdoing is by experiencing and expressing blaming emotions. This raises the questions of what blaming emotions are and in what sense they can be appropriate. In this chapter I will provide an overview of different answers to both these questions. A common thread in the chapter will be a challenge for the Strawsonian tradition. Given that this tradition understands moral responsibility in terms of the appropriateness of blaming emotions, it must provide a realistic picture of these emotions and the practices in which they take part. On the other hand, it also aims to develop a normatively plausible account of the conditions of responsibility. I will try to show that it is often difficult to strike a satisfactory balance between these two aspiration

A parameter for IL-10 and TGF-β mediated regulation of HIV-1 specific T cell activation provides novel information and relates to progression markers

HIV replication is only partially controlled by HIV-specific activated effector T cells in chronic HIV infection and strategies are warranted to improve their efficacy. Chronic T cell activation is generally accompanied by regulation of antigen-specific T cell responses which may impair an effective control of chronic infections. The impact of HIV-induced T cell regulation on individual patients’ disease progression is largely unknown, since classical T cell activation assays reflect net activation with regulation as unknown contributing factor. We here explore a quantitative parameter for antigen-induced cytokine-mediated regulation (RAC) of HIV-specific effector T cell activation by functional antibody-blockade of IL-10 and transforming growth factor-ß. HIV Env- and Gag-specific T cell activation and RAC were estimated in peripheral blood mononuclear cells from 30 treatment-naïve asymptomatic HIV-infected progressors (CD4 count 472/µl, HIV RNA 37500 copies/ml) stimulated with overlapping peptide panels for 6 days. RAC was estimated from differences in T cell activation between normal and blocked cultures, and related to annual CD4 loss, immune activation (CD38) and microbial translocation (plasma lipopolysaccharides). RAC was heterogeneously distributed between individual patients and the two HIV antigens. Notably, RAC did not correlate to corresponding classical activation. Env RAC correlated with CD38 and CD4 loss rates (r> = 0.37, p = <0.046) whereas classical Gag activation tended to correlate with HIV RNA (r = -0.35, p = 0.06). 14 patients (47%) with low RAC’s to both Env and Gag had higher CD8 counts (p = 0.014) and trends towards lower annual CD4 loss (p = 0.056) and later start with antiretroviral treatment (p = 0.07) than the others. In contrast, patients with high RAC to both Env and Gag (n = 8) had higher annual CD4 loss (p = 0.034) and lower CD8 counts (p = 0.014). RAC to Env and Gag was not predicted by classical activation parameters and may thus provide additional information on HIV-specific immunity. RAC and other assessments of regulation deserve further in-depth exploration

Survival and death causes of patients with giant cell arteritis in Western Norway 1972-2012: a retrospective cohort study

Background: Our objective was to determine the survival and causes of death in a large and well-characterized cohort of patients with giant cell arteritis (GCA). Methods: This is a hospital-based, retrospective, observational cohort study including patients diagnosed with GCA in Western Norway during 1972–2012. Patients were identified through computerized hospital records using the International Classification of Diseases (ICD)-coding system. Medical records were reviewed. Patients were randomly assigned population controls matched on age, sex, and geography from the Central Population Registry of Norway (CPRN). Date and cause of death were obtained from the Norwegian Cause of Death Registry (NCoDR). The survival was analyzed using Kaplan-Meier methods with the Gehan-Breslow test and the causes of death using cumulative incidence and Cox models for competing risks. Results: We identified 881 cases with a clinical diagnosis of GCA of which 792 fulfilled the American College of Rheumatology (ACR) 1990 classification criteria. Among those fulfilling the ACR criteria, 528 were also biopsy-verified. Cases were matched with 2577 population controls. A total of 490 (56%) GCA patients and 1517 (59%) controls died during the study period. We found no difference in the overall survival of GCA patients compared to controls, p = 0.413. The most frequent underlying causes of death in both groups were diseases of the circulatory system followed by cancer. GCA patients had increased risk of dying of circulatory disease (HR 1.31, 95% CI 1.13–1.51, p < 0.001) but lower risk of dying of cancer (HR 0.56, 95% CI 0.42–0.73, p < 0.001) compared to population controls. Conclusions: We found no difference in the overall survival of GCA patients compared to matched controls, but there were differences in the distribution of underlying death causes.publishedVersio