Extended self-knowledge

We aim to move the externalism and self-knowledge debate forward by exploring two novel sceptical challenges to the prospects of self-knowledge of a paradigmatic sort, both of which result from ways in which our thought content, cognitive processes and cognitive successes depend crucially on our external environments. In particular, it is shown how arguments from extended cognition (e.g., Clark A, Chalmers D. Analysis 58:7–19 (1998); Clark A. Supersizing the mind: Embodiment, action, and cognitive extension. Oxford: Oxford University Press (2008)) and situationism (e.g., Alfano M. The Philosophical Quarterly 62:223–249 (2012), Alfano M. Expanding the situationist challenge to reliabilism about inference. In Fairweather A (ed) Virtue epistemology naturalized, Springer, Dordrecht, pp 103–122 (2014); Doris JM. Noûs 32:504–530 (1998), Doris JM. Lack of character: Personality and moral behavior. Cambridge University Press, Cambridge (2002); Harman G. Proceedings of the Aristotelian Society. 99:315–331 (1999), Harman G. Proceedings of the Aristotelian Society 100:223–226 (2000)) pose hitherto unexplored challenges to the prospects of self-knowledge as it is traditionally conceived. It is shown, however, that, suitably understood, these apparent challenges in fact only demonstrate two ways in which our cognitive lives can be dependent on our environment. As such, rather than undermining our prospects for attaining self-knowledge, they instead illustrate how self-knowledge can be extended and expanded

Downregulation of MIP-1α/CCL3 with praziquantel treatment in Schistosoma haematobium and HIV-1 co-infected individuals in a rural community in Zimbabwe

The results of our study show that the MIP-1alpha/CCL3 levels were positively associated with S. haematobium egg counts at baseline but not with HIV-1 infection status. MIP-1alpha/CCL3 levels were significantly reduced at three months post treatment with praziquantel. We therefore conclude that MIP-1alpha/CCL3 is produced during infection with S haematobium. S. haematobium infection is associated with increased MIP-1alpha/CCL3 levels in an egg intensity-dependent manner and treatment of S. haematobium is associated with a reduction in MIP-1alpha/CCL3

May Measurement Month 2017: An analysis of blood pressure screening results in Nepal - South Asia

Hypertension is the leading risk factor of mortality in Nepal accounting for ∼33 000 deaths in 2016. However, more than 50% of the hypertensive patients are unaware of their status. We participated in the May Measurement Month 2017 (MMM17) project initiated worldwide by the International Society of Hypertension to raise the awareness on the importance of blood pressure (BP) screening. In this paper, we discuss the screening results of MMM17 in Nepal. An opportunistic cross-sectional survey of volunteers aged ≥18 years was carried out in May 2017 following the standard MMM protocol. Data were collected from 18 screening sites in 7 districts covering 5 provinces. Screenings were conducted either in health facilities, public places, or participants' homes. Trained volunteers with health science background and female community health volunteers were mobilized to take part in the screening. A total of 5972 individuals were screened and of 5968 participants, for whom a mean of the 2nd and 3rd readings was available, 1456 (24.4%) participants had hypertension; 908 (16.8%) of those not receiving treatment were hypertensive; and 248 (45.2%) of those being treated had uncontrolled BP. MMM17 is the first nationwide BP screening campaign undertaken in Nepal. Given the suboptimal treatment and control rates identified in the study, there is a strong imperative to scale up hypertension prevention, screening, and management programmes. These results suggest that opportunistic screening can identify significant numbers with hypertension. Mobilization of existing volunteer networks and support of community stakeholders, would be necessary to improve the overall impact and sustainability of future screening programmes

Treatment of Helminth Co-Infection in Individuals with HIV-1: A Systematic Review of the Literature

Many people living in areas of the world most affected by the HIV/AIDS pandemic are also exposed to other common infections. Parasitic infections with helminths (intestinal worms) are common in Africa and affect over half of the population in some areas. There are plausible biological reasons why treating helminth infections in people with HIV may slow down the progression of HIV to AIDS. Thus, treating people with HIV for helminths in areas with a high prevalence of both HIV and helminth infections may be a feasible strategy to help people with HIV delay progression of their disease or initiation of antiretroviral therapy. After a comprehensive review of the available literature, we conclude that there is not enough evidence to determine whether treating helminth infections in people with HIV is beneficial

‘Clinically unnecessary’ use of emergency and urgent care : a realist review of patients' decision making

Background Demand is labelled ‘clinically unnecessary’ when patients do not need the levels of clinical care or urgency provided by the service they contact. Objective To identify programme theories which seek to explain why patients make use of emergency and urgent care that is subsequently judged as clinically unnecessary. Design Realist review. Methods Papers from four recent systematic reviews of demand for emergency and urgent care, and an updated search to January 2017. Programme theories developed using Context‐Mechanism‐Outcome chains identified from 32 qualitative studies and tested by exploring their relationship with existing health behaviour theories and 29 quantitative studies. Results Six mechanisms, based on ten interrelated programme theories, explained why patients made clinically unnecessary use of emergency and urgent care: (a) need for risk minimization, for example heightened anxiety due to previous experiences of traumatic events; (b) need for speed, for example caused by need to function normally to attend to responsibilities; (c) need for low treatment‐seeking burden, caused by inability to cope due to complex or stressful lives; (d) compliance, because family or health services had advised such action; (e) consumer satisfaction, because emergency departments were perceived to offer the desired tests and expertise when contrasted with primary care; and (f) frustration, where patients had attempted and failed to obtain a general practitioner appointment in the desired timeframe. Multiple mechanisms could operate for an individual. Conclusions Rather than only focusing on individuals' behaviour, interventions could include changes to health service configuration and accessibility, and societal changes to increase coping ability

Why ‘Swampman’ Would Not Even Get as Far as Thinking it Was Davidson:On the Spatio‐temporal Basis of Davidson's Conjuring Trick

In this article, we analyse one of the most famous recent thought experiments in philosophy, namely Donald Davidson’s Swampman. Engaging recent commentators on Davidson’s Swampman as well as analysing the spatio-temporal conditions of the thought-experiment, we will show how the ‘experiment’ inevitably fails. For it doesn’t take seriously some of its own defining characteristics: crucially, Swampman’s creation of a sudden in a place distinct from Davidson’s. Instead of denigrating philosophical thought-experiments per se, our analysis points towards considering thought-experiments in a different sense: imaginary scenarios helpfully self-deconstructing rather than constituting substantive philosophical resources

Measures used to assess interventions for increasing patient involvement in Danish healthcare setting: a rapid review

Objective: To identify measures used within Denmark evaluating any type of intervention designed to facilitate patient involvement in healthcare. Design: Environmental scan employing rapid review methods. Data sources: MEDLINE, PsycInfo and CINAHL were searched from 6–9 April 2021 from database inception up to the date of the search. Eligibility criteria: Quantitative, observational and mixed methods studies with empirical data on outcomes used to assess any type of intervention aiming to increase patient involvement with their healthcare. Language limitations were Danish and English. Data extraction and synthesis: Two independent reviewers extracted data from 10% of the included studies and, due to their agreement, the data from the rest were extracted by first author. Data were analysed with reference to existing categories of measuring person-centred care; findings were synthesised using narrative summaries. Adapted Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines were used to guide reporting. Results: Among 3767 records, 43 studies met the inclusion criteria, including 74 different measures used to evaluate interventions aimed at increasing patient involvement within healthcare in Danish hospital and community settings. Generic measures assessed: patient engagement (n=3); supporting self-management (n=8); supporting shared decision-making (n=9); patient satisfaction and experiences of care (n=11); health-related patient-reported outcome (n=20). Conclusions: Across Denmark, complex interventions designed to improve patient involvement with healthcare vary in their goals and content. Some targeting healthcare professionals, some patient health literacy and some service infrastructure. A plethora of measures assess the impact of these interventions on patient, professional and service delivery outcomes. Few measures assessed patient involvement directly, and it is unclear which proxy measures capture indicators of perceived involvement. Lack of conceptual clarity between intervention goals, the components of change and measures makes it difficult to see what types of intervention can best support change in services to ensure patients are more effectively involved in their healthcare