When Inequality is Equitable: Validity, Propriety and Third Party Allocations

The author summarizes theories of equity and distributive justice that predict actors use legitimate distribution rules to act to maintain or to restore equity. He elaborates those ideas, distinguishing legitimacy based on validity (socially supported) from propriety (acceptance by the focal actor). Experimental research showed strong effects of both types of legitimacy on behavior, with validity having slightly stronger effects.This research was supported by a grant from the National Science Foundation (SOC #7817^3<»), Morris Zelditch, Jr.» Principal Investigator. Computations were supported by a grant from the Office of the Dean of Graduate Studies and Research at Stanford University

Bilateral tactile hypersensitivity and neuroimmune responses after spared nerve injury in mice lacking vasoactive intestinal peptide.

Vasoactive intestinal peptide (VIP) is one of the neuropeptides showing the strongest up-regulation in the nociceptive pathway after peripheral nerve injury and has been proposed to support neuropathic pain. Nevertheless, the story may be more complicated considering the known suppressive effects of the peptide on the immune reactivity of microglial cells, which have been heavily implicated in the onset and maintenance of pain after nerve injury. We here used mice deficient in VIP and the model of spared nerve injury, characterized by persistent tactile hypersensitivity. While tactile hypersensitivity developed similarly to wild type mice for the ipsilateral hindpaw, only transgenic mice showed a mirror-image tactile hypersensitivity in the contralateral hindpaw. This exacerbated neuropathic pain phenotype appeared to be mediated through a local mechanism acting at the level of the lumbar spinal cord as a distant nerve lesion in the front limb did not lead to hindpaw hypersensitivity in VIP-deficient mice. Innocuous tactile hindpaw stimulation was found to increase a neuronal activation marker in the bilateral superficial laminae of the lumbar dorsal horn of VIP-deficient, but not wild type mice, after SNI. A deeper study into the immune responsiveness to the nerve lesion also proved that VIP-deficient mice had a stronger early pro-inflammatory cytokine response and a more pronounced microglial reactivity compared to wild type controls. The latter was also observed at four weeks after spared nerve injury, a time at which bilateral tactile hypersensitivity persisted in VIP-deficient mice. These data suggest an action of VIP in neuropathic states that is more complicated than previously assumed. Future research is now needed for a deeper understanding of the relative contribution of receptors and fiber populations involved in the VIP-neuropathic pain link

De B van Bekwaam: Naar een toekomstbestendige Wet BIG

De Raad ziet een aantal maatschappelijke ontwikkelingen waardoor de wet BIG ten onder gaat aan zijn eigen succes. De zorgvraag van burgers in Nederland wordt steeds uitgebreider en complexer. Dat vraagt om snelle aanpassing van bekwaamheden bij zorgverleners. In de praktijk leidt dit tot een wildgroei van nieuwe beroepen in de zorg; inmiddels zijn dat er zeker 2400, waarvan niet altijd duidelijk is waar zij voor staan. Denk daarbij aan de bachelor medisch hulpverlener, de klinisch technoloog of de regieverpleegkundige. Dat zorgt voor onduidelijkheid en versplintering in plaats van samenwerking over domeinen heen. De Raad pleit er daarom voor de Wet BIG (Beroepen in de Individuele Gezondheidszorg) om te vormen tot de Wet op de Bekwaamheden in de Individuele Gezondheidszorg. Dat wil zeggen: alleen basisberoepen in de wet regelen en verdere bekwaamheden - die zorgverleners door opleiding en maar ook in de praktijk verwerven - vastleggen in een persoonlijk portfolio

Amelioration of motor/sensory dysfunction and spasticity in a rat model of acute lumbar spinal cord injury by human neural stem cell transplantation

INTRODUCTION: Intraspinal grafting of human neural stem cells represents a promising approach to promote recovery of function after spinal trauma. Such a treatment may serve to: I) provide trophic support to improve survival of host neurons; II) improve the structural integrity of the spinal parenchyma by reducing syringomyelia and scarring in trauma-injured regions; and III) provide neuronal populations to potentially form relays with host axons, segmental interneurons, and/or α-motoneurons. Here we characterized the effect of intraspinal grafting of clinical grade human fetal spinal cord-derived neural stem cells (HSSC) on the recovery of neurological function in a rat model of acute lumbar (L3) compression injury. METHODS: Three-month-old female Sprague–Dawley rats received L3 spinal compression injury. Three days post-injury, animals were randomized and received intraspinal injections of either HSSC, media-only, or no injections. All animals were immunosuppressed with tacrolimus, mycophenolate mofetil, and methylprednisolone acetate from the day of cell grafting and survived for eight weeks. Motor and sensory dysfunction were periodically assessed using open field locomotion scoring, thermal/tactile pain/escape thresholds and myogenic motor evoked potentials. The presence of spasticity was measured by gastrocnemius muscle resistance and electromyography response during computer-controlled ankle rotation. At the end-point, gait (CatWalk), ladder climbing, and single frame analyses were also assessed. Syrinx size, spinal cord dimensions, and extent of scarring were measured by magnetic resonance imaging. Differentiation and integration of grafted cells in the host tissue were validated with immunofluorescence staining using human-specific antibodies. RESULTS: Intraspinal grafting of HSSC led to a progressive and significant improvement in lower extremity paw placement, amelioration of spasticity, and normalization in thermal and tactile pain/escape thresholds at eight weeks post-grafting. No significant differences were detected in other CatWalk parameters, motor evoked potentials, open field locomotor (Basso, Beattie, and Bresnahan locomotion score (BBB)) score or ladder climbing test. Magnetic resonance imaging volume reconstruction and immunofluorescence analysis of grafted cell survival showed near complete injury-cavity-filling by grafted cells and development of putative GABA-ergic synapses between grafted and host neurons. CONCLUSIONS: Peri-acute intraspinal grafting of HSSC can represent an effective therapy which ameliorates motor and sensory deficits after traumatic spinal cord injury