355 research outputs found
The Case for Legal Regulation of Physiciansâ Off-Label Prescribing
Deafness has been associated with poor abilities to deal with digits in the context of arithmetic and memory, and language modality-specific differences in the phonological similarity of digits have been shown to influence short-term memory (STM). Therefore, the overall aim of the present thesis was to find out whether language modality-specific differences in phonological processing between sign and speech can explain why deaf signers perform at lower levels than hearing peers when dealing with digits. To explore this aim, the role of phonological processing in digit-based arithmetic and memory tasks was investigated, using both behavioural and neuroimaging methods, in adult deaf signers and hearing non-signers, carefully matched on age, sex, education and non-verbal intelligence. To make task demands as equal as possible for both groups, and to control for material effects, arithmetic, phonological processing, STM and working memory (WM) were all assessed using the same presentation and response mode for both groups. The results suggested that in digit-based STM, phonological similarity of manual numerals causes deaf signers to perform more poorly than hearing non-signers. However, for digit-based WM there was no difference between the groups, possibly due to differences in allocation of resources during WM. This indicates that similar WM for the two groups can be generalized from lexical items to digits. Further, we found that in the present work deaf signers performed better than expected and on a par with hearing peers on all arithmetic tasks, except for multiplication, possibly because the groups studied here were very carefully matched. However, the neural networks recruited for arithmetic and phonology differed between groups. During multiplication tasks, deaf signers showed an increased reliance on cortex of the right parietal lobe complemented by the left inferior frontal gyrus. In contrast, hearing non-signers relied on cortex of the left frontal and parietal lobes during multiplication. This suggests that while hearing non-signers recruit phonology-dependent arithmetic fact retrieval processes for multiplication, deaf signers recruit non-verbal magnitude manipulation processes. For phonology, the hearing non-signers engaged left lateralized frontal and parietal areas within the classical perisylvian language network. In deaf signers, however, phonological processing was limited to cortex of the left occipital lobe, suggesting that sign-based phonological processing does not necessarily activate the classical language network. In conclusion, the findings of the present thesis suggest that language modality-specific differences between sign and speech in different ways can explain why deaf signers perform at lower levels than hearing non-signers on tasks that include dealing with digits.Dövhet har kopplats till bristande förmÄga att hantera siffror inom omrÄdena aritmetik och minne. SÀrskilt har sprÄkmodalitetsspecifika skillnader i fonologisk likhet för siffror visat sig pÄverka korttidsminnet. Det övergripande syftet med den hÀr avhandlingen var dÀrför att undersöka om sprÄkmodalitetsspecifika skillnader i fonologisk bearbetning mellan teckenoch talsprÄk kan förklara varför döva presterar sÀmre Àn hörande pÄ sifferuppgifter. För att utforska det omrÄdet undersöktes fonologisk bearbetning i sifferbaserade minnesuppgifter och aritmetik med hjÀlp av bÄde beteendevetenskapliga metoder och hjÀrnavbildning hos grupper av teckensprÄkiga döva och talsprÄkiga hörande som matchats noggrant pÄ Älder, kön, utbildning och icke-verbal intelligens. För att testförhÄllandena skulle bli sÄ likartade som möjligt för de bÄda grupperna, och för att förebygga materialeffekter, anvÀndes samma presentations- och svarssÀtt för bÄda grupperna. Resultaten visade att vid sifferbaserat korttidsminne pÄverkas de dövas prestation av de tecknade siffrornas fonologiska likhet. DÀremot fanns det ingen skillnad mellan grupperna gÀllande sifferbaserat arbetsminne, vilket kan bero pÄ att de bÄda grupperna fördelar sina kognitiva resurser pÄ olika sÀtt. Dessutom fann vi att den grupp teckensprÄkiga döva som deltog i studien presterade bÀttre pÄ aritmetik Àn vad tidigare forskning visat och de skiljde sig bara frÄn hörande pÄ multiplikationsuppgifter, vilket kan bero pÄ att grupperna var sÄ noggrant matchade. DÀremot fanns det skillnader mellan grupperna i vilka neurobiologiska nÀtverk som aktiverades vid aritmetik och fonologi. Vid multiplikationsuppgifter aktiverades cortex i höger parietallob och vÀnster frontallob för de teckensprÄkiga döva, medan cortex i vÀnster frontal- och parietallob aktiverades för de talsprÄkiga hörande. Detta indikerar att de talsprÄkiga hörande förlitar sig pÄ fonologiberoende minnesstrategier medan de teckensprÄkiga döva förlitar sig pÄ ickeverbal magnitudmanipulering och artikulatoriska processer. Under den fonologiska uppgiften aktiverade de talsprÄkiga hörande vÀnsterlateraliserade frontala och parietala omrÄden inom det klassiska sprÄknÀtverket. För de teckensprÄkiga döva var fonologibearbetningen begrÀnsad till cortex i vÀnster occipitallob, vilket tyder pÄ att teckensprÄksbaserad fonologi inte behöver aktivera det klassiska sprÄknÀtverket. Sammanfattningsvis visar fynden i den hÀr avhandlingen att sprÄkmodalitetsspecifika skillnader mellan tecken- och talsprÄk pÄ olika sÀtt kan förklara varför döva presterar sÀmre Àn hörande pÄ vissa sifferbaserade uppgifter
Can a nudge keep you warm? Using nudges to reduce excess winter deaths: insight from the Keeping Warm in Later Life Project (KWILLT)
Nudges are interventions that aim to change people's behaviour through changing the environment in which they choose rather than appealing to their reasoning. Nudges have been proposed as of possible use in relation to health-related behaviour. However, nudges have been criticized as ethically dubious because they bypass peoples reasoning and (anyway) are of little help in relation to affecting ill-health that results from social determinants, such as poverty. Reducing the rate of excess winter deaths (EWDs) is a public health priority; however, EWD seems clearly to be socially determined such that nudges arguably have little role. This article defends two claims: (i) nudges could have a place in tackling even the heavily socially determined problem of EWD. We draw on evidence from an empirical study, the Keeping Warm in Later Life Project (KWILLT), to argue that in some cases the risk of cold is within the personâs control to some extent such that environmental modifications to influence behaviour such as nudges are possible. (ii) Some uses of behavioural insights in the form of nudges are acceptable, including some in the area of EWD. We suggest a question-based framework by which to judge the ethical acceptability of nudges
The Enhanced Danger of Physiciansâ Off-Label Prescribing
The COVID-19 pandemic represents a major challenge to both technologically advanced and resource-poor countries. There are currently no effective treatments for severe disease other than supportive care and advanced life support measures, including the use of mechanical ventilators. With the urgency and necessity bred from desperation, there have been many calls to utilize unproven therapies, such as hydroxychloroquine, for which little evidence of efficacy exists. We have previously argued that such off-label use, while legal, is problematic (and even dangerous) and have suggested several regulatory remedies that could protect patients and advance their interests while preserving the reasonable authority of physicians to do what they and their patients think is the best course of action. In this essay we ask whether the special conditions existing in a public healthcare crisis, such as the current pandemic, would justify a relaxing of our argument and permit ongoing unregulated off-label use. We outline at least four areas of concern, all of which can be exacerbated by the widespread distress and despair amongst doctors, patients and other stakeholders. We contend that, if anything, these conditions warrant even more caution and scrutiny of this practice
Investing in Prevention or Paying for Recovery - Attitudes to Cyber Risk
The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Broadly speaking an individual can invest time and effort to avoid becoming victim to a cyber attack and/or they can invest resource in recovering from any attack. We introduce a new game called the pre-vention and recovery game to study this trade-off. We report results from the experimental lab that allow us to categorize different approaches to risk taking. We show that many individuals appear relatively risk loving in that they invest in recovery rather than prevention. We find little difference in behavior between a gain and loss framing
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