Concerns about medication and medication adherence in patients with chronic pain recruited from general practice

This study examines the concerns and beliefs about medication reported by patients with nonmalignant chronic pain encountered within general practice. Two hundred thirty-nine patients with chronic pain took part in this research. Patients completed the Pain Medication Attitudes Questionnaire, a measure of patient concerns and beliefs relating to addiction, withdrawal, side effects, mistrust in doctors, perceived need of medication, scrutiny from others, and tolerance. The data revealed that patient concerns and beliefs predicted general medication nonadherence. In addition, concerns were related to the direction of nonadherence: overuse of medication was related to increased perceived need for medication and greater concern over side effects; underuse was related to decreased concerns over withdrawal and increased mistrust in the prescribing doctor. Analyses also indicated that patient attitudes and concerns about medication were more predictive of nonadherence than both level of pain and the reported frequency of experienced side effects. This research contributes to the increasing evidence that patient attitudes and beliefs about pain medication are associated with adherence behavior. Training general practitioners to identify and address these concerns may reduce concerns, improve adherence, and facilitate the doctor-patient relationship

Indestructibility of Vopenka's Principle

We show that Vopenka's Principle and Vopenka cardinals are indestructible under reverse Easton forcing iterations of increasingly directed-closed partial orders, without the need for any preparatory forcing. As a consequence, we are able to prove the relative consistency of these large cardinal axioms with a variety of statements known to be independent of ZFC, such as the generalised continuum hypothesis, the existence of a definable well-order of the universe, and the existence of morasses at many cardinals.Comment: 15 pages, submitted to Israel Journal of Mathematic

Transcriptional profiling identifies differentially expressed genes in developing turkey skeletal muscle

<p>Abstract</p> <p>Background</p> <p>Skeletal muscle growth and development from embryo to adult consists of a series of carefully regulated changes in gene expression. Understanding these developmental changes in agriculturally important species is essential to the production of high quality meat products. For example, consumer demand for lean, inexpensive meat products has driven the turkey industry to unprecedented production through intensive genetic selection. However, achievements of increased body weight and muscle mass have been countered by an increased incidence of myopathies and meat quality defects. In a previous study, we developed and validated a turkey skeletal muscle-specific microarray as a tool for functional genomics studies. The goals of the current study were to utilize this microarray to elucidate functional pathways of genes responsible for key events in turkey skeletal muscle development and to compare differences in gene expression between two genetic lines of turkeys. To achieve these goals, skeletal muscle samples were collected at three critical stages in muscle development: 18d embryo (hyperplasia), 1d post-hatch (shift from myoblast-mediated growth to satellite cell-modulated growth by hypertrophy), and 16wk (market age) from two genetic lines: a randombred control line (RBC2) maintained without selection pressure, and a line (F) selected from the RBC2 line for increased 16wk body weight. Array hybridizations were performed in two experiments: Experiment 1 directly compared the developmental stages within genetic line, while Experiment 2 directly compared the two lines within each developmental stage.</p> <p>Results</p> <p>A total of 3474 genes were differentially expressed (false discovery rate; FDR < 0.001) by overall effect of development, while 16 genes were differentially expressed (FDR < 0.10) by overall effect of genetic line. Ingenuity Pathways Analysis was used to group annotated genes into networks, functions, and canonical pathways. The expression of 28 genes involved in extracellular matrix regulation, cell death/apoptosis, and calcium signaling/muscle function, as well as genes with miscellaneous function was confirmed by qPCR.</p> <p>Conclusions</p> <p>The current study identified gene pathways and uncovered novel genes important in turkey muscle growth and development. Future experiments will focus further on several of these candidate genes and the expression and mechanism of action of their protein products.</p

Moral exemplars in theory and practice

In this article I outline an original form of ethical theory that I call exemplarist virtue theory. The theory is intended to serve the philosophical purposes of a comprehensive moral theory, but it is also intended to serve the practical purpose of moral education by structuring the theory around a motivating emotion – the emotion of admiration. In this theory, basic moral concepts are defined via direct reference to exemplars of moral goodness, picked out through reflective admiration. The theory gives narratives a critical function, and it connects empirical studies with the a priori side of ethics.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

How Reasoning Aims at Truth

Many hold that theoretical reasoning aims at truth. In this paper, I ask what it is for reasoning to be thus aim-directed. Standard answers to this question explain reasoning’s aim-directedness in terms of intentions, dispositions, or rule-following. I argue that, while these views contain important insights, they are not satisfactory. As an alternative, I introduce and defend a novel account: reasoning aims at truth in virtue of being the exercise of a distinctive kind of cognitive power, one that, unlike ordinary dispositions, is capable of fully explaining its own exercises. I argue that this account is able to avoid the difficulties plaguing standard accounts of the relevant sort of mental teleology

Anterior cruciate ligament injuries of the knee: Patterns of association between the mechanism of injury and pathology visualised on magnetic resonance imaging

Background: Anterior cruciate ligament (ACL) injuries are common among athletes and the general public. These injuries may lead to significant absence from all activities with associated financial and social burdens for the patient. No definitive association has been described between the mechanism of injury and the pathology to enable the implementation of preventative measures to limit these injuries.Aim: To determine whether there is an association between the mechanism of injury and the pathology seen on a magnetic resonance imaging (MRI) scan in ACL injuries.Methods: This was a cross-sectional analytical study. Eighty-seven male patients with an ACL injury and who had an MRI scan of the knee within the last two years participated in this study. Participants were contacted to give their informed consent to participate in this study. The mechanism of injury and the pathology seen on the MRI scan was noted and categorised into different groups of injuries and associated pathologies. Statistical analyses included summaries of the data and a test for the association between the mechanism of injury and the pathology. Since there were multiple pathology responses to each mechanism, a modified version of the chi-square test for independence was used. A five percent level of significance was specified.Results: MRI scans of ACL injuries indicated that the mechanism of a solid foot plant with rotation of the knee has a greater tendency to be associated with medial meniscal injuries (77%). There was also a 54% possibility for it to be associated with lateral meniscal injuries. A solid foot plant with a valgus stress on the knee showed a higher incidence of associated medial collateral ligament (MCL) injuries (41%) and femoral bone bruising (62%). These two mechanisms of injury are the most common in ACL injuries and contribute to the clinical significance found in this study. The p-value was, however, not statistically significant (p=0.44, chi-square value=20.27, df=45) for any association between the pathology and the mechanism of injury.Conclusion: Some injury mechanisms causing an ACL injury were more common than others and had more associated pathologies. The most common mechanism of injury noted in this study was a solid foot plant with either rotation of the knee or valgus stress on the knee. Strengthening the tissue structures involved in those movement patterns causing these mechanisms can possibly limit future ACL injuries in athletes and the general public.Keywords: knee injury, mechanism, association, pathology, MRI scan, preventio