Complementary and Alternative Medicine legitimation efforts in a hostile environment: The case of Portugal.

This article explores complementary and alternative medicine (CAM) organisations' legitimation efforts that face extra obstacles as they are subject to more than one institutional logics (hybrids) and operate in a contested organisational space (hostile environment). CAM organisations espouse the health and market logics and their practices are questioned at an institutional level. The study is conducted in Portugal, where the legalisation of CAM therapies was a contested process over 10 years. Taking an abductive approach and drawing on qualitative interviews, the authors analyse CAM managers' efforts to legitimise their practices and build viable organisations despite hostile conditions. Contrary to prior studies of hybrid healthcare organisations, CAM organisations derive moral legitimacy from the market logic rather than the health logic. The findings show that relationships, trust-building and consumer education appear to be the primary vehicles for establishing pragmatic legitimacy. Thus, pragmatic legitimacy relies on the health logic. The market logic dominates the pursuit of moral legitimacy through financial sustainability, human capital, marketing communications and partnerships, and advocating complementarity with biomedicine. We propose a model through which organisations use pragmatic legitimacy to enhance moral legitimacy and to create recursive feedback between moral and pragmatic legitimacy on the path to cognitive legitimacy.

Molecular Computation for Molecular Classification.

DNA as an informational polymer has, for the past 30 years, progressively become an essential molecule to rationally build chemical reaction networks endowed with powerful signal-processing capabilities. Whether influenced by the silicon world or inspired by natural computation, molecular programming has gained attention for diagnosis applications. Of particular interest for this review, molecular classifiers have shown promising results for disease pattern recognition and sample classification. Because both input integration and computation are performed in a single tube, at the molecular level, this low-cost approach may come as a complementary tool to molecular profiling strategies, where all biomarkers are quantified independently using high-tech instrumentation. After introducing the elementary components of molecular classifiers, some of their experimental implementations are discussed either using digital Boolean logic or analog neural network architectures.

Differences in brain connectivity of meditators during assessing neurocognition via gamified experimental logic task: A machine learning approach.

Meditation practices increase attention, memory, and self-awareness. The neuroscientific study of meditation has helped gain useful insights into the functional changes in the brain. In this study, we have assessed the performance of meditators with different years of practice while performing an engaging task rather than studying the meditation practice itself. This task helps assess many neural processes simultaneously and represents task performance in presence of multiple audio-visual distractors as in a real-life scenario. The long-term practice of meditation could bring neuroplastic changes in the way cognitive processing is carried out. It could be conscious and effortful in short-term practitioners and relatively unconscious and effortless in long-term practitioners. Our goal is to understand if it is possible to differentiate between long-term and short-term meditators solely based on their cognitive processing. A group of proficient Rajayoga meditators from the Brahma Kumaris were recruited based on their meditation experience-Long-Term Practitioners (n = 12, mean 13,596 h) and Short-Term Practitioners (n = 10, mean 1095 h). A task-based functional Magnetic Resonance Imaging was acquired while the subjects performed the task. Functional Connectivity Analysis was performed to derive the correlation measures to be used as features for classification. Five supervised Machine Learning algorithms Logistic Regression, Support Vector Machine, Decision Tree, Random Forest, and Gradient Boosted Tree were used for classification. Among all the classifiers Gradient Boosted Tree performed the best with an accuracy of 77% when all the four Functional Connectivity Metrics were used. Connectivity in visual areas, cerebellum, left rostral prefrontal cortex, and middle frontal gyrus was found to be higher in long-term meditators. Such a classification demonstrates that long-term meditation practice brings about neuroplastic changes that influence cognitive processing.

Logic model for opioid safety in chronic non-malignant pain management, an in-depth qualitative study.

BACKGROUND: Opioids are commonly used for the management of chronic non-malignant pain in Pakistan; but there is a lack of literature around precursors or motivators in the use of opioids. AIM: The study holistically explored factors contributing towards the unsafe use of opioids and identifies strategies to overcome them. METHOD: Exploratory qualitative methods using interviews, focus groups and non-participant observational case studies were used. Interviews and focus groups were carried out face-to-face as well as virtually and observations were conducted in community pharmacies in Islamabad and Khyber Pukhtoon Khuwa province, Pakistan. Data were collected from 4 stakeholder groups; pharmacy policy makers (n = 11), people with chronic non-malignant pain (n = 14), doctors (n = 31) and community pharmacists (n = 36) by purposive critical case sampling method. Data were analysed inductively using reflexive thematic analysis and then deductively mapped to a social ecological framework. Non-participant observations were analysed using a cross case synthesis using explanation building technique. Data from all three methods were triangulated to develop a logic model. RESULTS: Identified factors at macro (regulation), meso (social perceptions of pain and opioids) and micro levels (uncontrolled pain, self-medication, health literacy) and strategies are presented holistically and were used to develop a logic model for the prevention and mitigation of factors currently causing unsafe use of opioids. CONCLUSION: The study provides an in-depth view of factors contributing towards diversion of pharmaceutical opioids and can help guide national and international policy makers in their future initiatives to promote safe use of opioids in the management of chronic non-malignant pain in Pakistan.

Nanoflare Couple: Multiplexed mRNA Imaging and Logic-Controlled Combinational Therapy.

Theranostics, which combines both diagnostic and therapeutic capabilities in one dose, has always been an intractable challenge in personalized cancer treatment. Herein, a versatile nanotheranostic platform "nanoflare couple (NC)" has been developed for in situ multiplex cancer-related mRNA imaging and subsequent logic-controlled aggregation of gold nanoparticles, leading to gene therapy and photothermal therapy upon irradiation with infrared light. As a proof of concept, TK1 and survivin mRNAs that are highly expressed in most tumor tissues are selected as endogenous cancer indicators and therapy triggers to design the NC. Mice bearing breast cancer cells MCF-7 are prepared as a model to test its efficacy. The in vitro and in vivo assays validate that the NC show the capability for multiplexed mRNA imaging and high efficiency for logic-controlled combinational therapy of breast cancer.

Thinking differently with Chinese medicine: 'Explanations' and case studies for a postcolonial STS.

In Mandarin, the English word 'nature' translates as 'ziran' (zìrán) in science, biomedicine and everyday life. At the same time, ziran indexes a second older set of meanings that make little immediate sense in English. Current in many Chinese medical practices as well as in classical Chinese philosophy, these include 'what is spontaneously so' or 'let the character of the self unfold'. In this article we explore how these two families of meaning are related by particular Taiwanese Chinese medical practitioners as they describe how they negotiate the relations between biomedicine and Chinese medicine in daily professional practice. At the same time, inspired by related logic-shifting writing in anthropology, postcolonial studies and postcolonial STS, we draw on the 'art of patterning' ( biàn zhèng) to understand how ziran-nature relations are specified in those accounts. Patterning is the art of specifying the shifting arrangements and misalignments that lead to ill health. Treating this as a way of thinking about ziran-related overlaps between biomedicine and Chinese medicine, we show that patterning attends not to objects 'out there' but to appearances (xiang, xiàng). Put into use as an STS term of art it therefore shifts the epistemological basis of inquiry because case-stories no longer reveal underlying mechanisms, but instead narrate patterned appearances. One implication of this is that any particular pattern diagnosis lies alongside a galaxy of alternatives that might be equally good to think with. Within the limits set by referential academic conventions, we thus attempt a postcolonial shi ()-inflected STS in this paper by resisting the use of a single analytical framework, instead setting different forms of patterning alongside one another.

Sam's Story: The Financial and Human Costs of Disjointed Logics of Care.

I am an anthropologist and family doctor who has the good fortune of working in northern California with colleagues who prioritize the social needs of our patients alongside medical ones. In the essay that follows, I share details from my patient Sam's (pseudonym) last 2 years of life to underscore how attending to social precarity cannot be fully achieved within our safety net institutions as they are currently structured. While we have strong evidence that addressing social needs as part of clinical care offers good return on investment, Sam's story makes visible the problems we face when attempting to address social determinants of health. After introducing a concept from the social sciences about rationales that underlie health care delivery, I call on primary care doctors to redefine the medical paradigm to remedy the disjointed logics of care that result in unnecessarily high financial and human costs.

Discussion on "Correct and logical causal inference for binary and time-to-event outcomes in randomized controlled trials" by Yi Liu, Bushi Wang, Miao Yang, Jianan Hui, Heng Xu, Siyoen Kil, and Jason C. Hsu.

In their paper, Liu et al. (2020) pointed out illogical discrepancies between subgroup and overall causal effects for some efficacy measures, in particular the odds and hazard ratios. As the authors show, the culprit is subgroups having prognostic effects within treatment arms. In response to their provocative findings, we found that the odds and hazard ratios are logic respecting when the subgroups are purely predictive, that is, the distribution of the potential outcome for the control treatment is homogeneous across subgroups. We also found that when we redefined the odds and hazards ratio causal estimands in terms of the joint distribution of the potential outcomes, the discrepancies are resolved under specific models in which the potential outcomes are conditionally independent. In response to other discussion points in the paper, we also provide remarks on association versus causation, confounding, statistical computing software, and dichotomania.

Anatomy of Being, Metaphysics of Death: The Case of Avicenna's Logical Dissection.

Elucidating a metaphysics of medicine is vital for framing a coherent medical ethics. In this paper, I examine the historical case of Avicenna, the eleventh century physician-philosopher. Avicenna radicalizes the dissective power of reason using a logicized Aristotelian metaphysics to clarify concepts at the metaphysical level, which I call his anatomy of being. One of the practical consequences of Avicenna's metaphysics is a dehumanizing eschatology of death. I outline the main elements of Avicenna's thought that constitute his anatomy of being. Through an examination of his logic, metaphysics, and psychology, I show how Avicenna develops a dissective logic. I conclude that one's epistemology, as a method of knowing, entails a metaphysics, and, in turn, results in an ethical stance to the object of knowledge. For Avicenna, mental dissective logic applied to humans results in dehumanization, thereby destroying the humanistic impulse of medicine.

[Study on endpoint determination method of tablet coating based on 3σ criteria and logic regression].

This paper explores the statistical distribution characteristics of coating film thickness, so as to present a new method for determining coating endpoint based on 3σ criterion and logic regression. Firstly, the spectrum and thickness of 4 batch samples were collected. Secondly, the spectral range of normal products was obtained by 3σ criterion, with the spectral feature NI as the number of test spectrum in the above range. Then, the model based on 3σ criterion and logic regression was built according to the best condition in K-fold cross-validation and the determined threshold of qualified rate in the coating endpoint. Finally, the qualified rate of test set samples at different time points was calculated by the above model, and the above change trend and the threshold value were combined to determine the coating endpoint. The results of KS analysis showed the distribution of thickness of the qualified products followed the normal distribution(P=0.081>0.05). The accuracy of the coating endpoint determination was as high as 100% by the model based on 3σ criterion and logic regression when the determined threshold of qualified rate was 90%. Therefore, the 3σ criterion was feasible to the research of coating eligibility. This paper reveals certain random phenomena in the coating process, and the method features a high accuracy, quick analysis and a good interpretability, which provides a reference for online detection and qualify evaluation in future.

Centrality and compatibility of institutional logics when introducing value-based reimbursement.

PURPOSE: Using financial incentives has been criticised for putting too much focus on things that can be measured. Value-based reimbursement may better align professional values with financial incentives. However, professional values may differ between actor groups. In this article, the authors identify institutional logics within healthcare-providing organisations. Further, the authors analyse how the centrality and compatibility of the identified logics affect the institutionalisation of external demands. DESIGN/METHODOLOGY/APPROACH: 41 semi-structured interviews were conducted with representatives from healthcare providers within spine surgery in Sweden, where a value-based reimbursement programme was introduced. Data were analysed using thematic content analysis with an abductive approach, and a conceptual framework based on neo-institutional theory. FINDINGS: After the introduction of the value-based reimbursement programme, the centrality and compatibility of the institutional logics within healthcare-providing organisations changed. The logic of spine surgeons was dominating whereas physiotherapists struggled to motivate a higher cost for high quality physiotherapy. The institutional logic of nurses was aligned with spine surgeons, however as a peripheral logic facilitating spine surgery. To attain holistic and interdisciplinary healthcare, dominating institutional logics within healthcare-providing organisations need to allow peripheral institutional logics to attain a higher centrality for higher compatibility. Thus, allowing other occupations to take responsibility for quality and attain the feeling of professional pride. ORIGINALITY/VALUE: Interviewing spine surgeons, physiotherapists, nurses, managers and administrators allows us to deepen the understanding of micro-level behaviour as a reaction (or lack thereof) to macro-level decisions.

Light sensitive Belousov-Zhabotinsky medium accommodates multiple logic gates.

Computational functionality has been implemented successfully on chemical reactions in living systems. In the case of Belousov-Zhabotinsky (BZ) reaction, this was achieved by using collision-based techniques and by exploiting the light sensitivity of BZ. In order to unveil the computational capacity of the light sensitive BZ medium and the possibility to implement re-configurable logic, the design of multiple logic gates in a fixed BZ reservoir was investigated. The three basic logic gates (namely NOT, OR and AND) were studied to prove the Turing completeness of the architecture. Namely, all possible Boolean functions can be implemented as a combination of these logic gates. Nonetheless, a more complicated logic function was investigated, aiming to illustrate further capabilities of a fixed size BZ reservoir. The experiments executed within this study were implemented with a Cellular Automata (CA)-based model of the Oregonator equations that simulate excitation and wave propagation on a light sensitive BZ thin film. Given that conventional or von Neumann architecture computations is proved possible on the proposed configuration, the next step would be the realization of unconventional types of computation, such as neuromorphic and fuzzy computations, where the chemical substrate may prove more efficient than silicon.

Development of a Logic Model to Guide Implementation and Evaluation of a Mobile Integrated Health Transitional Care Program.

To provide medical and social services to underserved communities, many health care organizations across the United States have expanded the role of emergency medical services to include mobile integrated health and community paramedicine (MIH-CP). Although MIH-CP programs differ in structure and setting, many share the common goal of improving health through home-based, patient-centered care management models. Ideally, these innovative programs reduce use of health care services, including 911 (US emergency system) calls and emergency department visits. In 2018 a large, urban academic medical center partnered with the city's fire department to establish an MIH-CP program to support patients as they transition in their first 30 days at home after hospitalization. Prior to launch, a multidisciplinary team developed a logic model to guide development, implementation, and evaluation of this complex and innovative program. This paper describes the team's structured process for developing a logic model. It also describes key components of the initial logic model and the Transitional Health Support program structure, as well as subsequent revisions to both.

Boolean Logic Networks Mimicked with Chimeric Enzymes Activated/Inhibited by Several Input Signals.

Reactions catalyzed by artificial allosteric enzymes, chimeric proteins with fused biorecognition and catalytic units, were used to mimic multi-input Boolean logic systems. The catalytic parts of the systems were represented by pyrroloquinoline quinone-dependent glucose dehydrogenase (PQQ-GDH). Two biorecognition units, calmodulin or artificial peptide-clamp, were integrated into PQQ-GDH and locked it in the OFF or ON state respectively. The ligand-peptide binding cooperatively with Ca2+ cations to a calmodulin bioreceptor resulted in the enzyme activation, while another ligand-peptide bound to a clamp-receptor inhibited the enzyme. The enzyme activation and inhibition originated from peptide-induced allosteric transitions in the receptor units that propagated to the catalytic domain. While most of enzymes used to mimic Boolean logic gates operate with two inputs (substrate and co-substrate), the used chimeric enzymes were controlled by four inputs (glucose - substrate, dichlorophenolindophenol - electron acceptor/co-substrate, Ca2+ cations and a peptide - activating/inhibiting signals). The biocatalytic reactions controlled by four input signals were considered as logic networks composed of several concatenated logic gates. The developed approach allows potentially programming complex logic networks operating with various biomolecular inputs representing potential utility for different biomedical applications.

Scaling up perioperative medicine for older people undergoing surgery (POPS) services; use of a logic model approach.

Perioperative medicine for older people undergoing surgery (POPS) services are gaining traction, in acknowledgment of the poorer outcomes experienced by older surgical patients. In response to the NHS' growing focus on scaling innovation, a logic model of the POPS service at Guy's and St Thomas' NHS Foundation Trust was developed to articulate a founding centre's experience. The logic model was applied as a means of service evaluation and to guide implementation of a new POPS service at a district general trust. This is a novel study within the field of perioperative medicine for older people, interlinking implementation science theory to achieve meaningful clinical results and describe the lessons learnt during the process. Future work will include validation of this logic model to facilitate national POPS scale-up.

Not-XOR (NXOR) Logic Gate Realized with Enzyme-Catalyzed Reactions: Optical and Electrochemical Signal Transduction.

The studied enzyme-based biocatalytic system mimics NXOR Boolean logic gate, which is a logical operator that corresponds to equality in Boolean algebra. It gives the functional value true (1) if both functional arguments (input signals) have the same logical value (0,0 or 1,1), and false (0) if they are different (0,1 or 1,0). The output signal producing reaction is catalyzed by pyrroloquinoline quinone-dependent glucose dehydrogenase (PQQ-GDH), which is inhibited at acidic and basic pH values. Two other reactions catalyzed by esterase and urease produce acetic acid and ammonium hydroxide, respectively, shifting solution pH from the optimum pH for PQQ-GDH to acidic and basic values (1,0 and 0,1 input combinations, respectively), thus switching the enzyme activity off (output 0). When the input signals are not applied (0,0 combination) or both applied compensating each other (1,1 combination) the optimum pH is preserved, thus keeping PQQ-GDH running at the high rate (output 1). The biocatalytic cascade mimicking the NXOR gate was characterized optically and electrochemically. In the electrochemical experiments the PQQ-GDH enzyme communicated electronically with a conducting electrode support, thus resulting in the electrocatalytic current when signal combinations 0,0 and 1,1 were applied. The logic gate operation, when it was realized electrochemically, was also extended to the biomolecular release controlled by the gate. The release system included two electrodes, one performing the NXOR gate and another one activated for the release upon electrochemically stimulated alginate hydrogel dissolution. The studied system represents a general approach to the biocatalytic realization of the NXOR logic gate, which can be included in different catalytic cascades mimicking operation of concatenated gates in sophisticated logic circuitries.

Critical appraisal of the proposed defenses for planned home birth.

Two prominent proposed defenses have been offered of planned home birth. The first focuses on the very low absolute risk of planned home birth, which is considered to be safe because it is so low, irrespective of its significantly elevated relative risk. The second invokes an analogy between trial of labor after cesarean delivery and planned home birth. Because trial of labor after cesarean delivery and planned home birth have similar, very low absolute risks and because the former is an acceptable clinical practice, defenders of planned home birth argue that the latter should be considered acceptable. This article presents a critical appraisal of these 2 proposed defenses of planned home birth. Question 1: Are proposed defenses of planned home birth focused on its low absolute risks consistent with the commitment to patient safety? This commitment to patient safety requires the identification of variation in the processes of patient care and reduction of variation when reduction improves outcomes. Relative, as well as absolute, risks therefore must be identified. Compared with hospital midwives, planned home births have a significantly higher relative total neonatal mortality risk of 3.87 (1.26 vs 0.32 per 1000 births; P<.001) and a significantly higher relative risk of 5-minute Apgar score of zero of 18.11 (1.63 vs 0.0/1000 births; P<.001). Planned hospital birth prevents these risks. It follows that planned home birth as a variant in birth setting is not consistent with the commitment to patient safety. Question 2: Is the analogy to trial of labor after cesarean delivery consistent with the philosophic rules of analogic reasoning? The long-established philosophic rules for analogic reasoning require that the 2 cases that are compared are similar in all relevant respects and that all relevant analogies have been considered. The 2 cases are dissimilar because the perinatal risks of planned home births are approximately 3 times higher than trial of labor after cesarean delivery. At least 8 clinical analogies to other situations of very low absolute, but unacceptable, risks are ignored. The clinical implication of the results of this critical appraisal is that obstetricians should respond to expressions of interest in planned home birth based on these proposed defenses with a respectful explanation of the inadequacies, the failure to commit to patient safety, and a recommendation for planned hospital birth.

["Natural remedy" but without scientific evidence! Ethnography of the logics structuring the prescription of phyto-drugs by physicians in Burkina Faso]. / Des « remèdes naturels ¼ mais sans preuves scientifiques ! Ethnographie des logiques structurant la prescription des phyto-médicaments par les médecins au Burkina Faso.

INTRODUCTION: Since the 1970s, WHO has recommended the valorization of medicines derived from "traditional" medicine. In Burkina Faso, despite a political will to promote phyto-medications, their prescription by health professionals remains weak. The purpose of this article is to highlight the logics behind the prescribing practices of phyto-drugs by Burkinabe doctors. METHODS: Adopting a qualitative approach, this study was conducted in Ouagadougou with general practitioners and specialists. Data collected were from semi-directive individual interviews and direct observation. A total of 47 interviews were conducted at medical centers with a surgical unit (CMA) and university hospital centers (CHU). RESULTS: Our results show that phyto-drugs have not been included in the initial training of the doctors surveyed. The only sources of information for doctors are then from colleagues, family, patients or the media. Their perceptions of this type of medication are ambivalent, ranging from "natural products" to products at risk due to lack of studies. Prescribing practices are subject to four main rationales : personal and professional experiences, patient judgment, validation by clinical trials and consideration of iatrogenic risk. DISCUSSION: In the absence of a strong academic setting, knowledge of phyto-drugs has been acquired informally. As the standards and technical references remain weak, several subjective logics are essential in the construction of prescribing practices. CONCLUSION: Beyond the symbolic and subjective logics explaining the low prescription of phyto-medications, our study invites us to wonder about the place of political and institutional logics in the weak integration of traditional medicine into the Burkinabé healthcare system.

La enfermería como apertura a la interdisciplina / Nursing as an opening to interdisciplinarity / A enfermagem como abertura à interdisciplinar

Resumen Este artículo reexamina los conceptos interdisciplinario, complejo, el cuidado y enfermería. Lo que busca es argumentar que la noción de enfermería y el cuidado, como propiedad esencial de esta, siempre lleva a ser una interdisciplina. Se parte de la noción de holístico, que suele usarse como concepto contrario de específico en las intervenciones de enfermería, y que se relaciona con el objeto formal propio de esta: el cuidado. A partir de estos dos elementos se propone y defiende que el mejor término para describir su objeto es complejo, considerando la propuesta de Rolando García de sistema complejo, para defender a la enfermería como un todo complejo, incluso al compararla con los elementos teóricos (como los de la enfermería) y las evidencias empíricas de testimonios de la práctica de la enfermería. Por último, se muestra que la ética es un ejemplo de esa realidad compleja de la profesión del cuidar. Se concluye con una reflexión final.

Abstract This paper reexamines the concepts of interdisciplinary, complexity, care and nursing. The main target is to argue that the notion of nursing and care, as an essential property of this, always leads to the interdisciplinary approach. It is based on the holistic idea of care which is used as an opposite concept of specific nursing interventions, and which is related to the formal object of this: care. From these two elements, it is proposed and defended that the best term to describe its purpose is complex, considering Rolando Garcia's proposal of a complex system. To support nursing a complex whole, even when it's compared with theoretical elements (such as nursing elements) and the empirical evidence of the nursing practice. Finally, it is shown that ethics is an example of that complex reality of the caring profession. It concludes with a final reflection.

Resumo Este artigo reexamina os conceitos, interdisciplinar, complexo, o cuidado e enfermagem. O que ele procura é argumentar que a noção de enfermagem e o cuidado, como uma propriedade essencial dela, sempre leva a ser uma interdisciplina. A partir da noção de holístico, que é frequentemente usada como um conceito oposto de específico nas intervenções de enfermagem, e que está relacionado com o objeto formal próprio desta: o cuidado. A partir desses dois elementos, é proposto e defende que o melhor termo para descrever seu objeto é complexo, considerando a proposta de Rolando García de sistema complexo, para defender à enfermagem como um todo complexo, mesmo quando comparado com os elementos teóricos (como os da enfermagem) e as evidências empíricas de testemunhos da prática de enfermagem. Finalmente, é demonstrado que a ética é um exemplo dessa complexa realidade da profissão de cuidar. Conclui-se com uma reflexão final.