Personalized health care: from theory to practice

The practice of medicine stands at the threshold of a transformation from its current focus on the treatment of disease events to an emphasis on enhancing health, preventing disease and personalizing care to meet each individual's specific health needs. Personalized health care is a new and strategic approach that is driven by personalized health planning empowered by personalized medicine tools, which are facilitated by advances in science and technology. These tools improve the capability to predict health risks, to determine and quantify the dynamics of disease development, and to target therapeutic approaches to the needs of the individual. Personalized health care can be implemented today using currently available technologies and know-how and thereby provide a market for the rational introduction of new personalized medicine tools. The need for early adoption of personalized health care stems from the necessity to reduce the egregious and wasteful burden of preventable chronic diseases, which is not effectively addressed by our current approach to care.     

Telomeres and cancer: from crisis to stability to crisis to stability

Telomere attrition unleashes genomic instability, promoting cancer development. Once established, however, the malignant clone often re-establishes genomic stability through overexpression of telomerase. In two papers, one in this issue of Cell and one in the subsequent issue, DePinho and colleagues explore the consequences of telomerase re-expression and its validity as a therapeutic target in mouse models of cancer.     

The return of the Inseminator: Eutelegenesis in past and contemporary reproductive ethics

Eugenicists in the 1930s and 1940s emphasised our moral responsibilities to future generations and the importance of positively selecting traits that would benefit humanity. In 1935 Herbert Brewer recommended 'Eutelegenesis' (artificial insemination with sperm from specially selected males) so that that future generations are not only protected from hereditary disease but also become more intelligent and fraternal than us. The development of these techniques for human use and animal husbandry was the catalyst for the cross fertilization of moral ideas and the development of a critical procreative morality. While eugenicists argued for a new critical morality, religious critics argued against artificial insemination because of its potential to damage important moral institutions. The tension between critical and conservative procreative morality is a feature of the contemporary debates about reproductive technologies. This and some of the other aspects of the early and contemporary debates about artificial insemination and reproductive technologies are discussed in this article.     

The ecosystem approach to environmental assessment: moving from theory to practice

The ecosystem approach to environmental management is viewed by many as being fundamental to the development of appropriate management strategies. While this approach represents a major advance in the way researchers view environmental assessment, the approach in itself does not provide practical information as to what questions to ask and what tools to use in assessing and managing ecosystems. Similarly, the concept of ecosystem health, as it is usually defined, has little practical value for ecosystem managers. We suggest the next stage in environmental assessment will be the development of specific frameworks designed to assess individual ecosystems. Of primary importance is the need to consider the basic structure and function of the ecosystem itself. Such consideration, together with explicit identification of anthropogenic stresses particular to the system, serves to identify those components most at risk and those issues most deserving of attention. Researchers should explore critical linkages between environmental stressors and their observable, measurable and predictable effects on ecological parameters and use this understanding to develop a management strategy that incorporates appropriate ecological indicators. The importance of these considerations will be illustrated using examples from the Northern River Basins Study.     

Automatic classification and robust identification of vestibulo-ocular reflex responses: from theory to practice

The Vestibulo-Ocular Reflex (VOR) stabilizes images of the world on our retinae when our head moves. Basic daily activities are thus impaired if this reflex malfunctions. During the past few decades, scientists have modeled and identified this system mathematically to diagnose and treat VOR deficits. However, traditional methods do not analyze VOR data comprehensively because they disregard the switching nature of nystagmus; this can bias estimates of VOR dynamics. Here we propose, for the first time, an automated tool to analyze entire VOR responses (slow and fast phases), without a priori classification of nystagmus segments. We have developed GNL-HybELS (Generalized NonLinear Hybrid Extended Least Squares), an algorithmic tool to simultaneously classify and identify the responses of a multi-mode nonlinear system with delay, such as the horizontal VOR and its alternating slow and fast phases. This algorithm combines the procedures of Generalized Principle Component Analysis (GPCA) for classification, and Hybrid Extended Least Squares (HybELS) for identification, by minimizing a cost function in an optimization framework. It is validated here on clean and noisy VOR simulations and then applied to clinical VOR tests on controls and patients. Prediction errors were less than 1 deg for simulations and ranged from .69 deg to 2.1 deg for the clinical data. Nonlinearities, asymmetries, and dynamic parameters were detected in normal and patient data, in both fast and slow phases of the response. This objective approach to VOR analysis now allows the design of more complex protocols for the testing of oculomotor and other hybrid systems.     

Ecology and ethics: relation of religious belief to ecological practice in the Biblical tradition

The Bible, without which Western civilization is inexplicable, has powerful ecological teachings that support an ecological worldview. While these teachings are not widely practised in our time. continuing degradation of ecological systems by humanity requires their re-examination by ecologists and the church. Such re-examination can help develop the mutual understanding necessary for making ethical ecological judgements and putting these teachings into practice in an appropriate manner. Among these teachings are the expectation that people will serve and keep the Creation (earthkeeping principle), that creatures and ecosystems not be relentlessly pressed (sabbath principle), that provisions must be made for the flourishing of the biosphere (fruitfulness principle), that the Earth be filled with biologically diverse and abundant life (fulfilment principle), that pressing the biosphere's absolute limits must be avoided (buffer principle), that people should seek contentment and not selfish gain (contentment principle), that people should seek biospheric integrity rather than self-interest (priority principle) and that people should not fail to act on what they know is right (praxis principle). Ecologists need to recognize and respect these and other biblical ecological teachings and be ready to assist churches in their care and keeping of Creation. And churches must join ecologists in the work of assuring the continued integrity of the biosphere.     

The contemporary refugee crisis: an overview of mental health challenges

There has been an unprecedented upsurge in the number of refugees worldwide, the majority being located in low‐income countries with limited resources in mental health care. This paper considers contemporary issues in the refugee mental health field, including developments in research, conceptual models, social and psychological interventions, and policy. Prevalence data yielded by cross‐sectional epidemiological studies do not allow a clear distinction to be made between situational forms of distress and frank mental disorder, a shortcoming that may be addressed by longitudinal studies. An evolving ecological model of research focuses on the dynamic inter‐relationship of past traumatic experiences, ongoing daily stressors and the background disruptions of core psychosocial systems, the scope extending beyond the individual to the conjugal couple and the family. Although brief, structured psychotherapies administered by lay counsellors have been shown to be effective in the short term for a range of traumatic stress responses, questions remain whether these interventions can be sustained in low‐resource settings and whether they meet the needs of complex cases. In the ideal circumstance, a comprehensive array of programs should be provided, including social and psychotherapeutic interventions, generic mental health services, rehabilitation, and special programs for vulnerable groups. Sustainability of services, ensuring best practice, evidence‐based approaches, and promoting equity of access must remain the goals of future developments, a daunting challenge given that most refugees reside in settings where skills and resources in mental health care are in shortest supply.     

Torture by Cieng: ethical theory meets social practice among the Dinka Agaar of south Sudan

Here I detail violence in South Sudan by first discussing a specific Dinka Agaar practice alongside existing discourses on the social aspects of violence and universal human rights, then I show how these acts had meaning and purpose using data from personal accounts of violence. I posit that the violence described was consistent with Dinka Agaar concepts of justice and basic human rights and that it cannot be judged against any universal human rights standard, devoid of local context or of an overarching metanarrative. These events highlight conflicting subjectivities, ethical norms, and the painful difficulties inherent to advocacy in areas of conflict. Viewed from the perspective of the larger social unit, it is easy to see how violence was required to end violence. However, witnessing punitive violence purposefully enacted on innocent individuals to achieve peace has the potential to create conflicting positions that modern anthropological discourse cannot reconcile.     

Critical bioethics: beyond the social science critique of applied ethics

This article attempts to show a way in which social science research can contribute in a meaningful and equitable way to philosophical bioethics. It builds on the social science critique of bioethics present in the work of authors such as Renee Fox, Barry Hoffmaster and Charles Bosk, proposing the characteristics of a critical bioethics that would take social science seriously. The social science critique claims that traditional philosophical bioethics gives a dominant role to idealised, rational thought, and tends to exclude social and cultural factors, relegating them to the status of irrelevancies. Another problem is they way in which bioethics assumes social reality divides down the same lines/categories as philosophical theories. Critical bioethics requires bioethicists to root their enquiries in empirical research, to challenge theories using evidence, to be reflexive and to be sceptical about the claims of other bioethicists, scientists and clinicians. The aim is to produce a rigorous normative analysis of lived moral experience.