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Is data-driven analysis sufficient for understanding the COVID-19 pandemic and for justifying public health regulations? In this paper, we argue that such analysis is insufficient. Rather what is needed is the identification and implementation of over-arching hypothesis-related and/or theory-based rationales to conduct effective SARS-CoV2/COVID-19 (Corona) research. To that end, we analyse and compare several published recommendations for conceptual and methodological frameworks in medical research (e.g., public health, preventive medicine and health promotion) to current research approaches in medical Corona research. Although there were several efforts published in the literature to develop integrative conceptual frameworks before the COVID-19 pandemic, such as social ecology for public health issues and systems thinking in health care, only a few attempts to utilize these concepts can be found in medical Corona research. For this reason, we propose nested and integrative systemic modelling approaches to understand Corona pandemic and Corona pathology. We conclude that institutional efforts for knowledge integration and systemic thinking, but also for integrated science, are urgently needed to avoid or mitigate future pandemics and to resolve infection pathology.

The purposes of the present review are to examine the emergence of nutrigenetics/nutrigenomics, to analyze the relationship between nutrigenetics and nutrigenomics, to explore the impact of nutrigenetics/nutrigenomics on healthcare with respect to noncommunicable diseases, and to discuss the challenges facing the implementation of nutrigenetics/nutrigenomics within healthcare. Nutrigenetics/nutrigenomics is certainly a thriving specialty given the sharp increase of publications over the last two decades. The relationship between nutrigenetics and nutrigenomics is proposed as complementary. The current clinical and research literature supports the significant impact nutrigenetics/nutrigenomics has on treating and preventing noncommunicable diseases. Although several challenges face the implementation of nutrigenetics/nutrigenomics into healthcare, they are not insurmountable. Nutrigenetics/nutrigenomics plays an important role not only in treating diseases and illnesses but also in promoting health and wellness through both basic and clinical research; and it is critical for the future of both personalized nutrition and precision healthcare.

The year 2018 was the centennial of the naming of heparin by Emmett Holt and William Howell and the 102nd anniversary of Jay McLean's discovery of an anticoagulant heparphosphatide at Johns Hopkins Hospital in Baltimore. This article discusses recently discovered historical artifacts that shed new light on heparin's christening, including McLean's unpublished letter written in 1950 that represents one of the most complete accounts of heparin's discovery before his untimely death. In addition, the article describes the finding of a plaque dedicated to McLean and explores the circumstances of its removal from public display, as learned from interviews with present and former staff members.

For at least the past several decades, medicine has been embroiled in a crisis concerning the nature of its professionalism. The fundamental questions that drive this ongoing crisis are primarily three. First, what is the nature of medical professionalism? Second, who are medical professionals? Third, what does medicine or these professionals profess or promise? In this paper, the professionalism crisis vis-a-vis these questions is examined and analyzed chiefly in terms of both Francis Peabody’s and Edmund Pellegrino’s writings. Based on their writings, I introduce a conceptual framework for professionalism to address the crisis. In addition, I contend that to address the professionalism crisis adequately, medicine’s position within an evolving health care network must also be considered. To that end, I first discuss the genesis of the crisis in terms of the Flexner Report and especially Peabody’s response to it. Next, I explore how the crisis intensified during the twentieth century, particularly in terms of medicine’s ultimate scientification and eventual commercialization, and how Pellegrino reacted to this. I then propose a health care professionalism cycle and a care-competence cycle to provide a conceptual framework for addressing the crisis. I conclude that medicine’s position is no longer as the center of health care but rather as another node within a wider evolving health care network. And the resolution of medicine’s professionalism crisis depends on medicine’s positioning and defining itself in terms of the professionalism for each of the other professions within the health care network.

In this paper, an axiological analysis for the role of values in person-centered healthcare is undertaken from aesthetic, epistemic, and ethical perspectives, given the backdrop of a robust notion of personhood. To that end, personhood is first analyzed and conceptualized to provide a practical framework for situating the axiological analysis for the role of values, especially the value of human dignity, in healthcare. In terms of aesthetic values, beauty plays an essential role within person-centered healthcare, especially with respect to the value of wellbeing, and for providing a platform to analyze further both epistemic and ethical values in healthcare. With respect to epistemic values, truth - particularly in terms of the value of competence - plays a critical role in providing effective healthcare. In terms of ethical values, the good, especially with respect to the value of caring, plays a vital role in shaping how both clinicians and patients comport themselves in the clinical encounter. In a concluding section, the significance of the axiological analysis for the role of values in person-centered healthcare, in contrast to healthcare based on the biomedical model, is briefly discussed.

This review covers the current literature, since the completion of the Human Genome Project, on the cancer epigenome, including both cancer epigenetics and epigenomics. To that end, the transition from the human genome to the cancer genome is initially discussed, especially in terms of the hallmarks of cancer and its associated somatic mutation theory of cancer, along with the failure of this theory-based strictly on genetic mutations-to account for carcinogenesis and metastasis. The cancer epigenome (as well as both cancer epigenetics and epigenomics) is examined next, especially with respect to its role in tumorigenesis. The review’s main goal is to address what constitutes the cancer epigenome vis-a-vis the cancer genome and what the relationship is between them.

Over the past decade, a number of accounting and financial reporting frauds have led to lost stock wealth, destroyed public trust, and a worldwide recession that called for necessary reform. Regulatory responses and systemic reforms quickly followed, and we show that, while necessary, these reforms are insufficient. The purpose of this paper is to forward virtuous professionalism as a necessary path toward restoring financial reporting systems. We take the position of external observer and analyze the accounting profession over time to assess what has transpired within our financial reporting systems. Our analysis reveals that the combined influence of commercialism and regulatory response has led to a systemic decline in accounting’s professional ideals and, as a result, an erosion of public trust. We then propose virtuous professionalism as a necessary process for restoring financial reporting systems based on sociological, professional, and philosophical theories. We argue that virtuous professionalism is necessary for restoring the public servant identity of the accounting professional. We conclude that efforts to restore financial reporting systems should begin with reforms that restore professional identity shaped by virtues.

Robust clinical decision-making depends on valid reasoning and sound judgment and is essential for delivering quality healthcare. It is often susceptible, however, to a clinician’s biases such as towards a patient’s age, gender, race, or socioeconomic status. Gender bias in particular has a deleterious impact, which frequently results in cognitive myopia so that a clinician is unable to make an accurate diagnosis because of a patient’s gender—especially for female patients. Virtue epistemology provides a means for confronting gender bias in clinical decision-making and for correcting or even preventing its impact. The medical literature on cardiovascular and coronary heart disease is used to illustrate the role intellectual virtues can play in redressing the deleterious impact of gender bias on clinical decision-making and practice. Finally, questions are considered surrounding the pedagogy of intellectual virtues for medical students and practicing clinicians in order to provide quality care for patients, regardless of gender.

Rationale, aims and objectives Challenging clinical encounters can often be frustrating and demoralizing not only for clinicians but also for patients. The paper's aims are twofold. The first is to analyse the nature and origins of such encounters. The second is to appraise the CALMER and REBELS models for managing them. Methods After reviewing the medical literature on challenging clinical encounters, a clinical case is briefly reconstructed from it. The reconstructed case is then used to analyse the nature and origins of challenging encounters and to evaluate the two models for handling them. Results The reconstructed clinical case is an apt example for examining and evaluating the medical literature on challenging clinical encounters. In terms of what challenging encounters are and what elicits them, the literature captures their frustrating, demoralizing, demanding and, at times, insufferable dimensions – as well as the role of patients in their origins – as the clinical case also illustrates. With respect to managing them, the CALMER and REBELS models are effective strategies for handling challenging encounters – again, as the clinical case exemplifies. Conclusions Although the clinical case supports the medical literature on challenging clinical encounters, the literature fails to provide an adequate account of their nature and origins. Specifically, challenging encounters are a type of dysfunction – not pathophysiological but existential – in a clinical setting, with their origins not only in patients but also in clinicians and health care systems. Finally, based upon the dysfunctional nature of such encounters, revisions of the CALMER and REBELS models are proposed for better managing these encounters.

Rationale, aims and objectives Multimorbidity is a serious challenge to providing patients with quality health care. Sturmberg et al. propose a P4 or whole-person medical model based on a holistic approach to deliver such care. The aim of this commentary is to examine critically their P4 model and holistic approach. Methods The P4 model and holistic approach of Sturmberg et al. are analysed conceptually in terms of an effective strategy or sequence for framing P4 medicine and with respect to different philosophical notions of holism for grounding it. Results Instead of a P4 medicine strategy or sequence that emphasizes the predictive and preventive aspects of health care from a biomedical perspective, as Sturmberg et al. do, a more effective strategy or sequence for framing P4 medicine to deliver quality health care is to accentuate the personalized and participatory aspects from a humanistic perspective. The basis of this proposed strategy for P4 medicine is not a technoscientific holism that emphasizes mechanisms to define the whole utilizing bottom-up causation, as Sturmberg et al. ground their biomedical P4 model, but rather a phenomenological holism that also incorporates the person's illness experience and top-down causation. Conclusions The proposal of Sturmberg et al. to treat patient multimorbidity through P4 medicine and a holistic approach is certainly a move in the right direction. However, to achieve their goal requires an alternative strategy for P4 medicine and a more robust notion of holism.

Jonathan Fuller, in a recent CMAJ article,[1][1] examines the transition from an “old” biomedical model to a “new” one, as well as the challenges that have emerged with the new model. Indeed, one of the more pressing challenges that he identifies is the fragmentation of clinical care. And

In this chapter, I survey the literature concerning selected metaphysical, epistemological, and ethical issues surrounding the intersection of spirituality and religion with medicine. The metaphysical issues concern what constitutes spirituality and its distinction from religion, especially with respect to medical research and practice; the nature of the causal relationship, particularly in mechanistic terms, between spirituality and clinical outcomes; and, the presuppositions animating clinical studies. The epistemological issues pertain to empirical evidence from clinical trials. The main issue is whether the evidence from these trials justifies an impact of spirituality and religion on health and clinical outcomes. The ethical issues involve how best to incorporate spirituality and religion into clinical practice, if they should be incorporated at all. Finally, the fundamental philosophical issue addressed in this chapter is whether the intersection of spirituality and religion with medicine has led to a humanized medicine that achieves medicine’s primary goal of relieving or reducing human suffering associated with illness.

Information technology literacy is a broad, many-dimensional description of the skills and knowledge needed for effective participation in business and education in the twenty-first century. First considered to be generic, those capabilities are now understood to be contextual, social, determined by the specific situation, be it workplace, academic, or social. This becomes clear when the term is compared to information literacy (knowing when information is needed, search strategy development, accessing and managing the information, and using it legally and ethically to meet the need). Information literacy (IL) is extensively explored and discussed in a vast literature. There remains considerable disagreement about what it is and how it should be taught and assessed; yet IL is relatively simple compared to the less developed concept of IT literacy. Information technology literacy involves using the tools of information technology (hardware, software, networks) as well as the data and information (as with IL), as well as working in a specific context (which might be professional, social, industrial, or academic). Workplace, social, behavioral, and cognitive issues become, therefore, part of the complexities in play. Furthermore, complexity accelerates as new media, new communication technologies, and new collaborative capabilities combine to create a dynamic information universe of participation and interactivity. This emergent reality changes the way people learn and the very nature of knowledge. Librarianship, scholarship, research, business, and the professions are all being reformulated in the process of adapting to these new conditions. Information technology (IT) literacy provides a useful concept for tracing, exploring, and better understanding this world-changing phenomenon

Rationale and aim Clinical reasoning is an important component for providing quality medical care. The aim of the present paper is to develop a model of clinical reasoning that integrates both the non-analytic and analytic processes of cognition, along with metacognition. Method The dual-process theory of cognition (system 1 non-analytic and system 2 analytic processes) and the metacognition theory are used to develop an integrated model of clinical reasoning. Results In the proposed model, clinical reasoning begins with system 1 processes in which the clinician assesses a patient's presenting symptoms, as well as other clinical evidence, to arrive at a differential diagnosis. Additional clinical evidence, if necessary, is acquired and analysed utilizing system 2 processes to assess the differential diagnosis, until a clinical decision is made diagnosing the patient's illness and then how best to proceed therapeutically. Importantly, the outcome of these processes feeds back, in terms of metacognition's monitoring function, either to reinforce or to alter cognitive processes, which, in turn, enhances synergistically the clinician's ability to reason quickly and accurately in future consultations. Conclusions The proposed integrated model has distinct advantages over other models proposed in the literature for explicating clinical reasoning. Moreover, it has important implications for addressing the paradoxical relationship between experience and expertise, as well as for designing a curriculum to teach clinical reasoning skills.

In A Life-Centered Approach to Bioethics, Lawrence Johnson extends the discussion he began in A Morally Deep World (1991), except now the focus is on bioethics—or what he calls biocentric ethics (BCE)—rather than on environmental ethics. Johnson makes what he considers a non-trivial distinction between anthropocentric bioethics, which places humans at the heart of bioethical discussion and which he claims represents the common approach of most bioethicists, and BCE, which places life, of all organisms, at the core of bioethical deliberation. The distinction is non-trivial because BCE does not isolate or individuate humans from one another or from their environment but interconnects and integrates them in both social and ecological terms. Briefly, Johnson predicates BCE upon a foundation composed of the following notions: life as process, health as maintaining life processes, and the moral significance of living organisms proportional to their interest in continuing their life processes. After a brief introductory chapter that examines the nature of bioethics and the issue of moral skepticism and canvasses BCE’s major themes, Johnson provides the reader—in four chapters—with the background material required for analyzing conventional bioethical issues, such as euthanasia, abortion, genetic engineering, and reproductive cloning, among others, from a BCE perspective. In chapter 2, he discusses the traditional notion of self in terms of the rational, which he claims is often responsible for the confusion emanating from bioethical pronouncements. Rather than a hierarchical approach to the self with reason at the pinnacle, he advocates a systems approach consisting of complex interactions and relationships that include even the spiritual or transcendental. BCE’s underlying approach is thus holistic in contrast to the traditional biomedical assumption of reductionism, which is key to contemporary bioethics’s emphasis on autonomy. In the next chapter, he reviews the two dominant post-Enlightenment approaches to ethics: utilitarianism

The evolution of models for current medical knowledge and practice, with respect to their philosophical dimensions, is expounded upon herein—especially in terms of a shift away from viewing the patient as just a diseased entity or body part to a whole person. To that end, the metaphysical, epistemological, and ethical dimensions of the techno-scientific model, and its humanistic versions, and of holistic models are examined. The metaphysics of each model is first analyzed with respect to its presuppositions, since these presuppositions influence the entities, such as body and disease, which compose a medical model or worldview. Next, epistemological issues that face these medical models, particularly those driven by methodological procedures undertaken by epistemic agents to constitute medical knowledge and practice, are discussed. Finally, the ethical implications of each model, especially in terms of the physician–patient relationship, are investigated. The advantages and disadvantages of these different models for medical knowledge and practice as they evolve, particularly in terms of envisaging the patient as more than simply a diseased object or body part, are discussed in a concluding section.

Rationale Virtues are an important component in the practice of clinical medicine. Prudence or wisdom and charity or love are often viewed as crucial for virtuous practice. Generally, the two virtues are discussed separately, with no connection between them; however, a synergy exists between the two virtues as a compound virtue of prudent love in which the properties of the compound virtue transcend those of the individual virtues. Aims and objectives To examine the nature of prudent love and to discuss its role in the practice of clinical medicine. Methods Philosophical and conceptual analyses. Results Prudent love exhibits properties, which are the result of a synergistic interaction between the two individual virtues. Succinctly, prudent love synergism is an outcome of a particular structural relationship between the two virtues in which motivational love prompts the prudent clinician to acquire and utilize clinical competence, which then allows the loving clinician to take care of an individual patient's health care needs. In turn, the virtuous clinician's ability to meet those needs successfully feedbacks onto the motivation to satisfy them initially, thereby encouraging and enhancing the clinician to fulfil them even more prudently and lovingly, not only for the individual patient but also for other patients. Conclusions The compound virtue of prudent love provides a comprehensive approach to practising medicine that meets not only the needs of patients but also fulfils the physician's sense as healer. Although challenges face teaching virtues in the medical curriculum, strategies are available for incorporating training in virtues into the curriculum.

Medicine often defines progress in terms of medical cures; however, such cures are rare. At best, medical progress generally consists of managing patients more efficiently or competently, especially in terms of relieving their symptoms. Today, medicine stands on the edge of curing a number of diseases. However, before achieving such cures, biomedical scientists need to understand in finer detail the mechanisms of physiological and pathological processes, especially from a systems perspective, and students of biomedical studies need to understand more precisely what a medical cure is conceptually or philosophically. This article utilizes type-1 diabetes to explore the issues surrounding medical progress with respect to defining medical cure, especially in terms of distinguishing it from managing a patient's illness.

Evidence-based practice and person-centered healthcare are often seen as opposing approaches to clinical practice. And yet both offer advantages to providing quality healthcare. In this paper, both approaches to clinical practice are analyzed and mapped philosophically by comparing and contrasting their key foundational principles. The goal is to progress the dialogue between them in order to determine whether a common ground exists in which they might be integrated and how best to operationalize, both clinically and pedagogically, an integrated approach. To that end, key principles undergirding them are enumerated and then integrated by shifting the focus from evidence to the person - whether patient or clinician - for the delivery of quality healthcare. In this way, person-centered healthcare provides the optimal starting point for framing evidence-based practice. Next, operationalizing the integrated approach to clinical practice and medical education is addressed. Finally, the root of modern healthcare must be a person’s, whether patient’s or clinician’s, dignity. For the goal of healthcare is to relieve suffering associated with illness, whether that involves curing a disease or not and not adding to the suffering associated with illness.

In this article, I introduce the notion of horizon for scientific practice (HSP), representing limits or boundaries within which scientists ply their trade, to facilitate analysis of scientific discovery and progress. The notion includes not only constraints that delimit scientific practice, e.g. of bringing experimentation to a temporary conclusion, but also possibilities that open up scientific practice to additional scientific discovery and to further scientific progress. Importantly, it represents scientific practice as a dynamic and developmental integration of activities to investigate and analyze the natural world. I use the discovery of the clotting factor, thrombin, and the experiments conducted by the Johns Hopkins physiologist, William Howell, on the enzymatic nature of thrombin to illustrate the notion of HSP. In a concluding section, I compare the notion of HSP to other notions for scientific practice proposed in the history and philosophy of science literature.

There is growing concern that a variety of factors threaten the sustainability of academic libraries: developing and preserving print and digital collections, supplying and supporting rapidly changing technological and networking infrastructure, providing free services, maintaining growing costs of library buildings, and lowering libraries’ ecological footprint. This paper discusses the multidimensional issues of sustainability in academic libraries and identifies needs for designing an integrated framework for sustainable strategies in academic libraries. Additionally, the paper presents a synthesis of existing literature on the increasingly popular topic of “green libraries” and prepares a background toward developing a framework for sustainable strategies in academic libraries.

In the seventeenth century, Newton published his famous experimentum crucis, in which he claimed that light is heterogeneous and is composed of rays with different refrangibilities. Experiments, especially the crucial experiment, were important for justifying Newton’s theory of light, and eventually his theory of color. A century later, Goethe conducted a series of experiments on the nature of color, especially in contradistinction to Newton, and he defended his research with a methodological principle formulated in “Der Versuch als Vermittler.” Goethe’s principle included two elements: a series of experiments and resultant higher empirical evidence, which functioned as mediator between the objective (a natural phenomenon) and the subjective (a theory or hypothesis). Although the notion of experimentum crucis became popular among scientists for reconstructing experimental research and for justifying theories, especially for rhetorical purposes, Newton’s justification of his theory of light and color is best reconstructed in terms of Goethe’s methodological principle. Finally, Goethe’s principle has important consequences for the contemporary philosophical underdetermination thesis.

This is the first of a series of columns on the emerging new role of the academic library as a center for learning—but learning in a new sense, with a new focus on what the student actually actively incorporates rather than on teaching method. The new perspective is captured in the concept of student-centered or inquiry-based learning, with special emphasis on reading and better utilization of the extensive print resources carefully collected by academic libraries over the decades.

Purpose – The purpose of this paper is to suggest approaches for nurturing the kinds of new thinking and new mental models among library staff that will support the development of more sustainable libraries.Design/methodology/approach – The paper discusses several key components – and problems – to adapting systems for greater sustainability in libraries.Findings – Human behavior patterns are entrenched and grounded in perceptions and expectations about the world that often are unconscious.Originality/value – Suggestions for replacing assumptions of growth with ideas of sustainability and learning are offered.

PurposeTo begin making the library sustainable requires a vision of what will be created and a description of the outcome of the process. This paper aims to address the issueDesign/methodology/approachThe paper provides a viewpoint on developing the sustainable library.FindingsLibraries have important roles to play in the unfolding internet saga, from preserving and organizing knowledge to accelerating and designing learning environments. Achieving sustainability is the new imperative, but the process is difficult, not easy. New mindsets, new strategies of collaboration and networking, widespread professional and staff engagement, and measuring and managing progress are all challenges to be met.Practical implicationsIn these troubled times clear vision and purpose are needed to maintain stakeholder support. Sustainability provides a model for designing appropriate vision, facilities, and services toward that end.Originality/valueThe complexities of designing sustainable libraries requires ongoing discussion and exploration. This paper adds insight to the debate.