Ethical challenges in nephrology : a call for action

The American Society of Nephrology, the European Renal Association-European Dialysis and Transplant Association and the International Society of Nephrology Joint Working Group on Ethical Issues in Nephrology have identified ten broad areas of ethical concern as priority challenges that require collaborative action. Here, we describe these challenges - equity in access to kidney failure care, avoiding futile dialysis, reducing dialysis costs, shared decision-making in kidney failure care, living donor risk evaluation and decision-making, priority setting in kidney disease prevention and care, the ethical implications of genetic kidney diseases, responsible advocacy for kidney health and management of conflicts of interest - with the aim of highlighting the need for ethical analysis of specific issues, as well as for the development of tools and training to support clinicians who treat patients with kidney disease in practising ethically and contributing to ethical policy-making. Here, the ASN-ERA-EDTA-ISN Joint Working Group on Ethical Issues in Nephrology highlights ten areas of ethical concern as priority challenges that require collaborative action and discusses the need for development of ethical training and guidance tools to manage these issues

The host response to the probiotic Escherichia coli strain Nissle 1917: Specific up-regulation of the proinflammatory chemokine MCP-1

BACKGROUND: The use of live microorganisms to influence positively the course of intestinal disorders such as infectious diarrhea or chronic inflammatory conditions has recently gained increasing interest as a therapeutic alternative. In vitro and in vivo investigations have demonstrated that probiotic-host eukaryotic cell interactions evoke a large number of responses potentially responsible for the effects of probiotics. The aim of this study was to improve our understanding of the E. coli Nissle 1917-host interaction by analyzing the gene expression pattern initiated by this probiotic in human intestinal epithelial cells. METHODS: Gene expression profiles of Caco-2 cells treated with E. coli Nissle 1917 were analyzed with microarrays. A second human intestinal cell line and also pieces of small intestine from BALB/c mice were used to confirm regulatory data of selected genes by real-time RT-PCR and cytometric bead array (CBA) to detect secretion of corresponding proteins. RESULTS: Whole genome expression analysis revealed 126 genes specifically regulated after treatment of confluent Caco-2 cells with E. coli Nissle 1917. Among others, expression of genes encoding the proinflammatory molecules monocyte chemoattractant protein-1 ligand 2 (MCP-1), macrophage inflammatory protein-2 alpha (MIP-2α) and macrophage inflammatory protein-2 beta (MIP-2β) was increased up to 10 fold. Caco-2 cells cocultured with E. coli Nissle 1917 also secreted high amounts of MCP-1 protein. Elevated levels of MCP-1 and MIP-2α mRNA could be confirmed with Lovo cells. MCP-1 gene expression was also up-regulated in mouse intestinal tissue. CONCLUSION: Thus, probiotic E. coli Nissle 1917 specifically upregulates expression of proinflammatory genes and proteins in human and mouse intestinal epithelial cells

Authority, Autonomy and Automation: The Irreducibility of Pedagogy to Information Transactions

"This paper draws attention to the tendency of a range of technologies to reduce pedagogical interactions to a series of datafied transactions of information. This is problematic because such transactions are always by definition reducible to finite possibilities. As the ability to gather and analyse data becomes increasingly fine-grained, the threat that these datafied approaches over-determine the pedagogical space increases. Drawing on the work of Hegel, as interpreted by 20th century French radical philosopher Alexandre Kojève, this paper develops a model of relational pedagogy which highlights three points of incompatibility with a datafied learning environment reduced to finite measures. Firstly: Kojève’s accont of authority in Hegel posits two aspects to the mimetic relation between teacher and student: recognition and realisation, which belong to the ipseity or about-self-ness of the subject, and are incompatible with a general definition of data. Secondly, the Hegelian approach to human historical time, in particular the assertion that time and desire are begun in the future, not the past, renders it incompatible with mathematical time as used in data processing. Finally, from these it is possible to derive a distinctive notion of the work of pedagogy, grounded in Kojève’s realist reading of Hegel, irreducible to information processing. In consequence of this threefold irreducibility, the paper draws attention to a need for relations of human pedagogical work to be inherent in the design of educational technologies and highlights the dangers of presuming a machine intelligence model in the design of learning environments.

Countering Countermeasures: Detecting Identity Lies by Detecting Conscious Breakthrough

One major drawback of deception detection is its vulnerability to countermeasures, whereby participants wilfully modulate their physiological or neurophysiological response to critical guilt-determining stimuli. One reason for this vulnerability is that stimuli are usually presented slowly. This allows enough time to consciously apply countermeasures, once the role of stimuli is determined. However, by increasing presentation speed, stimuli can be placed on the fringe of awareness, rendering it hard to perceive those that have not been previously identified, hindering the possibility to employ countermeasures. We tested an identity deception detector by presenting first names in Rapid Serial Visual Presentation and instructing participants to lie about their own identity. We also instructed participants to apply a series of countermeasures. The method proved resilient, remaining effective at detecting deception under all countermeasures