US scientists have discovered that appyling a magnetic field to a particular place on the scalp can alter people’s moral judgement by interfering with activity in the right temporo-parietal junction (TPJ) of the brain. They said their finding helps us better understand how the brain constructs morality.You can read about the study, led by researchers from the Massachusetts Institute of Technology (MIT), in Cambridge, Massachusetts, in the 29 March online issue of the Proceedings of the National Academy of Sciences, PNAS. The research was led by Dr Rebecca Saxe, assistant professor of brain and cognitive sciences at MIT.Lead author Dr Liane Young, a postdoctoral associate in Saxe’s department, told the media that because people are normally very confident and consistent in making moral judgements, it comes as surprise to learn that their ability to do so can altered like this.

“You think of morality as being a really high-level behavior. To be able to apply (a magnetic field) to a specific brain region and change people’s moral judgments is really astonishing,” said Young in a statement.

She said the study reveals “striking evidence” that the right TPJ, which sits on the surface of the brain, above and behind the right ear, plays a crucial role in making moral judgements.When we make moral judgements about other people we often need to infer their intentions. For instance, when a hunter on a hunting trip shoots a fellow hunter, did he mistake his colleague for prey, or was he secretly jealous?This ability has been termed “theory of mind”, that is the ability to attribute mental states such as beliefs, intentions, and other qualities to oneself and others, and also to understand that other people’s mental states can be different to one’s own.

Ten years ago Saxe identified that the TPJ played a role in theory of mind and wrote about it in her PhD thesis in 2003. Since then she has been using functional magnetic resonance imaging (fMRI) to show that the right TPJ is active when people are asked to make moral judgements that require them to think about the intentions of others.Other studies have also shown that the TPJ is highly active when we think about other people’s intentions, their beliefs and their thoughts.
For this study, Saxe, Young and colleagues wanted to investigate what might happen if they could actually disrupt activity in the right TPJ.
In this case, instead of the usual fMRI, they did two sets of experiments where they used a non-invasive method called transcranial magnetic stimulation (TMS) to apply a magnetic field to a small area of the skull (on the scalp) to create weak electric currents that stop nearby brain cells from firing normally for a while.
They found that this was enough to impair subjects’ ability to make moral judgments that involve an understanding of other people’s intentions: as in for example, a failed murder attempt.In the first set of “offline stimulation” experiments, they exposed volunteers to the TMS method for 25 minutes and then asked them to take a test where they read about several scenarios and then had to judge the actions of the characters portrayed on a scale of one to seven (from “absolutely forbidden” to “absolutely permissible”).For example, for one scenario they were asked to judge how permissible would it be for a man to allow his girlfriend to walk across a bridge he knew to be unsafe, even if she does eventually cross it safely. In such a scenario, judging the man solely on the outcome would hold him blameless, even though he apparently intended harm.

In the second set of “online stimulation” experiments, the volunteers underwent a 500-millisecond burst of TMS at the point when they were asked to make a moral judgement.In both experiments, Saxe, Young and colleagues found that disrupting the right TPJ resulted in volunteers being more likely to judge failed attempts to harm as morally permissible.

They suggested this was because they were relying more on information about the outcome than inference on intention, since the process that normally helped them get information on intention was disrupted by the electrical current from the TMS.

“It doesn’t completely reverse people’s moral judgments, it just biases them,” explained Saxe.

The researchers also found that when they applied TMS to a brain region near the right TPJ , the volunteers’ judgments were nearly identical to those of volunteers who received no TMS at all.

They concluded that:

“Relative to TMS to a control site, TMS to the RTPJ caused participants to judge attempted harms as less morally forbidden and more morally permissible. Thus, interfering with activity in the RTPJ disrupts the capacity to use mental states in moral judgment, especially in the case of attempted harms.”

When we judge other people, understanding their intentions is just one aspect of what we take into account. We also assess things like their previous record, what we understand about their desires, and what constraints they might be under. We are also guided by our own ideas about loyalty, fairness and integrity, said Saxe.
Moral judgement is not a single process, even though it might feel like it, explained Saxe, who described it as more a mixture of “competing and conflicting judgments, all of which get jumbled into what we call moral judgment”.Dr Walter Sinnott-Armstrong, professor of philosophy at Duke University, who was not involved in this research, said that by going beyond fMRI, the study marks a major step forward for the field of moral neuroscience:

“Recent fMRI studies of moral judgment find fascinating correlations, but Young et al usher in a new era by moving beyond correlation to causation,” said Sinnott-Armstrong.

The National Center for Research Resources, the MIND Institute, the Athinoula A. Martinos Center for Biomedical Imaging, the Simons Foundation and the David and Lucille Packard Foundation funded the study.

“Disruption of the right temporoparietal junction with transcranial magnetic stimulation reduces the role of beliefs in moral judgments.”
Liane Young, Joan Albert Camprodon, Marc Hauser, Alvaro Pascual-Leone, and Rebecca Saxe
PNAS, published online ahead of print 29 March 2010
DOI:10.1073/pnas.0914826107

Sources: MIT, Wikipedia.

Written by: Catharine Paddock, PhD
Copyright: Medical News Today

A new study from researchers at the UK Medical Research Council and the Harvard School of Public Health (HSPH) projects that the severity of the H1N1 flu during the autumn-winter flu season in the U.S. will likely be less than previously feared. The estimates of hospitalizations and life-threatening events in the study are the most accurate to date of the H1N1 pandemic’s impact in the U.S. The study appears online on December 7, 2009 in the journal PLoS Medicine.

“As more detailed data have become available, we have been able to improve our estimates of how severe this disease is. Early on, it was difficult to measure the flu’s impact and it was crucial to plan for the full range of possible outcomes. Fortunately, the virus now appears to be near the milder end,” said Marc Lipsitch, professor of epidemiology at HSPH and the study’s senior author. Lipsitch heads the Center for Communicable Disease Dynamics at HSPH, which focuses on mathematical modeling and analysis of data on pandemic influenza, drug resistant infections, seasonal infectious diseases, and intervention allocation. The Center is funded through the National Institutes of Health’s Models of Infectious Disease Agent Study (MIDAS), which is aiming to increase capacity to model disease spread, evaluate different intervention strategies, and help inform public health officials and policymakers.

While the news is better than was thought at the start of the pandemic, Lipsitch emphasizes that it remains important to continue to vaccinate against pandemic H1N1 and to remain vigilant about disease in groups at risk of complications. “This is a serious disease,” said Lipsitch. “The U.S. Centers for Disease Control (CDC) and others have shown that certain high-risk groups, including pregnant women, people with asthma, and people with compromised immune systems, should be vaccinated and should seek prompt treatment if they suspect they are sick with H1N1. Even for people outside these high-risk groups, vaccination is an important way to reduce the risk of what can be a serious illness.”

Estimates of the H1N1 flu’s severity are important because they help public health officials plan for the types of interventions that are needed to treat symptoms, including life-threatening respiratory situations, and help officials project the possible burden on the health care system.

“Providing unbiased estimates to gauge the severity of the flu pandemic is crucial in order for local health services to be able to plan their resources properly and deliver the best level of care possible. Our study was careful to account for uncertainty in the evidence and analyze the different ways severity of the illness is being measured,” said first author Anne Presanis of the Medical Research Council Biostatistics Unit in Cambridge, UK.

Up until this point, the severity of H1N1 flu among the U.S. population had been hard to measure, partly due to the difficulties of counting the large numbers of cases that overwhelmed health authorities and of testing the large numbers of people that had symptoms. The World Health Organization counts 209,000 laboratory-confirmed cases and more than 3,205 deaths worldwide as of September 11, 2009, but health authorities worldwide believe that these are substantial underestimates.

The researchers, led by Presanis and Lipsitch, measured the severity of the pandemic by analyzing what fraction of people in the study population that were sick with H1N1 flu were (1) hospitalized, (2) in an intensive-care unit (ICU) or on a ventilator or (3) had died. They analyzed data from the CDC and from New York and Milwaukee, two cities where health officials collected particularly high-quality surveillance data during the wave of infections from April to July 2009. The researchers then combined all the evidence using a statistical approach called Bayesian evidence synthesis to estimate the probability of the three outcomes above for individuals who fell ill with H1N1 in the overall U.S. population and by age group.

The researchers used two different approaches to estimate these risks. One approach led to an estimate that approximately 1.44% of patients with symptoms of H1N1 flu during the April-July time period were hospitalized, 0.239% required intensive care or mechanical ventilation and 0.048% died. The other estimate found probabilities 7 to 9 times lower, due to the use of different data to estimate how many individuals were sick. Based on these findings and assuming that the virus doesn’t change its characteristics, the researchers estimate that the severity of the autumn-winter pandemic wave of H1N1 flu could have a death toll in a range from considerably below the estimated 36,000 associated with an average flu season in the U.S. to slightly higher. Also, unlike seasonal flu, which kills mainly elderly adults, the H1N1 flu could have the greatest impact in children aged 0-4 and especially adults 18-64, a shift toward nonelderly persons that has been seen in prior flu pandemics.

“The good news is that, along with previous work by the CDC and others, our work shows that the severity of the H1N1 flu may be less than initially feared,” said Lipsitch. However, he adds that between 1 in 70 and 1 in 600 people who are sick with the illness will be hospitalized, and a fraction of those will die.

A preliminary version of this article was posted on PLoS Currents (September 25th 2009), a new forum for rapid publication of results designed to aid timely dissemination of important information during the pandemic.

Support for the study was provided by the UK Medical Research Council, the UK Health Protection Agency, the U.S. National Institutes of Health and Department of Homeland Security.

“The Severity of Pandemic H1N1 Influenza in the United States from April to July 2009: A Bayesian Analysis,” Anne M. Presanis, Daniela De Angelis, The New York City Swine Flu Investigation Team, Angela Hagy, Carrie Reed, Steven Riley, Ben S. Cooper, Lyn Finelli, Paul Biedrzycki, Marc Lipsitch, PLoS Medicine, online Dec. 7, 2009

Source:   Harvard School of Public Health

Though there are signs the H1N1 (swine flu) has peaked in the U.S. and Canada, a WHO flu expert said Thursday it is too early to declare the pandemic over, Canadian Press reports. “‘In the Northern Hemisphere, we continue to see an up and down pattern by countries. And so what you see in one country is not necessarily what you are seeing in another country,’ Keiji Fukuda, special adviser to WHO Director-General Margaret Chan on pandemic influenza, said in a teleconference briefing,” the news service writes. Fukada added that it was difficult to predict what would happen with the virus in the springtime (Branswell, 12/3).

Reuters/ABC News: “I think it’s fair to say that we still haven’t fully gotten through the pandemic and that it is possible that there could be unexpected events which occur,” Fukuda said, adding, “It is quite possible to have a pandemic on the milder side. And if we are experiencing that and the number of serious cases is kept down, then it is something again for which we should all be thankful.” Fukada said the WHO and its advisory committee continue to gather scientific evidence and would likely decide when to declare the end to the pandemic in 2010 (Nebehay, 12/3).

Los Angeles Times’ blog “Booster Shots” reports that more than 150 million H1N1 vaccine doses have been distributed in about 40 countries, according to Fukada. “The United States, with at least 70 million doses, represents nearly half that total,” the blog writes (Maugh, 12/3).

In related news, Bloomberg examines the growing criticism the WHO is facing over claims it exaggerated the threat of H1N1 to benefit members of the pharmaceutical industry. The WHO responded to such criticism in a statement released yesterday (Gale, 12/3). The Canadian Press adds: “The agency said all experts who advise the WHO do so for free and must disclose any potential conflicts of interest. … ‘Allegations of undeclared conflicts of interest are taken very seriously by WHO, and are immediately investigated,’ the statement said” (12/3).

This information was reprinted from globalhealth.kff.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Global Health Policy Report, search the archives and sign up for email delivery at globalhealth.kff.org.

CADTH’s health technology assessment examined the impact of the anti-tumour necrosis factor alpha (anti-TNF-α) agents adalimumab, etanercept, and infliximab compared with conventional therapy and surgery for patients with Crohn disease or ulcerative colitis who do not adequately respond to conventional therapy.

The assessment examines comparative clinical- and cost-effectiveness, the effect of dosage and timing, the role of maintenance therapy, and health care resource use.

The assessment is timely as there is growing use of anti-TNF-α agents and considerable uncertainty regarding their clinical role and appropriate reimbursement policies in the publicly funded health care system.

What is amoxicillin?

Amoxicillin is an antibiotic in the penicillin group of drugs. It fights bacteria in your body.
Amoxicillin is used to treat many different types of infections caused by bacteria, such as ear infections, bladder infections, pneumonia, gonorrhea, and E. coli or salmonella infection. Amoxicillin is also sometimes used together with another antibiotic called clarithromycin (Biaxin) to treat stomach ulcers caused by Helicobacter pylori infection.

This combination is sometimes used with a stomach acid reducer called lansoprazole (Prevacid).Amoxicillin may also be used for other purposes not listed in this medication guide.

Important information about amoxicillin

Do not use this medication if you are allergic to amoxicillin or to any other penicillin antibiotic, such as ampicillin (Omnipen, Principen), carbenicillin (Geocillin), dicloxacillin (Dycill, Dynapen), oxacillin (Bactocill), penicillin (Beepen-VK, Ledercillin VK, Pen-V, Pen-Vee K, Pfizerpen, V-Cillin K, Veetids), and others.

Before using amoxicillin, tell your doctor if you are allergic to cephalosporins such as Ceclor, Ceftin, Duricef, Keflex, and others. Also tell your doctor if you have asthma, liver or kidney disease, a bleeding or blood clotting disorder, mononucleosis (also called “mono”), or any type of allergy.

Amoxicillin can make birth control pills less effective, which may result in pregnancy. Before taking amoxicillin, tell your doctor if you use birth control pills. Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Amoxicillin will not treat a viral infection such as the common cold or flu. Do not give this medication to another person, even if they have the same symptoms you do.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.
Before taking amoxicillin

Do not use this medication if you are allergic to amoxicillin or to any other penicillin antibiotic, such as:
•    ampicillin (Omnipen, Principen);
•    carbenicillin (Geocillin);
•    dicloxacillin (Dycill, Dynapen);
•    oxacillin (Bactocill); or
•    penicillin (Beepen-VK, Ledercillin VK, Pen-V, Pen-Vee K, Pfizerpen, V-Cillin K, Veetids, and others).

Before using amoxicillin, tell your doctor if you are allergic to any drugs (especially cephalosporins such as Ceclor, Ceftin, Duricef, Keflex, and others), or if you have:
•    asthma;
•    liver disease;
•    kidney disease;
•    a bleeding or blood clotting disorder;
•    mononucleosis (also called “mono”);
•    a history of diarrhea caused by taking antibiotics; or
•    a history of any type of allergy.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take amoxicillin.
FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Amoxicillin can make birth control pills less effective, which may result in pregnancy. Before taking amoxicillin, tell your doctor if you use birth control pills. Amoxicillin can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
The amoxicillin chewable tablet may contain phenylalanine. Talk to your doctor before using this form of amoxicillin if you have phenylketonuria (PKU).