[Preservation of residual kidney function in chronic haemodialysis]

Residual kidney function (RKF) is defined as the production of a clinically significant amount of urine in dialysis patients. Observational studies suggest that those with preserved RKF have a better prognosis than anuric patients. Preserved RKF allows the prescription of a lower dialysis dose compared to the traditional thrice weekly schedule. Such an "incremental" approach has also been associated with a better global prognosis. In view of the overall growth of incremental HD in the western world, we review the main studies supporting this approach, as well as the benefits and limitations related to RKF preservation.

Regulatory landscape of alternatives to animal testing in food safety evaluations with a focus on the western world

Traditional animal models are increasingly being replaced by new approach methodologies (NAMs) which focus on predicting toxicity of chemicals based on mechanistic data rather than apical endpoint data usually obtained from animal models. Beyond in vitro genetic tests, however, only a handful of NAMs have been successfully implemented in regulatory decision-making processes, mostly in the cosmetics and chemicals sector. Regulatory guidance on food safety testing in many jurisdictions still relies on data obtained from animal studies. This is due to the lack of validated models to predict systemic toxicity, which is essential to develop health-based guidance values for food additives. Other factors limiting the adoption of NAMs into food safety assessment include sector legislation lagging behind scientific progress, and lack of training and expertise to use the new models. While regulatory and industry bodies are working to combat these challenges, more needs to be done before these models can be used as standalone tools for regulatory decision-making. This review summarizes the current state and challenges of regulatory acceptance of NAMs for decision-making, and the efforts by governing bodies and industry to transition from animal testing for food safety assessments.

[Endoscopic submucosal dissection: advances and perspectives]

Endoscopic submucosal dissection (ESD) is a mini-invasive technique allowing to resect superficial lesions of the digestive tract and maintaining organ function. High technical expertise is required as well as a network approach with referring physicians, pathologists, radiologists, surgeons and oncologists. Rigorous selection of cases as well as endoscopic management of potential complications (hemorrhage, perforation) is mandatory. Therefore, ESD should preferably be performed in expert centers with high volumes of cases, in order to maintain competency and offer optimal patient's management. Most frequent indications in the Western world are early cancers of the esophagus, stomach and colon as well as non-non-lifting polyps and gastrointestinal stromal tumors (GIST).

Incidence Trends of Inflammatory Bowel Disease in a Southern European Country: A Mirror of the Western World?

INTRODUCTION

Inflammatory bowel disease (IBD) affects people from all age categories worldwide. Although the incidence of the disease is stabilizing or decreasing in most Western world countries, its prevalence is still increasing because of the rise in life expectancy and better disease management. This work intends to identify the trends related to IBD incidence nationwide, analyzing regional, sex, and age distributions.

METHODS

Data were provided by the Portuguese Shared Services of the Ministry of Health. This study consisted of a retrospective analysis of all first consultations coded for "Chronic enteritis/ulcerative colitis" (D94) in a primary healthcare setting, between 2017 and 2020, in Portugal. The primary outcome measure was the IBD incidence rate per 100,000 inhabitants. We also calculated the incidence rate per person-year and forecasted incidence until 2024.

RESULTS

Between 2017 and 2019, the incidence rate of IBD in Portugal decreased from 54.9 to 48.6 per 100,000 inhabitants. The average incidence was 20 new cases of IBD per 1,000 person-year. It was predicted that, in December 2023, IBD incidence would reach 305.4 new cases (95% Prediction Interval 156.6-454.3), a similar result to the values forecasted for December 2021 (305.4, 95% Prediction Interval 197.3-413.6).

DISCUSSION

The incidence of IBD slightly declined from 2017 to 2019, and it is posed to stabilize in the future. The presented data are of the utmost importance for the characterization of IBD in Southern European countries and the establishment of future health policies in the setting of compounding prevalence in the Western world.

The Art of Rhinoplasty: Researching Technical and Cultural Foundations of Western World Rhinosurgery, from the Middle Ages to the Renaissance

The analysis of the written sources allowed to follow the gradual development of every new technique in the field of rhinoplasty but also to understand the value of this surgery in those ancient times, highlighting a deep connection between traumatologic surgery of the nose and the development of modern “aesthetic and reconstructive” Rhinosurgery. Specifically, we analyzed the techniques described by less known surgeons to emphasize their cultural and surgical value. As a matter of fact, the descriptions offered by these authors clearly show the importance of rhinoplasty as a cardinal and autonomous practice since Antiquity, also clarifying the persistence and development of specific techniques for this surgical practice in the History of medicine. In the manuscript, the contributions of the Italian surgeons, such as Brancas and Vianeos families, are highlighted, demonstrating their influence on the progress of this surgical specialty in the Early Modern Age. Finally, we deepen the description of Gaspare Tagliacozzi’s work, pointing out the topics and controversial debates arising from his techniques and innovations in “rhinosurgery” and also in the field of tissue transplantation, laying the foundations of modern Plastic Surgery.

Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266.

Food-Derived Opioid Peptides in Human Health: A Review

World Health Organization data suggest that stress, depression, and anxiety have a noticeable prevalence and are becoming some of the most common causes of disability in the Western world. Stress-related disorders are considered to be a challenge for the healthcare system with their great economic and social impact. The knowledge on these conditions is not very clear among many people, as a high proportion of patients do not respond to the currently available medications for targeting the monoaminergic system. In addition, the use of clinical drugs is also associated with various side effects such as vomiting, dizziness, sedation, nausea, constipation, and many more, which prevents their effective use. Therefore, opioid peptides derived from food sources are becoming one of the safe and natural alternatives because of their production from natural sources such as animals and plant proteins. The requirement for screening and considering dietary proteins as a source of bioactive peptides is highlighted to understand their potential roles in stress-related disorders as a part of a diet or as a drug complementing therapeutic prescription. In this review, we discussed current knowledge on opioid endogenous and exogenous peptides concentrating on their production, purification, and related studies. To fully understand their potential in stress-related conditions, either as a drug or as a therapeutic part of a diet prescription, the need to screen more dietary proteins as a source of novel opioid peptides is emphasized.

Moxibustion for the treatment of diabetic peripheral neuropathy: A systematic review and meta-analysis following PRISMA guidelines

BACKGROUND

At present, the effect of western-medicine (WM) therapy to treat diabetic peripheral neuropathy (DPN) is limited. Moxibustion is a representative external treatment in traditional Chinese medicine that has been beneficial to DPN. We aim to systematically assess the efficacy and safety of moxibustion in treating DPN, following PRISMA guidelines.

METHODS

Eight electronic databases were searched to acquire information on eligible trials published from inception to June 1, 2019. We included randomized controlled trials (RCTs) applying moxibustion therapy with a minimum of 14-days treatment duration for DPN patients compared with placebo, no intervention, or conventional WM interventions. The primary outcomes in our study include the sensory-nerve conduction velocity (SNCV) and motor-nerve conduction velocity (MNCV). We used the Cochrane Collaboration Risk of Bias tool to assess the methodological quality of eligible RCTs. Statistical analyses were conducted using Review Manager 5.3. Risk ratios (RR) and mean differences (MD) were calculated with a 95% confidence interval (CI). The χ test was applied to assess the heterogeneity.

RESULTS

In total, 11 RCTs were included that involved 927 DPN patients. Compared with the control group, there was an increase in median MNCV (MD = 6.26, 95% CI 2.64-9.89, Z = 3.39, P = .0007) and peroneal MNCV (MD = 6.45, 95% CI 5.30-7.61, P < .00001). There was also an increase in median SNCV (MD = 6.64, 95% CI 3.25-10.03, P = .0001) and peroneal SNCV (MD = 3. 57, 95% CI 2.06-5.09, Z = 4.63, P < .00001) in the treatment groups. The treatment groups receiving moxibustion therapy indicated a more significant improvement in total effectiveness rate (RR = 0.25, 95% CI 0.18-0.37, Z = 7.16, P < .00001). Toronto Clinical Scoring System indicated a significant decrease in the treatment groups (MD = -2.12, 95% CI -2.82 to 1.43, P < .00001). Only 1 study reported that treatment groups experienced no adverse reactions. The other 10 studies did not mention adverse events.

CONCLUSIONS

Moxibustion therapy may be an effective and safe option for DPN patients but needs to be verified in further rigorous studies.

The Impact of Two Different Cultures on Juvenile Attitudes Toward the Police in China

This study examines juvenile attitudes toward the police (JATP) from an unconventional angle by examining the possible effect of two different cultures along with more conventional factors typically associated with youth attitude formation. A unique feature of this study is the inclusion of measures of attachment to both the traditional Chinese culture and Western popular culture. The data were collected from 30 minority middle schools with more than 6,500 students in a southern autonomous region in China in 2014. The primary findings indicate that juveniles who are more firmly attached to the traditional Chinese culture and who show respect for parents/teachers tend to hold a more positive view of the police. In contrast, juveniles who endorse Western popular culture and are perceived as a fan of that culture are more likely to hold a negative view of the police, societal actors who are viewed as primary representatives of the mainstream culture.

Combining the wisdoms of traditional medicine with cutting-edge science and technology at the forefront of medical sciences

BACKGROUND

A central topic is to bring traditional medicine to a new horizon by integrating the latest advances in genomic, metabolomic, and system biological approaches, in order to re-examine the wisdom and knowledge of traditional Chinese medicine (TCM) and other traditional medicines.

PURPOSE

A new consortium has been formed at a conference of the Harvard Medical School, Boston, on October 29-30, 2018. The main goal was to build a collaborative platform for the scientific investigation of traditional medicine with cutting edge sciences and technologies at the forefront of biomedicine.

RESULTS

Traditional medicines are largely experience-based, but the scientific basis is largely non-satisfactory. Therefore, the transformation from experience-based to evidence-based medicine would be an important step forward. The consortium covers three main fields: TCM diagnostics, acupuncture and TCM pharmacology. Diseases occur because of regulatory imbalances of holistic physiological display and genetic information/expression related to systems biology and energy consumption/release (e.g. cold and hot) within body. As organs are interconnected by meridians, affecting the meridians by acupuncture and medicinal herbs restores healthy organ function and body balance. There are two concepts in herbal medicine: The traditional way is based on complex herbal mixtures. The second concept is related to Western pharmacological drug development including the isolation of bioactive phytochemicals, which are subjected to preclinical and clinical investigations.

CONCLUSION

Development of collaborative scientific project to integrate the best of both worlds - Western and Eastern medicine into a "One World Integrative Medicine" for the sake of patients worldwide.

End stage scurvy in the developed world: A diagnostic conundrum but not to be mistaken for pyoderma gangrenosum

Scurvy is a clinical syndrome, resulting from ascorbic acid deficiency. Prevalence of the condition is now extremely low in the Western population and its diagnosis can be challenging without a high index of suspicion. When cases do present, they are often misdiagnosed initially. Therefore, a thorough history, physical exam, and laboratory evaluation are key to showing this now rare but extremely well-known disease. We report a case of scurvy manifesting as persistent non-healing lower-extremity ulcerations, initially mistaken for pyoderma gangrenosum. The patient responded to appropriate replacement therapy, but ulcers were slow to heal. As was the case in our patient, symptom reversal may require additional nutritional replacement. We encourage physicians to consider nutritional deficiencies in their differential diagnoses and highlight the incidence of malnutrition in the proper clinical setting to avoid diagnostic delay.

Gut microbiota phenotypes of obesity

Obesity is a disease with a complex etiology and variable prevalence across different populations. While several studies have reported gut microbiota composition differences associated with obesity in humans, there has been a lack of consistency in the nature of the reported changes; it has been difficult to determine whether methodological differences between studies, underlying differences in the populations studied, or other factors are responsible for this discordance. Here we use 16 S rRNA data from previously published studies to explore how the gut microbiota-obesity relationship varies across heterogeneous Western populations, focusing mainly on the relationship between (1) alpha diversity and (2) Prevotella relative abundance with BMI. We provide evidence that the relationship between lower alpha diversity and higher BMI may be most consistent in non-Hispanic white (NHW) populations and/or those with high socioeconomic status, while the relationship between higher Prevotella relative abundance and BMI may be stronger among black and Hispanic populations. We further examine how diet may impact these relationships. This work suggests that gut microbiota phenotypes of obesity may differ with race/ethnicity or its correlates, such as dietary components or socioeconomic status. However, microbiome cohorts are often too small to study complex interaction effects and non-white individuals are greatly underrepresented, creating substantial challenges to understanding population-level patterns in the microbiome-obesity relationship. Further study of how population heterogeneity influences the relationship between the gut microbiota and obesity is warranted.

Re-examining the impact of European astronomy in seventeenth-century China: a study of Xue Fengzuo's system of thought and his integration of Chinese and Western knowledge

During the late Ming and early Qing period, Jesuit missionaries introduced European science into China, and thereby profoundly influenced the later development of Chinese astronomy. Not only did European astronomy become the official system of the Qing dynasty, but the traditional way to 'attain up above' by connecting the study of astronomy and Yi learning gradually fell into disuse. However, the astronomers in this period expressed different views on these two processes. As one of the most important early Qing astronomers, Xue Fengzuo's case presents a distinctive and important example. Firstly, under the influences of both Chinese tradition and European science, Xue Fengzuo rebuilt the way to 'attain up above' based on his three-fold 'calendrical learning', i.e. calendrical astronomy, astrology and related pragmatic applications, through which he could realize the highest Confucian ideal. Secondly, he integrated Chinese and Western knowledge for all three aspects of his 'calendrical learning', instead of ceding the dominant position to Western methods. From Xue Fengzuo's example, many of the complex effects of the encounter between different cultures and the process of knowledge transfer can be revealed.

Observation of the clinical effect of the combined therapy of zushima tablet and western medicine in the treatment of rheumatoid arthritis and MRI test results

To evaluate the clinical efficacy of combined therapy of Zushima tablet and western medicine in treatment of rheumatoid arthritis and analyze the MRI test results. A total of 170 patients who had been treated for rheumatoid arthritis at our hospital from August 2016 and June 2018, were enrolled as research objects. They were randomly divided into control group and research group, with 85 patients in each group. The patients in the control group were treated with western medicine, while patients in the research group were treated with combined therapy of Zushima tablet and western medicine. The clinical efficacies of two groups were compared. results showed that the overall effective rate of the research group was higher than that of the control group (p<0.05). Various clinical symptoms including joint swelling, joint tenderness, duration of morning stiffness for both groups before and after treatment were recorded, and results showed that the improvement of the research group was significantly better than that of the control group (p<0.05). Application of combined therapy of Zushima tablet and western medicine in treatment of rheumatoid arthritis could lead to favorable effects and improvement of the patients' clinical symptoms.

Improving functional outcomes in college and university students with schizophrenia in the Western world

Retrospective research from patients with schizophrenia suggests that remission becomes increasingly less likely the longer psychosis goes untreated. Yet symptoms of schizophrenia are insidious and disease evolution varies between patients, requiring an ongoing diagnostic process. One way of justifying early treatment is by focusing on functionality rather than symptomatology. Most patients are diagnosed with schizophrenia between the ages of 17 and 25-when many young adults are undergraduates or pursuing post-graduate education. The extent to which schools partner with mental health services has implications for the short-term success of students' recovery and their future employability. Translating study findings on schizophrenia to the college setting remains an important area of investigation.

How Peircean semiotic philosophy connects Western science with Eastern emptiness ontology

In recent articles in this journal I have discussed why a traditional physicalist and mechanist, as well as an info-computationalist, view of science cannot fulfil the goal of building a transdisciplinary science across Snow's two cultures. There seems to be no path proceeding from mechanistic physicalism to views that encompass phenomenological theories of experiential consciousness and meaning-based cognition and communication. I have suggested, as an alternative, the Cybersemiotic framework's integration of Peirce's semiotics and Luhmann's autopoietic system theory. The present article considers in greater depth the ontological developments necessary to make this possible. It shows how Peirce avoids materialism and German idealism through his building on a concept of emptiness similar to modern quantum field theory, positing an indeterminist objective chance feeding into an evolutionary philosophy of knowing based on pure mathematics and phenomenology that is itself combined with empirically executed fallibilism. Furthermore, he created a new metaphysics in the form of a philosophical synechist triadic process philosophy. This was integrated into the transcendentalist view of process view of science and spirituality developed from Western Unitarianism by Emerson (agapism), and featuring a metaphysics of emptiness and spontaneity (tychism) that are also essential for the Eastern philosophies of Buddhism and Vedanta.

The East, the West and the universal machine

After reviewing the basic of theology of Universal Numbers/Machines, as detailed in Marchal (2007), I illustrate how that body of thought might be used to shed some light upon the apparent dichotomy in Eastern/Western spirituality. This paper relies entirely on my previous interdisciplinary work in mathematical logic, computer science and machine's theology, where "theology" is used here in the sense of Plato: it is the truth, or the "truth-theory" (in the sense of logicians) about a machine that the machine can either deduce from some of its primitive beliefs, or can be intuited in some sense that eventually is made clear through the modal logic of machine self-reference. Such a theology appears to be testable, because it has been shown that physics has to be necessarily retrieved from it when we assume the mechanist hypothesis in the cognitive sciences, and this in a unique precise (introspective) way, so that we only need to compare the physics of the introspective machine with the physics inferred from the human observation; and up to now, it is the only theory known to fit both the existence of personal "consciousness" (undoubtable yet unjustifiable truth) and quanta and quantum relationships (Marchal, 1998; Marchal, 2004; Marchal, 2013; Marchal, 2015).

A causal framework for integrating contemporary and Vedic holism

Whereas the last Century of science was characterized by epistemological uncertainty; the current Century will likely be characterized by ontological complexity (Gorban and Yablonsky, 2013). Advances in Systems Theory by mathematical biologist Robert Rosen suggest an elegant way forward (Rosen, 2013). "R-theory" (Kineman, 2012) is a synthesis of Rosen's theories explaining complexity and life in terms of a meta-model for 'whole' systems (and their fractions) in terms of "5^th-order holons". Such holons are Rosen "modeling relations" relating system-dependent processes with their formative contexts via closed cycles of four archetypal (Aristotelian) causes. This approach has post-predicted the three most basic taxa of life, plus a quasi-organismic form that may describe proto, component, and ecosystemic life. R-theory thus suggests a fundamentally complex ontology of existence inverting the current view that complexity arises from simple mechanisms. This model of cyclical causality corresponds to the ancient meta-model described in the Vedas and Upanishads of India. Part I of this discussion (Kineman, 2016a) presented a case for associating Vedic philosophy with Harappan civilization, allowing interpretation of ancient concepts of "cosmic order" (Rta) in the Rig Veda, nonduality (advaita), seven-fold beingness (saptanna) and other forms of holism appearing later in the Upanishads. By deciphering the model of wholeness that was applied and tested in ancient times, it is possible to compare, test, and confirm the holon model as a mathematical definition of life, systemic wholeness, and sustainability that may be applied today in modern terms, even as a foundation for holistic science.

An extended framework for science

We may be at the cusp of a next generation framework for science which can be facilitated by understanding current limitations in the context of a divergence of 'scientific' tradition from the Axial Age (800-200 BCE) to the present. A powerful advance may come from fusing certain elements from Western and Eastern traditions, synthesizing the framework with an apt understanding of the divergence. Key traits will include the ethopoetic nature of the scientist with attention to his/her experience of self. The framework will also 'access' knowledge through a state of mind less encumbered with paradoxes, duality, incompatibility and other aporias. Case studies in biology and physics illustrate possibilities.

Brains, language and the argumentative mind in Western and Eastern societies. The fertile differences between Western-Eastern argumentative traditions

The philosophical differences between Western and Eastern philosophy not only derive from general cultural ideas about reality, but as Nisbet writes (2003), are also methodological, ontological, and cognitively driven. Thus, we can see that strategies of thought and theory-generation are constrained and enabled by conceptual levels, and that the existence of differences and within these levels may be pragmatically combined in fruitful ways. At this point, I remark that there is not a single way to connect biology and culture, but at least we need to admit that brains allow the existence of minds and that these create languages, which also organize the world symbolically following a long set of (sometimes interconnected) heuristics. Throughout the paper we will see how fundamental, geographically located cultural perspectives have affected reasoning strategies and discourses, determining the main Western and Eastern Traditions. At the same time, we can conclude that different traditional perspectives allow more diversity for knowledge acquisition.

Comparison of geographic distributions of Irritable Bowel Syndrome with Inflammatory Bowel Disease fail to support common evolutionary roots: Irritable Bowel Syndrome and Inflammatory Bowel Diseases are not related by evolution

Irritable Bowel Syndrome (IBS) shares overlapping symptoms and some features of pathogenesis with Inflammatory Bowel Diseases (IBD: Crohn's disease [CD], and Ulcerative Colitis [UC]). Geographic markers such as latitude/sunshine and more recently lactase population distributions are found to be correlated with IBD. As a result of clinical and pathogenic similarities between the 2 conditions, some authorities questioned whether a connection exists between them. We compare IBS directly with IBD, and indirectly with geographic markers associated with IBD, in order to evaluate possible evolutionary links between IBS and IBD. Similar correlations may link IBS as a precursor to IBD and possibly other conditions which are geographically connected with IBD. Data from four systematic reviews on IBD incidence and prevalence, IBS prevalence, and lactase distributions were included. Pearson's correlations were used for comparisons, with IBD values log-transformed because of skewed distribution. The articles provided 18-28 complete set of national data. Direct comparison between IBS and IBD showed no significant correlations (r = -0.14, r = -0.06 for CD and UC prevalence, r = -0.10 for CD incidence). Indirect comparisons also failed to show correlations of IBS with lactase distributions (r = -0.17), sunshine (r = -0.2) or latitude (r = 0.097); however, there was significant correlation between lactase distributions and CD incidence (r = -0.84), prevalence (r = -0.55) and UC prevalence (r = -0.59). Both sunshine (r= -0.53) and latitude (r = 0.58) are also significantly related to CD incidence. It is concluded that IBS and IBD do not follow similar global geographic patterns. This suggests a lack of an evolutionary genetic background coincident with emergence of lactase persistence. As well, vitamin D has no obvious impact on development of IBS. Similarities with IBD may result from sub groups (not yet identified) within the current Rome criteria of IBS. Alternatively limited intestinal gut-brain responses to host microbial interactions may result in similar overlap features in both.

Current differences in dental education between Chinese and Western models

Dental education is the foundation of a country's development of dental science. Economic conditions and cultural backgrounds vary across countries; hence, there are some differences in dental education between Chinese and Western models, including the education programmes, licensures, curricula, teaching methods, facilities. These differences may become obstacles for mutual communication and the development of dental education. In the last 5 years, China has introduced several policies and published some standards, such as the residency programmes and Accreditation Standards for Undergraduate Dental Education Programs. These actions aim to improve the current situation of dental education and reduce the gap between Chinese and Western education models. Indeed, some changes have been made. This article provides a brief introduction of the existing differences and changes and can, thus, serve as a reference for educators.

The resolution of ambiguity as the basis for life: A cellular bridge between Western reductionism and Eastern holism

Boundary conditions enable cellular life through negentropy, chemiosmosis, and homeostasis as identifiable First Principles of Physiology. Self-referential awareness of status arises from this organized state to sustain homeostatic imperatives. Preferred homeostatic status is dependent upon the appraisal of information and its communication. However, among living entities, sources of information and their dissemination are always imprecise. Consequently, living systems exist within an innate state of ambiguity. It is presented that cellular life and evolutionary development are a self-organizing cellular response to uncertainty in iterative conformity with its basal initiating parameters. Viewing the life circumstance in this manner permits a reasoned unification between Western rational reductionism and Eastern holism.

[Schofield and the first spread of western medicine in Shanxi]

After the Second Opium War, the signing of the Tientsin Treaty and the Peking Treaty legitimized the missionary activities and authorized the missionary the rights to enter inland China for propagating their religious doctrines. In the late 1870s, the"The extraordinary famine of the Ding Wu year"and the subsequent epidemic provided the opportunity for missionaries to enter Shanxi. Dr. Schofield, sent by the China Inland Mission, arrived in Taiyuan in 1880, set up clinics and practised there. He died of typhus after treating a typhus patient in the summer of 1883. Schofield stayed and practised in Taiyuan for 2 years and 8 months. Later, the China Inland Mission and other missionaries donated to establish a Shanxi's first western medicine Hospital to commemorate Schofield. The medical activities of Dr. Schofield enlightened and promoted the Shanxi people's understanding of western medicine.

Taking the Text out of Context as One of the Causes of the Crisis in the Contemporary Muslim World

Our world is in a state of crisis which tends to worsen. The Muslim intellectuals today make significant efforts to detect causes of the exceptionally difficult situation the Muslim world is in today for it is engaged in several severe conflicts. In order to overcome the crisis, it is necessary to reach, subjectively conscious and efficient, the full sense of the Qur'anic explications on God's placing of Man as his emissary on the Earth. A reinterpretation of the Text in conremporariness is necessary, that is, a competent introduction of the Text in the Context, for that is the only way for it to act correctly and optimally.

Dietary Transition in the South Asian Diaspora: Implications for Diabetes Prevention Strategies

BACKGROUND

South Asians (SA) have a four to five fold higher risk for type 2 diabetes mellitus (T2DM) in comparison to other Asian migrant groups. Dietary patterns have been attributed as an important independent modifiable risk factor.

OBJECTIVE

The aim of this review is to document the dietary patterns of SA migrants in Western countries and to summarize the evidence for the association of dietary patterns with T2DM and its predisposing factors.

METHODS

Using key search words articles from 1990 onwards were sourced from MEDLINE Pro- Quest and PubMed (not MEDLINE) databases for this narrative review.

RESULTS

A significant shift in meal pattern with frequent dining out and eating fast foods, traditional festival foods and Western desserts and snacks was common among SA. Consumption of potatoes, dairy, oil, meat and fish increased and beans, lentils, fruits and vegetables decreased post-migration. "Animal protein" and "fried snacks, sweets and high-fat dairy" were associated with greater insulin resistance and lower HDL cholesterol. A "mixed" dietary pattern was associated with obesity and hypertension and a "western" dietary pattern was associated with overall risk for Metabolic Syndrome. A 70% increase in the odds of diabetes per standard deviation in gram of protein intake was also observed.

CONCLUSION

Dietary patterns pave the way to develop diabetes and other obesity related diseases among SA as duration of residence increases. The first five years since migration maybe a window of opportunity to provide targeted interventions to ensure maintenance of healthy dietary habits.

Medical education in a foreign language and history-taking in the native language in Lebanon - a nationwide survey

BACKGROUND

With the adoption of the English language in medical education, a gap in clinical communication may develop in countries where the native language is different from the language of medical education. This study investigates the association between medical education in a foreign language and students' confidence in their history-taking skills in their native language.

METHODS

This cross-sectional study consisted of a 17-question survey among medical students in clinical clerkships of Lebanese medical schools. The relationship between the language of medical education and confidence in conducting a medical history in Arabic (the native language) was evaluated (n = 457).

RESULTS

The majority (88.5%) of students whose native language was Arabic were confident they could conduct a medical history in Arabic. Among participants enrolled in the first clinical year, high confidence in Arabic history-taking was independently associated with Arabic being the native language and with conducting medical history in Arabic either in the pre-clinical years or during extracurricular activities. Among students in their second clinical year, however, these factors were not associated with confidence levels.

CONCLUSIONS

Despite having their medical education in a foreign language, the majority of students in Lebanese medical schools are confident in conducting a medical history in their native language.

Culture, Brain Death, and Transplantation

From the social sciences, we know the space between life and death is historically and culturally constructed, fluid and open to dispute. The definition of death has cultural, legal, and political dimensions. As healthcare becomes more culturally diverse, the interface between culture and the delivery of healthcare will increase. In our increasingly pluralistic, interdependent society, there is a growing demand to integrate healthcare, including transplantation, into a broader context that respects both individual and cultural diversity. It is important that we first consider and explore what elements of Western healthcare practices including definitions and advances, such as brain death and organ donation, are culturally influenced. This article highlights some of the cultural influences on brain death by focusing on Western and Japanese perspectives on the permissibility of organ procurement from brain-dead persons. It also offers 4 recommendations for healthcare workers working cross-culturally.

Death Obsession in Arabic and Western Countries

The current investigation compared a measure of death obsession among 1,853 volunteer undergraduates from four Arab countries (Egypt, Kuwait, Lebanon, and Syria) with 791 from three Western countries, i.e., Britain, Spain, and the USA. Comparable Arabic, Spanish, and English versions of the Death Obsession Scale were used. The mean scores on death obsession for the Arabic participants were higher than those of their Western counterparts for both men and women.

Ethical and Cultural Considerations in Informed Consent in Botswana

Reflections on my experience of conducting research in Botswana are used to highlight tensions and conflicts that arise from adhering to the western conceptualization of bioethics and the need to be culturally sensitive when carrying out research in one's own culture. Cultural practices required the need to exercise discretionary judgement guided by respect for the culture and decision-making protocols of the research participants. Ethical challenges that arose are discussed. The brokerage role of nurse educators and leaders in contextualizing western bioethics is emphasized.

The bioethics of medical research in very poor countries

Sociologists have had only a marginal effect on the development of bioethical principles for medical research despite their interest in the effects of social and economic inequality on health and its implications for issues of social and individual justice. In this article we review existing bioethical standards for conducting medical research in very poor countries. Given the substantial differences in individual exposure to health risks and the availability of health protective resources as well as differences in the disease burden and mortality and morbidity at the population level, it is clear that illness in poor countries can be better understood using a social causation of illness perspective. In turn we suggest that such a perspective can be useful for identifying bioethical standards that better apply in this context.

Postpartum Practices and Depression Prevalences: Technocentric and Ethnokinship Cultural Perspectives

Reports of non-Western prevalence of postpartum depression (PPD) are highly variable. This variation may indicate that the label of PPD may be unacceptable in some groups or not used, that manifestations may vary by culture, or that cross-cultural diagnostic standards do not match Western clinical criteria. These factors complicate efforts to explore the relationship of postpartum traditional practices to PPD between Western and non-Western cultures. Although Stern and Kruckman viewed PPD as a culture-bound phenomenon of Western culture, an expanding international literature has demonstrated that PPD occurs in a variety of countries. To address these issues, the authors examined the literature to describe cultural postpartum traditions, to explore possible relationships among practices and PPD prevalence, to critique the culture-bound theory, and to discuss clinical practice implications.

The rise of western rationalism: Paul Feyerabend's story

I summarize certain aspects of Paul Feyerabend's account of the development of Western rationalism, show the ways in which that account is supposed to run up against an alternative, that of Karl Popper, and then try to give a preliminary comparison of the two. My interest is primarily in whether what Feyerabend called his 'story' constitutes a possible history of our epistemic concepts and their trajectory. I express some grave reservations about that story, and about Feyerabend's framework, finding Popper's views less problematic here. However, I also suggest that one important aspect of Feyerabend's material, his treatment of religious belief, can be given an interpretation which makes it tenable, and perhaps preferable to a Popperian approach.

Uncovering Metaethical Assumptions in Bioethical Discourse across Cultures

Much of bioethical discourse now takes place across cultures. This does not mean that cross-cultural understanding has increased. Many cross-cultural bioethical discussions are marked by entrenched disagreement about whether and why local practices are justified. In this paper, I argue that a major reason for these entrenched disagreements is that problematic metaethical commitments are hidden in these cross-cultural discourses. Using the issue of informed consent in East Asia as an example of one such discourse, I analyze two representative positions in the discussion and identify their metaethical commitments. I suggest that the metaethical assumptions of these positions result from their shared method of ethical justification: moral principlism. I then show why moral principlism is problematic in cross-cultural analyses and propose a more useful method for pursuing ethical justification across cultures.

Female genital alteration: a compromise solution

Despite 30 years of advocacy, the prevalence of non-therapeutic female genital alteration (FGA) in minors is stable in many countries. Educational efforts have minimally changed the prevalence of this procedure in regions where it has been widely practiced. In order to better protect female children from the serious and long-term harms of some types of non-therapeutic FGA, we must adopt a more nuanced position that acknowledges a wide spectrum of procedures that alter female genitalia. We offer a revised categorisation for non-therapeutic FGA that groups procedures by effect and not by process. Acceptance of de minimis procedures that generally do not carry long-term medical risks is culturally sensitive, does not discriminate on the basis of gender, and does not violate human rights. More morbid procedures should not be performed. However, accepting de minimis non-therapeutic f FGA procedures enhances the effort of compassionate practitioners searching for a compromise position that respects cultural differences but protects the health of their patients.

Connecting the East and the West, the Local and the Universal: The Methodological Elements of a Transcultural Approach to Bioethics

From the outset, cross-cultural and transglobal bioethics has constituted a potent arena for a dynamic public discourse and academic debate alike. But prominent bioethical debates on such issues as the notion of common morality and a distinctive "Asian" bioethics in contrast to a "Western" one reveal some deeply rooted and still popular but seriously problematic methodological habits in approaching cultural differences, most notably, radically dichotomizing the East and the West, the local and the universal. In this paper, a "transcultural" approach to bioethics and cultural studies is proposed. It takes seriously the challenges offered by social sciences, anthropology in particular, towards the development of new methodologies for comparative and global bioethics. The key methodological elements of "transculturalism" include acknowledging the great internal plurality within every culture; highlighting the complexity of cultural differences; upholding the primacy of morality; incorporating a reflexive theory of social power; and promoting changes or progress towards shared and sometimes new moral values.