Mirror-view reverses somatoparaphrenia: dissociation between first- and third-person perspectives on body ownership

Right-hemisphere stroke can lead to the somatoparaphrenic delusion that parts of one's own body belong to someone else. To our knowledge, no previous study has experimentally assessed the sense of body part ownership in somatoparaphrenic patients when they see the body from a third-person perspective, as in a mirror. In alternating trials, we provided either direct first-person perspective vision of the arms, or indirect third-person perspective vision via a mirror in the frontal plane. We tested body ownership in these conditions in five patients with right-hemisphere lesions with left hemiplegia and neglect, including two patients with this somatoparaphrenic delusion. The somatoparaphrenic patients systematically attributed the ownership of their left plegic hands to someone else in direct view, but showed a statistically significant increase in ownership of the left hand in mirror view trials, as compared with the three control patients. Depending on the view offered (mirror or direct), judgements of ownership and disownership of the same limb could alternate within a few seconds. The patients did not particularly remark on these dramatic and repeated alterations between ownership and disownership. Conditions of direct- and mirror-view with simultaneous touch of the hand by the experimenter showed the same patterns of results as conditions without touch. This study provides the first experimental evidence that limb disownership can be altered using self-observation in a mirror, and in turn suggests dissociation between first- and third-person visual perspectives on the body. Furthermore, the fact that reinstatement of ownership by third-person perspective did not permanently abolish somatoparaphrenia suggests that the subjective sense of body ownership remained dominated by an impaired first-person representation of the body that could not be updated, nor integrated with other signals. More generally, our findings suggest that a neural network involving the perisylvian areas of the right hemisphere may be necessary for the integration of multiple representations of one's body and for a higher order re-representation of various bodily signals into a first-person sense of body ownership. We suggest that other areas, possibly including the occipital cortex, may be involved in the recognition of the body from a third-person visual perspective. We thus propose that somatoparaphrenia can be regarded as a neurogenic dissociation between the ‘subjectively felt’ and ‘objectively seen’ body. This recalls the developmental finding that young infants cannot link their ‘felt body’ with the view of themselves in a mirror.     

Welfare reform, labor supply, and health insurance in the immigrant population

Although the 1996 welfare reform legislation limited the eligibility of immigrant households to receive assistance, many states chose to protect their immigrant populations by offering state-funded aid to these groups. I exploit these changes in eligibility rules to examine the link between the welfare cutbacks and health insurance coverage in the immigrant population. The data reveal that the cutbacks in the Medicaid program did not reduce health insurance coverage rates among targeted immigrants. The immigrants responded by increasing their labor supply, thereby raising the probability of being covered by employer-sponsored health insurance.     

Solidarity and the Role of the State in Italian Health Care

The article deals with the issue of solidarity in health care,with particular reference to the Italian context. It presents thedifficulties of the Italian NHS and assesses the current proposalto counter the crisis of the Welfare State by giving upinstitutional arrangements, in order to favour the so-called`social private'. Moreover, it addresses the question ofprioritisation and targeting in the context of health care,arguing for the insufficiency of the standard approach of neutralliberalism, and showing how the concept of solidarity might helpto develop a different account. Lastly, it discusses the case oforgan transplantion in Italy, as an example ofsolidarity-inspired health care policy.     

Pay equity and nursing in Ontario: ten years later

Abstract
'Nurses have never been compensated in accordance with their central role in health care' ( Schreiber 1994 ), reflecting the generalized and well-documented under-valuing of the work of women ( Schreiber 1993 ). Pay equity legislation, passed in Ontario, Canada in 1987, designed to correct gender wage discrimination, created great optimism that the under-valuing of nurses' work might be ending. Nonetheless, this has not been the case, as the social, political, and economic climate has not kept pace with the speed and enormity of social change necessary to enact the intent of the legislation. Indeed, gains in nurses' wages have been directly offset by significant lay-offs. In this paper, we examine the issues surrounding the implementation of pay equity legislation in Ontario, Canada, along with analysis and implications of these issues, drawn from 10 years of experience. In addition, we highlight lessons that can be learned from the Ontario experience.     

Who “Owns” Cells and Tissues?

Opposition to `ownership' of cells and tissues often depends on arguments about the special or sacred nature of human bodies and other living things. Such arguments are not very helpful in dealing with the patenting of DNA fragments. Two arguments undergird support for patenting: the notion that an author has a `right' to an invention resulting from his/her labor, and the utilitarian argument that patents are needed to support medical inventiveness. The labor theory of ownership rights is subject to critique, though it may still have enduring value. The more important argument is that deriving from the common good. If patents on DNA are supported on the basis of their contributions to the common good, then they can also be limited based on considerations of the common good. This revised version was published online in July 2006 with corrections to the Cover Date.     

医疗卫生机构改制上市的策略

随着我国加入WTO在即,医疗市场将全面放开,我国的医疗卫生机构的管理者应当认清形势,采取相应策略,作者认为,有些医疗卫生构应当更新观念,逐步向医疗卫生服务产业化,集团化、多元化的远行机制转变,采用与资本市场有机结合,把高投入,规范化的融资手段引入,使医疗卫生机构获得超长发展,为此,医疗卫生机构产权应多元化,如医院集团、股份制、委托经营等,随后阐述了资本运营对医疗卫生机构机构股份制改制的促进作用,并就资本运营与医疗卫生机构改制和医疗卫生股票上市的程序进行了论述。     

马克思关于人类社会阶段“跨越”发展的辩证法

马克思曾设想俄国农村公社有可能跨越资本主义制度“卡夫丁峡谷”而直接进入共产主义社会。本文运用马克思主义理论辩证地阐述了人类社会实现跨越发展所必备的条件内在因素、外在条件、动力以及跨越的内容。     

Allergen avoidance does not alter airborne cat allergen levels in classrooms

BACKGROUND: Some schools in Sweden offer allergen avoidance classrooms for allergic children with severe asthma. However, the measures commonly used to achieve a reduction in allergen levels have not been properly evaluated. The aim of the present prospective study was to study whether the levels of airborne cat allergen are altered after introducing feasible intervention measures in classrooms, without interfering with peoples' freedom of choice regarding pet ownership. METHODS: Twenty-five classes, including five established allergy prevention classrooms participated in the study during a school year. After one term, six classes underwent a number of intervention measures recommended by the Swedish National Institute of Public Health. Curtains, upholstery and plants were removed, bookshelves were replaced with cupboards and regular cleaning was increased. Airborne dust was collected weekly (32 weeks) using duplicate Petri dishes (n = 1574) and on six occasions using two personal air samplers in each class (n = 264). RESULTS: Airborne cat allergen levels were showing a similar variability throughout the whole study in all classes. Despite extensive measures in order to reduce allergen exposure, cat allergen levels were unaltered in the six classes after intervention. Allergen levels were not significantly lower in the established allergy prevention classes, compared with the other classes. Cat allergen levels differed, however, significantly between classes with few and many cat owners (P < 0.05). CONCLUSIONS: We conclude that the recommended allergen avoidance measures used in this study did not reduce airborne cat allergen. It seems plausible that measures that fail to reduce allergen levels also fail to influence health status in allergic children but this remains to be shown.     

Stress and welfare: two complementary concepts that are intrinsically related to the animal's point of view

The closely associated concepts of welfare and stress may be considered as opposites since welfare cannot be achieved under stress and vice versa. Stress was first considered as an unspecific response to any challenge taxing the organism's resources where the HPA axis plays a central role [Selye H. A syndrome produced by diverse nocuous agents. Nature 1936:32]. Along the same lines, welfare was considered as the state of an individual on a continuum between poor and good depending on the efforts required to adapt to the environment [Broom DM. Animal welfare: concepts and measurement. J Anim Sci 1991;69:4167-75]. However, these views cannot explain opposite results such as up- vs. down-regulation of the HPA axis and hypo- vs. hyper-behavioural reactivity under chronic stress. Later, it was shown that aversive situations trigger stress responses only if the individual perceives them as aversive. Mason [Mason JW. A re-evaluation of the concept of 'non-specificity' in stress theory. J Psychiatr Res 1971;8:323-33] suggested that the unspecificity of stress responses originates from a common emotion that produces them. Welfare has also been defined in terms of emotional states by Dawkins [Dawkins MS. Animal suffering, the science of animal welfare. London: Chapman and Hall Ltd.; 1980] and Duncan [Duncan IJH. Welfare is to do with what animals feel. J Agric Environ Ethics 1993;6:8-14]. Hence, both concepts are linked to mental states. Recent advances in psychology suggest that the very nature of an emotion results from a series of evaluations of the triggering situation that the individual makes based on criteria including novelty, predictability, controllability, and others [Scherer KR. Appraisal considered as a process of multi-level sequential checking. In: Scherer KR, Schorr A, Johnstone T, editors. Appraisal processes in emotion: theory, methods, research. New York: Oxford University Press; 2001. p. 92-120]. It is therefore suggested that the discrepancies found in the literature in terms of responses of the HPA axis or modification of behaviour under aversive conditions may stem from differences in the way a situation is evaluated. It is argued that stress comes from the animal's evaluation of the outcome of a situation, and that welfare is the state resulting from that evaluation.     

Policy incongruence and public health professionals' dissonance: the case of immigrants and welfare policy

The steady increase in immigrants to the United States has fueled a critical analysis of the process of allocation of health and social benefits to these newcomers. The myriad of interests and values surrounding this issue precipitated the formulation and adoption of the Personal Responsibility and Work Opportunity (Welfare Reform) Act of 1996. This dramatic welfare reform impacts federal, state, and local agencies that are required to determine the eligibility of benefits and manage the attendant consequences to the public as well as members of this vulnerable group. Especially challenging are the decisions confronting public health professionals who struggle to reconcile the resulting policy, programmatic mandates, and compliance imperatives with prevailing public health principles and practice norms. This paper proposes a framework for understanding the incongruence between the provisions of the law as it pertains to legal and illegal immigrants and public health values. The impact of policy incongruence and professionals' dissonance on public health practice norms is explored with an explicit focus on public health outcomes and legal implications. The examination of tuberculosis as a health example reveals the policy conflicts and public health dilemmas. Finally, the paper elicits a range of options available to public professionals for responding to these legal mandates.