Publications by authors named "Giuseppe Schiavone"

19 Publications

  • Page 1 of 1

MRI-Compatible and Conformal Electrocorticography Grids for Translational Research.

Adv Sci (Weinh) 2021 05 8;8(9):2003761. Epub 2021 Mar 8.

Bertarelli Foundation Chair in Neuroprosthetic Technology Laboratory for Soft Bioelectronic Interfaces Institute of Microengineering Institute of Bioengineering Center for Neuroprosthetics Ecole Polytechnique Fédérale de Lausanne (EPFL) Geneva 1202 Switzerland.

Intraoperative electrocorticography (ECoG) captures neural information from the surface of the cerebral cortex during surgeries such as resections for intractable epilepsy and tumors. Current clinical ECoG grids come in evenly spaced, millimeter-sized electrodes embedded in silicone rubber. Their mechanical rigidity and fixed electrode spatial resolution are common shortcomings reported by the surgical teams. Here, advances in soft neurotechnology are leveraged to manufacture conformable subdural, thin-film ECoG grids, and evaluate their suitability for translational research. Soft grids with 0.2 to 10 mm electrode pitch and diameter are embedded in 150 µm silicone membranes. The soft grids are compatible with surgical handling and can be folded to safely interface hidden cerebral surface such as the Sylvian fold in human cadaveric models. It is found that the thin-film conductor grids do not generate diagnostic-impeding imaging artefacts (<1 mm) nor adverse local heating within a standard 3T clinical magnetic resonance imaging scanner. Next, the ability of the soft grids to record subdural neural activity in minipigs acutely and two weeks postimplantation is validated. Taken together, these results suggest a promising future alternative to current stiff electrodes and may enable the future adoption of soft ECoG grids in translational research and ultimately in clinical settings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/advs.202003761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8097365PMC
May 2021

Dimensional scaling of thin-film stimulation electrode systems in translational research.

J Neural Eng 2021 05 13;18(4). Epub 2021 May 13.

Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, 1202 Geneva, Switzerland.

Electrical stimulation of biological tissue is an established technique in research and clinical practice that uses implanted electrodes to deliver electrical pulses for a variety of therapies. Significant research currently explores new electrode system technologies and stimulation protocols in preclinical models, aiming at both improving the electrode performance and confirming therapeutic efficacy. Assessing the scalability of newly proposed electrode technology and their use for tissue stimulation remains, however, an open question.We propose a simplified electrical model that formalizes the dimensional scaling of stimulation electrode systems. We use established equations describing the electrode impedance, and apply them to the case of stimulation electrodes driven by a voltage-capped pulse generator.We find a hard, intrinsic upward scalability limit to the electrode radius that largely depends on the conductor technology. We finally provide a simple analytical formula predicting the maximum size of a stimulation electrode as a function of the stimulation parameters and conductor resistance.Our results highlight the importance of careful geometrical and electrical designs of electrode systems based on novel thin-film technologies and that become particularly relevant for their translational implementation with electrode geometries approaching clinical human size electrodes and interfacing with voltage-capped neurostimulation systems.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1088/1741-2552/abf607DOI Listing
May 2021

Neuroprosthetic baroreflex controls haemodynamics after spinal cord injury.

Nature 2021 02 27;590(7845):308-314. Epub 2021 Jan 27.

Motac Neuroscience Ltd, Manchester, UK.

Spinal cord injury (SCI) induces haemodynamic instability that threatens survival, impairs neurological recovery, increases the risk of cardiovascular disease, and reduces quality of life. Haemodynamic instability in this context is due to the interruption of supraspinal efferent commands to sympathetic circuits located in the spinal cord, which prevents the natural baroreflex from controlling these circuits to adjust peripheral vascular resistance. Epidural electrical stimulation (EES) of the spinal cord has been shown to compensate for interrupted supraspinal commands to motor circuits below the injury, and restored walking after paralysis. Here, we leveraged these concepts to develop EES protocols that restored haemodynamic stability after SCI. We established a preclinical model that enabled us to dissect the topology and dynamics of the sympathetic circuits, and to understand how EES can engage these circuits. We incorporated these spatial and temporal features into stimulation protocols to conceive a clinical-grade biomimetic haemodynamic regulator that operates in a closed loop. This 'neuroprosthetic baroreflex' controlled haemodynamics for extended periods of time in rodents, non-human primates and humans, after both acute and chronic SCI. We will now conduct clinical trials to turn the neuroprosthetic baroreflex into a commonly available therapy for people with SCI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41586-020-03180-wDOI Listing
February 2021

Recruitment of upper-limb motoneurons with epidural electrical stimulation of the cervical spinal cord.

Nat Commun 2021 01 19;12(1):435. Epub 2021 Jan 19.

Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.

Epidural electrical stimulation (EES) of lumbosacral sensorimotor circuits improves leg motor control in animals and humans with spinal cord injury (SCI). Upper-limb motor control involves similar circuits, located in the cervical spinal cord, suggesting that EES could also improve arm and hand movements after quadriplegia. However, the ability of cervical EES to selectively modulate specific upper-limb motor nuclei remains unclear. Here, we combined a computational model of the cervical spinal cord with experiments in macaque monkeys to explore the mechanisms of upper-limb motoneuron recruitment with EES and characterize the selectivity of cervical interfaces. We show that lateral electrodes produce a segmental recruitment of arm motoneurons mediated by the direct activation of sensory afferents, and that muscle responses to EES are modulated during movement. Intraoperative recordings suggested similar properties in humans at rest. These modelling and experimental results can be applied for the development of neurotechnologies designed for the improvement of arm and hand control in humans with quadriplegia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41467-020-20703-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7815834PMC
January 2021

Guidelines to Study and Develop Soft Electrode Systems for Neural Stimulation.

Neuron 2020 10;108(2):238-258

Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, 1202 Geneva, Switzerland. Electronic address:

Electrical stimulation of nervous structures is a widely used experimental and clinical method to probe neural circuits, perform diagnostics, or treat neurological disorders. The recent introduction of soft materials to design electrodes that conform to and mimic neural tissue led to neural interfaces with improved functionality and biointegration. The shift from stiff to soft electrode materials requires adaptation of the models and characterization methods to understand and predict electrode performance. This guideline aims at providing (1) an overview of the most common techniques to test soft electrodes in vitro and in vivo; (2) a step-by-step design of a complete study protocol, from the lab bench to in vivo experiments; (3) a case study illustrating the characterization of soft spinal electrodes in rodents; and (4) examples of how interpreting characterization data can inform experimental decisions. Comprehensive characterization is paramount to advancing soft neurotechnology that meets the requisites for long-term functionality in vivo.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.neuron.2020.10.010DOI Listing
October 2020

Structured nanoscale metallic glass fibres with extreme aspect ratios.

Nat Nanotechnol 2020 10 3;15(10):875-882. Epub 2020 Aug 3.

Laboratory of Photonic Materials and Fibre Devices (FIMAP), Institute of Materials, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.

Micro- and nanoscale metallic glasses offer exciting opportunities for both fundamental research and applications in healthcare, micro-engineering, optics and electronics. The scientific and technological challenges associated with the fabrication and utilization of nanoscale metallic glasses, however, remain unresolved. Here, we present a simple and scalable approach for the fabrication of metallic glass fibres with nanoscale architectures based on their thermal co-drawing within a polymer matrix with matched rheological properties. Our method yields well-ordered and uniform metallic glasses with controllable feature sizes down to a few tens of nanometres, and aspect ratios greater than 10. We combine fluid dynamics and advanced in situ transmission electron microscopy analysis to elucidate the interplay between fluid instability and crystallization kinetics that determines the achievable feature sizes. Our approach yields complex fibre architectures that, combined with other functional materials, enable new advanced all-in-fibre devices. We demonstrate in particular an implantable metallic glass-based fibre probe tested in vivo for a stable brain-machine interface that paves the way towards innovative high-performance and multifunctional neuro-probes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41565-020-0747-9DOI Listing
October 2020

Soft, Implantable Bioelectronic Interfaces for Translational Research.

Adv Mater 2020 Apr 16;32(17):e1906512. Epub 2020 Mar 16.

Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, Geneva, 1202, Switzerland.

The convergence of materials science, electronics, and biology, namely bioelectronic interfaces, leads novel and precise communication with biological tissue, particularly with the nervous system. However, the translation of lab-based innovation toward clinical use calls for further advances in materials, manufacturing and characterization paradigms, and design rules. Herein, a translational framework engineered to accelerate the deployment of microfabricated interfaces for translational research is proposed and applied to the soft neurotechnology called electronic dura mater, e-dura. Anatomy, implant function, and surgical procedure guide the system design. A high-yield, silicone-on-silicon wafer process is developed to ensure reproducible characteristics of the electrodes. A biomimetic multimodal platform that replicates surgical insertion in an anatomy-based model applies physiological movement, emulates therapeutic use of the electrodes, and enables advanced validation and rapid optimization in vitro of the implants. Functionality of scaled e-dura is confirmed in nonhuman primates, where epidural neuromodulation of the spinal cord activates selective groups of muscles in the upper limbs with unmet precision. Performance stability is controlled over 6 weeks in vivo. The synergistic steps of design, fabrication, and biomimetic in vitro validation and in vivo evaluation in translational animal models are of general applicability and answer needs in multiple bioelectronic designs and medical technologies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/adma.201906512DOI Listing
April 2020

Conformable Hybrid Systems for Implantable Bioelectronic Interfaces.

Adv Mater 2020 Apr 14;32(15):e1903904. Epub 2019 Oct 14.

Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronic Interfaces, Institute of Microengineering, Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, 1202, Geneva, Switzerland.

Conformable bioelectronic systems are promising tools that may aid the understanding of diseases, alleviate pathological symptoms such as chronic pain, heart arrhythmia, and dysfunctions, and assist in reversing conditions such as deafness, blindness, and paralysis. Combining reduced invasiveness with advanced electronic functions, hybrid bioelectronic systems have evolved tremendously in the last decade, pushed by progress in materials science, micro- and nanofabrication, system assembly and packaging, and biomedical engineering. Hybrid integration refers here to a technological approach to embed within mechanically compliant carrier substrates electronic components and circuits prepared with traditional electronic materials. This combination leverages mechanical and electronic performance of polymer substrates and device materials, respectively, and offers many opportunities for man-made systems to communicate with the body with unmet precision. However, trade-offs between materials selection, manufacturing processes, resolution, electrical function, mechanical integrity, biointegration, and reliability should be considered. Herein, prominent trends in manufacturing conformable hybrid systems are analyzed and key design, function, and validation principles are outlined together with the remaining challenges to produce reliable conformable, hybrid bioelectronic systems.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/adma.201903904DOI Listing
April 2020

Conformable bioelectronic interfaces: Mapping the road ahead.

Sci Transl Med 2019 07;11(503)

Bertarelli Foundation Chair in Neuroprosthetic Technology, Laboratory for Soft Bioelectronics Interface, Institute of Microengineering, Institute of Bioengineering, Centre for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne, 1202 Geneva, Switzerland

Translating conformable bioelectronic interface research into clinical reality foretells a promising future for an aging society.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1126/scitranslmed.aaw5858DOI Listing
July 2019

Long-term functionality of a soft electrode array for epidural spinal cord stimulation in a minipig model.

Annu Int Conf IEEE Eng Med Biol Soc 2018 Jul;2018:1432-1435

Long-term biointegration of man-made neural interfaces is influenced by the mechanical properties of the implant materials. Substantial experimental work currently aims at replacing conventional hard implant materials with soft alternatives that can favour a lower immune response. Here we assess the performance of a soft electrode array implanted in the spinal epidural space of a minipig model for a period of 6 months. The electrode array includes platinum-silicone electrode contacts and elastic thin-film gold interconnects embedded in silicone. textbfIn-vivo electrode impedance and voltage transients were monitored over time. Following implantation, epidural stimulation produced muscle-specific evoked potentials and visible muscle contractions. Over time, postoperative and stimulation induced changes in electrode impedance were observed. Such trends provide a basis for future technological improvements aiming at ensuring the stability of soft implantable electrodes for neural interfacing.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1109/EMBC.2018.8512584DOI Listing
July 2018

Selective Recruitment of Arm Motoneurons in Nonhuman Primates Using Epidural Electrical Stimulation of the Cervical Spinal Cord.

Annu Int Conf IEEE Eng Med Biol Soc 2018 Jul;2018:1424-1427

Recovery of reaching and grasping ability is the priority for people with cervical spinal cord injury (SCI). Epidural electrical stimulation (EES) has shown promising results in improving motor control after SCI in various animal models and in humans. Notably, the application of stimulation bursts with spatiotemporal sequences that reproduce the natural activation of motoneurons restored skilled leg movements in rodent and nonhuman primate models of SCI. Here, we studied whether this conceptual framework could be transferred to the design of cervical EES protocols for the recovery of reaching and grasping in nonhuman primates. We recorded muscle activity during a reaching and grasping task in a macaque monkey and found that this task involves a stereotypical spatiotemporal map of motoneuron activation. We then characterized the specificity of a spinal implant for the delivery of EES to cervical spinal segments in the same animal. Finally, we combined these results to design a simple stimulation protocol that may reproduce natural motoneuron activation and thus facilitate upper limb movements after injury.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1109/EMBC.2018.8512554DOI Listing
July 2018

Integration of Electrodeposited Ni-Fe in MEMS with Low-Temperature Deposition and Etch Processes.

Materials (Basel) 2017 Mar 22;10(3). Epub 2017 Mar 22.

SMC, School of Engineering, University of Edinburgh, Edinburgh EH9 3FF, UK.

This article presents a set of low-temperature deposition and etching processes for the integration of electrochemically deposited Ni-Fe alloys in complex magnetic microelectromechanical systems, as Ni-Fe is known to suffer from detrimental stress development when subjected to excessive thermal loads. A selective etch process is reported which enables the copper seed layer used for electrodeposition to be removed while preserving the integrity of Ni-Fe. In addition, a low temperature deposition and surface micromachining process is presented in which silicon dioxide and silicon nitride are used, respectively, as sacrificial material and structural dielectric. The sacrificial layer can be patterned and removed by wet buffered oxide etch or vapour HF etching. The reported methods limit the thermal budget and minimise the stress development in Ni-Fe. This combination of techniques represents an advance towards the reliable integration of Ni-Fe components in complex surface micromachined magnetic MEMS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ma10030323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503316PMC
March 2017

Intraoperative Ultrasound-Guided Resection of Gliomas: A Meta-Analysis and Review of the Literature.

World Neurosurg 2016 Aug 10;92:255-263. Epub 2016 May 10.

Department of Neurosurgery, University of Dundee and Ninewells Hospital, Dundee, United Kingdom. Electronic address:

Background: Image-guided surgery has become standard practice during surgical resection, using preoperative magnetic resonance imaging. Intraoperative ultrasound (IoUS) has attracted interest because of its perceived safety, portability, and real-time imaging. This report is a meta-analysis of intraoperative ultrasound in gliomas.

Methods: Critical literature review and meta-analyses, using the MEDLINE/PubMed service. The list of references in each article was double-checked for any missing references. We included all studies that reported the use of ultrasound to guide glioma-surgery. The meta-analyses were conducted according to statistical heterogeneity between the studies using Open MetaAnalyst Software. If there was no heterogeneity, fixed effects model was used for meta-analysis; otherwise, a random effect model was used. Statistical heterogeneity was explored by χ(2) and inconsistency (I(2)) statistics; an I(2) value of 50% or more represented substantial heterogeneity.

Results: A wide search yielded 19,109 studies that might be relevant, of which 4819 were ultrasound in neurosurgery; 756 studies used ultrasound in cranial surgery, of which 24 studies used intraoperative ultrasound to guide surgical resection and 74 studies used it to guide biopsy. Fifteen studies fulfilled our stringent inclusion criteria, giving a total of 739 patients. The estimated average gross total resection rate was 77%. Furthermore, the relationship between extent of surgical resection and study population was not linear. Gross total resection was more likely under IoUS when the lesion was solitary and subcortical, with no history of surgery or radiotherapy. IoUS image quality, sensitivity, specificity, and positive and negative predictive values deteriorated as surgical resection proceeded.

Conclusion: IoUS-guided surgical resection of gliomas is a useful tool for guiding the resection and for improving the extent of resection. IoUS can be used in conjunction with other complementary technologies that can improve anatomic orientation during surgery. Real-time imaging, improved image quality, small probe sizes, repeatability, portability, and relatively low cost make IoUS a realistic, cost-effective tool that complements any existing tools in any neurosurgical operating environment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2016.05.007DOI Listing
August 2016

Dual Orientation 16-MHz Single-Element Ultrasound Needle Transducers for Image-Guided Neurosurgical Intervention.

IEEE Trans Ultrason Ferroelectr Freq Control 2016 Feb 8;63(2):233-44. Epub 2015 Dec 8.

Image-guided surgery is today considered to be of significant importance in neurosurgical applications. However, one of its major shortcomings is its reliance on preoperative image data, which does not account for brain deformations and displacements that occur during surgery. In this work, we propose to tackle this issue through the incorporation of an ultrasound device within the type of biopsy needles commonly used as an interventional tool to provide immediate feedback to neurosurgeons during surgical procedures. To identify the most appropriate path to access a targeted tissue site, single-element transducers that look either forward or sideways have been designed and fabricated. Micromolded 1-3 piezocomposites were adopted as the active materials for feasibility tests and epoxy lenses have been applied to focus the ultrasound beam. Electrical impedance analysis, pulse-echo testing, and wire phantom scanning have been carried out, demonstrating the functionality of the needle transducers at [Formula: see text]. The capabilities of these transducers for intraoperative image guidance were demonstrated by imaging within soft-embalmed cadaveric human brain and fresh porcine brain.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1109/TUFFC.2015.2506611DOI Listing
February 2016

Epistocracy for online deliberative bioethics.

Camb Q Healthc Ethics 2015 Jul;24(3):272-80

The suggestion that deliberative democratic approaches would suit the management of bioethical policymaking in democratic pluralistic societies has triggered what has been called the "deliberative turn" in health policy and bioethics. Most of the empirical work in this area has focused on the allocation of healthcare resources and priority setting at the local or national level. The variety of the more or less articulated theoretical efforts behind such initiatives is remarkable and has been accompanied, to date, by an overall lack of method specificity. We propose a set of methodological requirements for online deliberative procedures for bioethics. We provide a theoretical motivation for these requirements. In particular, we discuss and adapt an "epistocratic" proposal and argue that, regardless of its merits as a general political theory, a more refined version of its normative claims can generate a useful framework for the design of bioethical forums that combine maximal inclusiveness with informed and reasonable deliberation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S0963180114000590DOI Listing
July 2015

Libertarian paternalism and health care policy: a deliberative proposal.

Med Health Care Philos 2014 Feb;17(1):103-13

European Institute of Oncology (IEO), Via Adamello 16, 20139, Milan, Italy,

Cass Sunstein and Richard Thaler have been arguing for what they named libertarian paternalism (henceforth LP). Their proposal generated extensive debate as to how and whether LP might lead down a full-blown paternalistic slippery slope. LP has the indubitable merit of having hardwired the best of the empirical psychological and sociological evidence into public and private policy making. It is unclear, though, to what extent the implementation of policies so constructed could enhance the capability for the exercise of an autonomous citizenship. Sunstein and Thaler submit it that in most of the cases in which one is confronted with a set of choices, some default option must be picked out. In those cases whoever devises the features of the set of options ought to rank them according to the moral principle of non-maleficence and possibly to that of beneficence. In this paper we argue that LP can be better implemented if there is a preliminary deliberative debate among the stakeholders that elicits their preferences, and makes it possible to rationally defend them.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11019-013-9502-4DOI Listing
February 2014

Constructing the Medical Humanities gaze.

Crit Rev Oncol Hematol 2012 Dec;84 Suppl 2:S5-10

SEMM-European School of Molecular Medicine & IEO-European Institute of Oncology, Via Adamello 16, 20139 Milan, Italy.

In the last few decades genomics has completely reshaped the way in which patients and physicians experience and make sense of illness. In this paper we build upon a real case - namely that of breast cancer genetic testing - in order to point to the shortcomings of the paradigm currently driving healthcare delivery. In particular, we put forward a viable analytical model for the construction of a proper decisional process broadening the scope of medical gaze onto human experience of illness. This model revolves around four main conceptual axes: (i) communicating information; (ii) informing decisions; (iii) respecting narratives; (iv) empowering decision-making. These four kernels, we argue, map precisely onto the main pitfalls of the model presently dealing with genetic testing provision. Medical Humanities, we conclude, ought to play a pivotal role in constructing the environment for competent decision-making, autonomous self-determination and respectful narritivization of one's own life.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/S1040-8428(13)70003-9DOI Listing
December 2012

Mechanistic understanding in clinical practice: complementing evidence-based medicine with personalized medicine.

J Eval Clin Pract 2012 Oct;18(5):1000-5

European School of Molecular Medicine, Milano, Italy.

In the last century, medicine has undergone an unprecedented wave of radical changes. From the implementation of surgery up to the development of single gene-targeted therapies, clinical decision making has become increasingly complex to handle. Today, this complexity needs to be rethought in the light of two emerging paradigms: evidence-based medicine (EBM) and personalized medicine (P-Med). The new availability of diverse sources of scientific evidence raises significant issues concerning how clinicians will compare, evaluate and orient their decisions in front of a rapidly growing plethora of therapies, procedures, medical technologies and drugs. In this paper, we compare the background visions behind these two paradigms, evaluating their respective relevance for present and future clinical decision making. In particular, we argue that EBM and P-Med are driven by two diverse modes of reasoning about 'evidence making' in medicine. EBM is grounded on statistical notions and epidemiological data, generally gathered through systematic meta-reviews of randomized controlled trials; P-Med, instead, is grounded on mechanistic explanations of molecular interactions, metabolic pathways and biomarkers. While both paradigms are epistemically sound, we argue that they cannot, and should not, be hybridized into a unique model. Rather, they ought to represent two compatible, but alternative ways of informing the clinical practice. Hence, we conclude that clinicians may expect to see their responsibility increasing as they will deal with diverse, but equally compelling, ways of reasoning and deciding about which intervention will qualify as the 'best one' in each individual case.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1365-2753.2012.01907.xDOI Listing
October 2012

What autonomy for telecare? An externalist approach.

Am J Bioeth 2012 ;12(9):55-7

European School of Molecular Medicine, Milano, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/15265161.2012.699150DOI Listing
November 2012