The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient (...) data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use. (shrink)

Background: In response to the pandemic caused by COVID-19, World Health Organization (WHO), together with International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), developed research protocols facilitating global collaboration and accelerating the understanding of the disease, to identify the potential symptoms and persistent sequelae in infected individuals, which can be used in different areas of health, that is, in primary care, at a hospital or outpatient level, both public and private. Objective: To describe the International Severe Acute Respiratory (...) and Emerging Infection Consortium (ISARIC) protocol as a new global collaborative platform for global clinical trials targeting post-COVID-19 patients. Methods: The standardized forms were developed from the COVID-19 Clinical Characterization Protocol (PCC) by the ISARIC/WHO working group composed of specialist researchers with experience in clinical research in different areas of medicine and public health, especially outbreaks and infectious diseases. Conclusion: It is expected that the creation of a database composed of different populations from all over the world will help in the characterization of risk factors, in the best form of clinical intervention and in the best prevention strategies for physical, neurological and psychosocial sequelae in the medium and long term in post-COVID-19 patients. (shrink)

Psychopathy, which is characterized by a constellation of antisocial behavioral traits, may be subdivided on the basis of etiology: “primary” (low-anxious) psychopathy is viewed as a direct consequence of some core intrinsic deficit, whereas “secondary” (high-anxious) psychopathy is viewed as an indirect consequence of environmental factors or other psychopathology. Theories on the neurobiology of psychopathy have targeted dysfunction within ventromedial prefrontal cortex (vmPFC) as a putative mechanism, yet the relationship between vmPFC function and psychopathy subtype has not been fully explored. (...) In this study, we administered two laboratory decision-making tasks (the Ultimatum Game and the Dictator Game) to a group of prisoners (n=47) to determine whether the different subtypes of psychopathy (primary vs. secondary) are associated with characteristic patterns of economic decision-making, and furthermore, whether either subtype exhibits similar performance to patients with vmPFC lesions. Comparing primary psychopaths (n=6) to secondary psychopaths (n=6) and non-psychopaths (n=22), we found that primary psychopathy was associated with significantly lower acceptance rates of unfair Ultimatum offers and lower offer amounts in the Dictator Game. Moreover, primary psychopaths were quantitatively similar to vmPFC lesion patients in their response patterns. These results support the purported connection between psychopathy and vmPFC dysfunction, bolster the distinction between primary and secondary psychopathy, and demonstrate the utility of laboratory economic decision-making tests in differentiating clinical subgroups. (shrink)

Why are some people capable of sympathizing with and/or committing acts of political violence, such as attacks aimed at innocent targets? Attempts to construct terrorist profiles based on individual and situational factors, such as clinical, psychological, ethnic, and socio-demographic variables, have largely failed. Although individual and situational factors must be at work, it is clear that they alone cannot explain how certain individuals are radicalized. In this paper, we propose that a comprehensive understanding of radicalization and of how it (...) may lead to political violence requires the integration of information across multiple levels of analysis and interdisciplinary perspectives from evolutionary theory, social, personality and cognitive psychology, political science and neuroscience. Characterization of the structural-functional relationships between neural mechanisms and the cognitive and affective psychological processes that underpin group dynamics, interpersonal processes, values and narratives, as well as micro-sociological processes may reveal latent drivers of radicalization and explain why some people turn to extreme political violence. These drivers may not be observable within a single individual level of scientific enquiry. The integrative, multilevel approach that characterizes social neuroscience has the potential to provide theoretical and empirical clarity regarding the antecedents of radicalization and support for extreme violence. (shrink)

A well known and referenced global result is the nilpotent characterisation of the finite p-groups. This un doubtedly transends into neutrosophy. Hence, this fact of the neutrosophic nilpotent p-groups is worth critical studying and comprehensive analysis. The nilpotent characterisation depicts that there exists a derived series (Lower Central) which must terminate at {ϵ} (an identity), after a finite number of steps. Now, Suppose that G(I) is a neutrosophic p-group of class at least m ≥ 3. We show in this (...) paper that Lm−1(G(I)) is abelian and hence G(I) possesses a characteristic abelian neutrosophic subgroup which is not supposed to be contained in Z(G(I)). Furthermore, If L3(G(I)) = 1 such that pm is the highest order of an element of G(I)/L2(G(I)) (where G(I) is any neutrosophic p-group) then no element of L2(G(I)) has an order higher than pm. (shrink)

Reflecting on group theory within clinical supervision offers useful vantage points from which to engage nursing and the helping professions in the task of supervisory practice. This paper presents reflective experiences of group clinical supervision training and practice through a critique of Hawkins and Shohet’s process centred model. The underlying premise of transference hypothesis is that experiences and memories from the past inform present behaviours. Little has been written about the hypothesis in relation to clinical (...) supervision in nursing and the helping professions. However, the hypothesis was criticised by John M. Shlien in the 1980s and remains pertinent today due to expansion into social and healthcare practice. Reflective autobiographical diary entries focus on the model’s two latter stages which propose the use of Sigmund Freud’s transference hypothesis. The work of Freud, Foulkes, Heidegger and Hawkins and Shohet are synthesised and conclude with a phenomenological suggestion that immediacy and openness are necessary ontological conditions for group clinical supervision. Valuing empathic attunement to better understand group clinical supervision may be more important than theoretical distractions for non-therapeutic clinical supervision practice. (shrink)

I argue that generic generalizations expressed in language (i.e. ‘generics’) are apt for clinical reasoning. I introduce generics and describe two problems in the use and interpretation of generics: Generics may license inaccurate judgements about the frequency of events or properties within a group (i.e. a problem with the ‘truth-aptness’ of generics) and may facilitate problematic beliefs about social kinds (e.g. prejudice or essentializing). I provide an account of clinical reasoning and describe some features of what I (...) call ‘good’ clinical reasoning. I offer examples of generics in clinical contexts and examine how the two problems with generics (i.e. of truth-aptness and social generics) can harm patients and impair clinical reasoning. However, I ultimately argue that generics are important for good clinical reasoning because they track ‘conspicuous’ features of disease processes (e.g. severe possible outcomes). Further, I argue that prejudicial generics are often irrational to believe. Social generics that are rational to believe need not lead to problematic implicatures about social kinds and can instead facilitate meaningfully articulating societal injustices. I then argue that statistical statements, which are tempting alternatives to generics in clinical reasoning, are no better than generics for good clinical reasoning. (shrink)

The principle of clinical equipoise has been variously characterized by ethicists and clinicians as fundamentally flawed, a myth, and even a moral balm. Yet, the principle continues to be treated as the de facto gold standard for conducting randomized control trials in an ethical manner. Why do we hold on to clinical equipoise, despite its shortcomings being widely known and well-advertised? This paper reviews the most important arguments criticizing clinical equipoise as well as what the most prominent (...) proposed alternatives are. In the process, it evaluates the justification for continuing to use clinical equipoise as the gold standard for randomized control trials. (shrink)

An adequate semantics for generic sentences must stake out positions across a range of contested territory in philosophy and linguistics. For this reason the study of generic sentences is a venue for investigating different frameworks for understanding human rationality as manifested in linguistic phenomena such as quantification, classification of individuals under kinds, defeasible reasoning, and intensionality. Despite the wide variety of semantic theories developed for generic sentences, to date these theories have been almost universally model-theoretic and representational. This essay outlines (...) a range of proof-theoretic analyses for characterizing generics. Particular attention is given to an expressivist proof-theory that can be traced to 1) work on logical syntax that Carnap undertook prior to his turn toward truth-conditional model theory in the late 1930s, and 2) research on sequent calculi and natural deduction systems that originate in work from Gentzen and Prawitz.11 This essay offers a more precise exposition of some of the material discussed in the first two chapters of my dissertation (Stovall Citation2015a). These ideas developed in the context of a working group on non-monotonic logic run by Robert Brandom, and they were subsequently clarified through the work of Nissim Francez (particularly Francez Citation2015). I am indebted to many people for feedback and criticism on this essay, though I am sure none among them would agree with everything I say and do here. I would particularly like to thank Brandom, Francez, Ulf Hlobil, Daniel Kaplan, Jared Millson, Bernhard Nickel, Jaroslav Peregrin, Jeffry Pelletier, Thomas Ricketts, Mark Risjord, Shawn Standefer, and two reviewers for this journal. Work on this essay was supported by the joint Lead-Agency research grant between the Austrian Science Foundation (FWF) and the Czech Science Foundation (GAČR), Inferentialism and Collective Intentionality, GF17-33808L. It was substantially revised prior to its final submission. (shrink)

Background: The internationalization of clinical studies requires a shared understanding of the fundamental ethical values guiding clinical studies. It is important that these values are not only embraced at the legal level but also adopted by clinicians themselves during clinical studies. Objective: Our goal is to provide an insight on how clinicians in Germany and Poland perceive and identify the different ethical issues regarding informed consent in clinical studies. Methods: To gain an understanding of how clinicians (...) view clinical studies in the countries they work in, we carried out semi-structured problem-centered interviews per telephone in Poland (n = 6) and Germany (n = 6). Our interviewees concentrated on three main topics: an appraisal of the normative framework, challenges in the information process and the protection of all participants in clinical studies. Results: Clinicians generally supported the normative framework, even though they considered it quite complex. In the two study countries, a widely noted dilemma in the information process was whether to overburden participants with extensive information or risking leaving out important facts. Clinicians were ready to exclude larger population groups from participating in clinical studies when the information process could not be carried out with standard procedures or when their inclusion was ethically sensitive. Conclusion: Clinicians need to gain a better understanding of the consequences of excluding larger population groups form participating in clinical studies. They should seek assistance in improving the information process for the inclusion of underrepresented groups in clinical studies. (shrink)

This paper presents a systematic approach for analyzing and explaining the nature of social groups. I argue against prominent views that attempt to unify all social groups or to divide them into simple typologies. Instead I argue that social groups are enormously diverse, but show how we can investigate their natures nonetheless. I analyze social groups from a bottom-up perspective, constructing profiles of the metaphysical features of groups of specific kinds. We can characterize any given kind of social group (...) with four complementary profiles: its “construction” profile, its “extra essentials” profile, its “anchor” profile, and its “accident” profile. Together these provide a framework for understanding the nature of groups, help classify and categorize groups, and shed light on group agency. (shrink)

The volume of clinical research is increasing exponentially—far beyond our ability to process and absorb the results. Given this situation, it may be beneficial to consider reducing the flow at its source. In what follows, I will motivate and critically evaluate the following proposal: researchers should conduct fewer clinical trials. More specifically, I c onsider whether researchers should be permitted to conduct only clinical research of very high quality and, in turn, whether research ethics committees should prohibit (...) all other, lower-quality research, even when it might appear to meet some minimal ethical standard. Following a close analysis of the social-value requirement of ethical clinical research, I argue that this proposal is defensible. The problem identified in this paper has two parts, quantity and quality, and some clarification is needed about the latter because “quality” is a highly contested term in the medical literature. When some scholars advocate for high-quality trials, they mean large-scale, simple, explanatory randomized controlled trials. Others, including myself, have defended a different characterization of high-quality research that tends more toward pragmatic trial design and the use of methods other than RCTs. Pragmatic trials aim to provide evidence that directly supports clinical decision-making in “usual” care settings. Unlike explanatory trials, which aim to abstract away from particular settings and patients, in the hopes of creating ideal conditions for the success of an intervention, pragmatic trials deliberately pursue knowledge of high applicability, through the use of representative subjects, clinically important questions, flexible treatment protocols, patient-oriented outcome measures, and so on. I see applicability as a marker of high-quality research. The context in which research is meant to be applied should be the context in which new interventions are evaluated. (shrink)

I argue that propaganda does not characteristically interfere with individual rationality, but instead with group agency. Whereas it is often claimed that propaganda involves some sort of incitement to irrationality, I show that this is neither necessary nor sufficient for a case’s being one or propaganda. For instance, some propaganda constitutes evidence of the speaker’s power, or else of the risk and futility of opposing them, and there is nothing irrational about taking such evidence seriously. I outline an alternative (...) account of propaganda inspired by Hannah Arendt, on which propaganda characteristically creates or destroys group agency. One aspiring to control the public should have an interest in both creating and suppressing group agency, I argue, both because groups have capacities that individuals don’t, and because participation in group action can have a transformative effect upon the individual. Finally, I suggest that my characterization of propaganda suggests a vision of resistance to propaganda quite unlike the one that emerges from irrational-belief accounts, on which propaganda cannot be resisted by oneself. (shrink)

The chemical characterization of the substance responsible for the phenomenon of “transformation” of pneumococci was presented in the now famous 1944 paper by Avery, MacLeod, and McCarty. Reception of this work was mixed. Although interpreting their results as evidence that deoxyribonucleic acid (DNA) is the molecule responsible for genetic changes was, at the time, controversial, this paper has been retrospectively celebrated as providing such evidence. The mixed and changing assessment of the evidence presented in the paper was due to (...) the work’s interpretive flexibility – the evidence was interpreted in various ways, and such interpretations were justified given the neophytic state of molecular biology and methodological limitations of Avery’s transformation studies. I argue that the changing context in which the evidence presented by Avery’s group was interpreted partly explains the vicissitudes of the assessments of the evidence. Two less compelling explanations of the reception are a myth-making account and an appeal to the wartime historical context of its publication. (shrink)

Background Analysis of aphasic narratives can be a challenge for clinicians. Previous studies have mainly employed measures that categorized speech samples at the word level. They included quantification of the use and misuse of different word classes, presence and absence of narrative contents and errors, paraphasias, and perseverations, as well as morphological structures and errors within a narrative. In other words, a great amount of research has been conducted in the aphasiology literature focusing on micro-linguistic structures of oral narratives. Aspects (...) of macro- linguistic structures, such as the analysis of content information by a speaker, consistency of using cohesive devices to present information within a narrative, and order of presenting information necessary to form a coherent discourse, have not been extensively investigated. The current investigation proposes a clinical analytic system to target three aspects of macro-linguistic structures in narratives among speakers with aphasia. Specifically, (1) the presence of search events (i.e., the mentioning of key events that allow the listener to understand; Capilouto, Wright, &Wagovich, 2006) within a narrative, (2) the sequence of the mentioned events, and (3) the informativeness (i.e., the fulfillment of lexical items that allow the user to understand what the event is detailing) of the event contents, were focused in the proposed framework. Method Ten controls transcripts from were selected from the AphasiaBank (MacWhinney, Fromm, Forbes, & Holland, 2011). Three narrative tasks, including sequential picture description of ‘Refused Umbrella’, procedural narrative of making a ‘Peanut Butter and Jelly Sandwich’, and telling of ‘Cinderella’ story, were used to establish normative data for the basis of analysis. Specifically, the Search Events (e) and Informative Words (i) used by at least 70% of the speakers were listed for each genre. The sequential order of mentioning the Search Events, i.e., common order of events in 90% of the speakers, (s.total) was determined. Twelve speakers with aphasia (nine fluent and three non-fluent) were recruited and administered the Western Aphasia Battery and Object and Action Naming Battery. Their performance in the above three discourse tasks were orthographically transcribed and analyzed using the following measures: e.total, e.matched with norm, e.missed, e.irrlevant, e.extra, s.total, i.pb&j, i.umbr, i.cind, and i.total. Three samples were randomly chosen to be re-analyzed for inter- and intra-rater reliability. Results Results of an independent t-test suggested significant differences between the fluent and non-fluent subjects in sequential order of Search Events for all genres (s.total) and i.total, suggesting sensitivity of this framework to differentiate between the two fluency groups. Results of Pearson product-moment correlations revealed significant relation between Informative Words and WAB spontaneous speech scores, AQ, as well as OAB scores, for both aphasic groups. The mean value of coefficients for intra-rater reliability (0.992), with significant correlations on e.match, e.miss, and e.extra, was higher than that of inter-rater reliability (0.897). Discussion Based on our preliminary results, this objective framework allowed clinical evaluation of impairment in macro-linguistic structures present in aphasic discourse. Further extension should involve more subjects encompassing a wider range of severity with different types of aphasia. (shrink)

This paper is devoted to present Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method for multi-attribute group decision making under rough neutrosophic environment. The concept of rough neutrosophic set is a powerful mathematical tool to deal with uncertainty, indeterminacy and inconsistency. In this paper, a new approach for multi-attribute group decision making problems is proposed by extending the TOPSIS method under rough neutrosophic environment. Rough neutrosophic set is characterized by the upper and lower approximation operators (...) and the pair of neutrosophic sets that are characterized by truth-membership degree, indeterminacy membership degree, and falsity membership degree. In the decision situation, ratings of alternatives with respect to each attribute are characterized by rough neutrosophic sets that reflect the decision makers’ opinion. Rough neutrosophic weighted averaging operator has been used to aggregate the individual decision maker’s opinion into group opinion for rating the importance of attributes and alternatives. Finally, a numerical example has been provided to demonstrate the applicability and effectiveness of the proposed approach. (shrink)

This chapter provides a critical overview and interpretation of fair subject selection in clinical and social scientific research. It first provides an analytical framework for thinking about the problem of fair subject selection. It then argues that fair subject selection is best understood as a set of four subprinciples, each with normative force and each with distinct and often conflicting implications for the selection of participants: fair inclusion, fair burden sharing, fair opportunity, and fair distribution of third-party risks. It (...) then defends an approach to navigating the conflicting imperatives of these subprinciples, one which privileges the need to include epistemically distinct groups in research, before concluding by considering the most pressing research questions regarding fair subject selection. (shrink)

An important part of the Unified Medical Language System (UMLS) is its Semantic Network, consisting of 134 Semantic Types connected to each other by edges formed by one or more of 54 distinct Relation Types. This Network is however for many purposes overcomplex, and various groups have thus made attempts at simplification. Here we take this work further by simplifying the relations which involve the three Semantic Types – Diagnostic Procedure, Laboratory Procedure and Therapeutic or Preventive Procedure. We define operators (...) which can be used to generate terms instantiating types from this selected set when applied to terms designating certain other Semantic Types, including almost all the terms specifying clinical tasks. Usage of such operators thus provides a useful and economical way of specifying clinical tasks. The operators allow us to define a mapping between those types within the UMLS which do not represent clinical tasks and those which do. This mapping then provides a basis for an ontology of clinical tasks that can be used in the formulation of computer-interpretable clinical guideline models. (shrink)

There is a way of talking that would appear to involve ascriptions of purpose, goal directed activity, and intentional states to groups. Cases are familiar enough: classmates intend to vacation in Switzerland, the department is searching for a metaphysician, the Democrats want to minimize losses in the upcoming elections, and the US intends to improve relations with such and such country. But is this talk to be understood just in terms of the attitudes and actions of the individuals involved? Is (...) the talk, to take an overly simple proposal as an example, a mere summary of familiar individual attitudes of the group members? Or is the ascription of attitudes and actions to groups to be taken more literally, as suggesting that the group for example believes that P, or intends to A, over and above what the members individually think and do? In short, are there groups with minds of their own? Philip Pettit has deployed the “discursive dilemma” to defend the thesis that there are such group minds. In what follows, I explore the relationship between the group allegedly with a mind of its own and the individuals it comprises, and I consider just how this relationship must be understood in order to give Pettit’s argument for group minds its best chance for success. As I understand it, the discursive dilemma has to be used in conjunction with what might be called an indispensability argument for group minds. It is useful to distinguish two forms of this argument. The explanatory version of the indispensability argument is, very schematically, as follows: there is a compelling explanatory theory T concerning the social, certain indispensable elements of T entail the group mind thesis, so the group mind thesis is true. Several questions immediately arise: What sort of theory is T? In what sense is it indispensable? Are there other forms of indispensability? I don’t have definitive answers to these questions. But how we settle them will have implications for the interaction and support the discursive dilemma provides the indispensability argument. In particular, using the discursive dilemma to defend what I characterize below as a practical version of the indispensability argument commits us to the rationality of individual participants in a way that the explanatory version of the indispensability argument does not. My point in the first part of the paper is that if Pettit wants to avoid the weaknesses of the explanatory indispensability argument and pursue the practical version, then he owes us a story about the rationality of individual participation in groups. Pettit also owes us a story about the agency an individual exercises as part of a group. If it takes the actions of individuals to execute the intentions of the group, how are we to understand those actions in order for the group to count as having a mind of its own? How must group intentions figure in the practical or deliberative perspective of individuals who execute those intentions? I will argue that the proponent of the group mind thesis must proceed with some care here, because some natural ways of answering these questions will undermine the thesis. But in the end, I think that these questions are interesting independently of whether Pettit is right to think that groups do have minds of their own. That’s because investigating Pettit’s arguments might lead to new ideas about how the rationality and agency of individuals can be exercised, and suggests new ways of understanding how individuals can act together, irrespective of whether the groups they compose ever have minds of their own. (shrink)

Mitochondrial DNA (mtDNA) diseases are a group of neuromuscular diseases that often cause suffering and premature death. New mitochondrial replacement techniques (MRTs) may offer women with mtDNA diseases the opportunity to have healthy offspring to whom they are genetically related. MRTs will likely be ready to license for clinical use in the near future and a discussion of the ethics of the clinical introduction ofMRTs is needed. This paper begins by evaluating three concerns about the safety of (...) MRTs for clinical use on humans: (1) Is it ethical to use MRTs if safe alternatives exist? (2) Would persons with three genetic contributors be at risk of suffering? and (3) Can society trust that MRTs will be made available for humans only once adequate safety testing has taken place, and that MRTs will only be licensed for clinical use in a way that minimises risks? It is then argued that the ethics debate about MRTs should be reoriented towards recommendingways to reduce the possible risks of MRT use on humans. Two recommendations are made: (1) licensed clinical access to MRTs should only be granted to prospective parents if they intend to tell their children about their MRT conception by adulthood; and (2) sex selection should be used in conjunction with the clinical use ofMRTs, in order to reduce transgenerational health risks. (shrink)

Background: Biomedical research nowadays is increasingly carried out in multinational and multicenter settings. Due to disparate national regulations on various ethical aspects, such as informed consent, there is the risk of ethical compromises when involving human subjects in research. Although the Declaration of Helsinki is the point of reference for ethical conduct of research on humans, national normative requirements may diverge from its provisions. The aim of this research is to examine requirements on informed consent in biomedical research in Germany, (...) Poland, and Russia to determine how each national regulatory framework relates to the provisions of the Declaration of Helsinki. Methods: For this analysis, we conducted a search of the legal databases “Gesetze im Internet” for Germany, “Internetowy System Aktow Prawnych” for Poland, and “ГAPAHT – Garant” for Russia. The search was complemented by a review of secondary literature contained in the databases Google Scholar, PubMed, Polish National Library, and eLibrary ru. We have identified 21 normative regulations containing provisions on informed consent in clinical research in all three countries. The content of these documents was systematically categorized and analyzed. Results: The normative framework in all three countries shows a strong commitment towards the core ethical principles of research envisaged in the Declaration of Helsinki. Nevertheless, provisions on informed consent vary between these three countries. The differences range from the method and language in which information should be provided, through the amount of information required to be disclosed, to the form of documenting consent or withdrawal. In the case of research on vulnerable groups, these differences are particularly visible. Conclusions: The identified differences can negatively impact the ethical conduct of international clinical studies. Attention needs to be paid that flexibilities within national regulations are not misused to undermine the protection of research subjects. Achieving global or regional legislative harmonization might prove impossible. Such lack of legal consensus reinforces the significance of the international ethical agreements. (shrink)

"Our literature is replete with complaints about the chaotic state of the systematics of psychoses and every psychiatrist knows that it is impossible to come to any common understanding on the basis of the old diagnostic labels. ... Thus, not even the masters of science can make themselves understood on the basis of the old concepts and with many patients the number of diagnoses made equals the number of institutions they have been too. ... Errors are the greatest obstacles to (...) the progress of science; to correct such errors is of more practical value than to achieve new knowledge. We have here eliminated chaos of terms behind which useful concepts of disease were mistakenly sought; we have eliminated a veritable forest of boundary posts, not one of which indicated any natural line of demarcation. ... By the term „dementia praecox“ or „schizophrenia“ we designate a group of psychoses whose course is at times chronic, at times marked by intermittent attacks, and which can stop or retrograde at any stage, but does not permit a full restitutio ad integrum. The disease is characterized by a specific type of alteration of thinking, feeling, and relation to the external world which appears nowhere else in this particular fashion." Eugen Bleuler. Dementia Praecox or the Group of Schizophrenias. Translated by Joseph Zinkin. International Universities Press, New York, 1950. (shrink)

While most of healthcare research and practice fully endorses evidence-based healthcare, a minority view borrows popular themes from philosophy of science like underdetermination and value-ladenness to question the legitimacy of the evidence-based movement’s philosophical underpinnings. While the feminist origins go unacknowledged, those critics adopt a feminist reading of the “gap argument” to challenge the perceived objectivism of evidence-based practice. From there, the critics seem to despair over the “subjective elements” that values introduce to clinical reasoning, demonstrating that they do (...) not subscribe to feminist science studies’ normative program——where contextual values can enable good science and justified decisions. In this paper, I investigate why it is that the critics of evidence-based medicine adopt feminist science’s characterization of the problem but resist the productive solutions offered by those same theorists. I suggest that the common feminist empiricist appeal to idealized epistemic communities is impractical for those working within the current biomedical context and instead offer an alternate stream of feminist research into the empirical content of values (found in the work of Elizabeth Anderson and Sharyn Clough) as a more helpful recourse for facilitating the important task of legitimate and justified clinical decision-making. I use a case study on clinical decision-making to illustrate the fruitfulness of the latter feminist empiricist framework. -/- See response by Sharyn Clough: http://wp.me/p1Bfg0-1aN See reply by Maya Goldenberg: http://wp.me/p1Bfg0-1oY. (shrink)

t Intentional sampling methods are non-randomized procedures that select a group of individuals for a sample with the purpose of meeting specific prescribed criteria. In this paper we extend previous works related to intentional sampling, and address the problem of sequential allocation for clinical trials with few patients. Roughly speaking, patients are enrolled sequentially, according to the order in which they start the treatment at the clinic or hospital. The allocation problem consists in assigning each new patient to (...) one, and only one, of the alternative treatment arms. The main requisite is that the profiles in the alternative arms remain similar with respect to some relevant patients’ attributes (age, gender, disease, symptom severity and others). We perform numerical experiments based on a real case study and discuss how to conveniently set up perturbation parameters, in order to yield a suitable balance between optimality – the similarity among the relative frequencies of patients in the several categories for both arms, and decoupling – the absence of a tendency to allocate each pair of patients consistently to the same arm. (shrink)

There has been a growing concern over establishing norms that ensure the ethically acceptable and scientifically sound conduct of clinical trials. Among the leading norms internationally are the World Medical Association's Declaration of Helsinki, guidelines by the Council for International Organizations of Medical Sciences, the International Conference on Harmonization's standards for industry, and the CONSORT group's reporting norms, in addition to the influential U.S. Federal Common Rule, Food and Drug Administration's body of regulations, and information sheets by the (...) Department of Health and Human Services. There are also many norms published at more local levels by official agencies and professional groups.Any account of international standards should cover both scientific and ethical norms at once – the two are conceptually intertwined. Recent sources recognize that “[s]cientifically unsound research on human subjects is unethical in that it exposes research subjects to risks without possible benefit.”. (shrink)

The article by MacKay and Saylor (2020) claims that the principle of fair subject selection yields conflicting imperatives (e.g. in the case of pregnant women) and should be understood as “a bundle of four distinct sub-principles” (i.e. fair inclusion, burden sharing, opportunity, distribution of third-party risks), each having conflicting normative recommendations (MacKay and Saylor 2020). The authors also offer guidance as to how we should navigate between subprinciples that may conflict with each other. The problem is a crucial one since (...) fair subject selection is one of the principles regulating clinical research that produces generalizable knowledge with the potential of improving people’s health. Therefore, there may be cases where the way in which participants are selected directly influences the generalizability (or its lack) of the clinically relevant knowledge and its value (if any) to different groups. In my commentary article, written from the philosophical perspective, I notice a number of interrelated problems which I believe have not been discussed thoroughly in the target article: (1) the precise way in which health care priority setting should influence the content of health research priority setting and fair inclusion principles; (2) the distinction between group and individual benefits and burdens from clinical research; (3) the reference class problem in medical research. (shrink)

The MgAl2O4 spinel doped with Eu2+ ions powder phosphor was prepared at temperature as low as 500 oC using the combustion route. A structural property of the powder was characterized by X-ray diffraction (XRD). This XRD pattern shows the well crystallized cubic phase, Fd-3m space group of MgAl2O4. The estimated average crystalline size is about 36 and 30 nm for MgAl2O4 and Eu doped MgAl2O4 particles respectively. The photoluminescent property of prepared powder was investigated using excitation and emission spectroscopy (...) at room temperatures. Energy levels scheme is proposed for emission from MgAl2O4: Eu2+. (shrink)

The classification of preserved hypothalamic activity in brain death and brainstem death as functional or non-functional has become a subject of debate. While proponents of the neurological criterion claim that these activities lack functional significance (Shemie et al. 2014), Nair-Collins and Joffe (2023) argue for their functional physiological role. However, the interpretation of the term "function" within the medico-legal framework, where death is characterized by the irreversible cessation of all brain functions, remains unclear. -/- My intention here is not to (...) engage in a debate over the validity of different viewpoints regarding the functional significance of preserved activities in the hypothalamus or the heart. Rather, I aim to highlight the critical importance of exploring and defining the concept of function in medicine, which currently lacks clarity. My point is that, whatever our position in the brain death debate, reaching a consensus on this conceptual matter would minimize misunderstandings and establish a robust foundation for further insightful analysis. (shrink)

- First book to describe what pain means in vulnerable or special groups of people - Clinical applications described in each chapter - Provides insight into the nature of pain experience across the lifespan -/- This book, the third and final volume in the Meaning of Pain series, describes what pain means to people with pain in “vulnerable” groups, and how meaning changes pain – and them – over time. -/- Immediate pain warns of harm or injury to the (...) person with pain. If pain persists over time, more complex meanings can become interwoven with this primitive meaning of threat. These cognitive meanings include thoughts and anxiety about the adverse consequences of pain. Such meanings can nourish existential sufferings, which are more about the person than the pain, such as loss, loneliness, or despair. -/- Although chronic pain can affect anyone, there are some groups of people for whom particular clinical support and understanding is urgently needed. This applies to “vulnerable” or “special” groups of people, and to the question of what pain means to them. These groups include children, women, older adults, veterans, addicts, people with mental health problems, homeless people, or people in rural or indigenous communities. Several chapters in the book focus on the lived experience of pain in vulnerable adults, including black older adults in the US, rural Nigerians, US veterans, and adults with acquired brain injury. The question of what pain experience could mean in the defenceless fetus, neonate, pre-term baby, and child, is examined in depth across three contributions. -/- This book series aspires to create a vocabulary on the “meanings of pain” and a clinical framework with which to use it. It is hoped that the series stimulates self-reflection about the role of meaning in optimal pain management. -/- Meanings of Pain is intended for people with pain, family members or caregivers of people with pain, clinicians, researchers, advocates, and policy makers. Volume I was published in 2016; Volume II in 2019. (shrink)

The rule of rescue holds that special weight should be given to protecting the lives of assignable individuals in need, implying that less weight is given to considerations of cost-effectiveness. This is sometimes invoked as an argument for funding or reimbursing life-saving treatment in public healthcare even if the costs of such treatment are extreme. At first sight one might assume that an individualist approach to ethics—such as Scanlon’s contractualism—would offer a promising route to justification of the rule of rescue. (...) In this chapter I argue that contractualism cannot endorse the rule of rescue, whereas a collectivist approach that appeals to group solidarity would offer support for rescue cases. The argument, however, has its limitations, and though solidarity is of central concern in shaping public healthcare, there are good reasons for not endorsing the rule of rescue as a moral basis for allocating scarce resources in clinical care. (shrink)

BACKGROUND Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians (...) use them and if OTAs themselves modify clinician prescribing practices. OBJECTIVE To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. DESIGN We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. PARTICIPANTS 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. APPROACH Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. KEY RESULTS Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. CONCLUSION This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)

This dissertation addresses the problem of how to evaluate and compare the theories that inform diverse approaches to psychotherapy. It is argued that the field needs a superordinate epistemology to provide legitimacy for its theories and for the clinical work that these theories guide. Such a superordinate epistemology would occupy a higher level of analysis than the theories it is used to evaluate. ;Using a constructivist framework, it is argued that much of the epistemological confusion currently characterizing clinical (...) psychology can be traced to a traditional failure to distinguish among levels of analysis when evaluating clinical psychology theories. It is demonstrated that evaluations of such theories often conflate theory and epistemology. ;The received view of a natural science epistemology and hermeneutics provide the usual terms in which epistemology is debated. These are found inadequate to fill the necessary role of superordinate epistemology. The received view is criticized, in part, for "bracketing" the domain of meaning, and hermeneutics is criticized, in part, for "bracketing" the domain of extra-linguistic reality. For these reasons, it is shown that neither of these approaches can be considered to be superordinate to clinical theories. ;Next, some preliminary theoretical groundwork for the development of a constructivist superordinate epistemology for clinical psychology is offered. The domain of clinical psychology is defined as the conjunction of the domains of meaning and reality. A constructivist reformulation of the role of empirical research and observational knowledge is outlined. A reconceptualization of clinical theories as narratives and "expert languages" is suggested as well. ;It is argued that theoretical propositions first should be evaluated according to whether they conform to observational knowledge about the unintentional constraints on human intentionality. Then theories should be evaluated according to the coherence of their accounts of the transactions between the domains of meaning and reality. The hermeneutic circle is suggested as a methodology for choosing among different interpretations in a given therapeutic encounter. ;Finally, some directions for future work are suggested. (shrink)

Objective: Patients' satisfaction is one of the most important goals in complete denture therapy, and there are many factors influencing this parameter. This study aimed to determine patient satisfaction with conventional removable complete denture made by clinical year students at the Faculty of Dentistry, Al Azhar University - Gaza. Methods: A sample of 85 patient who had conventional removable complete denture made by clinical year students at the Faculty of Dentistry Al Azhar University - Gaza filled a questionnaire (...) two months after denture insertion. The questionnaire involving four sections including personal information, history, denture evaluation in aspects of mastication, speech, aesthetics and retention, and patient comfort. Results: Of the 85 patient studied, 81% were males, and the mean age was 60.3 years SD+-9.64. The majority (n= 67, 79 %) lost their teeth because of bad oral hygiene. The overall satisfaction level was (92.1%), and patients were more satisfied with their upper denture. A significant association was found between the patient satisfaction and prior denture use experience (p=0.013). No significant correlation was established between the patient satisfaction and their gender (p=0.188), age group (p=0.640) and employment status (p=0.667).Conclusion: The patients have shown a high level of overall satisfaction. A significant association was found between the overall satisfaction level of patients and prior denture use experience. No statistically significant association was observed between the overall satisfaction level of patients and with each of age group, employment status and gender. (shrink)

The evolution from pre-human primates to modern Homo sapiens is a complex one involving many domains, ranging from the material to the social to the cognitive, both at the individual and the community levels. This article focuses on a critical qualitative transition that took place during this evolution involving both the social and the cognitive domains. For the social domain, the transition is from the face-to-face forms of social interaction and organization that characterize the non-human primates that reached, with Pan, (...) a hiatus due to the centripetal effects that highly individualized behavior has on a social system. The transition is to the relation-based forms of social organization that evolved in the hominins ancestral to Homo sapiens and are universal in human societies today. For the cognitive domain, this transition involves going from behavior responding mainly to phenomenal level sensory inputs to behavior formed in accordance with the concept of a relation, initially abstracted from behavior patterns, then extending the concept of a relation beyond abstraction from behavior patterns to the concept of a relation generated recursively through constructing the relation of a relation. This extension made possible the construction of systems of relations; initially genealogical systems of relations constructed culturally using the logic of recursion, and subsequently, the symbolic, computational systems of kin term relations referred to by anthropologists as kinship terminologies. The latter are “constructed realities” in the sense this term is used by cultural anthropologists. It follows that the evolution of relation-based systems of social interaction is not adequately accounted for through population model evolutionary accounts such as the Dual Inheritance Theory of human evolution since “constructed realities” constitute collectively and publicly shared cultural knowledge rather than the individually and privately possessed knowledge that is assumed in the population model framework for human evolution. (shrink)

The powerful role that teachers can play in our development is the focus Binyamin, Jayusi, and Tamir’s chapter in this volume. They argue that teachers, in particular teachers that don’t share the same background as their students, can help counter the increasing polarization that characterizes our current era. In these critical notes I raise three challenges to their proposal. First, by exploring the mechanisms of polarization I demonstrate that polarization is not a problem unique to thick diversity or thick multiculturalism. (...) Second, the central premise of the authors’ proposal rests on the ability of greater contact to reduce prejudice. The contact hypothesis, however, has numerous backlash effects and unintended consequences that can increase prejudice rather than reduce prejudice. These backlash effects and unintended consequences raise serious doubts for the success of placing minority teachers in majority classrooms to reduce prejudice. Third, I raise concerns about how the proposal tokenizes minority teachers, the use of instrumental rationales for diversity, and the politics of deference and being-in-the-room privilege that also go unaddressed in their proposal. (shrink)

A method of identifying banks’ business models and studying the features of their risk profile, considering the system of indicators featuring the structure of assets, liabilities, income, expenses, and other qualitative indicators based on monthly statistical reporting. Kohonen's self-organizing maps (SOM) are used to process large data sets, revealing objects’ hidden features by forming homogeneous groups according to similar values of a large system of indicators. The choice of the system of indicators that play the most significant role in describing (...) the business models of modern banks is substantiated. The proposed method makes it possible to group banks with homogeneous characteristics into so-called structural-functional groups and studies the change in the characteristics of groups of banks over time to compare their behavior during periods of active development of the system and during a crisis. That approach is useful for studying the banking system at the macro level, as it provides a quantitative measure of its financial stability. The more banks are in groups with negative values of parameters, increased risks, and unprofitable performance, the worse the general state of the system. The method also allows studying the features of each structural and functional group and the business models’ features at the meso-level. The number and composition of banks inherent in any group change dynamically, which characterizes the features of the relevant business model in a particular period. The averages of each group reflect the objective changes in the banking system structure. In addition, the SOM trajectory can be built for each individual bank determining the development of its strategy, features of a particular business model, and risk profile. At the micro-level, it allows comparing the features of individual banks within the SFGB and models ways to improve efficiency and financial stability by forecast values for SOM. An extensive system of indicators used to form structural and functional groups of banks allows to quickly respond to changes in the banking system, identify areas of increased risk and explore the adequacy and effectiveness of banks’ business models. (shrink)

Ectopic pregnancy is defined as the fertilized ovum implants in a location outside the endometrial cavity, remains to be an important cause of maternal morbidity and mortality worldwide and is a health problem with incidence ranges between 0.25% and 2% of all pregnancies. In our study, in Izmir Katip Celebi University Ataturk Training and Research Hospital, Department of Obstetrics and Gynecology from 2011 to 2013, 96 cases with diagnosis of ectopic pregnancy managed by the adapted RCOG’s Guide were analyzed retrospectively. (...) The data were analyzed as follows: age, the history of operation, smoking, the presence of intrauterine device, blood groups, hemoglobin, platelets, values of B-hCG, the diagnostic interval, intra-abdominal free fluid and/or acute abdomen, the method of treatment and the success of treatment. (shrink)

Clinical psychology is characterized by persistent disagreement about fundamental aspects of the discipline ranging from what mental disorders are to what constitutes effective treatment. Attempts to address the problem of epistemic disagreement have been frequently based on establishing the correct answer by fiat without identifying and addressing the sources of the disagreement. We argue that this strategy has not worked very well and the result is frequently ongoing and intractable disagreement, with each side in an argument convinced they are (...) correct. In this paper, we outline an epistemic disagreement procedural model intended to assist researchers and clinicians in the field of clinical psychology to identify, explore, and develop inquiry strategies that capitalize on situations where competing knowledge claims are made. The result is a flexible conceptual framework committed to a defensible epistemic pluralism, fallibilism, and contextualism, across the various research tasks constituting the field of clinical psychology. (shrink)

While various definitions of moral distress have been proposed, some agreement exists that it results from illegitimate constraints in clinical practice affecting healthcare professionals’ moral agency. If we are to reduce moral distress, instruments measuring it should provide relevant information about such illegitimate constraints. Unfortunately, existing instruments fail to do so. We discuss here several shortcomings of major instruments in use: their inability to determine whether reports of moral distress involve an accurate assessment of the requisite clinical and (...) logistical facts in play, whether the distress in question is aptly characterized as moral, and whether the moral distress reported is an appropriate target of elimination. Such failures seriously limit the ability of empirical work on moral distress to foster appropriate change. (shrink)

Clinical delusions are widely characterized as being pathological beliefs in both the clinical literature and in common sense. Recently, a philosophical debate has emerged between defenders of the commonsense position (doxasticists) and their opponents, who have the burden of pointing toward alternative characterizations (anti-doxasticists). In this chapter, I argue that both doxasticism and anti- doxasticism fail to characterize the functional role of delusions while at the same time being unable to play a role in the explanation of these (...) phenomena. I also argue that though a more nuanced view of belief in which mental states are more or less belief-like instills a healthy skepticism towards the precision of folk-psychological concepts, such a stance fails to be of use in building a theory of delusion that will be able to bridge different levels of explanation, such as the phenomenology and neurobiology of delusion. Thus, I advocate moving past the question ‘Are delusions beliefs?’ and their description as propositional attitudes toward the description of the processes that generate delusion, with a view toward explaining, rather than explaining away, the personal-level aspects of the phenomenon that have been made inscrutable by investing in doxastic terminology. (shrink)

We characterize a type of functional explanation that addresses why a homologous trait originating deep in the evolutionary history of a group remains widespread and largely unchanged across the group’s lineages. We argue that biologists regularly provide this type of explanation when they attribute conserved functions to phenotypic and genetic traits. The concept of conserved function applies broadly to many biological domains, and we illustrate its importance using examples of molecular sequence alignments at the intersection of evolution and (...) cell biology. We use these examples to show how the study of conserved functions can integrate knowledge of a trait’s causal effects on fitness and its history of natural selection without invoking adaptation. We also show how conserved function provides a novel basis for addressing objections against evolutionary functions raised by Robert Cummins. (shrink)

Our era is characterized by a significant conflict between populism and anti-populism, both politically and culturally. Populist groups and leaders often portray themselves as the true voices of the common people, gaining electoral support or even taking power by framing society as a battle between the ordinary people and the elite, challenging the political and economic establishment. Conversely, parties within the liberal political spectrum counteract the rise of populism by articulating a strong anti-populist discourse, sometimes successfully dominating the political arena. (...) However, despite the increase in studies on populism, there are not many publications regarding anti-populism. This article seeks to examine the anti-populist discourse in Argentina and Greece, two countries with many similarities in political, economic, and cultural aspects. By analyzing the key ideas of anti-populist discourse, we aim to highlight the common anti-populist logic marked by typical paths of modernization, which not only opposes populism but also frequently disregards or opposes specific social groups, such as minorities. (shrink)

Clinical delusions have traditionally been characterized as beliefs in psychiatry. However, philosophers have recently engaged with the empirical literature and produced a number of objections to the so-called doxastic status of delusion, stemming mainly from the mismatch between the functional role of delusions and that expected of beliefs. In response to this, an appeal to dispositionalism about the nature of belief has been proposed to vindicate the doxastic status of delusion. In this paper, I first present the objections to (...) attributing beliefs to delusional patients and the application of dispositionalism in the attempt to vindicate doxasticism. I then assess this application and some responses to the objections to the doxastic characterization. Finally, I offer some conclusions about the limits of folk-psychological concepts in the characterization and explanation of complex psychological phenomena such as delusions. (shrink)

Dwork, Hardt, Pitassi, Reingold, & Zemel [6] introduced two notions of fairness, each of which is meant to formalize the notion of similar treatment for similarly qualified individuals. The first of these notions, which we call additive metric fairness, has received much attention in subsequent work studying the fairness of a system composed of classifiers which are fair when considered in isolation [3, 4, 7, 8, 12] and in work studying the relationship between fair treatment of individuals and fair treatment (...) of groups [6, 7, 13]. Here, we extend these lines of research to the second, less-studied notion, which we call multiplicative metric fairness. In particular, we exactly characterize the fairness of conjunctions and disjunctions of multiplicative metric fair classifiers, and the extent to which a classifier which satisfies multiplicative metric fairness also treats groups fairly. This characterization reveals that whereas additive metric fairness becomes easier to satisfy when probabilities of acceptance are small, leading to unfairness under functional and group compositions, multiplicative metric fairness is better-behaved, due to its scale-invariance. (shrink)

Two controversies exist regarding the appropriate characterization of hierarchical and adaptive evolution in natural populations. In biology, there is the Wright-Fisher controversy over the relative roles of random genetic drift, natural selection, population structure, and interdemic selection in adaptive evolution begun by Sewall Wright and Ronald Aylmer Fisher. There is also the Units of Selection debate, spanning both the biological and the philosophical literature and including the impassioned group-selection debate. Why do these two discourses exist separately, and interact (...) relatively little? We postulate that the reason for this schism can be found in the differing focus of each controversy, a deep difference itself determined by distinct general styles of scientific research guiding each discourse. That is, the Wright-Fisher debate focuses on adaptive process, and tends to be instructed by the mathematical modeling style, while the focus of the Units of Selection controversy is adaptive product, and is typically guided by the function style. The differences between the two discourses can be usefully tracked by examining their interpretations of two contested strategies for theorizing hierarchical selection: horizontal and vertical averaging. (shrink)

Bioethics experts played a key role in ensuring a coherent ethical response to the COVID-19 pandemic in the fields of healthcare, public health, and scientific research in Canada. In the province of Quebec, a group of academic and practicing bioethicists met periodically in the early months of the pandemic to discuss approaches and solutions to ethical dilemmas encountered during the crisis. These meetings created the opportunity for a national survey of bioethics practitioners from different fields. The survey, in which (...) forty-five Canadian bioethics practitioners (clinical ethicists, ethicist members of REBs and government health policy ethicists, or any bioethicist practicing outside of academia) participated, explored their concerns, challenges and opportunities during the first wave of the pandemic, with the objective of informing bioethics research about the difficulties experienced by bioethicists “in the field”. Participants reported increased stress levels, increased workloads, and a greater proportion of their work being devoted to public health ethics. Most of their concerns focused on groups other than themselves, such as health professionals, patients, research participants, and people in vulnerable socio-economic situations. An optimism about the future of bioethics was noted due to an increased awareness of the importance of bioethics by the public and by health and research institutions. (shrink)

This paper aims to analyze the ethical challenges in experimental drug use during the early stage of the COVID-19 pandemic, using Germany as a case study. In Germany uniform ethical guidelines were available early on nationwide, which was considered as desirable by other states to reduce uncertainties and convey a message of unity. The purpose of this ethical analysis is to assist the preparation of future guidelines on the use of medicines during public health emergencies. The use of hydroxychloroquine, remdesivir (...) and COVID-19 convalescent plasma in clinical settings was analyzed from the perspective of the ethical principles of beneficence, non-maleficence, justice and autonomy. We observed that drug safety and drug distribution during the pandemic affects all four ethical principles. We therefore recommend to establish ethical guidelines (i) to discuss experimental treatment options with patients from all population groups who are in urgent need, (ii) to facilitate the recording of patient reactions to drugs in off-label use, (iii) to expand inclusion criteria for clinical studies to avoid missing potentially negative effects on excluded groups, and (iv) to maintain sufficient access to repurposed drugs for patients with prior conditions. (shrink)

In psycho-clinical research the notion of spirituality acquires a semantic plurality. This equivocal and ambiguous connotation that characterizes this term represents an obstacle to the epistemic and methodological validity of research designs, recognized as the threat to construct validity. In order to overcome this difficulty, we introduce, from Dietrich von Hildebrand's phenomenology, the notions of intentionality and transcendence insofar as these are capable of accounting for the specific element of the spiritual-religious phenomenon and discriminating it from the other phenomena (...) or variables that may be included under the notion of spirituality. This conceptual elucidation task allows evaluating the legitimacy of the variable selection process and establishing why they are or are not representatives of the phenomenon of spiritual-religious experience. (shrink)

Mathematicians often describe the importance of well-developed intuition to productive research and successful learning. But neither education researchers nor philosophers interested in epistemic dimensions of mathematical practice have yet given the topic the sustained attention it deserves. The trouble is partly that intuition in the relevant sense lacks a usefully clear characterization, so we begin by offering one: mature intuition, we say, is the capacity for fast, fluent, reliable and insightful inference with respect to some subject matter. We illustrate (...) the role of mature intuition in mathematical practice with an assortment of examples, including data from a sequence of clinical interviews in which a student improves upon initially misleading covariational intuitions. Finally, we show how the study of intuition can yield insights for philosophers and education theorists. First, it contributes to a longstanding debate in epistemology by undermining epistemicism, the view that an agent’s degree of objectual understanding is determined exclusively by their knowledge, beliefs and credences. We argue on the contrary that intuition can contribute directly and independently to understanding. Second, we identify potential pedagogical avenues towards the development of mature intuition, highlighting strategies including adding imagery, developing associations, establishing confidence and generalizing concepts. (shrink)

Our evidential environments are reflections of our social contexts. This is important because the evidence we encounter influences the beliefs we form. But, traditional epistemologists have paid little attention to the generation of this evidential environment, assuming that it is irrelevant to epistemic normativity. This assumption, I argue, is dangerous. Idealizing away the evidential environment obscures the ways that our social contexts distort its contents. Such social distortion can lead to evidential oppression, an epistemic injustice arising from the ubiquity of (...) ideologically-inflected portrayals of oppressed social groups. In some cases, this distortion can be so pervasive as to create a skeptical pothole in agents' epistemic environments---a limited region in which a skeptical scenario obtains. The skeptical challenge of social distortion is important because it suggests that prejudice and irrationality alone may not be enough to explain many harmful beliefs. Where justified belief is merely a matter of responding well to one's evidence, the ubiquity of ideologically-inflected evidence may impel a matching doxastic state, even for exemplary epistemic agents. Nevertheless, there is an asymmetry in blameworthiness between the Cartesian victim and someone laboring under evidential oppression. This asymmetry reveals the need for distinctively non-ideal epistemic norms. I offer a characterization of one such norm: the internalist practice of self-stewardship. (shrink)