We are immersed within an odorous sea of chemical currents that we parse into individual odors with complex structures. Odors have been posited as determined by the structural relation between the molecules that compose the chemical compounds and their interactions with the receptor site. But, naturally occurring smells are parsed from gaseous odor plumes. To give a comprehensive account of the nature of odors the chemosciences must account for these large distributed entities as well. We offer a focused review of (...) what is known about the perception of odor plumes for olfactory navigation and tracking, which we then connect to what is known about the role odorants play as properties of the plume in determining odor identity with respect to odor quality. We end by motivating our central claim that more research needs to be conducted on the role that odorants play within the odor plume in determining odor identity. (shrink)

Wall, G. Locke's attack on innate knowledge.--Harris, J. Leibniz and Locke on innate ideas.--Greenlee, D. Locke's idea of idea.--Aspelin, G. Idea and perception in Locke's essay.--Greenlee, D. Idea and object in the essay.--Mathews, H. E. Locke, Malebranche and the representative theory.--Alexander, P. Boyle and Locke on primary and secondary qualities.--Ayers, M. R. The ideas of power and substance in Locke's philosophy.--Allison, H. E. Locke's theory of personal identity.--Kretzmann, N. The main thesis of Locke's semantic theory.--Woozley, A. D. Some remarks on (...) Locke's account of knowledge.--Laudan, L. The nature and sources of Locke's views on hypotheses. (shrink)

In this paper I examine the question of when human life begins from a neo-Aristotelian perspective. In my view, the basic principles of Aristotle’s metaphysics inform an account of human life (and the human person) that offers the best available explanation of the available phenomena. This account – the substance account of the human person – can fully incorporate the contemporary findings of empirical embryology, while also recognizing the essential uniqueness of rational human nature.

In this article I develop Heidegger's phenomenology of poetry, showing that it may provide grounds for rejecting claims that he lapses into linguistic idealism. Proceeding via an analysis of the three concepts of language operative in the philosopher's work, I demonstrate how poetic language challenges language's designative and world-disclosive functions. The experience with poetic language, which disrupts Dasein's absorption by emerging out of equipmentality in the mode of the broken tool, brings Dasein to wonder at the world's existence in such (...) a way that doubt about its reality cannot enter the picture. (shrink)

Many philosophers are impressed by the progress achieved by physical sciences. This has had an especially deep effect on their ontological views: it has made many of them physicalists. Physicalists believe that everything is physical: more precisely, that all entities, properties, relations, and facts are those which are studied by physics or other physical sciences. They may not all agree with the spirit of Rutherford's quoted remark that 'there is physics; and there is stamp-collecting',' but they all grant physical science (...) a unique ontological authority: the authority to tell us what there is. Physicalism is now almost orthodox in much philosophy, notably in much recent philosophy of mind. But although often invoked, it is rarely explicitly defined. It should be. The claim that everything is physical is not as clear as it seems. In this paper, we examine a number of proposed definitions of physicalism and reasons for being a physicalist. We will argue both that physicalism lacks a clear and credible definition, and that in no non-vacuous interpretation is it true. We are concerned here only with physicalism as a doctrine about the empirical world. In particular, it should not be confused with nominalism, the doctrine that there are no universals.2 Nominalism and physicalism are quite independent doctrines. Believers in universals may as consistently assert as deny that the only properties and relations are those studied by physical science. And nominalists may with equal consistency assert or deny that physical science could provide enough predicates to describe the world. That is the question which concerns physicalists, not whether physical predicates name real universals. (We will for brevity write as if they do, but we do not need that assumption.). (shrink)

This article connects value-sensitive design to Gibson’s affordance theory: the view that we perceive in terms of the ease or difficulty with which we can negotiate space. Gibson’s ideas offer a nonsubjectivist way of grasping culturally relative values, out of which we develop a concept of political affordances, here understood as openings or closures for social action, often implicit. Political affordances are equally about environments and capacities to act in them. Capacities and hence the severity of affordances vary with age, (...) health, social status and more. This suggests settings are selectively permeable, or what postphenomenologists call multistable. Multistable settings are such that a single physical location shows up differently – as welcoming or hostile – depending on how individuals can act on it. In egregious cases, authoritarian governments redesign politically imbued spaces to psychologically cordon both them and the ideologies they represent. Selective permeability is also orchestrated according to business interests, which is symptomatic of commercial imperatives increasingly dictating what counts as moral and political goods. (shrink)

To evaluate the overall good/welfare of any action, policy or institutional choice we need some way of comparing the benefits and losses to those affected: we need to make interpersonal comparisons of the good/welfare. Yet sceptics have worried either: that such comparisons are impossible as they involve an impossible introspection across individuals, getting ‘into their minds’; that they are indeterminate as individual-level information is compatible with a range of welfare numbers; or that they are metaphysically mysterious as they assume the (...) existence either of a social mind or of absolute levels of welfare when no such things exist. This article argues that such scepticism can potentially be addressed if we view the problem of interpersonal comparisons as fundamentally an epistemic problem – that is, as a problem of forming justified beliefs about the overall good based on evidence of the individual good. (shrink)

When evidence-based policymaking is so often mired in disagreement and controversy, how can we know if the process is meeting its stated goals? We develop a novel mathematical model to study disagreements about adequate knowledge utilization, like those regarding wild horse culling, shark drumlines and facemask policies during pandemics. We find that, when stakeholders disagree, it is frequently impossible to tell whether any party is at fault. We demonstrate the need for a distinctive kind of transparency in evidence-based policymaking, which (...) we call transparency of reasoning. Such transparency is critical to the success of the evidence-based policy movement, as without it, we will be unable to tell whether in any instance a policy was in fact based on evidence. (shrink)

This paper explores an emerging sub-field of both empirical bioethics and experimental philosophy, which has been called “experimental philosophical bioethics” (bioxphi). As an empirical discipline, bioxphi adopts the methods of experimental moral psychology and cognitive science; it does so to make sense of the eliciting factors and underlying cognitive processes that shape people’s moral judgments, particularly about real-world matters of bioethical concern. Yet, as a normative discipline situated within the broader field of bioethics, it also aims to contribute to substantive (...) ethical questions about what should be done in a given context. What are some of the ways in which this aim has been pursued? In this paper, we employ a case study approach to examine and critically evaluate four strategies from the recent literature by which scholars in bioxphi have leveraged empirical data in the service of normative arguments. (shrink)

“Love hurts”—as the saying goes—and a certain amount of pain and difficulty in intimate relationships is unavoidable. Sometimes it may even be beneficial, since adversity can lead to personal growth, self-discovery, and a range of other components of a life well-lived. But other times, love can be downright dangerous. It may bind a spouse to her domestic abuser, draw an unscrupulous adult toward sexual involvement with a child, put someone under the insidious spell of a cult leader, and even inspire (...) jealousy-fueled homicide. How might these perilous devotions be diminished? The ancients thought that treatments such as phlebotomy, exercise, or bloodletting could “cure” an individual of love. But modern neuroscience and emerging developments in psychopharmacology open up a range of possible interventions that might actually work. These developments raise profound moral questions about the potential uses—and misuses—of such anti-love biotechnology. In this article, we describe a number of prospective love-diminishing interventions, and offer a preliminary ethical framework for dealing with them responsibly should they arise. (shrink)

Pharmaceuticals or other emerging technologies could be used to enhance (or diminish) feelings of lust, attraction, and attachment in adult romantic partnerships. While such interventions could conceivably be used to promote individual (and couple) well-being, their widespread development and/or adoption might lead to “medicalization” of human love and heartache—for some, a source of serious concern. In this essay, we argue that the “medicalization of love” need not necessarily be problematic, on balance, but could plausibly be expected to have either good (...) or bad consequences depending upon how it unfolds. By anticipating some of the specific ways in which these technologies could yield unwanted outcomes, bioethicists and others can help direct the course of love’s “medicalization”—should it happen to occur—more toward the “good” side than the “bad.”. (shrink)

There is congruence between Nietzsche’s philosophy of life and the biopolitical philosophy of Giorgio Agamben. For both philosophers the human animal possesses a divided relationship to its being alive. For both philosophers this division is of a political nature, such that membership in political community as we know it is conditional on the human animal’s alienation from its biological being. Both philosophers are also concerned with the possibility of transformation and, because of the connection they establish between politics and animality, (...) link this possibility to a change in the relationship between humans and their being alive. Yet both philosophers end up with an entirely different understanding of the nature of this change, and of its potential scope. This paper is an attempt at clarifying this disagreement between Nietzsche and Agamben, and with using it to come to a better understanding of the latter’s political ontology. It presents a reading of Kafka’s “The Burrow” in an attempt to show how Agamben’s concept of the anthropological machine challenges the Nietzschean program of the affirmation of life as will to power. (shrink)

If I were asked to put forward an ethical principle which I considered to be especially certain, it would be that no one can be responsible, in the properly ethical sense, for the conduct of another. Responsibility belongs essentially to the individual. The implications of this principle are much more far-reaching than is evident at first, and reflection upon them may lead many to withdraw the assent which they might otherwise be very ready to accord to this view of responsibility. (...) But if the difficulties do appear to be insurmountable, and that, very certainly, does not seem to me to be the case, then the proper procedure will be, not to revert to the barbarous notion of collective or group responsibility, but to give up altogether the view that we are accountable in any distinctively moral sense. (shrink)

Background: Recent literature on addiction and judgments about the characteristics of agents has focused on the implications of adopting a ‘brain disease’ versus ‘moral weakness’ model of addiction. Typically, such judgments have to do with what capacities an agent has (e.g., the ability to abstain from substance use). Much less work, however, has been conducted on the relationship between addiction and judgments about an agent’s identity, including whether or to what extent an individual is seen as the same person after (...) becoming addicted. Methods: We conducted a series of vignette-based experiments (total N = 3,620) to assess lay attitudes concerning addiction and identity persistence, systematically manipulating key characteristics of agents and their drug of addiction. Conclusions: In Study 1, we found that US participants judged an agent who became addicted to drugs as being closer to ‘a completely different person’ than ‘completely the same person’ as the agent who existed prior to the addiction. In Studies 2-6, we investigated the intuitive basis for this result, finding that lay judgments of altered identity as a consequence of drug use and addiction are driven primarily by perceived negative changes in the moral character of drug users, who are seen as having deviated from their good true selves. (shrink)

A great achievement makes one’s life go better independently of its results, but what makes an achievement great? A simple answer is—its difficulty. I defend this view against recent, pressing objections by interpreting difficulty in terms of competitiveness. Difficulty is determined not by how hard the agent worked for the end but by how hard others would need to do in order to compete. Successfully reaching a goal is a valuable achievement because it is difficult, and it is difficult because (...) it is competitive. Hence, both virtuosic performances and lucky successes can be valuable achievements. (shrink)

In this paper I offer an argument against one important version of panentheism, that is, mereological panentheism. Although panentheism has proven difficult to define, I provide a working definition of the view, and proceed to argue that given this way of thinking about the doctrine, mereological accounts of panentheism have serious theological drawbacks. I then explore some of these theological drawbacks. In a concluding section I give some reasons for thinking that the classical theistic alternative to panentheism is preferable, all (...) things considered. (shrink)

In recent years, scholars have increasingly paid attention to the philosophy of Josiah Royce. Long lost in the shadow of fellow classical American figures, Royce’s philosophy has enjoyed a renascence, with a spate of publications in a variety of venues studying and applying his thought.1 Like his philosophical brethren, Royce wrote on a wide variety of subjects, his discussions underpinned by a smattering of influences. Much has been remarked of the various Western sources that made an impression on Royce’s thought, (...) but comparatively little has been said of his indebtedness to Eastern sources. Kurt Leidecker’s Josiah Royce and Indian Thought2 and Frank M... (shrink)

Attributions of omnipresence, most familiar within the philosophy of religion, typically take the omnipresence of an entity to either consist in that entity's occupation of certain regions or be dependent upon other of that entity's attributes, such as omnipotence or omniscience. This paper defends an alternative conception of omnipresence that is independent of other purported divine attributes and dispenses with occupation. The resulting view repurposes the metaphysics of necessitism and permanentism, taking omnipresent entities to be those entities that exist at (...) all regions. This view is then shown to best accommodate attributions of omnipresence to a diverse range of metaphysical posits, like abstract entities, and a more diverse class of religious posits. (shrink)

In this issue, Ahmadi1 reports on the practice of hymenoplasty—a surgical intervention meant to restore a presumed physical marker of virginity prior to a woman's marriage. As Mehri and Sills2 have stated, these women ‘want to ensure that blood is spilled on their wedding night sheets.’ Although Ahmadi's research was carried out in Iran specifically, this surgery is becoming increasingly popular in a number of Western countries as well, especially among Muslim populations.3 What are the ethics of hymen restoration?Consider the (...) role of the physician. Two of the doctors interviewed by Ahmadi reported being in ‘a perpetual state of guilt because of the surgery's inherent aim at deceiving the groom’ and noted their ‘personal conflict’ at being involved in this deception. Yet: "None of the doctors believed that the surgery was unethical, arguing that the girl could be ‘abused’ and ‘can even die’ if she is discovered not … ". (shrink)

Wicked problems are tricky to solve because of their many interconnected components and a lack of any single optimal solution. At the science–policy interface, all problems can look wicked: research exposes the complexity that is relevant to designing, executing and implementing policy fit for ambitious human needs. Expertise in philosophical research can help to navigate that complexity.

We argue that the value of authenticity does not explain the value of self-knowledge. There are a plurality of species of authenticity; in this paper we consider four species: avoiding pretense (section 2), Frankfurtian wholeheartedness (section 3), existential self-knowledge (section 4), and spontaneity (section 5). Our thesis is that, for each of these species, the value of (that species of) authenticity does not (partially) explain the value of self-knowledge. Moreover, when it comes to spontaneity, the value of (that species of) (...) authenticity conflicts with the value of self-knowledge. (shrink)

What are the effects of circumcision on sexual function and experience? And what does sex—in the sense related to gender—have to do with the ethics of circumcision? Jacobs and Arora (2015) give short shrift to the first of these questions; and they do not seem to have considered the second. In this commentary, I explore the relationship between sex (in both senses) and infant male circumcision, and draw some conclusions about the ongoing debate regarding this controversial practice.

Objective: There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this. -/- Methods: We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a “Points to (...) Consider” (P2C) document, and convened a national expert panel to review and critique the P2C. -/- Results: We developed the P2C to aid informaticists designing an advanced query tool for an electronic health record (EHR) system in Indianapolis. The P2C consists of six questions (“Points”) that frame important ethical issues, apply accepted principles of bioethics and Fair Information Practices, comment on how questions might be answered, and address implications for patient care. -/- Discussion: The P2C is intended to clarify whatis at stake when designers try to accommodate potentially competing ethical commitments and logistical realities. The P2C was developed to guide informaticists who were designing a query tool in an existing EHR that would permit patient granular control. While consideration of ethical issues is coming to the forefront of medical informatics design and development practices, more reflection is needed to facilitate optimal collaboration between designers and ethicists. This report contributes to that discussion. (shrink)

In 2012, the politician Todd Akin caused a firestorm by suggesting, in the context of an argument about the moral permissibility of abortion, that some forms of rape were. This seemed to imply that other forms of rape must not be legitimate. In response, several commentators pointed out that rape is a and that there are. While the intention of these commentators was clear, I argue that they may have played into the very stereotype of rape endorsed by Akin. Such (...) a response, I claim, actually obscures a range of sexual harms, including some that may not rise to the level of being a crime. I also offer some thoughts on the moral psychology behind anti-abortion arguments of the kind advanced by Akin. (shrink)

The kind of empathy that is communicated through expressions like “I feel your pain” or “I share your sadness” is important, but peculiar. For it seems to require something perplexing and elusive: sharing another’s experience. It’s not clear how this is possible. We each experience the world from our own point of view, which no one else occupies. It’s also unclear exactly why it is so important that we share others' pains. If you are in pain, then why should it (...) matter, and be a good thing, that I am also in the same pain? Our goal in this paper is to address these questions. Specifically, our goal is to clarify how empathy, in the regimented sense of sharing another’s pain, is possible and why it is important. Central to our account is the concept of being acquainted with—that is, directly aware of—pain. When I feel my own pain, and am acquainted with it, I want the pain to stop, and I’m moved—sometimes compelled—to stop it. My acquaintance with the pain is what reveals that it is no good, to be gotten rid of, and to be avoided in the future. Acquaintance also appears to be implicated in our understanding of, and motivation to relieve, others’ pains. When I say “I feel your pain” I express an awareness of your pain, a direct appreciation of its noxious qualities, and, as with my own pain, an understanding of why it ought to be eased. Explaining how empathy is both possible and important therefore involves clarifying the nature of acquaintance: its limits, epistemic role, and motivational significance. What our analysis reveals is that agents have both epistemic and moral reasons to share other people’s pain because pain-sharing is the source of a species of character-building knowledge that we have no other way of accessing except through direct acquaintance with pain. (shrink)

This study is intended to provide in-depth insights into how design thinking and creativity issues are understood and possibly evolve in the course of design discussions in a company context. For that purpose, we use the seminar transcripts of the Design Thinking Research Symposium 12 (DTRS12) dataset “Tech-centred Design Thinking: Perspectives from a Rising Asia,” which are primarily concerned with how Korean companies implement design thinking and what role designers currently play. We employed a novel method of information processing based (...) on constructed dynamic semantic networks to investigate the seminar discussions according to company representatives and company size. We compared the quantitative dynamics in two seminars: the first involved managerial representatives of four companies, and the second involved specialized designers and management of a design center of single company. On the basis of dynamic semantic networks, we quantified the changes in four semantic measures—abstraction, polysemy, information content, and pairwise word similarity—in chronologically reconstructed individual design-thinking processes. Statistical analyses show that design thinking in the seminar with four companies, exhibits significant differences in the dynamics of abstraction, polysemy, and information content, compared to the seminar with the design center of single company. Both the decrease in polysemy and abstraction and the increase in information content in the individual design-thinking processes in the seminar with four companies indicate that design managers are focused on more concrete design issues, with more information and less ambiguous content to the final design product. By contrast, specialized designers manifest more abstract thinking and appear to exhibit a slightly higher level of divergence in their design processes. The results suggest that design thinking and creativity issues are articulated differently depending on designer roles and the company size. (shrink)

I argue that a group can have normative commitments, and that the commitment of a group is not merely a sum or aggregate of the commitments of individual group members. I begin with a set of simple cases which illustrate two structurally different ways that group commitments can go wrong. These two kinds of potential failure correspond to two different levels of commitment: one at the individual level, owed to the other group members, and one at the group level, which (...) the group as a single body owes either to itself or to some third party. I distinguish the content of a commitment (what must be done for the commitment to be fulfilled) from the holder of that commitment: the party to whom the content is owed. I then discuss examples which support the two-level view of group commitment and show that, even when individual-level and group-level commitments have the same content, they are understood to have different holders. Finally I return to my original cases and argue that a two-level structure of group commitment allows us to make sense of the problems that occur in them. (shrink)

We argue that the fragility of contemporary marriages—and the corresponding high rates of divorce—can be explained (in large part) by a three-part mismatch: between our relationship values, our evolved psychobiological natures, and our modern social, physical, and technological environment. “Love drugs” could help address this mismatch by boosting our psychobiologies while keeping our values and our environment intact. While individual couples should be free to use pharmacological interventions to sustain and improve their romantic connection, we suggest that they may have (...) an obligation to do so as well, in certain cases. Specifically, we argue that couples with offspring may have a special responsibility to enhance their relationships for the sake of their children. We outline an evolutionarily informed research program for identifying promising biomedical enhancements of love and commitment. (shrink)

Whipple disease is a rare, infectious, disease first described from a single case by Whipple in 1907. As well as characterising the clinical and pathological features of the condition, Whipple made two suggestions regarding its aetiology. These were either than the disease was caused by an infectious agent, or that it was of metabolic origin. As the disease is now thought to be caused by infection with the bacterium Tropheryma whipplei, historical reviews of the history of the disease typically mention (...) only the first of these suggestions. In this paper, we therefore revisit Whipple’s other theory. We argue that a diverse and often successful research programme was developed around this mechanism of disease causation which gave rise to many useful findings on the condition. In the later parts of this article, we then turn to discuss the surprising neglect of this period of Whipple disease research in the current literature, and conclude by offering a brief reconstruction of this early history suitable for use in a technical context. (shrink)

An exploratory pilot study with a small homogenous sample of Christian English speaking participants provided support for an alternative research hypothesis that a Christ consciousness contemplation with Heart Prayer of HeartMath techniques was significantly associated with increasing psychophysiological coherence, sense of coherence, spirituality and health perceptions. Participants described feelings of a peaceful place in oneness and connection with Christ. Integrative findings point towards Christ consciousness as an ultimately non-dual process of sensing vibrational resonance radiating from the human heart. Implications for (...) further research are discussed. (shrink)

In 2012, a German court ruled that religious circumcision of male minors constitutes criminal bodily assault. Muslim and Jewish groups responded with outrage, with some commentators pegging the ruling to Islamophobic and anti-Semitic motivations. In doing so, these commentators failed to engage with any of the legal and ethical arguments actually given by the court in its landmark decision. In this brief commentary, I argue that a firm distinction must be drawn between criticisms of religious practices that stem from irrational (...) prejudice and bigoted attitudes and those that are grounded in sound moral reasoning. Given that ritual circumcision is a pre-Enlightenment custom that elevates the inclinations of the community over the rights of the individual, it is hardly surprising that a growing number of post-Enlightenment philosophers and legal scholars are taking an ethical stand against it. As the “circumcision debate” continues, parties on all sides of the issue must remember to reason through the relevant considerations with care and respect. (shrink)

Sam Harris, in his book The Moral Landscape, argues that "science can determine human values." Against this view, I argue that while secular moral philosophy can certainly help us to determine our values, science must play a subservient role. To the extent that science can what we ought to do, it is only by providing us with empirical information, which can then be slotted into a chain of deductive reasoning. The premises of such reasoning, however, can in no way be (...) derived from the scientific method: they come, instead, from philosophy – and common sense. (shrink)

This integral investigation explored phenomenological and neurophysiologic, individual and collective dimensions of Christian Trinitarian meditation experiences in a volunteer, convenience sample of 10 practicing Christians, 6 men and 4 women, with a mean age of 48 years and an age range from 21 to 85 years. Participants meditated for a minimum period of 15 minutes, during which neurophysiologic data in the form of electroencephalographic (EEG), electromyographic (EMG), blood volume pulse (BVP) and respiratory activity were recorded. A phenomenological analysis indicated that (...) the meditation process generally involved a movement from body to mind to spirit as evident in reports of an increasingly relaxed, contented and focused state of consciousness characterised by Christian Trinitarian imagery, wonder, surrender, peace, bliss, openness and formlessness. The neuropsychological findings indicated significant increases, from baseline to meditation recordings, in the alpha and beta range, accompanied by increasing mean trends in the theta and gamma range, and decreasing mean trends in the delta range, EMG, BVP and respiration. Integrative findings indicated the practical theological value of small doses of Christian Trinity meditation to enhance spiritual life for those forms of waking, thinking, conscious behaviour needed in everyday world involvement and healing. Findings were discussed in relation to further integrative investigations and interventions with practical theological implications. (shrink)

German philosopher Immanuel Kant employs the story of Eve in the Garden of Eden as a way to think about what the development of autonomy in human beings must have involved. In the beginning, our ancestors invariably listened to their instincts, which would have seemed to them, as Kant describes it, like the “voice of God which all animals must obey”. Regardless of whether it has any basis in historical reality, that moment represents for Kant the birth of human autonomy: (...) at some point in our history, our ancestors attained self‐awareness and realized that they could disobey their instincts. There is a limited sense in which the actions that stem from internal sources, whether natural or artificial, are autonomous in the sense of involving internal control. The responsibility is one that every autonomous individual has, for better or worse, whether guest or host, in Westworld or outside of it. (shrink)

The research was generally motivated by a dearth of studies on joy, and particularly inspired by a book of joy celebrating the inter-spiritual dialogue between the Dalai Lama and Desmond Tutu. Its aim was to investigate whether the direct contemplation of joy would be associated with improvements in psychophysiological coherence, spirituality and various positive emotions and feelings. Integrative quantitative and qualitative findings emerging from a small pilot study, including a convenience sample of six participants with a mean age of 42 (...) years and age range of 25-69 years, supported the research hypothesis. Significant quantitative increases in psychophysiological coherence, spirituality and positive feelings were coherently and consistently supported by participants' individual and collective experiences. Integrative discussion amplified the paradoxical theme of joy through suffering in human emotional and spiritual life. (shrink)

Translating risk estimates derived from epidemiologic study into evidence of causality for a particular patient is problematic. The difficulty of this process is not unique to the medical context; rather, courts are also challenged with the task of using risk estimates to infer evidence of cause in particular cases. Thus, an examination of how this is done in a legal context might provide insight into when and how it is appropriate to use risk information as evidence of cause in a (...) medical context. A careful study of the case of Goodman v. Viljoen, a medical malpractice suit litigated in the Ontario Superior Court of Justice in 2011, reveals different approaches to how risk information is used as or might be considered a substitute for evidence of causation, and the pitfalls associated with these approaches. Achieving statistical thresholds, specifically minimizing the probability of falsely rejecting the null hypothesis, and exceeding a relative risk of 2, plays a significant role in establishing causality of the particular in the legal setting. However, providing a reasonable explanation or establishing “biological plausibility” of the causal association also seems important, and (to some) may even take precedent over statistical thresholds for a given context. (shrink)

Rationale, Aims, and Objectives: Confidence (or belief) that a therapy is effective is essential to practicing clinical medicine. GRADE, a popular framework for developing clinical recommendations, provides a means for assigning how much confidence one should have in a therapy's effect estimate. One's level of confidence (or “degree of belief”) can also be modelled using Bayes theorem. In this paper, we look through both a GRADE and Bayesian lens to examine how one determines confidence in the effect estimate. Methods: Philosophical (...) examination. Results: The GRADE framework uses a criteria‐based method to assign a quality of evidence level. The criteria pertain mostly to considerations of methodological rigour, derived from a modified evidence‐based medicine evidence hierarchy. The four levels of quality relate to the level of confidence one should have in the effect estimate. The Bayesian framework is not bound by a predetermined set of criteria. Bayes theorem shows how a rational agent adjusts confidence (ie, degree of belief) in the effect estimate on the basis of the available evidence. Such adjustments relate to the principles of incremental confirmation and evidence proportionism. Use of the Bayesian framework reveals some potential pitfalls in GRADE's criteria‐based thinking on confidence that are out of step with our intuitions on evidence. Conclusions: A rational thinker uses all available evidence to formulate beliefs. The GRADE criteria seem to suggest that we discard some of that information when other, more favoured information (eg, derived from clinical trials) is available. The GRADE framework should strive to ensure that the whole evidence base is considered when determining confidence in the effect estimate. The incremental value of such evidence on determining confidence in the effect estimate should be assigned in a manner that is theoretically or empirically justified, such that confidence is proportional to the evidence, both for and against it. (shrink)

The three most recent reviews of Wild Wise Weird received this week follow. Review contents will be used for a statisical analysis subsequently.

Health care providers (HCPs) are routinely placed into morally challenging situations that have the potential to cause moral distress. This is especially true for HCPs working in the military, whether they are on deployment outside their typical contexts of practice such as in disaster relief (e.g., Haiti and the Ebola missions in West Africa), or in more typically military settings such as peace keeping or armed conflicts (e.g., Afghanistan, Syria). Moral distress refers to “painful feelings and/or psychological disequilibrium” (Nilsson, Sjöberg, (...) Kallenberg, & Larsson, 2011, p. 50) that occur when an individual is aware of a morally appropriate action in a moral dilemma but obstruction prevents them from carrying it out, or when in a situation where they must choose between upholding equally treasured but conflicting moral values. Similarly, moral distress can occur when faced with a ‘tragic choice’ where all available courses of action require something of moral significance to be given up, such as surgical triage in a mass casualty event (Hunt, Sinding, & Schwartz, 2012). In the literature, moral distress has been connected to negative psychological effects and even stress related mental health issues including compassion fatigue, burnout, and post-traumatic stress disorder (Owen & Wanzer, 2014; Gustafsson, Eriksson, Strandberg, & Norberg, 2010; Litz, et al., 2009). (shrink)

The vital role of the private sector in the overall development of a country is crucial as proven by private tertiary industries. Despite its phenomenal success all over the world, private sectors are facing enormous challenges due to the frequent turnover of Generation Y (Gen Y). Such phenomena cause massive overt and covert losses. Gen Y workers are optimistic, practical and often have attrition tendencies at workplaces. Extensive literature indicates the turnover problem of Gen Y remains unresolved. Frustration acts as (...) the most crucial factor contributing to frequent turnover. The employers state similar effects. Turnover studies have been performed in the Western sense, though turnover problems exist all over the world, which include a developing country like Bangladesh. Another problem is the turnover rate in the public sector is lower than in the private sector. Since each company strives to achieve the best output and lower turnover to avoid brain drain, they refrain from high turnover costs and maintaining competent staff. This quantitative study discovers that there is an urgent need to establish retention-friendly approaches to mitigate Gen Y frustration and retain them in the workplace. Gen Y retention approaches, management initiatives, soft HRM, work-life balance, and employee satisfaction are vital resources for Gen Y retention in the private sector. (shrink)

Clark and Chalmers (1998) defend the hypothesis of an ‘Extended Mind’, maintaining that beliefs and other paradigmatic mental states can be implemented outside the central nervous system or body. Aspects of the problem of ‘language acquisition’ are considered in the light of the extended mind hypothesis. Rather than ‘language’ as typically understood, the object of study is something called ‘utterance-activity’, a term of art intended to refer to the full range of kinetic and prosodic features of the on-line behaviour of (...) interacting humans. It is argued that utterance activity is plausibly regarded as jointly controlled by the embodied activity of interacting people, and that it contributes to the control of their behaviour. By means of specific examples it is suggested that this complex joint control facilitates easier learning of at least some features of language. This in turn suggests a striking form of the extended mind, in which infants’ cognitive powers are augmented by those of the people with whom they interact. (shrink)

The evidence based medicine movement has championed the need for objective and transparent methods of clinical guideline development. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) framework was developed for that purpose. Central to this framework is criteria for assessing the quality of evidence from clinical studies and the impact that body of evidence should have on our confidence in the clinical effectiveness of a therapy under examination. Grades of Recommendation, Assessment, Development, and Evaluation has been adopted by a (...) number of professional medical societies and organizations as a means for orienting the development of clinical guidelines. As a result, the method of GRADE has implications on how health care is delivered and patient outcomes. In this paper, we reveal several issues with the underlying logic of GRADE that warrant further discussion. First, the definitions of the “grades of evidence” provided by GRADE, while explicit, are functionally vague. Second, the “criteria for assigning grade of evidence” is seemingly arbitrary and arguably logically incoherent. Finally, the GRADE method is unclear on how to integrate evidence grades with other important factors, such as patient preferences, and trade‐offs between costs, benefits, and harms when proposing a clinical practice recommendation. Much of the GRADE method requires judgement on the part of the user, making it unclear as to how the framework reduces bias in recommendations or makes them more transparent—both goals of the programme. It is our view that the issues presented in this paper undermine GRADE's justificatory scheme, thereby limiting the usefulness of GRADE as a tool for developing clinical recommendations. (shrink)