Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino (...) and Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend to disadvantage individuals with barriers in access to care (3). There is mounting evidence of racial, ethnic, and socioeconomic disparities in access to medications for COVID-19 (4, 5). -/- One potential method to promote equitable allocation is to use a weighted lottery, which is an allocation strategy that gives all eligible patients a chance to receive the scarce treatment while also allowing the assignment of higher or lower chances according to other ethical considerations (6). We sought to assess the feasibility of implementing a weighted lottery to allocate scarce COVID-19 medications in a large U.S. health system and to determine whether the weighted lottery promotes equitable allocation. (shrink)

Conflicts between morality and prudence are often thought to pose a special problem because the normativity of moral considerations derives from a distinctively moral point of view, while the normativity of prudential considerations derives from a distinctively prudential point of view, and there is no way to ‘put together’ the two points of view. I argue that talk of points of view is a red herring, and that for any ‘prumoral’ conflict there is some or other more comprehensive value – (...) often nameless – that accounts for the relative normative weight of conflicting moral and prudential considerations. The rational resolution of conflict is possible only in virtue of a more comprehensive value that includes the conflicting moral and prudential considerations as parts. (shrink)

Objective: This study aimed to investigate and compare the effects of tubular gastroesophageal anastomosis and traditional gastroesophageal supra-arch anastomosis on the postoperative lung function of patients with esophageal carcinoma. -/- Methods: A total of 90 patients with middle-lower segmental esophageal cancer admitted in our hospital from August 2014 to August 2016 were recruited to our study. They were randomly divided into two groups. The observation group underwent tubular gastroesophageal anastomosis, whereas the control group underwent traditional gastroesophageal supra-arch anastomosis. (...) Changes in the postoperative pulmonary function were compared between the two groups. -/- Results: The numbers of CD4 cells (27.45 ± 5.48), CD8 cells (35.97 ± 7.16), and natural killer cells (20.79 ± 2.49), as well as the CH4/CD8 ratio (0.69 ± 0.18), of the patients in the observation group were significantly higher than the (38.45 ± 5.98), (20.45 ± 6.41), (39.44 ± 3.49), and (1.31 ± 0.48), respectively, of the patients in the control group. The differences between the two groups were statistically significant (P<0.05). By contrast, the preoperative forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and maximum voluntary ventilation (MVV) did not significantly differ between the two groups (P>0.05). The FEV1 (1.76 ± 0.41 L), FVC (2.33 ± 0.32 L), and MVV (33.7 ± 5.2 L/min) of the observation group were significantly higher than those of the control group (P<0.05). Meanwhile, the complication rate of the observation group was 42.2%, which was significantly lower than that of the control group (75.6%) (P<0.05). -/- Conclusion: Tubular gastroesophageal anastomosis can benefit patients with esophageal cancer by significantly reducing the adverse effects on their postoperative pulmonary function and control the occurrence of postoperative complications. (shrink)

On a ‘comparative’ conception of practical reasons, reasons are like ‘weights’ that can make an action more or less rational. Bernard Gert adopts instead a ‘toggle’ conception of practical reasons: something counts as a reason just in case it alone can make some or other otherwise irrational action rational. I suggest that Gert’s conception suffers from various defects, and that his motivation for adopting this conception – his central claim that actions can be rational without there being reasons for them (...) – does not require adoption of the toggle conception. The more intuitive comparative conception of reasons for action can accommodate the insight. (shrink)

Does DBS change a patient’s personality? This is one of the central questions in the debate on the ethics of treatment with Deep Brain Stimulation (DBS). At the moment, however, this important debate is hampered by the fact that there is relatively little data available concerning what patients actually experience following DBS treatment. There are a few qualitative studies with patients with Parkinson’s disease and Primary Dystonia and some case reports, but there has been no qualitative study (...) yet with patients suffering from psychiatric disorders. In this paper, we present the experiences of 18 patients with Obsessive-Compulsive Disorder (OCD) who are undergoing treatment with DBS. We will also discuss the inherent difficulties of how to define and assess changes in personality, in particular for patients with psychiatric disorders. We end with a discussion of the data and how these shed new light on the conceptual debate about how to define personality. (shrink)

People suffering from Obsessive-Compulsive Disorder (OCD) do things they do not want to do, and/or they think things they do not want to think. In about 10 percent of OCD patients, none of the available treatment options is effective. A small group of these patients is currently being treated with deep brain stimulation (DBS). Deep brain stimulation involves the implantation of electrodes in the brain. These electrodes give a continuous electrical pulse to the brain area in which they (...) are implanted. It turns out that patients may experience profound changes as a result of DBS treatment. It is not just the symptoms that change; patients rather seem to experience a different way of being in the world. These global effects are insufficiently captured by traditional psychiatric scales, which mainly consist of behavioural measures of the severity of the symptoms. In this article we aim to capture the changes in the patients’ phenomenology and make sense of the broad range of changes they report. For that we introduce an enactive, affordance-based model that fleshes out the dynamic interactions between person and world in four aspects. The first aspect is the patients’ experience of the world. We propose to specify the patients’ world in terms of a field of affordances, with the three dimensions of broadness of scope (‘width’ of the field), temporal horizon (‘depth’), and relevance of the perceived affordances (‘height’). The second aspect is the person-side of the interaction, that is, the patients’ self-experience, notably their moods and feelings. Thirdly, we point to the different characteristics of the way in which patients relate to the world. And lastly, the existential stance refers to the stance that patients take towards the changes they experience: the second-order evaluative relation to their interactions and themselves. With our model we intend to specify the notion of being in the world in order to do justice to the phenomenological effects of DBS treatment. (shrink)

“I am still in despair over losing my identity,” said a blog comment in a discussion about post-menopause weight gain. Instead of recovering an identity, for some of us, as women age, our attitudes toward fitness may require forging new identities. But the challenge in coming to desire fitness, post-menopause, is a project of actually changing my desires. Habituating a good practice can lead to a change in our appetites, so that instead of losing our identities, we may (...) become the characters that we set goals to be. (shrink)

Different sort of people are interested in personal identity. Philosophers frequently ask what it takes to remain oneself. Caregivers imagine their patients’ experience. But both philosophers and caregivers think from the armchair: they can only make assumptions about what it would be like to wake up with massive bodily changes. Patients with a locked-in syndrome (LIS) suffer a full body paralysis without cognitive impairment. They can tell us what it is like. Forty-four chronic LIS patients and 20 (...) age-matched healthy medical professionals answered a 15-items questionnaire targeting: (A) global evaluation of identity, (B) body representation and (C) experienced meaning in life. In patients, selfreported identity was correlated with B and C. Patients differed with controls in C. These results suggest that the paralyzed body remains a strong component of patients’ experienced identity, that patients can adjust to objectives changes perceived as meaningful and that caregivers fail in predicting patients’ experience. (shrink)

This commentary defends 3 arguments for changing the label of levonorgestrel-based emergency contraception (LNG EC) so that it no longer supports the possibility of a mechanism of action after fertilization. First, there is no direct scientific evidence confirming any postfertilization mechanisms. Second, despite the weight of evidence, there is still widespread public misunderstanding over the mechanism of LNG EC. Third, this FDA label is not a value-free claim, but instead it has functioned like a political tool for reducing contraceptive (...) access. The label is laden with antiabortion values (even though EC is contraception, not abortion), and it imposes these values on potential users, resulting in barriers to access such as with Burwell v. Hobby Lobby. These 3 arguments together provide scientific, social, and ethical grounds for the FDA to take the initiate in changing Plan B's drug label. (shrink)

This paper critically examines Japan's approach toward the adoption of Generative AI such as ChatGPT in education via studying media discourse and guidelines at both the national as well as local levels. It highlights the lack of consideration for socio-cultural characteristics inherent in the Japanese educational systems, such as the notion of self, teachers’ work ethics, community-centric activities for the successful adoption of the technology. We reveal ChatGPT’s infusion is likely to further accelerate the shift away from traditional notion (...) of self, which has been ongoing during past educational reforms, towards active and self-directed learning. The current discourse on Generative AI’s infusion in education is driven by neoliberal agendas aimed at increasing employability and individualism. Moreover, the introduction of ChatGPT in the context of Japan's educator culture offers potential solutions to address issues of overwork but also necessitates considerations regarding increased responsibilities for teachers and the preservation of their central role in student education. Finally, the irreplicable social growth fostered by community-centric activities in the Japanese educational system highlights the limitations of ChatGPT in replicating dynamic social interactions, emphasizing the importance of holistic approaches to education beyond technological integration. (shrink)

Lippert-Rasmussen and Petersen discuss my ‘Moral case for legal age change’ in their article ‘Age change, official age and fairness in health’. They argue that in important healthcare settings (such as distributing vital organs for dying patients), the state should treat people on the basis of their chronological age because chronological age is a better proxy for what matters from the point of view of justice than adjusted official age. While adjusted legal age should not be used (...) in deciding who gets scarce vital organs, I remind the readers that using chronological age as a proxy is problematic as well. Using age as a proxy could give wrong results and it is better, if possible, for states to use the vital information directly than use age as a proxy. (shrink)

Can quite different values be rationally weighed against one another? Can the value of one thing always be ranked as greater than, equal to, or less than the value of something else? If the answer to these questions is no, then in what areas do we find commensurability and comparability unavailable? And what are the implications for moral and legal decision making? This book struggles with these questions, and arrives at distinctly different answers.".

What sorts of consideration can be normative reasons for action? If we systematize the wide variety of considerations that can be cited as normative reasons, do we find that there is a single kind of consideration that can always be a reason? Desire-based theorists think that the fact that you want something or would want it under certain evaluatively neutral conditions can always be your normative reason for action. Value-based theorists, by contrast, think that what plays that role are evaluative (...) facts (or the facts that subvene them) about what you want, such as the fact that having it would be good in some way. This paper argues that value-based theorists are wrong; if we try to find a single kind of consideration that can always be normative reason, we find that sometimes our reason is the fact that we want something and not any corresponding evaluative fact. (shrink)

What, normatively speaking, are the grounds of rational choice? This paper defends ‘comparativism’, the view that a comparative fact grounds rational choice. It examines three of the most serious challenges to comparativism: 1) that sometimes what grounds rational choice is an exclusionary-type relation among alternatives; 2) that an absolute fact such as that it’s your duty or conforms to the Categorial Imperative grounds rational choice; and 3) that rational choice between incomparables is possible, and in particular, all that is needed (...) for the possibility of rational choice is that one alternative is not worse than the others. Each challenge is questioned. If comparativism is correct, then no matter what normative theory you favor, your answer to the question, ‘What makes my choice rational?’ must be comparative in form. In this way, comparativism provides a framework for normative theorizing. (shrink)

The quantization error in a fixed-size Self-Organizing Map (SOM) with unsupervised winner-take-all learning has previously been used successfully to detect, in minimal computation time, highly meaningful changes across images in medical time series and in time series of satellite images. Here, the functional properties of the quantization error in SOM are explored further to show that the metric is capable of reliably discriminating between the finest differences in local contrast intensities and contrast signs. While this capability of the QE is (...) akin to functional characteristics of a specific class of retinal ganglion cells (the so-called Y-cells) in the visual systems of the primate and the cat, the sensitivity of the QE surpasses the capacity limits of human visual detection. Here, the quantization error in the SOM is found to reliably signal changes in contrast or colour when contrast information is removed from or added to the image, but not when the amount and relative weight of contrast information is constant and only the local spatial position of contrast elements in the pattern changes. While the RGB Mean reflects coarser changes in colour or contrast well enough, the SOM-QE is shown to outperform the RGB Mean in the detection of single-pixel changes in images with up to five million pixels. This could have important implications in the context of unsupervised image learning and computational building block approaches to large sets of image data (big data). (shrink)

Psychotherapy is effective. Since the 1970’s, meta-analyses, and meta-analyses of meta-analyses, have consistently shown a significant effect size for psychotherapeutic interventions when compared to no treatment or placebo treatments. This effectiveness is normally taken as a sign of the scientific legitimization of clinical psychotherapy. A significant problem, however, is that most psychotherapies appear to be equally effective. This poses a problem for specific psychotherapies: they may work, but likely not for the reasons that ground their theoretical explanations for their effectiveness. (...) A prominent explanation for the findings of common efficacy in psychotherapy is to postulate that all successful therapies work by altering maladaptive meanings and providing patients with new, more adaptive meanings. This paper argues that the ‘meaning view’ of psychological change is likely mistaken; psychological problems are not normally problems of meaning nor are they directly ameliorated by changes in meaning. This paper then outlines a skill-based explanation for the findings of the common efficacy of psychotherapy. (shrink)

In virtue of what is something a reason for action? That is, what makes a consideration a reason to act? This is a metaphysical or meta-normative question about the grounding of reasons for action. The answer to the grounding question has been traditionally given in ‘pure’, univocal terms. This paper argues that there is good reason to understand the ground of practical normativity as a hybrid of traditional ‘pure’ views. The paper 1) surveys the three leading ‘pure’ answers to the (...) question of a normative ground, 2) examines one or two of the most difficult problems for each, proposing along the way a new objection to one, and 3) argues that a particular hybrid view about normative grounds –‘hybrid voluntarism’ – avoids each of the main problems faced by the three leading ‘pure’ views. (shrink)

This article explores the main similarities and differences between Derek Parfit’s notion of imprecise comparability and a related notion I have proposed of parity. I argue that the main difference between imprecise comparability and parity can be understood by reference to ‘the standard view’. The standard view claims that 1) differences between cardinally ranked items can always be measured by a scale of units of the relevant value, and 2) all rankings proceed in terms of the trichotomy of ‘better than’, (...) ‘worse than’, and ‘equally good’. Imprecise comparability, which can be understood in terms of the more familiar notions of cardinality and incommensurability, rejects only the first claim while parity rejects both claims of the standard view. -/- I then argue that insofar as those attracted to imprecise comparability assume that all rankings are trichotomous, as Parfit appears to, the view should be rejected. This is because imprecise equality is not a form of equality but is a sui generis ‘fourth’ basic way in which items can be ranked. We should, I argue, understand imprecise equality as parity, and imprecise comparability as entailing ‘tetrachotomy’ – that if two items are comparable, one must better than, worse than, equal to, or on a par with the other. Thus those attracted to the idea that cardinality can be imprecise should abandon trichotomy and accept parity and tetrachotomy instead. -/- Finally, I illustrate the difference between Parfit’s trichotomous notion of imprecise comparability and parity by examining how each notion might be employed in different solutions to the problem posed by the Repugnant Conclusion in population ethics. I suggest that parity provides the arguably more ecumenical solution to the problem. (shrink)

This chapter argues that there is a particular kind of ‘internal’ commitment typically made in the context of romantic love relationships that has striking meta-normative implications for how we understand the role of the will in practical normativity. Internal commitments cannot plausibly explain the reasons we have in committed relationships on the usual model—as triggering reasons that are already there, in the way that making a promise triggers a reason via a pre-existing norm of the form ‘If you make a (...) promise to x, then you have a reason to x’. Instead, internal commitments are that in virtue of which one has the special reasons of committed relationships; they are the grounds of such reasons. In this way, the will is a source of practical normativity. (shrink)

One of the most common judgments of normative life takes the following form: With respect to some things that matter, one item is better than the other, with respect to other things that matter, the other item is better, but all things considered – that is, taking into account all the things that matter – the one item is better than the other. In this paper, I explore how all-things-considered judgments are possible, assuming that they are. In particular, I examine (...) the question of how the different considerations relevant to an all-things-considered judgment come together in a way that gives each relevant consideration its proper due. I propose an answer which provides a unified account of all-things-considered judgments and highlights a deep connection between value and reason. My suggestion is that ‘all things considered’ is, in effect, a placeholder for a more comprehensive, sometimes nameless, value that includes the things considered as parts, and that this more comprehensive value determines how the things considered normatively relate. (shrink)

This paper investigates two puzzles in practical reason and proposes a solution to them. First, sometimes, when we are practically certain that neither of two alternatives is better than or as good as the other with respect to what matters in the choice between them, it nevertheless seems perfectly rational to continue to deliberate, and sometimes the result of that deliberation is a conclusion that one alternative is better, where there is no error in one’s previous judgment. Second, there are (...) striking differences between rational agents – some rational agents have most reason to pursue careers on Wall Street while others have most reason to take up a career in teaching, or scuba diving, or working for political causes. These differences aren’t plausibly explained by ‘passive’ facts about our psychology or their causal interaction with our environment; instead, these facts seem in some sense to ‘express who we are’. But what is this sense? These puzzles disappear if we adopt a novel view about the source of the normativity of reasons – some reasons are given to us and others are reasons in virtue of an act of will. We make certain considerations reasons through an act of will and thus sometimes make it true through an act of agency that we have most reason to do one thing rather than another. (shrink)

‘Value pluralism’ as traditionally understood is the metaphysical thesis that there are many values that cannot be ‘reduced’ to a single supervalue. While it is widely assumed that value pluralism is true, the case for value pluralism depends on resolution of a neglected question in value theory: how are values properly individuated? Value pluralism has been thought to be important in two main ways. If values are plural, any theory that relies on value monism, for example, hedonistic utilitarianism, is mistaken. (...) The plurality of values is also thought to raise problems for rational choice. If two irreducibly distinct values conflict, it seems that there is no common ground that justifies choosing one over the other. The metaphysical plurality of values does not, however, have the implications for rational choice that many have supposed. A charitable interpretation of value pluralist writings suggests a ‘nonreductive’ form of value pluralism. Nonreductive value pluralism maintains that in the context of practical choice, there are differences between values—whether or not those values reduce to a single supervalue—that have important implications for rational choice. This article examines the main arguments for metaphysical value pluralism, argues that metaphysical value pluralism does not have certain implications that it is widely thought to have, and outlines three forms of nonreductive value pluralism. (shrink)

In this article, I identify and critically examine 3 dogmas of normativity that support a commonly accepted ‘Passivist View' of rational agency. I raise some questions about these dogmas, suggest what we should believe in their place, and moot an alternative ‘Activist View' of what it is to be a rational agent that grows out of rejection of the 3 dogmas. Underwriting the dogmas and the Passivist View, I suggest, is a deeply held but mistaken assumption that the normative domain (...) is fundamentally akin to the nonnormative domain. Once we allow that the normative may be fundamentally unlike the nonnormative in certain key ways, a shift in our thinking about what it is to be rational becomes possible. I end by considering some implications of this paradigm shift in rationality from the passive to the active for various applied matters. (shrink)

Background: Multi Drug Therapy approved by WHO is the best treatment option for Leprosy. There is a significant decline of mortality and morbidity after the introduction of multi drug therapy. But the adverse effects causing changes in clinical and laboratory parameters to multi drug therapy are the main limiting obstacle for the treatment course completion. Objective: The aim of this study is to find out the effects on routine laboratory parameters including hematological and biochemical changes before, during and after the (...) treatment of multi drug therapy in leprosy. Methodology: A descriptive cohort hospital based study on 85 multi drug therapy treated leprosy patients using standard laboratory tools for routine investigations for 18 months. Results: During the one year multidrug treatment period, most of the routine laboratory parameters showed mild to moderate change from normal level during the first 3 months with gradual recovery in the following months. Complete blood count assessment revealed mild decline in Hb, PCV, MCH, MCHC, and moderate decline in WBC and Platelet count. A mild increase in liver function tests (Bilirubin, AST, ALT, Alkaline phosphatase) and renal function tests (S.Creatinine, b. Urea) was observed. A moderate decline in S. Sodium with mild increase in S. Potassium was found on investigating S. Electrolytes. Patients were fully recovered from all hemato-biochemical adverse effects after 6 months of completion of the multi drug therapy. Conclusion: Despite of mild to moderate hematological and biochemical adverse reactions with multi drug therapy, recovery was excellent after 6 months of completion of therapy. (shrink)

In this paper, I defend the agent/patient distinction against critics who argue that causal interactions are symmetrical. Specifically, I argue that there is a widespread type of causal interaction between distinct entities, resulting in a type of ontological asymmetry that provides principled grounds for distinguishing agents from patients. The type of interaction where the asymmetry is found is when one of the entities undergoes a change in kind, structure, powers, or intrinsic properties as a result of the interaction (...) while the other does not. Interactions of this type are widespread in molecular biology and chemistry. I focus specifically on (i) the actions of enzymes on substrates and (ii) water molecules breaking the bonds of polarized molecules. Finally, I respond to objections by laying out and to a limited extent defending three commitments of my account: emergent entities and powers, realism about chemical kinds or structures, and the assumption of the agent/patient distinction in functional attributions in biology. (shrink)

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: -/- The main aim of this review will be to assess the effects of changing practitioner empathy or patient expectations for all conditions. The main objective is to conduct a systematic review of randomised trials where the intervention involves manipulating either (a) practitioner empathy or (b) patient expectations, or (c) both.

This paper argues that there is a particular kind of ‘internal’ commitment typically made in the context of romantic love relationships that has striking meta-normative implications for how we understand the role of the will in practical normativity. Internal commitments cannot plausibly explain the reasons we have in committed relationships on the usual model – as triggering reasons that are already there, in the way that making a promise triggers a reason via a pre-existing norm of the form ‘If you (...) make a promise to x, then you have a reason to x’. Instead, internal commitments are that in virtue of which one has the special reasons of committed relationships; they are the grounds of such reasons. In this way, the will is a source of practical normativity. (shrink)

‘Normative powers’ are capacities to create normative reasons by our willing or say-so. They are significant, because if we have them and exercise them, then sometimes the reasons we have are ‘up to us’. But such powers seem mysterious. How can we, by willing, create reasons? In this paper, I examine whether normative powers can be adequately explained normatively, by appeal to norms of a practice, normative principles, human interests, or values. Can normative explanations of normative powers explain how an (...) exercise of the will can afford us special freedom in determining our reasons? I argue that normative approaches to answering this question prove to be inadequate. To vindicate the thought that normative powers can make our reasons ‘up to us’, we need an altogether different approach to understanding them, one that is located not in the normative but in the metaphysical. I end the paper by sketching a metaphysical explanation of normative powers. This metaphysical defence of normative powers provides a window into a different, more agent-centered way of thinking about rational agency. (shrink)

The paper has two aims. The first is to propose a general framework for organizing some central questions about normative practical reasons in a way that separates importantly distinct issues that are often run together. Setting out this framework provides a snapshot of the leading types of view about practical reasons as well as a deeper understanding of what are widely regarded to be some of their most serious difficulties. The second is to use the proposed framework to uncover and (...) diagnose what I believe is a structural problem that plagues the debate about practical reasons. A common move in the debate involves a proponent of one type of view offering what she and others proposing that type consider to be a devastating criticism of an opposing type of view, only to find that her criticism is shrugged off by her opponents as easy to answer, misguided, or having little significance for their view. This isn’t due to conceptual blindness or mere slavish devotion to a theory but something fundamental about the argumentative structure of a debate over genuinely shared issues. Hence, the debate about practical reasons suffers from argumentative gridlock. The proposed framework helps us to see why this is so, and what we might do to move beyond it. (shrink)

This paper proposes a way to understand transformative choices, choices that change ‘who you are.’ First, it distinguishes two broad models of transformative choice: 1) ‘event-based’ transformative choices in which some event—perhaps an experience—downstream from a choice transforms you, and 2) ‘choice-based’ transformative choices in which the choice itself—and not something downstream from the choice—transforms you. Transformative choices are of interest primarily because they purport to pose a challenge to standard approaches to rational choice. An examination of the event-based (...) transformative choices of L. A. Paul and Edna Ullman-Margalit, however, suggests that event-based transformative choices don’t raise any difficulties for standard approaches to rational choice. An account of choice-based transformative choices—and what it is to be transformed—is then proposed. Transformative choices so understood not only capture paradigmatic cases of transformative choice but also point the way to a different way of thinking about rational choice and agency. (shrink)

This paper begins with a response to Josh Gert’s challenge that ‘on a par with’ is not a sui generis fourth value relation beyond ‘better than’, ‘worse than’, and ‘equally good’. It then explores two further questions: can parity be modeled by an interval representation of value? And what should one rationally do when faced with items on a par? I argue that an interval representation of value is incompatible with the possibility that items are on a par (a mathematical (...) proof is given in the appendix). I also suggest that there are three senses of ‘rationally permissible’ which, once distinguished, show that parity does distinctive practical work that cannot be done by the usual trichotomy of relations or by incomparability. In this way, we have an additional argument for parity from the workings of practical reason. (shrink)

This paper presents an argument against the widespread view that ‘hard choices’ are hard because of the incomparability of the alternatives. The argument has two parts. First, I argue that any plausible theory of practical reason must be ‘comparativist’ in form, that is, it must hold that a comparative relation between the alternatives with respect to what matters in the choice determines a justified choice in that situation. If comparativist views of practical reason are correct, however, the incomparabilist view of (...) hard choices should be rejected. Incomparabilism about hard choices leads us to an implausible error theory about the phenomenology of hard choices, threatens an unattractive view of human agency, and leaves us in perplexity about what we are doing when we choose in hard choices. The second part of the argument explores the main competitor to comparativist views of practical reason, noncomparativist view, according tow which a choice is justified so long as it is not worse than any of the alternatives. This view is often assumed by rational choice theorists but has its best philosophical defense in work by Joseph Raz. On Raz’s view, incomparabilism about hard choices avoids the problems faced if comparativism is correct, but it faces different difficulties. I argue that Raz’s noncomparativist view mistakenly assimilates practical reason to more restricted normative domains such as the law. (shrink)

Recently, some of the leading proponents of the view that there is widespread incommensurability among goods have suggested that the incommensurability of some goods is a constitutive feature of the goods themselves. So, for example, a friendship and a million dollars are incommensurable because it is part of what it is to be a friendship that it be incommensurable with money. According to these ‘constitutive incommensurabilists’ incommensurability follows from the very nature of certain goods. In this paper, I examine this (...) idea and argue that constitutive incommensurabilists have mistaken for constitutive incommensurability a particular emphatic kind of comparability. This examination involves an account of ‘higher’ and ‘lower’ goods and an explanation of how goods of different ‘types’ figure in practical conflict. (shrink)

Do sensory measurements deserve the label of “measurement”? We argue that they do. They fit with an epistemological view of measurement held in current philosophy of science, and they face the same kinds of epistemological challenges as physical measurements do: the problem of coordination and the problem of standardization. These problems are addressed through the process of “epistemic iteration,” for all measurements. We also argue for distinguishing the problem of standardization from the problem of coordination. To exemplify our claims, we (...) draw on olfactory performance tests, especially studies linking olfactory decline to neurodegenerative disorders. (shrink)

The feeling of being offended, as a moral emotion, plays a key role in issues such as slurs, the offense principle, ethics of humor, etc. However, no adequate theory of offense has been developed in the literature, and it remains unclear what questions such a theory should answer. This paper attempts to fill the gap by performing two tasks. The first task is to clarify and summarize the questions of offense into two kinds, the descriptive questions (e.g., what features differentiate (...) offense from similar moral states like anger?) and the normative questions (e.g., what are the conditions for taking offense to be apt?). The second task is to answer these questions by developing what I call ‘the violated norm theory of offense’. According to this theory, feeling offended entails that the norm one endorses is judged to be violated by the offender. Appealing to the violated norm enables this theory to answer the descriptive questions (e.g., taking offense differs from anger because of features like not requiring victims and the difficulty of animal offense) and the normative questions of offense (e.g., taking offense is apt only if the violated norm is universalizable). (shrink)

Most theories of slurs fall into one of two families: those which understand slurring terms to involve special descriptive/informational content (however conveyed), and those which understand them to encode special emotive/expressive content. Our view is that both offer essential insights, but that part of what sets slurs apart is use-theoretic content. In particular, we urge that slurring words belong at the intersection of a number of categories in a sociolinguistic register taxonomy, one that usually includes [+slang] and [+vulgar] and always (...) includes [-polite] and [+derogatory]. Thus, e.g., what distinguishes ‘Chinese’ from ‘chink’ is neither a peculiar sort of descriptive nor emotional content, but rather the fact that ‘chink’ is lexically marked as belonging to different registers than ‘Chinese’. It is, moreover, partly such facts which makes slurring ethically unacceptable. (shrink)

Slurs are derogatory, and theories of slurs aim at explaining their “derogatory force”. This paper draws a distinction between the type derogatory force and the token derogatory force of slurs. To explain the type derogatory force is to explain why a slur is a derogatory word. By contrast, to explain the token derogatory force is to explain why an utterance of a slur is derogatory. This distinction will be defended by examples in which the type and the token derogatory force (...) come apart. Because of the distinction, an adequate theory of slurs must be plausible for both the type and the token derogatory force. However, I will argue that many theories fail to be plausible for both. In particular, Hom’s combinatorial externalism and the conventional implicature theory offer implausible accounts of the token derogatory force, whereas the prohibitionist theory is insufficient to explain the type derogatory force. (shrink)

Slurs are both derogatory and offensive, and they are said to exhibit “derogatory force” and “offensiveness.” Almost all theories of slurs, except the truth-conditional content theory and the invocational content theory, conflate these two features and use “derogatory force” and “offensiveness” interchangeably. This paper defends and explains the distinction between slurs’ derogatory force and offensiveness by fulfilling three goals. First, it distinguishes between slurs’ being derogatory and their being offensive with four arguments. For instance, ‘Monday’, a slur in the Bostonian (...) argot, is used to secretly derogate African Americans without causing offense. Second, this paper points out that many theories of slurs run into problems because they conflate derogatory force with offensiveness. For example, the prohibition theory’s account of offensiveness in terms of prohibitions struggles to explain why ‘Monday’ is derogatory when it is not a prohibited word in English. Third, this paper offers a new explanation of this distinction from the perspective of a speech act theory of slurs; derogatory force is different from offensiveness because they arise from two different kinds of speech acts that slurs are used to perform, i.e., the illocutionary act of derogation and the perlocutionary act of offending. This new explanation avoids the problems faced by other theories. (shrink)

The present study collected a larger set of three-dimensional data on human crania from the Kofun period (as well as from previous periods, i.e., the Jomon and Yayoi periods) in the Japanese archipelago (AD 250 to around 700) than previous studies. Three-dimensional geometric morphometrics were employed to investigate human migration patterns in finer-grained phases. These results are consistent with those of previous studies, although some new patterns were discovered. These patterns were interpreted in terms of demic diffusion, archaeological findings, (...) and historical evidence. In particular, the present results suggest the presence of a gradual geological cline throughout the Kofun period, although the middle period did not display such a cline. This discrepancy might reflect social changes in the middle Kofun period, such as the construction of keyhole-shaped mounds in the peripheral regions. The present study implies that a broader investigation with a larger sample of human crania is essential to elucidating macro-level cultural evolutionary processes. (shrink)

Multiple loop heat pipes which have two evaporators and two condensers in one loop are a kind of active heat transfer device. Since they have two evaporators and two condensers, the operating mode also becomes multiple. This work discusses the cases that multiple loop heat pipes were operated with one condenser at high temperature and the other at low temperature. To avoid the high temperature returning liquid and keep the multiple loop heat pipes work properly, the flow regulator which was (...) made of polyethylene was designed, fabricated and applied in this test. The effect of flow regulator was confirmed and analyzed. In the test that large temperature difference existed between two sinks, it can be found according to the result that the flow regulator worked effectively and prevented the high temperature vapor to enter the inlet of common liquid line, which can keep the evaporators and returning liquid to operate at low temperature. With the increment of heat loads and the temperature difference between two sinks, the pressure difference between two condensers became larger and larger. When the pressure difference was larger than the flow regulator’s capillary force, the flow regulator could not work properly because the high temperature vapor began to flow through the flow regulator. According to the test data, the flow regulator can work properly within the sinks’ temperature 0?C/60?C and the two evaporators’ heat load 30/30 W. (shrink)

Husserl's Absolute-Flow-Model (AFM) represents an approach to a coherent phenomenological description of time-consciousness. Within the AFM framework the streaming of every real moment in the flow of time-consciousness is necessarily concomitant with some retentional or protentional modifications of time-consciousness modes. These modifications of consciousness, i.e. all retentions and protentions, are characterized here as "temporal apprehension." By means of this distinctive function of time-consciousness, all constituents of one and the same consciousness phase are assigned an intentional sense as their temporal index, (...) so that all these constituents can be temporally represented and distinguished by time-consciousness. In this way, the AFM can overcome some of the difficulties in describing the flow of consciousness. (shrink)

Background: The complexity of diagnostic presentations of an inpatient psychiatry population requires an integrative approach to health and well-being. In this sense, the primary need of this research aims at developing clinical strategies and healthier coping skills for anger, anxiety, and depression; promoting self-esteem, healthier sleep, and anxiety reduction; as well as enhancing mood and emotional–behavioral regulation via exercise and nutrition education. Objectives: The primary objective is to promote exercise, fitness, and physical health in inpatient psychiatry patients. The secondary (...) objective includes therapeutic management of depressive symptoms and patient-centered approach to mania, angry outbursts, and generalized disruptive behavior. The tertiary objective is promoting research in the psychophysiological effectors of exercise and nutrition education in combination with psychotherapy. Method: Monitoring self-reported changes in mood and general well-being via administration of surveys and questionnaires pre- and postexercise sessions. Results: The research yielded positive outcomes in all areas investigated, suggesting the positive effects of exercise and mind–body strategies in the context of psychotherapy in inpatient psychiatry. Conclusion: Physical exercise may be a helpful way to reduce mental health disorders in the context of inpatient psychiatry by targeting anxiety, depression, anger, psychomotor agitation, and muscle tension and addressing stressors and triggers and to develop a more balanced and integrated sense of self. (shrink)

Christine Korsgaard bases her interpretation of personal identity upon the notion of moral agency and thereby refutes the Reductionist thesis of Derek Parfit. Korsgaard indicates that actions and choices, from the practical standpoint, must be viewed as having agents and choosers. This is what makes them our own actions and choices as well as contributes to the process of self-constitution. Personal identity manifested as the chooser of our desires and author of our actions can be viewed as the common denominator (...) between Korsgaard and Wang Yangming (王陽明). For liangzhi (良知) is none other than the agency that acts as the capacity for moral judgment and the motivation of performing moral actions. Given liangzhi is the authentic self that make laws for us, our true identities are exhibited in the performance of moral behaviors. Moreover, further engagement between the two sides reveals that Wang’s characterizations of liangzhi, particularly those of practical justification, law-embodying identity, and zhih –zhi (致知), can be seen as either a complement to practical standpoint argument or an approach of consummating self-constitution. (shrink)

Aim: The researcher studied how the teachers at Guangdong Business and Technology University manage change based on the present situation in the country. -/- Methodology: This study utilized the descriptive – comparative research design with 275 teachers as respondents. Statistical test of data includes frequency count and percentage, weighted mean, t- test and/or ANOVA. -/- Results: Teacher respondents are very much ready to manage the change for the teaching and learning based on teaching-related factors which ranked first, as (...) well as on teaching-related factors which ranked second, and on technology-related factors which ranked third. It is noticeable that technology-related factor was the least assessed factors as regards their readiness to manage the change. Generally, an over-all mean value of 3.52 reveals that teachers are very much ready to manage the change for the teaching and learning. Based on the result, teacher respondents strongly agree on their level of motivation on their teaching and learning performance. The result reveals that teachers are highly motivated in performing their job as teachers based on their own assessment. -/- Conclusion: Majority of the respondents are female teachers in middle age aiming to earn their doctoral degree and have been in the university for not more than five years. Teachers believed that they are very much ready to manage the change for the teaching and learning. They also seem to be less ready in terms of accessing professional development opportunities that focus on continuous improvement of digital-age teaching skills. The use of variety of assessment strategies applying the technology and the implementation of alternative strategies in the classroom seems to be less managed by the teachers. They also have relatively the same assessment on how ready they are to manage the change in the teaching and learning regardless of their sex, age, educational level they have attained, and the length of stay in the institution. (shrink)

The aim of this paper is to provide a detailed characterisation of some ways in which our preferences reflect our reasons. I will argue that practical reasons can be characterised along two dimensions that influence our preferences: their balance and their weight. This is analogous to a similar characterisation of the way in which probabilities reflect the balance and weight of evidence in epistemology. In this paper, I will illustrate the distinction between the balance and weight of (...) reasons, and show how this is crucial for an adequate account of preference and choice. The upshot is a more complete picture of a particular kind of decision, labelled by Isaac Levi and, more recently, Ruth Chang as ‘hard choices’. These are choices in which one option is better than another in some ways, the other is better than the first in some ways, but neither seems better overall. The distinction between the balance and weight of reasons presents a new way of understanding how hard choices vary by degree and what it is that makes them so hard. (shrink)

The paper explores the influence of greenwash on green trust and discusses the mediation roles of green consumer confusion and green perceived risk. The research object of this study focuses on Taiwanese consumers who have the purchase experience of information and electronics products in Taiwan. This research employs an empirical study by means of the structural equation modeling. The results show that greenwash is negatively related to green trust. Therefore, this study suggests that companies must reduce their greenwash behaviors to (...) enhance their consumers’ green trust. In addition, this study finds out that green consumer confusion and green perceived risk mediate the negative relationship between greenwash and green trust. The results also demonstrate that greenwash is positively associated with green consumer confusion and green perceived risk which would negatively affect green trust. It means that greenwash does not only negatively affect green trust directly but also negatively influence it via green consumer confusion and green perceived risk indirectly. Hence, if companies would like to reduce the negative relationship between greenwash and green trust, they need to decrease their consumers’ green consumer confusion and green perceived risk. (shrink)

Improvements of the happiness of the rural population are an essential sign of the effectiveness of relative poverty governance. In the context of today’s digital economy, assessing the relationship between digital literacy and the subjective happiness of rural low-income groups is of great practicality. Based on data from China Family Panel Studies, the effect of digital literacy on the subjective well-being of rural low-income groups was empirically tested. A significant happiness effect of digital literacy on rural low-income groups was found. (...) Digital literacy promotes the subjective happiness of rural low-income groups through income increase and consumption growth effects. The observed happiness effect is heterogeneous among different characteristic groups, and digital literacy significantly positively impacts the subjective happiness of rural low-income groups. Decomposition of subjective happiness into life satisfaction and job satisfaction shows that digital literacy significantly positively affects the job and life satisfaction of rural low-income groups. This paper demonstrates that digital literacy induces a practical happiness effect. To further strengthen the subjective welfare effect of digital literacy in the construction of digital villages, the government should focus on cultivating digital literacy among low-income groups from the demand side. The construction of digital infrastructure should be actively promoted from the supply side. (shrink)

Epileptogenesis involves an increase in excitatory synaptic strength in the brain in a manner similar to synaptic potentiation. In the present study we investigated the mechanisms of short-term synaptic potentiation in patients with focal epilepsy by using 5 Hz repetitive transcranial magnetic stimulation (rTMS), a non invasive neurophysiological technique able to investigate the mechanisms of synaptic plasticity in humans. Ten patients with focal idiopathic cortical epilepsy were studied. 5 Hz-rTMS (10 stimuli-trains, 120% of motor threshold, RMT) was delivered (...) over the first dorsal interosseus (FDI) motor area of both (affected and unaffected) hemispheres. Changes in the motor evoked potential (MEP) size in the FDI muscle during the trains and the RMT were measured and compared between the hemispheres. 5 Hz-rTMS was also delivered in a group of healthy subjects over both hemispheres. 5 Hz-rTMS in patients elicited a reduced MEP facilitation compared to normal subjects. The reduced MEP amplitude was more evident in the affected hemisphere than in the unaffected hemisphere. RMT in the affected hemisphere was higher than in the unaffected hemisphere and in healthy subjects. Our findings showing a decreased response to 5 Hz-rTMS over the affected hemisphere, differently from the expected results suggest a reduced cortical excitability in epileptic patients. We hypothesize an altered balance between excitatory and inhibitory circuits in epileptic patients under chronic therapy. (shrink)

Big Data is a large-sized and complex dataset, which cannot be managed using traditional data processing tools. Mining process of big data is the ability to extract valuable information from these large datasets. Association rule mining is a type of data mining process, which is indented to determine interesting associations between items and to establish a set of association rules whose support is greater than a specific threshold. The classical association rules can only be extracted from binary data where an (...) item exists in a transaction, but it fails to deal effectively with quantitative attributes, through decreasing the quality of generated association rules due to sharp boundary problems. In order to overcome the drawbacks of classical association rule mining, we propose in this research a new neutrosophic association rule algorithm. The algorithm uses a new approach for generating association rules by dealing with membership, indeterminacy, and non-membership functions of items, conducting to an efficient decision-making system by considering all vague association rules. To prove the validity of the method, we compare the fuzzy mining and the neutrosophic mining. The results show that the proposed approach increases the number of generated association rules. (shrink)

Both patients and clinicians frequently report problems around communicating and assessing pain. Patients express dissatisfaction with their doctors and doctors often find exchanges with chronic pain patients difficult and frustrating. This chapter thus asks how we could improve pain communication and thereby enhance outcomes for chronic pain patients. We argue that improving matters will require a better appreciation of the complex meaning of pain terms and of the variability and flexibility in how individuals think about pain. (...) We start by examining the various accounts of the meaning of pain terms that have been suggested within philosophy and suggest that, while each of the accounts captures something important about our use of pain terms, none is completely satisfactory. We propose that pain terms should be viewed as communicating complex meanings, which may change across different communicative contexts, and this in turn suggests that we should view our ordinary thought about pain as similarly complex. We then sketch what a view taking seriously this variability in meaning and thought might look like, which we call the “polyeidic” view. According to this view, individuals tacitly occupy divergent stances across a range of different dimensions of pain, with one agent, for instance, thinking of pain in a much more “bodycentric” kind of way, while another thinks of pain in a much more "mindcentric” way. The polyeidic view attempts to expand the multidimensionality recognised in, e.g., biopsychosocial models in two directions: first, it holds that the standard triumvirate— dividing sensory/cognitive/affective factors— needs to be enriched in order to capture important distinctions within the social and psychological dimensions. Second, the polyeidic view attempts to explain (at least in part) why modulation of experience by these social and psychological factors is possible in the first place. It does so by arguing that because the folk concept of pain is complex, different weightings of the different parts of the concept can modulate pain experience in a variety of ways. Finally, we argue that adopting a polyeidic approach to the meaning of pain would have a range of measurable clinical outcomes. (shrink)