Data from medical research are typically summarized with various types of outcome measures. We present three arguments in favor of absolute over relative outcome measures. The first argument is from cognitive bias: relative measures promote the reference class fallacy and the overestimation of treatment effectiveness. The second argument is decision-theoretic: absolute measures are superior to relative measures for making a decision between interventions. The third argument is causal: interpreted as measures of causal (...) strength, absolute measures satisfy a set of desirable properties, but relative measures do not. Absolute outcome measures outperform relative measures on all counts. (shrink)

It is a plausible speculation that conventional choices in outcome measures might influence the results of meta-analyses. We test that speculation by simulating data from trials on antidepressants. We vary real drug effectiveness while modulating conventional values for outcome measures. We had previously shown that one conventional choice used in meta-analyses of antidepressants falls in a narrow range of values that maximize estimates of effectiveness. Our present analysis investigates why this phenomenon occurs. Moreover, our results suggest (...) the superiority of absolute outcome measures over relative measures. This research program can be extended to test numerous other aspects of clinical research. (shrink)

Measuring the effectiveness of medical interventions faces three epistemological challenges: the choice of good measuring instruments, the use of appropriate analytic measures, and the use of a reliable method of extrapolating measures from an experimental context to a more general context. In practice each of these challenges contributes to overestimating the effectiveness of medical interventions. These challenges suggest the need for corrective normative principles. The instruments employed in clinical research should measure patient-relevant and disease-specific parameters, and should not (...) be sensitive to parameters that are only indirectly relevant. Effectiveness always should be measured and reported in absolute terms (using measures such as 'absolute risk reduction'), and only sometimes should effectiveness also be measured and reported in relative terms (using measures such as 'relative risk reduction')-employment of relative measures promotes an informal fallacy akin to the base-rate fallacy, which can be exploited to exaggerate claims of effectiveness. Finally, extrapolating from research settings to clinical settings should more rigorously take into account possible ways in which the intervention in question can fail to be effective in a target population. (shrink)

What should the goals of scientific inquiry be? What questions should scientists investigate, and how should our resources be distributed between different lines of investigation? Philip Kitcher has suggested that we should answer these questions by appealing to an ideal based on the consideration of hypothetical democratic deliberations under ideal circumstances. The paper argues that we have no reason to adopt this ideal. The paper examines both traditional arguments for democracy and Kitcher's own reasons for adopting this ideal, as presented (...) in Kitcher (2001) and in Kitcher (2011b), and argues that none of these supports adoption of Kitcher's proposed ideal. (shrink)

This paper aims to assess knowledge management maturity at HEI to determine the most effecting variables on knowledge management that enhance the total performance of the organization. This study was applied on Al-Azhar University in Gaza strip, Palestine. This paper depends on Asian productivity organization model that used to assess KM maturity. Second dimension assess high performance was developed by the authors. The controlled sample was (364). Several statistical tools were used for data analysis and hypotheses testing, including reliability Correlation (...) using Cronbach’s alpha, “ANOVA”, Simple Linear Regression and Step Wise Regression. The overall findings of the current study suggest that KMM is suitable for measuring and lead to enhance high performance. KMM assessment shows that the university maturity level is in level three. Findings also support the main hypothesis and it is subhypotheses. The most important factors effecting high performance are: Processes, KM leadership, People, KM Outcomes, Knowledge Process. Furthermore the current study is unique by the virtue of its nature, scope and way of implied investigation, as it is the first study at HEI in Palestine explores the status of KMM using the Asian productivity model. (shrink)

Entanglement measures quantify the amount of quantum entanglement that is contained in quantum states. Typically, different entanglement measures do not have to be partially ordered. The presence of a definite partial order between two entanglement measures for all quantum states, however, allows for meaningful conceptualization of sensitivity to entanglement, which will be greater for the entanglement measure that produces the larger numerical values. Here, we have investigated the partial order between the normalized versions of four entanglement (...) class='Hi'>measures based on Schmidt decomposition of bipartite pure quantum states, namely, concurrence, tangle, entanglement robustness and Schmidt number. We have shown that among those four measures, the concurrence and the Schmidt number have the highest and the lowest sensitivity to quantum entanglement, respectively. Further, we have demonstrated how these measures could be used to track the dynamics of quantum entanglement in a simple quantum toy model composed of two qutrits. Lastly, we have employed state-dependent entanglement statistics to compute measurable correlations between the outcomes of quantum observables in agreement with the uncertainty principle. The presented results could be helpful in quantum applications that require monitoring of the available quantum resources for sharp identification of temporal points of maximal entanglement or system separability. (shrink)

Background: Many people with aphasia and people without brain injury talk to themselves in their heads, i.e., have “inner speech.” Inner speech may be more preserved compared with spoken speech for some people with aphasia and may serve a variety of functions (e.g., emotion regulation), which motivates us to provide a high-fidelity characterization of it. Researchers have used multiple methods to measure this internal phenomenon in the past, which we combine here for the first time in a single study. -/- (...) Aims: We compare performance between individuals with and without aphasia on inner speech tasks that assess inner speech “inthe- moment” to general subjective impressions of inner speech to tease apart the relationship of aphasia severity to inner speech. Methods and Procedures: Twenty people with mild-moderate aphasia and twenty neurotypical controls completed several inner speech tasks, including objective silent rhyme judgements (picture, written, and auditory), subjective reports of inner speech during naming, and subjective rating scales about inner speech experience more generally. -/- Outcomes and Results: In-the-moment inner speech during silent rhyming tasks was associated with aphasia severity only for picture and written rhyming but not auditory rhyming. In-the-moment inner speech reports during silent naming were not associated with aphasia severity, nor were the subjective ratings about general inner speech experience. Individuals with and without aphasia demonstrated a variety of subjective general inner speech experiences, demonstrating heterogeneity of this phenomenon more broadly. -/- Conclusions: Methods of measuring inner speech complement each other and speak to different facets of the inner speech phenomenon, and clinicians and researchers must carefully choose the method(s) that will provide the information about inner speech that they desire. (shrink)

With the ageing of the Portuguese population, there are more people in dependency situations and needing long-term care (LTC). In this context, it is important to ensure the quality of life (QoL) of those individuals, and that quality can be measured through their health-related quality of life (HRQoL) and overall well-being. Also, understanding how perceived service quality (PSQ) can be related to how people perceive their QoL is pertinent since service quality is an important factor to achieve patient health outcomes. (...) To develop this project, a LTC unit located in the district of Lisbon was chosen, the LTC unit of Arruda dos Vinhos. The main objective was to assess the relation between the PSQ, the HRQoL and the overall well-being of patients receiving LTC at the LTC unit of Arruda dos Vinhos. A project based on a case study was performed, through interviews based on the items of the SERVPERF, EQ-5D and ICECAP-O questionnaires, which were then analysed through content analysis. Results showed there is a relation between PSQ and HRQoL and between HRQoL and overall well-being. It was also possible to realise that to better evaluate the quality of this specific service, other subjects as the activities performed at the LTC unit, the physiotherapy service and the food provided, should be taken in consideration. Concluding, there is a relation between PSQ and the QoL of the patients receiving LTC at the LTC unit of Arruda dos Vinhos, when quality of life is measured through HRQoL. (shrink)

Background: Screen time among adults represents a continuing and growing problem in relation to health behaviors and health outcomes. However, no instrument currently exists in the literature that quantifies the use of modern screen-based devices. The primary purpose of this study was to develop and assess the reliability of a new screen time questionnaire, an instrument designed to quantify use of multiple popular screen-based devices among the US population. -/- Methods: An 18-item screen-time questionnaire was created to quantify use of (...) commonly used screen devices (e.g. television, smartphone, tablet) across different time points during the week (e.g. weekday, weeknight, weekend). Test-retest reliability was assessed through intra-class correlation coefficients (ICCs) and standard error of measurement (SEM). The questionnaire was delivered online using Qualtrics and administered through Amazon Mechanical Turk (MTurk). -/- Results: Eighty MTurk workers completed full study participation and were included in the final analyses. All items in the screen time questionnaire showed fair to excellent relative reliability (ICCs = 0.50–0.90; all < 0.000), except for the item inquiring about the use of smartphone during an average weekend day (ICC = 0.16, p = 0.069). The SEM values were large for all screen types across the different periods under study. -/- Conclusions: Results from this study suggest this self-administered questionnaire may be used to successfully classify individuals into different categories of screen time use (e.g. high vs. low); however, it is likely that objective measures are needed to increase precision of screen time assessment. (shrink)

The game theoretic notion of best-response reasoning is sometimes criticized when its application produces multiple solutions of games, some of which seem less compelling than others. The recent development of the theory of team reasoning addresses this by suggesting that interacting players in games may sometimes reason as members of a team – a group of individuals who act together in the attainment of some common goal. A number of properties have been suggested for team-reasoning decision-makers’ goals to satisfy, but (...) a few formal representations have been discussed. In this paper we suggest a possible representation of these goals based on the notion of mutual advantage. We propose a method for measuring extents of individual and mutual advantage to the interacting decision-makers, and define team interests as the attainment of outcomes associated with maximum mutual advantage in the games they play. (shrink)

When we compare the influences of two causes on an outcome, if the conclusion from every group is against that from the conflation, we think there is Simpson’s Paradox. The Existing Causal Inference Theory (ECIT) can make the overall conclusion consistent with the grouping conclusion by removing the confounder’s influence to eliminate the paradox. The ECIT uses relative risk difference Pd = max(0, (R − 1)/R) (R denotes the risk ratio) as the probability of causation. In contrast, Philosopher Fitelson (...) uses confirmation measure D (posterior probability minus prior probability) to measure the strength of causation. Fitelson concludes that from the perspective of Bayesian confirmation, we should directly accept the overall conclusion without considering the paradox. The author proposed a Bayesian confirmation measure b* similar to Pd before. To overcome the contradiction between the ECIT and Bayesian confirmation, the author uses the semantic information method with the minimum cross-entropy criterion to deduce causal confirmation measure Cc = (R − 1)/max(R, 1). Cc is like Pd but has normalizing property (between −1 and 1) and cause symmetry. It especially fits cases where a cause restrains an outcome, such as the COVID-19 vaccine controlling the infection. Some examples (about kidney stone treatments and COVID-19) reveal that Pd and Cc are more reasonable than D; Cc is more useful than Pd. (shrink)

In a recent paper, Yoaav Isaacs, Alan Hájek, and John Hawthorne argue for the rational permissibility of "credal imprecision" by appealing to certain propositions associated with non-measurable spatial regions: for example, the proposition that the pointer of a spinner will come to rest within a certain non-measurable set of points on its circumference. This paper rebuts their argument by showing that its premises lead to implausible consequences in cases where one is trying to learn, by making multiple observations, whether a (...) certain outcome is associated with a non-measurable region or a measurable one. (shrink)

The basic idea of quantum mechanics is that the property of any system can be in a state of superposition of various possibilities. This state of superposition is also known as wave function and it evolves linearly with time in a deterministic way in accordance with the Schrodinger equation. However, when a measurement is carried out on the system to determine the value of that property, the system instantaneously transforms to one of the eigen states and thus we get only (...) a single value as outcome of the measurement. Quantum measurement problem seeks to find the cause and exact mechanism governing this transformation. In an attempt to solve the above problem, in this paper, we will first define what the wave function represents in real world and will identify the root cause behind the stochastic nature of events. Then, we will develop a model to explain the mechanism of collapse of the quantum mechanical wave function in response to a measurement. In the process of development of model, we will explain Schrodinger cat paradox and will show how Born’s rule for probability becomes a natural consequence of measurement process. (shrink)

Knowledge of human uses of animals is an important, but understudied, aspect of how humans treat animals. We developed a measure of one kind of knowledge of human uses of animals – knowledge of factory farming. Studies 1 (N = 270) and 2 (N = 270) tested an initial battery of objective, true or false statements about factory farming using Item Response Theory. Studies 3 (N = 241) and 4 (N = 278) provided evidence that responses to a 10-item Knowledge (...) of Factory Farming Scale predicted a reduction in consumption of animal products (rs = −.17- −.27) and approval of political actions aimed at factory farming (rs = .2 – .24). Path models from Studies 3 and 4 suggested that different kinds of knowledge uniquely predicted different outcomes. The Knowledge of Factory Farming scale was a unique predictor of approval of political actions concerning factory farmed animals but not animal consumption. Knowledge of Animals Used as Food predicted animal consumption but not political actions concerning farmed animals. These results highlight that different kinds of knowledge can be relevant for different animal related outcomes. (shrink)

Unlike its friendly cousin the placebo effect, the nocebo effect (the effect of expecting a negative outcome) has been almost ignored. Epistemic and ethical confusions related to its existence have gone all but unnoticed. Contrary to what is often asserted, adverse events following from taking placebo interventions are not necessarily nocebo effects; they could have arisen due to natural history. Meanwhile, ethical informed consent (in clinical trials and clinical practice) has centred almost exclusively on the need to inform patients (...) about intervention risks with patients to preserve their autonomy. Researchers have failed to consider the harm caused by the way in which the information is conveyed. In this paper, I argue that the magnitude of nocebo effects must be measured using control groups consisting of untreated patients. And, because the nocebo effect can produce harm, the principle of non-maleficence must be taken into account alongside autonomy when obtaining (ethical) informed consent and communicating intervention risks with patients. (shrink)

In biomedical measurement, biomarkers are used to achieve reliable prediction of, and useful causal information about patient outcomes while minimizing complexity of measurement, resources, and invasiveness. A biomarker is an assayable metric that discloses the status of a biological process of interest, be it normative, pathophysiological, or in response to intervention. The greatest utility from biomarkers comes from their ability to help clinicians (and researchers) make and evaluate clinical decisions. In this paper we discuss a specific methodological use of clinical (...) biomarkers in pharmacological measurement: Some biomarkers, called ‘surrogate markers’, are used to substitute for a clinically meaningful endpoint corresponding to events and their penultimate risk factors. We confront the reliability of clinical biomarkers that are used to gather information about clinically meaningful endpoints. Our aim is to present a systematic methodology for assessing the reliability of multiple surrogate markers (and biomarkers in general). To do this we draw upon the robustness analysis literature in the philosophy of science and the empirical use of clinical biomarkers. -/- After introducing robustness analysis we present two problems with biomarkers in relation to reliability. Next, we propose an intervention-based robustness methodology for organizing the reliability of biomarkers in general. We propose three relevant conditions for a robust methodology for biomarkers: (R1) Intervention-based demonstration of partial independence of modes: In biomarkers partial independence can be demonstrated through exogenous interventions that modify a process some number of “steps” removed from each of the markers. (R2) Comparison of diverging and converging results across biomarkers: By systematically comparing partially-independent biomarkers we can track under what conditions markers fail to converge in results, and under which conditions they successfully converge. (R3) Information within the context of theory: Through a systematic cross-comparison of the markers we can make causal conclusions as well as eliminate competing theories. We apply our robust methodology to currently developing Alzheimer’s research to show its usefulness for making causal conclusions. (shrink)

In 1957, Feyerabend delivered a paper titled ‘On the Quantum-Theory of Measurement’ at the Colston Research Symposium in Bristol to sketch a completion of von Neumann's measurement scheme without collapse, using only unitary quantum dynamics and well-motivated statistical assumptions about macroscopic quantum systems. Feyerabend's paper has been recognised as an early contribution to quantum measurement, anticipating certain aspects of decoherence. Our paper reassesses the physical and philosophical content of Feyerabend's contribution, detailing the technical steps as well as its overall philosophical (...) motivations and consequences. Summarising our results, Feyerabend interpreted collapse as a positivist assumption in quantum mechanics leading to a strict distinction between the uninterpreted formalism of unitary evolution in quantum mechanics and the classically interpreted observational language describing post-measurement outcomes. Thus Feyerabend took the no-collapse completion of the von Neumann measurement scheme to show the dispensability of the positivist assumption, leading the way to a realistic interpretation of quantum theory. We note, however, that there are substantial problems with his account of measurement that bring into question its viability as a legitimate foil to the orthodox view. We further argue that his dissatisfaction with the von Neumann measurement scheme is indicative of early views on theoretical pluralism. (shrink)

The Levelling-Down Objection is a standard objection to monistic egalitarian theories where equality is the only thing that has intrinsic value. Most egalitarians, however, are value pluralists; they hold that, in addition to equality being intrinsically valuable, the egalitarian currency in which we are equal or unequal is also intrinsically valuable. In this paper, I shall argue that the Levelling-Down Objection still minimizes the weight that the intrinsic badness of inequality could have in the overall intrinsic evaluation of outcomes, given (...) a certain way of measuring the badness of inequality, namely, the Additive Individual-Complaints Measure. (shrink)

Traumatic brain injury is the leading cause of death in children. Children with severe TBI are in need of neurointensive care where the goal is to prevent secondary brain injury by avoiding secondary insults. Monitoring of cerebral blood flow (CBF) and autoregulation in the injured brain is crucial. However, there are limited studies performed in children to investigate this. Current studies report on age dependent increase in CBF with narrow age range. Low initial CBF following TBI has been correlated to (...) poor outcome and may be more prevalent than hyperemia as previously suggested. Impaired cerebral pressure autoregulation is also detected and correlated with poor outcome but it remains to be elucidated if there is a causal relationship. Current studies are few and mainly based on small number of patients between the age of 0–18 years. Considering the changes of CBF and cerebral pressure autoregulation with increasing age, larger studies with more narrow age ranges and multimodality monitoring are required in order to generate data that can optimize the therapy and clinical management of children suffering TBI. (shrink)

In a rigorous systematic review, Dukhanin and colleagues categorize metrics and evaluative tools of the engagement of patient, public, consumer, and community in decision-making in healthcare institutions and systems. The review itself is ably done and the categorizations lead to a useful understanding of the necessary elements of engagement, and a suite of measures relevant to implementing engagement in systems. Nevertheless, the question remains whether the engagement of patient representatives in institutional or systemic deliberations will lead to improved clinical (...) outcomes or increased engagement of individual patients themselves in care. Attention to the conceptual foundations of patient engagement would help make this systematic review relevant to the clinical care of patients. (shrink)

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

Background: Mental health professionals working in correctional contexts engage a double role to care and control. This dual loyalty conflict has repeatedly been criticized to impede the development of a high-quality alliance. As therapeutic alliance is a robust predictor of outcome measures of psychotherapy, it is essential to investigate the effects of this ethical dilemma. Methods: This qualitative interview study investigates patients’ perceptions of their therapists’ dual role conflict in court-mandated treatment settings. We interviewed 41 older incarcerated persons (...) using a semi-structured interview guide, the interviews were subsequently analyzed following thematic analysis. Results: We first present the patients’ perceptions of their treating psychotherapist’s dual loyalty conflict, which was linked to their overall treatment experience. In a second step, we outline the study participants’ reasons for this judgment, which were most commonly linked to feelings of trust or betrayal. More specifically, they named certain therapist characteristics and activities that enabled them to develop a trustful therapeutic alliance, which we grouped into four topics: respecting the patient’s pace and perceived coercion; patient health needs to be first priority; clarity in roles and responsibilities; and the art of communication – between transparency and unchecked information sharing. Discussion: Developing a high quality alliance in mandatory offender treatment is central due to its relationship with recovery and desistance. Our findings show that some therapists’ characteristics and activities attenuate the negative impact of their double role on the development and maintenance of the alliance. To increase the effectiveness of court-mandated treatments, we need to support clinicians in dealing with their dual role to allow the formation of a high quality therapeutic alliance. Our qualitative interview study contributed to this much-needed empirical research on therapist’ characteristics promoting a trustful relationship in correctional settings. (shrink)

Context — Children and adults with psychopathic traits and conduct or oppositional defiant disorder demonstrate poor decision making and are impaired in reversal learning. However, the neural basis of this impairment has not previously been investigated. Furthermore, despite high comorbidity of psychopathic traits and attention deficit/hyperactivity disorder, to our knowledge, no research has attempted to distinguish neural correlates of childhood psychopathic traits and attention-deficit/hyperactivity disorder. Objective—To determine the neural regions that underlie the reversal learning impairments in children with psychopathic traits (...) plus conduct or oppositional defiant disorder. Design — Case-control study. Setting — Government clinical research institute. Participants — Forty-two adolescents aged 10 to 17 years: 14 with psychopathic traits and oppositional defiant disorder or conduct disorder, 14 with attention-deficit/hyperactivity disorder only, and 14 healthy controls. Main Outcome Measure — Blood oxygenation level–dependent signal as measured via functional magnetic resonance imaging during a probabilistic reversal task. Results — Children with psychopathic traits showed abnormal responses within the ventromedial prefrontal cortex (Brodmann area 10) during punished reversal errors compared with children wit hattention deficit/hyperactivity disorder and healthy children (P < .05 corrected for multiple comparisons). Conclusions — To our knowledge, this study provides the first evidence of abnormal ventromedial prefrontal cortex responsiveness in children with psychopathic traits and demonstrates this dysfunction was not attributable to comorbid attention-deficit/hyperactivity disorder. These findings suggest that reversal learning impairments in patients with developmental psychopathic traits relate to abnormal processing of reinforcement information. (shrink)

Objectives To increase postmortem organ donation rates, several countries are adopting an opt-out (presumed consent) policy, meaning that individuals are deemed donors unless they expressly refused so. Although opt-out countries tend to have higher donation rates, there is no conclusive evidence that this is caused by the policy itself. The main objective of this study is to better assess the direct impact of consent policy defaults per se on deceased organ recovery rates when considering the role of the family in (...) the decision-making process. This study does not take into account any indirect effects of defaults, such as potential psychological and behavioural effects on individuals and their relatives. -/- Design Based on previous work regarding consent policies, we created a conceptual model of the decision-making process for deceased organ recovery that included any scenario that could be directly influenced by opt-in or opt-out policies. We then applied this model to internationally published data of the consent process to determine how frequently policy defaults could apply. -/- Main outcome measures We measure the direct impact that opt-in and opt-out policies have per se on deceased organ recovery. -/- Results Our analysis shows that opt-in and opt-out have strictly identical outcomes in eight out of nine situations. They only differ when neither the deceased nor the family have expressed a preference and defaults therefore apply. The direct impact of consent policy defaults is typically circumscribed to a range of 0%–5% of all opportunities for organ recovery. Our study also shows that the intervention of the family improves organ retrieval under opt-in but hinders it under opt-out. -/- Conclusions This study may warn policy makers that, by emphasising the need to introduce presumed consent to increase organ recovery rates, they might be overestimating the influence of the default and underestimating the power granted to families. (shrink)

Introduction Current treatments for pain have limited benefits and worrying side effects. Some studies suggest that pain is reduced when clinicians deliver positive messages. However, the effects of positive messages are heterogeneous and have not been subject to meta-analysis. We aimed to estimate the efficacy of positive messages for pain reduction. -/- Methods We included randomized trials of the effects of positive messages in a subset of the studies included in a recent systematic review of context factors for treating pain. (...) Several electronic databases were searched. Reference lists of relevant studies were also searched. Two authors independently undertook study selection, data extraction, risk of bias assessment, and analyses. Our primary outcome measures were differences in patient- or observer-reported pain between groups who were given positive messages and those who were not. -/- Results Of the 16 randomized trials (1703 patients) that met the inclusion criteria, 12 trials had sufficient data for meta-analysis. The pooled standardized effect size was −0.31 (95% confidence interval [CI] −0.61 to −0.01, p = 0.04, I2 = 82%). The effect size remained positive but not statistically significant after we excluded studies considered to have a high risk of bias (standard effect size −0.17, 95% CI −0.54 to 0.19, P = 0.36, I2 = 84%). -/- Conclusion Care of patients with chronic or acute pain may be enhanced when clinicians deliver positive messages about possible clinical outcomes. However, we have identified several limitations of the present study that suggest caution when interpreting the results. We recommend further high-quality studies to confirm (or falsify) our result. -/- FUNDING -/- Alexander Mebius research has been funded through the ERC grant "Philosophy of Pharmacology: Safety, Statistical Standards, and Evidence Amalgamation" (GA: 639276). (shrink)

Objective: To assess the relation between autocratisation—substantial decreases in democratic traits (free and fair elections, freedom of civil and political association, and freedom of expression)—and countries’ population health outcomes and progress toward universal health coverage (UHC). -/- Design: Synthetic control analysis. -/- Setting and country selection: Global sample of countries for all years from 1989 to 2019, split into two categories: 17 treatment countries that started autocratising during 2000 to 2010, and 119 control countries that never autocratised from 1989 to (...) 2019. The treatment countries comprised low and middle income nations and represent all world regions except North America and western Europe. A weighted combination of control countries was used to construct synthetic controls for each treatment country. This statistical method is especially well suited to population level studies when random assignment is infeasible and sufficiently similar comparators are not available. The method was originally developed in economics and political science to assess the impact of policies and events, and it is now increasingly used in epidemiology. -/- Main outcome measures: HIV-free life expectancy at age 5 years, UHC effective coverage index (0-100 point scale), and out-of-pocket spending on health per capita. All outcome variables are for the period 1989 to 2019. -/- Results: Autocratising countries underperformed for all three outcome variables in the 10 years after the onset of autocratisation, despite some improvements in life expectancy, UHC effective coverage index, and out-of-pocket spending on health. On average, HIV-free life expectancy at age 5 years increased by 2.2% (from 64.7 to 66.1 years) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 3.5% (95% confidence interval 3.3% to 3.6%, P<0.001) (from 64.7 to 66.9 years) in the absence of autocratisation. On average, the UHC effective coverage index increased by 11.9% (from 42.5 to 47.6 points) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by 20.2% (95% confidence interval 19.6% to 21.2%, P<0.001) (from 42.5 to 51.1 points) in the absence of autocratisation. Finally, on average, out-of-pocket spending on health per capita increased by 10.0% (from $4.00 (£3.1; €3.4) to $4.4, log transformed) during the 10 years after the onset of autocratisation. This study estimated that it would have increased by only 4.4% (95% confidence interval 3.9% to 4.6%, P<0.001) (from $4.0 to $4.2, log transformed) in the absence of autocratisation. -/- Conclusions: Autocratising countries had worse than estimated life expectancy, effective health service coverage, and levels of out-of-pocket spending on health. These results suggest that the noticeable increase in the number of countries that are experiencing democratic erosion in recent years is hindering population health gains and progress toward UHC. Global health institutions will need to adjust their policy recommendations and activities to obtain the best possible results in those countries with a diminishing democratic incentive to provide quality healthcare to populations. (shrink)

Objectives The study aims to evaluate the impact of the Revised Health Insurance Law 2014 on the utilisation of outpatient and inpatient care services, healthcare services utilisation at different levels of providers, types of providers and types of visits across different entitlement groups. Design/setting Secondary data from two waves of the Vietnam Household Living Standard Survey (VHLSS) 2016, VHLSS 2014 were used. A cross-sectional study applying propensity score matching was conducted. Participants A total of 4900 individuals who reported using healthcare (...) services are analysed. Outcomes measure Numbers of outpatient and inpatient visits, frequency of healthcare service utilisation at commune health stations, district hospitals, provincial hospitals, public and private health facilities, number of visits at health facility for medical treatment and health checks per year. Results The result indicates that health insurance (HI) policy increased the number of outpatient visits for the enrolled between 0.87 and 1.29. The greatest impact was found on participants of heavily subsidised health insurance (HSHI) programmes with 1.29 visits per person per year. Similarly, an increase between 0.08 and 0.16 in the number of inpatient admissions was because of participation in HI. With regard to type of healthcare providers, the study found that participation in HI has the most effect on the use of healthcare services at district hospitals. However, the study demonstrated that the impacts of HI on the increase in the frequency of visiting commune health stations, number of visits at the provincial hospital for HSHI groups, and number of visits at health facilities for health check and consultation were sensitive to unobserved characteristics. Conclusion Our findings imply that policy-makers in Vietnam could continue expanding health insurance coverage to increase access to healthcare services for citizens, especially vulnerable groups. In addition, the government should draw more attention to primary healthcare level. (shrink)

In order to achieve the World Health Organization’s Millennium Development Goal of reducing maternal mortality by three quarters by 2015, a strong global commitment is needed to address this issue in low-income nations where the risk to women is greatest. A comprehensive international effort must include provision of obstetric and general medical care as well as community-based interventions, with an emphasis on the latter in nations where the majority of women deliver babies at home without a trained attendant. Methods: This (...) systematic analysis evaluates interventions published in Medline and CINAHL whose outcome measure is maternal mortality. Analysis includes components of the intervention, nation and maternal death rates. Results: Nine studies documented the effectiveness of various clinical and community-based interventions, including specific drug regimens and procedures, in reducing the risk of maternal death. Six studies reported interventions that did not significantly alter maternal mortality outcomes, and the intervention in one study demonstrated increased risk of maternal death. Conclusion: The dearth of evidence highlights the need for increased focus on translational research that bridges the gap between medical advances and community-based interventions that are feasible in low-income nations. This cannot be accomplished without a stronger commitment to reducing maternal mortality by global health practitioners and researchers. (shrink)

This paper aims to measure Knowledge Management Maturity (KMM) in the universities to determine the impact of knowledge management on high performance. This study was applied on Al-Quds Open University in Gaza strip, Palestine. Asian productivity organization model was applied to measure KMM. Second dimension which assess high performance was developed by the authors. The controlled sample was (306). Several statistical tools were used for data analysis and hypotheses testing, including reliability Correlation using Cronbach’s alpha, “ANOVA”, Simple Linear Regression and (...) Step Wise Regression.The overall findings of the current study suggest that KMM is suitable for measuring high performance. KMM assessment shows that maturity level is in level three. Findings also support the main hypothesis and it is sub- hypotheses. The most important factors effecting high performance are: Processes, KM leadership, People, KM Outcomes and Learning and Innovation. Furthermore the current study is unique by the virtue of its nature, scope and way of implied investigation, as it is the first comparative study in the universities of Palestine explores the status of KMM using the Asian productivity Model. (shrink)

The primary quantum mechanical equation of motion entails that measurements typically do not have determinate outcomes, but result in superpositions of all possible outcomes. Dynamical collapse theories (e.g. GRW) supplement this equation with a stochastic Gaussian collapse function, intended to collapse the superposition of outcomes into one outcome. But the Gaussian collapses are imperfect in a way that leaves the superpositions intact. This is the tails problem. There are several ways of making this problem more precise. But many authors (...) dismiss the problem without considering the more severe formulations. Here I distinguish four distinct tails problems. The first (bare tails problem) and second (structured tails problem) exist in the literature. I argue that while the first is a pseudo-problem, the second has not been adequately addressed. The third (multiverse tails problem) reformulates the second to account for recently discovered dynamical consequences of collapse. Finally the fourth (tails problem dilemma) shows that solving the third by replacing the Gaussian with a non-Gaussian collapse function introduces new conflict with relativity theory. (shrink)

Psychiatric research is in crisis because of repeated failures to discover new drugs for mental disorders. Lack of measurement validity could partly account for these failures. If researchers do not actually measure the effects of drugs on the disorders they aim to investigate, one should expect suboptimal treatment outcomes. I argue that this is the case, focusing on depression, and fear & anxiety disorders. In doing so, I show how psychiatric research illustrates a more general phenomenon that I call “validity (...) drift.” A validity drift occurs when, in the course of developing new measurement procedures, researchers end up studying something different from what they originally aimed to study. I analyze the different ways in which scientists attempt to validate procedures for measuring mental disorders for the purpose of testing drugs in animal models. I show how those validation efforts might fail, thereby leading to validity drifts. Overall, this analysis highlights the complex interplay between the development of new measurement procedures, their calibration, and scientific theories of the target phenomena. (shrink)

Local participation is always beneficial for sustainable action and environmental problems resulting from urban implementation due to the failure of social and institutional change necessary for a successful transformation of rural life to urban life ahead of the rapid movement of the population. Despite good legal practice and comprehensive guidelines, evidence suggests that Environmental Impact Assessment (EIA) or more broadly Environmental, Social and Health Impact Assessment (ESHIA) have not yet been found satisfactory in Nigeria, as the current system amounts to (...) duplication of efforts and cost. However, ESHIA has been developed and integrated to help manage project activities, facilities, and operations sustainably, so that both economic and ecological profits are accrued (sustainable development) or ensure that any development project does not result in excessive deterioration of and/or the irreversible adverse effect on any component of the environment – a recite for sustainable development. A literature review was done by using a variety of search engines including Research Gate, Google Scholar, Academia, Mendeley, SSRN search strategy to retrieve research publications, “grey literature” and expert working group reports. The thrust of this study is to evaluate the potential benefits of ESHIA as a tool for sustainable environmental development. The evaluation and implementation of EIA are one of the strengths of these tools. Indeed, EIA is the first and foremost management tool employed to help mitigate adverse, potential, and associated impacts of proposed major developments in our environment. EIA is a regulatory requirement that is efficiently used to improve performance, project design, enhancing decision-making, and facilitating policy programs in a sustainable environment. An evaluation of the EIA systems reveals several weaknesses of the EIA system. These include the inadequate capacity of EIA approval authorities, deficiencies in screening and scoping, poor EIA quality, insufficient public participation, and weak monitoring, and erratic government policies. Overall, most EIA study rarely meets the objectives of being a project planning tool to contribute to achieving sustainable development and mitigate the impact of the development project. The study recommends some directions for the future to ensure that entire content of the EIA are religiously implemented, review the existing EIA act, increase the expertise of EIA consultants, create a liaison office with an international organisation and with sister agency, ESHIA must enjoy Improved budgetary provision, time latitude, spatial contexts and methodological improvements for outcome measures to achieve results that are relevant to sustainable development by improving project design, enhancing decision making and facilitating policy programs. (shrink)

Based on a survey of 237 managers in Singapore, three measures of organizational ethics (namely, top management support for ethical behavior, the organization''s ethical climate, and the association between ethical behavior and career success) are found to be associated with job satisfaction. The link between organizational ethics and job satisfaction is argued from Viswesvaran et al.''s (1998) organizational justice and cognitive dissonance theories. The findings imply that organizational leaders can favorably influence organizational outcomes by engaging in, supporting and rewarding (...) ethical behavior. (shrink)

”It is often assumed that knowledge claims must be justified. But what kind of justification is required for knowledge ? . . . ” (*) -/- presupposition: the kind of epistemic justification depends on the type of the knowledge claim and its respective knowledge claim tradeoff ’vague vs. precise’. -/- procedere: in two - almost purely logical - case studies I account for this tradeoff and question in each case what (if any) were its general outcome wrt justification -/- (...) first for basic measurement statements of the form ′′ϕ(x) = r ∈ IR ± δ′′ (wrt ”measurement accuracy realism” debate) -/- and secondly predication statements of the form ′′x is ( a case of )P′′ (wrt ”epistemic vagueness” debate). (shrink)

Fitness plays many roles throughout evolutionary theory, from a measure of populations in the wild to a central element in abstract theoretical presentations of natural selection. It has thus been the subject of an extensive philosophical literature, which has primarily centered on the way to understand the relationship between fitness values and reproductive outcomes. If fitness is a probabilistic or statistical quantity, how is it to be defined in general theoretical contexts? How can it be measured? Can a single conceptual (...) model for fitness be offered that applies in all biological cases, or must fitness measures be case-specific? Philosophers have explored these questions over the last several decades, largely in the context of an influential definition of fitness proposed in the late 1970s: the propensity interpretation. This interpretation as first described undeniably suffers from significant difficulties, and debate regarding the tenability of amendments and alternatives to it remains unsettled. (shrink)

The famous EPR article of 1935 challenged the completeness of quantum mechanics and spurred decades of theoretical and experimental research into the foundations of quantum theory. A crowning achievement of this research is the demonstration that nature cannot in general consist in noncontextual pre-measurement properties that uniquely determine possible measurement outcomes, through experimental violations of Bell inequalities and Kochen-Specker theorems. In this article, I reconstruct an argument from Niels Bohr’s writings that the reality of the Einstein-Planck-de Broglie relations alone implies (...) that no such properties can exist for momentum and position measurements, show how this argument responds to the challenge of EPR on general physical grounds, and advance that this reconstruction shows that and how Bohr’s “complementarity” is a view of the objective content and logic of quantum theory. (shrink)

The rediscovery of the silver-backed chevrotain, an endemic species to Vietnam, in 2019, after almost 30 years of being lost to science, is a remarkable outcome for the global conservation agenda. However, along with the happiness, there is a tremendous concern for the conservation of the species as eating wildmeat, including chevrotain, is deeply rooted in the socio-cultural values of Vietnamese. Meanwhile, conservation plans face multiple obstacles since the species has not been listed in the list of endangered, precious, (...) and rare wildlife prioritized for protection and is still classified by the IUCN as lacking data. Given the limited effectiveness of conservation measures, this essay discusses the determining roles of local actions, community cooperation, and humanistic values oriented toward eco-surplus culture in addressing the global biodiversity conservation agenda, specifically the conservation of the silver-backed chevrotain. Local actions and community cooperation for conservation can be actualized to achieve conservation goals through citizen and community sciences, integration of modern technologies (e.g., Internet, crowdfunding platforms, social media, AI, etc.), and the bonding capability of humanistic values that prioritize environmental healing. Communicating conservation information to the community, especially the children, has to stimulate their thinking and imagination about nature, develop their curiosity and desire to protect wildlife, and eventually build eco-surplus core values in their mindsets. To successfully awaken the humanistic values within the community and incorporate them into conservation endeavors, the conservation message with the name “mouse-deer”, “chevrotain”, or scientific name (Tragulus versicolor) is largely insufficient as they show an unfamiliar feeling. Therefore, we suggest calling the mouse-deer “cheo cheo”, a local name that can create familiarity and closeness, awaken the environmental conscience and humanistic values, and stimulate thinking and imagination. All these factors are essential for conservationists, scientists, and the government to support the community in building the eco-surplus culture. (shrink)

Environmental activism is crucial in increasing awareness of environmental degradation and preventing actions that harm the environment. A radical environmentalist movement has emerged within the community of activists. They advocate using illegal measures to attain their goals. This paper discusses these radical environmentalist groups’ motivations, their actions and their consequences. Activities that many consider unacceptable, such as art vandalism and road blockades, may result in adverse outcomes and diminish public support for environmental endeavors. We propose an alternative solidarity approach (...) whereby activists focus their efforts on disseminating information to the general public on climate change and other environmental issues, advocating for the adoption of eco-surplus culture, and fostering cooperation among governments, businesses, and individuals to develop effective solutions. (shrink)

Diabetic ketoacidosis is a serious, medical emergency that can be fatal but treatable, we aimed to evaluate the clinical profile of patients admitted with diabetic ketoacidosis. This case series study enrolled 213 non-pregnant adult and adolescent patients admitted with diabetic ketoacidosis at Tripoli Diabetes Hospital from January to September 2023. Demographic data, clinical characteristics, laboratory findings, precipitating factors, and patient outcomes were extracted from medical records and analyzed. Type 1 diabetes mellitus was present in 187 (87.8%) of patients, the age (...) range 11-84 years, (30.26±13.28), with 130 patients ≤30 years old (61.0%), females accounting for 110 of the patients (51.6%), 109 had a diabetes duration of less than 10 years (51.2%). The most common precipitating factor was insulin omission 92 (43.2%) in patients with known diabetes mellitus, whereas, diabetic ketoacidosis as the first presentation of diabetes mellitus in 24 patients (11.7%), systolic blood pressure ranged 50-160 mmHg (112.82±16.19), diastolic blood pressure varied 30-100 mmHg (70.24±11.32). Plasma glucose at presentation ranged 183-1494 mg/dl (462.92±169.85), with Eu-glycemic diabetic ketoacidosis 100-249 mg/dl were in nine patients (4.2%), whereas most of cases (135 patients, 63.4%) present with plasma glucose 250-500 mg/dl, while hyperosmolar status (≥701 mg/dl) were present in 13 patients (6.1%). Venous pH varied from 6.7-7.42 (7.13±0.14), 132 (62.0%) patients presented with pH <7.24, while severe acidosis was pH < 7 in 32 of patients (14.6%), serum bicarbonate with 10.93±4.95, severe (<5 mmol) in 91 patients (42.7%) and moderate (5-10 mmol) were in 79 patients (37.08%). The mean length of hospital stay was 3.33 days, with an average of 2.11 days spent in the high-dependent unit. Serum potassium varied from 2.4-6.7 meq/L with 3.66± 0.63, most common complications of diabetic ketoacidosis treatment were hypokalemia observed in 82 (35.7%) of cases, and hypoglycemia was detected in 41 patients (19.2%). 170 patients were discharged in good condition (79.8%), and 17.8% of patients were transferred to another hospital to receive further management for co-morbid diseases with diabetes after controlling their hyperglycemic crises. The majority of patients presented with the critical status of diabetic ketoacidosis. The findings emphasize the importance of patient education about prevention measures prompt presentation to the hospital, and clinicians' awareness for early and aggressive treatment of hyperglycemic crises. (shrink)

According to QBism, quantum states, unitary evolutions, and measurement operators are all understood as personal judgments of the agent using the formalism. Meanwhile, quantum measurement outcomes are understood as the personal experiences of the same agent. Wigner’s conundrum of the friend, in which two agents ostensibly have different accounts of whether or not there is a measurement outcome, thus poses no paradox for QBism. Indeed the resolution of Wigner’s original thought experiment was central to the development of QBist thinking. (...) The focus of this paper concerns two very instructive modifications to Wigner’s puzzle: One, a recent no-go theorem by Frauchiger and Renner, and the other a thought experiment by Baumann and Brukner. We show that the paradoxical features emphasized in these works disappear once both friend and Wigner are understood as agents on an equal footing with regard to their individual uses of quantum theory. Wigner’s action on his friend then becomes, from the friend’s perspective, an action the friend takes on Wigner. Our analysis rests on a kind of quantum Copernican principle: When two agents take actions on each other, each agent has a dual role as a physical system for the other agent. No user of quantum theory is more privileged than any other. In contrast to the sentiment of Wigner’s original paper, neither agent should be considered as in “suspended animation.” In this light, QBism brings an entirely new perspective to understanding Wigner’s friend thought experiments. (shrink)

Algorithms can now identify patterns and correlations in the (big) datasets, and predict outcomes based on those identified patterns and correlations with the use of machine learning techniques and big data, decisions can then be made by algorithms themselves in accordance with the predicted outcomes. Yet, algorithms can inherit questionable values from the datasets and acquire biases in the course of (machine) learning, and automated algorithmic decision-making makes it more difficult for people to see algorithms as biased. While researchers have (...) taken the problem of algorithmic bias seriously, but the current discussion on algorithmic fairness tends to conceptualize ‘fairness’ in algorithmic fairness primarily as a technical issue and attempts to implement pre-existing ideas of ‘fairness’ into algorithms. In this paper, I show that such a view of algorithmic fairness as technical issue is unsatisfactory for the type of problem algorithmic fairness presents. Since decisions on fairness measure and the related techniques for algorithms essentially involve choices between competing values, ‘fairness’ in algorithmic fairness should be conceptualized first and foremost as a political issue, and it should be (re)solved by democratic communication. The aim of this paper, therefore, is to explicitly reconceptualize algorithmic fairness as a political question and suggest the current discussion of algorithmic fairness can be strengthened by adopting the accountability for reasonableness framework. (shrink)

Norm theory (Kahneman & Miller, 1986) described a tendency for people to associate stronger regret with a negative outcome when it is a result of an exception (abnormal behavior) compared to when it is a result of routine (normal behavior). In two pre-registered studies, we conducted a replication and extension of three classic experiments on past behavior exception/routine contrasts (N = 684). We successfully replicated Kahneman and Miller’s (1986) experiments with the classic hitchhiker-scenario (Part 1) and car accident-scenario (Part (...) 2). In both cases, participants examined negative outcomes and tended to indicate a protagonist who deviated from own past behavior as more regretful than another who followed routine. Pre-registered extensions also showed effects for ratings of social norms, negative affect, and perceived luck. We did not find support for the Miller and McFarland (1986) experiment robbery scenario (Part 3) using a compensation measure, in that compensation to a victim of a robbery was not significantly different comparing exceptional and routine circumstances. However, a pre-registered extension showed that robbery under exceptional circumstances was regretted more than robbery under routine circumstances. We discuss implications for current and future research. (shrink)

A longstanding issue in attempts to understand the Everett (Many-Worlds) approach to quantum mechanics is the origin of the Born rule: why is the probability given by the square of the amplitude? Following Vaidman, we note that observers are in a position of self-locating uncertainty during the period between the branches of the wave function splitting via decoherence and the observer registering the outcome of the measurement. In this period it is tempting to regard each branch as equiprobable, but (...) we argue that the temptation should be resisted. Applying lessons from this analysis, we demonstrate (using methods similar to those of Zurek's envariance-based derivation) that the Born rule is the uniquely rational way of apportioning credence in Everettian quantum mechanics. In doing so, we rely on a single key principle: changes purely to the environment do not affect the probabilities one ought to assign to measurement outcomes in a local subsystem. We arrive at a method for assigning probabilities in cases that involve both classical and quantum self-locating uncertainty. This method provides unique answers to quantum Sleeping Beauty problems, as well as a well-defined procedure for calculating probabilities in quantum cosmological multiverses with multiple similar observers. (shrink)

Capacity of conscious agents to perform genuine choices among future alternatives is a prerequisite for moral responsibility. Determinism that pervades classical physics, however, forbids free will, undermines the foundations of ethics, and precludes meaningful quantification of personal biases. To resolve that impasse, we utilize the characteristic indeterminism of quantum physics and derive a quantitative measure for the amount of free will manifested by the brain cortical network. The interaction between the central nervous system and the surrounding environment is shown to (...) perform a quantum measurement upon the neural constituents, which actualize a single measurement outcome selected from the resulting quantum probability distribution. Inherent biases in the quantum propensities for alternative physical outcomes provide varying amounts of free will, which can be quantified with the expected information gain from learning the actual course of action chosen by the nervous system. For example, neuronal electric spikes evoke deterministic synaptic vesicle release in the synapses of sensory or somatomotor pathways, with no free will manifested. In cortical synapses, however, vesicle release is triggered indeterministically with probability of 0.35 per spike. This grants the brain cortex, with its over 100 trillion synapses, an amount of free will exceeding 96 terabytes per second. Although reliable deterministic transmission of sensory or somatomotor information ensures robust adaptation of animals to their physical environment, unpredictability of behavioral responses initiated by decisions made by the brain cortex is evolutionary advantageous for avoiding predators. Thus, free will may have a survival value and could be optimized through natural selection. (shrink)

Publication date: 29 September 2016 Source: Author: Samy S. Abu Naser, Mazen J. Al Shobaki, Youssef M. Abu Amuna This paper aims to measure knowledge management maturity in higher education institutions to determine the impact of knowledge management on high performance. Also the study aims to compare knowledge management maturity between universities and intermediate colleges. This study was applied on five higher education institutions in Gaza strip, Palestine. Asian productivity organization model was applied to measure Knowledge Management Maturity. Second dimension (...) which assess high performance was developed by the authors. The controlled sample was. Several statistical tools were used for data analysis and hypotheses testing, including reliability correlation using Cronbach’s alpha, “ANOVA”, Simple Linear Regression and Step Wise Regression. The overall findings of the current study shows that maturity level is in the second level. Findings also support the main hypothesis and it is sub- hypotheses. The most important factors effecting high performance are: Processes, knowledge management leadership, People, knowledge management Outcomes. Furthermore the current study is unique by the virtue of its nature, scope and way of implied investigation, as it is the first comparative study between universities and intermediate colleges in Gaza Strip that explores the status of knowledge management maturity using the Asian productivity Model. (shrink)

Estimates of the burden of disease assess the mortality and morbidity that affect a population by producing summary measures of health such as quality-adjusted life years and disability-adjusted life years. These measures typically do not include stillbirths among the negative health outcomes they count. Priority-setting decisions that rely on these measures are therefore likely to place little value on preventing the more than three million stillbirths that occur annually worldwide. In contrast, neonatal deaths, which occur in comparable (...) numbers, have a substantial impact on burden of disease estimates and are commonly seen as a pressing health concern. In this article we argue in favor of incorporating unintended fetal deaths that occur late in pregnancy into estimates of the burden of disease. Our argument is based on the similarity between late-term fetuses and newborn infants and the assumption that protecting newborns is important. We respond to four objections to counting stillbirths: that fetuses are not yet part of the population and so their deaths should not be included in measures of population health; that valuing the prevention of stillbirths will undermine women's reproductive rights; that including stillbirths implies that miscarriages should also be included; and that birth itself is in fact ethically significant. We conclude that our proposal is ethically preferable to current practice and, if adopted, is likely to lead to improved decisions about health spending. (shrink)

This chapter will review selected aspects of the terrain of discussions about probabilities in statistical mechanics (with no pretensions to exhaustiveness, though the major issues will be touched upon), and will argue for a number of claims. None of the claims to be defended is entirely original, but all deserve emphasis. The first, and least controversial, is that probabilistic notions are needed to make sense of statistical mechanics. The reason for this is the same reason that convinced Maxwell, Gibbs, and (...) Boltzmann that probabilities would be needed, namely, that the second law of thermodynamics, which in its original formulation says that certain processes are impossible, must, on the kinetic theory, be replaced by a weaker formulation according to which what the original version deems impossible is merely improbable. Second is that we ought not take the standard measures invoked in equilibrium statistical mechanics as giving, in any sense, the correct probabilities about microstates of the system. We can settle for a much weaker claim: that the probabilities for outcomes of experiments yielded by the standard distributions are effectively the same as those yielded by any distribution that we should take as a representing probabilities over microstates. Lastly, (and most controversially): in asking about the status of probabilities in statistical mechanics, the familiar dichotomy between epistemic probabilities (credences, or degrees of belief) and ontic (physical) probabilities is insufficient; the concept of probability that is best suited to the needs of statistical mechanics is one that combines epistemic and physical considerations. (shrink)

In the Bayesian approach to quantum mechanics, probabilities—and thus quantum states—represent an agent’s degrees of belief, rather than corresponding to objective properties of physical systems. In this paper we investigate the concept of certainty in quantum mechanics. Particularly, we show how the probability-1 predictions derived from pure quantum states highlight a fundamental difference between our Bayesian approach, on the one hand, and Copenhagen and similar interpretations on the other. We first review the main arguments for the general claim that probabilities (...) always represent degrees of belief. We then argue that a quantum state prepared by some physical device always depends on an agent’s prior beliefs, implying that the probability-1 predictions derived from that state also depend on the agent’s prior beliefs. Quantum certainty is therefore always some agent’s certainty. Conversely, if facts about an experimental setup could imply agent-independent certainty for a measurement outcome, as in many Copenhagen-like interpretations, that outcome would effectively correspond to a preexisting system property. The idea that measurement outcomes occurring with certainty correspond to preexisting system properties is, however, in conflict with locality. We emphasize this by giving a version of an argument of Stairs [(1983). Quantum logic, realism, and value-definiteness. Philosophy of Science, 50, 578], which applies the Kochen–Specker theorem to an entangled bipartite system. (shrink)

While philosophers hold that it is patently absurd to blame robots or hold them morally responsible [1], a series of recent empirical studies suggest that people do ascribe blame to AI systems and robots in certain contexts [2]. This is disconcerting: Blame might be shifted from the owners, users or designers of AI systems to the systems themselves, leading to the diminished accountability of the responsible human agents [3]. In this paper, we explore one of the potential underlying reasons for (...) robot blame, namely the folk's willingness to ascribe inculpating mental states or "mens rea" to robots. In a vignette-based experiment (N=513), we presented participants with a situation in which an agent knowingly runs the risk of bringing about substantial harm. We manipulated agent type (human v. group agent v. AI-driven robot) and outcome (neutral v. bad), and measured both moral judgment (wrongness of the action and blameworthiness of the agent) and mental states attributed to the agent (recklessness and the desire to inflict harm). We found that (i) judgments of wrongness and blame were relatively similar across agent types, possibly because (ii) attributions of mental states were, as suspected, similar across agent types. This raised the question - also explored in the experiment - whether people attribute knowledge and desire to robots in a merely metaphorical way (e.g., the robot "knew" rather than really knew). However, (iii), according to our data people were unwilling to downgrade to mens rea in a merely metaphorical sense when given the chance. Finally, (iv), we report a surprising and novel finding, which we call the inverse outcome effect on robot blame: People were less willing to blame artificial agents for bad outcomes than for neutral outcomes. This suggests that they are implicitly aware of the dangers of overattributing blame to robots when harm comes to pass, such as inappropriately letting the responsible human agent off the moral hook. (shrink)