RationaleSurrogates of critically ill patients often have inaccurate expectations about prognosis. Yet there is little research on how intensive care unit clinicians should discuss prognosis, and existing expert opinion-based recommendations give only general guidance that has not been validated with surrogate decision makers.ObjectiveTo determine the perspectives of key stakeholders regarding how prognostic information should be conveyed in critical illness.MethodsThis was a multicenter study at three academic medical centers in California, Pennsylvania, and Washington. One hundred eighteen key stakeholders completed in-depth semistructured (...) interviews. Participants included 47 surrogates of adult patients with acute respiratory distress syndrome; 45 clinicians working in study ICUs, including physicians, nurses, social workers, and spiritual care providers; and 26 experts in health communication, decision science, ethics, family-centered care, geriatrics, healthcare disparities, palliative care, psychology, psychiatry, and critical care.Measurements and main resultsThere was broad support among surrogates for existing expert recommendations, including truthful prognostic disclosure, emotional support, tailoring the disclosure strategy to each family's needs, and checking for understanding. In addition, stakeholders offered suggestions that add specificity to existing recommendations, including: In addition to conveying prognostic estimates, clinicians should help families "see the prognosis for themselves" by showing families radiographic images and explaining the clinical significance of physical manifestations of severe disease at the bedside. Many physicians did not support using numeric estimates to convey prognosis to families, whereas many surrogates, clinicians from other disciplines, and experts believed numbers could be helpful. Clinicians should conceptualize prognostic communication as an iterative process that begins with a preliminary mention of the possibility of death early in the ICU stay and becomes more detailed as the clinical situation develops. Although prognostic information should be initially disclosed by physicians, other members of the multidisciplinary team-nurses, social workers, and spiritual care providers-should be given explicit role responsibilities to reinforce physicians' prognostications and help families process a poor prognosis emotionally.ConclusionsFamily members, clinicians, and experts identified specific communication behaviors that clinicians should use to discuss prognosis in the critical care setting. These findings extend existing opinion-based recommendations and should guide interventions to improve communication about prognosis in ICUs. (shrink)

This textbook brings the humanities to students in order to evoke the humanity of students. It helps to form individuals who take charge of their own minds, who are free from narrow and unreflective forms of thought, and who act compassionately in their public and professional worlds. Using concepts and methods of the humanities, the book addresses undergraduate and premed students, medical students, and students in other health professions, as well as physicians and other healthcare practitioners. It encourages them to (...) consider the ethical and existential issues related to the experience of disease, care of the dying, health policy, religion and health, and medical technology. Case studies, images, questions for discussion, and role-playing exercises help readers to engage in the practical, interpretive, and analytical aspects of the material, developing skills for critical thinking as well as compassionate care. (shrink)

Symbolic arithmetic is fundamental to science, technology and economics, but its acquisition by children typically requires years of effort, instruction and drill1,2. When adults perform mental arithmetic, they activate nonsymbolic, approximate number representations3,4, and their performance suffers if this nonsymbolic system is impaired5. Nonsymbolic number representations also allow adults, children, and even infants to add or subtract pairs of dot arrays and to compare the resulting sum or difference to a third array, provided that only approximate accuracy is required6–10. Here (...) we report that young children, who have mastered verbal counting and are on the threshold of arithmetic instruction, can build on their nonsymbolic number system to perform symbolic addition and subtraction11–15. Children across a broad socio-economic spectrum solved symbolic problems involving approximate addition or subtraction of large numbers, both in a laboratory test and in a school setting. Aspects of symbolic arithmetic therefore lie within the reach of children who have learned no algorithms for manipulating numerical symbols. Our findings help to delimit the sources of children’s difficulties learning symbolic arithmetic, and they suggest ways to enhance children’s engagement with formal mathematics. We presented children with approximate symbolic arithmetic problems in a format that parallels previous tests of non-symbolic arithmetic in preschool children8,9. In the first experiment, five- to six-year-old children were given problems such as ‘‘If you had twenty-four stickers and I gave you twenty-seven more, would you have more or less than thirty-five stickers?’’. Children performed well above chance (65.0%, t1952.77, P 5 0.012) without resorting to guessing or comparison strategies that could serve as alternatives to arithmetic. Children who have been taught no symbolic arithmetic therefore have some ability to perform symbolic addition problems. The children’s performance nevertheless fell short of performance on non-symbolic arithmetic tasks using equivalent addition problems with numbers presented as arrays of dots and with the addition operation conveyed by successive motions of the dots into a box (71.3% correct, F1,345 4.26, P 5 0.047)8.. (shrink)

The suggested citation for this white paper is: University of Waterloo Working Group on Bibliometrics, Winter 2016. White Paper: Measuring Research Outputs through Bibliometrics, Waterloo, Ontario: University of Waterloo.

_Essays on Beauvoir’s influences, contemporary engagements, and legacy in the philosophical tradition._.

The aim of this article is to explain the transition from implicit CSR to explicit CSR that has taken place in Scandinavia over the last two decades. Matten and Moon’s distinction between implicit and explicit CSR is the point of departure for the analysis, which is based on case studies of two Norwegian companies: HÅG and Hydro. On the basis of these case studies, we identify two forces that are pushing the transition from implicit to explicit CSR in Scandinavia: Organizational (...) expressiveness and Re-legitimizing. Both of these measures are adjustments to the globalization of the economy, altering the competitive situation even in highly institutionalized, Scandinavian economies. HÅG, a midsized Norwegian manufacturer of office chairs, made CSR and environmental values an integral part of their expressive strategy in the early 1990s. Hydro, a big Norwegian aluminium producer, made CSR an explicit issue around the turn of the millennium, in an attempt to re-legitimize their business operations in a new market situation where plants in local communities in Norway were shut down and relocated to less regulated regimes in low-cost regions abroad. (shrink)

There is a long tradition, in the history and philosophy of science, of studying Kant’s philosophy of mathematics, but recently philosophers have begun to examine the way in which Kant’s reflections on mathematics play a role in his philosophy more generally, and in its development. For example, in the Critique of Pure Reason , Kant outlines the method of philosophy in general by contrasting it with the method of mathematics; in the Critique of Practical Reason , Kant compares the Formula (...) of Universal Law, central to his theory of moral judgement, to a mathematical postulate; in the Critique of Judgement , where he considers aesthetic judgment, Kant distinguishes the mathematical sublime from the dynamical sublime. This last point rests on the distinction that shapes the Transcendental Analytic of Concepts at the heart of Kant’s Critical philosophy, that between the mathematical and the dynamical categories. These examples make it clear that Kant's transcendental philosophy is strongly influenced by the importance and special status of mathematics. The contributions to this book explore this theme of the centrality of mathematics to Kant’s philosophy as a whole. This book was originally published as a special issue of the Canadian Journal of Philosophy. (shrink)

State health departments are at the core of the United States public health infrastructure. Surveillance to monitor trends in disease and injury; the development, coordination, and delivery of services; and public education are some of the core functions health department employees oversee every day. As such, agencies and their employees are well positioned to inform policy decisions that affect the public’s health. However, little is known about the role of health department staff — a sizeable proportion of the public health (...) workforce — as advocates for public health policies, independent of their agency roles. Anecdotally, some health department employees with whom we have spoken expressed reluctance to engage in policy advocacy for fear of violating little known or understood agency or state rules. (shrink)

ObjectiveOverweight and obesity [body mass index ≥ 25 kg/m2] are associated with poorer prognosis among women with breast cancer, and weight gain is common during treatment. Symptoms of depression and anxiety are also highly prevalent in women with breast cancer and may be exacerbated by post-diagnosis weight gain. Altered brain function may underlie psychological distress. Thus, this secondary analysis examined the relationship between BMI, psychological health, and resting state functional connectivity among women with breast cancer.MethodsThe sample included 34 post-menopausal women (...) newly diagnosed with Stage 0-IIa breast cancer who were enrolled in a 6-month randomized controlled trial of aerobic exercise vs. usual care. At baseline prior to randomization, whole-brain analyses were conducted to evaluate the relationship between BMI and seed-to-voxel rsFC of the hippocampus and amygdala. Connectivity values from significant clusters were then extracted and examined as predictors of self-reported depression and anxiety.ResultsMean BMI was in the obese range. For both seeds examined, higher BMI was associated with lower rsFC with regions of prefrontal cortex, including ventrolateral PFC, dorsolateral PFC, and superior frontal gyrus. Hippocampal connectivity with the vlPFC was negatively correlated with self-reported anxiety.ConclusionHigher BMI was associated with lower hippocampal and amygdala connectivity to regions of PFC implicated in cognitive control and emotion regulation. BMI-related differences in hippocampal and amygdala connectivity following a recent breast cancer diagnosis may relate to future worsening of psychological functioning during treatment and remission. Additional longitudinal research exploring this hypothesis is warranted. (shrink)

Interpreters are less univocal than one might think in assessing Søren Kierkegaard's attitude toward eudaimonism. Through an analysis of several key texts from across Kierkegaard's authorship, I argue that existing interpretations do not convincingly address the relationship between Kierkegaard's critique of eudaimonism and his mid-nineteenth-century context, which was dominated by post-Kantian idealists. While I am sympathetic to aspects of deontological and aretaic interpretations, a contextual reading shows that his critique centers on what he diagnoses as the enclosure of the modern (...) self. This puts his critique of eudaimonism in the purview of his moral psychology and in continuity with his critique of romanticism. (shrink)

As a contribution to a wider discussion on moral discernment in theological anthropology, this paper seeks to answer the question “What is the impact of mental illness on an individual’s ability to make moral decisions?” Written from a clinical psychiatric perspective, it considers recent contributions from psychology, neuropsychology and imaging technology. It notes that the popular conception that mental illness necessarily robs an individual of moral responsibility is largely unfounded. Most people who suffer from mental health problems do not lose (...) the capacity to make moral decisions, and mental illness on its own rarely explains anti-social or criminal behaviour. Moreover, the assumptions of some scientists, that recent developments in neuropsychology and brain imaging suggest biological determinism, must be treated with caution. (shrink)

Christians look to Scripture to inform their ethical decision-making, believing that God speaks through it. However, disagreement as to what the Bible requires us to do can often lead to acrimonious splits within the church. So long as sharp divisions amongst Christians over ethical issues remain, injustices continue, and the reputation of the church is undermined. This article suggests that lessons may be learned from the story of the use of the Bible in the American Abolitionism debate which can help (...) the contemporary church to discuss and perhaps even resolve some enduring ethical questions which are dividing Christians today. (shrink)

The 2017 codetection of electromagnetic radiation and gravitational waves was the first of its kind and marked the beginning of multimessenger astronomy. But this event has been treated within recent literature as something of an end as well. The 2017 detection is often regarded as an instance of falsification for all theories of modified gravity which postulate gravitational waves propagate along separate geodesics from electromagnetic radiation, perhaps most notably Jacob Bekenstein’s Tensor-Vector-Scalar gravity. I critically examine this explicit endorsement of falsification (...) by astronomers and astrophysicists. While the current state of multimetric modified gravity theories is dim, recent developments in multimessenger observation do not offer a deductive falsification. Rather such evidence should be regarded as a corroboration of the null hypothesis, following Deborah Mayo's error-statistical account. (shrink)

How should we distinguish between ethical and unethical ways of pursuing profit in a market? The market failures approach (MFA) to business ethics purports to provide an answer to this question. I argue that it fails to do so. The source of this failure is the MFA’s reliance on Pareto efficiency as a core ethical principle. Many ethically “preferred” tactics for seeking profit cannot be justified by appeal to Pareto efficiency. One important reason for this is that Pareto efficiency, as (...) understood by the theory of welfare economics upon which the MFA relies, assumes a static conception of efficiency. This is a problem because many ethically “preferred” tactics can only be justified by appeal to dynamic efficiency considerations. I argue that, instead of Pareto efficiency, we should look to the value of wealth creation to understand the ethical constraints on how market actors may pursue profit. (shrink)

Volume 19, Issue 9, September 2019, Page 54-56.

An Institute of Medicine panel charged with reviewing the system for overseeing research involving children concluded in 2004 that Institutional Review Boards, institutions engaged in research, and study sponsors should “adopt explicit written policies on acceptable and unacceptable types and amounts of payments related to [children’s] research participation.” We previously reported data on practices and policies in the U.S. regarding payments to children who participate in research and their parents. Here, we report additional results from our study and identify some (...) of the decisions that must be made in developing payment plans and on which payment policies will be expected to offer guidance. We conclude that further conceptual analysis and empirical research are necessary before IRBs, institutions, and sponsors can develop specific rules on numerous aspects of payment. Nevertheless, payment policies that promote the ethical treatment of children in research and their parents can be developed. We propose a structure for such policies. (shrink)

Many business ethicists assume that if a type of conduct is illegal, then it is also unethical. This article scrutinizes that assumption, using the rideshare company Uber’s illegal operation in the city of Philadelphia as a case study. I argue that Uber’s unlawful conduct was permissible. I also argue that this position is not an extreme one: it is consistent with a variety of theoretical commitments in the analytic philosophical tradition regarding political obligation. I conclude by showing why business ethicists (...) would have a better rejoinder to the “dominant view” of business ethics associated with Milton Friedman if they dispensed with the assumption that illegal implies unethical. (shrink)

Paul Churchland's book (hereafter ER)is an entertaining and instructive advertisement for a "neurocomputational" vision of how the brain (and mind) works. While we agree with its general thrust, and commend its lucid pedagogy on a host of difficult topics, we note that such pedagogy often exploits artificially heightened contrast, and sometimes the result is a misleading caricature instead of a helpful simplification. In particular, Churchland is eager to contrast the explanation of consciousness that can be accomplished by his "aspiring new (...) structural and dynamic cognitive prototype: recurrent PDP networks" (p.266) with what strikes him as the retrograde introduction by Dennett of a virtual von Neumannesque machine--a "failed prototype"--as the key element in an explanation of human consciousness (in Consciousness Explained, 1991, hereafter, CE). We will try to show that by oversimplifying Dennett's alternative, he has taken a potential supplement to his own view--a much needed supplement--and transformed it in his imagination into a subversive threat. In part 1, we will expose and correct the mistaken contrasts. In part 2, we will compare the performance of the two views on Churchland's list of seven features of consciousness any theory must account for, showing that Dennett's account provides more than Churchland has recognized, and indeed offers answers to key questions that Churchland's account is powerless to address. At that point, Churchland's project and Dennett's could be seen to collaborate in a useful division of labor instead of being in mortal combat, were it not for what appears to be a fairly major disagreement about consciousness in non-human animals. Part 3 briefly examines this issue. It may be due to a misunderstanding, which when cleared up might restore the happy prospect of unification. (shrink)

Buying local is a prominent form of ethical consumption. We commonly assume that products that are local are in some respect ethically superior to ones that are not. This article contributes to research on local food by scrutinizing this assumption in light of some central values of the locavore movement. It identifies four central ethical causes from prior literature on locavorism: protecting the environment, promoting community, promoting small business, and contributing to the prosperity of one’s local economy. It then analyzes (...) whether the contribution of buying local to these causes can justify the general perception that buying local is a good way to be an ethical consumer. Its main finding is that these justifications fail to provide a strong positive ethical reason for consumers in general to adopt the practice of buying local. (shrink)

In our everyday social interactions, we try to make sense of what people are thinking, why they act as they do, and what they are likely to do next. This process is called mindreading. Mindreading, Shannon Spaulding argues in this book, is central to our ability to understand and interact with others. Philosophers and cognitive scientists have converged on the idea that mindreading involves theorizing about and simulating others’ mental states. She argues that this view of mindreading is limiting (...) and outdated. Most contemporary views of mindreading vastly underrepresent the diversity and complexity of mindreading. She articulates a new theory of mindreading that takes into account cutting edge philosophical and empirical research on in-group/out-group dynamics, social biases, and how our goals and the situational context influence how we interpret others’ behavior. -/- Spaulding's resulting theory of mindreading provides a more accurate, comprehensive, and perhaps pessimistic view of our abilities to understand others, with important epistemological and ethical implications. Deciding who is trustworthy, knowledgeable, and competent are epistemically and ethically fraught judgments: her new theory of mindreading sheds light on how these judgments are made and the conditions under which they are unreliable. -/- This book will be of great interest to students of philosophy of psychology, philosophy of mind, applied epistemology, cognitive science and moral psychology, as well as those interested in conceptual issues in psychology. (shrink)

Hedgehog (Hh) signaling is a widely studied signaling pathway because of its critical roles during development and in cell homeostasis. Vertebrate canonical and non‐canonical Hh signaling are typically assumed to be distinct and occur in different cellular compartments. While research has primarily focused on the canonical form of Hh signaling and its dependency on primary cilia – microtubule‐based signaling hubs – an extensive list of crucial functions mediated by non‐canonical Hh signaling has emerged. Moreover, amounting evidence indicates that canonical and (...) non‐canonical modes of Hh signaling are interlinked, and that they can overlap spatially, and in many cases interact functionally. Here, we discuss some of the many cellular effects of non‐canonical signaling and discuss new evidence indicating inter‐relationships with canonical signaling. We discuss how Smoothened (Smo), a key component of the Hh pathway, might coordinate such diverse downstream effects. Collectively, pursuit of questions such as those proposed here will aid in elucidating the full extent of Smo function in development and advance its use as a target for cancer therapeutics. (shrink)

Paul Churchland's book is an entertaining and instructive advertisement for a "neurocomputational" vision of how the brain works. While we agree with its general thrust, and commend its lucid pedagogy on a host of difficult topics, we note that such pedagogy often exploits artificially heightened contrast, and sometimes the result is a misleading caricature instead of a helpful simplification. In particular, Churchland is eager to contrast the explanation of consciousness that can be accomplished by his "aspiring new structural and dynamic (...) cognitive prototype: recurrent PDP networks" with what strikes him as the retrograde introduction by Dennett of a virtual von Neumannesque machine--a "failed prototype"--as the key element in an explanation of human consciousness. We will try to show that by oversimplifying Dennett's alternative, he has taken a potential supplement to his own view--a much needed supplement--and transformed it in his imagination into a subversive threat. In part 1, we will expose and correct the mistaken contrasts. In part 2, we will compare the performance of the two views on Churchland's list of seven features of consciousness any theory must account for, showing that Dennett's account provides more than Churchland has recognized, and indeed offers answers to key questions that Churchland's account is powerless to address. At that point, Churchland's project and Dennett's could be seen to collaborate in a useful division of labor instead of being in mortal combat, were it not for what appears to be a fairly major disagreement about consciousness in non-human animals. Part 3 briefly examines this issue. It may be due to a misunderstanding, which when cleared up might restore the happy prospect of unification. (shrink)

Name der Zeitschrift: Kierkegaard Studies Yearbook Jahrgang: 19 Heft: 1 Seiten: 231-252.

Background Informed consent is an integral component of good medical practice. Many researchers have investigated measures to improve the quality of informed consent, but it is not clear which techniques work best and why. To address this problem, we propose developing a core outcome set to evaluate interventions designed to improve the consent process for surgery in adult patients with capacity. Part of this process involves reviewing existing research that has reported what is important to patients and doctors in the (...) informed consent process. Methods This qualitative synthesis comprises four phases: identification of published papers and determining their relevance; appraisal of the quality of the papers; identification and summary of the key findings from each paper while determining the definitiveness of each finding against the primary data; comparison of key themes between papers such that findings are linked across studies. Results Searches of bibliographic databases returned 11,073 titles. Of these, 16 studies met the inclusion criteria. Studies were published between 1996 and 2016 and included a total of 367 patients and 74 health care providers. Thirteen studies collected data using in-depth interviews and constant comparison was the most common means of qualitative analysis. A total of 94 findings were extracted from the primary papers and divided into 17 categories and ultimately 6 synthesised findings related to: patient characteristics, knowledge, communication, the model patient, trust and decision making. Conclusions This qualitative meta-aggregation is the first to examine the issue of informed consent for surgery. It has revealed several outcomes deemed important to capture by patients and clinicians when evaluating the quality of a consent process. Some of these outcomes have not been examined previously in research comparing methods for informed consent. This review is an important step in the development of a COS to evaluate interventions designed to improve the consent process for surgery. Registration The study protocol was registered on the international prospective register for systematic reviews. (shrink)

This paper examines the use of case studies in ethics education. While not dismissing their value for specific purposes, the paper shows the limits of their use. While agreeing that case studies are narratives, although rather thin stories, the paper argues that the claim that case studies could represent reality is difficult to sustain. Instead, the paper suggests a way of using stories in ethics teaching that could be more real for students, while also giving them a way of thinking (...) about their own professional practices. The paper shows how the method can be used to develop a more critical and reflective practice for students in the health care professions. Some immediate problems with the method are discussed. (shrink)

Imagination seems to play an epistemic role in philosophical and scientific thought experiments, mindreading, and ordinary practical deliberations insofar as it generates new knowledge of contingent facts about the world. However, it also seems that imagination is limited to creative generation of ideas. Sometimes we imagine fanciful ideas that depart freely from reality. The conjunction of these claims is what I call the puzzle of knowledge through imagination. This chapter aims to resolve this puzzle. I argue that imagination has an (...) epistemic role to play, but it is limited to the context of discovery. Imagination generates ideas, but other cognitive capacities must be employed to evaluate these ideas in order for them to count as knowledge. Consideration of the Simulation Theory's so-called "threat of collapse” provides further evidence that imagination does not, on its own, yield new knowledge of contingent facts, and it suggests a way to supplement imagination in order to get such knowledge. (shrink)

Firearm violence is a major public health problem in the United States. In 2000, firearms were used in 10,801 homicides – two-thirds of all homicides in the U.S. – and 533,470 non-fatal criminal victimizations including rapes, robberies, and assaults. The social costs of gun violence in the United States are also staggering, and have been estimated to be on the order of $100 billion per year.Illegal gun carrying, usually concealed, in public places is an important risk factor for firearm-related crime. (...) In the 1980s and 1990s, police departments across the country began to develop and implement strategies to address illegal weapons carrying. Often these strategies have involved aggressive efforts to identify and physically search individuals suspected of illegally carrying a firearm. (shrink)

Firearm violence is a major public health problem in the United States. In 2000, firearms were used in 10,801 homicides – two-thirds of all homicides in the U.S. – and 533,470 non-fatal criminal victimizations including rapes, robberies, and assaults. The social costs of gun violence in the United States are also staggering, and have been estimated to be on the order of $100 billion per year.Illegal gun carrying, usually concealed, in public places is an important risk factor for firearm-related crime. (...) In the 1980s and 1990s, police departments across the country began to develop and implement strategies to address illegal weapons carrying. Often these strategies have involved aggressive efforts to identify and physically search individuals suspected of illegally carrying a firearm. (shrink)

Scott Carson - Aristotle's Philosophy of Biology: Studies in the Origins of Life Science - Journal of the History of Philosophy 40:3 Journal of the History of Philosophy 40.3 391-392 Book Review Aristotle's Philosophy of Biology: Studies in the Origins of Life Science James G. Lennox. Aristotle's Philosophy of Biology: Studies in the Origins of Life Science. New York: Cambridge University Press, 2001. Pp. xxiii + 321. Cloth, $64.95. This excellent book is a collection of Lennox's papers, published in (...) the last twenty years, on the structure and methodology of Aristotle's philosophy of biology. In spite of the fact that the papers have had little, if any, re-editing for inclusion in the present volume, the book presents a remarkably seamless and impressively argued interpretation not only of Aristotle's philosophy.. (shrink)

The Oxford Handbook of Philosophy of Technology gives readers a view into this increasingly vital and urgently needed domain of philosophical understanding, offering an in-depth collection of leading and emerging voices in the philosophy of technology. The thirty-two contributions in this volume cut across and connect diverse philosophical traditions, methodologies, and subfields, providing the reader with provocative and original insights on the history, concepts, problems and challenges that mark humanity's attempts to attain deeper and more lasting wisdom about our complex (...) and evolving relationship to technology. (shrink)

In response to the ubiquitous graphs and maps of COVID-19, artists, designers, data scientists, and public health officials are teaming up to create counter-plots and subaltern maps of the pandemic. In this intervention, we describe the various functions served by these projects. First, they offer tutorials and tools for both dataviz practitioners and their publics to encourage critical thinking about how COVID-19 data is sourced and modeled—and to consider which subjects are not interpellated in those data sets, and why not. (...) Second, they demonstrate how the pandemic’s spatial logics inscribe themselves in our immediate material landscapes. And third, they remind us of our capacity to personalize and participate in the creation of meaningful COVID visualizations—many of which represent other scales and dimensions of the pandemic, especially the quarantine quotidian. Together, the official maps and counter-plots acknowledge that the pandemic plays out differently across different scales: COVID-19 is about global supply chains and infection counts and TV ratings for presidential press conferences, but it is also about local dynamics and neighborhood mutual aid networks and personal geographies of mitigation and care. (shrink)