BackgroundAs the population of the United States ages, chronic diseases increase and treatment options become technologically more complicated. As such, patients’ autonomy, or the right of patients to accept or refuse a medical treatment, may become a more pressing and complicated issue. This autonomy rests upon a patient’s capacity to make a decision. As more older, cognitively and functionally impaired individuals enter healthcare systems, quality assessments of decision-making capacity must be made. These assessments should be done in a time-efficient manner (...) at a patient’s bedside by the patient’s own physician. Thus, a clinically practical tool to assist in decision-making capacity assessments could help guide physicians in making more accurate judgments.ObjectivesTo create a clinically relevant Bedside Capacity Assessment Tool (BCAT) to help physicians make timely and accurate clinical assessments of a patient’s decision-making capacity for a specific decision.SettingThe Department of Medicine, Division of Geriatrics and Palliative Medicine, Zucker School of Medicine at Hofstra/northwell.ParticipantsGeriatric medicine fellows, palliative medicine fellows, and internal medicine residents (n = 30).MeasurementsSubjects used the BCAT to assess the decision-making capacity of patients described in 10 written, clinically complex capacity assessment vignettes. Subjects’ conclusions were compared to those of experts.ResultsThe subjects’ and experts’ assessments of capacity had a 76.1 percent rate of agreement, with a range of 50 percent to 100 percent. With removal of three complex outlier vignettes, the agreement rate reached 83.2 percent.ConclusionThe strong correlation between the two groups—one of physicians in training utilizing the BCAT and the other of specialists in this area—suggests that the BCAT may be a useful adjunct for clinicians who assess decision-making capacity in routine practice. The range indicates that further refinement and testing of this tool is necessary. The potential exists for this tool to improve capacity assessment skills for physicians in clinical practice. (shrink)

Cancer and its treatment pose challenges that affect not only patients but also their significant others, including intimate partners. Accumulating evidence suggests that couples’ ability to communicate effectively plays a major role in the psychological adjustment of both individuals and the quality of their relationship. Two key conceptual models have been proposed to account for how couple communication impacts psychological and relationship adjustment: the social-cognitive processing (SCP) model and the relationship intimacy (RI) model. These models posit different mechanisms and outcomes, (...) and thus have different implications for intervention. The purpose of this project is to test and compare the utility of these models using comprehensive and methodologically rigorous methods. Aims are: (1) to examine the overall fit of the SCP and RI models in explaining patient and partner psychological and relationship adjustment as they occur on a day-to-day basis and over the course of 1 year; (2) to examine the fit of the models for different subgroups (males vs. females, and patients vs. partners); and (3) to examine the utility of various methods of assessing communication by examining the degree to which baseline indices from different measurement strategies predict self-reported adjustment at 1-year follow up. The study employs a longitudinal, multi-method approach to examining communication processes including: standard self-report questionnaires assessing process and outcome variables collected quarterly over the course of 1 year; smartphone-based ecological momentary assessments to sample participant reports in real time; and laboratory-based couple conversations from which we derive observational measures of communicative behavior and affective expression, as well as vocal indices of emotional arousal. Participants are patients with stage II-IV breast, colon, rectal, or lung cancer and their spouses/partners, recruited from two NCI-designated comprehensive cancer centers. Results will be published in scientific journals, presented at scientific conferences, and conveyed to a larger audience through infographics and social media outlets. Findings will inform theory, measurement, and the design and implementation of efficacious interventions aimed at optimizing both patient and partner well-being. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:BOOK REVIEWS The Glory of the Lord: A Theological Aesthetics. Vol. VI: Theology: The Old Covenant. By HANS Uns VoN BALTHASAR. Trans. Brian McNeil, C.R.V. and Erasmo Leiva-Merikakis. Ed. John Riches. San Francisco: Ignatius Press, 1991. Pp. 443. In this penultimate-volume of The Glory of the Lord, von Balthasar sets forth a " biblical aesthetics " in which the manner of the emergence of the Glory of God (...) in the world of man is spelled out. He proceeds by examining the bewildering variety of the manifestations of God's Glory in the Old Testament, but always as unified in their historical convergence upon Jesus, the Christ, the final and definitive presence in history of the divine Glory in whom Word and Image, Messiah and Servant, Son of Man and Son of God, are at one. This manner of proceeding is little consonant with contemporary Catholic exegesis, which prefers to regard the Old Testament as a free-standing hook, and is rather fastidious about reading it as " literally " the prologue and the Sitz im Leben of the New. For such exegetes, the literal and the historical senses are entirely distinct, because of their methodological enlistment in the historical pessimism of the Enlightenment. Balthasar, of course, is not of their camp. Balthasar's mastery of Old Testament exegesis is on a par with the effortless command of the Western philosophical, theological, and literary tradition which he has displayed in the earlier volumes of this work. While he relies heavily upon von Rad, a glance at the index shows that his knowledge of Old Testament scholarship is based upon a wide reading, upon which he levies throughout the book with practiced ease. The exegetical method implicit in his analysis is the one employed by scholars such as de Lubac, Guillet, and Ligier; its classic Augustinian understanding of the free unity of history, and of the consequently free meaning of Old Testament and the New as fulfilled in the Kingdom of God, needs no apology. The currently common supposition that the " literal " sense of Scripture is that which an Enlightened positivism will permit needs only to be recognized to be rejected. In the opening pages of the Introduction Balthasar sets the theme which will dominate the book: the rationally irresolvable dialectical 139 140 BOOK REVIEWS tension between God and all that is not God, a tension inherent in the revelation of the Glory of God. In keeping with the emphasis of his earlier volumes, Balthasar is insistent upon the radical gratuity of the revelation of the Glory of God. The revelatory manifestation of God as God, who is beyond all perception, all knowing, all communication, and yet is communicated, perceived the more surely where the more veiled, and definitively revealed on the Cross. The revelation of God's Glory is of God as the Absolutely Other, as formless, and so as in tension with all form which would mediate the revelation. This communication, this mediation, is utterly ex nihilo; it relies upon no capacity in man, upon no natural process of spiritual development, and is unrelated to, because absolutely transcendent to, all human projects. Impossible to prepare for, the manifestation is constantly new, arising out of no prior possibility in man or his world, and responding to nothing in him which might make the revelation capable of anticipation. The paradox of God's self communication of his formless Glory is then beyond all utterance, and yet is uttered, given form: the final Form is, of course, the Christ. This is the basic datum, the ground upon which all theology rests, and is pure grace, a gift beyond all expectation, incapable of being imagined. All the preparatory Old Testament images finally fail. The paradox, the self communication of God who is beyond all utterance, yet is uttered, has its resolution only in the Form, the personal unity, of Christ. The revelation always at once transcends and assimilates the concrete historical forms by which it is mediated. The pagan materials are transformed by their historical deployment in the revelatione.g., the pagan myths of creation, of divine wars and marriages, the pagan wisdom-and in their deployment, they converge, hut not within the Old... (shrink)

Many philosophers, I suspect, are partial to supervaluational theories of vagueness. And with good reason. Its rivals all seem to promise metaphysical mysteries concerning hitherto unnoticed, and perhaps unnoticeable, sharp boundaries around our concepts, or radical revision in our logical practices. And not only have philosophers been so tempted. The texts are a little unclear, but it seems several economists can be read as adopting supervaluational solutions to the difficulties raised by vagueness in economic concepts. Given its popularity, and plausibility, (...) supervaluationism deserves a book-length defence. Yet this is the first such book in the philosophical canon. (shrink)

What the world needs now is another theory of vagueness. Not because the old theories are useless. Quite the contrary, the old theories provide many of the materials we need to construct the truest theory of vagueness ever seen. The theory shall be similar in motivation to supervaluationism, but more akin to many-valued theories in conceptualisation. What I take from the many-valued theories is the idea that some sentences can be truer than others. But I say very different things to (...) the ordering over sentences this relation generates. I say it is not a linear ordering, so it cannot be represented by the real numbers. I also argue that since there is higher-order vagueness, any mapping between sentences and mathematical objects is bound to be inappropriate. This is no cause for regret; we can say all we want to say by using the comparative truer than without mapping it onto some mathematical objects. From supervaluationism I take the idea that we can keep classical logic without keeping the familiar bivalent semantics for classical logic. But my preservation of classical logic is more comprehensive than is normally permitted by supervaluationism, for I preserve classical inference rules as well as classical sequents. And I do this without relying on the concept of acceptable precisifications as an unexplained explainer. The world does not need another guide to varieties of theories of vagueness, especially since Timothy Williamson (1994) and Rosanna Keefe (2000) have already provided quite good guides. I assume throughout familiarity with popular theories of vagueness. (shrink)

We use data collected among Hadza hunter-gatherers between 2005 and 2009 to examine hypotheses about the causes and consequences of men’s foraging and food sharing. We find that Hadza men foraged for a range of food types, including fruit, honey, small animals, and large game. Large game were shared not like common goods, but in ways that significantly advantaged producers’ households. Food sharing and consumption data show that men channeled the foods they produced to their wives, children, and their consanguineal (...) and affinal kin living in other households. On average, single men brought food to camp on 28% of days, married men without children at home on 31% of days, and married men with children at home on 42% of days. Married men brought fruit, the least widely shared resource, to camp significantly more often than single men. A model of the relationship between hunting success and household food consumption indicates that the best hunters provided 3–4 times the amount of food to their families than median or poor hunters. These new data fill important gaps in our knowledge of the subsistence economy of the Hadza and uphold predictions derived from the household and kin provisioning hypotheses. Key evidence and assumptions backing prior claims that Hadza hunting is largely a form of status competition were not replicated in our study. In light of this, family provisioning is a more viable explanation for why good hunters are preferred as husbands and have higher fertility than others. (shrink)

We revisit classical Utilitarianism by connecting and generalizing two ideas. The first is that there is a representation theorem possible for hedonic value similar to, but also importantly different from, the one provided by von Neumann and Morgenstern to measure decision utility. The idea is to use objective time, in place of objective chance, to measure hedonic value. This representation for hedonic value delivers a stronger kind of scale than von Neumann–Morgenstern utility, a ratio scale rather than merely an interval (...) scale. The second idea is that measurement on a ratio scale allows the meaningful aggregation of utilities over a group. This is aggregation by product rather than sum. Aggregation by product is known to have interesting Prioritarian consequences. Aggregation becomes complicated when the two approaches are mixed, when hedonic value is mixed with uncertainly. It becomes problematic when pain as well as pleasure is taken into account. (shrink)

Frank Hindriks has attempted to derive a variant of Timothy Williamson’s knowledge rule for assertion on the basis of a more fundamental belief expression analysis of that speech act. I show that his attempted derivation involves a crucial equivocation between two senses of ‘must,’ and therefore fails. I suggest two possible repairs; but I argue that even if they are successful, we should prefer Williamson’s fully general knowledge rule to Hindriks’s restricted moral norm.

It is common for philosophers to reject otherwise plausible moral theories on the ground that they are objectionably demanding, and to endorse “Moderate” alternatives. I argue that while support can be found within the method of reflective equilibrium for Moderate moral principles of the kind that are often advocated, it is much more difficult than Moderates have supposed to provide support for the view that morality’s demands in circumstances like ours are also Moderate. Once we draw a clear distinction between (...) Moderate accounts of the content of moral principles, and Moderate accounts of morality’s demands in circumstances like ours, we can see that defenses of Moderate views that include both of these components are subject to both methodological and substantive objections. I consider arguments for Moderate views that have been made by Samuel Scheffler and Richard Miller, and argue that both are methodologically problematic because they rely on appeals to intuitions that we have strong grounds to think are unreliable. I conclude that we must take seriously the possibility that Moderate principles, applied to well off people in circumstances like ours, imply demands that are much more extensive than Moderates typically accept. (shrink)

Early Renaissance naturalists worked to identify the plans described in ancient sources. But during the middle decades of the sixteenth century, naturalists instead began to describe and name plans unknown to the ancients. They also divided nature much more finely, distinguishing species that their predecessors had lumped together. As a result, they created an information overload. Dictionaries of synonyms and local flora were invented in the early seventeenth century as partial solutions to this problem of information overload.

There are two views of the essences of speech acts: according to one view, they are natural kinds; according to the other, they are what I call normative kinds—kinds in the (possibly non-reductive) definition of which some normative term occurs. In this article I show that speech acts can be normative but also natural kinds by deriving Williamson's account of assertion, on which it is an act individuated, and constitutively governed, by a norm (the knowledge rule), from a consideration of (...) the natural characteristics of normal cases of its performance. (shrink)

It is well-known that classical models of belief are not realistic representations of human doxastic capacity; equally, models of actions involving beliefs, such as decisions based on beliefs, or changes of beliefs, suffer from a similar inaccuracies. In this paper, a general framework is presented which permits a more realistic modelling both of instantaneous states of belief, and of the operations involving them. This framework is motivated by some of the inadequacies of existing models, which it overcomes, whilst retaining technical (...) rigour in so far as it relies on known, natural logical and mathematical notions. The companion paper (Towards a “sophisticated” model of belief dynamics. Part II) contains an application of this framework to the particular case of belief revision. (shrink)

Academic discussions concerning what to do about conspiracy theories often focus on whether or not to debunk them. Less often discussed are the methods, audiences and effectiveness of debunking eff...

Fast and effective detection of the causative agent of malaria in humans, protozoan Plasmodium parasites, is of crucial importance for increasing the effectiveness of treatment and to control a devastating disease that affects millions of people living in endemic areas. The microscopic examination of Giemsa‐stained blood films still remains the gold‐standard in Plasmodium detection today. However, there is a high demand for alternative diagnostic methods that are simple, fast, highly sensitive, ideally do not rely on blood‐drawing and can potentially be (...) conducted by the patients themselves. Here, the history of Plasmodium detection is discussed, and advantages and disadvantages of diagnostic methods that are currently being applied are assessed. (shrink)

Carey has argued that there is a system of core numerical cognition – the analog magnitude system – in which cardinal numbers are explicitly represented in iconic format. While the existence of this system is beyond doubt, this paper aims to show that its representations cannot have the combination of features attributed to them by Carey. According to the argument from abstractness, the representation of the cardinal number of a collection of individuals as such requires the representation of individuals as (...) such, and this in turn requires non-iconic format, from which it is concluded that the explicit representation of the cardinal number of some individuals requires non-iconic representational format. In support of the first premise, an account is given of what approximate cardinal numbers might be, and in support of the second, a direct argument is articulated and defended. Finally, in response to an objection, a second argument for the central thesis is provided. While the discussion is couched in the terms of Carey’s work, the considerations it adduces are perfectly general, and the conclusion should therefore be taken into consideration by all those aiming to characterize the AM system. (shrink)

Even if we do not observe those who own or manage capital doing anything, are there nevertheless good reasons for saying that they have power over government? My thesis is that, on any analysis of `power over others' that enables us to say that voters have power over those elected and that consumers have power over producers, we also have to say that those who own or control capital have power over government. Conversely, the reasons that can be given (and (...) have been given) for denying that owners of capital have power over governments would be equally good reasons for denying that voters have power over governments and that consumers have power over producers. Key Words: power • capitalism • democracy. (shrink)

Wavefunction collapse models modify Schrödinger's equation so that it describes the rapid evolution of a superposition of macroscopically distinguishable states to one of them. This provides a phenomenological basis for a physical resolution to the so-called “measurement problem.” Such models have experimentally testable differences from standard quantum theory. The most well developed such model at present is the Continuous Spontaneous Localization (CSL) model in which a universal fluctuating classical field interacts with particles to cause collapse. One “side effect” of this (...) interaction is that the field imparts energy to the particles: experimental evidence on this has led to restrictions on the parameters of the model, suggesting that the coupling of the classical field to the particles must be mass-proportional. Another “side effect” is that the field imparts momentum to particles, causing a small blob of matter to undergo random walk. Here we explore this in order to supply predictions which could be experimentally tested. We examine the translational diffusion of a sphere and a disc, and the rotational diffusion of a disc, according to CSL. For example, we find that the rms distance an isolated 10−5 cm radius sphere diffuses is ≈(its diameter, 5 cm) in (20 sec, a day), and that a disc of radius 2 ⋅ 10−5 cm and thickness 0.5 ⋅ 10−5 cm diffuses through 2πrad in about 70 sec (this assumes the “standard” CSL parameter values). The comparable rms diffusions of standard quantum theory are smaller than these by a factor 10−3±1. It is shown that the CSL diffusion in air at STP is much reduced and, indeed, is swamped by the ordinary Brownian motion. It is also shown that the sphere's diffusion in a thermal radiation bath at room temperature is comparable to the CSL diffusion, but is utterly negligible at liquid He temperature. Thus, in order to observe CSL diffusion, the pressure and temperature must be low. At the low reported pressure of 5 ⋅ 10−17 Torr, achieved at 4.2°K, the mean time between air molecule collisions with the (sphere, disc) is ≈(80, 45)min. This is ample time for observation of the putative CSL diffusion with the standard parameters and, it is pointed out, with any parameters in the range over which the theory may be considered viable. This encourages consideration of how such an experiment may actually be performed, and the paper closes with some thoughts on this subject. (shrink)

This paper contains a positive development and a negative argument. It develops a theory of function loss and shows how this undermines an objection raised against the etiological theory of function in support of the modal theory of function. Then it raises two internal problems for the modal theory of function.

Since its founding in 1950, the Metaphysical Society of America has remained a pluralistic community dedicated to rigorous philosophical inquiry into the most basic metaphysical questions. At each year’s conference, the presidential address offers original insights into metaphysical questions. Both the insights and the questions are as perennial as they are relevant to contemporary philosophers. This volume collects eighteen of the finest representatives from those presidential addresses, including contributions from George Allan, Richard Bernstein, Norris Clarke, Vincent Colapietro, Frederick Ferré, Jorge (...) J. E. Gracia, Joseph Grange, Marjorie Grene, George Klubertanz, Ivor Leclerc, Ralph McInerny, Ernan McMullin, Joseph Owens, John Herman Randall, Jr., Nicholas Rescher, Stanley Rosen, John E. Smith, and Robert Sokolowski. Also included are Paul Weiss’s inaugural address to the Society, an introduction chronicling the history of the Society, and an original Foreword by William Desmond and Epilogue by Robert Neville. (shrink)

This paper argues that the church should give especial care to the needs of older folk in their communities, needs that are often neglected. It analyses why such folk have especial needs in our contemporary society and suggests practical ways that churches can and should respond. It summarises particular approaches to learning to grow old, and to die well, given by various authors who have had experience in these areas. It considers the problem of pain and suffering and suggests a (...) dualistic approach that can give comfort. (shrink)

Public health legal preparedness begins with effective legal authorities, and law provides a key foundation for public health practice in the United States. Laws not only create public health agencies and fund them, but also authorize and impose duties upon government to protect the public's health while preserving individual liberties. As a result, law is an essential tool in public health practice and is one element of public health infrastructure, as it defines the systems and relationships within which public health (...) practitioners operate.For purposes of this paper, law can be defined as a rule of conduct derived from federal or state constitutions, statutes, local laws, judicial opinions, administrative rules and regulations, international codes, or other pronouncements by entities authorized to prescribe conduct in a legally binding manner. Public health legal preparedness, a subset of public health preparedness, is defined as attainment of legal benchmarks within a public health system. (shrink)

The structure of Reichenbach's pragmatic vindication of induction is analysed in detail. The argument is seen to proceed in two stages, the first being a pragmatic justification of the frequency interpretation of probability which is taken as a license for considering the aim of induction to be the discovery of limiting relative frequencies, and the second being the pragmatic justification of induction itself. Both justifications are found to contain flaws, and the arguments used to support Reichenbach's definition of the aim (...) of induction presuppose the availability of a type of predicate which generates paradoxes closely related to Goodman's "grue-bleen" paradox. Next, Salmon's "Criterion of Linguistic Invariance" is evaluated as a canon of inductive logic, which singles out the "straight rule" from an infinite class of convergent inductive rules. Upon close examination, its credentials are seen to be unimpressive. In connection with Salmon's work on linguistic invariance, we take a closer look at the impact of the Goodman paradox on probability estimator rules like Reichenbach's "straight rule." We find that its undesirable consequences for such systems of inductive logic cannot be escaped by Salmon's solution, or indeed by any solution whose motivating idea is to rule "queer" predicates out of court. Finally, the discussion of the Goodman paradox leads us to a modest methodological proposal for systems of inductive logic which incorperate probability estimator rules of the type at issue. (shrink)

Market events of the past few years have resurrected long unheeded calls for the professionalization of the occupation of business manager, not in terms of increased technical proficiency, but in terms of a renewed vigor to shape the practice of management and the education of those who will fill its ranks along the lines of the “ideal of service” which characterizes socially established professions like law and medicine. In this paper I argue that the push to professionalize business management can (...) be grounded in an ISCT (Integrative Social Contracts Theory) treatment of the “vulnerable values” argument which itself has served as a source for the professionalization of medicine and law. Additionally, I offer a sketch of an argument that once business managers are considered to be members of a profession, we can begin to develop an account of “business malpractice” which would, when it occurs, represent an ethical violation of the “publicpledge” that members of all professions make to serve the broader good of society. (shrink)

Religions don’t simply make claims about the world; they also offer existential resources, resources for dealing with basic human problems, such as the need for meaning, love, identity, and personal growth. For instance, a Buddhist’s resources for addressing these existential needs are different than a Christian’s. Now, imagine someone who is agnostic but who is deciding whether to put faith in religion A or religion B. Suppose she thinks A and B are evidentially on par, but she regards A as (...) offering much more by way of existential resources. Is it epistemically rational for her to put her faith in A rather than B on this basis? It is natural to answer No. After all, what do the existential resources of a religion have to do with its truth? However, I argue that this attitude is mistaken. My thesis is that the extent to which it is good for a certain religion to be true is relevant to the epistemic rationality of faith in that religion. This is plausible, I’ll argue, on the correct account of the nature of faith, including the ways that emotion and desire can figure into faith and contribute to its epistemic rationality. (shrink)

Taken from a larger qualitative multi-case study, this article centers the voices of high school students who are from military affiliated families and how they want war to be taught to them. Using heritage history and difficult knowledge as theoretical frames, this article argues that military affiliated students seek a more robust teaching of war. Students demonstrated an interest in developing a deeper understanding of the community in which they live. Students requested a pedagogy that was inquiry and discussion based (...) with teachers not telling them what or how to think about war, a curriculum that was thematic in nature, teaching that was connected to the present, and teaching that was mindful of the personal connections students had to the subject of war through their family. (shrink)