In his denial that language refers to anything but itself and in his undoing representation, Joyce anticipates contemporary developments in the history of critical theory. Contrary to modern criticism, Joyce does not abandon representation, the idea that language affords access to reality.

There have recently been novel applications of medical systematic review guidelines to economic policy interventions which contain controversial methodological assumptions that require further scrutiny. A landmark 2017 Cochrane review of unconditional cash transfer (UCT) studies, based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE), exemplifies both the possibilities and limitations of applying medical systematic review guidelines to UCT and universal basic income (UBI) studies. Recognizing the need to upgrade GRADE to incorporate the differences between medical and policy interventions, (...) the GRADE Public Health Project Group (PHPG) was convened to enumerate and address these methodological challenges. However, in light of our analysis of additional methodological challenges that arise for UCT and UBI studies, we argue that the adaptation of medical systematic review guidelines to economic methodology is far from straightforward and is in fact more challenging than claimed by the PHPG. (shrink)

Sextus Empiricus does not reveal anything of himself as distinct from ‘the Sceptic’ except in a passing and incidental way. He does not refer to his contemporaries, nor to his country, nor to any personal experiences, in such a way as to provide a definite picture of his life and times. The few references he makes to his involvement in the medical profession are as perplexing as they are enlightening. The only attachments which Sextus strongly identifies with in his extant (...) writings are the demands of the Pyrrhonean philosophy. (shrink)

Suppose that John asks, ‘Is the window open?’ and Mary replies, ‘The window is open.’ Then John and Mary have produced two distinct utterances, and in doing so, they have performed two different kinds of speech act. But clearly there is something that these utterances have in common. According to the standard theory of speech acts, in these utterances different illocutionary forces have been applied to the same propositional content. Similarly, if John and Mary both believe that roses are red, (...) the same propositional content is attributed to their individual mental states.The propositional contents of utterances and beliefs have traditionally been identified with propositions. In turn, propositions have been characterized as language-independent particulars that can be re-identified in different contexts. In this article, I will argue that various phenomena that have hitherto been explained by propositions are better understood in terms of propositional acts. (shrink)

In the work of Nietzsche, sacrifice can only sacrifice itself over and over (in an eternal return of the same) because what it seeks to overcome (the nihilistic revelation of truth that sublates sacrifice's negation) makes this sacrifice of itself both necessary and useless. The truth is eternally postponed in a necessary sacrificial gesture that can only sacrifice itself, thereby rendering itself useless. In the attempt to step beyond nihilism, that is, in the attempt to negate (or sacrifice) nihilism, one (...) repeats the negation characteristic of nihilism. One becomes inextricably implicated in the move of nihilistic sacrifice. The sacrifice of the sacrifice characteristic of nihilism, that is, the sacrifice of sacrifice, can only take place as (perform itself as) the impossibility (or eternally postponed possibility) of its realization. One, therefore, produces or performs an interminable step/not beyond, an incessant step beyond that eternally returns. (shrink)

Context: Few professional philosophers have addressed in any detail radical constructivism, but have focused instead on the related assumptions and limitations of postmodern epistemology, various anti-realisms, and subjective relativism. Problem: In an attempt to supply a philosophical answer to the guest editors’ question, “Why isn’t everyone a radical constructivist?” I address the realist (hence non-radical) implications of the theory’s invocation of “others” as an invariable, observer-independent, “external” constraint. Results: I argue that constructivists cannot consistently defend a radically subjectivist theory of (...) knowing while remaining entirely agnostic about the nature and existence of the larger world (including independent others). That is, any non-solipsistic account of human experience must explicitly acknowledge its extra-subjective, ontological dimension. Implications: It follows that no pedagogical, social, philosophical, or commonsensical insight associated with so-called “trivial” or “social” constructivism survives or receives any support from the move to radical constructivism. (shrink)

This work is a volume in the series Ancient Commentators on Aristotle, edited by Richard Sorabji. The aim of the series is to make the Greek commentaries available in English. Konstan does an admirable job of this. The translation is extremely careful, clear, and readable. Konstan succeeds in staying close to the text without sacrificing intelligibility. Whenever necessary, he inserts words or phrases in brackets to complete the sense of an accurately translated passage. Konstan also makes use of brackets to (...) give precise citations to fill out Simplicius' references. The footnotes, too, are excellent. There the reader finds information about deviations from Diels's text, about alternative readings, and explanations of renderings into English that might be controversial. In the introduction, Sorabji gives a thumbnail sketch of the philosophical issues raised by Physics 6. Several useful documents are appended to the commentary, namely, a list of all departures from Diels's text, an appendix written by the editor providing a brief survey of the ancient Greek commentators, and a list of the philosophers cited by Simplicius with a onesentence description of each. (shrink)

In the de Anima, Aristotle outlines a theory of perception. In de Anima II, 5-12, he considers the basic kinds of sensory perception — seeing, hearing, touching, tasting and smelling. He uses a few basic elements, viz., the five senses and their proper, common and incidental objects, and a few explanatory principles to explain sensory perception. In de Anima III, 1–2, Aristotle turns to apperception, viz. perceptual selfawareness. He considers several basic cases of apperception – the selfconscious awareness of occurrent (...) perceptions and the awareness that the objects of different senses are different. (shrink)

In his 1987 book _Conditionals, Frank Jackson presents an argument to the effect that the indicative conditionals of natural language have the same truth conditions as the material conditional of truth-functional logic. This Jackson refers to as the "paradox of indicative conditionals." I offer a solution to this paradox by arguing that some conditionals that appear to be in the indicative mood are actually subjunctives, to which the paradox does not apply. I support this proposed solution with some historical observations (...) on the evolution of the English verb phrase. (edited). (shrink)

Scientific developments of the last 20 years have made the transplantation of cadaveric solid organs a viable and expected treatment alternative for patients suffering from various forms of End Stage Organ Disease. Of the number of organs that could be utilized for this, only a small percentage of them are actually made available. North American legislation explicitly categorizes the transfer of cadaveric organs as an anatomical or tissue “gift”. The concept of the gift is mediated by transculturally consistent unwritten, but (...) powerfully felt, rules of conduct. Among the most profound elements of the concept is the obligatory gift-exchange which is central to the gift-relationship. Obviously, neither of these are permitted by the organ transplant scenario. As a result, dissonance is created within the thought process of the individual which cannot be easily resolved, paralyzing many into inaction. We maintain that the present legal framework, designed to facilitate the transfer of organs, clashes with the human phenomenon of giving, and may actually prevent organs from being made available. In a search for a solution to this gift-relationship dilemma, giving organs is contrasted with taking organs as a basis upon which to ground ethically sound public policy. Liberty-limiting principles and the concept of harm are considered within this context. (shrink)

Weil’s essay on Homer’s Iliad contains a philosophical analysis of la force that divides it into two phenomena with one metaphysical ground. Her analysis is a corrective to misunderstandings of force as something that can be possessed. The first half of my elaboration of Weil’s analysis is devoted to the phenomena she identifies in relation to la force, which I call might. In the second half, I elaborate the varieties of misunderstanding of la force. First, might is an illusion sustained (...) by the shared belief of those in submission to might. Second, forces, i.e. the material forces on which weaponry depends, cannot be possessed. Third, what lies behind material forces is necessity, a third meaning of la force, which functions as a superordinate or ultimate force to which everyone and everything is subject. Understanding the last of these is the corrective that Weil means to present. (shrink)

David KC Cooper,1 David Ayares21Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 2Revivicor, Blacksburg, VA, USA: The transplantation of organs and cells from pigs into humans could overcome the critical and continuing problem of the lack of availability of deceased human organs and cells for clinical transplantation. Developments in the genetic engineering of pigs have enabled considerable progress to be made in the experimental laboratory in overcoming the immune barriers to successful xenotransplantation. With regard to (...) pig organ xenotransplantation, antibody- and cell-mediated rejection have largely been overcome, and the current major barrier is the development of coagulation dysregulation. This is believed to be due to a combination of immune activation of the vascular endothelial cells of the graft and molecular incompatibilities between the pig and primate coagulation–anticoagulation systems. Pigs with new genetic modifications specifically directed to this problem are now becoming available. With regard to less complex tissues, such as islets, neuronal cells, and corneas, the remaining barriers are less problematic, and graft survival in nonhuman primate models extends for >1 year in all three cases. In planning the initial clinical trials, consideration will be concentrated on the risk–benefit ratio, based to a large extent on the results of preclinical studies in nonhuman primates. If the benefit to the patient is anticipated to be high, eg, insulin-independent control of glycemia, and the potential risks low, eg, minimal risk of transfer of a porcine infectious agent, then a clinical trial would be justified.Keywords: infection, pigs, genetically-engineered, xenotransplantation, islets, xenotransplantation, organs. (shrink)

Case 1 reminds us that patients have duties too, while case 2 presents an instance of justified withholding of informationHow refreshing to read these two cases! No conjoined twins, fantastical chimeras, or other incredible scenarios at the fringes of medical reality. Each case highlights the practical and theoretical difficulties that doctors face in their everyday practice.Case 1: In case 1, the patient, who had declined an HIV test, changed his mind and requested an HIV test on the request form without (...) informing the doctor. The pathologist performed the tests and returned the results to the unsuspecting doctor, who duly investigated the matter. The doctor’s anxiety at the situation, as well as the worries of the entire practice and pathology laboratory, must have been deeply unpleasant. Thus the patient, no doubt unintentionally, caused much distress by requesting the HIV test. He was, at the very least, guilty of a lack of foresight and consideration. As a minimum, he should have informed the doctor of his last minute alteration. This would have enabled the doctor to discuss the implications of the test, to organise appropriate counselling, and, most importantly, to receive the results in full knowledge of the situation.As Dr Fraser points out, the experience of case 1 reinforces the importance of taking good medical notes. Even if the patient’s refusal had been documented in the notes, however, this would not have prevented him from requesting the HIV test, and indeed other tests, on the blood form. Pharmacists may still occasionally be faced with situations when they are unsure whether the doctor prescribed 10 capsules of a drug, or 110 capsules, as the patient may have added a “1” in front of the doctor’s original prescription. Similarly, how …. (shrink)

This study examined the relationship between unethical employee behavior and the dimensions of the Ethical Climate Questionnaire (ECQ). In order to explore the relationship between the dimensions of the ECQ and unethical behavior, the factor structure of five previously identified empirical models and the hypothesized nine-dimension model for the ECQ was tested with a confirmatory factor analysis. The analysis revealed that the hypothesized nine-dimension model provided as good or even better fit to the data than the five empirically derived models. (...) Therefore, the nine-dimensional model was used to examine the criterion-related validity of the ECQ. The results demonstrated that the nine ethical climate dimensions were correlated with some of the unethical behaviors examined in this study, but not others. However, the results clearly demonstrated that most of the ethical climate dimensions were significantly related to an aggregate measure of unethical behavior. It was suggested that these results might account for the differences in previous studies on the criterion-related validity of the ECQ. The results also replicated a previous report that the association between unethical behavior and ethical climate is stronger in organizations that do not have a code of ethics. Finally, a difference was observed in the ethical climates for organizations with a code of ethics and organizations without a code of ethics. (shrink)

The public revelation in 2003 that medical students perform intimate examinations without patient consent has engendered much debate in the press and scientific journals. Using this case as a springboard for discussion, I will argue that medical schools should encourage students to raise their ethical concerns and call for a change of policy making it easier for students to do so. I will also address the question of medical students’ moral obligations towards their patients, and conclude that medical students ought (...) to express their discontent when faced with unethical practices or attitudes.In early January 2003, a study appeared in the British Medical Journal revealing that nearly a quarter of rectal and vaginal examinations on anaesthetised patients were performed by medical students without patient consent.1 Although the study did not generate the firestorm of controversy many expected, it engendered much discussion on ethical issues surrounding informed consent and patient autonomy, as well as stressing the need for greater ethics training for medical students. As an ethical problem, however, the case of intimate examinations is, to my mind, relatively uninteresting. If we agree that it is wrong for doctors to perform a vaginal examination on a conscious person without their consent, then it follows that it will still be …. (shrink)

Alzheimer's disease is characterized by formation of neuritic plaque primarily composed of a small filamentous protein called amyloid-beta peptide . The rate-limiting step in the production of Abeta is the processing of Abeta precursor protein by beta-site APP-cleaving enzyme . Hence, BACE1 activity plausibly plays a rate-limiting role in the generation of potentially toxic Abeta within brain and the development of AD, thereby making it an interesting drug target. A phase II trial of the promising LY2886721 inhibitor of BACE1 was (...) suspended in June 2013 by Eli Lilly and Co., due to possible liver toxicity. This outcome was apparently a surprise to the study's team, particularly since BACE1 knockout mice and mice treated with the drug did not show such liver toxicity. Lilly proposed that the problem was not due to LY2886721 anti-BACE1 activity. We offer an alternative hypothesis, whereby anti-BACE1 activity may induce apparent hepatotoxicity through inhibiting BACE1's processing of beta-galactoside alpha-2,6-sialyltransferase I . In knockout mice, paralogues, such as BACE2 or cathepsin D, could partially compensate. Furthermore, the short duration of animal studies and short lifespan of study animals could mask effects that would require several decades to accumulate in humans. Inhibition of hepatic BACE1 activity in middle-aged humans would produce effects not detectable in mice. We present a testable model to explain the off-target effects of LY2886721 and highlight more broadly that so-called off-target drug effects might actually represent off-site effects that are not necessarily off-target. Consideration of this concept in forthcoming drug design, screening, and testing programs may prevent such failures in the future. (shrink)