Medical care in the United States traditionally has focused on the treatment of disease rather than on its prevention. Heart disease, cancer, hypertension, diabetes, and other chronic diseases are the primary drivers of American health care costs; compared to other high-income countries, U.S. health indices are lowest and costs are highest.A “triple aim” — “improving the individual experience of care, improving the health of populations, and reducing the per capita costs of care for populations” — has gained traction, as the (...) social determinants of health are recognized as having significant effects on health outcomes. (shrink)

This is one of four interrelated action agenda papers resulting from the National Summit on Public Health Legal Preparedness convened in June 2007 by the Centers for Disease Control and Prevention and nineteen multi-disciplinary partner organizations. Each of the action agenda papers deals with one of the four core elements of public health legal preparedness: laws and legal authorities; competency in using those laws; coordination of law-based public health actions; and information. Options presented in this paper are for consideration by (...) policymakers and practitioners — in all jurisdictions and all relevant sectors and disciplines — with responsibilities for all-hazards emergency preparedness.This paper focuses on the fourth core element: information that can be used in shaping and applying law as a public health tool, specifically in the context of public health emergencies. (shrink)

All communities have common resources that are vulnerable to selfish motives. The current paper explores this challenge in the specific case of the urban commons, defined as the public spaces and scenery of city neighborhoods. A theoretical model differentiates between individual incentives and social incentives for caring for the commons. The quality of a commons is defined as the level of physical (e.g., loose garbage) and social (e.g., public disturbances) disorder. A first study compared levels of disorder across the census (...) block groups of a single city; the second compared the disorder generated by individual addresses in two neighborhoods. Each study found that homeownership, an individual incentive, was the main predictor of disorder. Owner-occupied parcels generated less disorder than their renter-occupied neighbors, but both parcel types produced less disorder in a neighborhood with greater homeownership. The results emphasize the need for considering both individual and social incentives for group-beneficial behaviors. (shrink)

In this paper I describe the imaginary community of Gullible. Gulliblians are led by moral pressures to believe whatever they are told and, in the scenario that I sketch, this leads to them having widespread contradictory beliefs. This community is nevertheless intelligible to us given what we know about their situation and their moral code. Davidson, however, holds there to be what I call a logicist constraint on interpretation: thinkers can only be interpreted if a good proportion of their beliefs (...) are rational and, for Davidson, rationality entails logical consistency. The possibility of Gullible therefore forces us to reject this logicist aspect of Davidson’s account of interpretation and intelligibility. (shrink)

This book is an in-depth treatment of Darwinian evolutionism and its applicability to the investigation of the archaeological record. The authors explain the unique position that this kind of evolutionism holds in science and how it bears on any attempt to explain change over time in the organic world, demonstrate commonalities between archaeology and paleobiology, and explain the principles, methods, and techniques - the systematics - inherent in the approach.

Doctors have an ethical and legal duty to respect patient confidentiality. We consider the basis for this duty, looking particularly at the meaning and value of autonomy in health care. Enabling patients to decide how information about them is disclosed is an important element in autonomy and helps patients engage as active partners in their care.Good quality data is, however, essential for research, education, public health monitoring, and for many other activities essential to provision of health care. We discuss whether (...) it is necessary to choose between individual rights and the wider public interest and conclude that this should only rarely be necessary. The paper makes some recommendations on practical steps which could help ensure that good quality information is available for work which benefits society and the public health, while still enabling patients’ autonomy to be respected. (shrink)

Personal observations and survey data are used to examine the future of the village in a restructured food and agricultural sector in the former Soviet Union. Specific comparisons are made between the subjective quality of life of residents in two villages in the former Soviet Union (one in southern Russia and one in eastern Ukraine) and two villages in northwest Missouri. Residents of the Russian and Ukrainian villages have substantially lower assessments of specific domains of their lives than do American (...) villagers. Respondents in the Russian and Ukrainian sample express an interest in some aspects of privatization of services and consumer goods but, by and large, exhibit little interest in replacing the collective farms with household-level private farming. Historical factors, different incentive structures, and the possibilities for different institutional arrangements are discussed. (shrink)

Information is the fourth core element of public health legal preparedness and of legal preparedness for public health emergencies specifically. Clearly, the creation, transmittal, and application of information are vital to all public health endeavors. The critical significance of information grows exponentially as the complexity and scale of public threats increase.Only a small body of organized information on public health law existed before the 21st century: a series of landmark books published beginning in 1926 by Tobey, Grad, and Wing ; (...) model public health laws published as early as 1907; systematic reviews of original research studies published in the 1990s; and a small but growing number of articles published in public health journals and law reviews.With the new century came new public health law programs and activities at the Centers for Disease Control and Prevention, in public health professional associations, and in numerous non-profit and academic organizations. (shrink)

While new generations of implantable brain computer interface devices are being developed, evidence in the literature about their impact on the patient experience is lagging. In this article, we address this knowledge gap by analysing data from the first-in-human clinical trial to study patients with implanted BCI advisory devices. We explored perceptions of self-change across six patients who volunteered to be implanted with artificially intelligent BCI devices. We used qualitative methodological tools grounded in phenomenology to conduct in-depth, semi-structured interviews. Results (...) show that, on the one hand, BCIs can positively increase a sense of the self and control; on the other hand, they can induce radical distress, feelings of loss of control, and a rupture of patient identity. We conclude by offering suggestions for the proactive creation of preparedness protocols specific to intelligent—predictive and advisory—BCI technologies essential to prevent potential iatrogenic harms. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:A Political Theology of Climate Change by Michael S. Northcott, and: Restored to Earth: Christianity, Environmental Ethics, and Ecological Restoration by Gretel Van WierenKevin J. O’BrienA Political Theology of Climate Change Michael S. Northcott grand rapids, mi: eerdmans, 2013. 335 pp. $30.00Restored to Earth: Christianity, Environmental Ethics, and Ecological Restoration Gretel Van Wieren washington, dc: georgetown university press, 2013. 208 pp. $29.95These two excellent books, A Political Theology (...) of Climate Change by Michael S. Northcott and Restored to Earth by Gretel Van Wieren, offer distinct directions for Christian environmental ethics: Northcott develops a rigorous analysis of climate change as a failure of enlightenment rationality and politics, while Van Wieren argues that those who care about the earth can connect with it through the practice of ecological restoration. Northcott theologically defines a complex global problem; Van Wieren theologically engages a community-based solution. Each book advances Christian environmental ethics in important ways; considered together, they have much to teach about the content and methods of the field.Northcott’s A Political Theology of Climate Change argues that climate change is a “cosmopolitical crisis” and that Christians should embrace a more ecological and theological politics in response. Theologians and ethicists have long argued that environmental degradation has cosmological roots: The belief that human beings are separate from nature makes global-scale degradation and pollution acceptable. Northcott adds a nuanced political analysis, noting that modern politics is based on a denial “that the weather is political, or that politics influences the climate” (46). Enlightenment thinkers who laid the groundwork for contemporary political structures insisted that storms and floods were not divine responses to human behavior, so modern nation-states are premised on an ideological separation from nature. Climate change reveals the failure of such thinking, so the facts of climate change pose an inherently political challenge.Thus, failures to act on climate change are political failures. Mainstream politics cannot consider that economic growth is unsustainable because it is premised on ignorance about nature. Nations cannot collaborate to solve the problem because they have no common moral agreement “about the ends and goals of human life” (245). Any response to climate change that simply extends [End Page 198] the enlightenment project—by ascribing “rights” to the natural world, or by trusting existing secular political structures—is doomed to failure. Instead, climate change calls for a different cosmology and a different politics.Northcott argues that both can be found in the Christian tradition. Natural law thinking respects the relationship between human beings and external moral standards “set into the structure of the cosmos,” demanding careful accounting for the atmospheric consequences of human action (246). Virtue ethics teaches the ideal of politics as a “community of friendship and love,” nurturing practices of participation in the good life, lived with less consumption and less destructive energy (200).Northcott hopes that small-scale communities inspired by Christian cosmology and Christian politics will transition away from destructive practices and thereby demonstrate a new way of life to the world. His book concludes by reasserting that because climate change is a political problem, it is fundamentally a theological problem, calling human communities to “re-create the historic and customary connections between nature and culture, land and life, love for neighbour and nature which are central to the Jewish and Christian messianism of empire-challenging love” (316).In contrast to Northcott’s focus on political and philosophical failures, Gretel Van Wieren’s Restored to Earth seeks a “more positive, solution-oriented” approach to Christian ethics (viii). The book is about reconnecting humans with the natural world through ecological restoration, “the science and art of repairing ecosystems that have been damaged by human activities” (2), and it argues that restoration models moral life by creating physical, intellectual, emotional, communal, and spiritual connections with the natural world.Van Wieren begins with an interdisciplinary definition of ecological restoration and argues that views on the practice depend upon varied definitions of nature. She then moves to a nuanced account of restoration ecology as a spiritual practice (chapter 3) of community formation (chapter 4). Evocatively recounting a controlled prairie burn in Illinois on Maundy Thursday, Van Wieren... (shrink)

The dominant model for bioethical inquiry taught in medical schools is that of principlism. The heritage of this methodology can be traced to the Enlightenment project of generating a universalizable justification for normative morality arising from within the individual, rational agent. This project has been criticized by Alasdair MacIntyre who suggests that its failure has resulted in a fragmented and incoherent contemporary ethical framework characterized by fundamental intractability in moral debate. This incoherence implicates principlist conceptions of bioethics. Medical ethics as (...) practiced, though, is partially in keeping with teleological alternatives to principlism. Nonetheless, the hegemony of principlism threatens to harm the practice of good medicine whenever it is used to provide justification for the sanction or prohibition of practices, despite not being equipped to grant moral authority to such justifications. An example of this failure and its resulting harm is expressed in the growing obsolescence of living donor liver transplantation. (shrink)

In order to promote social distancing during the recent COVID-19 pandemic, physicians and healthcare systems have made efforts to replace in-person with virtual clinic visits when feasible. While these efforts have been well received and seem compatible with sound clinical practice, they do not perfectly replicate the experience of a face-to-face exchange between doctor and patient. This essay attempts to describe features of the virtual visit that distinguish it from its face-to-face analog and considers the phenomenological work of Emmanuel Levinas (...) in arguing that these differences may limit the force of the ethical summons a provider would otherwise experience before the face of a patient. The diminishment of this signal therapeutic experience may engender vocational as well as clinical consequences, which should be weighed against the practical benefits of the virtual visit as we consider whether our enthusiasm for this mode of practice should continue. (shrink)

Archaeologists have proposed that behavioral knowledge of a tool can be conceptualized as a “recipe”—a unit of cultural transmission that combines the preparation of raw materials, construction, and use of the tool, and contingency plans for repair and maintenance. This parallels theories in cognitive psychology that behavioral knowledge is hierarchically structured—sequences of actions are divided into higher level, partially independent subunits. Here we use an agent-based simulation model to explore the costs and benefits of hierarchical learning relative to holistic learning, (...) where entire behavioral sequences are learned in an all-or-nothing fashion, and diffusionist learning, where actions are completely independent. Hierarchical learning is favored under the reasonable assumptions that learning is associated with some degree of both error and cost, and that behavior can be grouped into subunits that repeat in one or more tool recipes. These general predictions can be tested in the archaeological and ethnographic record. Recent advances in evolutionary developmental biology have revealed a number of parallels between the hierarchically structured, recipe-like organization of behavioral knowledge that we examine here and the manner in which biological organisms develop. (shrink)

The belief that primitive men lived like beasts and that civilisation developed out of these brutal origins is found in numerous ancient authors, both Greek and Latin. It forms part of certain theories about the beginnings of culture current in late antiquity. These are notoriously difficult to trace to their sources, but they already existed in some form in the fifth century b.c. One idea common to these theories is that of progress, and for this reason a fragment of Xenophanes (...) is sometimes cited as their remote prototype: ‘The gods did not reveal all things to men from the beginning; instead, by seeking, men discover what is better in time’. Mainly on the strength of this fragment, Ludwig Edelstein devoted the first chapter of his book The Idea of Progress in Classical Antiquity to Xenophanes, and W. K. C. Guthrie has even declared that there is good reason to attribute to him a fuller account of progress, one that would include details found in later authors who speak of the early life of mankind. One of these details is the statement that the life of primitive men was ‘brutal’ or ‘beastlike’ . In these authors the implication of that term varies from ‘unschooled in the basic crafts’ to ‘inhumanly violent and bloodthirsty’. In one sense or the other it is repeatedly encountered in ancient references to this subject. Accounts of primitive brutishness which make use of the word θηριώδης (or θηριωδς can be found in the Suppliants of Euripides, in the Hippocratic treatise On Ancient Medicine, in three passages of Diodorus, one of which is thought by some to contain Democritean doctrine, in four passages of Isocrates, in a fragment from a satyr-play Sisyphus which the ancient sources attribute variously to Euripides and to Critias, in a fragment of Athenion, in a second-century inscription, in Plutarch, in Tatian, in Themistius, and in a scholion to Euripides. (shrink)

The project of the paper is a critical examination of the "strong thesis of eliminative materialism" in the philosophy of mind--The claim that all the mental entities that constitute the framework of commonsense psychology are, In principle at least, Eliminable from our ontology. The central conclusion reached is that the traditional formulation of this thesis is demonstrably untenable as it rests on a mistaken view of the relationship between our psychological self-Knowledge and language.

We agree that the emergence of cumulative technological culture was tied to nonsocial cognitive skills, namely, technical-reasoning skills, which allowed humans to constantly acquire and improve information. Our concern is with a reading of the history of cumulative technological culture that is based largely on modern experiments in simulated settings and less on phenomena crucial to the long-term dynamics of cultural evolution.

This issue brings together papers by Australasian philosophers on language, thought, and their relationship. Contributors were given complete freedom to treat these topics in any way they saw fit. The results reflect the diverse interests of Australasian philosophers, and, perhaps even more strikingly, the diversity of philosophical methods they employ to pursue these interests.

Niche construction is the process whereby organisms, through their activities and choices, modify their own and each other’s niches. By transforming natural-selection pressures, niche construction generates feedback in evolution at various different levels. Niche-constructing species play important ecological roles by creating habitats and resources used by other species and thereby affecting the flow of energy and matter through ecosystems—a process often referred to as “ecosystem engineering.” An important emphasis of niche construction theory (NCT) is that acquired characters play an evolutionary (...) role through transforming selective environments. This is particularly relevant to human evolution, where our species has engaged in extensive environmental modification through cultural practices. Humans can construct developmental environments that feed back to affect how individuals learn and develop and the diseases to which they are exposed. Here we provide an introduction to NCT and illustrate some of its more important implications for the human sciences. (shrink)