Purpose Prescription stimulant use as “cognitive enhancers” has been described among undergraduate college students. However, the use of prescription stimulants among future health care professionals is not well characterized. This study was designed to determine the prevalence of prescription stimulant misuse among students at an academic health sciences center. -/- Method Electronic surveys were e-mailed to 621 medical, pharmacy, and respiratory therapy students at East Tennessee State University for four consecutive weeks in fall 2011. Completing the survey was voluntary and (...) anonymous. Surveys asked about reasons for, frequency of, and side effects of nonprescription misuse of prescription stimulants. Given the sensitive material, an opportunity to win one of ten $50 gift cards was used as an incentive. -/- Results Three hundred seventy-two (59.9%) students completed the survey from three disciplines (47.6% medical, 70.5% pharmacy, and 57.6% respiratory therapy). Overall, 11.3% of responders admitted to misusing prescription stimulants. There was more misuse by respiratory therapy students, although this was not statistically significant (10.9% medicine, 9.7% pharmacy, 26.3% respiratory therapy; P = .087). Reasons for prescription stimulant misuse included to enhance alertness/ energy (65.9%), to improve academic performance (56.7%), to experiment (18.2%), and to use recreationally/get high (4.5%). -/- Conclusions Prescription stimulant misuse was prevalent among participating students, but further research is needed to describe prevalence among future health care workers more generally. The implications and consequences of such misuse require further study across professions with emphasis on investigating issues of academic dishonesty (e.g., “cognitive enhancement”), educational quality, and patient safety or health care quality. (shrink)

Conducting “difficult conversations” with patients and caregivers is one of the most difficult aspects of the medical profession. These conversations can involve communicating a terminal prognosis, advance care planning, or changing the goals of treatment. Although they are challenging, the need for these conversations is underwritten by the tenets of medical ethics. Unfortunately, medical professionals lack adequate training in communication skills and overestimate their abilities in conducting difficult conversations. I suggest that one way to improve that ability would be the (...) strategic use of pharmaceutical neuroenhancements. Pharmaceutically augmenting a professional’s capacity for recognizing masked emotional expressions might conduce to his or her development of open and responsive communication with patients and caregivers. I conclude by examining the limitations and objections to this use of a communication enhancement by illustrating that it would still require the development of, and indeed a greater emphasis on, communication skills in medical education and training. (shrink)

Emerging data indicates the prevalence and increased use of pharmaceutical enhancements by young medical professionals. As pharmaceutical enhancements advance and become more readily available, it is imperative to consider their impact on medical professionals. If pharmaceutical enhancements augment a person’s neurological capacities to higher functioning levels, and in some situations having higher functioning levels of focus and concentration could improve patient care, then might medical professionals have a responsibility to enhance? In this paper, I suggest medical professionals may have a (...) responsibility to use pharmaceutical enhancements. In some situations, having higher functioning levels of focus and concentration is conducive to providing the best possible care to a patient. In these circumstances medical professionals should use pharmaceutical cognitive enhancements. I conclude by examining the limitations and implications of this responsibility in the practice of medicine and areas for future research. (shrink)

Peterson, Karlawish, and Largent’s “Supported Decision Making with People at the Margins of Autonomy” not only elucidates the conceptual framework but also the practical importance of suppor...

In end-of-life care discussions, I contend that the distinction between “having a life” vs. “being alive” is an underutilized distinction. This distinction is significant in separating different states of existence conflated by patients, families, and clinicians. In the clinical setting, applying this distinction in end-of-life care discussions aids patients’ and family members’ decision-making by helping them understand that being alive can differ from having a life. Moreover, this distinction helps them decide which state may be the most important to them. (...) After applying this distinction to three complex cases, I respond to the likely objection that “having a life” vs. “being alive” is less accurate and more controversial than other distinctions. I conclude by arguing that “having a life” vs. “being alive” is more accurate and less controversial than distinctions between medically indicated vs. medically inappropriate treatments, personhood, and quantity vs. quality of life. (shrink)

Discussions about the permissibility of students using enhancements in education are often framed by the question, “Is a student who uses cognitive-enhancing drugs cheating?” While the question of cheating is interesting, it is but only one question concerning the permissibility of enhancement in education. Another interesting question is, “What kinds of students do we want in our academic institutions?” I suggest that one plausible answer to this question concerns the ideals of human excellence or virtues. The students we want in (...) our academic institutions are virtuous or, at least minimally, possess certain virtues. I argue that a virtuous student may choose to use cognitive-enhancing drugs for reasons of self-improvement. That a virtuous student may choose to use cognitive-enhancing drugs for reasons of self-improvement illustrates that under certain conditions motivation can determine the permissibility of using enhancements. Building upon this I suggest a virtues-based institutional rule for governing and guiding student-use of cognitive enhancers in an academic institution to be for the right reasons. This ideals of human excellence or virtues approach offers interesting and unique insights for issues of enhancement in education, as it might turn out, that uneasiness many people have about students using cognitive-enhancing drugs has less to do with issues of enhancement and more to do with the motivations and character of students. (shrink)

Bryan Frances’s recent argument is for the epistemic position called Live Skepticism. The Live Skepticism Argument (LSA) attempts to establish a restricted set of skeptical conclusions. The LSA’s “skeptical hypotheses” are scientific and philosophical positions that are “live actual possibilities” in an intellectual community. In order to “rule out” live hypotheses, an expert must know them to be false. However, since these are live hypotheses in this expert’s intellectual community—endorsed by others who have parallel levels of knowledge, intelligence, and understanding—this (...) expert is unable to rule them out. Consistent with the LSA is the outcome that people not exposed to these live hypotheses can know what these experts cannot. However, in this paper, I defeat the LSA by developing and defending a counterexample that focuses on the phenomenon of genius testimony. Everyone, including the LSA’s proponent, can and should allow that expertise comes in degrees. While in many cases a person’s intelligence, understanding, and knowledge are parallel to others in the field, there are some who are extraordinary in their intelligence, understanding, and knowledge (geniuses). If an expert meets with a genius, it is possible that the genius provides this individual with beliefs that can rule out a skeptical hypothesis. Therefore, an expert can have knowledge, even if the skeptical hypothesis is live and endorsed by others who have parallel levels of knowledge, intelligence, and understanding. After providing this counterexample, I present three potential objections, and show how people can know global warming exists and that smoking does not give someone cancer. I conclude by defending this counterexample from a likely reply by proponents of the LSA involving luck and knowledge. (shrink)

In 1837 the German-born astronomer F. G. W. Struve published his famous catalogue of double stars. For Struve this was the culmination of 12 years' detailed observation of a class of celestial objects lying exclusively beyond the solar system; for historians of astronomy it poses the problem of explaining why the study of double stars became a significant part of astronomical endeavour, as it did, during the 1820s and 1830s. For, although Struve's interest was extreme, it was shared to a (...) lesser extent by several eminent contemporaries, including John Herschel, Friedrich Bessel, Johann Encke, James South and Félix Savary. Their combined efforts represented an important transition in astronomy: for the first time one of the emphases of the subject moved beyond the solar system to the so-called fixed stars. The question of the emergence of interest in double stars is of historical significance, therefore, as it is related to the problem of the origins of ‘stellar astronomy’. This essay is thus intended to offer an explanation of astronomers' interest in double stars, and to tackle the related question of whether this transition constituted a major break in the history of astronomy. Furthermore it is proposed that answers to these problems may be found by considering the practice of astronomy dominant during the first half of the nineteenth century. Astronomers in this period were overwhelmingly concerned with a refined form of positional astronomy. The problems they chose to solve were by and large related to the difficulties of the accurate reduction of observational data, and the compilation of reliable tables and star charts, which were then used as a background against which the motions of solar system objects were plotted. By assessing individuals' studies of double stars within this context it can be seen firstly that such studies were no more or less than specific examples of a general case, and secondly that the stars themselves were not usually of intrinsic interest. In general it was the positions of the stars on the. (shrink)

In his article, a unified brain-based determination of death is described by James Bernat (2024) as a permanent cessation of systemic circulation causing a permanent cessation of brain circulation...

This thoughtful, learned, well-written, extensively illustrated, and heavily documented study deserves to be regarded as a landmark in art history. Traditional art history has dealt for the most part with the “fine arts” (chiefly painting, drawing, sculpture, and architecture), whereas other human creations that take physical form (such as furniture, ceramics, textiles, and metal and glass items), whether utilitarian or decorative (or both at once), are considered “craft” or “applied art” and are studied by folklorists, anthropologists, and archaeologists and often (...) displayed in different museums. Cooke wishes to break down this “hierarchical taxonomy,” this “fragmented, hierarchical field,” that emerged from Western Europe's “misunderstanding of art,” which valued “the cerebral over the manual.” His goal, in other words, is to outline “a more inclusive human history of art”— “a connected art history.” This phrase from his subtitle refers not simply to connecting “fine art” with “applied art” but also to crossing temporal and regional boundaries. Still another act of connecting is to examine all parts of an object's life history, and thus the three main divisions of the book deal with the making of objects, their circulation from one person and place to another (and “their ability to transmit ideas” in the process), and their meaning for the persons who possessed or encountered them.Over the years I have repeatedly said that all objects made by human beings are worthy of preservation and study because they bring us into direct contact with the past and, as part of our surroundings, affect our thoughts in the present. Every object, I have argued, including copies of a single printed edition of a book (so-called duplicates), is an independent witness to the past. I am particularly pleased, therefore, to welcome a major book that explores in detail, with a wealth of examples from many centuries and cultures, the place of objects in human history. Cooke's pursuit is “object-driven,” beginning with the nature of the materials and finally coming to “the inherent power of the object itself to influence human thought and action.” (Compare the subtitle of Sherry Turkle's 2007 anthology Evocative Objects: Things We Think With.) Cooke's refusal to separate “materials” from “people,” or “technologies” from “values,” reminds me of John Szarkowski's approach to photographs. In Photography until Now (1989), Szarkowski points out that histories of photography generally treat technical matters separately from artistic ones—a split between the “empirical” and the “intuitive” that he finds indefensible, for “these two ways of knowing meet in the process of making things.” He adds, “The meeting can be cordially symbiotic or aggressively competitive, but its resolution defines the character and meaning of the thing that is made.” This statement has been a favorite of mine as an elegant characterization of the nature of art, and it is one that Cooke would clearly agree with.Cooke does not discuss photography, but he makes clear that he is not attempting a “comprehensive history that charts the complete ebb and flow of objects over time.” Rather, his book is meant to be a “suggestive guide” to the “principles of material literacy,” a “kit of tools for future complex constructions of history.” Even so, I find some of the omissions puzzling. Why, for example, are glass objects not taken up, when he so thoroughly deals with other common materials? More serious, in my opinion, is the exclusion of the fine arts. (Of the 215 illustrations, five are of oil paintings and one is of a Japanese print, but they are present only as the sources for information drawn from their pictorial content; one Hogarth engraving is shown because its image was often reproduced on punch bowls; and there is a very brief passage on the “uneasy relationship” between sculpture and material culture, but no sculptures are illustrated or used as examples for discussion.) Presumably Cooke felt it was unnecessary for his book to encompass the fine arts after demonstrating that functional objects are just as sophisticated artistically and culturally as products of the fine arts are. Yet those products also belong to the universe of “entangled objects” (How could they not?), and it would have been illuminating to see them adduced among the examples Cooke cites. One could argue that by excluding them—and by referring to the makers of the objects he does discuss as “artisans” and “craftspeople”—he comes close to reinforcing the division he wishes to eliminate.Less easy to explain is Cooke's omission of books, for they have been one of the largest and most widely circulated classes of utilitarian objects. Most people never think about books as objects, treating them only as disposable receptacles for transmitting verbal texts in tangible form (which is why so many books are destroyed when their texts supposedly become available in another form). Such people do not realize that texts have connections with their physical embodiments. (For example, books, whether manuscript or printed, often contain clues revealing how their texts were affected by the production process; and readers’ attitudes toward texts can be influenced by their presentation.) Cooke, however, with his deep understanding of the way objects function and his impressive knowledge of the scholarship, cannot be one of these uninformed people. He would obviously be aware of the vast literature devoted to leather and cloth bookbindings and their decoration, as well as to the myriad styles of letters and the varieties of paper and parchment; he would also know how letterforms and binding designs reflect a complex interplay of social, political, and artistic forces. Bibliographers have long studied books as Cooke advocates studying other objects: “working from the inside out,” beginning with the evidence in books themselves for reconstructing the routines that were followed in their creation. And book historians are recognizing the necessity for an international approach like Cooke's, since many of the books circulating in one country originated in other countries. Books would have been a prolific additional source for illustrating Cooke's analyses.My admiration for Cooke's book is not altered by these few disappointments. Even without discussions of paintings, sculptures, and books, it is still exhilarating in its scope and depth. One hopes that art and material-culture historians will pay attention to it. But it ought to have a wider audience, for the daily lives of all of us would be enriched by a greater appreciation of the objects that make up a significant part of our environment. (shrink)

I want to suggest that Plato arrived at a revised theory of forms in the later dialogues. Or perhaps I might rather say that he constructed a new underpinning for the theory. This can be discerned, I believe, in the Sophist, taken together with certain parts of the dialectic of the Parmenides which use the same language as the Sophist.

The theoretical and practical problems of providing incentives for people's activity in society are becoming increasingly more urgent as the role of the human factor in the development of society grows. In light of modern historical experience, we can see the onesidedness of conceptions according to which the types and directions of activity are mechanically predetermined by conditions external to it, and we can see the necessity of understanding the laws of activity itself in all their complicated dialectical essence. These (...) problems have become particularly important at the present stage of development of Soviet society, when a greater active involvement of the masses and profound changes in social psychology are becoming acutely necessary. (shrink)

Obstetricians face difficult decisions when the interests of fetus and mother conflict. An example is the problem of choosing the delivery method when labour begins prematurely and the fetus is breech. Vaginal delivery involves risks for the breech fetus of brain damage or death caused by umbilical cord compression and head entrapment. Caesarean section might avoid these dangers but involves risks for the mother, including infection, haemorrhage and even death in a small percentage of cases. If a caesarean section is (...) performed the infant might die anyway, due to complications of prematurity. Thus, decisions about delivery method involve balancing the risks to mother and fetus. Uncertainty about the frequency of fetal injuries in vaginal breech deliveries adds to the difficulty of these decisions. (shrink)

The meaning of the once widely used term the Gibbs Free Energy in terms of available work energy is perfectly illustrated for chemical reactions by the Van’t Hoff Equilibrium Box. Combining this with DeDonder’s extent of reaction variable and using the reaction of $$\hbox {NH}_3$$ to $$\hbox {H}_2$$ and $$\hbox {N}_2$$ at $$200^{\circ }\hbox {C}$$ as an example shows the difference between total work energy and available work energy, and in addition allows calculation of the equilibrium composition, demonstration of the (...) minimum in the Gibbs energy curve, and the standard relationship between $$\Delta _\textrm{r}G^{\circ }$$ and $$\ln {K}$$. (shrink)

In his 1841-2 Berlin lectures, Schelling critiques German idealism’s negative method of regressing from existence to its first principle, which is supposed to be intelligible without remainder. He sees existence as precisely its remainder since there could be nothing that exists. To solve this, Schelling enlists the positive method of progressing from the fact of existence to a proof of this principle’s reality. Since this proof faces the absurdity that there is anything rather than nothing, he concludes that this fact’s (...) constitution and this principle’s proof are mutually dependent, non-dischargeable tasks. I trace this reciprocal relation to one Kant establishes between the constitutive categories of experience and the experience that proves their applicability and argue that it adheres to Kant’s threefold criterion of proof. I do so by uncovering the Maimonian skeptical motivation—specifically, the need to answer what I call the question quid indicii—behind the qualified return to Kant on which Schelling’s critique of idealism relies. (shrink)

Lichtenbergs Schriften können wir uns als der wunderbarsten Wünschelrute be‐dienen; wo er einen Spass macht, liegt ein Problem verborgen.

The problems of this passage were concisely stated by M. Platnauer more than thirty years ago and his suggestions for their solution have been adopted and developed in A. S. F. Gow's magnum opus. Its authority—so the present writer suspects—is liable at this point to eclipse the meaning of the text.