Scientific and medical practice both relate to and differ from each other, as do discussions of how to handle decisions under uncertainty in the laboratory and clinic respectively. While studies of science have pointed out that scientific practice is more complex and messier than dominant conceptions suggest, medical practice has looked to the rigour of scientific and statistical methods to address clinical uncertainty. In this article, we turn to epistemological studies of the laboratory to highlight how clinical practice already has (...) strategies for dealing with messiness. We draw on Hans-Jo ̈rg Rheinberger’s Toward a History of Epistemic Things, in which he invokes the metaphor of a spider’s web to explain the role of tacit practices in experimental biochemistry for helping practitioners manage messiness. We argue that diagnostic practices in clinical medicine employ similar, albeit codified, procedures to evaluate epistemic significance, ensure sensitivity to the unforeseen, and allow focused grounds for action. We consider three practices: (a) the pre-set structure of medical records, ensuring broad coverage in initial anamnesis, (b) the use of lists of differential diagnoses and ongoing ‘anchoring and adjusting’ as inquiry progresses, and (c) shared decision-making as an occasion to synthesize empirical evidence and reopen inquiry for potential missed information. We end by suggesting that while philosophy of medicine may learn from laboratory epistemology, the sciences may learn something from medical practice. (shrink)

Consensus plays an ambiguous role in deliberative democracy. While it formed the horizon of early deliberative theories, many now denounce it as an empirically unachievable outcome, a logically impossible stopping rule, and a normatively undesirable ideal. Deliberative disagreement, by contrast, is celebrated not just as an empirically unavoidable outcome but also as a democratically sound and normatively desirable goal of deliberation. Majority rule has generally displaced unanimity as the ideal way of bringing deliberation to a close. This article offers an (...) epistemic perspective on this question of consensus versus disagreement. For ensuring the production of better decisions, we argue, the normative appeal of consensus varies depending on the deliberative task – whether it entails problem solving or prediction. We argue that in pure problem-solving contexts, consensus retains a strong normative appeal and forms the ideal deliberative outcome of deliberation. In contrast, on predictive tasks, consensus should generally not be used as a stopping rule noris it likely to be epistemically desirable as an outcome. Instead deliberators may be better served by ending the deliberation with a form of deliberative disagreement we call ‘positive dissensus’, which paves the way for more accurate aggregate predictions. (shrink)

Introducing the practices of Eastern Hinduism, Shintoism, Daoism, Confucianism, and Buddhism, a lavishly illustrated volume is complemented by full-color reproductions of sacred art, architecture, symbols, landscapes, ceremonies, and festivals.

For most pre‐modern philosophers, questions about the good life and the happy life were inseparable. Happiness is primarily a subjective notion. The Good Place suggests that relationships are key to the good life. It is a laboratory for testing moral theories, providing the show's writers opportunities to see which theories help the protagonists become better persons. An ethics of virtue is difficult and messy because it does not reduce morality to a simple formula. Instead, it involves an inner transformation of (...) character that leads to virtuous actions. In Aristotle's ethical system, true moral progress toward the good life is within reach. In spite of the verbal commitments made to Kant's ethics, the show ultimately proves to be a vindication of virtue ethics. A universe governed by Aristotelian morality is one in which moral development is possible. (shrink)

The year 2018 was the 40th anniversary of the birth of Louise Joy Brown, marking four decades of clinical in vitro fertilization and embryo transfer. Though this milestone, reached first by Steptoe and Edwards in the United Kingdom, is well acknowledged through Nobel accolade, the achievement was not entirely celebrated at the time. Global contention was not just moral, but political and legislative. In the United States, the achievement led in 1978 to the freezing of federal funds by the National (...) Institute of Health for research on human embryos and oocytes.A report published on May 4, 1979, by the Ethics Advisory Board of the Department of Health... (shrink)

Bone marrow is the main site for hematopoiesis in adults. It acts as a niche for hematopoietic stem cells (HSCs) and contains non‐hematopoietic cells that contribute to stem cell dormancy, quiescence, self‐renewal, and differentiation. HSC also exist in resting spleen of several species, although their contribution to hematopoiesis under steady‐state conditions is unknown. The spleen can however undergo extramedullary hematopoiesis (EMH) triggered by physiological stress or disease. With the loss of bone marrow niches in aging and disease, the spleen as (...) an alternative tissue site for hematopoiesis is an important consideration for future therapy, particularly during HSC transplantation. In terms of harnessing the spleen as a site for hematopoiesis, here the remarkable regenerative capacity of the spleen is considered with a view to forming additional or ectopic spleen tissue through cell engraftment. Studies in mice indicate the potential for such grafts to support the influx of hematopoietic cells leading to the development of normal spleen architecture. An important goal will be the formation of functional ectopic spleen tissue as an aid to hematopoietic recovery following clinical treatments that impact bone marrow. For example, expansion or replacement of niches could be considered where myeloablation ahead of HSC transplantation compromises treatment outcomes. (shrink)

This paper stems from an ethnographic, multidisciplinary study that explored the views and experiences of practitioners and scientists on social, ethical and clinical dilemmas encountered when working in the area of pre-implantation genetic diagnosis for serious genetic disorders. We focus here on staff perceptions and experiences of working with embryos and helping women/couples to make choices that will result in selecting embryos for transfer and disposal of 'affected' embryos, compared to the termination of affected pregnancies following prenatal diagnosis. Analysis and (...) discussion of our data led us to consider the possible advantages of pre-implantation genetic diagnosis and whether a gradualist account of the embryo's and fetus's moral status can account for all of these, particularly since a gradualist account concentrates on the significance of time (developmental stage) and makes no comment as to the significance of place (in vitro, in utero). (shrink)

On August 30, 2013, the American Political Science Association sponsored a roundtable on political epistemology as part of its annual meetings. Co-chairing the roundtable were Jeffrey Friedman, Department of Government, University of Texas at Austin; and Hélène Landemore, Department of Political Science, Yale University. The other participants were Scott Althaus, Department of Political Science, University of Illinois at Urbana-Champaign; Mark Bevir, Department of Political Science, University of California at Berkeley; Rogers Smith, Department of Political Science, University of Pennsylvania; and (...) Susan Stokes, Department of Political Science, Yale University. We thank the participants for permission to republish their remarks, which they subsequently edited for clarity. (shrink)

Although many new ideas are generated, only a few are ever implemented. Thus, it seems reasonable to conclude that idea evaluation represents an important aspect of the creative process. In the present article, we examine the cognitive operations involved in idea evaluation. We argue that idea evaluation is a complex activity involving appraisal of ideas, forecasting of their implications, and subsequent revision and refinement. We note that the outcomes of these activities depend on both the standards applied in idea evaluation (...) and the context surrounding evaluation of a new idea. Implications for the development of idea evaluation skills are discussed. (shrink)

Trait emotional intelligence concerns people’s perceptions of their emotional functioning. Two studies investigated this construct in surgeons and comparison occupations. We hypothesized that trait EI profiles would differ both within surgical specialties as well as between them and other professions. Study 1 compared the trait EI profiles of four different surgical specialties. There were no significant differences amongst these specialties or between consultant surgeons and trainees in these specialties. Accordingly, the surgical data were combined into a single target sample that (...) was compared against samples of engineers, executives and senior managers, lawyers, junior military managers, nurses, and salespeople. Surgeons scored significantly higher on global trait EI than junior military managers, but lower than executives and senior managers, salespeople, and nurses. There were no significant differences vis-à-vis engineers or lawyers. A MANOVA confirmed a similar pattern of differences in the four trait EI factors. Global trait EI scores correlated strongly with single-question measures of job satisfaction and job performance in the surgical sample. These findings suggest that interventions to optimize the trait EI profiles of surgeons can be helpful in relation to job satisfaction, job performance, and overall psychological wellbeing. (shrink)

The Psychology of Creative Writing takes a scholarly, psychological look at multiple aspects of creative writing, including the creative writer as a person, the text itself, the creative process, the writer's development, the link between creative writing and mental illness, the personality traits of comedy and screen writers, and how to teach creative writing. This book will appeal to psychologists interested in creativity, writers who want to understand more about the magic behind their talents, and educated laypeople who enjoy reading, (...) writing, or both. From scholars to bloggers to artists, The Psychology of Creative Writing has something for everyone. (shrink)

Should the assessment of decision‐making capacity (DMC) be risk sensitive, that is, should the threshold for DMC vary with risk? The debate over this question is now nearly five decades old. To many, the idea that DMC assessments should be risk sensitive is intuitive and commonsense. To others, the idea is paternalistic or incoherent, or both; they argue that the riskiness of a given decision should increase the epistemic scrutiny in the evaluation of DMC, not increase the threshold for DMC. (...) We respond to the critics’ main concerns by providing a comprehensive account of how risk‐sensitive DMC is coherent, avoids paternalism, and best fulfills the epistemic goal of DMC evaluations. (shrink)

The goal of this essay is to illustrate how Ebrahim Moosa's method of “contrapuntal reading” can be applied fruitfully to the Sunni hadith literature. My case study is the set of penalties (hudud) for illicit sex, which include flogging, stoning, and banishment. I propose a fresh reading of these sacred texts that brings to the fore the ethical dimension of Prophet Muhammad's conduct, especially his strong reluctance to apply these measures. I conclude by identifying four ethical problems that the stoning (...) penalty raises and suggest how the hadith literature can be read to argue against the validity of this specific punishment. (shrink)

In this article I propose to reframe debates about ideals of emotion in medicine, abandoning the current binary setup of this debate as one between ‘clinical detachment’ and empathy. Inspired by observations from my own field work and drawing on Sky Gross’ anthropological work on rituals of practice as well as Henri Lefebvre’s notion of rhythm, I propose that the normative drive of clinical practice can be better understood through the notion of attunement. In this framework individual types of emotions (...) are not, as such, appropriate or inappropriate, but are evaluated depending on their synchronicity with the specific rhythms of the practice. To set up this proposal, I show how typical arguments about emotions in medicine—what I call emotion-entity focused frameworks—are insufficient. I then draw on ethnographic observations from two orthopaedic departments and interviews with medical practitioners to show (1) how clinical practice is driven by rhythmicity, shaped in the case of orthopaedic surgery by a clinical aim of efficient, controlled intervention, and (2) how clinicians continuously refer to this drive and the flow of rhythms when evaluating inappropriate or problematic emotion. I argue that the use of a rhythm framework rather than ideals of detachment or empathy allows for a sensitivity to the complexity and situation-dependent elements of emotional ideals in clinical practice; and I end by proposing the term ‘attuned concern’—which stresses the importance of regulation and adjustment to circumstances rather than of maintaining a constant distance/involvement—as a more fitting alternative to ‘clinical detachment’. (shrink)

From the acclaimed author and scholar James C. Scott, the compelling tale of Asian peoples who until recently have stemmed the vast tide of state-making to live at arm’s length from any organized state society For two thousand years the disparate groups that now reside in Zomia (a mountainous region the size of Europe that consists of portions of seven Asian countries) have fled the projects of the organized state societies that surround them—slavery, conscription, taxes, corvée labor, epidemics, and (...) warfare. This book, essentially an “anarchist history,” is the first-ever examination of the huge literature on state-making whose author evaluates why people would deliberately and reactively remain stateless. Among the strategies employed by the people of Zomia to remain stateless are physical dispersion in rugged terrain; agricultural practices that enhance mobility; pliable ethnic identities; devotion to prophetic, millenarian leaders; and maintenance of a largely oral culture that allows them to reinvent their histories and genealogies as they move between and around states. In accessible language, James Scott, recognized worldwide as an eminent authority in Southeast Asian, peasant, and agrarian studies, tells the story of the peoples of Zomia and their unlikely odyssey in search of self-determination. He redefines our views on Asian politics, history, demographics, and even our fundamental ideas about what constitutes civilization, and challenges us with a radically different approach to history that presents events from the perspective of stateless peoples and redefines state-making as a form of “internal colonialism.” This new perspective requires a radical reevaluation of the civilizational narratives of the lowland states. Scott’s work on Zomia represents a new way to think of area studies that will be applicable to other runaway, fugitive, and marooned communities, be they Gypsies, Cossacks, tribes fleeing slave raiders, Marsh Arabs, or San-Bushmen. (shrink)

The ectoplasmic specialization (ES) is a testis‐specific, actin‐based hybrid anchoring and tight junction. It is confined to the interface between Sertoli cells at the blood–testis barrier, known as the basal ES, as well as between Sertoli cells and developing spermatids designated the apical ES. The ES shares features of adherens junctions, tight junctions and focal contacts. By adopting the best features of each junction type, this hybrid nature of ES facilitates the extensive junction‐restructuring events in the seminiferous epithelium during spermatogenesis. (...) For instance, the α6β1‐integrin–laminin 333 complex, which is usually limited to the cell–matrix interface in other epithelia to facilitate cell movement, is a putative apical ES constituent. Furthermore, JAM‐C and CAR, two tight junction integral membrane proteins, are also components of apical ES involving in spermatid orientation. We discuss herein the mechanisms that maintain the cross‐talk between ES and blood–testis barrier to facilitate cell movement and orientation in the seminiferous epithelium. BioEssays 29: 36–48, 2007. © 2006 Wiley Periodicals, Inc. (shrink)