Childhood obesity is in important respects a result of legal policies that influence both dietary intake and physical activity. The law must shift focus away from individual risk factors alone and seek instead to promote situational and environmental influences that create an atmosphere conducive to health. To attain this goal, advocates should embrace a population-wide model of public health, and policymakers must critically examine the fashionable rhetoric of consumer choice.

My topic is authenticity in or perhaps as painting, not the authenticity of paintings; I know next to nothing about the problem of verifying claims of authorship. I am interested in another kind of genuineness and fraudulence, the kind at issue when we say of a person that he or she is false, not genuine, inauthentic, lacks integrity, and, especially when we say he or she is playing to the crowd, playing for effect, or is a poseur. These are not (...) quite moral distinctions (no one has a duty to be authentic), but they are robustly normative appraisals, applicable even when such falseness is not a case of straight hypocrisy but of lack of self-knowledge or of self-deceit. (A person can be quite sincere and not realize the extent of her submission to the other’s expectations and demands.) This sort of appraisal also has a long history in post-Rousseauist reflections on the dangers of uniquely modern forms of social dependence, and they are prominent worries in the modern novel. (shrink)

In reading biographies or accounts of figures with which one agrees and sympathizes, there is a tendency that needs to be avoided, that is, of over -identifying with the figures in question and of too closely mapping one's own life and aspirations onto them.As such, there is some risk involved for a person like me in reading about the friendship between David Hume and Adam Smith. Dennis C. Rasmussen's excellent new volume, The Infidel and the Professor: David Hume, Adam Smith, (...) and the Friendship that Shaped Modern Thought, chronicles that friendship in an engaging and compelling narrative. The work is thoroughly researched and entertainingly written. Rasmussen uses the extant correspondence between Smith and... (shrink)

This edited collection explores the distinctive contributions of postphenomenological perspectives toward imaging in science, medicine, and everyday life. With its original empirical investigations of imaging across a variety of fields, the book expands our conceptual framework for understanding images.

In all systems of health care there are certain essential levels of care and service. These take the form of self-care within the family unit; primary professional care by general medical nursing or social practitioners within a local neighbourhood; general specialist care in a district and super-specialist care in a region. Each of these has its own special roles and responsibilities and each is considered in this paper.

The “function debate” in the philosophy of biology and the “venom debate” in the science of toxinology are conceptually related. Venom systems are complex multifunctional traits that have evolved independently numerous times throughout the animal kingdom. No single concept of function, amongst those popularly defended, appears adequate to describe these systems in all their evolutionary contexts and extant variations. As such, a pluralistic view of function, previously defended by some philosophers of biology, is most appropriate. Venom systems, like many other (...) functional traits, exist in nature as points on a continuum and the boundaries between “venomous” and “non-venomous” species may not always be clearly defined. This paper includes a brief overview of the concept of function, followed by in-depth discussion of its application to venom systems. A sound understanding of function may aid in moving the venom debate forward. Similarly, consideration of a complex functional trait such as venom may be of interest to philosophers of biology. (shrink)

BACKGROUND Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians (...) use them and if OTAs themselves modify clinician prescribing practices. OBJECTIVE To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. DESIGN We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. PARTICIPANTS 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. APPROACH Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. KEY RESULTS Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. CONCLUSION This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education. (shrink)

Librarians often object to Internet filters on the grounds that filters are prone to overblocking and underblocking. This argument implies that a significant problem with contemporary filters is that they are insufficiently fine-grained. In this article, we posit that present-day filters will always be conceptually capable of failure, regardless of how granular their content analysis becomes. This is because, we argue, objections to content are best understood as objections to problematic interactions between content and particular knowers. We import the concept (...) of the situated knower from feminist epistemology to capture the heterogeneous, socially embedded nature of patrons, about whom we cannot make blunt generalizations for filtering purposes. A successful filter would need information about these differently situated patrons, the content they seek, and the interactions between the two. We conclude that a genuinely successful Internet filter would therefore need to be both mind reading and fortune-telling. (shrink)

Drawing upon two independent national samples of 201 and 241 psychology graduate students, this article describes the development and psychometric evaluation of 4 Web-based student self-report scales tapping student socialization in the responsible conduct of research (RCR) with human participants. The Mentoring the Responsible Conduct of Research Scale (MRCR) is composed of 2 subscales assessing RCR instruction and modeling by research mentors. The 2 subscales of the RCR Department Climate Scale (RCR-DC) assess RCR department policies and faculty and student RCR (...) practices. The RCR Preparedness scale (RCR-P) and the RCR Field Integrity scale (RCR-FI) measure respectively students' confidence in their ability to conduct research responsibly and their belief in the RCR integrity of psychology as a discipline. Factor analysis, coefficient alphas, correlations, and multiple regression analyses demonstrated each of the scales had good internal consistency and concurrent and construct validity. (shrink)

The recently suggested reformulation of Darwinian evolutionary theory, based on the thermodynamics of self‐organizing processes, has strong philosophical implications. My claim is that the main philosophical merit of the thermodynamic approach, made especially clear in J.S. Wicken's work, is its insistence on the law‐governed, continuous nature of evolution. I attempt to substantiate this claim following a historical analysis of beginning‐of‐the‐century ideas on evolution and matter‐life relationship, in particular, the fitness‐of‐the‐environment‐for‐life theory of the Harvard physiologist L.J. Henderson. In addition, I point (...) to an epistemological common ground underlying the studies of the “thermodynamics school” and other currently active research groups focusing on the emergence and evolution of biological organization. (shrink)

My basic supposition is that the destruction of the little Jew's face and hands in Vandover and the Brute images the irruption of mere materiality within the scene of writing-that instead of Crane's double process of eliciting and repressing that materiality, what is figured in the shipwreck scene is a single, unstoppable process of materialization, involving both the act of representation and the marking tool and actual page , the result of which can only be the defeat of the very (...) possibility of writing .Here it might be objected that such a reading derives whatever plausibility it has from the comparison with Crane, and in a sense this is true: my claim is precisely that it's only against the background of Crane's seemingly bizarre but, in this regard, normative or centric enterprise that the wider problematic of late nineteenth- and early twentieth-century literary "impressionism" can be made out. In another sense, however, the comparison with Crane involves an appeal to issues—notably that of materialism—which have long been basic to Norris criticism and which the recent work of Walter Benn Michaels has brought to a new level of conceptual sophistication and historical refinement. Specifically, the title essay in Michaels's book, The Gold Standard and the Logic of Naturalism, interprets both McTeague and Vandover and the Brute in terms of a conflict between materiality and representation that found contemporary expression both in the debates over the gold and silver standards versus paper money and in the vogue for trompe l'oeil painting ." In this regard a crucial moment in Vandover's regression from man to beast is his discovery that, as a painter, he has lost the ability to represent nature three-dimensionally; Michaels treats this development as equivalent to "replac[ing] the painting with nature itself" , and goes on to remark: "But this ... is ultimately a distinction without a difference. Vandover the artist can so easily devolve into Vandover the brute precisely because both artist and brute are already committed to a naturalist ontology—in money, to precious metals; in art, to three-dimensionality. The moral of Vandover's regression, from this standpoint, is that it can only take place because . . . it has already taken place. Discovering that man is a brute, Norris repeats the discovery that paper money is just paper and that a painting of paper money is just paint" . My reading of the shipwreck passage would thus be consistent with what Michaels calls Norris's "trompe l'oeil materialism" , though the nearly sadomasochistic violence of that passage may be taken to imply that materialism's consequences for writing threaten to be even more disastrous than they are for painting. But rather than analyze the role of writing as such in Vandover, which would involve an intricate discussion not just of that novel and McTeague but also of Michaels's essay, I want to turn to another, lesser-known book by Norris, in which a thematic of writing plays a conspicuous and more nearly univocal role: A Man's Woman . Michael Fried is J. R. Herbert Boone Professor of Humanities and director of the Humanities Center at the Johns Hopkins University. His most recent book is Courbet's Realism . He is currently at work on a book to be titled Manet's Modernism. (shrink)

In the pages that follow I looked closely at two major paintings by Gustave Courbet : the After Dinner at Ornans, perhaps begun in the small town of the title but certainly completed in Paris during the winter of 1848-49; and the Stonebreakers, painted wholly in Ornans just under a year later. The After Dinner and the Stonebreakers are the first in a series of large multifigure compositions--others are the Burial at Ornans and the Peasants of Flagey Returning from the (...) Fair —that mark not only Courbet's maturity as an artist but his emergence as a disruptive force, almost a one-man wrecking crew, in the cultural politics of his time. They are also those works in which his self-declared identity as a Realist first becomes manifest, and probably the chief concern of the most interesting recent scholarship on Courbet has been to try to decode that epithet in social-historical terms, or at any rate to situate his activity as a painter during the years 1848-55 in the context of the social and political struggles that accompanied the creation of the Second Republic and its subversion by Louis Bonaparte.2 At the core of that tradition, motivating and, as it were, mobilizing it, is the demand that the painter succeed in placing in abeyance the primordial convention that paintings are made to be beheld—that he contrive in one way or another to establish the fiction, the meta-illusion, that the beholder does not exist, that there is no one standing before the picture. From Greuze through Gèricault, this was chiefly to be accomplished in and through the medium of visual drama, that is, by representing figures so deeply absorbed in their actions, emotions, and states of mind and furthermore so efficaciously bound together in a single comprehensive dramatic situation that they would strike one as absolutely immured in the world of the painting and a fortiori as oblivious to the very possibility of being viewed. And one way of describing the crisis that I believe overtook French painting by the 1820s and '30s is to say that the dramatic as such came more and more to be revealed as inescapably theatrical—that the array of conventions that once had served to establish the meta-illusion of the beholder's nonexistence now seemed merely to attest to his controlling presence.1. The present essay is adapted from a book-length study, in progress, of Courbet's art. Recent books and articles emphasizing social and political considerations include Linda Nochlin, Gustave Courbet: A Study of Style and Society ; T.J. Clark, "A Bourgeois Dance of Death: Max Buchon on Courbet," Burlington Magazine 111 : 208-12, 282-89, and Image of the People: Gustave Courbet and the Second French Republic, 1848-51 ; Jack LIndsay, Gustave Courbet: His Life and Art ; Klaus Herding, ed., Realismus als Widerspruch: Die Wirklichkeit in Courbets Malerei ; Herding, "Les Lutteurs 'détestables': Critique de style, critique sociale," Histoire et critique de l'art 4-5 : 94-122; and James Henry Rubin, Realism and Social Vision in Courbet and Proudhon .2. For an account of the early evolution of that tradition, see my Absorption and Theatricality: Painting and Beholder in the Age of Diderot , as well as the essays on Courbet cited in n. 3.Michael Fried, professor of humanities and the history of art at the Johns Hopkins University, is the author of Morris Louis and Absorption and Theatricality: Painting and Beholder in the Age of Diderot. He is currently at work on a book on Courbet. (shrink)

Sara T. Fry maintains that care is a central concept for nursing ethics. This requires, among other things, that care is a virtue rather than a mode of being. But if care is a central virtue of ethics and medical ethics then the claim that care is a central concept for nursing ethics is trivial. Otherwise, it is implausible.

So there will be no mistake, I don’t deny, why would I wish to, that a thematic of racial difference is crucial to the overall plot of Almayer’s Folly. What I claim is that that thematic falls short of significantly determining or even, to use Brown’s word, appreciably “complicating” the problematic of erasure that surfaces in the closing chapters. It’s as though the rest of the novel is there chiefly to stage those chapters and their dramatization of erasure; something similar (...) takes place in Powell’s narrative of spying into Captain Anthony’s cabin toward the end of Chance and even, to a lesser degree, in the climactic encounter between Winnie Verloc and her husband in chapter 11 of The Secret Agent. It’s worth noting, too, that the opening paragraphs of A Personal Record, Conrad’s autobiographical account of the beginnings and origins of his “writing life,” describe the circumstances under which “the tenth chapter of ‘Almayer’s Folly’ was begun.”8 This in itself suggests that Conrad has a special stake in the last three chapters of his first novel, and one of my aims in “Almayer’s Face” was to discover what that stake may have been.9 8. Joseph Conrad, A Personal Record , pp. 72: my emphasis.9. Again, so there will be no mistake, I would distinguish Almayer’s Folly sharply in this respect from, for example, The Nigger of the “Narcissus,” in which effects of erasure are disseminated throughout the text and in which the title character’s blackness is crucial to their production. Michael Fried, J. R. Herbert Boone Professor of Humanities at the Johns Hopkins University, is currently at work on books on Manet and on literary “impressionism.” His most recent book is Courbet’s Realism. (shrink)

A critical examination of the religious theories of Axel Hägerström and Anders Nygren, their respective disciples, Martin Fries and Ragnar Bring, and the critical literature on the two main figures. Hemberg's study focuses on the questions: whether all reality must be referred to spatial-temporal experience; the status of metaphysics; and the nature of religious experience. The religious theories of Hägerström and Nygren are of considerable philosophical interest although, for primarily linguistic reasons, their influence outside Sweden has remained slight. Despite the (...) presence of a fifteen page English summary one suspects that interest in Hemberg's book will be similarly provincial, for similar reasons.—A. E. J. (shrink)

We would like to thank Dolega and Dewhurst for a thought-provoking and informed deconstruction of our article, which we take as applause from valued members of our audience. In brief, we fully concur with the theatre-free formulation offered by Dolega and Dewhurst and take the opportunity to explain why we used the Cartesian theatre metaphor. We do this by drawing an analogy between consciousness and evolution. This analogy is used to emphasize the circular causality inherent in the free energy principle. (...) We conclude with a comment on the special forms of active inference that may be associated with selfawareness and how they may be especially informed by dream states. (shrink)

while kant's transcendental philosophy as expounded in the Critique of Pure Reason and the Prolegomena has been extraordinarily influential over the past two centuries, its transcendental methodology has continued to puzzle commentators. Recently, Colin Marshall, in an article entitled "Does Kant Demand Explanations for All Synthetic A Priori Claims?," has brought one of the central problems for any interpretation of Kant's methodology to the fore again.1 In his paper, Marshall discusses what he calls "the Regress Puzzle": Several commentators have noted (...) that there is a puzzle about how the positive part of Kant's project could work. The puzzle, which I will call the "Regress Puzzle," arises when we ask: If Kant... (shrink)

Bernard Williams quotes Charles Fried's description of an emergency situation in which a man (call him Joe) must choose between helping his wife and helping a stranger. Famously, Williams goes on to remark, -/- It might have been hoped by some (for instance, by his wife) that his motivating thought, fully spelled out, would be the thought that it was his wife, not that it was his wife and that in situations of this kind it is permissible to save one's (...) wife. -/- That is, Williams maintains that in this situation Joe should help his wife simply because of their loving relationship. His first thought should be to help her, and he should have no second thoughts. In particular, he should not even consider the question of whether helping his wife is morally permissible. A Permissibility Thought would be "one thought too many.". (shrink)

Introduction: In The Netherlands, physicians have to be convinced that the patient suffers unbearably and hopelessly before granting a request for euthanasia. The extent to which general practitioners (GPs), consulted physicians and members of the euthanasia review committees judge this criterion similarly was evaluated. Methods: 300 GPs, 150 consultants and 27 members of review committees were sent a questionnaire with patient descriptions. Besides a “standard case” of a patient with physical suffering and limited life expectancy, the descriptions included cases in (...) which the request was mainly rooted in psychosocial or existential suffering, such as fear of future suffering or dependency. For each case, respondents were asked whether they recognised the case from their own practice and whether they considered the suffering to be unbearable. Results: The cases were recognisable for almost all respondents. For the “standard case” nearly all respondents were convinced that the patient suffered unbearably. For the other cases, GPs thought the suffering was unbearable less often (2–49%) than consultants (25–79%) and members of the euthanasia review committees (24–88%). In each group, the suffering of patients with early dementia and patients who were “tired of living” was least often considered to be unbearable. Conclusions: When non-physical aspects of suffering are central in a euthanasia request, there is variance between and within GPs, consultants and members of the euthanasia committees in their judgement of the patient’s suffering. Possible explanations could be differences in their roles in the decision-making process, differences in experience with evaluating a euthanasia request, or differences in views regarding the permissibility of euthanasia. (shrink)

At least since the seminal work of the (US) National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research in the 1970s, a fundamental distinction between research and practice has underwritten both conceptual work in research ethics and regulations governing research involving human subjects. Notwithstanding its undoubted historical importance, I believe the distinction is problematic because it misrepresents clinical inquiry. In this essay, I aim to clarify the character of clinical inquiry by identifying crucial contextual constraints on (...) justification constitutive of clinical science. This analysis shows that, from an epistemological point of view, clinical research and clinical practice are not sharply distinct but intimately intertwined. This result is important in its own right—an enriched understanding of the epistemology of clinical research is valuable in and of itself. But this result is also important because it has profound implications for the ethics of human subjects research. (shrink)

One of the great virtues of Oxford is that most of its members are not academics, nor ever supposed that they sould be. They come to Oxford for three or four years and then go on their way to other occupations in "the service of God in Church and State". It is not that they were not good enough to become dons: it is simply that they had other fish to fry, and would rather be a barrister, a Member of (...) Parliament, a schoolmaster or a clergyman, and would not be tempted from their chosen vocation by any offer of a Fellowship or a life of ease and scholarship. The benefits of this are great. To have left Oxford of one's own accord and not on account of having failed to get an award or a post is to part from a friend with no sense of having been rejected. The Civil Servant who goes down with a first in Greats has no sense that he did not make it at Oxford, no need to shake its dust off his shoes because Oxford did not offer him a job, and in consequence he can easily look back on four golden years of widening horizons, untarnished by some final disappointment. And in general our alumni can feel warmly to their alma mater, because their going was of their choosing, and not because they were rudely pushed out of the nest. (shrink)

A diagnosis of dementia often comes with difficulties in understanding a conversational context and expressing how one feels. So far, research on how to facilitate advance care planning for people with dementia focused on defining relevant themes and topics for conversations, or on how to formalize decisions made by surrogate decision makers, e.g., family members. The aim of this review is to provide a better scope of the existing research on practical communication aspects related to dementia in ACP conversations. In (...) November 2020, seven databases were searched to select papers for inclusion. This search was updated in December 2021. The search strategy consisted of three tiers, intersected by using the Boolean term “AND,” and resulted in 787 studies. Two researchers followed explicit criteria for two sequential levels of screening, based on titles and abstracts and full papers. A total of 22 studies were included for data analysis. Seven topics emerged clustered around two themes. This scoping review provides practical suggestions for healthcare professionals to improve ACP communication and uncovered gaps in research on communication aspects related to dementia in ACP conversations, such as non-verbal behavior, timing and implementation, and personal preferences. (shrink)