Context Conflicts over treatment decisions have been linked to physicians' emotional states. Objective To measure the prevalence of emotional exhaustion and conflicts over treatment decisions among US obstetrician/gynaecologists (ob/gyns), and to examine the relationship between the two and the physician characteristics that predict each. Methods Mailed survey of a stratified random sample of 1800 US ob/gyn physicians. Criterion variables were levels of emotional exhaustion and frequency of conflict with colleagues and patients. Predictors included physicians' religious characteristics and self-perceived empathy. Results (...) Response rate among eligible physicians was 66% (1154/1760). 36% of ob/gyns reported high levels of emotional exhaustion, and majorities reported conflict with colleagues (59%) and patients (61%). Those reporting conflict were much more likely to report emotional exhaustion (58% vs 29% who never conflict, OR, 95% CI 2.8, 1.6 to 4.8 for conflict with colleagues; 55% versus 26%, OR, 95% CI 2.2, 1.4 to 3.5 for conflict with patients). Physicians with lower self-perceived empathy were more likely to report physician-patient conflicts (65% vs 58% with higher empathy, OR, 95% CI 1.4, 1.0 to 1.9), as were female ob/gyns (66% vs 57% of males, OR, 95% CI 1.5, 1.1 to 2.0). Foreign-born physicians were less likely to report such conflicts (47% vs 64% of US born, OR, 95% CI 0.5, 0.4 to 0.8). Physicians' religious characteristics were not significantly associated with reporting conflict. Conclusions Conflicts over treatment decisions are associated with physicians' empathy, gender, immigration history and level of emotional exhaustion. With respect to the latter, conflict in the clinical encounter may represent an overlooked source or sign of burnout among ob/gyns. (shrink)

The patient was a woman in her 30s who, until the rapid progression of an ultimately fatal neurologic disease, had been a very successful professional, enjoying athletics and an active social life. In the 6 months of swift deterioration, she had gone from being extremely vibrant and energetic to being totally unable to care for her personal needs. There had been no loss of intellectual capacity. Her sister later recounted to Dr. J., the emergency department physician, that she had found (...) the patient unconscious and unresponsive at home and had immediately called the patient's neurologist in a neighboring city. He directed her to call the paramedics. (shrink)

This essay some first steps toward the naturalization of what I call rational intentionality or alternatively type II intentionality. By rational or type II intentionality, I mean that full combination of rational powers and content-bearing states that is paradigmatically enjoyed by mature intact human beings. The problem I set myself is to determine the extent to which the only currently extant approach to the naturalization of the intentional that has the singular virtue of not being a non-starter can be aggregated (...) up into an account of rational intentionality. I have in mind a broadly defined family of accounts whose main members are the indicator/information-theoretic approach of Dretske (1988), the asymmetric dependence theory of Jerry Fodor (1987, 1990, 1994) and the teleo-semantics of Ruth Millikan (1984, 1993). Somewhat inaccurately, I will call this family of approaches the information-theoretic family. To be sure, there is only a rough family resemblance among the members of the information-theoretic family. Indeed, several intense quarrels divide the members of that family one from another, but the precise outcome of those internecine struggles is not directly relevant to the aims of this essay. ² Taken collectively, the information-theoretic family yields a compelling picture of the place of at least a crude form of intentionality -- what I call frog-like or type I intentionality -- in the natural order. Though frog-like or type I intentionality is, I think, a genuine species of intentionality, it may subsist in the absence of rational powers. It is that species of intentionality enjoyed by irritable creatures who, following Brandom (1994). (shrink)

Strike explores the differences between Marxists and liberals over the nature of the good life, about how human beings are formed, and about episemology, and uses these discussions to explore views of schooling.

Over the past two decades we have seen dramatic improvements in the efficacy, safety and availibity of antiretroviral therapy (ART). In the USA and Europe, life expectancy in people living with HIV disease approaches that of the HIV-uninfected.1 Even in regions hardest hit by the HIV epidemic, effective HIV therapy has reversed more than a decade of HIV-related decreased survival. Despite these advances in ART, motivations to pursue HIV cure remain strong due to the toxicity, adherence challenges, cost and access (...) to care issues associated with HIV therapy, as well as the persistant stigma associated with having HIV infection. Further and renewed motivation comes from a single case of HIV cure after stem cell transplantation for acute leukaemia. Given the tremendous improvements in ART, it is important to assess how effective and safe an HIV cure would need to be in order to be a viable option compared to ART. We argue that this should be done prior to the availability of a cure to provide realistic goals for researchers and policy makers. One methodology that has been increasingly popular over the past decade is the use of mathematical simulation modelling to assess the clinical impact, cost-effectiveness and clinical role of different treatment strategies in HIV disease, as well as in medicine broadly.2 Such models provide a framework and approach for using the best available data at any point in time, and assessing the potential impact of emerging innovations. Further, unlike individual trials focused on a single endpoint, these models can integrate multiple data sources to project beyond the timeline or outcomes of individual studies and project long-term outcomes in many domains, including virologic, immunologic, clinical and cost.3 Mathematical models have particular value in their ability to assess uncertainty in clinical care. Examples include parameters determined in …. (shrink)

The primary psychological process leading aggressive children to grow into dysfunctional adults is a defensive mindset, which encompasses a pattern of deviant social information processing steps, including hypervigilance to threat; hostile attributional biases; psychophysiological reactivity, experience of rage and testosterone release (in males); aggressive problem-solving styles; aggressogenic decision-making biases; and deficient behavioral skills. These processes are acquired in childhood and predict adult maladjustment outcomes, including incarceration and premature death. The antecedents of defensive mindset lie in early childhood experiences of trauma (...) and threat. The Fast Track (FT) intervention was designed to improve social competence in aggressive children. A randomized controlled trial demonstrated that FT is effective in preventing externalizing psychopathology; the primary mediating factor is the reduction of defensive mindset processes. This Element concludes with insights that defensive mindset might also explain dysfunction in other realms, including school culture, parenting, marriage, the workplace, intergroup relationships, politics, and international relations. (shrink)

The argument in this paper is that the exclusion of empirical research has led to a deficiency in the Positivist model; the neglect of conflict in the form of the trouble-case. In the attempt to define law in a relatively narrow way Positivists have avoided important knowledge about social behavior. In addition the analytical method of Positivism has been connected with a value-position which tends to exaggerate the extent to which law functions within social structures as an orderly system. One (...) consequence of this perspective is that the role of conflict in the law process is hardly appreciated. Studies of law in some primitive societies suggest that although social behavior generally is not regulated in rule-terms, conflict often is institutionalized in a manner capable of providing norms appropriate to new situations. It is suggested that the focus upon the trouble-case is more likely to develop our understanding of conflict as a dynamic element in the law process. (shrink)

If reason is a real causal force,operative in some, but not all ofour cognition and conation, then itought to be possible to tell anaturalistic story that distinguishes themind which is moved byreason from the mind which is movedby forces other than reason.This essay proposes some steps towardthat end. I proceed by showingthat it is possible to reconcile certainemerging psychological ideasabout the causal powers of themind/brain with a venerablephilosophical vision of reason as the facultyof norms. My accountof reason is psychologistic, social, (...) and consistent with anevolutionary approach to mind. The account preserves thenormativity by deflating it. But I argue that onlysuch deflated normativity has any chance of beingmade naturalistically respectable. (shrink)

I propose that there are four standards to be met if a given educational enterprise is to be considered humane: the practice to be mastered must be socially justified; the disciplines pursued to master the practice must be appropriate to the practice; the practice must be owned by the learner; and this ownership must itself meet certain ethical requirements. The paper emphasizes the problem of ownership. It argues for a view of ownership that is “communitarian.” This view sees ownership as (...) a function of identification or membership. People become committed to certain educational ends in virtue of the fact that they see themselves as members of a group and the ends as the ends of the group. It is central to this view that ownership of ends does not require full understanding or rational appraisal of such ends. I argue that a rational appraisal of ends is difficult when a novice seeks to appraise the ends of some practice both because the ends of the practice are internal to it in a way that makes grasping such ends difficult prior to mastery of the practice and because initiation into the practice will change the individual's standards of appraisal. (shrink)

As a neurodevelopmental condition that affects cognitive functioning, autism has been used as a test case for theories of moral responsibility. Most of the relevant literature focuses on autism’s impact on theory of mind and empathy. Here I examine aspects of autism related to executive function. I apply an account of how we might fail to be reasons responsive to argue that autism can increase the frequency of excuses for transgressive behavior, but will rarely make anyone completely exempt from moral (...) responsibility in general. On this account, although excuses may apply more often to autists than to others, the excuses that apply to autists are just the same excuses that can apply to anyone. (shrink)

Model-theoretic methods are used to extend Craig's Interpolation Theorem to the loop-free portion of Pratt's dynamic logic of programs with simple assignments.

I argue that a certain initially appealing Fregean conception of our shared semantic competence in our shared language cannot be made good. In particular, I show that we must reject two fundamental Fregean principles‐what I call Frege's Adequacy Condition and what I call Frege's Cognitive Constraint on Reference Determination. Frege's adequacy condition says that in an adequate semantic theory, sentence meanings must have the same fineness of grain as attitude contents. The Cognitive Constraint on Reference Determination says that in an (...) adequate semantic theory mechanisms of reference determination will fix routes of epistemic access to referents and will mediate one‐sided recognition judgments about referents. I argue against Frege's adequacy condition that if meanings are sliced as finely as it requires there will be too many meanings to go around. I argue against the cognitive constraint on reference determination that even in an adequate theory of reference, mechanisms of reference determination must be sharply distinguished from routes of epistemic access. If so, we have little reason to expect an adequate theory of reference determination to directly illuminate Frege's cognitive puzzles or be sufficient to explain the basis of our one‐sided recognition judgments. (shrink)

Agricultural research raises fundamental ethical and value questions going beyond those in other fields both because of its public funding and because its results have significant impacts on habitats and other species. Questions about the sustainability of modern agriculture, which are shared with other sectors, require us to examine alternative visions and structures. These can be seen to range from status quo preserving ideologies to change-oriented utopias. It is argued that at the national level current ideologies—which include positivistic approaches and (...) belief in the neutrality of technology—mask real structural and policy choices as well as their ethical and value implications. At the international level, the export of fossil-fuel based modes of agriculture to the developing countries raises additional structural, policy, value, and ethical issues. (shrink)

By appealing to Paul Ricoeur’s view of interpretation as the dialectical process of understanding through explanation, Kenneth A. Reynhout contributes to the growing field of religion and science by developing an alternative understanding of interdisciplinary theology that is fundamentally hermeneutical.

In a time when we as a society are in the process of deciding what our basic rights to health care are, it is critically important for us to have a full and complete understanding of what constitutes health. We argue for an analysis of health according to which certain states are healthy not in themselves but because they allow an individual to reach actual goals. Recognizing that the goals of an individual considered from the point of view of biology (...) and the goals of the same individual considered as an agent in the world might be different, we introduce a distinction between the health of an individual qua organism and the health of an individual qua person. We then argue that this distinction characterizes the evaluations made by patients and healthcare providers better than the widely discussed distinction between disease and illness. (shrink)

"This book casts the argument for personal immortality into new light as the outcome of systems processes rather than human nature. Personal immortality is the output of becoming human rather than of being human. If this is the case, then God must be seen to enter into personal relationships with us: a view that current science supports."--Jacket.

A meta-analytic review of studies that experimentally elicited awe and compared the emotion to other conditions (84; 487 effects; 17,801 participants) examined the degree to which experimentally elicited awe (1) affects outcomes relative to other positive emotions (2) affects experience, judgment, behaviour, and physiology, and (3) differs in its effects if the awe state was elicited through positive or threatening contexts. The efficacy of methods that have been used to experimentally elicit awe and the possibility of assessing changes in the (...) state of the self with experimental awe elicitations were also examined. Meta-analyses with robust variance estimation revealed that awe affected outcomes compared to other positive emotions and control conditions; affected experience, judgment, and behaviour; and had similar effects if elicited through positive or threatening contexts. The ability to compare awe to negative emotion states and its effects on physiology was limited by a small number of available effects. Images, videos, autobiographical recall, and naturalistic exposure were effective in eliciting awe. Exploratory analyses suggested that some processes involved in changes in the self can be related to experimental awe elicitations. These findings suggest awe is a discrete emotion and identifies areas for future investigation. (shrink)

“Imagination may be thought of as a ‘work-around.’ It is a resourceful tactic to ‘undo’ a rule by creating a path around it without necessarily defying it.... Transgression, on the other hand, is rule breaking. There is no pretense of reinterpretation; it is defiance pure and simple. Whether imagination or disobedience is the source, constraints need not constrain, ties need not bind.” So writes Kenneth A. Shepsle in his introduction to Rule Breaking and Political Imagination. Institutions are thought to (...) channel the choices of individual actors. But what about when they do not? Throughout history, leaders and politicians have used imagination and transgression to break with constraints upon their agency. Shepsle ranges from ancient Rome to the United States Senate, and from Lyndon B. Johnson to the British House of Commons. He also explores rule breaking in less formal contexts, such as vigilantism in the Old West and the CIA’s actions in the wake of 9/11. Entertaining and thought-provoking, Rule Breaking and Political Imagination will prompt a reassessment of the nature of institutions and remind us of the critical role of political mavericks. (shrink)

The premise of this article is that technologies are not neutral in terms of their design objectives, their scale, and the fact that they reflect the physical and social environments in which they have developed. Specific agricultural technologies, the midwestern plow, the California tomato harvester, and various biotechnologies, are evaluated in these terms and shown to have generally predictable impacts upon rural regions and farmers. Finally, the article examines a series of major threats such as climate change that require the (...) rethinking and restructuring of agriculture along more sustainable lines, something the can be accomplished only with a conscious recognition of the non-neutrality of technologies. (shrink)

Ethicists, researchers and policy makers have paid increasing attention to the ethical conduct of research, especially research involving human beings. Research performed with and by undergraduates poses a specific set of ethical challenges. These challenges are often overlooked by the research community because it is assumed that undergraduate student researchers do not have a significant impact on the research community and that their projects are not host to research posing important ethical issues. This paper identifies several features characteristic of research (...) in undergraduate environments. The paper pays special attention to selective small liberal arts colleges, an important segment of higher education in the US, and advocates integrating instruction in research ethics wherever undergraduates are engaged in research. (shrink)

This essay examines the syntax of names. It argues that names are a syntactically and not just semantically distinctive class of expressions. Its central claim is that names are a distinguished type of anaphoric device—devices of explicit co-reference. Finally it argues that appreciating the true syntactic distinctiveness of names is the key to resolving certain long-standing philosophical puzzles that have long been thought to be of a semantic nature.