SummaryThe dichotomy between ‘scientific’ and ‘practical’ approaches to guideline development is false and divisive. Instead we should concentrate on developing mechanisms to develop and implement valid guidelines to improve patient care. The development of valid guidelines requires considerable expertise and is time consuming and expensive. It is most efficiently done at a regional or national level. The implementation of valid guidelines requires local action including the identification and modification of valid guidelines and a coordinated evidence-based implementation strategy (Grimshaw & Eccles (...) 1998). (shrink)

Studies have shown that in the mammalian neuromuscular system stretch reflexes are localized within individual muscles. Neuromuscular compartmentalization, the partitioning of sensory output from muscles, and the partitioning of segmental pathways to motor nuclei have also been demonstrated. This evidence indicates that individual motor nuclei and the muscles they innervate are not homogeneous functional units. An analysis of the functional significance of reflex localization and partitioning suggests that segmental control mechanisms are based on subdivisions of motor nuclei–muscle complexes. A partitioned (...) organization of segmental control mechanisms could utilize (1) the potential functional diversity of muscle fiber types, (2) the variety of mechanical actions of individual muscles arising from their distributed origins and insertions, and (3) diverse architectural features such as intramuscular variations in pinnation and complex in-series and in-parallel arrangements of muscle fibers. The differentiated activity observed in some muscles during natural movements also calls for localized segmental control mechanisms. Partitioning may also play a role in mechanical interactions between contracting motor units and in increasing the stability of neuromuscular systems. The functional advantages of reflex localization and partitioning suggest they are probably common features of segmental systems, whose organization reflects the structure and function of their associated neuromuscular systems. (shrink)

La Consulta Ética Clínica es una actividad relativamente nueva en USA, como un servicio destinado a ayudar a pacientes individuales o grupos. Se describe la evolución histórica de la CEC desde su inicio en 1976. Entre otras funciones, la CEC presta un soporte moral y un “confort” psicológico a los profesionales de la salud en la toma de decisiones. Se describen los métodos operativos y de acceso a la CEC.

A dozen papers by internationally known scholars explore questions largely unthinkable without Richard Watson's classic Downfall of Cartesianism: Descartes in Holland, Descartes and Simon Foucher, and issues raised by Descartes for philosophy of mind, philosophy of science, translation and toleration.

Machine learning algorithms may radically improve our ability to diagnose and treat disease. For moral, legal, and scientific reasons, it is essential that doctors and patients be able to understand and explain the predictions of these models. Scalable, customisable, and ethical solutions can be achieved by working together with relevant stakeholders, including patients, data scientists, and policy makers.

For the successful achievement of evidence-based practice, clinicians, managers and purchasers need evidence on whether a particular intervention works and ways to judge the appropriateness of the outcome criteria and measures used. Guidance is needed on what outcome measure to use, especially within routine clinical care settings. Beginning with a re-clarification of the difference between a health status and an outcome measure, the paper presents an evaluative checklist for use by clinical audit and research staff to review outcome measures for (...) use in routine care settings. Central features include the user-centredness of the measure, its psychometric properties, feasibility of use and utility. The applicability of the checklist is illustrated for outcome measurement in diabetes and stroke care. A modified form of the checklist is proposed for use by the busy clinician as an aid to the critical review of research papers within the context of evidence-based practice and to aid health care practitioners' choice of which outcome measure(s) to use within routine clinical care. (shrink)

Stuart M. Shieber’s name is well known to computational linguists for his research and to computer scientists more generally for his debate on the Loebner Turing Test competition, which appeared a decade earlier in Communications of the ACM. 1 With this collection, I expect it to become equally well known to philosophers.

We appreciate Chapman and colleagues’ (2025) advocacy for revising the Common Rule to address the downstream effects of data-centric research, particularly the potential for group harms such as sti...

Abstract:By combining normative philosophy and empirical social science, we craft a research framework for assessing differential expectations embodied in normative conceptions of the economic social contract in the United States. We argue that there are distinct views of such a contract grounded in individualist and communitarian philosophical ideologies. We apply this framework to organizational downsizing, postulating that certain human resource practices, in combination with the respective ideological orientations, will affect perceptions of the justice of downsizing policies.

Purpose The purpose of this paper is to review current practice in sharing and mining medical data revealing benefits, costs and ethical issues. Based on stakeholder perspectives and values, the authors create an ethical code to regulate the sharing and mining of medical information. Design/methodology/approach The framework is based on a review of academic, practitioner and legal research. Findings Owing to the inability of current safeguards to protect consumers from risks related to the disclosure of medical information, the authors develop (...) a framework for ethical sharing and mining of medical data, security, transparency, respect, accountability, community and quality, which espouses security, transparency, respect, accountability, community and quality as the basic tenets of ethical data sharing and mining practice. Research limitations/implications The STRACQ framework is an original, previously unpublished contribution that will require modification over time based on discussion and debate within and among the academy, medical community and public policymakers. Social implications The framework for sharing borrows from the Fair Credit Reporting Act, allowing the collection and dissemination of identified medical data but placing strict limitations on use. Following this framework, benefits of shared and mined medical data are freely available with appropriate safeguards for consumer privacy. Originality/value Mandates for adoption of electronic health-care records require an understanding of medical data mining. This paper presents a review of data mining techniques and reasons for engaging in the practice of identifying benefits, costs and ethical issues. The authors create an original framework, STRACQ, for ethical sharing and mining of medical information, allowing knowledge exploration while protecting consumer privacy. (shrink)

Although social contracts theory has been applied to organizations (Donaldson & Dunfee, 1994), rarely has the theory been tested empirically. This article uses the traditions of communitarianism and individualism to instantiate an ideal-type economic social contract. We asked 269 subjects to complete the Ideological Orientation Scale and to make judgments on eight downsizing scenarios. Using social judgment theory, we assess the direct and indirect influences of ideology on judgments of fairness. Our findings suggest that ideology indeed shapes individual’s conceptions of (...) organizational fairness. (shrink)

Each of the following papers gives an account of a different UK clinical ethics committee. The committees vary in the length of time they have been established, and also in the main focus of their work. The accounts discuss the development of the committees and some of the ethical problems that have been brought to them. The issues raised will be relevant for other National Health Service (NHS) trusts in the UK that wish to set up such a committee.

By combining normative philosophy and empirical social science, we craft a research framework for assessing differential expectations embodied in normative conceptions of the economic social contract in the United States. We argue that there are distinctviews of such a contract grounded in individualist and communitarian philosophical ideologies. We apply this framework to organizational downsizing, postulating that certain human resource practices, in combination with the respective ideological orientations, will affect perceptions of the justice of downsizing policies.Living up to one’s word is (...) a decisive measure of moral character. Within the microsocial realm of the family, promises and commitments derive their social force and cultural meaning from the idea that love or biology binds people together in an absolute way. But outside of this world, in the larger society, the only thing binding people together is a sense that there is a social contract, a set of common obligations held collectively by society as a whole. But today’s workers say no one seems to care whether these promises are kept. (shrink)

Mental health professionals working in hospitals or community clinics inevitably face the realisation that we possess imperfect conceptual means to understand mental disorders. In this paper the authors bring together ideas from the fields of Philosophy, Psychiatry, Cognitive Psychology and Linguistics to reflect on the ways we represent phenomena of high practical importance that we often take for granted, but are nevertheless difficult to define in ontological terms. The paper follows through the development of the concept of psychosis over the (...) last two centuries in the interplay of three different conceptual orientations: the categorical, dimensional and network approaches. Each of these represent the available knowledge and dominant thinking styles of the era in which they emerged and take markedly different stances regarding the nature of mental phenomena. Without particular commitment to any ontological positions or models described, the authors invite the reader into a thinking process about the strengths and weaknesses of these models, and how they can be reconciled in multidisciplinary settings to benefit the process of patient care. (shrink)

We routinely need to process the identity of many faces around us, and how the brain achieves this is still the subject of much research in cognitive neuroscience. To date, insights on face identity processing have come from both healthy and clinical populations. However, in order to directly compare results across and within participant groups, and across different studies, it is crucial that a standard task is utilised which includes different exemplars (for example, non-face stimuli along with faces), is memory-neutral, (...) and taps into identity recognition across orientation and across viewpoint change. The goal of this study was to test a previously behaviourally tested, optimised face and object identity matching design in a healthy control sample whilst being scanned using fMRI. Specifically, we investigated categorical, orientation, and category-specific orientation effects while participants were focused on identity processing of simultaneously presented exemplar stimuli. Alongside observing category and orientation specific effects in a distributed set of brain regions, we also saw an interaction between stimulus category and orientation in the bilateral fusiform gyrus and bilateral middle occipital gyrus. Generally these clusters showed the pattern of a heightened response to inverted, as opposed to upright faces; and to upright, as opposed to inverted shoes. These results are discussed in relation to previous studies and to potential future research within prosopagnosic individuals. (shrink)

Faces carry key personal information about individuals, including cues to their identity, social traits, and emotional state. Much research to date has employed static images of faces taken under tightly controlled conditions yet faces in the real world are dynamic and experienced under ambient conditions. A common approach to studying key dimensions of facial variation is the use of facial caricatures. However, such techniques have again typically relied on static images, and the few examples of dynamic caricatures have relied on (...) animating graphical head models. Here, we present a principal component analysis -based active appearance model for capturing patterns of spatiotemporal variation in videos of natural dynamic facial behaviours. We demonstrate how this technique can be applied to generate dynamic anti-caricatures of biological motion patterns in facial behaviours. This technique could be extended to caricaturing other facial dimensions, or to more general analyses of spatiotemporal variations in dynamic faces. (shrink)

Arguably, children are among those most affected by contemporary models of conflict. Yet their plight is little discussed when it comes to agreeing on the minutiae of a peace proposal, despite the fact that children are widely recognized as significant to the sustainability of peace.

The underrepresentation of females in mathematics-related fields may be explained by gender differences in mathematics self-concept (rather than ability) favoring males. Mathematics self-concept typically declines with student age, differs with student ethnicity, and is sensitive to teacher influence in early schooling. We investigated whether change in mathematics self-concept occurred within the context of a longitudinal intervention to raise and sustain teacher expectations of student achievement. This experimental study was conducted with a large sample of New Zealand primary school students and (...) their teachers. Data were analyzed using longitudinal multilevel modeling with mathematics self-concept as the dependent variable and time (which represents students’ increasing age each year), gender, and ethnicity entered as predictors and achievement in mathematics included as a control variable. Interaction terms were also explored to investigate changes over time for different groups. All students demonstrated a small increase in mathematics self-concept over the 3-year period of the current study but mathematics self-concept was consistently greater for boys than girls. Māori, Asian, and Other students’ initial mathematics self-concept was higher than that of New Zealand European and Pacific Islanders’ (after controlling for achievement differences). However, a statistically significant decline in mathematics self-concept occurred for Māori students alone by the end of the study. The expected age-related reduction over time in student mathematics self-concept appeared to be mitigated in association with the longitudinal study. Nevertheless, the demonstration of a comparatively lower mathematics self-concept remained for girls overall and declined for Māori. Our results reinforce implications for future research into mathematics self-concept as a possible determinant of female student career choices. (shrink)

A school of idealism: meditatio laici, by J. Cappon.--Beati possidentes, by R. M. Wenley.--Moral validity: a study in Platonism, by R. C. Lodge.--Plato and the poet's eidōla, by A. S. Ferguson.--Some reflections on Aristotle's theory of tragedy, by G. S. Brett.--The function of the phantasm in St. Thomas Aquinas, by H. Carr.--The development of the psychology of Maine de Biran, by N. J. Symons.--A plea for eclecticism, by H. W. Wright.--Some present-day tendencies in philosophy, by J. M. MacEachran.--Evolution and personality, (...) J. G. Hume.--Emergent realism, by J. Muirhead.--Bibliography of publications by Dr. John Watson (p. 343-346). (shrink)

The concept of wilderness, as denned in the U.S.A. Wilderness Act of 1964, is analyzed and found to be ambiguous. This is an administrative advantage. The concept of underground wilderness is then introduced and found to be applicable under the terms of the Act. It is argued that the longest cave in the world, the Flint Ridge Cave System in Mammoth Cave National Park, Kentucky, can and should be officially declared as wilderness by Congress even though the surface above it (...) is now developed. (shrink)

In this paper I criticize Cartwright's analysis of capacities and offer an alternative analysis. I argue that Cartwright's attempt to connect capacities to her condition CC fails because individuals can exercise capacities only in certain contexts. My own analysis emphasizes three features of capacities: 1) Capacities belong to individuals; 2) Capacities are typically not metaphysically fundamental properties of individuals, but can be explained by referring to structural properties of individuals; and 3) Laws are best understood as ascriptions of capacities.

Since the Harvard Committees bold and highly successful attempt to redefine death in 1968 (Harvard Ad Hoc committee, 1968), multiple controversies have arisen. Stimulated by several factors, including the inherent conceptual weakness of the Harvard Committees proposal, accumulated clinical experience, and the incessant push to expand the pool of potential organ donors, the lively debate about the definition of death has, for the most part, been confined to a relatively small group of academics who have created a large body of (...) literature of which this issue of the Journal of Medicine and Philosophy is an example. Law and public policy, however, have remained essentially unaffected. This paper will briefly review the multiple controversies about defining death in an attempt to explain why they have and will remain unresolved in the academic community and have even less chance of being understood and resolved by politicians, legislators, and the general public. Considering this, we will end by suggesting the probable course of public policy and clinical practice in the decades ahead. (shrink)

In 1950, Alan Turing proposed his eponymous test based on indistinguishability of verbal behavior as a replacement for the question "Can machines think?" Since then, two mutually contradictory but well-founded attitudes towards the Turing Test have arisen in the philosophical literature. On the one hand is the attitude that has become philosophical conventional wisdom, viz., that the Turing Test is hopelessly flawed as a sufficient condition for intelligence, while on the other hand is the overwhelming sense that were a machine (...) to pass a real live full-fledged Turing Test, it would be a sign of nothing but our orneriness to deny it the attribution of intelligence. The arguments against the sufficiency of the Turing Test for determining intelligence rely on showing that some extra conditions are logically necessary for intelligence beyond the behavioral properties exhibited by an agent under a Turing Test. Therefore, it cannot follow logically from passing a Turing Test that the agent is intelligent. I argue that these extra conditions can be revealed by the Turing Test, so long as we allow a very slight weakening of the criterion from one of logical proof to one of statistical proof under weak realizability assumptions. The argument depends on the notion of interactive proof developed in theoretical computer science, along with some simple physical facts that constrain the information capacity of agents. Crucially, the weakening is so slight as to make no conceivable difference from a practical standpoint. Thus, the Gordian knot between the two opposing views of the sufficiency of the Turing Test can be cut. (shrink)

One way of increasing the supply of vital organs without violating the dead donor rule is to declare death on cardiopulmonary criteria after withdrawing life support. The question then is how quickly death may be declared.

Can dreams reveal insight into our cognitive abilities and aptitudes (i.e., “human intelligence”)? The relationship between dream production and trait-like cognitive abilities is the foundation of several long-standing theories on the neurocognitive and cognitive-psychological basis of dreaming. However, direct experimental evidence is sparse and remains contentious. On the other hand, recent research has provided compelling evidence demonstrating a link between dream content and new learning, suggesting that dreams reflect memory processing during sleep. It remains to be investigated whether the extent (...) of learning-related dream incorporation (i.e., the semantic similarity between waking experiences and dream content) is related to inter-individual differences in cognitive abilities. The relationship between pre–post sleep memory performance improvements and learning-related dream incorporation was investigated ( N = 24) to determine if this relationship could be explained by inter-individual differences in intellectual abilities (e.g., reasoning, short term memory (STM), and verbal abilities). The extent of dream incorporation using a novel and objective method of dream content analysis, employed a computational linguistic approach to measure the semantic relatedness between verbal reports describing the experience on a spatial (e.g., maze navigation) or a motor memory task (e.g., tennis simulator) with subsequent hypnagogic reverie dream reports and waking “daydream” reports, obtained during a daytime nap opportunity. Consistent with previous studies, the extent to which something new was learned was related ( r = 0.47) to how richly these novel experiences were incorporated into the content of dreams. This was significant for early (the first 4 dream reports) but not late dreams (the last 4 dream reports). Notably, here, we show for the first time that the extent of this incorporation for early dreams was related ( r = 0.41) to inter-individual differences in reasoning abilities. On the other hand, late dream incorporation was related ( r = 0.46) to inter-individual differences in verbal abilities. There was no relationship between performance improvements and intellectual abilities, and thus, inter-individual differences in cognitive abilities did not mediate the relationship between performance improvements and dream incorporation; suggesting a direct relationship between reasoning abilities and dream incorporation. This study provides the first evidence that learning-related dream production is related to inter-individual differences in cognitive abilities. (shrink)

From machine learning and computer vision to robotics and natural language processing, the application of data science and artificial intelligence is expected to transform health care (Ce...

In this paper I present both a critical appraisal of Humphreys' probabilistic theory of causality and a sketch of an alternative view of the relationship between the notions of probability and of cause. Though I do not doubt that determinism is false, I claim that the examples used to motivate Humphreys' theory typically refer to subjective rather than objective chance. Additionally, I argue on a number of grounds that Humphreys' suggestion that linear regression models be used as a canonical form (...) for the description of causal relations is untenable. I conclude by exploring the variety of ways in which probabilistic elements can be embedded into the structure of causal mechanisms. This investigation suggests both that deterministic mechanisms can produce stochastic behavior and stochastic mechanisms can produce deterministic behavior. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Breakdown of C i M phy " artes an eta sacs RICHARD A. WATSON WITHIN CARTESIANISMthere arose many problems deriving from conflicts between Cartesian principles. Inadequate attempts to solve these problems were crucial reasons for the breakdown of Cartesian metaphysics in the late seventeenth and early eighteenth centuries. The major difficulties derived from the acceptance of a dualism of substances seated in a system which included epistemological (...) and causal likeness principles plus an ontological framework in which the categories of substance and modification were exhaustive. The major solutions involved either denying the likeness principles or altering the ontological framework. The first led to unintelligibility ; the second, culminating in Hume, opened the way to non-Cartesian metaphysics. The first section of this study contains a characterization of late seventeenth -century Cartesian metaphysics. The second is an exposition of Foucher 's four major criticisms of this system. In the third section, monistic solutions suggested in Descartes and by Spinoza, Foucher, Leibniz, and Locke are considered; in the fourth, the dualistic solutions of the orthodox Cartesians Rohault, R~gis, Desgabets, La Forge, Le Grand, and Arnauld; and in the fifth, the occasionalist solution of Malebranche. The sixth section is an analysis of these orthodox and occasionalist solutions, showing how each ultimately fails because of dependence upon the ontology of substance and modification. The seventh section is a consideration of Berkeley and Hume in the Cartesian context. A consideration of their systems as offering solutions to Cartesian problems illuminates in new light both the systems and the problems. In broad terms, this study moves from a consideration of problems arising from an ontology of two substances, to a consideration of problems arising from the ontological pattern of substance and modification. The Cartesians were concerned with relationships between two substances, but they saw no difficulties connected with the relationship between a substance and its modifications (or properties). Berkeley's treatment (deriving from Male- [177] 178 HISTORY OF PHILOSOPHY branche) of the relationships between mind and idea, and between mind and notion, is illuminated by a consideration of the extent to which he took these relationships for granted in the Cartesian way, and of the extent to which he saw difficulties in the relationship between substance and modification. The Berkeleian solution to Cartesian problems, like that of Malebranche before him, was not successful; Malebranche belittled, and Berkeley denied the dualism of substances, but neither philosopher could break entirely with the ontological pattern of substance and modification. The final breakdown of Cartesian metaphysics came with Hume, who, in providing the culmination of a most important trend in modern philosophy, opened the way to new metaphysics and became the father of contemporary philosophy. I A model late seventeenth-century Cartesian metaphysical system. The last grand expositor of the Cartesian philosophy was Antoine Le Grand who in 1694 published An Entire Body of Philosophy. The characterization of the late seventeenth-century Cartesian system given below follows Le Grand's exposition more closely than others, but it also incorporates elements from those of Rohault, R6gis, Desgabets, La Forge, Malebranche, and Arnauld.1 None of these philosophers professed a system of exactly the sort this characterization pictures, nor is it implied here that they do. The guide and rationale for drawing from them such a model Cartesianism is the polemical writing of Simon Foucher. Foucher's series of attacks upon Cartesianism (of which the second is his criticism of Malebranche of 1675, Critique de la Rdcherche de la veritd) give clearly the most important objections against Cartesian metaphysics.2The system outlined below, while more com1Le Grand, Antoine, An Entire Body of Philosophy According to the Principles of the Famous Renate des Cartes (London, 1694); Rohault, Jacques, Traitd de physique (Paris, 1671); R6gis, Pierre-Sylvain, Syst~me de philosophie, contenant la logique, la mdtaphysique, la physique et la morale (Lyon, 1690); Desgabets, Robert, Critique de la Critique de la Recherche de la veritd, oCt l'on decouvre le chemin qui conduit aux connoissances solides. Pour servir de rdsponse gtla Lettre d'un academicien (Paris, 1675); La Forge, Louis de, Traitd de l'dme humaine, de ses facultds et fonctions et de son union avec le corps, d'apr~s les principes de... (shrink)

A Charter on Medical Professionalism (CMA) has just recently been developed internationally, and the Canadian Medical Association is calling for public dialogue on medical professionalism now that reforms in the Canadian system of health care are imminent. We posit that good practices are at issue; we outline the essence of these in general and also specifically in the knowing, teaching and intervening components of practice. We also see challenges not to, but in, medical professionalism – first and foremost in the (...) profession's definition of good practices and the payer's confinement of insurance coverage to these. (shrink)