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 & (...) class='Hi'>Eccles 1998). (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)

Objective Cluster randomised trial (CRT) investigators face challenges in seeking informed consent from individual patients (cluster members). This study examined associations between reporting of patient consent in healthcare CRTs and characteristics of these trials. Study design Consent practices and study characteristics were abstracted from a random sample of 160 CRTs performed in primary or hospital care settings that were published from 2000 to 2008. Multivariable logistic regression was used to examine associations between reporting of patient consent and methodological characteristics, as (...) well as publication features such as date and journal of publication. Results 82 (53.8%) of 160 studies reported obtaining informed consent from individual patients. Reporting of patient consent was independently and positively associated with: smaller cluster size, the evaluation of experimental interventions targeted at patients, data collection from individual patients, publication later than 2004 and publication in higher-impact journals. Conclusions Reporting of consent practices in published CRTs should be improved. Consent practices in published CRTs appear to be related to the type of interventions under study, as well as journal impact and trends in research ethics practices. These findings will inform best practices in trial conduct and ethics review, remediation of errors in consent practices and ethics review and the development of regulatory guidance for CRTs. (shrink)

Owing to unique features of their design, cluster randomized trials complicate the interpretation of standard ethics guidelines. The recently published Ottawa statement on the ethical design and conduct of cluster randomized trials provides researchers and research ethics committees with detailed guidance on the design, conduct and review of cluster trials. The Ottawa statement sets out 15 recommendations, including guidance on the justification of study design, the need for research ethics committee review, the identification of research participants, obtaining informed consent, the (...) role of gatekeepers in protecting cluster interests, the assessment of benefits and harms, and the protection of vulnerable participants. (shrink)

Earlier in this century, many philosophers of science (for example, Rudolf Carnap) drew a fairly sharp distinction between theory and observation, between theoretical terms like 'mass' and 'electron', and observation terms like 'measures three meters in length' and 'is _2° Celsius'. By simply looking at our instruments we can ascertain what numbers our measurements yield. Creatures like mass are different: we determine mass by calculation; we never directly observe a mass. Nor an electron: this term is introduced in order to (...) explain what we observe. This (once standard) distinction between theory and observation was eventually found to be wanting. First, if the distinction holds, it is difficult to see what can characterize the relationship between theory :md observation. How can theoretical terms explain that which is itself in no way theorized? The second point leads out of the first: are not the instruments that provide us with observational material themselves creatures of theory? Is it really possible to have an observation language that is entirely barren of theory? The theory-Iadenness of observation languages is now an accept ed feature of the logic of science. Many regard such dependence of observation on theory as a virtue. If our instruments of observation do not derive their meaning from theories, whence comes that meaning? Surely - in science - we have nothing else but theories to tell us what to try to observe. (shrink)

Modal dimensionalism is realism about spaces, times and worlds—metaphysical indices that make objects spatial, temporal and modal, respectively, and that play the role of alethic relativizers, i.e. items to which matters of truth are relativized. This paper examines several arguments against MD and shows that MD offers a feasible way to understand modal discourse.

When the first edition of Pediatric Psychopharmacology published in 2002, it filled a void in child and adolescent psychiatry and quickly establishing itself as the definitive text-reference in pediatric psychopharmacology. While numerous short, clinically focused paperbacks have been published since then, no competitors with the scholarly breadth, depth, and luster of this volume have emerged. In the second edition, Christopher Kratochvil, MD, a highly respected expert in pediatric psychopharmacology, joins the outstanding editorial team led by Dr. Martin and Dr. (...) Scahill. In the new edition, the editors streamline the flow of information to reflect the growth in scientific data since the first edition appeared. The overall structure of the book remains the same, with major sections on underlying biology; somatic interventions; assessment and treatment; and special considerations. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hermeneutics, Neuroscience and PsychiatryMichael T. H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM (bio)Hermeneutic practice in mental health has been a theme in Philosophy, Psychiatry, & Psychology (PPP) since its very beginnings. In this essay I argue that hermeneutics, the theory and practice of interpretation, promotes therapeutic interaction between mental health professionals, patients and their family.Why does this patient present in such a way at this (...) particular point in time? The distressing symptoms are there. The changes in behavior are obvious. Impairments of functions are hurting. A mental illness clearly runs in the family. There were early losses of loved ones, physical abuse at home, bullying by peers and self-medication with drugs and alcohol. Three in four adults with a mental illness first experienced that before they turned 24. The brain goes through major reorganization during adolescence and early adulthood. If synaptic pruning went wrong, psychoses emerged. When stresses activated the hypothalamic–pituitary–adrenal axis the elevated cortisol level impacted the size and function of the hippocampus and amygdala in the genetically vulnerable; anxiety, depression, bipolar, and personality disorders developed. The patient needs a voice/language to describe all these experiences and events and the psychiatrist needs a discourse to make sense of them.Eisenberg laments the swings between "brainlessness" and "mindlessness" in psychiatry. Engel argues for a "biopsychosocial" discourse. The major challenge for psychiatry is how to organize clinical information of different nature (categories, dimensions, narratives; i.e., objective vs. subjective, personal vs. interpersonal) into a coherent and comprehensible account for us all. Mental illnesses are not only neuropsychiatric spectrum disorders but also dysfunctions of social relationship and environmental/ecological adaptation. Psychiatry as a clinical neuroscience per se lacks the semantics to address the rich interactions between the physical, psychological, social, cultural, and spiritual in the illness experience of our patients. Explanation in the diagnostic formulation (objective scientific discourse on cause and effect) and understanding in the patient narrative (subjective ordinary everyday discourse on significance and meaning) are irreducible to each other (Wong, 2018). They instead interact with one another to achieve an integrative formulation, not through merging different discourses into a single assertion/monologue but via the dialectic/dialogue of "explaining more in order to understand better," as Ricoeur puts it, and between "the whole and the parts," as Schleiermacher highlights.This "therapeutic hermeneutic circle" of "explanation vs understanding" and "the whole vs the parts" includes symptoms behavior function and life events. It correlates between bio-psychosociocultural-spiritual dimensions/perspectives and does not reduce them to any particular/single [End Page 13] stance. The whole integrates the parts and the parts enrich the whole. It explains but does not explain away. It understands through an articulation of meaning and significance. This discourse is a multilayered (bio-psycho-social-cultural-spiritual) personal narrative that formulates diagnosis and care in a correlative (linking different voices/discourses) and non-reductive (no particular voice/discourse is prejudiced against) manner that is comprehensible to us all (Wong, 2021).PPP will be an excellent forum for discussing clinical hermeneutics in the future. In this digital era of social media and virtual reality, hermeneutics has the never-ending task to tackle the unprecedented challenges to meaning illness and health posed by polarizing discourses.Michael T. H. Wong Michael T.H. Wong, MBBS, MD, MA, MDiv, PhD, FRCPsych, FRANZCP, FHKAM, is Hon Clinical Professor, Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, HKSAR, China. Michael is Chair, Section of Philosophy & Humanities in Psychiatry, World Psychiatric Association. He is an Organizational Partner & International Lead with The Collaborating Centre for Values-Based Practice in Health and Social Care, St Catherine's College Oxford. He is Advisor to the Chinese Health Foundation of Australia.ReferencesWong M. T. H. (2018). Ricoeur and the third discourse of the person: From philosophy and neuroscience to psychiatry and theology. London: Lexington Books. Google ScholarWong, M. T. H. (2021). Values, meanings, hermeneutics and mental health. In Stoyanov, D., Fulford, K. M. W. F., Stanghellini, G., Van Staden, W., & Wong, M. TH. (Eds.), International perspectives in values-based mental health practice: Case studies and commentaries (pp. 341–349... (shrink)

Tactile distance perception is believed to require that immediate afferent signals be referenced to a stored representation of body size and shape (the body model). For this ability, recent studies have reported that the stored body representations involved are highly distorted, at least in the case of the hand, with the hand dorsum represented as wider and squatter than it actually is. Here, we aim to define the neural basis of this phenomenon. In a behavioural experiment participants estimated the distance (...) between touches on two points by adjusting the length of a visually-presented line on the screen. The technique of multidensional scaling (MDS) was used to reconstruct a perceptual map of tactile space. Analysis of spatial distortion using Procrustes alignment showed that maps were stretched in the mediolateral hand axis. In order to determine the neural correlates of these body distortions, we performed an fMRI study. For each participant, we used a searchlight pattern classifier with Euclidean distance on pre-defined regions of interests (ROIs). In order to relate the representations between the different points and to computational models, we compare response-pattern dissimilarity matrices in these ROIs. Similar to the behavioural experiment, we used MDS to reconstruct maps of the neural representation of tactile space using the values from the dissimilarities matrices. We were able to reconstruct the perceptual map of tactile space in the contralateral primary somatosensory and motor cortices. This suggests that these areas are critical to generate the tactile representations of the dorsum of the hand. (shrink)

We examined the neural basis of tactile distance perception by analyzing activity patterns induced by tactile stimulation of nine points on a 3 x 3 square grid on the hand dorsum using functional magnetic resonance (fMRI). We used a searchlight approach within pre-defined regions of interests (ROIs) to compute the pairwise Euclidean distances between the activity patterns elicited by tactile stimulation. Then, we used multidimensional scaling (MDS) to reconstruct skin space at the neural level and compare it with skin space (...) at the perceptual level. Our reconstructions of the shape of skin space in contralateral primary somatosensory (SI) and motor (M1) cortices reveal that it is distorted in a way that matches the perceptual shape of skin space. This suggests that early sensorimotor areas are critical to processing tactile distance perception. (shrink)

Sir Arthur Stanley Eddington was a key figure in the development of modern astrophysics, who also made important contributions to the philosophy of science and popular science writing. The Arthur Eddington Memorial Trust was set up after his death in order to hold annual lectures on the relationship between scientific thought and aspects of philosophy, religion or ethics. This 2012 collection gathers together six of these lectures, including contributions by Sir Edmund Whittaker, Herbert Dingle, Richard B. Braithwaite, John C. (...) class='Hi'>Eccles, Dame Kathleen Lonsdale, and Baroness Mary Warnock, together with Eddington's 1929 Swarthmore Lecture on Science and the Unseen World. A preface written by the Astronomer Royal, Baron Rees of Ludlow, is also included. This is a fascinating book that will be of value to anyone with an interest in the philosophy of science and Eddington's legacy. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Vessel of Honor: The Virgin Birth and the Ecclesiology of Vatican II by Brian A. GraebeAaron Pidel S.J.Vessel of Honor: The Virgin Birth and the Ecclesiology of Vatican II. By Brian A. Graebe (Steubenville, OH: Emmaus Academic, 2021), 351 pp.Though Mary's undiminished virginity in giving birth (virginitas in partu) was long understood to be an event as miraculous and a teaching as authoritative as her virginity in conceiving (...) (virginitas ante partum), virginitas in partu underwent a kind of existential reinterpretation in the middle of the twentieth century. Authors such as Albert Mitterer and Karl Rahner suggested that, physically speaking, Jesus's birth might have happened like any other, rupturing the hymen, distending the birth canal, and causing Mary pain, albeit not in the spiritually disintegrating way common to postlapsarian humanity. These arguments effectively "unsettled" the traditional understanding of virginitas in partu, leading theologians of the highest stature to distinguish between the doctrine itself and the anatomical aspects attached to it over time. Fr. Brian Graebe has written a fine book arguing that the bodily dimensions of the virgin birth, including the physical "seal" of virginity, belong to the substance of the doctrine. This more inclusive understanding not only does better justice to the data of tradition, he argues, but illuminates the ecclesiology of the Second Vatican Council. The book impresses by its theologically reflective method, its clarity of exposition, [End Page 1106] and its depth of research—especially into the archival and antepreparatory sources of Vatican II.Vessel of Honor responds in effect to Rahner's argument that physical intactness is peripheral to the dogmatic core of Mary's virginity in partu. To show otherwise, Rahner contended, one would need to show that such a doctrine can be found directly in the apostolic teaching, or that it, "being implicitly contained therein, has grown out of the apostolic doctrine, by a legitimate historical, logical, and theological process, as its authentic development" (68–69). If the bodily aspects of this doctrine really belonged to the deposit of faith, in other words, one would need to show how they are implied in the traditio divino-apostolica, as well as how they cohere organically with the rest of the deposit. The two major parts of Vessel of Honor respond in turn to each aspect of Rahner's challenge.The first three chapters argue that Mary's bodily integrity in parturition belongs at least implicitly to the traditio divino-apostolica. Turning first to the postapostolic tradition, Fr. Graebe shows that—apart from the early exceptions of Origen and Tertullian—patristic sources either affirm or strongly imply a miraculous delivery. This constant witness culminates in the Lateran Council (649 AD), which, while not itself an ecumenical council, was received into the magisterium of Pope Martin and affirmed by the Third Council of Constantinople (680 AD). Its teaching that Mary "gave birth without corruption" (incorruptibiliter... genuisse) would be defended by Paschasius, Ratramnus, Thomas Aquinas, and others. This consensus remained undisturbed until the eve of Vatican II.Even at Vatican II, Fr. Graebe argues in the next chapter, the Council Fathers intended to reaffirm the more inclusive idea of virginitas in partu against those who would marginalize its bodily dimensions. Here he really breaks new ground, delving deep into the antepreparatory, preparatory, and conciliar drafting history. He shows convincingly that many of the chief drafters of the final formula—"Our Lord, who did not diminish his mother's virginal integrity but sanctified it..." (Lumen Gentium §57)—saw it as excluding Rahner's and Mitterer's minimalizing interpretations. Drawing on material from the Vatican Apostolic Archives, Fr. Graebe shows that some of the very theologians who voted to omit the pointed phrase "in the birth itself" (in ipsomet partu) did so for tonal rather than substantive reasons.The third chapter argues that Mary's physical integrity in birth is to be believed with divine and Catholic faith, despite the ongoing confusion introduced by Rahner and others. Admittedly, Vatican II did not define but merely reaffirmed the traditional understanding of virginitas in partu. But there are other reasons for including it in the traditio divino-apostolica. [End Page 1107] Drawing heavily... (shrink)

En el trabajo "El mérito ejecutivo de fa póliifi de seguro y sus implicaciones frente al proceso rjecutivo", se busca responder la siguiente preglli11ta problemática: ¿Cuáles son las condiciones y límites para que la póliza de seguro se constituya en fundamento para la satisfacción de un derecho cierto por vía del proceso ejecutivo? En el desarrollo del ensayo se considera que la póliza de seguro, en los términos dispuestos por el artículo 1053 del Código de Comercio, se constituye en un (...) evento especial por el que se posibilita la ejecución, aunque no se cumplan los requisitos consagrados en el artículo 488 del Código de Procedimiento Civil. En el trabajo se presenta un cuestionamiento crítico frente a la regulación existente sobre el carácter ejecutivo de la póliza de seguro. Se estudian las connotaciones especiales del artículo 1053 del Código de Comercio frente a la regla general de los títulos ejecutivos del artículo 488 del Código de Procedimiento Civil. Adicionalmente, se establecen parámetros para entender cuándo la aseguradora ha objetado de manera seria la reclam.ación, y acerca de los cómputos frente al plazo que se tiene para objetar. Se consideran las ventajas y deficiencias del proceso ejecutivo para.obtener la satisfacción del derecho del asegurado o beneficiario en los eventos del artículo 1053 del Código de Comercio. De otro lado, se analizan las implicaciones surgidas del silencio de los aseguradores que dentro del plazo legal no objetan las reclamaciones realizadas. Finalmente, se delimitan los problemas que surgen en el proceso de ejecución, desde un perfil teórico procesal, teniendo en cuenta el postulado constitucional del debido proceso. (shrink)

El artículo analiza el problema de la expulsión de extranjeros sospechosos de ser delincuentes o anarquistas, tomando como marco temporal la acción de la policía de Buenos Aires durante la jefatura de Francisco Beazley (1896-1904). A partir del cruce de dos tradiciones historiográficas diferentes —aquella que toma como objeto a la institución policial y el mundo del delito y la que se ha preocupado por el surgimiento del anarquismo—, busca reflexionar sobre los mecanismos de deportación de inmigrantes antes y después (...) de la aprobación de la Ley de Residencia en 1902. Si bien el foco está puesto en el accionar de la policía de Buenos Aires, una de las ideasvertebradoras del análisis es que la comprensiónde la acción policial frente a la expulsión de extranjeros requiere un estudio detenido en los enlaces entre las ciudades portuarias del litoral atlántico sudamericano y europeo. De esta manera, el artículo se propone reconstruir una cartografía de la actuación transnacional de la policía,conectando a Buenos Aires con Rio de Janeiro, Montevideo y la costa española. Para ello, se ha consultado un heterogéneo conjunto de fuentes que van desde informes consulares y prensa policial, hasta periódicos de Brasil y Argentina, pasando por escritos anarquistas y socialistas. (shrink)

En diversos textos relacionados con la filosofía de la historia, Immanuel Kant presenta los conceptos de “naturaleza”, “destino” o “providencia” que dan sentido y finalidad a la historia de la humanidad en su conjunto. Estos textos fueron publicados durante las décadas de 1780 y 1790. El objetivo de este artículo es examinar las diferentes formas que adopta la teleología de la naturaleza en estos textos kantianos. Intentaremos mostrar las coincidencias y las diferencias entre las formas mencionadas.

Sexual violence has become a topic of intense media scrutiny, thanks to the bravery of survivors coming forward to tell their stories. But, unfortunately, mainstream public spheres too often echo reports in a way that inhibits proper understanding of its causes, placing too much emphasis on individual responsibility or blaming minority cultures. -/- In this powerful and original book, Linda Martín Alcoff aims to correct the misleading language of public debate about rape and sexual violence by showing how complex our (...) experiences of sexual violation can be. Although it is survivors who have galvanized movements like #MeToo, when their words enter the public arena they can be manipulated or interpreted in a way that damages their effectiveness. Rather than assuming that all experiences of sexual violence are universal, we need to be more sensitive to the local and personal contexts – who is speaking and in what circumstances – that affect how activists’ and survivors’ protests will be received and understood. -/- Alcoff has written a book that will revolutionize the way we think about rape, finally putting the survivor center stage. (shrink)

Feminist philosophy has been concerned with race and racism since its inception for both historical and conceptual reasons. Historically, the struggle against sexism consistently followed in the footsteps of the struggle against slavery and racism, both in the nineteenth as well as the twentieth centuries. Women who resisted slavery and racism began to rethink common beliefs about women's role, and took inspiration from the abolitionist and civil rights struggles. Nineteenth‐century transcendentalist Margaret Fuller Ossoli made a conceptual analogy between slavery as (...) an unfair restriction on human freedom and the social and economic restrictions on white women. Simone de Beauvoir argued that slaves and white women had been infantilized in similar ways. Many early feminist accounts of sexism borrowed from analyses of slavery and racism, how these were justified through attributions of inferiority and dependence, and how these affected the subjectivity of the oppressed. (shrink)

White identity is in ferment. White, European Americans living in the United States will soon share an unprecedented experience of slipping below 50% of the population. The impending demographic shifts are already felt in most urban centers and the effect is a national backlash of hyper-mobilized political, and sometimes violent, activism with a stated aim that is simultaneously vague and deadly clear: 'to take our country back.' Meanwhile the spectre of 'minority status' draws closer, and the material advantages of being (...) born white are eroding. This is the political and cultural reality tackled by Linda Martín Alcoff in The Future of Whiteness. She argues that whiteness is here to stay, at least for a while, but that half of whites have given up on ideas of white supremacy, and the shared public, material culture is more integrated than ever. More and more, whites are becoming aware of how they appear to non-whites, both at home and abroad, and this is having profound effects on white identity in North America. The young generation of whites today, as well as all those who follow, will have never known a country in which they could take white identity as the unchallenged default that dominates the political, economic and cultural leadership. Change is on the horizon, and the most important battleground is among white people themselves. The Future of Whiteness makes no predictions but astutely analyzes the present reaction and evaluates the current signs of turmoil. Beautifully written and cogently argued, the book looks set to spark debate in the field and to illuminate an important area of racial politics. (shrink)

William Oliver Martin published "The Order and Integration of Knowledge" in 1957 to address the problem of the nature and the order of various kinds of knowledge; in particular, the theoretical problem of how one kind of knowledge is related to another kind. Martin characterizes kinds of knowledge as being either autonomous or synthetic. The latter are reducible to two or more of the autonomous (or irreducible) kinds of knowledge, viz., history (H), metaphysics (Meta), theology (T), formal logic (...) (FL), mathematics (Math), and generalizations of experimental science (G). Metaphysics and theology constitute the two domains of the ontological context while history and experimental science are the two domains of the phenomenological context. The relation of one kind of knowledge to another may be instrumental, constitutive, and/or regulative. For instance, historical propositions are constitutive of G, metaphysical propositions are regulative of G, and propositions in formal logic and mathematics are instrumental to G. Theological propositions are not related to G and so there is no conflict between science and theology. Martin's work sheds light on the possible areas of incompatibility between science and religion. (shrink)

In this paper, I explore the problems of cultivating a critical attitude in pedagogy given problems with accounts grounded in critical social theory, rational liberalism and pragmatic esthetic theory. I offer instead an alternative account of criticism for education in open, pluralistic, liberal, democratic societies called 'pedagogy of difference' that is grounded in the diversity liberalism of Isaiah Berlin and the dialogical philosophy of Martin Buber. In our current condition in which there is no agreement as to the proper (...) criteria for assessing attitudes and actions, for a critical attitude to gain a foothold one must learn to evaluate proposed beliefs and behaviour-based standards within a particular tradition as well as those drawn from another viewpoint. To know oneself, one must engage others who are different. But to engage others in a meaningful way one must be immersed in a tradition to which one is heir or with which one chooses to affiliate. (shrink)

Globalization is a part of modern life. Sharing a common set of professional nursing values is critical in this global environment. The purpose of this research was to examine the professional values of nursing students from two distinct cultural perspectives. Nurse educators in Taiwan partnered with nurse educators in the United States to compare professional values of their respective graduating nursing students. The American Nurses Association Code of Ethics served as the philosophical framework for this examination. The convenience sample comprised (...) 94 Taiwanese students and 168 US students. Both groups reported high scores on an overall measure of values. They did differ substantially on the relative importance of individual items related to advocacy, competence, education, self-evaluation, professional advancement, and professional associations. Global implications for the collaborative practice of nurses from different cultures working together can be improved by first recognizing and then attending to these differences in value priorities. (shrink)