This detailed 1990 book describes the light and dark adaptation of receptoral and post-receptoral mechanisms from a number of perspectives. The authors emphasise the importance of the study of achromatopsia, a rare congenital condition in which the visual mechanisms that mediate day vision are absent whilst those that mediate night vision remain intact.

The article examines the patient-doctor relationship, relying on Michel Foucault’s concept of the clinical gaze. We argue that during the last decades, a profound transformation of the social nature of medicine took place, one that Foucault’s understanding of the clinical gaze cannot adequately account for. First, the article offers an elaboration of the three-node network of clinical gaze, the clinic, and nosology to explain the positioning of the doctor and the patient within the specific (...) social ontology generated by the rise of medicine. We then discuss intensive but irresolute developments brought by technological advancements, especially the X-ray tube. Finally, we argue that in the contemporary clinic, equipped with a plethora of sophisticated devices, the position of the doctor endured the most radical transformation in comparison with Foucault’s proponent of the clinical gaze at the dawn of modern medicine. (shrink)

Background Caring behaviour is critical for nursing quality, and the clinical internship environment is a crucial setting for preparing nursing students for caring behaviours. Evidence about how to develop nursing students’ caring behaviour in the clinical environment is still emerging. However, the mechanism between the clinical internship environment and caring behaviour remains unclear, especially the mediating role of moral sensitivity and the moderating effect of self-efficacy. Research objective This study aimed to examine the mediating effect of moral (...) sensitivity and the moderating function of self-efficacy on the association between the clinical internship environment and caring behaviours. Research design A cross-sectional design used acceptable validity scales. The hypothesised moderated mediation model was tested in the SPSS PROCESS macro. Participants and research context This survey collected data from 504 nursing students in an internship at a teaching hospital in Changsha, China. Ethical considerations This study was pre-approved by the ethics committee of the medical school (No. E2022210). Informed consent was obtained from all students. Results The clinical internship environment ( B = 0.450, 95% CI = [0.371, 0.530]) and moral sensitivity ( B = 1.352, 95% CI = [1.090, 1.615]) had positive direct effects on nursing students' caring behaviours. Clinical internship environment also indirectly influenced students’ caring behaviours via moral sensitivity ( B = 0.161, 95% CI = [0.115, 0.206]). In addition, self-efficacy played a moderating role between the clinical internship environment and caring behaviours ( B = 0.019, 95% CI = [0.007, 0.031]), as well as the relationship between the clinical internship environment and moral sensitivity ( B = 0.006, 95% CI = [0.003, 0.010]). Conclusion Moral sensitivity mediates the effect of the clinical internship environment on caring behaviour, and self-efficacy strengthens both direct and indirect effects. This study emphasises the importance of self-efficacy in developing moral sensitivity and caring behaviours in nursing students. (shrink)

The blink response to visual threat is a standard bedside method for testing visual processing. In response to a sudden gesture directed toward the eyes, a person with a normal blink response will promptly contract both orbicularis oculi muscles to close the eyelids momentarily. There is no consensus as to whether blinking to visual threat (BVT) is purely reflex1 or a cognitively mediated behavior that heralds consciousness; i.e., is incompatible with the diagnosis of the vegetative state (VS).2,3 Some authors (...) stated that “one should be extremely cautious in making the diagnosis of the VS when there is . . . response to threatening gestures.”4 Others stated that “react(ion) to visual threat” is a “compatible but atypical feature” of VS.5 Similarly, other guidelines stated that the “threat response is usually absent” in VS.6 Finally, BVT was not mentioned in some workgroup criteria on the minimally conscious state.7 The aim of the study was to determine the incidence of BVT in patients whose clinical features are in all other respects typical of the VS, as assessed by means of validated testing.7 We also investigated whether the presence of BVT in patients considered vegetative is predictive of recovery of consciousness. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical Bioethics at NIH:History and A New VisionJohn C. Fletcher (bio)On July 3, 1995, Dr. John I. Gallin, Director of the Magnuson Clinical Center of the National Institutes of Health (NIH), convened a one-day "Conference on the Future of Clinical Bioethics at the National Institutes of Health Intramural Program." Conferees included NIH officials and a panel of consultants from bioethics programs around the nation.1 The subject (...) was the future of NIH's intramural bioethics program and specifically a vision of a new multi-component program, presented by Dr. Gallin, the first speaker. Dr. Harold Varmus, Director of NIH, was there to assure his support for Dr. Gallin's vision. This author, honored to be second speaker, was invited to sketch a brief history of bioethics at NIH. The present article reviews some of this history and then reports on Dr. Gallin's proposal, points of consensus among speakers and conferees, and the search for a Chief of the Clinical Bioethics Program.History of Bioethics at NIHIt is often said that NIH is a well-kept secret as the nation's leading biomedical research facility. Also, few people know that NIH has a long history in bioethics. Some key events in that history are shown in Figure 1, beginning with two that occurred prior to the birth of bioethics. NIH made an early policy response to protect human subjects of research and to find acceptable limits for scientific freedom. The Clinical Center (CC), a 550-bed research hospital, opened in 1953. A subcommittee of the Medical Board, the Clinical Research Committee (CRC), was formed for prior group review of all studies with normal volunteers. The traditional practice was for researchers themselves to decide when studies would begin, which subjects to recruit, and whether informed consent would be sought. The CRC intervention bit into this tradition. In addition, patient studies that posed significant risks or departed widely from medical practice were reviewed by referral from the Clinical Directors of the various Institutes. Was this CRC an early institutional review [End Page 355] board (IRB)? As a guest researcher, I was permitted to observe the CRCs meetings between 1966 and 1969. It functioned much like an IRB but had no community or non-scientist members. Other IRB-like review groups undoubtedly existed prior to the CRC. Robert Levine (personal communication, September 7, 1995) recalls that Beth Israel Hospital in Boston had one in 1938. Historical research is clearly needed on the earliest forms of research review.Table 1. Bioethics at NIHEventYearClinical Research Committee1953Surgeon-General's PPO #1291966NIGMS funds Hastings Genetics Group1973OPRR's Mission1974NLM's grant to KennedyInstitute for Bibliography of Bioethics1974Recombinant DNA Advisory Committee1974STEP Series Bioethics Speakers1975Pre-IRBs at the CC1975-76Assistant for Bioethics to Director, CC1977RAC-Human Gene Therapy Subcommittee1983Lipsett Proposal (ICD)1983Liaison Group, CC1983Bioethics Program, CC1985Durable Power of Attorney for Researchwith Incapacitated Subjects1985-86NLM funds National Reference Centerfor Bioethics Literature1985National Institute for Nursing Research1986Bioethics Post-Doctoral Fellows Program1989ELSI Program1989Bioethicists on CC-IRBs1989CC-Ethics Committee1990Office of Human Subjects Research1992 [End Page 356]Between 1963 and 1967, the media exposed instances of ethically troubling research, and Beecher (1966) and Pappworth (1967) published sharp criticisms of the weak state of research ethics. In 1966, Surgeon-General William Stewart and NIH Director James Shannon issued a policy requiring local group review of all research involving human subjects before making an application for NIH peer review (Surgeon General 1966). The policy was the first in any nation to mandate ethics committees for clinical research. However, it did not apply to the NIH intramural program until Congress passed the National Research Act in 1974 (Public Law 93-348; 202, 88 Stat. 342, 1974). This lag permitted NIH intramural investigators the luxury of feeling above the norms imposed on ordinary mortals and guaranteed more resistance to the inevitable change to come. Resistance to change marked the intramural program from the mid-1960s to the mid-1970s... (shrink)

In his article In Between Us, Yoni van den Eede expands existing theories of mediation into the realm of the social and the political, focusing on the notions of opacity and transparency. His approach is rich and promising, but two pitfalls should be avoided. First, his concept of ‘in-between’ runs the risk to conceptualize mediation as a process ‘between’ pre-given entities. On the basis of current work in postphenomenology and actor-network theory, though, mediation should rather be seen as the origin (...) of entities, not as an intermediary between them. Second, Van den Eede’s separate discussion of transparency and opacity in ‘use’ and in ‘context’ runs the risk to make invisible the complementarity of the two dimensions. While transparency of use embodies an experiential form of the distinction between transparency and opacity, transparency of context embodies a more cognitive dimension of the distinction. Only by linking the two it becomes possible to take responsibility for the impact that technological mediations can have. Users and designers need a ‘double vision’ to simultaneously see the transparency of both use and context. (shrink)

The considerable prominence of internet addiction (IA) in adolescence is at least partly explained by the limited knowledge thus far available on this complex phenomenon. In discussing IA, it is necessary to be aware that this is a construct for which there is still no clear definition in the literature. Nonetheless, its important clinical implications, as emerging in recent years, justify the lively interest of researchers in this new form of behavioral addiction. Over the years, studies have associated IA (...) with numerous clinical problems. However, fewer studies have investigated what factors might mediate the relationship between IA and the different problems associated with it. Ours is one such study. The Italian version of the SCL-90 and the IAT were administered to a sample of almost 800 adolescents aged between 16 and 22 years. We found the presence of a significant association between IA and two variables: somatization (β = 7.80; p < 0.001) and obsessive-compulsive symptoms (β = 2.18; p < 0.05). In line with our hypothesis, the results showed that somatization predicted the relationship between obsessive-compulsive symptoms and IA (β = −2.75; t = −3.55; p < 0.001), explaining 24.5% of its variance (ΔR2 = 1.2%; F = 12.78; p < 0.01). In addition, simple slopes analyses revealed that, on reaching clinical significance (+1 SD), somatization showed higher moderation effects in the relationship between obsessive-compulsive symptoms and IA (β = 6.13; t = 7.83; p < 0.001). These results appear to be of great interest due to the absence of similar evidence in the literature, and may open the way for further research in the IA field. Although the absence of studies in the literature does not allow us to offer an exhaustive explanation of these results, our study supports current addiction theories which emphasize the important function performed by the enteroceptive system, alongside the more cited reflexive and impulsive systems. (shrink)

Background: Ethical behaviour in nursing practice is integral to establishing a harmonious nurse-patient relationship and improving the quality of care. A multitude of factors shapes such behaviour. Therefore, it is crucial to understand the interplay between these factors. Research objectives: This study aimed to explore the mechanisms underlying the influence of moral sensitivity on nurses’ ethical behaviour and clarify the mediating role of moral courage. Research design: This cross-sectional quantitative study was conducted between July and August 2023. Participants and Research (...) Context: The sample comprised 465 clinical nurses from three tertiary hospitals in Zhengzhou City, Henan Province, China. Data were collected using the Chinese version of the Moral Sensitivity Questionnaire-Revised Version, Nurses’ Moral Courage Scale, and Ethical Behaviour Scale for Nurses. Data analysis was performed with SPSS 26.0 and AMOS 24.0, using descriptive statistics, Pearson correlation analysis, structural equation modelling, and bootstrapping methods. Ethical considerations: This study was approved by the Ethical Review Committee of Life Sciences of Zhengzhou University, China. Results: The participants were predominantly female (95.1%), with a mean age of 31.9 years. Moral courage and moral sensitivity were positively correlated with ethical behaviour. Moral sensitivity was positively associated with moral courage. Moral courage partially mediates the relationship between moral sensitivity and ethical behaviour. The indirect effect of nurses’ moral sensitivity on ethical behaviour was quantified through moral courage (indirect effect = 0.290). Conclusion: Moral courage intermediates nurses’ moral sensitivity and ethical behaviour. This conclusion provides nursing administrators with the insight that improving clinical nurses’ moral sensitivity and courage can contribute to ensuring appropriate ethical behaviour. (shrink)

This article starts with a brief historical account of the ongoing debate about the status of clinical ethics: theory of practice. The author goes on to argue that clinical ethics is best understood as a practice. However, its practicality should not be measured by the extent to which clinical-ethical consultants manage to mediate or negotiate resolutions to ethical conflicts. Rather, clinical ethics is practical because it is characterized by a profound concern for the well-being of individual (...) patients as well as the moral parameters of swift and urgent medical action in the face of limited supportive information. (shrink)

Mediation in a legal sense is a means of alternative dispute resolution (ADR). Having evolved in the USA in the last half of 20th century the procedure is growing in popularity and proliferation all over the world. Many countries enacted particular legislation, and others included relevant articles into Civil and/or Criminal Procedure Codes. Howbeit, lawyers are to be aware of mediation and roles they may play within the process. Law school curriculum drafters face the challenge of including a new up-to-date (...) course in mediation into busy and very full academic programmes. Analysis of existing instructing practice showed that in Anglo-American law schools mediation teaching is a part of clinical legal education. As for European countries, there is a broad range of scenarios and no established experience. Recognition of communicative skills as key skills for mediators prompts the use of a CLIL approach in structuring such a course. Listening, reframing, summarising, questioning are skills to be mastered by law-students both in a foreign language and their mother tongue. Language teachers are in charge of this part of the course while law teachers can work out text contents built on the branches of law mediators deal with more often (family law, employment law, contracts, etc.). Moreover, some texts may cover mediation law in a home country and abroad. Another important factor to take into account is a career path chosen by a law-student – if s/he is going to become a mediator or a lawyer securing clients in mediation. Role plays and scenarios are an integral part of the course. Moreover, the course developed can serve as an introduction to internship in a law clinic. (shrink)

Contrasting traditional and common forms of ethics consultation with bioethics mediation, I describe the case of a “second opinion” consultation in the care of a patient with advanced cancer for whom treatment was futile. While the initial ethics consultation, performed by a colleague, led to a recommendation that some may deem ethical, the process failed to involve key stakeholders and failed to explore the underlying values and reasons for the opinions voiced by various stakeholders. The process of mediation ultimately led (...) to creative solutions in which all stakeholders could reach consensus on a plan of care. (shrink)

Cognitive therapies are often biased in their assessment of clinical problems by their emphasis on the role of verbally-mediated thought in shaping our emotions, and in stressing the influence of thought upon feeling. Alternatively, a more phenomenological appraisal of psychological dysfunction suggests that emotion and thinking are complementary processes which influence each other. Cognitive psychology developed out of information-processing models, whereas phenomenological psychology is rooted in a philosophical perspective which avoids the assumptions of positivist methodology. But, despite their (...) different origins, the two disciplines overlap and complement each other. This book, originally published in 1995, illustrates how feeling states are a crucial component of mental health problems and, if adequately differentiated, can result in a greater understanding of mental health. (shrink)

David KC Cooper,1 David Ayares21Thomas E Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; 2Revivicor, Blacksburg, VA, USA: The transplantation of organs and cells from pigs into humans could overcome the critical and continuing problem of the lack of availability of deceased human organs and cells for clinical transplantation. Developments in the genetic engineering of pigs have enabled considerable progress to be made in the experimental laboratory in overcoming the immune barriers to successful xenotransplantation. With regard (...) to pig organ xenotransplantation, antibody- and cell-mediated rejection have largely been overcome, and the current major barrier is the development of coagulation dysregulation. This is believed to be due to a combination of immune activation of the vascular endothelial cells of the graft and molecular incompatibilities between the pig and primate coagulation–anticoagulation systems. Pigs with new genetic modifications specifically directed to this problem are now becoming available. With regard to less complex tissues, such as islets, neuronal cells, and corneas, the remaining barriers are less problematic, and graft survival in nonhuman primate models extends for >1 year in all three cases. In planning the initial clinical trials, consideration will be concentrated on the risk–benefit ratio, based to a large extent on the results of preclinical studies in nonhuman primates. If the benefit to the patient is anticipated to be high, eg, insulin-independent control of glycemia, and the potential risks low, eg, minimal risk of transfer of a porcine infectious agent, then a clinical trial would be justified.Keywords: infection, pigs, genetically-engineered, xenotransplantation, islets, xenotransplantation, organs. (shrink)

Blindsight is the term commonly used to describe visually guided behaviour elicited by a stimulus falling within the scotoma (blind area) caused by a lesion of the striate cortex. Such is normally held to be unconscious and to be mediated by subcortical pathways involving the superior colliculus. Blindsight is of considerable theoretical importance since it suggests that destriate man is more like destriate monkey than had been previously believed and also because it supports the classical notion of two visual (...) systems. It is also of potential clinical importance, since it has been claimed recently that systematic practice in blindsight can lead to the recovery of normal visual function in patients with cortical lesions. From a review of the literature it is concluded that all of the phenomena of blindsight can be attributed either to light scatter into unimpaired parts of the visual field or to residual vision resulting from spared striate cortex. The possible contribution f other factors is also considered. It is concluded that blindsight studies have generally failed to control for such nonblindsight interpretations partly because of poor methodology and partly because of difficulties in defining the term. (shrink)

Pre-natal exposure to acute maternal trauma or chronic maternal distress can confer increased risk for psychiatric disorders in later life. Acute maternal trauma is the result of unforeseen environmental or personal catastrophes, while chronic maternal distress is associated with anxiety or depression. Animal studies investigating the effects of pre-natal stress have largely used brief stress exposures during pregnancy to identify critical periods of fetal vulnerability, a paradigm which holds face validity to acute maternal trauma in humans. While understanding these effects (...) is undoubtably important, the literature suggests maternal stress in humans is typically chronic and persistent from pre-conception through gestation. In this review, we provide evidence to this effect and suggest a realignment of current animal models to recapitulate this chronicity. We also consider candidate mediators, moderators and mechanisms of maternal distress, and suggest a wider breadth of research is needed, along with the incorporation of advanced -omics technologies, in order to understand the neurodevelopmental etiology of psychiatric risk. (shrink)

Opinions about cognitive enhancement (CE) are context-dependent. Prior research has demonstrated that factors like peer pressure, the influence of authority figures, competition, moral relevance, familiarity with enhancement devices, expertise, and the domain of CE to be enhanced can influence opinions. The variability and malleability of patient, expert, and public attitudes toward CE is important to describe and predict because these attitudes can influence at-home, clinical, research, and regulatory decisions. If individual preferences vary, they could influence opinions about practices and (...) regulations due to disagreements about the desirable levels of risks and benefits. The study of attitudes about CE would benefit from psychological theories that explain judgments. In particular, we suggest that variability in risk and benefit sensitivity could psychologically mediate judgments about CE in many contexts. Drawing from prospect theory, which originated in behavioral economics, it is likely that framing effects, shifted reference points, and the tendency to weigh losses (risks) more heavily than gains (benefits) predict decisions about CE. We suggest that public policy could benefit from a shared conceptual framework, such as prospect theory, that allows us to describe and predict real-world decisions about CE by patients, experts, and the public. (shrink)

Aims This study aims to examine the mediating effect of moral distress on the relationship between moral resilience and the intention to leave. Background Moral distress is a phenomenon that negatively impacts healthcare workers, healthcare institutions, and recipients. To eliminate or minimize the negative effects of moral distress, it is necessary to increase the moral resilience of nurses. Moral resilience is important in protecting against the negative effects of moral distress, such as burnout and turnover intention. In this direction, it (...) is necessary to increase the moral resilience of nurses to reduce negative situations such as turnover intention in nurses. Methods It is a descriptive–predictive study. Sociodemographic Information Form, Measure of Moral Distress – Healthcare Professionals, and Rushton Moral Resilience Scale were used to collect data from the nurses. A total of 220 clinical nurses were recruited. Ethical considerations Approval was obtained from the university’s non-interventional ethics committee, and informed consent was obtained from the participants. Results The study found a total moral distress score of 6.39 ± 0.3.12 and moral resilience score of 2.69 ± 0.48. A moderate and weak negative correlation was found between moral distress and moral resilience. Moral distress has a moderating effect on the intention to leave nursing (β = −0.158, p =.010) and the intention to leave the current position (β = −0.174, p =.000). Individual’s moral resilience directly affects the intention to leave. The presence of moral distress eliminates the direct effect of moral resilience and affects the intention to leave together with moral resilience. Conclusions Moral resilience leads to decreased intention to leave, and moral distress mediates this situation. An increase in moral distress decreases moral resilience and increases intention to leave. It can be assumed that if moral distress is not controlled, increasing moral resilience will not affect the intention to leave the job. (shrink)

Curiosity is a personality trait that is inversely related to depression and positively related to subjective wellbeing. However, the relationship between curiosity and these two outcomes is still unclear which hampers our general understanding of well-being. Based on research within positive psychology that showed character strengths such as curiosity can indirectly decrease depression, we hypothesized that the inverse relationship between curiosity and depression would be mediated by subjective well-being. Two hundred and fifty seven participants, between 18 and 64 years (...) old completed a web-based survey comprising: The Curiosity and Exploration Inventory - II, Center for Epidemiological Studies - Depression and the Steen Happiness Index. We found that well-being mediated the relationship between curiosity and depression. The results indicate that curious individuals tend to report higher levels of subjective well-being which, in turn, is associated with lower levels of depression. Our findings contribute to the understanding of positive results obtained from clinical samples that underwent positive psychotherapy of depression. (shrink)

In a society where mobility, globalization and contact with people from other cultures have become its basic descriptors, the enhancement of plurilingualism and intercultural understanding seem to be of the utmost concern. From a Positive Psychology Perspective, agency is the human capacity to affect other people positively or negatively through their actions. This agentic vision can be related to mediation, a concept rooted in the socio-cultural learning theory where social interaction is considered a fundamental cornerstone in the development of (...) cognition. Social interactions in the language learning setting may be facilitated through musical activities due to its social bonding effect. This paper tries to offer insights on how a musical-mediated experience in language learning may develop students’ interpersonal and collaborative competences to become active members of a more inclusive society. Mediation, considered as a paradigm shift in the foreign language classroom and the different out-of-class language learning possibilities, could also provide an environment where learners maximize their emotional intelligence. Our paper focuses on this paradigm shift spearheaded by the CEFR Companion Volume and the considerable repercussions it is bound to have for foreign language didactics, as cooperative tasks become central to foreign language learning. We hypothesize that mediated language learning experiences imply a socioemotional change in learners, focusing on the others, on their needs and interests, by trying to help them understand texts, concepts or facilitating communication with their peers. An intervention with a musical-mediated language learning experience was designed and implemented in the classroom. A self assessment scale with mediation descriptors and the socioemotional expertise scale (SEE) were administered. Results show that students become more mindful of their strengths, of their capacity for collaborating and team working. This leads to more awareness of their mediation skills. Students’ mediation skills correlate significantly with their socio-emotional skills, more concretely with their expressivity. The implementation of a musical-mediated experience also promoted tolerance and enhanced learners’ intrinsic motivation for language learning at the same time as they acknowledged their diversity. (shrink)

ObjectivesTo explore the objectives and outcomes most appropriate for evaluating clinical ethics support services (CESs) in the USA.MethodsA three-round e-Delphi was sent to two professional medical ethics listservs (Medical College of Wisconsin-Bioethics and American Society for Bioethics and Humanities) as well as 19 individual experts. The survey originally contained 15 objectives and 9 outcomes. In round 1, participants were asked to validate the content of these lists. In round 2, we had 17 objectives and 10 outcomes, and participants were (...) asked to rank them for appropriateness in a top 10 list of objectives and a top 5 list of outcomes.ResultsParticipants came to a high(at least 70%) level of agreement on seven objectives: mediate, educate, develop policy, improve the moral quality of a decision or action, counsel, create a moral space and manage moral distress. Participants came to a moderate (at least 51%) level of agreement on three objectives: empower, awareness of ethics and preventative ethics. Participants also came to a moderate (at least 51%) level of agreement on five outcomes: ethical justification, transformation of institution, improvement of quality of life, principled consensus and satisfaction with the expertise of a CES.ConclusionThis e-Delphi identified 10 objectives and 5 outcomes that are a good starting point for developing outcome measures to evaluate CESs in the USA, while reminding us of the diversity of perspectives still evident in the field. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Clinical Ethics: Balancing Praxis and TheoryEdmund D. Pellegrino (bio)When André Hellegers founded the Kennedy Institute, he envisioned a close collaboration between ethics and clinical practice. He even called for physician specialists whose expertise would be in both fields (Reich 1994, p. 324). A quarter of a century later, his vision and prediction have become realities. Clinical ethics is today a thriving entity with its own (...) literature, practitioners, and methodology.This clinical turn has, on the whole, been salutary. The abstractness of ethical theory has been tempered by the concreteness of clinical realities; clinicians have been helped to make bedside decisions even in the face of theoretical uncertainty and dissonance; and a variety of disciplines besides theology and philosophy have entered ethical discourse and enriched it.These advantages notwithstanding, clinical ethics has certain inherent traits that make it problematical. Some seek its norms in what “works” in practice or in paradigm cases (Jonsen and Toulmin 1988); others shape it to achieve consensus or satisfy the needs of public policy (Meilaender 1995); still others reduce bioethics to merely a method for the resolution of moral conflict. Rather than simply modulating theory by practice, clinical ethics can end up by repudiating theory entirely (Toulmin, in press). Taken to their logical conclusion, these tendencies make clinical ethics a species of the antifoundationalism that has strongly influenced moral philosophy in the last decade (Tollefsen 1995, pp. 3–18; Rockmore and Singer 1992). But antifoundationalism itself is a theory of ethics even though it supposedly denies the validity of any overarching theories.Antifoundationalism presents its own difficulties. For one thing it begs important questions that will not go away: for example, how do we know that a decision is a good one? what does it mean to say that a decision “works”? is the [End Page 347] outcome of a good decisional procedure itself a good decision? and to what extent are compromise and exigency admissible in moral decisions? Theoretical and “foundational” questions of this sort will not evaporate because they are ignored. They inevitably will be answered by begging the essential questions or grounding them solely in prelogical presuppositions.To avoid these difficulties, the advantages of clinical ethics must be retained without capitulation to the anti-theory bias of contemporary philosophy. This means that theory and practice must both be retained and be conceptually related to each other. To effect this we must take account of the long intellectual history of the relationship between the speculative and the practical intellect—i.e., between knowledge sought for its own sake and knowledge sought for some use beyond simply the possession of it (Lobkowicz 1967, pp. 78–81). Suffice it to say that medicine has long been the paradigm case for the union of theory and praxis. Relating them conceptually is an essential propaedeutic to any theory of moral praxis in medicine.The rest of this essay examines the inextricability of theory and practice in two of the three major branches of clinical ethics—the substantive and the professional. The third branch, procedural ethics—i.e., the ethics of the process of decision making—deals with informed consent, with respect for persons, professional colleagues, and families, and with the ethics of conflict resolution. Obviously, there are theoretical issues here as well. For want of space, procedural ethics will not be discussed, but it presents the same conjunction of theory and practice encountered in professional and substantive ethics.Substantive EthicsSubstantive ethics refers to the moral content rather than the process of moral decisions, to the moral status and permissibility of the specific clinical medical acts themselves—e.g., abortion, euthanasia, pre-implantation diagnosis, surrogate motherhood, withholding and withdrawing treatment, the physician as gatekeeper, and the like—the whole range of moral questions clinicians face in treating patients. Moral diversity and plurality on these issues is the most powerful force behind the dominance of procedural ethics. But, unfortunately, a morally valid decision-making procedure does not confer normative validity on the decision itself. Moral validity rests on questions that go beyond prevailing practices, on what we take to be the nature and moral status of persons, fetuses, and brain-damaged humans, the value or disvalue of... (shrink)

Chad A Witt, Ramsey R Hachem Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, Saint Louis, MO, USA: The role of donor-specific antibodies to human leukocyte antigens and the burden of antibody-mediated rejection in lung transplantation remain enigmatic. Over the past several years, evidence has been emerging that humoral immunity plays an important role in the development of both acute and chronic lung allograft dysfunction. Multiple case reports and case series have (...) identified lung allograft recipients with clinical findings consistent with acute AMR. However, there is currently no widely accepted definition for AMR in lung transplantation, and this has been a significant barrier to furthering our understanding of this form of rejection. Nonetheless, the development of DSA after transplantation has consistently been identified as an independent risk factor for persistent and high-grade acute cellular rejection and CLAD. This has raised the possibility that chronic AMR may be a distinct phenotype of CLAD although evidence supporting this paradigm is still lacking. Additionally, antibodies to lung-restricted self-antigens have been associated with primary graft dysfunction early and the development of CLAD late after transplantation, and emerging evidence underscores significant interactions between autoimmunity and alloimmunity after transplantation. There is currently an active International Society for Heart and Lung Transplantation working group that is developing an operational definition for AMR in lung transplantation. This will be critical to improve our understanding of this form of rejection and conduct clinical trials to identify optimal treatment strategies. This review will summarize the literature on DSA and AMR in lung transplantation and discuss the impact of antibodies to self-antigens on lung allograft dysfunction. Keywords: antibody-mediated rejection, donor-specific antibodies, lung transplantation. (shrink)

(This version was submitted to Behavioral and Brain Science. A revised version was published by Biological Theory) Estimates of autism’s incidence increased 5-10 fold in ten years, an increase which cannot be genetic. Though many mutations are associated with autism, no mutation seems directly to cause autism. We need to find the direct cause. Complexity science provides a new paradigm - confirmed in biology by extensive hard data. Both the body and the personality are complex dynamic systems which spontaneously self-organize (...) from simple dynamic systems. Autism may therefore be caused by the failure of a simple dynamic system. We know that infants who cannot track their mother’s face often become autistic, that eye-contact initiates intersubjectivity which is blocked in autism, and that the infant-mother pair seems designed to promote eye-contact, as does the eye’s appearance. This author earlier proposed that failure of eye-contact might directly cause autism and that early non-maternal childcare, including television/video, would therefore be statistically linked to autism. Waldman et al. (2008; 2006) recently proved that autism is strongly linked to precipitation (indoor activity) and to the introduction of cable. The most plausible explanation? Early exposure to television/video is linked to autism. Furthermore a normal developmental cascade (blocked in autism) has been deciphered: (a) Infant-mother eye-contact triggers increased maternal attention. (b) Early maternal attention permanently increases not only baseline vasopressin but also that oxytocin release which is triggered by subsequent maternal attention. (c) Vasopressin and oxytocin promote face recognition, gazing-at-the-eyes, emotion recognition, and social bonding. The eye-contact hypothesis suggests a clinical study addressing prevention: recruit prospective parents who agree to curtail television/video/computer/wi-fi in their families; measure autism’s incidence in their children. (shrink)

In 1996, President Clinton offered a promissory vision for human genetics when he said: “I think it won't be too many years before parents will be able to go home from the hospital with their newborn babies with a genetic map in their hands that will tell them, here's what your child's future will likely be like.”The rapid evolution of genetic sequencing technologies has advanced that vision. In October 2006, the cost of sequencing an entire human genome was (...) $10.4 million; by 2014 the cost had decreased a thousand fold. The term next generation sequencing describes a variety of laboratory methods that allow efficient determination of the precise order of nucleotides in a DNA sequence. The papers in this issue of the Journal of Law, Medicine & Ethics focus on “clinical NGS,” which refers to rapid DNA sequencing using second-, third- and fourth-generation sequencing technologies to perform genome-wide sequencing of multiple genes or alleles for clinical prognostic, diagnostic, and therapeutic purposes. (shrink)

Based on upper echelons, paradox, and social capital theory, this study extends the association of CEO vision articulation and feedback-seeking behavior with firm sustainability by identifying the mediating role of eco-innovation and top management team boundary-spanning behavior as a moderator. By analyzing the data of mid-sized to large Chinese firms using hierarchical regression and bootstrapping-based moderated path analysis, we found that product and process eco-innovation mediates the link between CEO vision articulation and firm sustainability while CEO feedback-seeking behavior (...) enhances firm’s sustainability through product eco-innovation only. Finally, conditional indirect effects show the vital role of TMT boundary-spanning behavior in facilitating CEOs to improve the firm’s long-term sustainability through eco-innovation. (shrink)

In Stig Hjarvard’s characterization, mediatization studies move beyond the positivist origins of the social sciences, as they must in order to avoid the fundamental contradiction between original commitments to classical determinism vis-à-vis human agency as acknowledged within mediatization studies. In order to sustain and enhance Hjarvard’s vision of the coherence between human agency and mediatization studies as a species of social science, I first sharpen these theoretical tensions by developing a robust account of human freedom as informed by Kant (...) and virtue ethics. I then adopt precise understandings of complementarity and epistemological pluralism as initially developed in Quantum Mechanics and subsequently by Karen Barad and Judith Simon as frameworks that can coherently conjoin contemporary social science with strong accounts of human freedom. The resulting coherency—or entanglement—between ethics and science implies new ethical responsibilities for social scientists as ‘virtuous agents’. (shrink)

The process of medicalization has been analyzed in the medical humanities with disapprobation, with much emphasis placed on its ability to reinforce existing social power structures to ill effect. While true, this is an incomplete picture of medicalization. I argue that medicalization can both reinforce and disrupt existing social hierarchies within the clinic and outside of it, to ill or good effect. We must attend to how this takes place locally and globally lest we misunderstand how medicalization mediates power and (...) justice. I provide concrete examples of how this occurs by considering dysesthesia ethiopsis, autism, chronic fatigue syndrome, depression, and HIV/AIDS. (shrink)

This mixed methods study investigates whether technology mediated collaborative practices during a professional development (PD) session led to growth in the collective efficacy of 21 special education teachers at an independent 1-12 school in Southeastern Virginia. This school specializes in individualized instruction for students with learning differences not limited to Autism Spectrum Disorder, Attention Deficit Hyperactivity Disorder, Specific Learning Disability, and their comorbidities. Teacher collective efficacy, which subsumes cohesive perceptions of classroom learning and behavior management, has been shown as (...) strongly related to student achievement and healthy school culture. Mastery experiences with specific tasks related to teaching and learning can spur collective efficacy. Cutting-edge technologies (Vibe and Newline collaborative all-in-one hardware and software interfaces) were used to engage teachers in an interdisciplinary vision boarding activity to outline academic, social, and technological goals within and across subject areas. Teachers also engaged in a behavior management reflection exercise. Pre- and post-survey analysis was conducted using a paired samples t-test, showing overall growth in collective efficacy after the brief PD session. Regression analyses revealed that technology savvy teachers grew most in collective efficacy. Network analysis of vision board output and a descriptive analysis of the behavior management surveys showed that teachers became united in interdisciplinary goals for learning, and in strategies for behavior management through conversational practices. (shrink)

A vivid and bizarre dream conjures up a myriad of novel mental images. The same exact images can be created volitionally when awake. The neurological mechanisms of these two processes are different. The voluntary combination of mental objects is mediated by the lateral prefrontal cortex and patients with damage to the LPFC often lose this ability. Conversely, the combination of mental objects into novel images during dreaming does not depend on the LPFC; LPFC is inactive during sleep and patients (...) whose LPFC is damaged do not notice a change in their dreams. Neither colloquial English nor scientific jargon has an established way to report on the origin of a conjured up mental image; the term “imagination” is regularly used to describe any experience generated internally whether voluntarily or involuntarily. Failing to distinguish be­tween voluntary and involuntary imagination leads to confusion in developmental psy­chology, neurolinguistics, and paleoanthropology. A comprehensive understanding of the distinction between voluntary and involuntary imagination will help develop better thera­py for children with language delay, contribute to a clearer understanding of the unique­ness of human language, and enable a more productive discussion of the evolutionary ori­gin of human language. (shrink)

Bioethics mediators manage a wide range of clinical conflict emanating from diverse sources. Parties to clinical conflict are often not fully aware of, nor willing to express, the true nature and scope of their conflict. As such, a significant task of the bioethics mediator is to help define that conflict. The ability to assess and apply the tools necessary for an effective mediation process can be facilitated by each mediator’s creation of a personal compendium of sources that generate (...) clinical conflict, to provide an orientation for the successful management of complex dilemmatic cases. (shrink)

Axel Honneth has had considerable success in grounding his normative social philosophy on recognitive structures, and the capacity of experiences of disrespect to stimulate “struggles for recognition.” These struggles for recognition are held to yield advances in social structure, and to expand the individual's capacity for self-realization. In this paper, I show that this account relies on a supressed dichotomy between the immediate pre-recognitive self, and the mediated self produced intersubjectively. I argue that this dichotomy persists beyond Honneth's explicit (...) use of Meadian terminology, and that Honneth relies on an unsophisticated account of mediation which, once critiqued, undermines his attempt to derive norms from recognition simpliciter. A promising alternative is found in Adorno's analysis of humanism and the category of the individual, which shows that true fidelity to the aims of humanism entails a rejection of humanism itself, as the individual is a proleptic category. (shrink)

We discuss the effectiveness of mediated communication (internet communication via a computer tablet) and tacit engagement in a Project on mental health. The project is aimed at improving the wellbeing of adult women living with chronic mental disorders in long-term psychiatric internment. The computer tablets act as "portals" to provide access and conatct with the outside world for patients who have poor (if any) external social support. This support includes a patient-centred psycho-social care, and accompanying clinical and pharmaceutical (...) treatment. Both patients and their relatives accepted the benefits of internet mediation, for very different reasons. For the patient, this is a flash of contact with humanity, and for the relatives the internet communication this proved to be an alternative to the need for physical proximity. As some patients had no relatives or friends to communicate (even remotely) with the outside world, and because there is a school next door to the clinic, we visualized that the communication between these two communities could provide both a therapeutic and poetic act of learning and compassion. The electronic portal could serve as a virtual bridge between two forbidden domains. Although awareness of students of the nearby school was raised about mental health, the use of internet mediation devoid of physical proximity made the students suspicious of the goal of the mediation. From the patient's side, however, each contact was an instance of joy. Several issues were raised from this exercise. (shrink)

The article examines the efficacy of social dialogue as a mechanism for addressing societal issues. While social dialogue was once viewed with great optimism, its effectiveness has waned in recent years, despite participants employing various persuasive strategies. The study distinguishes between two forms of dialogue: formal and substantive (productive), emphasizing that only the latter genuinely catalyzes shifts in participants’ perspectives. By analyzing historical examples and contemporary cases, the study identifies key factors that influence the success of social communication. Employing J.L. (...) Austin’s speech act theory, the article frames dialogue not merely as an exchange of information but as a form of social action, where the utterances of participants are performative, possessing the power to directly transform social reality. A historical case study is presented, examining the dialogue between Western-oriented Russian liberals who viewed their nation as socially and economically backward, and thinkers who challenged this assessment, perceiving Russia’s unique spiritual potential to address pan-European challenges. The statements of P.Ya. Chaadaev and F.M. Dostoevsky are analyzed as performative acts that shaped a new vision of Russia’s role in world history. Additionally, the author explores the role of identity in social dialogue, showing through examples from the lives of A.S. Pushkin and M.I. Tsvetaeva how identity structures can influence one’s openness or resistance to personal transformation in the face of internal conflict. The study hypothesizes that dialogue effectiveness correlates with participants’ ability to integrate new values into their identity without compromising its core. Furthermore, the author argues that rhetorical commitment to mediation alone is insufficient for bridging deep social divides and examines the historical social conditions required for effective mediation, such as a shared cultural foundations, formal dialogue platforms, robust legal frameworks, and flexible power structures. In conclusion, the author considers the question of whether it is inherently possible to create effective mechanisms for social dialogue under the current conditions of globalization and information society. (shrink)

This chapter sets out several views of empathy that draw not only on psychology's literature but on philosophical and psychiatric writings. Empathy is a set of complex concepts involving perception, emotion, attitudinal orientation, and other cognitive processes as well as an activity that expresses character traits and, hence, one of the virtues. In other words, an examination of the philosophical and clinical literature reveals empathy to be not one unified concept but instead a set of related characteristics and qualities (...) needed to be an ethical and therapeutically effective clinician. To this end, the chapter offers reasons as to why empathy is important to clinical work: empathy is both epistemically and ethically necessary to good social relations and, in particular, clinical relations. It then distinguishes empathy from a related concept called "world"-traveling and situates its relevance to therapeutic relations. Finally it brings these ideas together by highlighting Iris Murdoch's ideas of "just vision" and "loving attention.". (shrink)

The purpose of this paper is to introduce the notions of mediational fields and dynamic situated senses as a way to identify the structure of experiences, thoughts and their relations. To reach this purpose I draw some lessons from the debate between Dreyfus and McDowell about the structure of experience, from Cussins’s conception of mediational contents, and from Evans’s account of singular senses. I notice firstly that McDowell’s answer to Dreyfus consists in developing a practical and demonstrative notion of the (...) products of our conceptual capacities. A conception that entails that human experience is not entirely characterised in terms of an abstract specification of truth-conditions. McDowell and Cussins endorse Evans’s conception of singular senses. A specification that takes into account the dynamic and situated abilities involved in making reference. Whereas the first argues in favour of a conceptual conception of experience, the second one argues in favour of a nonconceptual conception. I introduce the notions of mediational fields and dynamic situated senses to argue that both converge in conceiving the contents of experience as mediational and not reducible to an abstract specification of truth-conditions. My proposal is to define a bidimensional space orthogonal to the conceptual/ nonconceptual, experience/thought, know-how/know-that dichotomies. Cognitive contents are ways to disclose the world both as mediational fields and as referential structures. The degree in which those elements are presented determine different varieties of cognition. I use the previous notions to develop the sketch of an account of singular, objective and contextual ways of cognition, and to argue that it is better to begin an enquiry about cognition with notions that do not presuppose a distinction between practical and intellectual capacities. (shrink)

In _Hidden Questions, Clinical Musings_, M. Robert Gardner chronicles an odyssey of self-discovery that has taken him beneath and beyond the categoies and conventions of traditional psychoanalysis. His essays offer a vision of psychoanalytic inquiry that blends art and science, a vision in which the subtly intertwining not-quite-conscious questions of analysand and analyst, gradually discerned, open to ever-widening vistas of shared meaning. Gardner is wonderfully illuminating in exploring the associations, images, and dreams that have fueled his own (...) analytic inquiries, but he is no less compelling in writing about the different perceptual modalities and endlessly variegated strategies that can be summoned to bring hidden questions to light. This masterfully assembled collection exemplifies the lived experience of psychoanalysis of one of its most gifted and reflective practitioners. In his vivid depictions of analysis oscillating between the poles of art and science, word and image, inquiry and self-inquiry, Gardner offers precious insights into tensions that are basic to the analytic endeavor. Evincing rare virtuosity of form and content, these essays are evocative clinical gems, radiating the humility, gentle skepticism, and abiding wonder of this lifelong self-inquirer. Gardner's most uncommon musings are a gift to the reader. (shrink)

This study attempts to examine the direct impact of corporate social responsibility initiatives on employees’ job performance and the indirect relationships between CSR initiatives on employees’ job performance via industrial relations climate and psychological contract fulfillment. Data were collected from 764 supervisor–subordinate dyads and 271 middle managers from 85 companies. Using a multilevel approach, the results showed that organizational-level CSR was positively related to employees’ job performance. Moreover, the industrial relations climate and psychological contract fulfillment played mediating effects between CSR (...) initiatives and job performance. This study provides novel theoretical evidence for why and how CSR initiatives improve job performance. Theoretical and practical implications for implementing CSR initiatives are discussed. (shrink)

Pragmatic disorders pose a barrier to effective communication in a significant number of children and adults. For nearly forty years, clinical investigators have attempted to characterize these disorders. This chapter examines the state of the art in clinical pragmatics, a subdiscipline of pragmatics that studies pragmatic disorders. The findings of recent empirical research in a range of clinical populations are reviewed. They include developmental pragmatic disorders found in autistic spectrum disorders, specific language impairment, intellectual disability and the (...) emotional and behavioural disorders, as well as acquired pragmatic disorders in adults with left- or right-hemisphere damage, traumatic brain injury, schizophrenia, and the dementias. Techniques used by clinicians to assess and treat pragmatic disorders are addressed. In recent years, theoretical frameworks with a cognitive orientation have increasingly been used to explain pragmatic disorders. Two such frameworks—relevance theory and theory of mind—will be examined in this essay. (shrink)

Amygdala is an intensively researched brain structure involved in social processing and multiple major clinical disorders, but its functions are not well understood. The functions of a brain structure are best hypothesized on the basis of neuroanatomical connectivity findings, and of behavioral, neuroimaging, neuropsychological and physiological findings. Among the heaviest neuroanatomical interconnections of amygdala are those with perirhinal cortex (PRC), but these are little considered in the theoretical literature. PRC integrates complex, multimodal, meaningful and fine-grained distributed representations of objects (...) and conspecifics. Consistent with this connectivity, amygdala is hypothesized to contribute meaningful and fine-grained representations of intangible knowledge for integration by PRC. Behavioral, neuroimaging, neuropsychological and physiological findings further support amygdala mediation of a diversity of such representations. These representations include subjective valence, impact, economic value, noxiousness, importance, ingroup membership, social status, popularity, trustworthiness and moral features. Further, the formation of amygdala representations is little understood, and is proposed to be often implemented through embodied cognition mechanisms. The hypothesis builds on earlier work, and makes multiple novel contributions to the literature. It highlights intangible knowledge, which is an influential but insufficiently researched factor in social and other behaviors. It contributes to understanding the heavy but neglected amygdala-PRC interconnections, and the diversity of amygdala-mediated intangible knowledge representations. Amygdala is a social brain region, but it does not represent species-typical social behaviors. A novel proposal to clarify its role is postulated. The hypothesis is also suggested to illuminate amygdala’s involvement in several core symptoms of autism spectrum disorder (ASD). Specifically, novel and testable explanations are proposed for the ASD symptoms of disorganized visual scanpaths, apparent social disinterest, preference for concrete cognition, aspects of the disorder’s heterogeneity, and impairment in some activities of daily living. Together, the presented hypothesis demonstrates substantial explanatory potential in the neuroscience, social and clinical domains. (shrink)

This unique book applies concepts from the field of anthropology to clinical settings to result in a powerful and dynamic model/theory of clinical anthropology.

Our society is heavily mediated by information technologies, so the simplest interactions become traceable, which collaborates to a deluge of data. They represent an abundant source for social analysis and an unparalleled opportunity for citizens to access, produce and disseminate information. Nevertheless, all this affluence of data, for presenting itself in a scattered way, also poses significant difficulties for achieving an integrated view of social reality and its interactions, and is organized in many competing interfaces and information architectures, that (...) may produce, reinforce and disseminate ideologies, hegemonic discourse and platform biases. We identify an emerging field of dispute of the place of mediation of the many flows of information, and efforts for repurposing and restructuring these flows over the seamless structuring of different competing architectures. In order to describe some of these efforts, we draw examples from the field of controversy mapping, and propose the concept of reverse mediation. (shrink)

Psychiatry has witnessed a new wave of approaches to clinical phenotyping and the study of psychopathology, including the National Institute of Mental Health’s Research Domain Criteria, clinical staging, network approaches, the Hierarchical Taxonomy of Psychopathology, and the general psychopathology factor, as well as a revival of interest in phenomenological psychopathology. The question naturally emerges as to what the relationship between these new approaches is – are they mutually exclusive, competing approaches, or can they be integrated in some way (...) and used to enrich each other? In this opinion piece, we propose a possible integration between clinical staging and phenomenological psychopathology. Domains identified in phenomenological psychopathology, such as selfhood, embodiment, affectivity, etc., can be overlaid on clinical stages in order to enrich and deepen the phenotypes captured in clinical staging (‘high resolution’ clinical phenotypes). This approach may be useful both ideographically and nomothetically, in that it could complement diagnosis, enrich clinical formulation, and inform treatment of individual patients, as well as help guide aetiological, prediction, and treatment research. The overlaying of phenomenological domains on clinical stages may require that these domains are reformulated in dimensional rather than categorial terms. This integrative project requires assessment tools, some of which are already available, that are sensitive and thorough enough to pick up on the range of relevant psychopathology. The proposed approach offers opportunities for mutual enrichment: clinical staging may be enriched by introducing greater depth to phenotypes; phenomenological psychopathology may be enriched by introducing stages of severity and disorder progression to phenomenological analysis. (shrink)

Mediators utilize a wide range of skills in the process of facilitating dialogue and resolving conflicts. Among the most useful techniques for clinical ethics consultants (CECs)—and surely the least discussed—are those employed in acrimonious, hostile conversations between stakeholders. In the context of clinical ethics disputes or other bedside conflicts, good mediation skills can reverse the negative interactions that have prevented the creation of workable treatment plans or ethical consensus. This essay lays out the central framework mediators use in (...) distinguishing positions from interests and describes a set of strategies for managing contentious ethics consultations or working with “difficult” patients, families, or patient-careprovider interactions. (shrink)

Cognitive Reserve, according to a recent consensus definition of the NIH-funded Reserve and Resilience collaboratory,1 is constituted by any mechanism contributing to cognitive performance beyond, or interacting with, brain structure in the widest sense. To identity multivariate activation patterns fulfilling this postulate, we investigated a verbal Sternberg fMRI task and imaged 181 people with age coverage in the ranges 20–30 and 55–70. Beyond task performance, participants were characterized in terms of demographics, and neuropsychological assessments of vocabulary, episodic memory, perceptual speed, (...) and abstract fluid reasoning. Participants studied an array of either one, three, or six upper-case letters for 3 s, then a blank fixation screen was presented for 7 s, to be probed with a lower-case letter to which they responded with a differential button press whether the letter was part of the studied array or not. We focused on identifying maintenance-related activation patterns showing memory load increases in pattern score on an individual participant level for both age groups. We found such a pattern that increased with memory load for all but one person in the young participants, and such a pattern for all participants in the older group. Both patterns showed broad topographic similarities; however, relationships to task performance and neuropsychological characteristics were markedly different and point to individual differences in Cognitive Reserve. Beyond the derivation of group-level activation patterns, we also investigated the inter-subject spatial similarity of individual working memory rehearsal patterns in the older participants’ group as a function of neuropsychological and task performance, education, and mean cortical thickness. Higher task accuracy and neuropsychological function was reliably associated with higher inter-subject similarity of individual-level activation patterns in older participants. (shrink)

Emergentism is generally viewed as a non‐materialist alternative to physicalism, although the exceptionally tolerant may count it as consistent with their physicalism. It disarms the threat of Causal Exclusion. The popular conception of explored emergentism is played off against two forms, including physical states and tokens of conscious states (c‐states). Emergentism competes not only with physicalism, but also with panpsychism. Panpsychism is the view that all matter has a conscious aspect. Panpsychism (and its various forms) suffers from several problems. This (...) chapter summarizes a few of the major ones. It scratches the surface of the issues separating emergentism and physicalism, on the one hand, and emergentism and panpsychism, on the other. However, perhaps enough has been divulged to show that emergentism is a live option, a serious candidate when trying to discover a c‐state's place in concrete reality. (shrink)

Whereas it appears that direct, or causal, theories dominate philosophy’s theories of reference, and it is widely held that they present an insuperable obstacle for a fictional character’s name to refer, I attempt to show not only that they can be easily made compatible with such theories, but that reference to the fictional fits rather smoothly into the distinctive articles of current theories of direct reference. However, the issues about reference to fictional characters goes well beyond those points, so its (...) compatibility with direct referential theories is not a demonstration that names of fictional things in fact refer. This essay argues only that certain popular objections to fictional reference are unsound. Moreover, if those references were to occur, it would remove a serious self-inflicted conundrum over negative existentials, one from which those raising it seem unable to extract themselves credibly. (shrink)