Robust technology infrastructure is needed to enable learning health care systems to improve quality, access, and cost. Such infrastructure relies on the trust and confidence of individuals to share their health data for healthcare and research. Few studies have addressed consumers’ views on electronic data sharing and fewer still have explored the dual purposes of healthcare and research together. The objective of the study is to explore factors that affect consumers’ willingness to share electronic health information for healthcare and research. (...) This study involved a random-digit dial telephone survey of 800 adult Californians conducted in English and Spanish. Logistic regression was performed using backward selection to test for significant associations of each explanatory variable with the outcome variable. The odds of consent for electronic data sharing for healthcare decreased as Likert scale ratings for EHR impact on privacy worsened, odds ratio = 0.74, 95% CI [0.60, 0.90]; security, OR = 0.80, 95% CI [0.66, 0.98]; and quality, OR = 0.59, 95% CI [0.46–0.75]. The odds of consent for sharing for research was greater for those who think EHR will improve research quality, OR = 11.26, 95% CI [4.13, 30.73]; those who value research benefit over privacy OR = 2.72, 95% CI [1.55, 4.78]; and those who value control over research benefit OR = 0.49, 95% CI [0.26, 0.94]. Consumers’ choices about electronically sharing health information are affected by their attitudes toward EHRs as well as beliefs about research benefit and individual control. Design of person-centered interventions utilizing electronically collected health information, and policies regarding data sharing should address these values of importance to people. Understanding of these perspectives is critical for leveraging health data to support learning health care systems. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

The article explores the rich and varied experiences of a collective writing project, unfolding through an anecdote involving Charlie, a young boy who creatively disrupted conventional photography methods. This incident, during an evening promenade by the sea in Ericeira (Portugal), epitomizes the project's embrace of playfulness and exploration of diverse perspectives–materialized through Charlie's playful insistence on experimenting with different angles. The event embodied the group’s approach to writing, leading to a collective inquiry into the interplay of ages, angles, and other (...) themes like waves, threads, shadows, and liminal spaces. The project, driven by the Between Ages Collective, began with informal gatherings in Plymouth, UK, and expanded into a year-long online reading group. Participants, spanning different generations and academic stages, shared various materials, including films, picture books, and scholarly texts, which inspired individual contributions. Influenced by the Collective's collaborative spirit, these contributions explore the concept of 'between ages' – a metaphorical and literal space of transition and fluidity. Contributors were invited to craft pieces that delve into the 'between ages' theme, often exploring serendipitous moments that transform interactions and experiences. The writing tries to capture a sense of openness and curiosity, embracing the uncertainties and ambiguities inherent in the process. The works do not strictly adhere to conventional academic or narrative forms but rather emerge from the collective's shared experiences, including cooking, eating, swimming and walking together. The article suggests that these writings are not meant to be definitive or conclusive but are explorations that invite readers to engage with the mundane and profound textures of everyday life. The stories and themes explored are marked by their diversity in style, rhythm, and imagery, ranging from reflections on the philosophy of shadows to the profound implications of intergenerational and interspecies relationships. The Collective’s work is presented as an ongoing experiment in thinking and writing together, with each piece offering unique insights into the fluid and often blurred boundaries between different states of being. This openness to the in-between spaces brings into question the notion of fixed identities and experiences, inviting a more nuanced understanding of the relational dynamics that shape existence. The article allows the readers to delve into these narratives and engage with the myriad ways they resonate with broader themes of being, storying, and connecting. (shrink)

The legal requirements and justifications for collecting patient-identifiable data without patient consent were examined. The impetus for this arose from legal and ethical issues raised during the development of a population-based disease register. Numerous commentaries and case studies have been discussing the impact of the Data Protection Act 1998 and Caldicott principles of good practice on the uses of personal data. But uncertainty still remains about the legal requirements for processing patient-identifiable data without patient consent for research purposes. This is (...) largely owing to ignorance, or misunderstandings of the implications of the common law duty of confidentiality and section 60 of the Health and Social Care Act 2001. The common law duty of confidentiality states that patient-identifiable data should not be provided to third parties, regardless of compliance with the DPA1998. It is an obligation derived from case law, and is open to interpretation. Compliance with section 60 ensures that collection of patient-identifiable data without patient consent is lawful despite the duty of confidentiality. Fears regarding the duty of confidentiality have resulted in a common misconception that section 60 must be complied with. Although this is not the case, section 60 support does provide the most secure basis in law for collecting such data. Using our own experience in developing a disease register as a backdrop, this article will clarify the procedures, risks and potential costs of applying for section 60 support. (shrink)

Identifying the referent of novel words is a complex process that young children do with relative ease. When given multiple objects along with a novel word, children select the most novel item, sometimes retaining the word‐referent link. Prior work is inconsistent, however, on the role of object novelty. Two experiments examine 18‐month‐old children's performance on referent selection and retention with novel and known words. The results reveal a pervasive novelty bias on referent selection with both known and novel names and, (...) across individual children, a negative correlation between attention to novelty and retention of new word‐referent links. A computational model examines possible sources of the bias, suggesting novelty supports in‐the‐moment behavior but not retention. Together, results suggest that when lexical knowledge is weak, attention to novelty drives behavior, but alone does not sustain learning. Importantly, the results demonstrate that word learning may be driven, in part, by low‐level perceptual processes. (shrink)

Risk communicators often need to communicate probabilistic predictions. On occasion, an event with 10% likelihood will occur, or one with 90% likelihood will not – a probabilistically unexpected ou...

Fustel de Coulanges' thesis that ancient society was founded upon the cult of ancestral tombs has had, for a thoroughly self-contradictory argument, a remarkably successful career. Neither Fustel himself nor the many subsequent scholars who have quoted his views with approval faced clearly the difficulty of deriving a social structure dominated by corporate descent groups from the veneration of tombs placed in individually owned landed property. On the whole, historians have tended to play down Fustel's insistence on the relation between (...) ancestor-cult and property and to exaggerate the role of the corporate kin group. This tendency, which assimilates Fustel to Sir Henry Maine and other lawyers interested in the reconstruction of Indo-European institutions has in my view considerably impeded understanding of the role of kinship in early Greek society; it also obscures one of the most individual aspects of Fustel's work which, thanks to the researches of Philippe Ariès on the development of the modern tomb-cult in the nineteenth century, can now be placed in its historical context. (shrink)

Augustine made a significant contribution to the history of philosophical accounts of affectivity which scholars have not yet noticed. He resolved a problem with the Stoic theory as it was known to him: the question of the cognitive cause of "preliminary passions" ( propatheiai ), reflex-like affective reactions which must be immediately controlled if a morally bad emotion is to be avoided. He identified this cognitive cause as momentary doubt, as I demonstrate by citing passages from sermons spanning twenty-seven years (...) in which Augustine consistently used a particular set of scriptural images and phrases as precise analogies for mental and affective states. (shrink)

Three experiments explored online recognition in a nonspeech domain, using a novel experimental paradigm. Adults learned to associate abstract shapes with particular melodies, and at test they identified a played melody’s associated shape. To implicitly measure recognition, visual fixations to the associated shape versus a distractor shape were measured as the melody played. Degree of similarity between associated melodies was varied to assess what types of pitch information adults use in recognition. Fixation and error data suggest that adults naturally recognize (...) music, like language, incrementally, computing matches to representations before melody offset, despite the fact that music, unlike language, provides no pressure to execute recognition rapidly. Further, adults use both absolute and relative pitch information in recognition. The implicit nature of the dependent measure should permit use with a range of populations to evaluate postulated developmental and evolutionary changes in pitch encoding. (shrink)

Observational astronomy is plagued with selection effects that must be taken into account when interpreting data from astronomical surveys. Because of the physical limitations of observing time and instrument sensitivity, datasets are rarely complete. However, determining specifically what is missing from any sample is not always straightforward. For example, there are always more faint objects (such as galaxies) than bright ones in any brightness-limited sample, but faint objects may not be of the same kind as bright ones. Assuming they are (...) can lead to mischaracterizing the population of objects near the boundary of what can be detected. Similarly, starting with nearby objects that can be well observed and assuming that objects much farther away (and sampled from a younger universe) are of the same kind can lead us astray. Demographic models of galaxy populations can be used as inputs to observing system simulations to create “mock” catalogues that can be used to characterize and account for multiple, interacting selection effects. The use of simulations for this purpose is common practice in astronomy, and blurs the line between observations and simulations; the observational data cannot be interpreted independent of the simulations. We will describe this methodology and argue that astrophysicists have developed effective ways to establish the reliability of simulation-dependent observational programs. The reliability depends on how well the physical and demographic properties of the simulated population can be constrained through independent observations. We also identify a new challenge raised by the use of simulations, which we call the “problem of uncomputed alternatives.” Sometimes the simulations themselves create unintended selection effects when the limits of what can be simulated lead astronomers to only consider a limited space of alternative proposals. (shrink)

Objective: Clock variance is an important statistic in many clinical and developmental studies. Existing methods require a large number of trials for accurate clock variability assessment, which is problematic in studies using clinical or either young or aged participants. Furthermore, these existing methods often implicitly convolute clock and memory processes, making it difficult to disentangle whether the clock or memory system are driving the observed deviations. Here we assessed whether twenty repeated productions of a well-engrained interval (1 second), a task (...) that does not incorporate memory updating nor the processing of feedback, could provide an accurate assessment of clock variability. Method: Sixty-eight undergraduate students completed two tasks: a 1-second production task in which they were asked to produce a 1-second duration by ending a tone by a keypress, and a multi-duration reproduction task. Durations presented in the reproduction task were tones lasting 1.17, 1.4 and 1.68 seconds. No feedback was presented in either task, and the order of presentation was counterbalanced between participants. Results: The observed central tendency in the reproduction task was better explained by models including the measures of clock variability derived from the 1-second production task than by models without it. Three clock variability measures were calculated for each participant (standard deviation, root mean squared residuals (RMSR) from an estimated linear slope, and RMSR scaled by mean production duration). The model including the scaled RMSR was prefered over the alternative models, and no notable effects of the order of presentation were observed. These results suggest that (1) measures of variability should account for drift, (2) the presentation of another timing task before a 1-second production task did not influence the assessment of the clock variability, and (3) the observed variability adheres to the scalar property and predicts temporal performance, and is thus a usable index of clock variability. Conclusion: This study shows that just 20 repeated productions of 1 second provide a reliable index of clock variability. As administering this task is fast and easy, it could prove to be useful in a large variety of developmental and clinical populations. (shrink)

Individuals have different experiences of work when they are self-employed, when they perform tasks in the gig economy, and when they follow directives from managers. But such differences are not represented in some of the most prominent non-ideal theories of work. These describe workers as a coherent group, with a position in the structure of the liberal capitalist economy. I present an alternative that does better at acknowledging difference, through a description of work and workers that has greater ‘pluralism’ and (...) less ‘unifying coherence’. Some might insist that their ‘unifying’ description has superior empirical plausibility. But if ‘pluralistic’ descriptions are valid rivals to provide an accurate characterization of our current condition, then we should consider whether their use in theory can serve valuable aims. I identify the distinctive and valuable non-ideal aims – epistemic, evaluative, and normative – that can be pursued with ‘pluralistic’ descriptions of work and workers. (shrink)

The Strangeness of Gods combines studies of changes in modern interpretations of Greek religion with studies of changes in Athenian ritual. The combination is necessary in order to combat influential stereotypes: that Greek religion consisted of ritual without theological speculation, that ritual is inherently conservative. To re-examine the evidence for Greek rituals and their interpretation is also to re-examine our own preconceptions and prejudices. The argument presented by S. C. Humphreys tries to bring Greek texts closer to the `classic' texts (...) of other civilizations, and religion, as a form of speculative thought, closer to science. Her studies of Athenian rituals put this emphasis on changing interpretations into practice, showing that the Athenians thought about their rites as well as celebrating them. (shrink)

Much research has explored developing sound representations in language, but less work addresses developing representations of other sound patterns. This study examined preschool children's musical representations using two different tasks: discrimination and sound–picture association. Melodic contour—a musically relevant property—and instrumental timbre, which is less musically relevant, were tested. In Experiment 1, children failed to associate cartoon characters to melodies with maximally different pitch contours, with no advantage for melody preexposure. Experiment 2 also used different-contour melodies and found good discrimination, whereas (...) association was at chance. Experiment 3 replicated Experiment 2, but with a large timbre change instead of a contour change. Here, discrimination and association were both excellent. Preschool-aged children may have stronger or more durable representations of timbre than contour, particularly in more difficult tasks. Reasons for weaker association of contour than timbre information are discussed, along with implications for auditory development. (shrink)

Two recent books consider the future of trade governance.Consent and Tradeproposes reforms to trade agreements so that states can consent more freely to their terms.On Trade Justicedefends reforms to the World Trade Organization, arguing that multilateralism is the foundation for a “new global deal” on trade. Each book describes trade's distinctive features and proposes a principle to regulate both trade and trade governance.Consent and Tradedefends a principle of respect for state consent in trade agreements.On Trade Justiceoffers a theory of trade (...) justice that requires nonexploitation. Consent and nonexploitation are important principles for economic exchanges. However, trade governance and trade itself are different forms of cooperation, with different agents and different interests at stake. Consent and nonexploitation are less compelling as principles for trade governance than for trade itself. Both books understate the conflict between their principles for trade governance and liberal justice. (shrink)

Some recent trade decisions, such as the U.S.’s imposition of protectionist measures against China, have attracted fervent popular support as well as outrage. Critics of these trade policies argue that they fail to promote society’s own interests. This paper catalogues the different ways that trade decisions can hinder and facilitate a society’s pursuit of social justice. I adopt a simple description of trade liberalization: a society forgoes the use of certain policy options, in order to pursue greater economic productivity through (...) increased trade flows. Using this simple descriptive account, the paper identifies two pathways for a society’s trade policies to shape its pursuit of social justice. First, greater economic productivity improves a society’s capacities to realize justice, especially distributive justice. I will argue that the value of greater economic capacities depends upon the society’s existing capacities and its inclinations to pursue justice. When a society has greater capacities and fails to extend their benefits to its worse-off citizens, these citizens have more serious grounds for complaint. Second, a society forgoes certain policy options when it liberalizes trade, and some of these options may be instrumentally valuable or even necessary for the society’s pursuit of justice. I will argue that, under non-ideal conditions, it can be desirable for a society to limit its own policy space so it cannot feasibly select policies that are unjust. Certain protectionist policies have taken on the expressive meaning that some groups are inferior in social and moral status. (shrink)

Well-being advocates state that it provides a more holistic, humanistic focus for public policy. Paradoxically, however, well-being debates tend to be dominated by highly quantitative, de-contextualised statistical methods accessible to only a minority of technical experts. This paper argues the need to reverse this trend. Drawing on original primary mixed method research in Zambia and India it shows the critical contribution of qualitative methods to the development of a quantitative model of subjective perspectives on well-being. Such contributions have a political, (...) ethical and practical urgency if subjective measures of well-being are to be used in policy. (shrink)

Shortages of life-saving medical resources caused by COVID-19 have prompted hospitals, healthcare systems, and governmentsto develop crisis standards of care, including 'triage protocols' to potentially ration medical supplies during the public health emergency. At the same time, the pandemic has highlighted and exacerbated racial, ethnic, and socioeconomic health disparities that together constitute a form of structural racism. These disparities pose a critical ethical challenge in developing fair triage systems that will maximize lives saved without perpetuating systemic inequities. Here we review (...) alternatives to 'utilitarian' triage, including first-come first-served, egalitarian, and prioritarian systems of allocating scarce medical resources. We assess the comparative advantages and disadvantages of these allocation schemes. Ultimately, we argue that while triage protocols should not exacerbate disparities, they are not an adequate mechanism for redressing systemic health inequities. Entrenched health disparities must be addressed through broader social change. (shrink)

Computer simulations of the formation and evolution of large-scale structure in the universe are integral to the enterprise of modern cosmology. Establishing the reliability of these simulations has been extremely challenging, primarily because of epistemic opacity. In this setting, robustness analysis defined by requiring converging outputs from a diverse ensemble of simulations is insufficient to determine simulation validity. We propose an alternative path of structured code validation that applies eliminative reasoning to isolate and reduce possible sources of error, a potential (...) path that is already being explored by some cosmologists. (shrink)

Theories of cognitive development must address both the issue of how children bring their knowledge to bear on behavior in-the-moment, and how knowledge changes over time. We argue that seeking answers to these questions requires an appreciation of the dynamic nature of the developing system in its full, reciprocal complexity. We illustrate this dynamic complexity with results from two lines of research on early word learning. The first demonstrates how the child's active engagement with objects and people supports referent selection (...) via memories for what objects were previously seen in a cued location. The second set of results highlights changes in the role of novelty and attentional processes in referent selection and retention as children's knowledge of words and objects grows. Together this work suggests that understanding systems for perception, action, attention, and memory, and their complex interaction, is critical to understand word learning. We review recent literature that highlights the complex interactions between these processes in cognitive development and point to critical issues for future work. (shrink)

In her recent book, Svärd uses theories of hierarchical and heterarchical power to reveal how women wielded power within the highest echelons of the Assyrian Empire. Svärd determines that the queen occupied a distinct position in the state hierarchy, separate from the king, and that only one woman at a time could be queen. The queen could retain her post even after the king died, though the new king could replace her if he deemed it necessary. The king decided the (...) queen mother’s role, depending on political circumstances. Both queens and queen mothers ran large, lucrative estates and participated in religious ceremonies. During the Sargonid period, military units were attached to their households. In some official spheres of action, their power could be qualitatively similar to that of the king, and in a crisis, they could even act for him. Other women associated with the palace, such as royal daughters, female administrators, and workers, were more apt to develop power heterarchically, through petitions, negotiation, or communication networks. Wishing to expand upon her theoretical approach, Svärd has studied diachronic changes in Assyrian queenship, concluding that the office developed to meet the needs of family and dynasty. In addition, I argue here that the demands of an expanding empire required the king to delegate authority to trusted relatives. Thus, as the empire reached its peak under the Sargonid kings, royal women naturally gained power and prominence, and kings benefited. For example, the queen’s prosperous estates and business ventures allowed her to help fund the military as well as some temples and building projects, and so defray the costs to the throne. All of this shows that Assyrian women had individual agency and authority, and could influence the king’s decisions. Despite the value of theory, it is also necessary to consider women individually, in the context of their times, and as they responded to unique circumstances. (shrink)

The Scourge of God: The Umman-manda and Its Significance in the First Millennium BC. By Selim Ferruh Adali. State Archives of Assyria Studies, vol. 20. Helsinki: The Neo-Assyrian Text Corpus ProJect, 2011. Pp. xviii + 218. $62.

Patients fit with cochlear implants commonly indicate at the time of device fitting and for some time after, that the speech signal sounds abnormal. A high pitch or timbre is one component of the abnormal percept. In this project, our aim was to determine whether a number of years of CI use reduced perceived upshifts in frequency spectrum and/or voice fundamental frequency. The participants were five individuals who were deaf in one ear and who had normal hearing in the other (...) ear. The deafened ears had been implanted with a 18.5 mm electrode array which resulted in signal input frequencies being directed to locations in the spiral ganglion that were between one and two octaves higher than the input frequencies. The patients judged the similarity of a clean signal presented to their implanted ear and candidate, implant-like, signals presented to their normal-hearing ear. Matches to implant sound quality were obtained, on average, at 8 months after device activation and at 35 months after activation. At Time 1, the matches to CI sound quality were characterized, most generally, by upshifts in the frequency spectrum and in voice pitch. At Time 2, for four of the five patients, frequency spectrum values remained elevated. For all five patients F0 values remained elevated. Overall, the data offer little support for the proposition that, for patients fit with shorter electrode arrays, cortical plasticity nudges the cortical representation of the CI voice toward more normal, or less upshifted, frequency values between 8 and 35 months after device activation. Cortical plasticity may be limited when there are large differences between frequencies in the input signal and the locations in the SG stimulated by those frequencies. (shrink)

We examine the reverse mathematical strength of a variation of Hindman’s Theorem (HT) constructed by essentially combining HT with the Thin Set Theorem to obtain a principle that we call thin-HT. This principle states that every coloring c:N→N has an infinite set S⊆N whose finite sums are thin for c, meaning that there is an i with c(s)≠i for all nonempty sums s of finitely many distinct elements of S. We show that there is a computable instance of thin-HT such (...) that every solution computes ∅′, as is the case with HT, as shown by Blass, Hirst, and Simpson (1987). In analyzing this proof, we deduce that thin-HT implies ACA0 over RCA0+IΣ20. On the other hand, using Rumyantsev and Shen’s computable version of the Lovász Local Lemma, we show that there is a computable instance of the restriction of thin-HT to sums of exactly 2 elements such that any solution has diagonally noncomputable degree relative to ∅′. Hence there is a computable instance of this restriction of thin-HT with no Σ20 solution. (shrink)

In response to the need for a more diverse workforce, our medical school developed new policies and procedures that focus on the recruitment and selection of diverse students with a specific focus on those considered underrepresented in medicine. To understand what these students bring to the practice of medicine, researchers investigated their perception of their cultural assets and how they plan to use these assets as physicians. A cross-section of 23 ethnically, culturally, and geographically diverse medical students were interviewed and (...) data were analyzed through phenomenographical methods. The results indicate that students view themselves as having multiple assets that could be of significant value in their future practice of medicine, including: a) an interest in science and access to family members in medicine, b) personal and familial struggles with health, c) self and family as immigrants, and d) strong family and community orientations. Students perceived these as cultural assets because they could directly identify where these assets could be valuable in medicine but questioned how to maintain them throughout medical school. Now that our institution has identified these assets, next steps include administrators' investigation of ways to leverage them through curricular and educational programs. (shrink)

Worry proneness is a transdiagnostic trait that predicts increased negative affect (NA), potentially in the service of preventing negative emotional contrasts. Although discrete types of NA vary along the dimension of arousal, the extent to which trait worry predicts high vs. low arousal forms of NA in daily life is unclear. This distinction has important implications for conceptualising how worry may perturb adaptive emotionality in various disorders. The present study (not pre-registered) aimed to isolate the effects of trait worry on (...) high (N = 88) and low (N = 122) arousal NA in daily life using ecological momentary assessment while controlling for potential physical and psychological confounds. Participants were assessed for trait worry and depressive symptoms at baseline then reported their affect, heart rate, and exercise three times per day for one week. Multilevel models revealed that trait worry predicted both increased high and low arousal NA after controlling for momentary heart rate, daily exercise, and depression. In contrast, baseline depressive symptoms only predicted low arousal NA in daily life. Findings support the contrast avoidance model of worry and suggest that worry is linked to increased state NA in daily life, independent of arousal. (shrink)