ObjectivesTo describe reporting of informed consent in pragmatic trials, justifications for waivers of consent and reporting of alternative approaches to standard written consent. To identify factors associated with (1) not reporting and (2) not obtaining consent.MethodsSurvey of primary trial reports, published 2014–2019, identified using an electronic search filter for pragmatic trials implemented in MEDLINE, and registered in ClinicalTrials.gov.ResultsAmong 1988 trials, 132 (6.6%) did not include a statement about participant consent, 1691 (85.0%) reported consent had been obtained, 139 (7.0%) reported a (...) waiver and 26 (1.3%) reported consent for one aspect (eg, data collection) but a waiver for another (eg, intervention). Of the 165 trials reporting a waiver, 76 (46.1%) provided a justification. Few (53, 2.9%) explicitly reported use of alternative approaches to consent. In multivariable logistic regression analyses, lower journal impact factor (p=0.001) and cluster randomisation (p<0.0001) were significantly associated with not reporting on consent, while trial recency, cluster randomisation, higher-income country settings, health services research and explicit labelling as pragmatic were significantly associated with not obtaining consent (all p<0.0001).DiscussionNot obtaining consent seems to be increasing and is associated with the use of cluster randomisation and pragmatic aims, but neither cluster randomisation nor pragmatism are currently accepted justifications for waivers of consent. Rather than considering either standard written informed consent or waivers of consent, researchers and research ethics committees could consider alternative consent approaches that may facilitate the conduct of pragmatic trials while preserving patient autonomy and the public’s trust in research. (shrink)

Randomized controlled trial trial designs exist on an explanatory-pragmatic spectrum, depending on the degree to which a study aims to address a question of efficacy or effectiveness. As conceptualized by Schwartz and Lellouch in 1967, an explanatory approach to trial design emphasizes hypothesis testing about the mechanisms of action of treatments under ideal conditions, whereas a pragmatic approach emphasizes testing effectiveness of two or more available treatments in real-world conditions. Interest in, and the number of, pragmatic trials has grown substantially (...) in recent years, with increased recognition by funders and stakeholders worldwide of the need for credible evidence to inform clinical decision-making. This increase has been accompanied by the onset of learning healthcare systems, as well as an increasing focus on patient-oriented research. However, pragmatic trials have ethical challenges that have not yet been identified or adequately characterized. The present study aims to explore the views of key stakeholders with respect to ethical issues raised by the design and conduct of pragmatic trials. It is embedded within a large, four-year project that seeks to develop guidance for the ethical design and conduct of pragmatic trials. As a first step, this study will address important gaps in the current empirical literature with respect to identifying a comprehensive range of ethical issues arising from the design and conduct of pragmatic trials. By opening up a broad range of topics for consideration within our parallel ethical analysis, we will extend the current debate, which has largely emphasized issues of consent, to the range of ethical considerations that may flow from specific design choices. Semi-structured interviews with key stakeholders, across multiple jurisdictions, identified based on their known experience and/or expertise with pragmatic trials. We expect that the study outputs will be of interest to a wide range of knowledge users including trialists, ethicists, research ethics committees, journal editors, regulators, healthcare policymakers, research funders and patient groups. All publications will adhere to the Tri-Agency Open Access Policy on Publications. (shrink)

Emerging adult newlywed couples often experience many demands on their time, and three common problems may surface as couples try to balance these demands—problems related to finances, sleep, and sex. We used two waves of dyadic data from 1,001 emerging adult newlywed couples to identify four dyadic latent profiles from husbands’ and wives’ financial management behaviors, sexual satisfaction, and sleep quality: Flounderers, Financially Challenged Lovers, Drowsy Budgeters, and Flourishers. We then examined how husbands’ and wives’ marital satisfaction, in relation to (...) profile membership, varied at a later wave. We found that Financially Challenged Lovers and Flourishers had significantly higher marital satisfaction than Drowsy Budgeters and Flounderers. Whereas, Financially Challenged Lovers and Flourishers did not differ in terms of marital satisfaction, Drowsy Budgeters seemed to have slightly higher marital satisfaction than Flounderers for wives only. However, we did not find evidence that these connections meaningfully differed by sex. Implications for the efforts of clinicians and educators are discussed. (shrink)

Introduction: Schools have become a primary setting for providing mental health care to youths in the U.S. School-based interventions have proliferated, but their effects on mental health and academic outcomes remain understudied. In this study we will implement and evaluate the effects of a flexible multidiagnostic treatment called Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems on students' mental health and academic outcomes.Methods and Analysis: This is an assessor-blind randomized controlled effectiveness trial conducted across five (...) school districts. School clinicians are randomized to either MATCH or usual care treatment conditions. The target sample includes 168 youths referred for mental health services and presenting with elevated symptoms of anxiety, depression, trauma, and/or conduct problems. Clinicians randomly assigned to MATCH or UC treat the youths who are assigned to them through normal school referral procedures. The project will evaluate the effectiveness of MATCH compared to UC on youths' mental health and school related outcomes and assess whether changes in school outcomes are mediated by changes in youth mental health.Ethics and Dissemination: This study was approved by the Harvard University Institutional Review Board. We plan to publish the findings in peer-reviewed journals and present them at academic conferences.Clinical Trial Registration:ClinicalTrials.gov ID: NCT02877875. Registered on August 24, 2016. (shrink)

On Simone Weil’s “Pythagorean” view, mathematics has a mystical significance. In this paper, the nature of this significance and the coherence of Weil’s view are explored. To sharpen the discussion, consideration is given to both Rush Rhees’ criticism of Weil and Vance Morgan’s rebuttal of Rhees. It is argued here that while Morgan underestimates the force of Rhees’ criticism, Rhees’ take on Weil is, nevertheless, flawed for two reasons. First, Rhees fails to engage adequately with either the assumptions underlying Weil’s (...) religious conception of philosophy or its dialectical method. Second, Rhees’ reading of Weil reflects an anti‐Platonist conception of mathematics his justification of which is unsound and whose influence impedes recognition of the coherence of Weil’s position. (shrink)

Herbert Spencer was regarded by the Victorians as the foremost philosopher of the age, the prophet of evolution at a time when the idea had gripped the popular imagination. Until recently Spencer's posthumous reputation rested almost excusively on his social and political thought, which has itself frequently been subject to serious misrepresentation. But historians of ideas now recognise that an acquaintance with Spencer's thought is essential for the proper understanding of many aspects of Victorian intellectual life, and (...) the present selection is designed to answer this need. It provides a cross-section of Spencer's works from his more popular and approachable essays to a number of the volumes of the Synthetic Philosophy itself. (shrink)

: A virtually unknown philosopher of the twentieth century, Spencer Heath was nevertheless well-known as a pioneer in the early development of commercial aviation. He retired from business in 1931 to devote the last thirty years of his life to his long-time interest in the philosophy of science and human social organization. He developed ….

In the early 2000s, Esteban Burchard and his colleagues defended a controversial route to the view that there’s a racial classification of people that’s useful in medicine. The route, which I call ‘Burchard’s route,’ is arguing that there’s a racial classification of people that’s useful in medicine because, roughly, there’s a racial classification with medically relevant genetic differentiation :1170–1175, 2003). While almost all scholars engaged in this debate agree that there’s a racial classification of people that’s useful in medicine in (...) some way, there’s tremendous controversy over whether any racial scheme is useful in medicine because there are medically relevant genetic differences among those races : 564–565, 2016). The goal of this paper will be to show that Burchard’s route is basically correct. However, I will use a slightly different argument than Burchard et al.’s in order to provide a firmer foundation for the thesis, both metaphysically and genetically. I begin by reviewing Burchard’s route and its critics. Second, I present an original argument for establishing Burchard et al.’s conclusion using a Burchard-like route. I call it ‘Spencer’s route’. I reply to major objections along the way, and I end with a summary. (shrink)

A sharp distinction between religion and science is, it is argued here, implicit in Rush Rhees's thought. This distinction is, moreover, underpinned by a view of philosophy as purely descriptive, which Rhees shares with Wittgenstein. The first half of this paper criticises both the distinction and this view of philosophy. The second half is constructive rather than critical. A pattern of reasoning in religion is explored, which offers a possibility of insight to those afflicted by the tragic and premature loss (...) of loved ones; a pattern of a kind which is effectively denied by Rhees. Logical relations between this reasoning in religion and reasoning in physics are then discussed, which lend further support to the earlier critical arguments. These relations also exhibit aspects of the coherence of the conception of the world as a divinely created Cosmos, which is consistent with classical theism. (shrink)

The debate about the ethical implications of Artificial Intelligence dates from the 1960s :741–742, 1960; Wiener in Cybernetics: or control and communication in the animal and the machine, MIT Press, New York, 1961). However, in recent years symbolic AI has been complemented and sometimes replaced by Neural Networks and Machine Learning techniques. This has vastly increased its potential utility and impact on society, with the consequence that the ethical debate has gone mainstream. Such a debate has primarily focused on principles—the (...) ‘what’ of AI ethics —rather than on practices, the ‘how.’ Awareness of the potential issues is increasing at a fast rate, but the AI community’s ability to take action to mitigate the associated risks is still at its infancy. Our intention in presenting this research is to contribute to closing the gap between principles and practices by constructing a typology that may help practically-minded developers apply ethics at each stage of the Machine Learning development pipeline, and to signal to researchers where further work is needed. The focus is exclusively on Machine Learning, but it is hoped that the results of this research may be easily applicable to other branches of AI. The article outlines the research method for creating this typology, the initial findings, and provides a summary of future research needs. (shrink)

This volume consists of a collection of articles published by Spencer in leading Victorian periodicals, such as The Westminster Review, The Fortnightly Review and Mind. The wide range of subjects explored includes science, philosophy, aesthetics, ethics, psychology and politics.

This early essay of Spencer's was originally published anonymously in The Leader for March 20 1852. It was the second contribution in a regular series entitled "The Haythorne Papers". Spencer's identity was revealed some while after. It is reproduced in Herbert Spencer, Essays Scientific, Political & Speculative, Williams and Norgate (3 vols 1891) pp.1 7]; and here in full. David Clifford, Ph.D., Cambridge University, prepared the html text in 1997; George P. Landow reformatted it in 2008.

There is a long tradition of employing a phenomenological approach to gain greater insight into the unique experience of psychiatric illness. Researchers in this field have shed light upon a distur...

The Study of Sociology, by English philosopher, biologist, anthropologist, and sociologist, Herbert Spencer, was originally published in 1873. Spencer was known for his contributions to evolutionary theory and for applying it outside of biology, to the fields of philosophy, psychology, and within sociology. In particular, this work is a survey of the foundations of sociology, by one of its founders. Within which he applies the idea of natural selection to the group survival and institutional structures.

Seeking a decision theory that can handle both the Newcomb problems that challenge evidential decision theory and the unstable problems that challenge causal decision theory, some philosophers recently have turned to ‘graded ratifiability’. However, the graded ratifiability approach to decision theory is, despite its virtues, unsatisfactory; for it conflicts with the platitude that it is always rationally permissible for an agent to knowingly choose their best option.

This article analyses Camille Henrot’s 2013 film Grosse Fatigue in relation to the histories of hypermedia and modes of interaction with the World Wide Web. It considers the development of non-hierarchical systems for the organisation of information, and uses Grosse Fatigue to draw comparisons between the Web, the natural history museum and the archive. At stake in focusing on the way in which information is organised through hypermedia is the question of subjectivity, and this article argues that such systems are (...) made ‘user-friendly’ by appearing to accommodate intuitive processes of information retrieval, reflecting the subject back to itself as autonomous. This produces an ideology of individualism which belies the forms of heteronomy that in fact shape and structure access to information online in significant ways. At the heart of this argument is an attention to the visual, and the significance of art as an immanent mode of analysis. Through the themes of transparency and opacity, and order and chaos, the article thus proposes a defining dynamic between autonomy and automation as a model for understanding the contemporary subject. (shrink)

In this highly original study of the nature of performance, Spencer Golub uses the insights of Ludwig Wittgenstein into the way language works to analyze the relationship between the linguistic and the visual in the work of a broad range of dramatists, novelists, and filmmakers, among them Richard Foreman, Mac Wellman, Peter Handke, David Mamet, and Alfred Hitchcock. Like Wittgenstein, these artists are concerned with the limits of language’s representational capacity. For Golub, it is these limits that give Wittgenstein’s (...) thought a further, very personal significance—its therapeutic quality with respect to the Obsessive Compulsive Disorder from which he suffers. Underlying what Golub calls “performance behavior” is Wittgenstein’s notion of “pain behavior”—that which gives public expression to private experience. Golub charts new directions for exploring the relationship between theater and philosophy, and even for scholarly criticism itself. (shrink)

The ideas upon which public education was founded in the last half of the nineteenth century were wrong. And despite their continued dominance in educational thinking for a century and a half, these ideas are no more right today. So argues one of the most original and highly regarded educational theorists of our time in 'Getting It Wrong from the Beginning'. Kieran Egan explains how we have come to take mistaken concepts about education for granted and why this dooms our (...) attempts at educational reform. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

Here I will re-purpose Nozick’s (1974) “Experience Machine” thought experiment against hedonism into an argument against Veritic Epistemic Consequentialism. According to VEC, the right action, epistemically speaking, is the one that results in at least as favorable a ratio of true to false belief as any other action available. A consequence of VEC is that it would be epistemically right to outsource all your cognitive endeavors to a matrix-like “True Belief Machine” that uploads true beliefs through artificial stimulation. Rather than (...) reflecting, inferring or inquiring, all of your beliefs would be the product of updates coming from the machine. This implication of VEC is counter intuitive. I will spend much of the paper considering defensive maneuvers and showing them to be lacking. The problem with going in for the True Belief Machine seems to be that the subject forfeits her autonomy. There has been much work lately on the virtue of intellectual autonomy and some of it has the potential to explain what is epistemically amiss about plugging into the machine. However, I will argue that the proponent of VEC cannot appeal to it without abandoning her preferred order of explanation. (shrink)