This manuscript describes the institutional and clinical considerations that apply to the question of whether to mandate opioid dose reduction in patients who have received opioids long-term. It describes how a calamitous rise in addiction and overdose involving opioids has both led to a clinical recalibration by healthcare providers, and to strong incentives favoring forcible opioid reduction by policy making agencies. Neither the 2016 Guideline issued by the Centers for Disease Control and Prevention nor clinical evidence can justify or promote (...) such policies as safe or effective. (shrink)

Marshall et al. (2024) identify a potential ethical conflict between the principles of beneficence and respect for patient autonomy when patients refuse to remain in an emergency department (ED) fo...

It is a commonly held belief among many psychological scientists that the more plausible a hypothesis, the better it is scientifically. It is also often believed that if there are two alternative theories which are equally strong in terms of explanatory power, one should choose the plausible theory over the implausible one. The goal of this article is to challenge these assumptions. Based on Popper's philosophical views, it will be argued that psychological scientists should be encouraged to formulate implausible hypotheses (...) and theories. Examples from other scientific disciplines will be presented to illustrate this argument. 2012 APA, all rights reserved). (shrink)

Despite the significant contribution of cognitive-behavioral therapy to effective treatment options for specific syndromes, treatment progress has been stagnating, with response rates plateauing over the past several years. This stagnation has led clinical researchers to call for an approach that instead focuses on processes of change and the individual in their particular context. Process-based therapy is a general approach representing a model of models, grounded in evolution science, with an emphasis on idiographic methods, network models of case conceptualization, and enhancing (...) wellbeing. In this paper, we describe the theory underlying PBT and present a case study for how to apply PBT tools and principles to deliver process-informed and person-centered evidence-based treatment. In addition, we discuss lessons learned from our case and provide suggestions for future considerations when implementing PBT in clinical settings. (shrink)

Since 2000, research within positive psychology has exploded, as reflected in dozens of meta-analyses of different interventions and targeted processes, including strength spotting, positive affect, meaning in life, mindfulness, gratitude, hope, and passion. Frequently, researchers treat positive psychology processes of change as distinct from each other and unrelated to processes in clinical psychology. This paper presents a comprehensive framework for positive psychology processes that crosses theoretical orientation, links coherently to clinical psychology and its more dominantly “negative” processes, and supports practitioners (...) in their efforts to personalize positive psychological interventions. We argue that a multi-dimensional and multi-level extended evolutionary approach can organize effective processes of change in psychosocial interventions, by focusing interventions on context-appropriate variation, selection, and retention of processes, arranged in terms of key biopsychosocial dimensions across psychological, biophysiological, and sociocultural levels of analysis. We review widely studied positive psychology constructs and programs and show how this evolutionary approach can readily accommodate them and provide a common language and framework for improving human and community flourishing. We conclude that Interventions should start with the person, not the protocol. (shrink)

A computational model of inference during story comprehension is presented, in which story situations are represented distributively as points in a high‐dimensional “situation‐state space.” This state space organizes itself on the basis of a constructed microworld description. From the same description, causal/temporal world knowledge is extracted. The distributed representation of story situations is more flexible than Golden and Rumelhart's [Discourse Proc 16 (1993) 203] localist representation.A story taking place in the microworld corresponds to a trajectory through situation‐state space. During the (...) inference process, world knowledge is applied to the story trajectory. This results in an adjusted trajectory, reflecting the inference of propositions that are likely to be the case. Although inferences do not result from a search for coherence, they do cause story coherence to increase. The results of simulations correspond to empirical data concerning inference, reading time, and depth of processing.An extension of the model for simulating story retention shows how coherence is preserved during retention without controlling the retention process. Simulation results correspond to empirical data concerning story recall and intrusion. (shrink)

Research ethics, once a platform for declaring intent, discussing moral issues and providing advice and guidance to researchers, has developed over time into an extra-legal regulatory system, complete with steering documents (ethics guidelines), overseeing bodies (research ethics committees) and formal procedures (informed consent). The process of institutionalizing distrust is usually motivated by reference to past atrocities committed in the name of research and the need to secure the trustworthiness of the research system. This article examines some limitations of this approach. (...) First, past atrocities cannot provide the necessary justification unless institutionalized distrust is a necessary or efficient means to prevent future ones – and there are several reasons to doubt this. Second, the efficacy of ethics review in safeguarding morally acceptable research depends on the moral competence and integrity of individual researchers – the very qualities that institutionalized distrust calls into question. Third, ethics guidelines cannot, as is sometimes assumed, educate or guide researchers in moral behaviour unless they already possess considerable capacity for moral judgment. Fourth, institutionalized distrust is a potential threat to the moral competence and integrity of researchers by encouraging a blinkered view of ethical issues, inducing moral heteronomy through incentives, and alienating them to research ethics. We conclude that the moral problem posed by inappropriate short-term behaviour on behalf of researchers is dwarfed by the potential long-term consequences if their moral competence is allowed to deteriorate. Measures must therefore be taken to ensure that researchers are equipped to take their individual responsibility and are not obstructed from so doing. (shrink)

In this book, Patrick G. Stefan argues that the subversive message of resurrection was instrumental in Christianity’s expansion. Using Foucault’s analysis of how material conditions shape and create individual subjects, Stefan shows how the idea of resurrection undermined Caesar’s control over those living in his domain.

Advance directives are propagated as instruments to maintain patients’ autonomy in case they can no longer decide for themselves. It has been never been examined whether patients’ and healthy persons themselves are inclined to adhere to these documents. Patients’ and healthy persons’ views on whether instructions laid down in advance directives should be followed because that is (or is not) “the right thing to do”, not because one is legally obliged to do so, were studied and compared with that of (...) medical staff. Method: Vignette study presenting five cases. Cancer patients, healthy persons, nursing staff and physicians (n = 100 in each group) were interviewed. An adherence score was calculated (maximum value 5). The adherence score is found to be low in all groups, yet lowest in patients (1.55; standard deviation 1.13) and healthy controls (1.60; 1.37). The scores are significantly different between nursing staff on the one hand and patients and healthy controls on the other (p < 0.005 and p < 0.05, respectively), and between doctors and patients (p < 0.05). Interviewees who want these documents to be followed tend to live alone and to have already written an advance directive. Conclusions: Cancer patients and healthy persons widely disregard instructions laid down in advance directives and consider them less binding than physicians and nursing staff do. Only a minority tends to adhere more to advance directives. To improve decision-making at the end of life when patients are no longer able to decide for themselves alternative concepts, such as advanced care planning, should be considered. (shrink)

Over the past four decades, software engineering has emerged as a discipline in its own right, though it has roots both in computer science and in classical engineering. Its philosophical foundations and premises are not yet well understood. In recent times, members of the software engineering community have started to search for such foundations. In particular, the philosophies of Kuhn and Popper have been used by philosophically-minded software engineers in search of a deeper understanding of their discipline. It seems, however, (...) that professional philosophers of science are not yet aware of this new discourse within the field of software engineering. Therefore, this article aims to reflect critically upon recent software engineers’ attempts towards a philosophy of software engineering and to introduce our own philosophical thoughts in this context. Finally, we invite the professional philosophers of science to participate in this interesting new discourse. (shrink)

Austrian economics focuses on markets but has much to say about organizations. In particular, Austrian insights on the structure of production, the heterogeneity and subjectivity of resources, the nature of uncertainty, the role of monetary calculation, and the function of the entrepreneur provide solid foundations for a distinctly Austrian theory of organizations. This chapter reviews these insights, discusses recent literature on Austrian economics and the theory of the firm, and suggests new directions for developing and extending an Austrian approach to (...) organizations. In doing so it answers the following questions: Why, do organizations, large and small, emerge and persist? How do they avoid the problem of economic calculation faced by socialist economies? Why do organizations take the shapes they do, why do their characteristics vary over time and across industries, and why do they succeed or fail? Are most organizations stable over time, or do organizations, like markets, adapt and learn? and How do entrepreneurs arrange assets and manage individuals within organizations? (shrink)

In a recent systematic review of the Sustainability Balanced Scorecard literature in this journal, we developed a typology of architectures as a basis for the process of SBSC design, implementation, use, and evolution. This paper addresses a comment by Hahn and Figge designed to stimulate further research. We argue that the existing literature demonstrates that the SBSC management tool can play an important role in corporate sustainability. The SBSC architectures—as representations of goals and priorities—form an integral and iterative part of (...) the corporate sustainability strategy-making process and therefore cannot be isolated from it. However, the concept as such should not be overloaded. In this paper, we first reflect on the potentials and constraints of the SBSC in relation to radical or transformational change and measuring performance outcomes on the level of human–earth systems. Second, we discuss the importance of SBSC architecture concerning how it enables the integration of sustainability into business organisations; how both strictly hierarchical cause-and-effect chains and less hierarchical designs can allow companies to seek inclusive profits; and the contingency-based use of generic architectures in contrast to its use as a diagnostic tool. (shrink)

The increasing strategic importance of environmental, social and ethical issues as well as related performance measures has spurred interest in corporate sustainability performance measurement and management systems. This paper focuses on the balanced scorecard, a performance measurement and management system aiming at balancing financial and non-financial as well as short and long-term measures. Modifications to the original BSC which explicitly consider environmental, social or ethical issues are often referred to as sustainability balanced scorecards. There is much scholarly discussion about SBSC (...) architecture and how it can be designed to relate performance dimensions, strategic objectives and the logical links among these elements. To synthesise the widely scattered research findings and publications on the SBSC, we conducted a thematic analysis based on a systematic literature review containing 69 relevant articles spanning a period of two decades. We found that sustainability-oriented modifications of the BSC architecture are motivated by instrumental, social/political or normative theoretical perspectives. Moreover, these modifications can be mapped with a typology of generic SBSC architectures. The first dimension of the typology describes the hierarchy between performance perspectives and strategic objectives and how it is related to the organisational value system. The second dimension describes how sustainability-related strategic objectives are integrated into SBSC performance perspectives and how this is related to corporate sustainability strategy. This study contributes to the development of the emerging SBSC literature and practice and, more generally, to research on corporate sustainability performance measurement and management. We conclude with a research agenda and implications for management. (shrink)

Beta‐oxidation of fatty acids and detoxification of reactive oxygen species are generally accepted as being fundamental functions of peroxisomes. Additionally, these pathways might have been the driving force favoring the selection of this compartment during eukaryotic evolution. Here we performed phylogenetic analyses of enzymes involved in beta‐oxidation of fatty acids in Bacteria, Eukaryota, and Archaea. These imply an alpha‐proteobacterial origin for three out of four enzymes. By integrating the enzymes' history into the contrasting models on the origin of eukaryotic cells, (...) we conclude that peroxisomes most likely evolved non‐symbiotically and subsequent to the acquisition of mitochondria in an archaeal host cell. (shrink)

This paper reports on comparative research on how textual representations of issues related to corporate social responsibility (CSR) in corporate annual reports from Sweden, Canada and the Netherlands have changed over time. The results show a substantial increase on a number of topics that can be linked to the general CSR-discourse in the 2001 sample in comparison to the 1991 and 1981 samples. The rise in the CSR-discourse appears to be related to a drop in other discourses related to issues (...) of social responsibility regarding the social, economic and political development of a company’s native country. (shrink)

According to Hempel’s influential theory of explanation, explaining why some a is G consists in showing that the truth that a is G follows from a law-like generalization to the effect that all Fs are G together with the initial condition that a is F. While Hempel’s overall account is now widely considered to be deeply flawed, the idea that some generalizations play the explanatory role that the account predicts is still often endorsed by contemporary philosophers of science. This idea, (...) however, conflicts with widely shared views in metaphysics according to which the generalization that all Fs are G is partially explained by the fact that a is G. I discuss two solutions to this conflict that have been proposed recently, argue that they are unsatisfactory, and offer an alternative. (shrink)

Volume 19, Issue 10, October 2019, Page 93-94.

Driven by technological innovations, newborn screening (NBS) panels have been expanded and the development of genomic NBS pilot programs is rapidly progressing. Decisions on disease selection for NBS are still based on the Wilson and Jungner (WJ) criteria published in 1968. Despite this uniform reference, interpretation of the WJ criteria and actual disease selection for NBS programs are highly variable. A systematic literature search [PubMED search “Wilson” AND “Jungner”; last search 16.07.22] was performed to evaluate the applicability of the WJ (...) criteria for current and future NBS programs and the need for adaptation. By at least two reviewers, 105 publications (systematic literature search, N = 77; manual search, N = 28) were screened for relevant content and, finally, 38 publications were evaluated. Limited by the study design of qualitative text analysis, no statistical evaluation was performed, but a structured collection of reported aspects of criticism and proposed improvements was instead collated. This revealed a set of general limitations of the WJ criteria, such as imprecise terminology, lack of measurability and objectivity, missing pediatric focus, and absent guidance on program management. Furthermore, it unraveled specific aspects of criticism on clinical, diagnostic, therapeutic, and economical aspects. A major obstacle was found to be the incompletely understood natural history and phenotypic diversity of rare diseases prior to NBS implementation, resulting in uncertainty about case definition, risk stratification, and indications for treatment. This gap could be closed through the systematic collection and evaluation of real-world evidence on the quality, safety, and (cost-)effectiveness of NBS, as well as the long-term benefits experienced by screened individuals. An integrated NBS public health program that is designed to continuously learn would fulfil these requirements, and a multi-dimensional framework for future NBS programs integrating medical, ethical, legal, and societal perspectives is overdue. (shrink)

In Sweden, most patients are recruited into biobank research by non-researcher doctors. Patients' trust in doctors may therefore be important to their willingness to participate. We suggest a model of trust that makes sense of such transitions of trust between domains and distinguishes adequate trust from mistaken trust. The unique position of doctors implies, we argue, a Kantian imperfect duty to compensate for patients' mistaken trust. There are at least three kinds of mistaken trust, each of which requires a different (...) set of countermeasures. First, trust is mistaken when necessary competence is lacking; the competence must be developed or the illusion dispelled. Second, trust is irrational whenever the patient is mistaken about his actual reasons for trusting. Care must therefore be taken to support the patient's reasoning and moral agency. Third, some patients inappropriately trust doctors to recommend only research that will benefit them directly. Such trust should be counteracted by nurturing a culture where patients expect to be asked occasionally to contribute to the common good. (shrink)

Recent findings indicate that the constituting digits of multi-digit numbers are processed, decomposed into units, tens, and so on, rather than integrated into one entity. This is suggested by interfering effects of unit digit processing on two-digit number comparison. In the present study, we extended the computational model for two-digit number magnitude comparison of Moeller, Huber, Nuerk, and Willmes (2011a) to the case of three-digit number comparison (e.g., 371_826). In a second step, we evaluated how hundred-decade and hundred-unit compatibility effects (...) were moderated by varying the percentage of within-hundred (e.g., 539_582) and within-hundred-and-decade filler items (e.g., 483_489). From the results we predict that numerical distance as well as compatibility effects should indeed be modulated by the relevance of tens and units in three-digit number magnitude comparison: While in particular the hundred distance effect should decrease, we predict hundred-decade and hundred-unit compatibility effects to increase with the relevance of tens and units. (shrink)

A measure of coherence is said to be reliability conducive if and only if a higher degree of coherence (asmeasured) of a set of testimonies implies a higher probability that the witnesses are reliable. Recently, it has been proved that the Shogenji measure of coherence is reliability conducive in restricted scenarios (e.g., Olsson and Schubert, Synthese, 157:297–308, 2007). In this article, I investigate whether the Shogenji measure, or any other coherence measure, is reliability conducive in general. An impossibility theorem is (...) proved to the effect that this is not the case. I conclude that coherence is not reliability conducive. (shrink)

The study of human-human communication and the development of computational models for human-agent communication have diverged significantly throughout the last decade. Yet, despite frequently made claims of “super-human performance” in, e.g., speech recognition or image processing, so far, no system is able to lead a half-decent coherent conversation with a human. In this paper, we argue that we must start to re-consider the hallmarks of cooperative communication and the core capabilities that we have developed for it, and which conversational agents (...) need to be equipped with: incremental joint co-construction and mentalizing. We base our argument on a vast body of work on human-human communication and its psychological processes that we reason to be relevant and necessary to take into account when modeling human-agent communication. We contrast those with current conceptualizations of human-agent interaction and formulate suggestions for the development of future systems. (shrink)