Medical decision making often utilizes subjective observations to arrive at concrete judgments. The decisions frequently affect who receives scarce medical treatments and, thus, who lives or dies. In this paper, a model health status index is described. It is specific for the problem of choosing patients for hemodialysis or transplantation. Such a health status index may be designed for any medical decision involving such issues as drug treatment priorities, identification of salvageable patients, and selection of patients for scarce medical treatment. (...) This index (1) incorporates a physician''s own medical criteria and values, (2) can be modified as the data base improves, (3) assures consistency from decision to decision, and (4) can be developed and used without the help of a mathematician or computer. (shrink)

With the publication of this book psychotherapy finally arrives at the mainstream of mental health practice. This volume is an essential companion for every practising psychiatrist, clinical psychologist, psychotherapy counsellor, mental health nurse, psychotherapist, and mental health practitioner. It is integrative in spirit, with chapters written by an international panel of experts who combine theory and research with practical treatment guidelines and illustrative case examples to produce an invaluable book. Part One gives a comprehensive account of all the major psychotherapeutic (...) approaches. Parts Two and Three systematically describe psychotherapeutic approaches to the major psychiatric disorders and personality disorders. Many chapters are multi-authored and describe the psychodynamic, cognitive behavioural and other approaches for treating these illnesses. Part Four examines applications and modifications of psychotherapy across the lifecycle. Part Five describes psychotherapy with specific populations such as medical patients and those where gender is an issue, and finally Part Six tackles some of the special topics of concern to psychotherapists including ethics, legal issues, and psychotherapy and neuroscience. The first of its kind, this is a 'must have' volume for all trainee and practising psychological therapists, whatever their background - psychiatry, psychology, social work, or nursing. (shrink)

Ethics researchers advise managers of organizations to link rewards and punishments to ethical and unethical behavior, respectively. We build on prior research maintaining that organizations operate at Kohlbergs stages of moral reasoning, and explain how the over-reliance on rewards and punishments encourages employees to operate at Kohlbergs lowest stages of moral reasoning. We advocate designing organizations as ethical communities and relying on different assumptions about employees in order to foster ethical reasoning at higher levels. Characteristics associated with ethical communities are (...) identified and AES Corporation and Semco S/A serve as examples of corporations exhibiting the design characteristics and assumptions of ethical organizations. (shrink)

Previous research demonstrates that implicitly learned probability information can guide visual attention. We examined whether the probability of an object changing can be implicitly learned and then used to improve change detection performance. In a series of six experiments, participants completed 120–130 training change detection trials. In four of the experiments the object that changed color was the same shape on every trial. Participants were not explicitly aware of this change probability manipulation and change detection performance was not improved for (...) the trained shape versus untrained shapes. In two of the experiments, the object that changed color was always in the same general location . Although participants were not explicitly aware of the change probability, implicit knowledge of it did improve change detection performance in the trained location. These results indicate that improved change detection performance through implicitly learned change probability occurs for location but not shape. (shrink)

Medical-legal partnerships connect legal advocates to healthcare providers and settings. Maintaining effectiveness of medical-legal partnerships and consistently identifying opportunities for innovation and adaptation takes intentionality and effort. In this paper, we discuss ways in which our use of data and quality improvement methods have facilitated advocacy at both patient (client) and population levels as we collectively pursue better, more equitable outcomes.

Patients sometimes visit their general practitioners with more than one concern. This article investigates when and how patients initiate presentations of such additional concerns. The study is conversation analytic in its approach and scope. It is based upon video-recordings of naturally occurring general practice consultations in Denmark. Data suggest that Danish patients relatively frequently initiate presentations of additional concerns and defer such initiations until moments when the parties would otherwise engage in closing down the consultations. Additional concerns are introduced in (...) response to the doctor’s possible pre-closing remarks. The parties, thereafter, employ a set of transitional elements: confirmation, preliminary announcement and ratification. This transition enables the parties to recycle the activities of the visit, to discuss and examine yet another concern. Thus, additional concerns are not presented completely unexpectedly or randomly as commonsense understanding sometimes has it; they are introduced at orderly moments and by means of recognizable methods. (shrink)

Affective variables have been shown to impact working memory and cognitive control. Theoretical arguments suggest that the functional impact of emotion on cognition might be mediated through shifting action dispositions related to changes in motivational orientation. The current study examined the effects of positive and negative affect on performance via direct manipulation of motivational state in tasks with high demands on cognitive control. Experiment 1 examined the effects of monetary reward on task-switching performance, while Experiment 2 examined the effects of (...) both rewards and punishments on working memory, using primary (liquid) reinforcers. In both experiments, dissociable trial-by-trial and contextual (block-related) enhancements of cognitive control during task performance were observed in relationship to motivational incentive value. Performance enhancements were equivalent in the reward and punishment conditions, but were differentially impacted by individual difference measures of trait reward and punishment sensitivity. Together, the results suggest both common and specific mechanisms by which approach and avoidance motivational states influence cognitive control, via activation of reward and punishment processing systems. (shrink)

Understanding the functional mechanisms underlying genetic signals associated with complex traits and common diseases, such as cancer, diabetes and Alzheimer's disease, is a formidable challenge. Many genetic signals discovered through genome‐wide association studies map to non‐protein coding sequences, where their molecular consequences are difficult to evaluate. This article summarizes concepts for the systematic interpretation of non‐coding genetic signals using genome annotation data sets in different cellular systems. We outline strategies for the global analysis of multiple association intervals and the in‐depth (...) molecular investigation of individual intervals. We highlight experimental techniques to validate candidate (potential causal) regulatory variants, with a focus on novel genome‐editing techniques including CRISPR/Cas9. These approaches are also applicable to low‐frequency and rare variants, which have become increasingly important in genomic studies of complex traits and diseases. There is a pressing need to translate genetic signals into biological mechanisms, leading to prognostic, diagnostic and therapeutic advances. (shrink)

Until quite recently, mind-body dualism has been regarded with deep suspicion by both philosophers and scientists. This has largely been due to the widespread identification of dualism in general with one particular version of it: the interactionist substance dualism of Réné Descartes. This traditional form of dualism has, ever since its first formulation in the seventeenth century, attracted numerous philosophical objections and is now almost universally rejected in scientific circles as empirically inadequate. During the last few years, however, renewed attention (...) has begun to be paid to the dualistic point of view, as a result of increasing discontent with the prevailing materialism and reductionism of contemporary scientific and philosophical thought. Awareness has grown that dualism need not be restricted to its traditional form and that other varieties of dualism are not subject to the difficulties commonly raised against Descartes' own version of it. -/- Interest in these alternative versions of dualism is growing fast today, because it seems that they are capable of capturing deep-seated philosophical intuitions, while also being fully consistent with the methodological assumptions and empirical findings of modern scientific work on the human mind and brain. The object of this book is to provide philosophers, scientists, their students, and the wider general public with an up-to-date overview of current developments in dualistic conceptions of the mind in contemporary philosophy and science. (shrink)

ABSTRACT Four decades ago, Gerald Kramer showed that economic conditions affect electoral outcomes. Some researchers took this to mean that voters were self-interested, voting their “pocketbooks,” while others, such as Leif Lewin, took it to mean that voters were sociotropic, motivated by the public interest—and therefore altruistic. It is important, however, to avoid conflating sociotropic voters with altruistic ones. Voters might be voting in favor of politicians or parties that they think will further the public interest as an indirect route (...) to furthering their own interests, as members of the public. More research, perhaps conducted using novel methodologies, is needed in order to settle the extent to which voters are motivated by self-interest or by the public interest. (shrink)

ABSTRACT Four decades ago, Gerald Kramer showed that economic conditions affect electoral outcomes. Some researchers took this to mean that voters were self-interested, voting their “pocketbooks,” while others, such as Leif Lewin, took it to mean that voters were sociotropic, motivated by the public interest—and therefore altruistic. It is important, however, to avoid conflating sociotropic voters with altruistic ones. Voters might be voting in favor of politicians or parties that they think will further the public interest as an indirect route (...) to furthering their own interests, as members of the public. More research, perhaps conducted using novel methodologies, is needed in order to settle the extent to which voters are motivated by self-interest or by the public interest. (shrink)

This article examines ancient depictions of the death of Troilus in art and literature and challenges the widespread belief that the Iliad implies an alternative version of the myth in which Troilus dies in battle. In particular, it argues that the death-in-battle interpretation is both insufficiently supported by the internal evidence and incompatible with the external evidence. Given the evident popularity of the story of Achilles’ ambush of Troilus in the Archaic period, it is hard to avoid the conclusion that (...) the poet of the Iliad knew the story of Troilus’ death by ambush. That the poem's only reference to Troilus does not contradict this story, and possibly even alludes to it, should persuade critics of the strong likelihood that the popular story of Troilus’ ambush at the fountain was also the one in the poet's mind. (shrink)

The thought-experiment presented by Bernard Williams in 'The self and the future' continues to draw the attention of writers in the debate about personal identity. While few of them agree on what implications it has for the debate, almost all agree that those implications are significant ones. Some have even claimed that it has consequences not only for personal identity, but also concerning the viability of thought-experiment as a method. This paper surveys what these consequences might be at both levels (...) - as a substantive contribution to the debate on identity, and as to what it shows about the usefulness of thought-experiments. It argues ultimately that thought-experiments like Williams's do provide a useful philosophical tool as long as we temper our expectations of them, and that it offers some support to a view of personal identity but one which is at odds with Williams's own view. (shrink)

Derek Parfit argues in Reasons and Persons that acting according to your present desires is more rational, or at least as rational, as acting in your long-term self-interest. To do this, he puts forward a case supporting a 'critical present-aim theory' of rationality opposed to the self-interest theory, and then argues against a number of possible replies. This article is a response to these arguments, concluding that Parfit's favouring of the present-aim theory is unfounded, and that self-interest is the better (...) theory of rationality. (shrink)

In this article, the attempts by David Lewis and Brian Loar to make perspicuous the logical form of sentences ascribing propositional attitudes to individuals are set out and criticized. Both work within the assumption of the truth of 'type' physicalism, and require that logically perspicuous attitude ascriptions be compatible with the demands of such a doctrine. It is argued that neither carry out this task successfully - Lewis's perspicuous ascriptions have counter-intuitive implications, while Loar's avoidance of these undermines type physicalism (...) itself. (shrink)

Medical records are documents of tremendous social importance. They have been the subject of much medical and sociological research, in particular regarding validity, accessibility and readability. This paper uses Conversation Analysis to add an aspect to the understanding of medical records that has been missing so far, namely how medical records are produced as interactional accomplishments; specifically, how hospital staff members during meetings conversationally negotiate and reach conclusions, treatment recommendations, and other types of consequential decisions. The process involves four steps: (...) assessing patients, interpreting implications, drawing conclusions, and dictating conclusions on tape. The key finding is that participants throughout the process orient towards a need for consensus, whilst at the same time acknowledging the doctors’ interactional leading roles. This insight can enhance our understanding of medical records in hospital settings as constructed and negotiated realities. (shrink)

Cytokines are polypeptides released by activated vertebrate blood cells which have profound effects on other blood cells and which have hormone‐like properties affecting other organ systems as well. In recent years a wide variety of these mediators has been isolated and characterized. Many of these molecules have subsequently been cloned and expressed in E. coli. The tremendous importance of these proteins to host immune and non‐specific defense systems along with the striking similarities of their properties among different species suggested to (...) us that cytokines may have been proteins that have been conserved through evolution. Investigations of the evolution of cytokines will help us decipher the complex cellular, humoral and molecular interactions that regulate host defenses. Studies of the invertebrates will shed light on the phylogenetic emergence of these molecules as well. (shrink)

This is a fluently written history of ancient Greece seen from the perspective of localism and the origins of the Greek City-State. Much like our own time, from the 8th century BCE until and even beyond its imperial end, the Greek world was constantly expanding and experiencing growing connectivity with the world at large. Conquest, exploration and exchange all grew Greece's global presence and helped develop an expanded world where a need to define and cherish the local would inevitably arise. (...) Beck draws on a breathtaking range of materials: texts, some of them rare, by both well-known and obscure writers; numismatics, visual culture, pottery analysis, landscape and traditional field archaeology. He brings all this together in developing fine-grained case studies about tensions between metropolis and local communities such as Miletus, Ithaca, and rural Attica in relation to Athens and other major centers. (shrink)

By working with underserved communities, anthropologists may play a larger role in democratizing society. The growth of disparities challenges anthropology to be used for social justice. This engaged stance moves the application of anthropological theory, methods, and practice toward action and activism. However, this engagement also moves anthropologists away from traditional roles of observation toward participatory roles that become increasingly involved with those communities or social groupings being studied. The chapters in this book suggest the roles anthropologists are able to (...) play to bring us closer to a public anthropology characterized as engagement. Sam Beck is Senior Lecturer in the College of Human Ecology and Director of the Urban Semester Program of Cornell University. His publications include Ethnicity and Nationalism in Southeastern Europe (1981, ed with John W. Cole) and Manny Almeida's Ringside Lounge: The Cape Verdean Struggle for their Neighborhood (1992). Carl A. Maida is Professor in the Institute of the Environment and Sustainability at the University of California, Los Angeles. His publications include Sustainability and Communities of Place (2007), Pathways through Crisis: Urban Risk and Public Culture (2008), Children and Disasters (1999), and The Crisis of Competence: Transitional Stress and the Displaced Worker (1990). (shrink)

This paper is a re-reading of Colin Radford's paper 'The Umpire's Dilemma', published in Analysis in 1985. It argues that Radford's dilemma has been unjustly ignored and has interesting (and problematic) implications for both intuitionism and Ronald Dworkin's constructive interpretationist jurisprudence.

“With great power comes great responsibility.” In today’s world, with our growing technological power and the knowledge about its impact, we are considered to be responsible for many instances that not long ago would have been deemed a matter of fate. At the same time, the looming options of, e.g., genome editing or neuroprosthetics, threaten traditional notions of responsibility if no longer the person but the technology involved is deemed to be responsible for a specific behaviour. The growing ethical debate (...) on the expansion of human responsibility, e.g. when it comes to human-machine-interaction, ambient intelligence, or reproductive technologies, thus intertwines with the challenge to formulate an appropriate understanding of the concept of personal responsibility and our respective anthropological self-understanding in today’s technological world. The volume brings together both perspectives and aims at illuminating crucial dimensions of responsibility in light of technological innovation and our self-understanding as responsible beings. (shrink)

We often think about the alternatives to a decision that has been made. Thinking in this way is known as counterfactual thinking, that is, thinking about what could have been had an alternative dec...

The goal is to present how shared decision-making in paediatric oncology occurs from the viewpoints of parents and physicians. Eight Swiss Pediatric Oncology Group centres participated in this prospective study. The sample comprised a parent and physician of the minor patient. Surveys were statistically analysed by comparing physicians’ and parents’ perspectives and by evaluating factors associated with children’s actual involvement. Perspectives of ninety-one parents and twenty physicians were obtained for 151 children. Results indicate that for six aspects of information provision (...) examined, parents’ and physicians’ perceptions differed. Moreover, parents felt that the children were more competent to understand diagnosis and prognosis, assessed the disease of the children as worse, and reported higher satisfaction with decision-making on the part of the children. A patient’s age and gender predicted involvement. Older children and girls were more likely to be involved. In the decision-making process, parents held a less active role than they actually wanted. Physicians should take measures to ensure that provided information is understood correctly. Furthermore, they should work towards creating awareness for systematic differences between parents and physicians with respect to the perception of the child, the disease, and shared decision-making. (shrink)

Epigenetic and transcriptional variability contribute to the vast diversity of cellular and organismal phenotypes and are key in human health and disease. In this review, we describe different types, sources, and determinants of epigenetic and transcriptional variability, enabling cells and organisms to adapt and evolve to a changing environment. We highlight the latest research and hypotheses on how chromatin structure and the epigenome influence gene expression variability. Further, we provide an overview of challenges in the analysis of biological variability. An (...) improved understanding of the molecular mechanisms underlying epigenetic and transcriptional variability, at both the intra- and inter-individual level, provides great opportunity for disease prevention, better therapeutic approaches, and personalized medicine. Epigenetic and transcriptional variability mediate phenotypic plasticity, enabling adaptation to changing environments. In this review, we describe the sources of inter- and intra-individual variability and discuss epigenetic regulators of gene expression variability, including DNA methylation and chromatin structure. Understanding these molecular mechanisms will improve therapeutic approaches and personalized medicine. (shrink)

Fatherly love should be evident in caring for the health and good of one's children, seeking to safeguard them from harm and to encourage their integrity. However, in Star Wars, Darth Vader promises his son's survival only on the condition that Luke Skywalker will serve his own monstrous, tyrannical master. Utilizing a philosophy of love and goodness to show how the parent–child relationship may be lost or regained, this chapter examines the transition in Anakin's life from a natural love of (...) others to a distorted, toxic caricature of love. The drama and trauma displayed in Star Wars allow us to recognize how an admirable love can lose its value, and in fact can become what motivates people to outrageously wicked acts. The chapter highlights that the good of the love in such relationships needs to be tempered by humility and wisdom. (shrink)

In large-scale assessments, disengaged participants might rapidly guess on items or skip items, which can affect the score interpretation’s validity. This study analyzes data from a linear computer-based assessment to evaluate a micro-intervention that blocked the possibility to respond for 2 s. The blocked response was implemented to prevent participants from accidental navigation and as a naive attempt to prevent rapid guesses and rapid omissions. The response process was analyzed by interpreting log event sequences within a finite-state machine approach. Responses (...) were assigned to different response classes based on the event sequence. Additionally, post hoc methods for detecting rapid responses based on response time thresholds were applied to validate the classification. Rapid guesses and rapid omissions could be distinguished from accidental clicks by the log events following the micro-intervention. Results showed that the blocked response interfered with rapid responses but hardly led to behavioral changes. However, the blocked response could improve the post hoc detection of rapid responding by identifying responses that narrowly exceed time-bound thresholds. In an assessment context, it is desirable to prevent participants from accidentally skipping items, which in itself may lead to an increasing popularity of initially blocking responses. If, however, data from those assessments is analyzed for rapid responses, additional log data information should be considered. (shrink)

This paper investigates the semantics of adverbials like ‘page by page’ and ‘stone upon stone’. An analysis is developed in which sentences containing such adverbials have a pluractional semantics; that is, pluralization affects simultaneously the event- and the individual-argument slot of a predicate. Sternefeld's system of plural operators is used and extended for this purpose. The adverbial constrains the relation that is pluralized and makes visible a higher plural operator. In the case of ‘page by page’-type adverbials, this is a (...) fairly standard operator that leads to a simple divisional interpretation. In the case of ‘stone upon stone’-type adverbials, the operator has a stronger semantics that leads to a sequence interpretation. The generality of our theory permits straightforward extension to data like ‘she ran and ran’ and ‘she climbed higher and higher’, among others. Finally we propose that inclusive alternative ordering reciprocals have a pluractional sequence interpretation as well. (shrink)

Background: This article describes the overall attitudes of children, their parents, and attending physicians toward including or excluding pediatric patients in medical communication and health care decision-making processes. Methods: Fifty-two interviews were carried out with pediatric patients (n = 17), their parents (n = 19), and attending oncologists (n = 16) in eight Swiss pediatric oncology centers. The interviews were analyzed using thematic coding. Results: Parenting styles, the child's personality, and maturity are factors that have a great impact upon the (...) inclusion of children in their health care processes. Children reported the desire to be heard and involved, but they did not want to dominate the decision-making process. Ensuring trust in the parent–child and physician–patient relationships and respecting the child as the affected person were important values determining children's involvement. These two considerations were closely connected with the concern that fantasies are often worse than reality. Seeking children's compliance with treatment was a practical but critical reason for informing them about their health care. The urge to protect them from upsetting news sometimes resulted in their (partial) exclusion. Conclusions: The ethical imperative for inclusion of children in their health care choices was not so much determined by the right for self-determination, but by the need to include them. If children are excluded, they imagine things, become more isolated, and are left alone with their fears. Nevertheless, the urge to protect children is innate, as adults often underestimate children's coping capacities. (shrink)

Jean-Jacques Rousseau's main work in political philosophy, the _Social Contract_, contains two beginnings; on the one hand, it commences, quite conventionally, with a social contract between individuals, on the other hand it also states that a lawmaker needs to precede the agreement of such a contract. This curious co-existence of two beginnings in the text has usually been ignored or played down by interpreters. This article, on the other hand, presents a reading of their interplay inspired by Zizek's theory of (...) ideology. It demonstrates how one of the beginnings, if seen from this point of view, may be understood as the truth about the other, and how the figure of the lawmaker specifically reveals the text as torn apart by contradictory internal tendencies. (shrink)

Ulrich Beck's best selling Risk Society established risk on the sociological agenda. It brought together a wide range of issues centering on environmental, health and personal risk, provided a rallying ground for researchers and activists in a variety of social movements and acted as a reference point for state and local policies in risk management. The Risk Society and Beyond charts the progress of Beck's ideas and traces their evolution. It demonstrates why the issues raised by Beck (...) reverberate widely throughout social theory and covers the new risks that Beck did not foresee, associated with the emergence of new technologies, genetic and cybernetic. The book is unique because it offers both an introduction to the main arguments in Risk Society and develops a range of critical discussions of aspects of this and other works of Beck. (shrink)

A student's future as a knowledge worker (one who "thinks for a living" with the task of problem solving) is the starting point of this book. With this in mind, the book combines a review of philosophical positions and problems with practical examples and perspectives gained from everyday challenges faced by knowledge workers in their businesses and organizations. Through the use of summative chapters, highlighted key concepts, questions for reflection, and illustrative examples on how to work with the theories presented, (...) the book provides a clear and accessible introduction to this challenging subject. Philosophy of Science primarily addresses students studying language, communication, marketing, economics, and management. However, the survey of the theoretical schools of thought - as well as the discussions on research ethics and the role of research in society - will be equally relevant for other students in the humanities and the natural and social sciences. (shrink)

It remains controversial whether touch is a truly spatial sense or not. Many philosophers suggest that, if touch is indeed spatial, it is only through its alliances with exploratory movement, and with proprioception. Here we develop the notion that a minimal yet important form of spatial perception may occur in purely passive touch. We do this by showing that the array of tactile receptive fields in the skin, and appropriately relayed to the cortex, may contain the same basic informational building (...) blocks that a creature navigating around its environment uses to build up a perception of space. We illustrate this point with preliminary evidence that perception of spatiotemporal patterns on the human skin shows some of the same features as spatial navigation in animals. We argue (a) that the receptor array defines a ‘tactile field’, (b) that this field exists in a minimal form in ‘skin space’, logically prior to any transformation into bodily or external spatial coordinates, and (c) that this field supports tactile perception without integration of concurrent proprioceptive or motor information. The basic cognitive elements of space perception may begin at lower levels of neural and perceptual organisation than previously thought. (shrink)