Understanding the components of clinical care that work best is a cornerstone of improving health care. And yet, the more we improve the quality of quality improvement and move to continuous learning about clinical care more broadly, the more we find ourselves in a regulatory environment that makes evaluation more difficult, expensive, and, in some situations, impossible. In their paper on the ethical underpinnings of the distinction between research and treatment, Ruth Faden and colleagues raise important implications for a wide (...) array of situations. These points give reason to rethink the definition of routine clinical operations to include evaluation of the processes and outcomes of care and dissemination of findings. We concur with the assertion by Faden and colleagues, and with previous work from The Hastings Center, that conducting continuous improvement activities such as these is an obligation of health systems and clinicians. We believe that rigorous, systematic evaluation should be considered part of normal, expected operations, rather than exceptional behavior that requires extraordinary regulatory control. (shrink)

Girotto and Legrenzi's 1993 facilitation effect for their SARS version of Wason s THOG problem a disjunctive reasoning task was examined. The effect was not replicated when the standard THOG problem instructions were used in Experiments 1 and 2. However, in Experiment 3 when Girotto and Legrenzi's precise instructions were used, facilitation was observed. Experiment 4 further investigated the role of the type of instructions in the observed facilitation. The results suggest that such facilitation may result from attentional factors rather (...) than the use of a combinatorial analysis in the problem. (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)

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)

"Cluster randomized trials," in which groups of patients are randomly assigned to different therapeutic interventions, provide a powerful way of evaluating drugs. CRTs have not been widely used, in good part because of concerns about whether patients must give informed consent to participate in them. A better understanding of how CRTs fit into clinical practice resolves the concerns.

Activators of RNA polymerase II transcription possess distinct and separable DNA‐binding and transcriptional activation domains. They are thought to function by binding to specific sites on DNA and interacting with proteins (transcription factors) binding near to the transcriptional start site of a gene. The ability of these proteins to activate transcription is a highly regulated process, with activation only occurring under specific conditions to ensure proper timing and levels of target gene expression. Such regulation modulates the ability of transcription factors (...) either to bind DNA or to interact with the transcriptional machinery. Here we discuss recent advances in our understanding of these mechanisms of transcriptional regulation in yeast. (shrink)

Mr. Richards is justified in saying that S0009838800006017_inline1 is here indefensible, but he does not much mend matters by reading S0009838800006017_inline2. Iocasta may have been a paragon of all the virtues, but what has that to do with it? No, the real correction is S0009838800006017_inline3. ‘ To whom should I tell even greater things than this rather than to thee ?’.

Logic has pride of place in mathematics and its 20th century offshoot, computer science. Modern symbolic logic was developed, in part, as a way to provide a formal framework for mathematics: Frege, Peano, Whitehead and Russell, as well as Hilbert developed systems of logic to formalize mathematics. These systems were meant to serve either as themselves foundational, or at least as formal analogs of mathematical reasoning amenable to mathematical study, e.g., in Hilbert’s consistency program. Similar efforts continue, but have been (...) expanded by the development of sophisticated methods to study the properties of such systems using proof and model theory. In parallel with this evolution of logical formalisms as tools for articulating mathematical theories (broadly speaking), much progress has been made in the quest for a mechanization of logical inference and the investigation of its theoretical limits, culminating recently in the development of new foundational frameworks for mathematics with sophisticated computer-assisted proof systems. In addition, logical formalisms developed by logicians in mathematical and philosophical contexts have proved immensely useful in describing theories and systems of interest to computer scientists, and to some degree, vice versa. Three examples of the influence of logic in computer science are automated reasoning, computer verification, and type systems for programming languages. (shrink)

The proof theory of many-valued systems has not been investigated to an extent comparable to the work done on axiomatizatbility of many-valued logics. Proof theory requires appropriate formalisms, such as sequent calculus, natural deduction, and tableaux for classical (and intuitionistic) logic. One particular method for systematically obtaining calculi for all finite-valued logics was invented independently by several researchers, with slight variations in design and presentation. The main aim of this report is to develop the proof theory of finite-valued first order (...) logics in a general way, and to present some of the more important results in this area. In Systems covered are the resolution calculus, sequent calculus, tableaux, and natural deduction. This report is actually a template, from which all results can be specialized to particular logics. (shrink)

This study reconstructs the relationship between philosophy and politics in the way in which Heidegger's failure as a politician influenced the redevelopment of philosophy in the 1930s. The author also explains how Heidegger's failure influenced the content and direction of his later work.

This second edition of the book contains a new chapter on the notions of natural-kind words and natural kinds.

Studies the politics of Heidegger in terms of "thrownness" or "existential contingency". Attempts to think through Heidegger's philosophy in a manner that parallels his own dialogue with other key western thinkers.

Textbook on Gödel’s incompleteness theorems and computability theory, based on the Open Logic Project. Covers recursive function theory, arithmetization of syntax, the first and second incompleteness theorem, models of arithmetic, second-order logic, and the lambda calculus.

Having visited Ireland regularly during the 1930s, Ludwig Wittgenstein resigned his Cambridge philosophy professorship in 1947 and moved there, living in a fishing village on the Atlantic coast and hotels in Dublin and the Wicklow Mountains. Although Wittgenstein spent some time out of the country, Ireland was effectively his base for three very productive years during which he worked on what would become one of his key books, the posthumously published Philosophical Investigations. Wittgenstein in Ireland represents the first sustained account (...) of Wittgenstein's time in Ireland, placing it in its historical context. Wall pays a good deal of attention to the representation of the Irish landscape in which the Austrian philosopher found himself able to work; a large part of his writings were produced in the bleak landscapes of Ireland and Norway. (shrink)

Despite their differences in origin, the three influential schools of twentieth-century continental cultural criticism--the Frankfurt School, existentialism, and poststructuralism--have long been treated as an ensemble and with critical hesitancy. Examining these schools as responses to the apparent collapse of Western civilization in the twentieth-century and as formidable intellectual challenges to the cultural legacies of the Enlightenment, this book provides a productive base for criticism and broadens our understanding of their histories and reception.

Hilbert’s program was an ambitious and wide-ranging project in the philosophy and foundations of mathematics. In order to “dispose of the foundational questions in mathematics once and for all,” Hilbert proposed a two-pronged approach in 1921: first, classical mathematics should be formalized in axiomatic systems; second, using only restricted, “finitary” means, one should give proofs of the consistency of these axiomatic systems. Although Gödel’s incompleteness theorems show that the program as originally conceived cannot be carried out, it had many partial (...) successes, and generated important advances in logical theory and metatheory, both at the time and since. The article discusses the historical background and development of Hilbert’s program, its philosophical underpinnings and consequences, and its subsequent development and influences since the 1930s. (shrink)

First published in 1991. Routledge is an imprint of Taylor & Francis, an informa company.

Methods available for the axiomatization of arbitrary finite-valued logics can be applied to obtain sound and complete intelim rules for all truth-functional connectives of classical logic including the Sheffer stroke and Peirce’s arrow. The restriction to a single conclusion in standard systems of natural deduction requires the introduction of additional rules to make the resulting systems complete; these rules are nevertheless still simple and correspond straightforwardly to the classical absurdity rule. Omitting these rules results in systems for intuitionistic versions of (...) the connectives in question. (shrink)

This classic, provocative introduction to classical metaphysical questions focuses on appreciating the problems, rather than attempting to proffer answers.

The papers in this collection discuss the central questions about the connections between language, reality and human understanding. The complex relations between accounts of meaning and facts about ordinary speakers’ understanding of their language are examined so as to illuminate the philosophical character of the connections between language and reality. The collection as a whole is a thematically unified treatment of some of the most central questions within contemporary philosophy of language.

Drawing on case studies from around the world - including Iran, Guatemala, USA and Mexico - this collection documents how transnational human rights discourses and legal institutions are materialised, imposed, resisted and transformed in a variety of contexts.

Written by a former student of Heidegger, this book examines the relationship between the philosophy and the politics of a celebrated teacher and the allure that Nazism held out for scholars committed to revolutionary nihilism.

In this study, Worsley argues that it is rational to believe in a loving God in the face of evil. Beginning with a critique of Alvin Plantinga, he shows that human freedom is highly complex, and so depends upon complex structures in nature. These are both necessary for freedom but also sufficient for natural evil. He offers close analysis of the evolution of the human brain. The book develops a parallel argument that human evil stems from the evolution of personality.

. History of the concept of economic efficiency . INTRODUCTION James Buchanan won the Nobel Prize by proving that the process by which elected officials ...

Background: Humor, both producing and appreciating, underpins positive social interactions acting as a facilitator of communication. There are clear links to wellbeing that go along with this form of social engagement. However, humor appears to be a seldom studied, cross-disciplinary area of investigation when applied to people with an intellectual disability, this review collates the current state of knowledge regarding the role of humor behavior in the social interactions of people with intellectual disabilities and their carers. Method: A systematic review (...) utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was completed which aimed to explore the current state of knowledge and quality of empirical evidence relating to humor in people with intellectual disabilities. Following this, articles were grouped thematically and summarized. A comprehensive search of four electronic databases (1954–2017) and additional search strategies yielded 32 articles which met the final inclusion criteria. Results: Humor played a significant positive and negative role in the social interactions of people with intellectual disabilities. Research had investigated humor in the classroom and humor expression in different groups including those with autism, Down syndrome, Angelman syndrome, Williams syndrome and Rett syndrome. Few investigations directly studied humor appreciation and comprehension hence themes did not focus solely on humor production/appreciation. Humor comprehension was reportedly supported by gestures. Some groups with intellectual disabilities found non-literal humor (e.g. sarcasm, irony) more difficult to understand which may affect social relationships. Various types of humor were found to be appreciated. The role of humor in relationship development, social facilitation, creativity and stigma had all received some limited attention. Humor also played a role for carer groups in coping with and enjoying the caring role. Research varied in quality with few experimental studies and mainly quasi-experimental and well-conducted qualitative studies. Conclusions: This review revealed the importance of humor behavior in many aspects of the social lives of people with intellectual disabilities. Limited disparate research exists pertaining to humor in this group, suggesting the need for further robust research in this area, including more high quality primary research in the areas of humor production, appreciation, comprehension and stigma. (shrink)