BackgroundStructured, systematic methods to formulate consensus recommendations, such as the Delphi process or nominal group technique, among others, provide the opportunity to harness the knowledge of experts to support clinical decision making in areas of uncertainty. They are widely used in biomedical research, in particular where disease characteristics or resource limitations mean that high-quality evidence generation is difficult. However, poor reporting of methods used to reach a consensus – for example, not clearly explaining the definition of consensus, or not stating (...) how consensus group panellists were selected – can potentially undermine confidence in this type of research and hinder reproducibility. Our objective is therefore to systematically develop a reporting guideline to help the biomedical research and clinical practice community describe the methods or techniques used to reach consensus in a complete, transparent, and consistent manner.MethodsThe ACCORD project will take place in five stages and follow the EQUATOR Network guidance for the development of reporting guidelines. In Stage 1, a multidisciplinary Steering Committee has been established to lead and coordinate the guideline development process. In Stage 2, a systematic literature review will identify evidence on the quality of the reporting of consensus methodology, to obtain potential items for a reporting checklist. In Stage 3, Delphi methodology will be used to reach consensus regarding the checklist items, first among the Steering Committee, and then among a broader Delphi panel comprising participants with a range of expertise, including patient representatives. In Stage 4, the reporting guideline will be finalised in a consensus meeting, along with the production of an Explanation and Elaboration document. In Stage 5, we plan to publish the reporting guideline and E&E document in open-access journals, supported by presentations at appropriate events. Dissemination of the reporting guideline, including a website linked to social media channels, is crucial for the document to be implemented in practice.DiscussionThe ACCORD reporting guideline will provide a set of minimum items that should be reported about methods used to achieve consensus, including approaches ranging from simple unstructured opinion gatherings to highly structured processes. (shrink)

The sublime has been a baffling concept since its introduction by Longinus nearly two thousand years ago. What do we mean when we say something is sublime? This paper will attempt to answer that question by proposing a radical new theory of the sublime, examining the aesthetic experience called the sublime through the lens of the Madhyamaka Buddhist philosophical view of emptiness (Skt. śūnyatā). Drawing on Guy Sircello’s work (1993), I critique traditional Western accounts of the sublime, with their explicit (...) or implicit—but always problematic—commitments to epistemological and ontological transcendence. A brief summary of the Madhyamaka Buddhist view of emptiness, as elucidated in the Prajñāpāramitā literature, Nāgārjuna’s Mūlamadhyamakakārikā, and elsewhere, provides a context for examining the dialectic of the sublime and emptiness. I make the argument that the sublime experience is, in fact, an experience of emptiness. I conclude by surveying five years of the early work of visual artist Robert Rauschenberg, which express the open, clear, vivid, and unselfconscious space of emptiness in his approach to, and process of, artistic expression. (shrink)

Mental health has become a domain of professional and scientific endeavor, distinguished in the modern mind from spirituality, which is understood as a more subjective, transcendent, and private concern. This sharp separation has been challenged in recent decades by scientific research, which demonstrates the positive benefits of spirituality/religion (S/R) for mental health. Increasing scientific interest in the topic is to be welcomed, but the contribution of theology to the debate has been neglected. It is proposed here that Jesus’ life and (...) teaching are presented in the synoptic Gospels as fundamentally concerned with what we now call mental health. Jesus’ teaching on worry, for example, offers various psychological strategies for dealing with anxiety. Moreover, it presents prayer as an effective and constructive response to worry, involving disciplined attention rather than avoidance. Critical interdisciplinary conversations between science and theology on matters such as worry offer a constructive approach to understanding the human condition in the context of adversity. (shrink)

Sober (1992) has recently evaluated Brandon's (1982, 1990; see also 1985, 1988) use of Salmon's (1971) concept of screening-off in the philosophy of biology. He critiques three particular issues, each of which will be considered in this discussion.

What is social justice? At this point, there is considerable disagreement. For many, the term social justice is baffling and useless, with no real meaning. Most who use it argue that social justice is the moral fairness of the system of rules and norms that govern society. Do these rules work so that all persons get what is due to them as human beings and as members of the community? Shifting from the will of individuals in rendering justice to the (...) outcome of the system of rules in achieving justice can be a dangerous leap. To some, it suggests that virtually every inequality arises because the rules of the game are unfair and that the state must intervene whenever there are unequal outcomes. The dangers of this leap are the primary focus of Is Social Justice Just?, whose twenty-one authors accepted an invitation to "explore, reassess, and critique the concept of social justice-relating it to ongoing debates in economics, history, philosophy, politics, public policy, religion, and the broader culture.". (shrink)

Pancreatitis is a complex, progressively destructive inflammatory disorder. Alcohol was long thought to be the primary causative agent, but genetic contributions have been of interest since the discovery that rare PRSS1, CFTR and SPINK1 variants were associated with pancreatitis risk. We now report two associations at genome-wide significance identified and replicated at PRSS1-PRSS2 and X-linked CLDN2 through a two-stage genome-wide study. The PRSS1 variant likely affects disease susceptibility by altering expression of the primary trypsinogen gene. The CLDN2 risk allele is (...) associated with atypical localization of claudin-2 in pancreatic acinar cells. The homozygous CLDN2 genotype confers the greatest risk, and its alleles interact with alcohol consumption to amplify risk. These results could partially explain the high frequency of alcohol-related pancreatitis in men. © 2012 Nature America, Inc. All rights reserved. (shrink)

Recovering Reason: Essays in Honor of Thomas L. Pangle is a collection of essays composed by students and friends of Thomas L. Pangle to honor his seminal work and outstanding guidance in the study of political philosophy. These essays examine both Socrates' and modern political philosophers' attempts to answer the question of the right life for human beings, as those attempts are introduced and elaborated in the work of thinkers from Homer and Thucydides to Nietzsche and Charles Taylor.

Biological evolution provides a creative fount of complex and subtle adaptations, often surprising the scientists who discover them. However, because evolution is an algorithmic process that transcends the substrate in which it occurs, evolution’s creativity is not limited to nature. Indeed, many researchers in the field of digital evolution have observed their evolving algorithms and organisms subverting their intentions, exposing unrecognized bugs in their code, producing unexpected adaptations, or exhibiting outcomes uncannily convergent with ones in nature. Such stories routinely reveal (...) creativity by evolution in these digital worlds, but they rarely fit into the standard scientific narrative. Instead they are often treated as mere obstacles to be overcome, rather than results that warrant study in their own right. The stories themselves are traded among researchers through oral tradition, but that mode of information transmission is inefficient and prone to error and outright loss. Moreover, the fact that these stories tend to be shared only among practitioners means that many natural scientists do not realize how interesting and lifelike digital organisms are and how natural their evolution can be. To our knowledge, no collection of such anecdotes has been published before. This paper is the crowd-sourced product of researchers in the fields of artificial life and evolutionary computation who have provided first-hand accounts of such cases. It thus serves as a written, fact-checked collection of scientifically important and even entertaining stories. In doing so we also present here substantial evidence that the existence and importance of evolutionary surprises extends beyond the natural world, and may indeed be a universal property of all complex evolving systems. (shrink)

For half a century, Ernest Fortin's scholarship has charmed and educated theologians and philosophers with its intellectual search for the best way to live. Written by friends, colleagues, and students of Fortin, this book pays tribute to a remarkable thinker in a series of essays that bear eloquent testimony to Fortin's influence and his legacy. A formidable commentator on Catholic philosophical and political thought, Ernest Fortin inspired others with his restless inquiries beyond the boundaries of conventional scholarship. With essays on (...) subjects ranging across philosophy, political science, literature, and theology Gladly to Learn and Gladly to Teach reflects the astonishing depth and breadth of Fortin's contribution to contemporary thought. (shrink)

For half a century, Ernest Fortin's scholarship has charmed and educated theologians and philosophers with its intellectual search for the best way to live. Written by friends, colleagues, and students of Fortin, this book pays tribute to a remarkable thinker in a series of essays that bear eloquent testimony to Fortin's influence and his legacy. A formidable commentator on Catholic philosophical and political thought, Ernest Fortin inspired others with his restless inquiries beyond the boundaries of conventional scholarship. With essays on (...) subjects ranging across philosophy, political science, literature, and theology Gladly to Learn and Gladly to Teach reflects the astonishing depth and breadth of Fortin's contribution to contemporary thought. (shrink)

Background: Treating medication-refractory freezing of gait in Parkinson’s disease remains challenging despite several trials reporting improvements in motor symptoms using subthalamic nucleus or globus pallidus internus deep brain stimulation. Pedunculopontine nucleus region DBS has been used for medication-refractory FoG, with mixed findings. FoG, as a paroxysmal phenomenon, provides an ideal framework for the possibility of closed-loop DBS.Methods: In this clinical trial, five subjects with medication-refractory FoG underwent bilateral GPi DBS implantation to address levodopa-responsive PD symptoms with open-loop stimulation. Additionally, PPN (...) DBS leads were implanted for CL-DBS to treat FoG. The primary outcome of the study was a 40% improvement in medication-refractory FoG in 60% of subjects at 6 months when “on” PPN CL-DBS. Secondary outcomes included device feasibility to gauge the recruitment potential of this four-lead DBS approach for a potentially larger clinical trial. Safety was judged based on adverse events and explantation rate.Findings: The feasibility of this approach was demonstrated as we recruited five subjects with both “on” and “off” medication freezing. The safety for this population of patients receiving four DBS leads was suboptimal and associated with a high explantation rate of 40%. The primary clinical outcome in three of the five subjects was achieved at 6 months. However, the group analysis of the primary clinical outcome did not reveal any benefit.Interpretation: This study of a human PPN CL-DBS trial in medication-refractory FoG showed feasibility in recruitment, suboptimal safety, and a heterogeneous clinical effect in FoG outcomes. (shrink)

The concentration of low‐density lipoprotein (LDL) cholesterol (C) in plasma is a key determinant of cardiovascular disease risk and human genetic studies have long endeavoured to elucidate the pathways that regulate LDL metabolism. Massive genome‐wide association studies (GWASs) of common genetic variation associated with LDL‐C in the population have implicated SORT1 in LDL metabolism. Using experimental paradigms and standards appropriate for understanding the mechanisms by which common variants alter phenotypic expression, three recent publications have presented divergent and even contradictory findings. (...) Interestingly, although these reports each linked SORT1 to LDL metabolism, they did not agree on a mechanism to explain the association. Here, we review recent mechanistic studies of SORT1 – the first gene identified by GWAS as a determinant of plasma LDL‐C to be evaluated mechanistically. (shrink)

Addressing the issue of how to read Nietzsche, this book presents an accessible series of essays for students and general readers on Nietzsche's individual works, written by such distinguished Nietzsche scholars as Frithjof Bergmann, Arthur Danto, Bernd Magnus, Christopher Middleton, Eric Blondel, Lars Gustaffson, Alexander Nehamas, Richard Schacht, Gary Shapiro, Hugh Silverman, and Ivan Soll. Among the works discussed are On the Genealogy of Morals, Beyond Good and Evil, Thus Spoke Zarathustra, Twilight of the Idols and The Will to (...) Power. (shrink)

Psychology may have to get seriously political as human aims in living and selfhood itself are increasingly influenced in a deleterious manner by the vicissitudes of living in a neoliberal political economy and one-sided “enterprise culture” (Martin & McLellan, 2013; Sugarman, 2015). This article reviews recent writings of several social critics, including Jackson Lears (2015), Sebastion Junger (2015), Philip Blond (2010), and Christopher Lasch (1995), who richly flesh out the picture of this detrimental state of affairs. We note that (...) many of these critics have little to say about credible alternatives to neoliberalism. The article then seeks to identify resources within theoretical and philosophical psychology, including hermeneutic philosophy and interpretive social science, for helping to overcome neoliberalism. They might help clarify and nurture a renewed democratic populism or engaged democratic politics and contribute to gaining what Lasch termed a much-needed “wisdom of limits” in today’s society. (shrink)

This paper reassesses Robert Koch’s work on tropical infections of humans and cattle as being inspired by an underlying interest in epidemiology. Such an interest was developed from the early 1890s when it became clear that an exclusive focus on pathogens was insufficient as an approach to explain the genesis and dynamics of epidemics. Koch, who had failed to do so before, now highlighted differences between infection and disease and described the role of various sub-clinical states of disease in the (...) propagation and—consequently—in the control of epidemics. Studying pathologies of men and cattle in tropical countries eventually facilitated the application of such measures in Europe through the screening of healthy carriers of typhoid, which was carried out in 1902. The concept of the carrier state can be understood as a spin-off from tropical medicine into the study and control of infectious disease in Europe. With it travelled assumptions that were typical for colonial and veterinary medicine where the health of indigenous individuals or cattle would be a secondary objective compared to the control of diseases in populations. (shrink)

Proponents of conditional logics such as David Lewis and Robert Stalnaker reject inferences containing counterfactuals from "if A, B" and "if B, C" to "if A, C" due to ordinary language counterexamples. Contextualists defend this inference rule called "hypothetical syllogism" or "transitivity" on the basis of a possible word semantics, which, however, assigns implausible truth values to certain counterfactuals. My defence of hypothetical syllogism avoids this problem, as it rests on Nelson Goodman's uncontroversial, metaphysically parsimonious assumption that we accept counterfactuals (...) as true only under certain conditions from which, in conjunction with the antecedent, the consequent can be inferred. The counterexamples to hypothetical syllogism can be rebutted because their premises are doxastically noncotenable; that is, there is no set of conditions under which the premises can be accepted as jointly true. (shrink)

One of Ludwik Fleck’s ideas about the development of scientific knowledge is that—once a system of interpretation is in place—the process that follows can be characterised as one of inertia: any new evidence comes under a strong pressure to be incorporated into the established frame. This can result in what Fleck called a harmony of illusions when contradictory evidence becomes almost invisible or is incorporated into the established frame only by huge efforts.The paper analyses early explanations of the tuberculin reaction (...) as a case study of Fleck’s argument. For Robert Koch, who had presented tuberculin in 1890, the compound was supposed to be a diagnostic tool and a cure for tuberculosis. His conception of its effect was rather peculiar, but strictly in line with ideas on the pathogenesis of infectious diseases he had developed much earlier. After tuberculin was released in late 1890, whether Koch’s conception was convincing depended on the place that a given observer had in the medical world in late-nineteenth-century Germany. Inside Koch’s group, the status of the tuberculin reaction remained stable and tuberculin retained its value as a diagnostic and curative tool. On the other hand, observers from outside that thought collective, and in particular from clinical medicine, soon pointed to flaws in its conception. These critics developed a rather different picture of tuberculin as a mysterious and dangerous drug. No reconciliation followed and what we find instead in German medicine around the year 1900 is the presence of rather contradictory concepts and practices surrounding Koch’s wonder cure. (shrink)

Bioethicists function in an environment in which their peers - healthcare executives, lawyers, nurses, physicians - assert the integrity of their fields through codes of professional ethics. Is it time for bioethics to assert its integrity by developing a code of ethics? Answering in the affirmative, this paper lays out a case by reviewing the historical nature and function of professional codes of ethics. Arguing that professional codes are aggregative enterprises growing in response to a field's historical experiences, it asserts (...) that bioethics now needs to assert its integrity and independence and has already developed a body of formal statements that could be aggregated to create a comprehensive code of ethics for bioethics. A Draft Model Aggregated Code of Ethics for Bioethicists is offered in the hope that analysis and criticism of this draft code will promote further discussion of the nature and content of a code of ethics for bioethicists. (shrink)

Which is more important, tragedy or treatise? This question, which was posed as early as in antiquity, cannot easily be answered since tragedy has reflective passages on existential issues, just as philosophy uses tragedy for argumentation or takes the dramatic form itself. This is particularly evident in the work of the ‘philosophus scaenicus’ Euripides, in Plato, whose understanding of tragedy as expressed in the Symposium and the Laws is discussed here, and with Cicero and Seneca, who were both authors of (...) treatises and verses of tragedy. They constitute the focus of this volume, which also examines the function of the poetry quotations in Chrysippus and finally the significance of tragedy for Hannah Arendt’s political analysis. With contributions by Sandra Erker, Susanna Fischer, Thomas Gärtner, Andreas Heil, Argyri Karanasiou, Giovanni Panno, Robert C. Pirro, Tobias Riedl and Petra Schierl. (shrink)

I defend Christopher Peacocke's and Robert Hopkins's experienced resemblance accounts of depiction against criticisms put forward by Gavin McIntosh in a recent article in this journal. I argue that, while there may be reasons for rejecting Peacocke's and Hopkins's accounts, McIntosh fails to provide any.

Oxford Studies in Ancient Philosophy is an annual publication which includes original articles, which may be of substantial length, on a wide range of topics in ancient philosophy, and review articles of major books. Contributors to this volume; Paul A. Vander Waerdt, Christopher Rowe, Rachel Rue, Paula Gottlieb, Robert Bolton, and John M. Cooper.

Socrates is one of the most important yet enigmatic philosophers of all time; his fame has endured for centuries despite the fact that he never actually wrote anything. In 399 B.C.E., he was tried on the charge of impiety by the citizens of Athens, convicted by a jury, and sentenced to death. About these facts there is no disagreement. However, as the sources collected in this book and the scholarly essays that follow them show, several of even the most basic (...) facts about these events were controversial in antiquity, and the questions persist today: How and why was Socrates brought to trial? Why did the jurors, members of the world's first democracy, find him guilty? When he was given an opportunity to escape execution, why did he refuse to do so and instead accept the punishment that he and his friends agreed was unjustly assigned to him? How exactly did Socrates die? Differences of opinion on these and other issues continue to arouse our curiosity and to challenge new generations of students and scholars. The Trial and Execution of Socrates: Sources and Controversies is the first work to collect in one place all of the major ancient sources on Socrates' death--those of both his critics and his defenders--as well as recent scholarly views. Part I includes new translations of Plato's Euthyphro, Apology, Crito, and the death scene from Phaedo, as well as other ancient sources that shed light on Socrates' trial and execution. Part II features some of the most influential recent scholarship on this historically momentous event with work by M. F. Burnyeat, Robert Parker, Mark L. McPherran, Thomas C. Brickhouse and Nicholas D. Smith, Richard Kraut, Christopher Gill, and Enid Bloch. Ideal for undergraduate surveys of ancient Greek philosophy and upper-level courses on Socrates and Socratic philosophy, this unique collection provides an unprecedented look into the many perplexing questions surrounding the trial and execution of this remarkable man. (shrink)

Over the past two decades many social studies educators have called for history to be taught as interpretation, which has included arguments for the teaching of history through inquiry. This case study examined four secondary social studies teachers and their development of beliefs and practices related to teaching history as interpretation. The data were collected longitudinally from their student teaching through the completion of their first year in the classroom. Corroborating arguments found in the pre-existing research, this study found that (...) classroom control and a limited understanding of history content were major barriers preventing teachers from teaching history as interpretation. However, the results also revealed that teachers desired a better development of their own practical “toolkit” and they believed this would have helped them overcome many of the barriers to teaching history as interpretation. (shrink)

BackgroundAs hospitals have grown more complex, the ethical concerns they confront have grown correspondingly complicated. Many hospitals have consequently developed health care ethics programs (HCEPs) that include far more than ethics consultation services alone. Yet systematic research on these programs is lacking.MethodsBased on a national, cross-sectional survey of a stratified sample of 600 US hospitals, we report on the prevalence, scope, activities, staffing, workload, financial compensation, and greatest challenges facing HCEPs.ResultsAmong 372 hospitals whose informants responded to an online survey, 97% (...) of hospitals have HCEPs. Their scope includes clinical ethics functions in virtually all hospitals, but includes other functions in far fewer hospitals: ethical leadership (35.7%), regulatory compliance (29.0%), business ethics (26.2%), and research ethics (12.6%). HCEPs are responsible for providing ongoing ethics education to various target audiences including all staff (77.0%), nurses (59.9%), staff physicians (49.0%), hospital leadership (44.2%), medical residents (20.3%) and the community/general public (18.4%). HCEPs staff are most commonly involved in policy work through review of existing policies but are less often involved in development of new policies. HCEPs have an ethics representative in executive leadership in 80.5% of hospitals, have representation on other hospital committees in 40.7%, are actively engaged in community outreach in 22.6%, and lead large-scale ethics quality improvement initiatives in 17.7%. In general, major teaching hospitals and urban hospitals have the most highly integrated ethics programs with the broadest scope and greatest number of activities. Larger hospitals, academically affiliated hospitals, and urban hospitals have significantly more individuals performing HCEP work and significantly more individuals receiving financial compensation specifically for that work. Overall, the most common greatest challenge facing HCEPs is resource shortages, whereas underutilization is the most common greatest challenge for hospitals with fewer than 100 beds. Respondents’ strategies for managing challenges include staff training and additional funds.ConclusionsWhile this study must be cautiously interpreted due to its limitations, the findings may be useful for understanding the characteristics of HCEPs in US hospitals and the factors associated with these characteristics. This information may contribute to exploring ways to strengthen HCEPs. (shrink)

ABSTRACTAn essential and yet often neglected motivation of Bernard Suits’ elevation of gameplay to the ideal of human existence is his account of capacities along perfectionist lines and the function of games in eliciting them. In his work Suits treats the expression of these capacities as implicitly good and the purest expression of the human telos. Although it is a possible interpretation to take Suits’ utopian vision to mean that gameplay in his future utopia must consist of the logically inevitable (...) replaying of activities we conduct in the present for instrumental reasons, because gameplay for Suits is identical with the expression of sets of capacities specifically elicited by game rules, it is much more likely that he intends utopian gameplay to be an endless series of carefully crafted opportunities for the elicitation of special capacities, and thus embody his ideal of existence. This article therefore provides a new lens for understanding both... (shrink)