The public debate on voluntary termination of life by elderly people, which has been an intensely controversial subject in the Netherlands for some time, has centered around the issue of “completed life” in recent years. In 2016, an ad hoc governmental advisory committee concluded that the already existing Euthanasia Act provided sufficient scope to resolve most of the problems related to the issue. Most of the older adults who feel they no longer have anything to look forward to in their (...) lives and who have developed a wish to die as a result would be able to invoke this Act. Partly for this reason, the committee considered broadening the legal options relating to assisted suicide undesirable. Analysis of the assessment practice of the regional euthanasia review committees reveals that the room for interpretation offered by the Euthanasia Act is indeed considerable. (shrink)

Euthanasia and assisted suicide have been legally possible in the Netherlands since 2001, provided that statutory due care criteria are met, including: voluntary and well-considered request; unbearable suffering without prospect of improvement; informing the patient; lack of a reasonable alternative; independent second physician’s opinion. ‘Unbearable suffering’ must have a medical basis, either somatic or psychiatric, but there is no requirement of limited life expectancy. All EAS cases must be reported and are scrutinised by regional (...) review committees. The purpose of this study was to investigate whether any particular difficulties arise when the EAS due care criteria are applied to patients with an intellectual disability and/or autism spectrum disorder. The 416 case summaries available on the RTE website were searched for intellectual disability and autism spectrum disorder. Direct content analysis was used on these nine cases. Assessment of decisional capacity was mentioned in eight cases, but few details given; in two cases, there had been uncertainty or disagreement about capacity. Two patients had progressive somatic conditions. For most, suffering was due to an inability to cope with changing circumstances or increasing dependency; in several cases, suffering was described in terms of characteristics of living with an autism spectrum disorder, rather than an acquired medical condition. Some physicians struggled to understand the patient’s perspective. Treatment refusal was a common theme, leading physicians to conclude that EAS was the only remaining option. There was a lack of detail on social circumstances and how patients were informed about their prognosis. Autonomy and decisional capacity are highly complex for patients with intellectual disabilities and difficult to assess; capacity tests in these cases did not appear sufficiently stringent. Assessment of suffering is particularly difficult for patients who have experienced life-long disability. The sometimes brief time frames and limited number of physician-patient meetings may not be sufficient to make a decision as serious as EAS. The Dutch EAS due care criteria are not easily applied to people with intellectual disabilities and/or autism spectrum disorder, and do not appear to act as adequate safeguards. (shrink)

One of the requirements in the Dutch regulation for euthanasia and assisted suicide is that the doctor must be satisfied ‘that the patient's suffering is unbearable, and that there is no prospect of improvement.’ In the notorious Chabot case, a psychiatrist assisted a 50 year old woman in suicide, although she did not suffer from any somatic disease, nor strictly speaking from any psychiatric condition. In Seduced by Death, Herbert Hendin concluded that apparently the Dutch regulation (...) now allows physicians to assist anyone in suicide simply because he or she is unhappy.In this paper, I reject Hendin's conclusion and in particular his description of Mrs Boomsma as someone who was ‘simply unhappy.’ After a detailed narration of her lifestory, I turn to the American philosopher Harry Frankfurt's account of volitional incapacity and love for a more accurate characterization of her suffering. Having been through what she had, she could only go on living as another person than the one she had been when she was a happy mother. That would have violated her integrity, and that she could not bring herself to do. (shrink)

Euthanasia and physician-assisted suicide are controversial issues in medical ethics and medical law. In the debate, several arguments against the moral acceptability and legal feasibility of active involvement of physicians in bringing about a patient’s death can be found.One argument refers back to the Ten Commandments: “Thou shall not kill”. Killing another human being is morally abject. According to the argument, this is certainly so for medical doctors, as can be seen in the Hippocratic Oath, which explicitly forbids abortion and (...) euthanasia. A less apodictic argument refers to the slippery slope: if euthanasia would be permitted, a downhill movement is set in motion. The end of this movement would be, on the one hand, that physicians will feel forced to assist people who ask for termination of life on whatever grounds. On the other hand, it might lead to a situation in which it becomes normal to kill people who are no longer useful for society.In the literature and in the public debate, there are also arguments in favour of euthanasia and physician-assisted suicide. One such argument invokes the right to die. According to this argument, decisions concerning life and death should be up to the individual who is concerned. In many countries, suicide is morally and legally accepted. If people are allowed to kill themselves, why should they be without rights when they are no longer able to perform the act themselves?In medical ethics and medical law, patient autonomy is a central pivot. Patients have the right to refuse treatment even if this leads to their death. Shouldn’t people also have the right to determine the moment of dying, if they are in a situation which is unbearable, and without prospect of improvement? Another argument focuses on the duty of the physician to alleviate pain and suffering. If there is no other option, the doctor, in fulfilling this duty, should be allowed to actively end the patient’s life. This argument is not based on autonomy, but on beneficence.The debate concerning euthanasia involves fundamentally different moral principles. This makes the debate interesting, if not central to medical ethics and medical law. Yet, the principles are normally presented in an abstract way. Discussants stick to very general ideas, which lack reference to specific social and historical conditions, and are not related to concrete experiences. To invoke the Ten Commandments, or plea for a right to die, implies the use of universal standards, which tend to be general and empty.From a philosophical perspective, this type of argumentation can be criticized. Following Aristotle, ethics should be based upon experience. Ethical knowledge requires participation in concrete practices. Central to ethics is a feeling for the concrete situation, which is always contingent and historical. From this perspective, it makes sense to consider how practitioners in specific situations deal with moral issues, for instance concerning euthanasia. What role do they give to notions such as autonomy and beneficence, how do they interpret them and apply them to the concrete situation?In this paper I will present the Dutch experience with euthanasia. I will focus upon the way in which during the past thirty years the arguments in favour of euthanasia have been developed, in interaction with euthanasia practice. I will show that patient autonomy has been a crucial pivot. Yet, the Dutch interpretation of autonomy is not purely liberal. It does not only involve rights, but also obligations. Next, I will make clear that the physician plays a central role, in that the moral and legal basis of euthanasia is a conflict of duties on the side of the physician.This brings in the issue of beneficence. Yet the Dutch interpretation of the duty to help is not simply paternalistic. In Dutch health care, the physician-patient relationship is based upon deliberation and mutual agreement. Therefore, my conclusion will be that the Dutch practice of euthanasia has a moral ground, which goes beyond the traditional opposition between autonomy and beneficence. (shrink)

United States federal regulations for pediatric research with no prospect of direct benefit restrict institutional review board (IRB) approval to procedures presenting: 1) no more than "minimal risk" (§ 45CFR46.404); or 2) no more than a "minor increase over minimal risk" if the research is commensurate with the subjects' previous or expected experiences and intended to gain vitally important information about the child's disorder or condition (§ 45CFR46.406) (DHHS 2001). During the 25 years since their adoption, these (...) regulations have helped IRBs balance subject protections with the pursuit of scientific knowledge to advance children's welfare. At the same time, inconsistency in IRB application of these regulations to pediatric protocols has been widespread, in part because of the ambiguity of the regulatory language. During the past decade, three federally-charged committees have addressed these ambiguities: 1) the National Human Research Protections Advisory Committee (NHRPAC) (Washington, DC), 2) the Institute of Medicine (IOM) Committee on the Ethical Conduct of Clinical Research Involving Children (Washington, DC); and 3) the United States Department of Health and Human Services Secretary's Advisory Committee for Human Research Protections (SACHRP) (Washington, DC). The committees have reached similar conclusions on interpretation of language within regulations § § 45CFR46.404 and 406; these conclusions are remarkably consistent with recent international recommendations and those of the original National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1977) report from which current regulations are based. Drawing on the committees' public reports, this article identifies the ethical issues posed by ambiguities in regulatory language, summarizes the committees' deliberations, and calls for a national consensus on recommended criteria. (shrink)

Genome editing holds the promise of revolutionizing many fields in which human interventions have hitherto proved to be insufficient to meet major global challenges, like nutrition and environmental protection. However, it is controversial how far this method might also be applied to the human germline with a view to preventing the transmission of serious genetic diseases to offspring. While there is a near-consensus that genome editing, at the present stage of science, should not be applied clinically, it is unclear (...) whether this also extends to clinically oriented research. It is argued that among the arguments against interventions in the human germline there is only one that is sufficiently strong to be practically relevant: The argument that it is doubtful whether the challenge of off-target effects with potentially fatal health consequences can be met. Since nearly all objectives of human germline genome editing can be attained by PGD, there are good grounds for directing clinically oriented research toward the improvement of this alternative method, which has been proven to be without substantial risks and which involves no ethical problems over and above those involved in genome editing. (shrink)

Commemorating the life and work of Dr John Bennett; his lifelong contribution to Early Childhood Education and Care, and his ongoing influence on policy, research and practice in this field, In Search of Social Justice is a tribute to a preeminent scholar and his vision for an equitable and high-quality start for all children. Working tirelessly to raise the profile of Early Childhood Education and Care, and prioritise the rights and well-being of children and families in national and international policy, (...) John Bennet played an invaluable role in improving the position of young children globally. In Search of Social Justice takes John's legacy as a starting point for critical examination of the changing discourse on Early Childhood Education, and argues for the continued relevance of his approach. Drawing on personal reflections, vignettes and testimonials from eminent authors who shared their professional lives with him, the book foregrounds John's insistence that we must continue to shape policy and provision through inquiry, high-quality evidence, passion and persistence, improving the early experiences of all young children. As much a celebration of John's work and achievements, as a call to collective action towards achieving his vision for equitable, quality early childhood education and care, this is a fascinating read for students, researchers and activists in the field of Early Childhood Education and Care. (shrink)

Euthanasia and assisted suicide was openly permitted but not technically legal in the Netherlands for decades. In 2002, it was formally legalised through the Termination of Life on Request and Assisted Suicide Review Procedures Act, subject to two main criteria: the patient had to be capable of making voluntary decisions and the patient had to experience unbearable suffering without prospect of improvement. Within the Netherlands, EAS has wide acceptance, and the public in general seems to favour (...) a liberal interpretation of both of these requirements. Physicians are expected to use ‘their own moral compass’ to decide about personal participation, and it is generally possible and permissible to find a substitute physician if the patient meets the legally required criteria but the physician is not comfortable assisting. Over the years, multiple quantitative and qualitative studies have explored the Dutch practice of EAS,1–3 but relatively little is known about the edges of what counts as meeting these criteria and how acceptable the practice is for physicians who participate. The study by Snijdewind et al gives a glimpse of these boundaries and suggests that at least sometimes the criteria are being stretched and adapted to meet the perceived needs of patients, and some participating physicians are relatively uncomfortable with some of the requests with which they are faced.4 Just how rare or common these ‘edgy’ cases are within the larger practice of EAS in the Netherlands cannot be answered by …. (shrink)

This paper examines whether having school students repeat a year improves their performance, focusing on learning English as a foreign language. It takes students’ English examination results from five years from a Chinese‐medium school, together with data on their learning styles and learning strategies. Drawing on local cultural and pedagogic factors, the study finds that repeating a year, far from improving scores, homogenizes the results of males and females, and, while finding a small but statistically insignificant rise in the (...) scores of females, is detrimental to the performance of males. Repeating a year either makes no difference or a negative difference to results. It is suggested that repeating a year reproduces, sharpens and potentiates gender differences in learning and performing in English as a foreign language, and that repeating a year is the medium and outcome of gender inequality. Implications are drawn for practice. (shrink)

Background One of the objectives of medicine is to relieve patients' suffering. As a consequence, it is important to understand patients' perspectives of suffering and their ability to cope. However, there is poor insight into what determines their suffering and their ability to bear it. Purpose To explore the constituent elements of suffering of patients who explicitly request euthanasia or physician-assisted suicide (EAS) and to better understand unbearable suffering from the patients' perspective. Patients and (...) methods A qualitative study using in-depth face-to-face interviews was conducted with 31 patients who had requested EAS. The grounded theory approach was used to analyse the data. Results Medical, psycho-emotional, socio-environmental and existential themes contributed to suffering. Especially fatigue, pain, decline, negative feelings, loss of self, fear of future suffering, dependency, loss of autonomy, being worn out, being a burden, loneliness, loss of all that makes life worth living, hopelessness, pointlessness and being tired of living were constituent elements of unbearable suffering. Only patients with a psychiatric (co)diagnosis suffered unbearably all the time. Conclusions Unbearable suffering is the outcome of an intensive process that originates in the symptoms of illness and/or ageing. According to patients, hopelessness is an essential element of unbearable suffering. Medical and social elements may cause suffering, but especially when accompanied by psycho-emotional and existential problems suffering will become ‘unbearable’. Personality characteristics and biographical aspects greatly influence the burden of suffering. Unbearable suffering can only be understood in the continuum of the patients' perspectives of the past, the present and expectations of the future. (shrink)

The proposed article provides an overview of European and North American states’ legislation, which regulates the procedure for pre-clinical research, clinical trials and state registration of medicinal products, as well as responsibility for its violation, analysis of the problems and prospects of adaptation of the national legislation to European legal space, particularly in the field of criminal and legal regulation of relations in the sphere of pre-clinical trials, clinical trials and state registration of medicine. The emphasis is put on the (...) matter that inclusion of Article 321-2 into the Criminal Code of Ukraine leads to a false concurrence with other provisions of the Code. The author proposes to introduce recent EU legislation (Acquis Communautaire) on legal regulation of clinical trials and circulation of medicine into the law of Ukraine, clarify terminology related to Fundamentals of Ukrainian Legislation on Health Protection and the Special Part of criminal law, introduce criminal liability for legal entities that will provide effective control over negative effects of research centers’ activity. It is suggested to develop legislative proposals to improve the provisions of the Criminal Code of Ukraine, which provide legal protection of relations arising in connection with pre-clinical research, clinical trials and state registration of medicinal products. (shrink)

As in the United States, the Dutch conversation about assisted suicide emerged primarily in the context of cancer. At least in that context, before acceding to a request for assistance in dying, caregivers must be sure that the person has made a voluntary and carefully considered request, and that her suffering is unbearable and without prospect of improvement. The Dutch have recently been trying to use those criteria in the context of Alzheimer's disease. Given the wave (...) of Alzheimer's cases poised to crash onto wealthy countries, along with emerging technology to detect the disease process before symptoms appear, we should be grateful to the Dutch for that attempt. As a newcomer to this discussion, however, I was struck that those criteria may have a somewhat odd result. A patient with Alzheimer's disease can easily meet the conditions in the early stage of the disease, when one usually has the mental capacity to request assistance in dying and to make the case that one's existential suffering is unbearable. If one is in the late stage, though, it can be much harder to get such assistance because one does not have that capacity. (shrink)

The study of rare diseases has long been an area of challenge for medical researchers, with agonizingly slow movement towards improved understanding of pathophysiology and treatments compared with more common illnesses. The push towards evidence-based medicine (EBM), which prioritizes certain types of evidence over others, poses a particular issue when mapped onto rare diseases, which may not be feasibly investigated using the methodologies endorsed by EBM, due to a number of constraints. While other trial designs have been suggested (...) to overcome these limitations (with varying success), perhaps the most recent and enthusiastically adopted is the application of artificial intelligence to rare disease data. This paper critically examines the pitfalls of EBM (and its trial design offshoots) as it pertains to rare diseases, exploring the current landscape of AI as a potential solution to these challenges. This discussion is also taken a step further, providing philosophical commentary on the weaknesses and dangers of AI algorithms applied to rare disease research. While not proposing a singular solution, this article does provide a thoughtful reminder that no ‘one-size-fits-all’ approach exists in the complex world of rare diseases. We must balance cautious optimism with critical evaluation of new research paradigms and technology, while at the same time not neglecting the ever-important aspect of patient values and preferences, which may be challenging to incorporate into computer-driven models. (shrink)

BackgroundDespite five decades of increasingly elegant studies aimed at advancing the pathophysiology and treatment of mental illness, the results have not met expectations. Diagnoses are still based on observation, the clinical history, and an outmoded diagnostic system that stresses the historic goal of disease specificity. Psychotropic drugs are still based on molecular targets developed decades ago, with no increase in efficacy. Numerous biomarkers have been proposed, but none have the requisite degree of sensitivity and specificity, and therefore have no (...) usefulness in the clinic. The obvious lack of progress in psychiatry needs exploration.MethodsThe historical goals of psychiatry are reviewed, including parity with medicine, a focus on diagnostic reliability rather than validity, and an emphasis on reductionism at the expense of socioeconomic issues. Data are used from Thomas Picketty and others to argue that our failure to advance clinical care may rest in part on the rise in social and economic inequality that began in the 1970s, and in part on our inability to move beyond the medical model of specificity of disease and treatment.ResultsIt is demonstrated herein that the historical goal of specificity of disease and treatment has not only impeded the advance of diagnosis and treatment of mental illness, but, in combination with a rapid increase in socioeconomic inequality, has led to poorer outcomes and rising mortality rates in a number of disorders, including schizophrenia, anxiety, and depression.ConclusionsIt is proposed that Psychiatry should recognize the fact of socioeconomic inequality and its effects on mental disorders. The medical model, with its emphasis on diagnostic and treatment specificity, may not be appropriate for investigation of the brain, given its complexity. The rise of scientific inequality, with billions allocated to connectomics and genetics, may shift attention away from the need for improvements in clinical care. Unfortunately, the future prospects of those suffering from mental illness appear dim. (shrink)

IntroductionPalliative care is an emotionally and spiritually high-demanding setting of care. The literature reports on the main issues in order to implement self-care, but there are no models for the organization of the training course. We described the structure of training on self-care and its effects for a Hospital Palliative Care Unit.MethodWe used action-research training experience based mostly on qualitative data. Thematic analysis of data on open-ended questions, researcher’s field notes, oral and written feedback from the trainer and the participants (...) on training outcomes and satisfaction questionnaires were used.ResultsFour major themes emerged: “Professional role and personal feelings”; “Inside and outside the team”; “Do I listen to my emotions in the care relationship?”; “Death: theirs vs. mine.” According to participants’ point of view and researchers’ observations, the training course resulted in ameliorative adjustments of the program; improved skills in self-awareness of own’s emotions and sharing of perceived emotional burden; practicing “compassionate presence” with patients; shared language to address previously uncharted aspects of coping; allowing for continuity of the skills learned; translation of the language learned into daily clinical practices through specific facilitation; a structured staff’s support system for emotional experiences.DiscussionSelf-care is an important enabler for the care of others. The core of our intervention was to encourage a meta-perspective in which the trainees developed greater perspicacity pertaining to their professional role in the working alliance and also recognizing the contribution of their personal emotions to impasse experienced with patients. (shrink)

This article describes two features of technoscience, which are significant for the consideration of the prospects of human improvement projects. The first feature of technoscience is that the object of its research is artificial in origin which means created by person. As an example of new objects, situations and problems are given projects to create «designer children», development of transplantation, creating implantable neural interface. The second feature of technoscience is that the well-established methods can't be applied to determine the (...) results of the implementation of human improvement projects. As an example, the article discussed neo-eugenics projects. The article concludes that today in the social sciences there is no clear position on the grounds of human improvement projects. However, this is not an obstacle for the development of technoscience. (shrink)

Realists have responded to challenges from the historical record of successful but ultimately rejected theories with what I call the selective confirmation strategy: arguing that only idle parts of past theories have been rejected, while truly success‐generating features have been confirmed by further inquiry. I argue first, that this strategy is unconvincing without some prospectively applicable criterion of idleness for theoretical posits, and second, that existing efforts to provide one either convict all theoretical posits of idleness (Kitcher) or stand (...) refuted by detailed consideration of the very examples (optical/electromagnetic ether, caloric fluid) to which they appeal (Psillos). I also argue that available avenues for improving on these proposals are unpromising. (shrink)

Background How often does refractory suffering, which is suffering due to symptoms that cannot be adequately controlled, occur at the end of life in modern palliative care? What are the causes of such refractory suffering? Should euthanasia be offered for refractory suffering at the end of life? We sought to shed light on these questions through interviews with palliative care specialists. Methods Semi-structured interviews with six nurses and six doctors working in palliative care in (...) five Norwegian hospitals. Transcripts were analysed with systematic text condensation, a qualitative analysis framework. Results Informants find that refractory suffering is rare, and that with palliative sedation satisfactory symptom control can nearly always be achieved at the end of life. However, the process of reaching adequate symptom control can be protracted, and there can be significant suffering in the meantime. Both somatic, psychological, social and existential factors can contribute to refractory suffering and potentiate each other. However, informants also place significant weight on factors pertaining to the organization of palliative care services as contributing to insufficient symptom control. Conclusions If refractory suffering is indeed rare, then this arguably weakens a common prima facie argument for the legalization of assisted dying. However, the process of reaching adequate symptom control can be protracted and involve significant suffering. The experiences of palliative care clinicians constitute important empirical premises for the assisted dying debate. The study points to several areas in which palliative care can be improved. (shrink)

Teleosemantics is the view that mental content depends on etiological function. Moral adaptationism is the view that human morality is an evolved adaptation. Jointly, these two views offer new venues for naturalist metaethics. Several authors have seen, in the conjunction of these views, the promise of assigning naturalistically respectable descriptive content to moral judgments. One such author is Neil Sinclair, who has offered a blueprint for how to conduct teleosemantic metaethics with the help of moral adaptationism. In this paper, (...) I argue that the prospects for assigning descriptive content to moral judgments on the basis of teleosemantics are bad. I develop my argument in dialogue with Sinclair’s paper and argue that, although Sinclair’s account of the evolution of morality is plausible, the teleosemantic account of the descriptive content of moral judgments which he bases thereon suffers from crucial shortcomings. I argue further that, given some minimal plausible assumptions about the evolution of morality made by Sinclair, no assignment of descriptive content is possible. Contrary to prevailing assumptions, the combination of moral adaptationism and teleosemantics suggests that moral judgments lack descriptive content. (shrink)

Even in the Netherlands, where the practice of physician-assisted death (PAD) has been legalized for over 20 years, there is no such thing as a ‘right to die’. Especially patients with extraordinary requests, such as a wish for PAD based on psychiatric suffering, advanced dementia, or (a limited number of) multiple geriatric syndromes, encounter barriers in access to PAD. In this paper, we discuss whether these barriers can be justified in the context of the Dutch situation where PAD (...) is legally permitted for those who suffer unbearably and hopelessly as a result of medical conditions. Furthermore, we explore whether there are options to address some of the barriers or their consequences, both within the Dutch legal framework or by adjusting the legal framework, and whether these options are feasible. We conclude that although there are insufficient arguments to overrule the doctor’s freedom of conscience in the Netherlands, there are ways to address some of the barriers, mainly by offering support to doctors that would be willing to support a request. Moreover, we believe it is morally required to reduce or mitigate where possible the negative consequences of the barriers for patients, such as the long waiting time for those who suffer from psychiatric disorders, because it is unlikely the adjustments suggested to the system will ensure reasonable access for these patient groups. (shrink)

BackgroundSarcomas are a diverse group of neoplasms that vary greatly in clinical presentation and responsiveness to treatment. Given the differences in the sites of involvement, rarity, and treatment modality, a multidisciplinary approach is required. Previous literature suggests patients with sarcoma suffer from poorer quality of life especially physical and functional wellbeing. Adolescent and young adult patients are an underrepresented population in cancer research and have differing factors influencing QoL.MethodsRetrospective analysis of Young Adult patients enrolled in the Sarcoma Tissue Repository (...) at University of Iowa. QoL was assessed using the self-report FACT-G questionnaire at enrollment and 12 months post-diagnosis; overall scores and the 4 wellbeing subscales were calculated. Linear mixed effects models were used to measure the association between the rate of change in FACT-G subscale scores and baseline clinical, comorbidity, and treatment characteristics.Results49 patients were identified. 57.1% of patients had a malignancy involving an extremity. Mean FACT-G scores of overall wellbeing improved from baseline to 12 months. Social and emotional wellbeing did not differ significantly between baseline and 12 months. Physical wellbeing and functional wellbeing scores improved from baseline to 12 months. No difference was seen for FACT-G overall scores for age, sex, laterality, marital status, performance status, having children, clinical stage, limb surgery, chemotherapy, or tumor size. A difference was demonstrated in physical wellbeing scores for patients with baseline limitation compared to those with no baseline limitation. A difference was demonstrated in social wellbeing based on anatomical site.ConclusionYoung adults with sarcoma treated at a tertiary center had improvements in overall reported QoL at 12 months from diagnosis. Overall baseline QoL scores on FACT-G were lower than the general adult population for YA patients with sarcoma but at 12 months became in line with general population norms. The improvements seen merit further investigation to evaluate how these change over the continuum of care. Quality of life changes may be useful outcomes of interest in sarcoma trials. (shrink)

The burden of research ethics review falls not just on researchers, but on those who serve on research ethics committees (RECs). With the advent of automated text analysis and generative artificial intelligence, it has recently become possible to teach models to support human judgment, for example by highlighting relevant parts of a text and suggesting actionable precedents and explanations. It is time to consider how such tools might be used to support ethics review and oversight. This commentary argues that (...) with a suitable strategy of engagement, artificial intelligence can be used in a variety of ways that can genuinely support RECs and manage their workload and improve the quality of review. It would be wiser to take an active role in the development of AI tools for ethics review, rather than to adopt ad hoc tools after the fact. (shrink)

Since the turn of the twenty-first century, biomedical psychiatry around the globe has embraced the so-called precision medicine paradigm, a model for medical research that uses innovative techniques for data collection and analysis to reevaluate traditional theories of disease. The goal of precision medicine is to improve diagnostics by restratifying the patient population on the basis of a deeper understanding of disease processes. This paper argues that precision is ill-fitting for psychiatry for two reasons. First, in psychiatry, unlike in fields (...) like oncology, precision medicine has been understood as an attempt to improve medicine by casting out, rather than merely revising, traditional taxonomic tools. Second, in psychiatry the term “biomarker” is often used in reference to signs or symptoms that allow patients to be classified and then matched with treatments; however, in oncology “biomarker” usually refers to a disease mechanism that is useful not only for diagnostics, but also for discovering causal pathways that drug therapies can target. Given these differences between how the precision medicine paradigm operates in psychiatry and in other medical fields like oncology, while precision psychiatry may offer successful rhetoric, it is not a promising paradigm. (shrink)

Objective: We aimed to analyze the characteristics and psychological mechanism of depressive symptoms in elderly patients with alcohol dependence under the COVID-19 epidemic and to observe the effect of acupuncture combined with emotional therapy of Chinese medicine treatment on depressive symptoms in elderly patients with alcohol dependence.Methods: Sixty patients were randomly divided into two groups. One group was treated by a set of emotional therapy of Chinese medicine treatment for 12 weeks. One group was treated by a (...) set of acupuncture combined with emotional therapy of Chinese medicine treatment for 12 weeks. We compared the curative effect between the control group and the treatment group, the mean alcohol consumption, the SF-36 scores before and after treatment, and the scores of Hamilton Depression Scale before and after treatment of 3, 6, and 9 weeks.Results: Based on the cognitive behavior model, the characteristics and psychological mechanism of depression in elderly patients with alcohol dependence under the COVID-19 epidemic situation were summarized. The total effective rate of the control group was 60%, and that of the treatment group was 100%. After 12 weeks of treatment, there were significant differences in PF, RF, physical pain, general health status, energy, and mental health between the treatment group and the control group. Before and after treatment, there were significant differences in PF, RF, physical pain, general health, energy, emotional function, and mental health of the treatment group. The PF, energy, and mental health of the control group were significantly different before and after treatment. There was no significant difference between the treatment group and the control group in the scores of Hamilton Depression Scale before treatment. There was significant difference between the treatment group and the control group in the scores of Hamilton Depression Scale at 3, 6, and 9 weeks after treatment.Conclusion: Attention, cognition, emotion, behavior, and physical response reinforce each other, creating a vicious cycle that reinforces and sustains the depressive symptoms of elderly alcohol dependence under the COVID-19 epidemic, and acupuncture combined with emotional therapy of Chinese medicine treatment for improving the depressive symptoms of elderly alcohol dependence during the epidemic period of COVID-19 has a brilliant therapeutic effect. (shrink)

Background:Women's health has received renewed attention in the last few years including health rehabilitation options for women affected by breast cancer. Dancing has often been regarded as one attractive option for supporting women's well-being and health, but research with women recovering from breast cancer is still in its infancy. Dancing with Health is multi-site pilot study that aimed to evaluate a dance programme for women in recovery from breast cancer across five European countries.Methods:A standardized 32 h dance protocol (...) introduced a range of Latin American dances presented within a sports and exercise framework with influences from dance movement therapy. Fifty-four women (M age 53.51; SD 7.99) participated in the study who had a breast cancer diagnosis 6 weeks, no indication of metastasis, or scheduled surgery/chemotherapy/radiation treatment for the duration of the intervention. Primary outcome data was collected for anthropometric and fitness measures next to cancer-related quality of life.T-tests and Wilcoxon signed ranked tests were used to establish differences pre and post intervention. Cohen's d was also calculated to determine the effect size of the intervention.Results:Statistically significant changes were found for: (i) weight, right and left forearm circumference and hip; (ii) 6 min walking, right and left handgrip, sit-to-stand and sit-and-reach; (iii) the EORTC-QLQ C30 summary score as well as the subscales of emotional and social functioning and symptoms. In all cases the direction of change was positive, while Cohen's d calculated showed that the effect of the intervention for these parameters ranged from intermediate to large.Conclusion:Changes on the above anthropometric, fitness and quality of life measures suggest that the intervention was of value to the participating women recovering from breast cancer. Results also advocate collaborative efforts across countries to further research. (shrink)

Schizophrenia is a severe and disabling mental illness, associated with persistent difficulties in social functioning. While gaining and retaining a job or staying socially integrated can be very difficult for the patients, the treatment of poor functionality remains challenging with limited options in pharmacotherapy. To address the limitations of medical treatment, several interesting and innovative approaches have been introduced in the field of psychotherapy. Recent approaches incorporate modern technology as well, such as virtual reality. A potential therapeutic benefit (...) of virtual reality is particularly significant when an interpersonal dimension of the problem needs to be addressed. One example is a Virtual Reality based Theory of Mind Intervention, a novel method, which enables patients to practice complex social interactions without the burden of real-life consequences. Our paper presents a case report showing promising results of VR-ToMIS. Ms. Smith is a 50- year-old patient who has been suffering from schizophrenia for 20 years. Although in her case there was no problem with compliance throughout the years, she had severe problems regarding social functionality. With VR-ToMIS, she improved in ToM and communicative-pragmatic skills. The effects of the intervention went beyond the increased scores of the tests. Before the intervention there was a risk of the patient becoming unemployed as she was unable to follow the main principles of communicative exchange. Usually, her contribution was more informative than was required. After the intervention her communication became more balanced and she could retain her job. This case suggests that VR-ToMIS may be a promising tool for treating social disfunction in schizophrenia. (shrink)

Early adversity and trauma can have profound effects on children’s affective development and mental health outcomes. Interventions that improve mental health and socioemotional development are essential to mitigate these effects. We conducted a pilot study examining whether a reading-based program improves emotion recognition and mental health through socialization in Syrian refugee and Jordanian non-refugee children aged 7–12 years old living in Jordan. To measure emotion recognition, children classified the expression in faces morphed between two emotions, while mental health was assessed (...) using survey measures of optimism, depression, anxiety, distress, and insecurity. Prior to the intervention, both groups of children were significantly biased to interpret ambiguous facial expressions as sad, while there was no clear bias on the fear–anger spectrum. Following the intervention, we found changes in Syrian refugee children’s bias in emotion recognition away from sad facial expressions, although this returned to pre-intervention levels 2 months after the end of the program. This shift in the bias away from sad facial expressions was not associated with changes in self-reported mental health symptoms. These results suggest a potential positive role of the reading intervention on affective development, but further research is required to determine the longer-term impacts of the program. (shrink)

This article describes two features of technoscience, which are significant for the consideration of the prospects of human improvement projects. The first feature of technoscience is that the object of its research is artificial in origin which means created by person. As an example of new objects, situations and problems are given projects to create «designer children», development of transplantation, creating implantable neural interface. The second feature of technoscience is that the well-established methods can't be applied to determine the (...) results of the implementation of human improvement projects. As an example, the article discussed neo-eugenics projects. The article concludes that today in the social sciences there is no clear position on the grounds of human improvement projects. However, this is not an obstacle for the development of technoscience. (shrink)

There is a long-standing debate concerning the eligibility of patients suffering from alcohol-related end-stage liver disease (ARESLD) for deceased donor liver transplantation. The question of retrospective and/or prospective responsibility has been at the center of the ethical discussion. Several authors argue that these patients should at least be regarded as partly responsible for their ARESLD. At the same time, the arguments for retrospective and/or prospective responsibility have been strongly criticized, such that no consensus has been reached. A third option (...) was proposed as a form of compromise, namely that responsibility should only be used as a tiebreaker in liver allocation. The present study provides an ethical investigation of this third option. First, we will provide an overview of the main arguments that have been offered for and against the use of responsibility as an allocation criterion. Second, we will explore the concept of responsibility as a tiebreaker in detail and discuss several types of situations, in which responsibility could be used as a tiebreaker, as well as the main ethical challenges associated with them. As we will show, an ethical justified use of responsibility as a tiebreaker is limited to a very restricted number of cases and is associated with a number of ethical concerns. For this reason, waiting time should be preferred as a tiebreaker in liver allocation, even though the criterion of waiting time, too, raises a number of equity-related concerns. (shrink)

Paraconsistent responses to vagueness are often thought to represent a revision of logical theory that is too radical to be defensible. The paracomplete logic of supervaluationism, SpV, is not only taken to be more conservative but is also commonly said to 'preserve classical logic'. This chapter argues that this is wrong on both counts. The paraconsistent logic SbV, or subvaluationism, is no less conservative than SpV nor more so. In the end both logics offer equally compelling theoretical approaches to vagueness. (...) Each approach is also equally objectionable, with neither providing an adequate account of vagueness, but this criticism arises from a feature shared by each approach that is independent of their paracompleteness or paraconsistency per se. For all that has been said, a paraconsistent approach, and the associated recourse to truth-value gluts, remains a contender in accounting for vagueness. (shrink)

Part of John Andrew Rice’s legacy, besides being a founder of Black Mountain College, is his vision of what a small liberal arts college curriculum should be. This vision helps shed light on some possible avenues by which to answer the following important questions: What implications do John Dewey’s progressive educational ideas have for experimenting with curricular design at small colleges? Does the college teacher’s struggle for improvement or growth depend on her having a belief that there is (...) an ideal liberal arts college curriculum? Probably the best known of such ready-made curricula is the Great Books Program, which employs a list of classic primary-source texts as the entry point into highly engaged dialogue, scholarship and learning guided by a teacher or tutor. In order to answer these questions, the paper turns to the historical debate between John Dewey and Robert Maynard Hutchins over the relative merits of progressive educational ideals and the Great Books approach. Most who have commented on this debate emphasize the differences between Dewey and Hutchins’ views.[ii] While Dewey emphasized learning through practical problem solving, in a dynamic mix of subject matter and method, Hutchins stressed exposure to and discussion of at least one-hundred primary texts in the Western canon, from Plato and Aristotle to Emerson and J.S. Mill. Hutchins resisted what he saw as the progressive educator’s push to transform the proper end of educating the whole person into training her for a particular vocation. In response, Dewey criticized Hutchins’ insistence that there existed a “hierarchy of truths” and that higher learning should remain aloof to the concerns of everyday life. Few commentators, however, mention the significant areas of agreement between the pedagogical approaches of Dewey and Hutchins, as well as other Great Books scholars. Since Rice praised the ideas of at least one Great Books proponent (Stringfellow Barr of St. John’s College), a more positive reconstruction of the Dewey-Hutchins exchange helps us to see how Dewey’s ideas informed Rice’s vision for the experimental college at Black Mountain—or so I argue.[iii]. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Eschatology, Sacred and Profane* PHILIP MERLAN LET ME BEGINthis paper with a double motto. The first is from a German poet, C. F. Meyer. It reads in my own translation: "We hosts of the dead ones--more numerous are we--than you who tread the earth and you who sail the sea." The second is a piece of statistical information for the correctness of which, however, I cannot vouchsafe. It (...) reads: "From the time when man first appeared, 77 billion people have been born. Thus, today's population of about 3 billion represents only 4 per cent of all men ever born" (Universitas 6 [1964], p. 423). With these two mottoes in mind let me proceed. Kant is one of the great representatives of the belief both in a goal to history and in progress. As he sees it, this goal is one world-wide society living under one law, which law coincides with the demands of morality, or as we could also say, in which legality and morality at least do not conflict. Kant is convinced that nature will by-and-by compel man to establish this world-wide society characterized, among other things, by eternal peace. Thus, Kant is an optimist with regard to the future. Yet, he is profoundly pessimistic with regard to the past. For him, history is one long chain of sufferings inflicted on man by man; and on the whole he has a very dim view of man's nature. The synthesis of his pessimism with his optimism is contained in a remarkable sentence which we find in one of his last writings--1793, when Kant was 69. The title is On the Adage--This May be Right in Theory, But Is Inapplicable to Practical Purposes, and here he says: When one contemplates the evil which in the course of history man has inflicted on man, one would be inclined to give up in despair. But there is one thought on the thinking of which our mind will cheer up. It is the thought: things will improve in the future. This kind of cheer will be entirely benevolent and unselfish, for this improvement will take place after we * I am indebted for the posthumous edition of this paper of my late husband Philip Merlan to Professor Frederick Sontag of Pomona College. My husband prepared this paper for, and read it to, various philosophical groups. In the course of these readings, he made numerous pencil additions. Thus, what Professor Sontag has done, is to change the tone to suit a printed presentation and to work the additions into the text as the logic of the arguments and notes seemed to dictate. Franciszka Merlan. [193] 194 HISTORY OF PHILOSOPHY have been buried for a long, long time. We ourselves will not be able to harvest what we ourselves have helped to plant. (WW8, 273-13) In whose name did Kant speak? Who are the altruists who feel cheered up by the prospect of a goal which they themselves will not live to reach? No easy answer can be found in Kant's writings. However it would not be surprising if Kant, a Rousseauian in so many respects, retained some of Rousseau's belief in the innate goodness of man (in spite of his pietistic heritage which encourages him to see man as thoroughly corrupt). Thus, he expects everybody to be capable of this altruistic attitude. We all do then cheer up when we think of the prospects for mankind. This means that our altruism permits us in some way to participate in mankind's bright future, to reach the goal, if I may say so, in hope and expectation, though not physically. For Kant the problem of history was never in the center of his own interest, nor would he have admitted that it is of central importance for man. Hegel's attitude is quite different. Man's participation in history is Hegel's main topic. At this point let me remind you briefly of Hegel's fundamental ideas. The enlightenment and romanticism produced two highly characteristic interpretations of religion. According to the former, the kernel of every religion is morality. According to the latter, the... (shrink)

The invention of development as public discourse began with US President Truman’s 1949 speech that trumped up an illusion of global material prosperity based on a total restructuring of the ‘developing’ world on the model of development and material achievement of the West. Truman argued that this painful process was the only recipe for world prosperity. After decades of serious engagement on development discourse and multiple implementations of successive theories, the situation of the developing countries has not improved as (...) rapidly as expected. At the same time, the developed countries are experiencing various forms of financial crises. This article acknowledges the professionalisation of development discourse, and proposes humanising development discourse in Africa in the light of Christian anthropology. This vision of integral development promotes the common good on the basis of God’s love and respect for the uniqueness of the human person. (shrink)

To investigate whether making performance predictions affects prospective memory processing, we asked one group of participants to predict their performance in a PM task embedded in an ongoing task and compared their performance with a control group that made no predictions. A third group gave not only PM predictions but also ongoing-task predictions. Exclusive PM predictions resulted in slower ongoing-task responding both in a nonfocal and in a focal PM task. Only in the nonfocal task was the additional slowing (...) accompanied by improved PM performance. Even in the nonfocal task, however, was the correlation between ongoing-task speed and PM performance reduced after predictions, suggesting that the slowing was not completely functional for PM. Prediction-induced changes could be avoided by asking participants to additionally predict their performance in the ongoing task. In sum, the present findings substantiate a role of metamemory for attention-allocation strategies of PM. (shrink)

Publishers are signing transformative agreements with different research institutions and funding bodies across the world. These agreements establish that the institution or funder makes a block payment in exchange for an annual quota of OA papers allowing their affiliated authors to publish OA in an agreed list of journals, at no extra cost to the individual author. This is a step towards the transformation of these journals into a Gold (commercial) Open Access regime. -/- In January 2023, the members (...) of the OA working group contacted the editors of the 27 journals listed as relevant for the field of philosophy of science on the website of the Philosophy of Science Association. We asked the editors-in-chief two questions: 1) Did your publishers discuss any plans to transition to gold open access exclusively with you? If so, how would it work? 2) If the publishers did contact you regarding this matter, what is your view on the project? -/- We collected 22 answers. The executive summary is: 10 of the 27 journals have started the transition to Gold Open Access, although many editors are not aware of this shift, but they wouldn’t support it, and many are actively against it. (shrink)

Although euthanasia and assisted suicide in people with psychiatric disorders is relatively rare, the increasing incidence of EAS requests has given rise to public and political debate. This study aimed to explore support of the public and physicians for euthanasia and assisted suicide in people with psychiatric disorders and examine factors associated with acceptance and conceivability of performing EAS in these patients. A survey was distributed amongst a random sample of Dutch 2641 citizens and 3000 physicians. Acceptance (...) and conceivability of performing EAS, demographics, health status and professional characteristics were measured. Multivariable logistic regression analyses were performed. Of the general public 53% were of the opinion that people with psychiatric disorders should be eligible for EAS, 15% was opposed to this, and 32% remained neutral. Higher educational level, Dutch ethnicity, and higher urbanization level were associated with higher acceptability of EAS whilst a religious life stance and good health were associated with lower acceptability. The percentage of physicians who considered performing EAS in people with psychiatric disorders conceivable ranged between 20% amongst medical specialists and 47% amongst general practitioners. Having received EAS requests from psychiatric patients before was associated with considering performing EAS conceivable. Being female, religious, medical specialist, or psychiatrist were associated with lower conceivability. The majority of the psychiatrists were of the opinion that it is possible to establish whether a psychiatric patient’s suffering is unbearable and without prospect and whether the request is well-considered. The general public shows more support than opposition as to whether patients suffering from a psychiatric disorder should be eligible for EAS, even though one third of the respondents remained neutral. Physicians’ support depends on their specialization; 39% of psychiatrists considered performing EAS in psychiatric patients conceivable. The relatively low conceivability is possibly explained by psychiatric patients often not meeting the eligibility criteria. (shrink)

Whole Brain Emulation has been championed as the most promising, well-defined route to achieving both human-level artificial intelligence and superintelligence. It has even been touted as a viable route to achieving immortality through brain uploading. WBE is not a fringe theory: the doctrine of Computationalism in philosophy of mind lends credence to the in-principle feasibility of the idea, and the standing of the Human Connectome Project makes it appear to be feasible in practice. Computationalism is a popular, independently plausible theory, (...) and Connectomics a well-funded empirical research program, so optimism about WBE is understandable. However, this optimism may be misplaced. This article argues that WBE is, at best, no more compelling than any of the other far-flung routes to achieving superintelligence. Similarly skeptical conclusions are found regarding immortality. The essay concludes with some positive considerations in favor of the Biological Theory of consciousness, as well as morals about the limits of Computationalism in both artificial intelligence and the philosophy of mind more generally. (shrink)

There is a growing trend in Australia to require lawyers to certify reasonable prospects of success for the cases they bring and defend. New South Wales has led the way with the Legal Profession Act 2004 (NSW) Pt 3.2 Division 10 requiring legal practitioners to certify reasonable prospects of success in all claims for damages. The requirement places a significant onus on lawyers to make a judgment about the merits of a case before it is begun, yet the common (...) law has long provided mechanisms to ensure that cases without prospects of success do not go to trial. This article considers Australian legislative provisions requiring lawyers to certify reasonable prospects of success of cases. It examines the application of the NSW legislation by the courts highlighting the difficulties of interpretation of what constitute 'reasonable prospects of success' and the application of the legislation in the context of the dynamic litigation process. It is argued that these legislated obligations on lawyers will have a detrimental effect on access to justice by denying parties, in particular plaintiffs, the opportunity to have their cases properly and fully determined in the courts. This article examines common law mechanisms for dissuading cases without prospects and argues that the general law is an effective system for ensuring that cases without prospects of success are not maintained. The Australian experience is instructive for consideration of optimal reform packages for the administration of justice and to evaluate the role of any litigation lawyer within the judicial and court process. (shrink)

Performing and creative artists have unique occupational and lifestyle stresses and challenges that can negatively affect self-esteem. Low self-esteem not only has serious implications for their psychological and physical health, it can also affect their performance and creativity. There is a need to establish effective interventions to deal with this issue. To the best of our knowledge, there are no reported studies specific to workshops or interventions on enhancing self- esteem for artists. The Al and Malka Green Artists’ Health (...) Centre at the Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada, is a unique multidisciplinary and integrative clinic serving the special needs of the artist population. We developed a workshop entitled “Building Confidence and Self Esteem Toolbox Workshop” to address this this need. We then designed a single-blind, randomized, prospective, pilot study to evaluate the effectiveness of the workshop on enhancing self-esteem in artists, and to evaluate the long-term effectiveness of using the recommended tools in maintaining a healthy self-esteem, as well as maintaining physical and emotional health. Both quantitative and qualitative data were collected. A validated “Self-Esteem Checkup” questionnaire was administered pre- and immediately post workshop, as well as at 2, 6, and 12 months post workshop. Open-ended questions were posed to study participants via email at 2 and 12 months following the workshop, and at 6 months in in-person interviews. Thirty-five professional artists consented to participate in the study, with 26 completing all study visits. Mean scores for all time points, and the individual questionnaire statement mean scores for the five timepoints increased significantly immediately post-workshop and remained statistically significantly improved by the by the 3rd follow-up 12 months later. (p<0.001). The mean self-esteem rating score increased significantly post-workshop and remained statistically significantly improved by the 3rd follow-up 12 months later. (p<0.01). Qualitative data showed positive feedback on the utilization of the tools learned in the workshop that helped maintain this improvement over a one-year period. This workshop may be an effective means of addressing the issue of self-esteem in artists. Further controlled studies of larger sample size and longer duration are needed to confirm these findings. (shrink)

Libertarian punishment theory was initially articulated by Murray N. Rothbard and Walter E. Block. It was broken down into four separate stages. To a great degree, this theory was accepted by Eduardo Blasco and Davie Marcos. However, they maintain it is in need of some slight adjustments and improvements, mainly dealing with the interest rate. The present paper claims their suggestion while valid, is unnecessary, since this theory already incorporates that element, at least implicitly.

When experienced in-person, engagement with art has been associated—in a growing body of evidence—with positive outcomes in wellbeing and mental health. This represents an exciting new field for psychology, curation, and health interventions, suggesting a widely-accessible, cost-effective, and non-pharmaceutical means of regulating factors such as mood or anxiety. However, can similar impacts be found with online presentations? If so, this would open up positive outcomes to an even-wider population—a trend accelerating due to the current COVID-19 pandemic. Despite (...) its promise, this question, and the underlying mechanisms of art interventions and impacts, has largely not been explored. Participants were asked to engage with one of two online exhibitions from Google Arts and Culture. With just 1–2 min exposure, both improved negative mood, state-anxiety, loneliness, and wellbeing. Stepdown analysis suggested the changes can be explained primarily via negative mood, while improvements in mood correlated with aesthetic appraisals and cognitive-emotional experience of the exhibition. However, no difference was found between exhibitions. We discuss the findings in terms of applications and targets for future research. (shrink)

Does God bring good out of evil? More specifically, does God defeat the suffering experienced by the victims of horrendous evils by making it the case that each victim's suffering contributes to some great good—a good that could not be obtained without such suffering, and that results in the victim enjoying greater total well-being than would be expected had no such evil occurred? Call the thesis that God does defeat evils in this way the defeat thesis. A (...) commitment to the defeat thesis can be discerned in many prominent treatments of God's relation to evil. But the defeat thesis is subject to the following objection: If the defeat thesis is true, so that horrendous evils ultimately lead to greater total well-being for the victims than would be expected without such evils, then it is not the case that we should hope that our loved ones escape the experience of such evils; but when we are faced with the prospect of a loved one being afflicted by some horrendous evil, we clearly should hope that our loved one does not experience the evil; so the defeat thesis must be false. In this paper, I attempt to defend the defeat thesis against this objection. I do so by contending that the norms that govern hope and other related attitudes are “non-consequentialist.” Non-consequentialist “norms of hope” hold that in some situations, one should hope (for the sake of subject S) that some event occurs even though one knows that this would lead to S having less total well-being. If the correct norms of hope are non-consequentialist, then one can appropriately and reasonably hope that some horrendous evil does not occur (and appropriately grieve if it does) even while acknowledging that if an evil occurs, God will use the evil to bring about more well-being for the victim than there otherwise would have been. (shrink)

Unilateral spatial neglect is a disorder characterized by the failure to report, respond to, or orient toward the contralateral side of space to a brain lesion. Current assessment methods often fail to discover milder forms, cannot differentiate between unilateral spatial neglect subtypes and lack ecological validity. There is also a need for treatment methods that target subtypes. Immersive virtual reality systems in combination with eye-tracking have the potential to overcome these shortcomings, by providing more naturalistic environments and tasks, (...) class='Hi'>with sensitive and detailed measures. This systematic review examines the state of the art of research on these technologies as applied in the assessment and treatment of USN. As we found no studies that combined immersive VR and ET, we reviewed these approaches individually. The review of VR included seven articles, the ET review twelve. The reviews revealed promising results. All included studies found significant group-level differences for several USN measures. In addition, several studies found asymmetric behavior in VR and ET tasks for patients who did not show signs of USN in conventional tests. Particularly promising features were multitasking in complex VR environments and detailed eye-movement analysis. No VR and only a few ET studies attempted to differentiate USN subtypes, although the technologies appeared appropriate. One ET study grouped USN participants using individual heatmaps, and another differentiated between subtypes on drawing tasks. Regarding ecological validity, although no studies tested the prognostic validity of their assessment methods, VR and ET studies utilized naturalistic tasks and stimuli reflecting everyday situations. Technological characteristics, such as the field of view and refresh rate of the head-mounted displays, could be improved, though, to improve ecological validity. We found no studies that utilized VR or ET technologies for USN treatment up until the search date of the 26th of February 2020. In conclusion, VR-ET-based systems show great potential for USN assessment. VR-ET holds great promise for treatment, for example, by monitoring behavior and adapting and tailoring to the individual person’s needs and abilities. Future research should consider developing methods for individual subtypes and differential diagnostics to inform individual treatment programs. (shrink)

ABSTRACT The individual-community relationship has always been one of the most fundamental topics of social sciences. In sociology, this is known as the micro-macro relationship while in economics it refers to the processes, through which, individual actions lead to macroeconomic phenomena. Based on philosophical discourse and systems theory, many sociologists even use the term "emergence" in their understanding of micro-macro relationship, which refers to collective phenomena that are created by the cooperation of individuals, but cannot be reduced to individual actions. (...) "Emergence" theories attempt to explain the nature of society as a complex system by examining how individuals and their relationships lead to the creation of integrated and macro-social phenomena such as markets, educational systems, cultural beliefs, and shared social practices. As a prelude to activity, every researcher has to answer the question from the methodological point of view, how is it possible to study the behavior of social groups and how can we gain knowledge about the laws related to social groups? Anyone who deals with humanities and social sciences or any reality and phenomenon that affects human beings, inevitably deals with the reality that is emerging. In fact, emergence occurs when one level of reality emerges radically from another level. Examples of emergent levels of reality include how the mind emerges from the body; or the way society emerges from human beings. Therefore, when there is an emerging factor, different scientific disciplines should be used, because it is inevitable to talk about social affairs, psychology and neurobiology, as well as physical and even chemical. -/- INTRODUCTION Since its beginning in the 19th century, sociology has faced the fundamental question of what a social phenomena stands for? At a glance, sociologists deal with the study of social groups, collective behavior, institutions, social structures, social networks, and social dynamics, and ultimately all such phenomena are composed of individuals. Therefore, social phenomena seem to have no independent ontological status, and in this case, sociology is ultimately about reducible individuals. Different approaches about the micro-macro relationship, using the concept of "emergence", argue that although collective phenomena are created by individuals, they cannot be reduced to individual action. The term "emergence" is used to distinguish "emergent results" from " Procedural results". Results are called Procedural that can only be calculated by adding or subtracting the causes that act together. On the contrary, they are emergent outcomes that are qualitatively novel compared to the causes from which they originate. An example of such emergent results is mental characteristics that emerge from neural processes, but are not considered among the characteristics of neural processes of components - which are their origin. Philosophical debates about emergentism and reductionism focus on the mind-brain relationship, but as many philosophers have noted, they can be generalized to apply to any hierarchical set of features. The cognitive revolution reactivated a 19th century controversy between theorists of Identity and dualism. The theorists of Identity believe in reductionist materialism and elimination of metaphysics, according to which the mind is nothing more than the biological, while the dualists believe that the mind and the brain are distinct from each other. Emergence has been considered as a third way between the theories of Identity and dualism. -/- METHODOLOGY Interdisciplinarity Is fundamentally indicated by the dominance of open systems as well as social and emerging systems at different levels. Therefore, as long as we are facing a new emergentism, there will necessarily be different fields and an interdisciplinary method. The commonality of social sciences and cognitive sciences on the issue of emergence provides the possibility of interaction and exchange of concepts between these two for deeper research. Therefore, in this research, apart from the concepts of Subvenience and downward causation, we have used multiple realization and wildly disjunctive, which are used to explain the emerging concept in cognitive sciences, including neurobiology, psychology, and philosophy. For analytical and interdisciplinary approaches, after examining the concepts of subvenience, and wildly disjunctive, Individualistic and collectivist emergentism have been reviewed. And then their adequacy is criticized and evaluated in meeting strong emergence conditions. -/- FINDINGS Philosophers of the mind have been able to define the conditions of irreducibility and downward causation, which are essential for strong emergence, by using the principle of subvenience with the help of multiple realization and wildly disjunctive principles. Therefore, by definition, emergentist individualism suffers from the problem of how to explain downward causality and irreducibility, and emergentist collectivism faces the challenge of reification. The analysis of the challenges facing the two methodological approaches of individualism and collectivism leads us to three unresolved issues about the emerging phenomenon, which are realism, downward causality, and mechanism. Despite the differences in the stances of these two approaches regarding the aforementioned triple problems, individualists and collectivists both agree that some social characteristics are reducible; and some others are irreducible due to their complexity, the determination of which, depends on the case study of the mechanism of emergence of each social characteristic. -/- CONCLUSION An emergence that is consistent with reductionism is called a weak emergence. And strong emergence includes the principle of irreducibility and downward causality. According to strong emergence, the characteristics of social phenomena have downward causal power, which cannot be reduced to the causal forces. The principle of subvenience, together with multiple realization and wildly disjunctive, can provide the conditions of irreducibility and downward causality, which are essential conditions of strong emergence. Based on the philosophical analysis of two methodological approaches, individualist and collectivist, it can be concluded that emergentist individualism suffers from the problem of how to explain downward causality and irreducibility, and reification collectivism faces the challenge of reification. The analysis of the problems faced by these two approaches leads us to three unresolved issues, which are realism, downward causality, and mechanism. individualist emergentists acknowledge the existence of emergent social characteristics, but despite this, they believe that these characteristics are not real but merely analytical constructs that require explanation based on individuals and their mutual actions. But collectivists argue that emergentism yields a categorical ontology and supports social realism. They accept the dependence of social characteristics on individuals, but claim that social entities and structures are ontologically independent. Individualists and collectivists both agree that some social characteristics are reducible; and others are irreducible due to their complexity; and the only way to recognize this is to engage in empirical studies of the mechanisms and temporal processes of "emergence" that create social characteristics. -/- NOVELTY The newness of this compact article is as follows: a) Presenting an interdisciplinary approach using the analysis of philosophy of cognitive sciences, including the philosophy of mind, neurobiology and psychology to formulate the issue of social emergence; b) Criticizing individualist and collectivist methodological approaches to the issue of social emergence and explaining the sufficiency and shortcomings of both in providing weak and strong emerging conditions; c) Explaining and categorizing the challenges facing methodological approaches in explaining the phenomenon of social emergence, in three categories: realism, downward causality, and mechanism. 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Resumen: La presente investigación tuvo por objetivo analizar los usos del discurso institucional de universidades chilenas autodefinidas como complejas en relación con la organización del conocimiento e iniciativas intertransdisciplinarias relevantes informadas a nivel de estructuras estáticas y noticias en sitios web oficiales de cada una de ellas. En este contexto y mediante un Análisis Crítico del Discurso, se indaga en el despliegue de estrategias comunicativas, la producción y difusión del discurso institucional, como asimismo, su exposición y disposición en las páginas (...) web. Desde esta base se contribuye con información cualitativa a la discusión en torno a los formatos y dispositivos de comunicación social referidos a las nociones de inter y transdisciplina en el contexto de la educación superior en el país. Los resultados dan cuenta de la emergencia, centralidad y valor comunicacional de la prospectiva inter y transdisciplinaria en el contexto universitario chileno, no obstante, también evidencian las condicionantes epistemológicas y metodológicas para su despliegue organizacional crítico y sostenible.: The following investigation had as an objective to analyse the usages of the Institutional Discourse from Chilean universities self-described as complex, in relation to the Knowledge Organization and relevant inter-disciplinaries initiatives that are informed at the level of static structures and pieces of news published on each official website. In this context, and, through a Critical Discourse Analysis, the communicative strategies deployment is explored, as well as the production and broadcasting of their institutional discourse. Likewise, their exposure and disposal on web pages. On this basis, the qualitative information is contributed to the discussion around the formats and social communication devices, referred to the concepts of inter and trans-disciplines in the context of higher education in the nation. The results, reflect the emergency, centrality and communicational value of the inter and trans-disciplinary prospective in the Chilean university context. However, the epistemological and methodological conditions are evidenced for its organizational, critical, and sustainable deployment. (shrink)

China’s efforts in Universal Health Coverage since the birth of the People’s Republic in 1949 has passed four stages: 1949–1983, Maoist UHC; 1984–2003, Deng’s Free-market healthcare experiment; 2004–2008, response to people’s call and restorative efforts; 2009-present, reducing fragmentation, co-payment and improving primary care. The efforts of the first three stages aimed more at extending coverage and service scope, and those of the fourth stage for better equity, quality, and affordability. This article updates recent efforts in the fourth stage and looks (...) ahead to the future after 2018, with the hope of providing references for the world in healthcare reform and development. (shrink)