We have begun work on two separate but related ontologies for the study of neurological diseases. The first, the Neurological Disease Ontology (ND), is intended to provide a set of controlled, logically connected classes to describe the range of neurological diseases and their associated signs and symptoms, assessments, diagnoses, and interventions that are encountered in the course of clinical practice. ND is built as an extension of the Ontology for General Medical Sciences — a high-level candidate OBO Foundry ontology that (...) provides a set of general classes that can be used to describe general aspects of medical science. ND is being built with classes utilizing both textual and axiomatized definitions that describe and formalize the relations between instances of other classes within the ontology itself as well as to external ontologies such as the Gene Ontology, Cell Ontology, Protein Ontology, and Chemical Entities of Biological Interest. In addition, references to similar or associated terms in external ontologies, vocabularies and terminologies are included when possible. Initial work on ND is focused on the areas of Alzheimer’s and other diseases associated with dementia, multiple sclerosis, and stroke and cerebrovascular disease. Extensions to additional groups of neurological diseases are planned. The second ontology, the Neuro-Psychological Testing Ontology (NPT), is intended to provide a set of classes for the annotation of neuropsychological testing data. The intention of this ontology is to allow for the integration of results from a variety of neuropsychological tests that assay similar measures of cognitive functioning. Neuro-psychological testing is an important component in developing the clinical picture used in the diagnosis of patients with a range of neurological diseases, such as Alzheimer’s disease and multiple sclerosis, and following stroke or traumatic brain injury. NPT is being developed as an extension to the Ontology for Biomedical Investigations. (shrink)

Reflections on principle and prudence in the thoughts and actions of great thinkers and statesmen. Discussions of the place of moral principle in political practice are haunted by the abstract and misleading distinction between realism and its various principled or “idealist” alternatives. This volume argues that such discussions must be recast in terms of the relationship between principle and prudence: as Nathan Tarcov maintains, that relationship is “not dichotomous but complementary.” In a substantive introduction, the editors investigate Leo Strauss’s attack (...) on contemporary political thought for its failure to account for both principle and prudence in politics. Leading commentators then reflect on principle and prudence in the writings of great thinkers such as Homer, Machiavelli, and Hegel, and in the thoughts and actions of great statesmen such as Pericles, Jefferson, and Lincoln. In a concluding section, contributors reassess Strauss’s own approach to principle and prudence in the history of political philosophy. “Principle and Prudence in Western Political Thought contains a series of first-rate essays on a—if not the—central problem of political thought: how should and can abstract and general principles inform contingent, particularistic political life.” — Catherine H. Zuckert, coauthor of Leo Strauss and the Problem of Political Philosophy. (shrink)

This article explores how scholarship can be put to work by specialists penning evidence-based policies seeking peaceful resolutions to long-standing, complex, and so-far intractable conflict in the Malay-Muslim dominated provinces of South Thailand. I contend that more is required than mere empirical data, and that the existing analysis of this conflict often lacks theoretical ballast and overlooks the wider historical context in which Bangkok pursued policies impacting its ethnolinguistically, and ethnoreligiously diverse citizens. I demonstrate the utility of both interacting with (...) what social theorists have written about what “religion” and language do—and do not—have in common, and the relative importance of both in sub-national conflicts, and comparative historical analysis. The case studies that this article critically introduces compare chapters of ethnolinguistic and ethnoreligious chauvinism against a range of minorities, including Malay-Muslim citizens concentrated in the southern provinces of Pattani, Yala, and Narathiwat. These include Buddhist ethnolinguistic minorities in Thailand’s Northeast, and Catholic communities during the second world war widely referred to as the high tide of Thai ethno-nationalism. I argue that these revealing aspects of the southern Malay experience need to be contextualized—even de-exceptionalized. (shrink)

Globalization leads to cross-border business transactions between societies with very different norms and regulations regarding bribery. Bribery in international business transactions can be seen as a function of not only the demand for such bribes in different countries, but the supply, or willingness to provide bribes by multinational firms and their representatives. This study addresses the propensity of firms from 30 different countries to engage in international bribery. The study incorporates both domestic (economic development, culture, and domestic corruption in the (...) supplying country) and international factors (those countries’ patterns of trade and involvement in international accords) in explaining the willingness to bribe abroad. The propensity to provide bribes was the lowest when corruption was not tolerated in the multinational firms’ home countries, when the firms’ countries were signatories of the Organization for Economic Cooperation and Development (OECD) anti-bribery convention, and when those countries traded heavily with wealthier nations. Further, these findings are maintained when controlling for levels of economic development and cultural values in the supplying country. In terms of culture, firms from high power distance countries showed a somewhat greater propensity for providing bribes in transactions with less-developed nations. (shrink)

We are developing the Neurological Disease Ontology (ND) to provide a framework to enable representation of aspects of neurological diseases that are relevant to their treatment and study. ND is a representational tool that addresses the need for unambiguous annotation, storage, and retrieval of data associated with the treatment and study of neurological diseases. ND is being developed in compliance with the Open Biomedical Ontology Foundry principles and builds upon the paradigm established by the Ontology for General Medical Science (OGMS) (...) for the representation of entities in the domain of disease and medical practice. Initial applications of ND will include the annotation and analysis of large data sets and patient records for Alzheimer’s disease, multiple sclerosis, and stroke. (shrink)

Issues of interest, identity and values intertwine in environmental conflicts, creating challenges that cannot generally be overcome using rationalities grounded in generalised argumentation and abstraction. To address the growing need to engage interests and identities along with plural values in the conservation of biodiversity and ecological systems, we introduce the concept of ‘appropriateness of actions’ and ground it in a relational understanding of environmental ethics. A determination of appropriateness for actions comes from combining outputs from value elicitation with those of (...) interest and identity negotiation in ways that are salient to specific people and their relationships to specific places. Drawing on the Blue Mountain Forest Partnership in the Pacific Northwest, we propose factors of success for supporting appropriate actions: 1) understanding context and identifying key stakeholders; 2) surfacing a diversity of interests and building system-level trust; 3) building empathy for different identities grounded in specific places; 4) eliciting diverse values and seeking to understand their links to worldviews and knowledge systems and; 5) seeking out appropriate actions. (shrink)

Philosophy, Science and Religion for Everyone brings together these great truth-seeking disciplines, and seeks to understand the ways in which they challenge and inform each other. Key topics and their areas of focus include: - Foundational Issues - why should anyone care about the science-and-religion debate? How do scientific claims relate to the truth? Is evolution compatible with design? - Faith and Rationality - can faith ever be rational? Are theism and atheism totally opposed? Is God hidden or does God (...) simply not exist? - Faith and Science - what provides a better explanation for the origin of the universe-science or religion? Faith and physics: can they be reconciled? Does contemporary neuroscience debunk religious belief? Creationism and evolutionary biology - what constitutes science and what constitutes pseudo-science? - Practical Implications - is fundamentalism just a problem for religious people? What are the ethical implications of the science-and-religion debate? Do logic and religion mix? This book is designed to be used in conjunction with the free 'Philosophy, Science and Religion' MOOC (massive open online course) created by the University of Edinburgh, and hosted by the Coursera platform (www.coursera.org). This book is also highly recommended for anyone looking for a concise overview of this fascinating discipline. (shrink)

In a recent paper published in this journal, Giubilini, Douglas and Savulescu argue that we have given insufficient weight to the moral importance of fairness in our account of the best policies for non-medical exemptions to childhood immunization requirements. They advocate for a type of policy they call Contribution, according to which parents must contribute to important public health goods before their children can receive NMEs to immunization requirements. In this response, we argue that Giubilini, Douglas and Savulescu give insufficient (...) weight to the moral importance parental liberty in ways that count against their preferred type of NMEs policy and threaten public support for mandatory vaccination laws and public health initiatives generally. (shrink)

According to a standard account of patient decision-making capacity, patients can provide ethically valid consent or refusal only if they are able to understand and appreciate their medical c...

This volume brings together a number of related contributions on the topic of expertise and education. Expertise is a topic that is beginning to receive more attention in the Philosophy of Education and discussions are closely related to the epistemological debate concerning the nature of know-how which has also burgeoned in recent years within ‘mainstream’ epistemology. More specifically, this volume focuses on the relevance of expertise to professional education and practice, with the aim on shedding light on what is involved (...) in professional expertise and the implications of a sound understanding of professional expertise for professional education. Although all contributions have roots in philosophical discussion, there is an element of cross-disciplinarity among them, reflecting the advances that have been made to our understanding of expertise from psychology in particular. (shrink)

Two new documents from the Committee on Bioethics of the American Academy of Pediatrics expand the terrain for parental decision making, suggesting that pediatricians may override only those parental requests that cross a harm threshold. These new documents introduce a broader set of considerations in favor of parental authority in pediatric care than previous AAP documents have embraced. While we find this to be a positive move, we argue that the 2016 AAP positions actually understate the importance of informed and (...) voluntary parental involvement in pediatric decision making. This article provides a more expansive account of the value of parental permission. In particular, we suggest that an expansive role for parental permission may reveal facts and values relevant to their child's treatment, encourage resistance to suboptimal default practices, improve adherence to treatment, nurture children's autonomy, and promote the interests of other family members. (shrink)

Critical notice of C. Pincock's Mathematics and Scientific Representation (2012).

Children’s preferences about medical treatment—like the preferences of other patients—hold moral weight in decision-making that is independent of considerations of autonomy or best interests. In light of this understanding of the moral value of patient preferences, the American Academy of Pediatrics could strengthen the ethical foundation for its formal guidance on pediatric assent.

Why has thinking about politics over the centuries been quite so intertwined with thinking about educational theory and practice? This book draws together a fascinating mix of educational pioneers and thinkers to answer this question and more.

This paper builds on previous research about the potential downsides of food sovereignty activism in relatively wealthy societies by developing a three-part taxonomy of harms that may arise in such contexts. These are direct opposition, false equivalence, and diluted goals and methods. While this paper provides reasons to resist complacency about wealthy-world food sovereignty, we are optimistic about the potential for food sovereignty in wealthy societies, and we conclude by describing how wealthy-world food sovereignty can be a location of either (...) transnational solidarity or nonharmful forms of cooptation. (shrink)

The National Center for Biomedical Ontology is now in its seventh year. The goals of this National Center for Biomedical Computing are to: create and maintain a repository of biomedical ontologies and terminologies; build tools and web services to enable the use of ontologies and terminologies in clinical and translational research; educate their trainees and the scientific community broadly about biomedical ontology and ontology-based technology and best practices; and collaborate with a variety of groups who develop and use ontologies and (...) terminologies in biomedicine. The centerpiece of the National Center for Biomedical Ontology is a web-based resource known as BioPortal. BioPortal makes available for research in computationally useful forms more than 270 of the world's biomedical ontologies and terminologies, and supports a wide range of web services that enable investigators to use the ontologies to annotate and retrieve data, to generate value sets and special-purpose lexicons, and to perform advanced analytics on a wide range of biomedical data. (shrink)

Background Following passage of the Patient Self Determination Act in 1990, health care institutions that receive Medicare and Medicaid funding are required to inform patients of their right to make their health care preferences known through execution of a living will and/or to appoint a surrogate-decision maker. We evaluated the impact of external factors and perceived patient preferences on physicians’ decisions to honor or forgo previously established advance directives (ADs). In addition, physician views regarding legal risk, patients’ ability to comprehend (...) complexities involved with their care, and impact of medical costs related to end-of-life care decisions were explored. Methods Attendees of two Mayo Clinic continuing medical education courses were surveyed. Three scenarios based in part on previously court-litigated matters assessed impact of external factors and perceived patient preferences on physician compliance with patient-articulated wishes regarding resuscitation. General questions measured respondents’ perception of legal risk, concerns over patient knowledge of idiosyncrasies involved with their care, and impact medical costs may have on compliance with patient preferences. Responses indicating strength of agreement or disagreement with statements were treated as ordinal data and analyzed using the Cochran Armitage trend test. Results Three hundred eighty-eight of 951 surveys were completed (41% response rate). Eighty percent reported they were likely to honor a patient’s AD despite its 5 year age. Fewer than half (41%) would honor the AD of a patient in ventricular fibrillation who had expressed a desire to “pass away in peace.” Few (17%) would forgo an AD following a family’s request for continued resuscitative treatment. A majority (52%) considered risk of liability to be lower when maintaining someone alive against their wishes than mistakenly failing to provide resuscitative efforts. A large percentage (74%) disagreed that patients could not appreciate complexities surrounding their care while 69% agreed that costs should never impact a physician’s decision as to whether to comply with a patient’s AD. Conclusions Our findings highlight the impact, albeit small, external factors have on physician AD compliance. Most respondents based their decision on the clinical situation at hand and interpretation of the patient’s initial wishes and preferences expressed by the AD. (shrink)

Vaccine refusal forces us to confront tensions between many values, including scientific expertise, parental rights, children’s best interests, social responsibility, public trust, and community health. Recent outbreaks of vaccine-preventable and emerging infectious diseases have amplified these issues. The prospect of a coronavirus disease 2019 vaccine signals even more friction on the horizon. In this contentious sociopolitical landscape, it is therefore more important than ever for clinicians to identify ethically justified responses to vaccine refusal.

This paper studies the properties and performance of models for estimating local probability distributions which are used as components of larger probabilistic systems — history-based generative parsing models. We report experimental results showing that memory-based learning outperforms many commonly used methods for this task (Witten-Bell, Jelinek-Mercer with fixed weights, decision trees, and log-linear models). However, we can connect these results with the commonly used general class of deleted interpolation models by showing that certain types of memory-based learning, including the kind (...) that performed so well in our experiments, are instances of this class. In addition, we illustrate the divergences between joint and conditional data likelihood and accuracy performance achieved by such models, suggesting that smoothing based on optimizing accuracy directError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMaply might greatly improve performance. (shrink)

The three of us work as academics and clinical ethicists. In our clinical ethics work, we often encounter patients who lack decision-making capacity, but who nonetheless have strong preferences abo...

In lieu of an abstract, here is a brief excerpt of the content:On PartnershipRyan Schwarz, Duncan Smith-Rohrberg Maru, Dan Schwarz, Bibhav Acharya, Bijay Acharya, Ruma Rajbhandari, Jason Andrews, Gregory Karelas, Ranju Sharma, and Mark ArnoldyRecently, Bayalpata Hospital, in the rural district of Achham, Nepal almost collapsed under the weight of its own staff's discontent. The hospital had been largely abandoned until 2009 when our organization, Nyaya Health, renovated and opened it in partnership with the Nepali government. Since then, (...) the hospital has seen great progress and has experienced widespread community support. Nonetheless, earlier this year, a broad-based staff revolt occurred, led primarily by our senior clinical staff members, raising concerns that Nyaya's management policies were ineffective, and wages and benefits were too low. The unrest included everything from a strike, limiting services to our patients, to aggression against non-strikers and slander and racist comments in public media against the Nyaya Health Board of Directors. Ultimately, the conflict was resolved, though not without the departure of our three most senior clinicians. The incident deeply damaged staff morale [End Page 101] and impeded basic services to our patients, and from our perspective as a leadership and management team, it was deeply troubling and spiritually challenging. We have learned much in the wake of the strike, but here we focus more narrowly on the concept of partnerships in our work by examining the recent strike and the two key issues that lead to it: wages and benefits, and management policies at Bayalpata Hospital.In grappling with the recent staff crisis, some of our leadership team expressed concerns that we would never be able to develop a true partnership in Achham if our senior-level employees led strikes against the organization. The leaders of the strike were our most well-educated and high-ranking staff. They were also individuals who had come to work for us specifically citing the moral imperative of our work, and their pride in helping to serve the poorest of the poor. One leadership team member asked, "What is 'partnership' then? We came into this work with the premise that we would work together, with our partnership built around the right to health—but who are our partners if they lead strikes damaging the very services our collective mission aims to offer?"Another leadership team member commented, "The first time I visited Achham I was invited for tea at Meena's* house (one of Nyaya's midwives). We arrived at her house and Meena greeted us warmly. She showed us in to a small room: there was no furniture, but there was an immaculately swept mat which we joined her on. We drank tea, seated on her rug, and listened to her tell us how she had come to live in the house, how she had come to work for Nyaya, and her pride in now being able to provide both for her own children, as well as, the children of her relatives. As the only employed family member, she now had the challenge of providing for all of them. When we question our partnership, I'm taken back to Meena's warm, but extremely poor, home. She has worked for Nyaya for almost four years. She has helped our organization provide free care to over 75,000 people. Is this not a type of 'partnership'?"Allow us to offer some background on the issue of wages—Meena has been with our team since 2008, and has been paid about $2,500 per year—a generous wage compared to other employers in the region. Meena was one of the striking staff members. Among other concerns about the way the hospital was being run, she and other staff asked indignantly why we couldn't provide them with higher wages, better benefits, and more resources, both for her and the hospital. Notably, Meena's salary (and the rest of our staff's) was well above her equivalent in other, more urban hospitals (to compensate for the extremely remote area in which we work), and in a district where most families are farmers, our staff's salaries occupy the highest income bracket in the region. Nonetheless, as is common throughout the world in both rich and poor areas... (shrink)

Recently, several states in the US have made it more difficult to receive nonmedical exemptions to school vaccine mandates in the hope of better orienting parents towards vaccination. However, little is known about how public-facing school staff implement and enforce mandate policies, including why or how often they steer parents towards nonmedical exemptions. This study focused on Michigan, which has recently added an additional burden for families seeking nonmedical exemptions. We used an anonymous online survey to assess Michigan public-school employees (...) (n = 157) about their knowledge, attitudes, and behaviors regarding Michigan's school enrollment vaccine mandate policy. Our main conclusions are that frontline school staff are generally knowledgeable about vaccines and immunization policy, but are at best ambivalent about their role in immunization governance, believing that other agents should be responsible for ensuring that children are vaccinated. Furthermore, some respondents indicated low vaccine confidence, which was associated with increased ambivalence about, or opposition to, their role in immunization governance. As more jurisdictions within and beyond the US consider introducing or tightening childhood vaccine mandates, it is increasingly important to understand how these policies can be improved by attending to the attitudes and roles of relevant frontline actors. (shrink)

While much is written about reading aloud to children, and as a teaching tool, far less is known about the oral reading that adults do at home, at work or in the community. This article presents the results of a national survey into whether, what, how and why adults across Britain may read aloud rather than in silence. Analysing data from 529 questionnaire responses, the article examines the frequency with which different text types are read aloud, the formations in which (...) this is done – alone, with one other person or in a group – and the purposes of reading aloud and being read to, with attention to differences according to gender and age. Findings suggest that reading aloud happens in a number of different ways and for different purposes, across contexts and life domains, and that it has a significant relationship with aspects of the lifecourse and with identity formation and performance. (shrink)

Two core questions in pediatric ethics concern when and how physicians are ethically permitted to intervene in parental treatment decisions (intervention principles), and the goals or values that should direct physicians’ and parents’ decisions about the care of children (guidance principles). Lainie Friedman Ross argues in this issue of The Journal of Clinical Ethics that constrained parental autonomy (CPA) simultaneously answers both questions: physicians should intervene when parental treatment preferences fail to protect a child’s basic needs or primary goods, and (...) both physicians and parents should be guided by a commitment to protect a child’s basic needs and primary goods. In contrast, we argue that no principle—neither Ross’s CPA, nor the best interest standard or the harm threshold—can serve as both an intervention principle and a guidance principle. First, there are as many correct intervention principles as there are different kinds of interventions, since different kinds of interventions can be justified under different conditions. Second, physicians and parents have different guidance principles, because the decisions physicians and parents make for a child should be informed by different values and balanced by different (potentially) conflicting commitments. (shrink)

Background Since 2015, Michigan has required parents who request nonmedical exemptions (NMEs) from school or daycare immunization mandates to receive education from local public health staff (usually nurses). This is unlike most other US states that have implemented mandatory immunization counseling, which require physicians to document immunization education, or which provide online instruction. -/- Purpose To attend to the activity and dispositions of the public health staff who provide “waiver education”. -/- Method This study reports results of focus group interviews (...) with 39 of Michigan's vaccine waiver educators (37 nurses), conducted during 2016 and 2017, and analyzed in 2018. -/- Findings Four themes emerged from analysis of the transcripts of these interviews: Participants had (1) complex and nuanced observations and evaluations of parents' judgments and feelings about vaccines and vaccine education; (2) sympathetic attitudes about alternative vaccine schedules; (3) critical and supportive evaluations of institutional policies and the background political context of immunization education; and (4) consistent commitments to respect parents, affirm their values, and protect their rights. Discussion These results show that public health nurses are sensitive to the burdens mandatory immunization education places on families, the motivations for parents' requests for nonmedical exemptions, and the values implicated by personal immunization decisions and government immunization policies. In light of the unique training, experiences, and public reputation of nurses, there is good reason for additional investigation into the roles that nurses can play in immunization education and in vaccine mandate policies, more generally. (shrink)

The chapters in is collection examine various aspects of JJ Rousseau's work as it relates to the concept of desire.

When a patient lacks decision-making capacity, then according to standard clinical ethics practice in the United States, the health care team should seek guidance from a surrogate decision-maker, either previously selected by the patient or appointed by the courts. If there are no surrogates willing or able to exercise substituted judgment, then the team is to choose interventions that promote a patient’s best interests. We argue that, even when there is input from a surrogate, patient preferences should be an additional (...) source of guidance for decisions about patients who lack decision-making capacity. (shrink)

Systemising is the drive to analyse or construct systems, and can be assessed by a systemising quotient (SQ). Empathising is the drive to identify mental states and respond with an appropriate emotion, and can be assessed by an empathising quotient (EQ). Previous evidence suggests that: (1) males are more drawn to systemise than females, and females are more drawn to empathise than males; and (2) males are more likely to work in science and engineering, or to study science subjects at (...) university. This study found: (1) males score more highly on the SQ, and females score more highly on the EQ; (2) controlling for age and gender, there is an association between degree subject and SQ and EQ scores, with ?scientists? scoring higher on the SQ and ?artists? scoring more highly on the EQ; and (3) individuals? scores on EQ and SQ were better predictors of degree subject than gender. (shrink)