There is no way literally to measure health, because health is multi-dimensional, and there is no metric whereby one person who is healthier than a second with respect to one dimension but less healthy with respect to another counts as healthier, less healthy or equally healthy overall. Health analysts instead measure how good or bad health states are in some regard. If these values are measures of health states, then identical health states must have identical values. But in different circumstances, (...) the same health state may have different values. It may be better or worse. Uniform values can nevertheless be assigned to kinds of health states, either as a weighted average of the values of their tokens or as the value of the performance in a standard environment of the capacity the health state constitutes. These uniform values are not well suited for some of the purposes for which summary measures of population health have been intended, and a set of non-evaluative indicators may be an attractive alternative. (shrink)

Shortages of new therapeutics to treat coronavirus disease (COVID-19) have forced clinicians, public health officials, and health systems to grapple with difficult questions about how to fairly allocate potentially life-saving treatments when there are not enough for all patients in need (1). Shortages have occurred with remdesivir, tocilizumab, monoclonal antibodies, and the oral antiviral Paxlovid (2) -/- Ensuring equitable allocation is especially important in light of the disproportionate burden experienced during the COVID-19 pandemic by disadvantaged groups, including Black, Hispanic/Latino and (...) Indigenous communities, individuals with certain disabilities, and low-income persons. However, many health systems have resorted to first-come, first-served approaches to allocation, which tend to disadvantage individuals with barriers in access to care (3). There is mounting evidence of racial, ethnic, and socioeconomic disparities in access to medications for COVID-19 (4, 5). -/- One potential method to promote equitable allocation is to use a weighted lottery, which is an allocation strategy that gives all eligible patients a chance to receive the scarce treatment while also allowing the assignment of higher or lower chances according to other ethical considerations (6). We sought to assess the feasibility of implementing a weighted lottery to allocate scarce COVID-19 medications in a large U.S. health system and to determine whether the weighted lottery promotes equitable allocation. (shrink)

Recent months have brought forth a new edition of Nemesianus and a 294-page study of the textual tradition that he shares with Calpurnius. The edition, prepared by P. Volpilhac for Budé , offers nothing new on the tradition beyond reports of a few manuscripts known to previous editors; but Luigi Castagna's book I bucolici latini minori: una ricerca di critica testuale makes an earnest attempt at solving once and for all the problems that survived the last contribution of any (...) class='Hi'>weight, Giarratano's edition . Though most of what Castagna says is true, however, his readers may be cushioned against the sharper points by an undue amount of padding, which also fails to hide gaps. Before he proceeds to his own edition of Nemesianus, therefore, a few things can usefully be said. (shrink)

Recent months have brought forth a new edition of Nemesianus and a 294-page study of the textual tradition that he shares with Calpurnius. The edition, prepared by P. Volpilhac for Budé, offers nothing new on the tradition beyond reports of a few manuscripts known to previous editors; but Luigi Castagna's book I bucolici latini minori: una ricerca di critica testuale makes an earnest attempt at solving once and for all the problems that survived the last contribution of any weight, (...) Giarratano's edition. Though most of what Castagna says is true, however, his readers may be cushioned against the sharper points by an undue amount of padding, which also fails to hide gaps. Before he proceeds to his own edition of Nemesianus, therefore, a few things can usefully be said. (shrink)

Johanna Knapstein,1 Daniel Grimm,1 Marcus A Wörns,1 Peter R Galle,1 Hauke Lang,2 Tim Zimmermann111st Department of Internal Medicine, Johannes Gutenberg-University, Mainz, Germany; 2Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg-University, Mainz, GermanyIntroduction: Hepatitis C virus reinfection occurs universally after liver transplantation, with accelerated cirrhosis rates of up to 30% within 5 years after liver transplantation. Dual antiviral therapy with pegylated interferon-2a and ribavirin only reaches sustained virological response rates of ~30% after liver transplantation. With the approval of viral NS3/4A (...) protease inhibitors telaprevir, boceprevir, and simeprevir and the NS5B polymerase inhibitor sofosbuvir, combination therapy offers new therapeutic options for HCV-infected patients, resulting in considerably higher sustained virological response rates in the nontransplant setting. Case presentation: We report three cases of TVR-based triple antiviral therapy in HCV genotype 1 reinfected patients after liver transplantation, of whom a 57-year-old Caucasian female and a 43-year-old Caucasian male were therapy naïve, and a 49-year-old Caucasian male patient was pretreated ineffectively. After 4 weeks of therapy, viral load decreased one to three log10 and became negative in weeks 6 to 8 in the therapy naïve patients. The pretreated patient showed a negative viral load in week 4. TVR was administered over 12 weeks, 750 mg thrice daily. Doses of immunosuppression with cyclosporine were reduced four to six fold. Initial peg-IFN and RBV doses ranged from 135–180 µg/week and 800–1,200 mg/day, according to the patient's body weight. Doses of peg-IFN and RBV were adapted to 90–135 µg/week and 400–800 mg/day after 2 to 12 weeks of protease inhibitor therapy. Dual therapy was continued for 36 weeks with total treatment duration of 48 weeks in the therapy naïve patients leading to a sustained virological response 12 weeks after the end of therapy. In the pretreated patient a breakthrough was detected in week 24 and therapy was discontinued. Overall, antiviral therapy was well tolerated. Side effects included dysgeusia and anemia leading to erythropoietin application and blood transfusions. Conclusion: This case series emphasizes that triple therapy with TVR is an efficient treatment for therapy naïve HCV genotype 1 reinfected patients after liver transplantation. But therapeutic options for pretreated patients require improvement. Keyword: cyclosporine, interferon, ribavirin, hepatitis C, protease inhibitor. (shrink)

We define a new topology on the space of strong types of a given theory and use it to state an omitting types theorem for countably saturated models of the theory. As an application we show that if T is a small, stable theory of finite weight such that every elementary extension of the countably saturated model is ω-saturated then every weakly saturated model is ω-saturated.

ObjectiveOverweight and obesity [body mass index ≥ 25 kg/m2] are associated with poorer prognosis among women with breast cancer, and weight gain is common during treatment. Symptoms of depression and anxiety are also highly prevalent in women with breast cancer and may be exacerbated by post-diagnosis weight gain. Altered brain function may underlie psychological distress. Thus, this secondary analysis examined the relationship between BMI, psychological health, and resting state functional connectivity among women with breast cancer.MethodsThe sample included 34 (...) post-menopausal women newly diagnosed with Stage 0-IIa breast cancer who were enrolled in a 6-month randomized controlled trial of aerobic exercise vs. usual care. At baseline prior to randomization, whole-brain analyses were conducted to evaluate the relationship between BMI and seed-to-voxel rsFC of the hippocampus and amygdala. Connectivity values from significant clusters were then extracted and examined as predictors of self-reported depression and anxiety.ResultsMean BMI was in the obese range. For both seeds examined, higher BMI was associated with lower rsFC with regions of prefrontal cortex, including ventrolateral PFC, dorsolateral PFC, and superior frontal gyrus. Hippocampal connectivity with the vlPFC was negatively correlated with self-reported anxiety.ConclusionHigher BMI was associated with lower hippocampal and amygdala connectivity to regions of PFC implicated in cognitive control and emotion regulation. BMI-related differences in hippocampal and amygdala connectivity following a recent breast cancer diagnosis may relate to future worsening of psychological functioning during treatment and remission. Additional longitudinal research exploring this hypothesis is warranted. (shrink)

Background: Editorial peer review is universally used but little studied. We examined the relationship between external reviewers' recommendations and the editorial outcome of manuscripts undergoing external peer-review at the Journal of General Internal Medicine. Methodology/Principal Findings: We examined reviewer recommendations and editors' decisions at JGIM between 2004 and 2008. For manuscripts undergoing peer review, we calculated chance-corrected agreement among reviewers on recommendations to reject versus accept or revise. Using mixed effects logistic regression models, we estimated intra-class correlation coefficients at the (...) reviewer and manuscript level. Finally, we examined the probability of rejection in relation to reviewer agreement and disagreement. The 2264 manuscripts sent for external review during the study period received 5881 reviews provided by 2916 reviewers; 28% of reviews recommended rejection. Chance corrected agreement on rejection among reviewers was 0.11. In mixed effects models adjusting for study year and manuscript type, the reviewer-level ICC was 0.23 and the manuscript-level ICC was 0.17. The editors' overall rejection rate was 48%: 88% when all reviewers for a manuscript agreed on rejection and 20% when all reviewers agreed that the manuscript should not be rejected. Conclusions/Significance: Reviewers at JGIM agreed on recommendations to reject vs. accept/revise at levels barely beyond chance, yet editors placed considerable weight on reviewers' recommendations. Efforts are needed to improve the reliability of the peer-review process while helping editors understand the limitations of reviewers' recommendations. © 2010 Kravitz et al. (shrink)

AimWhite matter changes in individuals at ultra-high risk for psychosis (UHR) may be involved in the transition to psychosis. Sleep-wake disturbances commonly precede the first psychotic episode and predict development of psychosis. We examined associations between white matter microstructure and sleep-wake disturbances in UHR individuals compared to healthy controls (HC), as well as explored the confounding effect of medication, substance use, and level of psychopathology.MethodsSixty-four UHR individuals and 35 HC underwent clinical interviews and diffusion weighted imaging. Group differences on global (...) and callosal mean fractional anisotropy (FA) was tested using general linear modeling. Sleep-wake disturbances were evaluated using the subjective measures disturbed sleep index (DSI) and disturbed awakening index (AWI) from the Karolinska Sleep Questionnaire, supported by objective sleep measures from one-night actigraphy. The primary analyses comprised partial correlation analyses between global FA/callosal FA and sleep-wake measures. Secondary analyses investigated multivariate patterns of covariance between measures of sleep-wake disturbances and FA in 48 white matter regions of interest using partial least square correlations.ResultsUltra-high risk for psychosis individuals displayed lower global FA (F = 14.56, p < 0.001) and lower callosal FA (F = 11.34, p = 0.001) compared to HC. Subjective sleep-wake disturbances were significantly higher among the UHR individuals (DSI: F = 27.59, p < 0.001, AWI: F = 36.42, p < 0.001). Lower callosal FA was correlated with increased wake after sleep onset (r = −0.34, p = 0.011) and increased sleep fragmentation index (r = −0.31, p = 0.019) in UHR individuals. Multivariate analyses identified a pattern of covariance in regional FA which were associated with DSI and AWI in UHR individuals (p = 0.028), but not in HC. Substance use, sleep medication and antipsychotic medication did not significantly confound these associations. The association with objective sleep-wake measures was sustained when controlling for level of depressive and UHR symptoms, but symptom level confounded the covariation between FA and subjective sleep-wake measures in the multivariate analyses.ConclusionCompromised callosal microstructure in UHR individuals was related to objectively observed disruptions in sleep-wake functioning. Lower FA in ventrally located regions was associated with subjectively measured sleep-wake disturbances and was partly explained by psychopathology. These findings call for further investigation of sleep disturbances as a potential treatment target. (shrink)

About one third of patients with epilepsy have seizures refractory to the medical treatment. Electrical stimulation mapping is the gold standard for the identification of “eloquent” areas prior to resection of epileptogenic tissue. However, it is time-consuming and may cause undesired side effects. Broadband gamma activity recorded with extraoperative electrocorticography during cognitive tasks may be an alternative to ESM but until now has not proven of definitive clinical value. Considering their role in cognition, the alpha and beta bands could further (...) improve the identification of eloquent cortex. We compared gamma, alpha and beta activity, and their combinations for the identification of eloquent cortical areas defined by ESM. Ten patients with intractable focal epilepsy participated in a delayed-match-to-sample task, where syllable sounds were compared to visually presented letters. We used a generalized linear model approach to find the optimal weighting of each band for predicting ESM-defined categories and estimated the diagnostic ability by calculating the area under the receiver operating characteristic curve. Gamma activity increased more in eloquent than in non-eloquent areas, whereas alpha and beta power decreased more in eloquent areas. Diagnostic ability of each band was close to 0.7 for all bands but depended on multiple factors including the time period of the cognitive task, the location of the electrodes and the patient’s degree of attention to the stimulus. We show that diagnostic ability can be increased by 3–5% by combining gamma and alpha and by 7.5–11% when gamma and beta were combined. We then show how ECoG power modulation from cognitive testing can be used to map the probability of eloquence in individual patients and how this probability map can be used in clinical settings to optimize ESM planning. We conclude that the combination of gamma and beta power modulation during cognitive testing can contribute to the identification of eloquent areas prior to ESM in patients with refractory focal epilepsy. (shrink)

The complexity of biobank research raises concerns about individuals’ understanding of the information conveyed in the consent process for such research.. We report the results of a qualitative, cognitive interview study with an ethnically, linguistically, and educationally diverse sample of 43 respondents to assess the clarity and utility of a multimedia tool developed for a biobank. Using weighted randomization, respondents were assigned to either view the multimedia tool or read a written consent document . The study illustrates the utility of (...) cognitive interviews for gaining insights from prospective research participants about the clarity of informed consent tools. Findings suggest that a multimedia tool is useful for communicating key messages but should be combined with a written consent document and personal interaction with the study staff. We recommend that the potential value of multimedia tools should be more rigorously tested in a randomized controlled trial. (shrink)

The objective of the study was to investigate the relationship between childhood IQ of parents and characteristics of their adult offspring. It was a prospective family cohort study linked to a mental ability survey of the parents and set in Renfrew and Paisley in Scotland. Participants were 1921-born men and women who took part in the Scottish Mental Survey in 1932 and the Renfrew/Paisley study in the 1970s, and whose offspring took part in the Midspan Family study in 1996. There (...) were 286 offspring from 179 families. Parental IQ was related to some, but not all characteristics of offspring. Greater parental IQ was associated with taller offspring. Parental IQ was inversely related to number of cigarettes smoked by offspring. Higher parental IQ was associated with better education, offspring social class and offspring deprivation category. There were no significant relationships between parental IQ and offspring systolic blood pressure, diastolic blood pressure, cholesterol, glucose, lung function, weight, body mass index, waist hip ratio, housing, alcohol consumption, marital status, car use and exercise. Structural equation modelling showed parental IQ associated with offspring education directly and mediated via parental social class. Offspring education was associated with offspring smoking and social class. The smoking finding may have implications for targeting of health education. (shrink)

Breaking new ground in the debate about the relation of mind and body, David Armstrong's classic text - first published in 1968 - remains the most compelling and comprehensive statement of the view that the mind is material or physical. In the preface to this new edition, the author reflects on the book's impact and considers it in the light of subsequent developments. He also provides a bibliography of all the key writings to have appeared in the materialist debate.

In this important study D. M. Armstrong offers a comprehensive system of analytical metaphysics that synthesises but also develops his thinking over the last twenty years. Armstrong's analysis, which acknowledges the 'logical atomism' of Russell and Wittgenstein, makes facts the fundamental constituents of the world, examining properties, relations, numbers, classes, possibility and necessity, dispositions, causes and laws. All these, it is argued, find their place and can be understood inside a scheme of states of affairs. This is a comprehensive and (...) rigorously this-worldly account of the most general features of reality, argued from a distinctive philosophical perspective, and it will appeal to a wide readership in analytical philosophy. (shrink)

Truths are determined not by what we believe, but by the way the world is. Or so realists about truth believe. Philosophers call such theories correspondence theories of truth. Truthmaking theory, which now has many adherents among contemporary philosophers, is the most recent development of a realist theory of truth, and in this book D. M. Armstrong offers the first full-length study of this theory. He examines its applications to different sorts of truth, including contingent truths, modal truths, truths about (...) the past and the future, and mathematical truths. In a clear, even-handed and non-technical discussion he makes a compelling case for truthmaking and its importance in philosophy. His book marks a significant contribution to the debate and will be of interest to a wide range of readers working in analytical philosophy. (shrink)

This is a study of a crucial and controversial topic in metaphysics and the philosophy of science: the status of the laws of nature. D. M. Armstrong works out clearly and in comprehensive detail a largely original view that laws are relations between properties or universals. The theory is continuous with the views on universals and more generally with the scientific realism that Professor Armstrong has advanced in earlier publications. He begins here by mounting an attack on the orthodox and (...) sceptical view deriving from Hume that laws assert no more than a regularity of coincidence between instances of properties. In doing so he presents what may become the definitive statement of the case against this position. Professor Armstrong then goes on to establish his own theory in a systematic manner defending it against the most likely objections, and extending both it and the related theory of universals to cover functional and statistical laws. This treatment of the subject is refreshingly concise and vivid: it will both stimulate vigorous professional debate and make an excellent student text. (shrink)

A wide-ranging study of the central concepts in epistemology - belief, truth and knowledge. Professor Armstrong offers a dispositional account of general beliefs and of knowledge of general propositions. Belief about particular matters of fact are described as structures in the mind of the believer which represent or 'map' reality, while general beliefs are dispositions to extend the 'map' or introduce casual relations between portions of the map according to general rules. 'Knowledge' denotes the reliability of such beliefs as representations (...) of reality. Within this framework Professor Armstrong offers a distinctive account of many of the main questions in general epistemology - the relations between beliefs and language, the notions of proposition, concept and idea, the analysis of truth, the varieties of knowledge, and the way in which beleifs and knowledge are supported by reasons. The book as a whole if offered as a contribution to a naturalistic account of man. (shrink)

In this short text, a distinguished philosopher turns his attention to one of the oldest and most fundamental philosophical problems of all: How it is that we are able to sort and classify different things as being of the same natural class? Professor Armstrong carefully sets out six major theories—ancient, modern, and contemporary—and assesses the strengths and weaknesses of each. Recognizing that there are no final victories or defeats in metaphysics, Armstrong nonetheless defends a traditional account of universals as the (...) most satisfactory theory we have.This study is written for advanced students, but as Armstrong goes considerably beyond his earlier work on this topic, it will interest professional scholars as well. Carefully plotted and clearly written, Universals is both a paradigm of exposition and a case study on the value of careful analysis of fundamental issues in philosophy. (shrink)

In larger animals a considerable part of the total body mass (e.g. body water, dissolved substances, mineral and organic deposits) does not consume significant amounts of oxygen. These materials can be considered to form a metabolically inert infrastructure which mainly serves three functions: (1) structural support to the organism, (2) storage of nutrients (building material and energy stores) and (3) transport and distribution of these materials. Considering the transport and support function of the metabolically inert structures and their interconnections it (...) is likely that the infrastructure will basically show some tree-like, branching building plan. The weight of the metabolically inert infrastructure of an organism, can be given by bW/(c+W), in which W=body weight, b and c are constants. With increasing size the weight of the metabolic inert infrastructure increases disproportionably. Experimental data concerning basic metabolic rate (M) in relation to body weight (W) better fit the equation M=a W(1-bW)/(c+W), (a=constant) than the conventional power law. (shrink)

The traditional empiricist view of perception is that in perception we receive information through the senses of the so-called external world. This idea is reflected in the notions of the ‘given’ and of 1‘data’ which have figured so largely in theories of perception. Even if philosophers of this persuasion have gone on to say something about what we do with the data, it remains true that at rock bottom and in the last resort perception is thought of as something passive. (...) I have tried to chart the historical issues elsewhere, and I shall not repeat anything about them here. That is not my concern. I am here interested in the question whether the notion of a purely passive perceiver makes any sense in itself. That it does not has been suggested by philosophers on occasion. There are some brief remarks to that effect in G.E.M. Anscombe’s Intention ; and Stuart Hampshire’s Thought and Action lays great weight on action in connection with our awareness of the world, although I do not myself believe that the exact nature of the connection is clearly worked out by him. Some aspects of his views, however, have been taken up by Campbell Garnett with explicit reference to perception in his The Perceptual Process, with a resulting theory that bears more than a superficial resemblance to that of Maine de Biran. (shrink)

This is a collection of twenty-five papers and reviews by the leading analytic philosopher of our time. It adds to the papers on metaphysics and epistemology to be found in his previous two-volume collection published by Oxford University Press. One previously unpublished paper—“Why Conditionalize?”—is included. Australasian philosophers may note with some pride that eleven of the pieces were first published in the Australasian Journal of Philosophy.

This study aimed to investigate the relationships between physical fitness and academic performance in youth handball players of different BMI classifications. Thirty-three male handball players were recruited from the Qatar handball first league and were assigned to their BMI age-adjusted groups. Measurements included anthropometric data and body fat percentage, and physical performance tests: agility T-half test; squat jump, and countermovement jump, 10 and 15 m sprint; medicine ball throw. Aerobic capacity was evaluated using the Yo-Yo Intermittent Recovery Test level 1. (...) Academic achievement was assessed through school records of grades point average of Mathematics, Science and Arabic. None academic performance parameter and four physical performance parameters were different between BMI related groups. In 43% of performance parameters and all academic parameters, the normal weight group showed the highest performance level, whereas the overweight group had the best performance in both sprint tests. The obese group was only superior in the medicine ball throw, but not at the p 0.5) between academic and physical performance parameters was only found between Yo-Yo IR 1 and science. A relevant correlation were found between CMJ and BMI. The agility T-half test was correlated with CMJ and 10 m sprint. These findings suggest being overweight or obese are related to science academic performance among schoolchildren athletes in Qatar. Possibly, a normal BMI could positively influence academic performance. Physical education teachers, staff, and administrators should be cognizant that health promotion interventions improving composition may have the additional potential to improve dimensions of academic performance. (shrink)

The central insight of Darwin's Origin of Species is that evolution is an ecological phenomenon, arising from the activities of organisms in the 'struggle for life'. By contrast, the Modern Synthesis theory of evolution, which rose to prominence in the twentieth century, presents evolution as a fundamentally molecular phenomenon, occurring in populations of sub-organismal entities - genes. After nearly a century of success, the Modern Synthesis theory is now being challenged by empirical advances in the study of organismal development and (...) inheritance. In this important study, D. M. Walsh shows that the principal defect of the Modern Synthesis resides in its rejection of Darwin's organismal perspective, and argues for 'situated Darwinism': an alternative, organism-centred conception of evolution that prioritises organisms as adaptive agents. His book will be of interest to scholars and advanced students of evolutionary biology and the philosophy of biology. (shrink)

Dispositions are essential to our understanding of the world. IDispositions: A Debate is an extended dialogue between three distinguished philosophers - D.M. Armstrong, C.B. Martin and U.T. Place - on the many problems associated with dispositions, which reveals their own distinctive accounts of the nature of dispositions. These are then linked to other issues such as the nature of mind, matter, universals, existence, laws of nature and causation.

D. M. Armstrong; II—Does Knowledge Entail Belief?, Proceedings of the Aristotelian Society, Volume 70, Issue 1, 1 June 1970, Pages 21–36, https://doi.org/10.109.

Argues that a set is the mereological whole of the singleton sets of its members (following Lewis's Parts of Classes), and that the singleton set of X is the state of affairs of X's having some unit-making property.

First, The doctrine of naturalism, That reality is spatio-Temporal, Is defended. Second, The doctrine of materialism or physicalism, That this spatio-Temporal reality involves nothing but the entities of physics working according to the principles of physics, Is defended. Third, It is argued that these doctrines do not constitute a "first philosophy." a satisfactory first philosophy should recognize universals, In the form of instantiated properties and relations. Laws of nature are constituted by relations between universals. What universals there are, And what (...) relations hold between them, Must be discovered "a posteriori" by scientific investigation. (shrink)

According to historical theories of biological function, a trait's function is determined by natural selection in the past. I argue that, in addition to historical functions, ahistorical functions ought to be recognized. I propose a theory of biological function which accommodates both. The function of a trait is the way it contributes to fitness and fitness can only be determined relative to a selective regime. Therefore, the function of a trait can only be specified relative to a selective regime. Apart (...) from its desirable pluralism, only this view of relational function can support the function/accident and function/malfunction distinctions commonly thought to be part of the concept of function. Furthermore, only relational function correctly characterizes the explanatory consequences of function attributions in evolutionary biology. (shrink)

This is a study, in two volumes, of one of the longest-standing philosophical problems: the problem of universals. In volume I David Armstrong surveys and criticizes the main approaches and solutions to the problems that have been canvassed, rejecting the various forms of nominalism and 'Platonic' realism. In volume II he develops an important theory of his own, an objective theory of universals based not on linguistic conventions, but on the actual and potential findings of natural science. He thus reconciles (...) a realism about qualities and relations with an empiricist epistemology. The theory allows, too, for a convincing explanation of natural laws as relations between these universals. (shrink)