Background and PurposeMany critically ill patients in intensive care units (ICUs) are unable to communicate their wishes about goals of care, particularly about the use of life-sustaining treatments. Surrogates and clinicians struggle with medical decisions because of a lack of clarity regarding patients’ preferences, leading to prolonged hospitalizations and increased costs. This project focused on the development and implementation of a tool to facilitate a better communication process by (1) assuring the early identification of a surrogate if indicated on admission (...) and (2) clarifying the decision-making standards that the surrogate was to use when participating in decision making. Before introducing the tool into the admissions routine, the staff were educated about its use and value to the decision-making process.Project and MethodsThe study was to determine if early use of a simple method of identifying a patient’s surrogate and treatment preferences might impact length of stay (LOS) and total hospital charges. A pre- and post-intervention study design was used. Nurses completed the surrogacy information tool for all patients upon admission to the neuroscience ICU. Subjects (total N=203) were critically ill patients who had been on a mechanical ventilator for 96 hours or longer, or in the ICU for seven days or longer. The project included staff education on biomedical ethics, critical communication skills, early identification of families and staff in crisis, and use of a simple tool to document patients’ surrogates and previously expressed care wishes. Data on hospital LOS and hospital charges were collected through a retrospective review of medical records for similar four-month time frames pre- and post-implementation of the assessment tool.ResultsSignificant differences were found between pre- and post-groups in terms of hospital LOS (F=6.39, p=.01) and total hospital charges (F=7.03, p=.009).ConclusionsProject findings indicate that the use of a simple admission assessment tool, supported by staff education about its completion, use, and available resources, can decrease LOS and lower total hospital charges. The reasons for the difference between the pre- and post-intervention groups remain unclear. Further research is needed to evaluate if the quality of communications between patients, their legally authorized representatives, and clinicians—as suggested in the literature—may have played a role in decreasing LOS and total hospital charges. (shrink)

The heart of philosophy is metaphysics, and at the heart of the heart lie two questions about existence. What is it for any contingent thing to exist? Why does any contingent thing exist? Call these the nature question and the ground question, respectively. The first concerns the nature of the existence of the contingent existent; the second concerns the ground of the contingent existent. Both questions are ancient, and yet perennial in their appeal; both have presided over the burial of (...) so many of their would-be undertakers that it is a good induction that they will continue to do so. For some time now, the preferred style in addressing such questions has been deflationary when it has not been eliminativist. Ask Willard Quine what existence is, and you will hear that "Existence is what existential quantification expresses. "! Ask Bertrand Russell what it is for an individual to exist, and he will tell you that an individual can no more exist than it can be numerous: there 2 just is no such thing as the existence of individuals. And of course Russell's eliminativist answer implies that one cannot even ask, on pain of succumbing to the fallacy of complex question, why any contingent individual exists: if no individual exists, there can be no question why any individual exists. Not to mention Russell's modal corollary: 'contingent' and 'necessary' can only be said de dicto (of propositions) and not de re (of things). (shrink)

Internationalism became an important feature of medicine and medical science during the second half of the nineteenth century. Internationalism emerged in a climate of nationalism and the latter sometimes affected cooperation, especially after the Franco-Prussian War of 1870-71, and the increased imperialism of the last third of the century. Against this backdrop, the International Sanitary Conferences, beginning with the first one in Paris in 1851, attempted to provide guidelines to control the spread of disease, especially cholera and plague. Quarantine was (...) seen as a central feature of disease control, but it remained a controversial measure, since it disrupted trade and inhibited freedom of movement. Most of the early Sanitary Conferences failed to reach agreement, but by the early twentieth century, a broader series of control measures began to be effected, as knowledge of the mode of spread of infectious diseases was achieved. (shrink)

"No matter who you are or what you aim to achieve, power determines whether you succeed or fail. But while power dynamics permeate every interaction in the workplace, the concept is very poorly understood or managed in practice. Everyone has influence over some people and is under the influence of others, and must choose how to deal with these realities in daily interactions. This book offers a comprehensive and applied understanding of power in a professional scenario: where it comes from, (...) how it moves and what that means in practice for how professionals work together. Drawing on numerous recent case studies, this book offers a toolbox that anyone can apply, including explanations of the different forms of power, the two ways power can move between parties, the perils of power, how to create accountability, the intersection of power and ethics, and tools for maintaining power relationships with both superiors and subordinates. It provides employers and employees alike the means to understand, manage, and exert the power necessary to control their own circumstances."-Provided by publisher. (shrink)

`Folk Psychology' - our everyday talk of beliefs, desires and mental events - has long been compared with the technical language of `Cognitive Science'. Does folk psychology provide a correct account of the mental causes of our behaviour, or must our everyday terms ultimately be replaced by a language developed from computational models and neurobiology? This broad-ranging book addresses these questions, which lie at the heart of psychology and philosophy. Providing a critical overview of the key literature in the field, (...) including the seminal work of Fodor and Churchland, the author explores the classic `Frame Problem' and assesses the future prospects of cognitive science. The scope of the frame problem, touching on connec. (shrink)

Aristotle maintains that every man has, or should have, a single end, a target at which he aims. The doctrine is stated in E.N. I 2. ‘If, then, there is some end of the things we do which we desire for its own sake, and if we do not choose everything for the sake of something else, clearly this must be the good and the chief good. Will not the knowledge of it, then, have a great influence on life? Shall (...) we not, like archers who have a mark to aim t, be more likely to hit upon what is right?’. Aristotle does not here prove, nor need we understand him as claiming to prove, that there is only one end which is desired for itself. He points out correctly that, if there are objects which are desired but not desired for themselves, there must be some object which is desired for itself. The passage further suggests that, if there were one such object and one only, this fact would be important and helpful for the conduct of life. (shrink)

W. F. R. Hardie; X—Aristotle's Doctrine that Virtue is a “Mean”, Proceedings of the Aristotelian Society, Volume 65, Issue 1, 1 June 1965, Pages 183–204, https.

This paper investigates connectionism's potential to solve the frame problem. The frame problem arises in the context of modelling the human ability to see the relevant consequences of events in a situation. It has been claimed to be unsolvable for classical cognitive science, but easily manageable for connectionism. We will focus on a representational approach to the frame problem which advocates the use of intrinsic representations. We argue that although connectionism's distributed representations may look promising from this perspective, doubts can (...) be raised about the potential of distributed representations to allow large amounts of complexly structured information to be adequately encoded and processed. It is questionable whether connectionist models that are claimed to effectively represent structured information can be scaled up to a realistic extent. We conclude that the frame problem provides a difficulty to connectionism that is no less serious than the obstacle it constitutes for classical cognitive science. (shrink)

Rapid developments in Artificial Intelligence are leading to an increasing human reliance on machine decision making. Even in collaborative efforts with Decision Support Systems (DSSs), where a human expert is expected to make the final decisions, it can be hard to keep the expert actively involved throughout the decision process. DSSs suggest their own solutions and thus invite passive decision making. To keep humans actively ‘on’ the decision-making loop and counter overreliance on machines, we propose a ‘reflection machine’ (RM). This (...) system asks users questions about their decision strategy and thereby prompts them to evaluate their own decisions critically. We discuss what forms RMs can take and present a proof-of-concept implementation of a RM that can produce feedback on users’ decisions in the medical and law domains. We show that the prototype requires very little domain knowledge to create reasonably intelligent critiquing questions. With this prototype, we demonstrate the technical feasibility to develop RMs and hope to pave the way for future research into their effectiveness and value. (shrink)

Does Aristotle in the Nicomachean Ethics give one consistent answer to the question what life is best or two mutually inconsistent answers? In the First Book he says that we can agree to say that the best life is eudaimonia or eupraxia but must go on to say in what eudaimonia consists. By considering the specific nature of man as a thinking animal he reaches a conclusion: eudaimonia, the human good, is the activity of soul in accordance with virtue, and (...) if there are more than one virtue in accordance with the best and most complete, and in a complete life. Aristotle states that his formula is no more than a sketch or outline, but that a good sketch is important since, if the outline is right, anyone can articulate it and supply details. He seems to be thinking here not just of the rest of his own treatise but of the work of pupils and successors; he speaks, as at the end of the Topics, of progress in a science. (shrink)

Originally published in 1926, this volume charts the achievements of Edward Thring, arguably the most original and striking figure in the schoolmaster world of England in the nineteenth century. Abroad, he was the only English schoolmaster of his generation widely known by name. The principles upon which he relied were that every boy should be taught, and the less able the boy, the more able should be the teacher who was set to deal with him; that no class should exceed (...) twenty-five boys; that each boy should have privacy in the dormitories and that trust between boys and masters was paramount. These were revolutionary principles in educational terms at the time but they have endured to form the cornerstones of British boarding-schools which are still recognized today. (shrink)

This study empirically assesses the extent to which intrinsic value theories of nature are accepted and acknowledged outside the realm of academic environmental ethics. It focuses on twenty of the largest landowning organisations in England, including both conservation and non-conservation organisations and investigates the environmental philosophical beliefs and values held by representative individuals of these groups. An in-depth interview was held with a representative from each organisation. The interviews were analysed using qualitative data analysis software and the results compared against (...) a backdrop of academic philosophical positions. The study found that an ecocentric position which acknowledges nature's intrinsic value was adopted by the majority of respondents, both from conservation and non-conservation organisations. However, it was also found that individuals felt the idea of nature's intrinsic value was generally not reflected in organisational policy. (shrink)

Argues that social science has not achieved the pre-eminence of physical science because it lacks a theory of social dynamics. To overcome this problem and prepare for a future of interacting agents, a theory is sketched of the social statics and dynamics in interaction contexts. The boundary limits of cognitive science are established and a theory that maps between objective and subjective reality is provided. By determining the relationships between perceived and actual situations and behaviors, interaction context theory has the (...) potential to advance our knowledge of human behavior. 2012 APA, all rights reserved). (shrink)

Rational social theorists have failed to confirm that observations of social reality equal social reality. Yet they argue that teams, organizations and social systems should minimize interdependence and competition, echoed by social psychologists to make data iid. But the evidence indicates that competitive teams maximize interdependence; self-reports of social reality correlate poorly with social behavior; and only competition measures interdependent social states. Rational expectations aside, we report progress towards a science of interdependence for human–machine teams. Our model of interdependence works (...) like an uncertainty principle in the sense that tradeoffs arise from the uncertainty caused by measuring interdependent actors in orthogonal roles; e.g., in the tradeoff between teams and individuals, teams are more productive but more opaque. Previously, we described interdependence as bistable stories of social reality; the motivation to reject alternative interpretations, increasing uncertainty and errors; and the inability to factor social states. Now we explore education as a surrogate for intelligence in teams. We hypothesized that teams rely on the education of its members to produce more patents. We found that the average schooling in a nation is significantly related to its total patents produced. (shrink)

Rational social theorists have failed to confirm that observations of social reality equal social reality. Yet they argue that teams, organizations and social systems should minimize interdependence and competition, echoed by social psychologists to make data iid. But the evidence indicates that competitive teams maximize interdependence; self-reports of social reality correlate poorly with social behavior; and only competition measures interdependent social states. Rational expectations aside, we report progress towards a science of interdependence for human–machine teams. Our model of interdependence works (...) like an uncertainty principle in the sense that tradeoffs arise from the uncertainty caused by measuring interdependent actors in orthogonal roles; e.g., in the tradeoff between teams and individuals, teams are more productive but more opaque. Previously, we described interdependence as bistable stories of social reality; the motivation to reject alternative interpretations, increasing uncertainty and errors; and the inability to factor social states. Now we explore education as a surrogate for intelligence in teams. We hypothesized that teams rely on the education of its members to produce more patents. We found that the average schooling in a nation is significantly related to its total patents produced. (shrink)

Rational social theorists have failed to confirm that observations of social reality equal social reality. Yet they argue that teams, organizations and social systems should minimize interdependence and competition, echoed by social psychologists to make data iid. But the evidence indicates that competitive teams maximize interdependence; self-reports of social reality correlate poorly with social behavior; and only competition measures interdependent social states. Rational expectations aside, we report progress towards a science of interdependence for human–machine teams. Our model of interdependence works (...) like an uncertainty principle in the sense that tradeoffs arise from the uncertainty caused by measuring interdependent actors in orthogonal roles; e.g., in the tradeoff between teams and individuals, teams are more productive but more opaque. Previously, we described interdependence as bistable stories of social reality; the motivation to reject alternative interpretations, increasing uncertainty and errors; and the inability to factor social states. Now we explore education as a surrogate for intelligence in teams. We hypothesized that teams rely on the education of its members to produce more patents. We found that the average schooling in a nation is significantly related to its total patents produced. (shrink)